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Early identification of autism spectrum disorder (ASD) is regarded as crucial for swift access to early intervention and, subsequently, better outcomes later in life. However, current instruments miss large proportions of children who later go on to be diagnosed with ASD, raising a question of what these instruments measure. The present study utilized data from the Norwegian Mother, Father, and Child Cohort Study and the Autism Birth Cohort study to explore the subsequent developmental and diagnostic characteristics of children raising developmental concern on the six-critical discriminative item criterion of the M-CHAT (DFA6) at 18 months of age (N = 834). The DFA6 identified 28.8% of children diagnosed with ASD (N = 163), but 4.4% with language disorder (N = 188) and 81.3% with intellectual disability (N = 32) without ASD. Scoring in the «at-risk» range was associated with lower IQ, impaired functional language, and greater severity of autism symptoms whether children had ASD or not.

Here we address the earlier published review by Øien et al. (J Autism Dev Disord, https://doi.org/10.1007/s10803-018-3686-7 , 2018) and the subsequent comments by Zucker and VanderLaan (J Autism Dev Disord, https://doi.org/10.1007/s10803-018-3748-x , 2018). The current commentary is a response to the corrections put forth by the latter authors where aspects related to diagnostic criteria of Gender Dysphoria and corrections to the existence of a control group were noted. Additionally, to highlight that research on Gender Dysphoria and ASD is becoming a very fast and growing field we also present an update of the original review which show a 13% increase of empirical studies published only in the past few months.

In this systematic map review, we aimed (1) at identifying studies including the co-occurrence of autism spectrum disorders (ASD) and gender dysphoria (GD) between 1946 and 2018, and (2) to present the papers included in this systematic map review to provide authors in the field of GD, sexuality and ASD with an important database of studies focusing on this very complex topic. The field is of emerging interest, as observed by the large increase of studies over the past decades, especially since 2015. However, future challenges are to be addressed in future studies.

Published research often address aspects related to "statistical significance" but fail to address the clinical and practical importance and meaning of results. Our main objectives in this article are to investigate the merit of common measures of Effect Size in statistical research and to highlight the importance of the simple Relative Risk ratio. In this article we present data where we consider two widely utilized effect size measures (Cohen's d and Pearson's r) in relations to relative risk. We conclude that probability analyses of risk surpass the most commonly used statistical approach used in clinical trials today and should thus be the preferred compared to the misuse and misunderstanding of reporting for instance p-values alone., (Copyright © 2018 The Authors. Published by Elsevier B.V. All rights reserved.)

Objectives: We compared sex-stratified developmental and temperamental profiles at 18 months in children screening negative for autism spectrum disorder (ASD) on the Modified Checklist for Autism in Toddlers (M-CHAT) but later receiving diagnoses of ASD (false-negative group) versus those without later ASD diagnoses (true-negative group)., Methods: We included 68 197 screen-negative cases from the Norwegian Mother and Child Cohort Study (49.1% girls). Children were screened by using the 6 critical items of the M-CHAT at 18 months. Groups were compared on domains of the Ages and Stages Questionnaire and the Emotionality Activity Sociability Temperament Survey., Results: Despite passing M-CHAT screening at 18 months, children in the false-negative group exhibited delays in social, communication, and motor skills compared with the true-negative group. Differences were more pronounced in girls. However, with regard to shyness, boys in the false-negative group were rated as more shy than their true-negative counterparts, but girls in the false-negative group were rated as less shy than their counterparts in the true-negative group., Conclusions: This is the first study to reveal that children who pass M-CHAT screening at 18 months and are later diagnosed with ASD exhibit delays in core social and communication areas as well as fine motor skills at 18 months. Differences appeared to be more pronounced in girls. With these findings, we underscore the need to enhance the understanding of early markers of ASD in boys and girls, as well as factors affecting parental report on early delays and abnormalities, to improve the sensitivity of screening instruments., Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose., (Copyright © 2018 by the American Academy of Pediatrics.)

Cohen's (Educ Psychol Meth. 1960;23:37-40) kappa statistic has been criticized recently for providing low chance-corrected coefficients (<0.40) despite high levels of examiner agreement (e.g., ≥85%). The AC1 statistic (Series. 2002;2:1-9; BMC Med Res Methodol. 2013;13:61), the alpha statistic (J Clin Epidemiol. 1996;49:775-782), the B statistic (BMC Med Res Methodol. 2013;13:97), and the delta statistic (Commun Statist Theory Meth. 2008;37:760-772) were developed to "correct" this "problem." Each of these statistics produces inaccurate results because they either derive from levels of chance agreement that are incorrect (Gwet's AC1 statistic) or fail to correct for chance levels of agreement (the alpha, B, and delta approaches). Implications for diagnoses of psychiatric disorders are critically discussed. The importance of kappa is demonstrated in a number of clinical scenarios.

In this study, we examined the frequency of sensory-related issues as reported by parents in a large sample of school-age adolescents and adults with autism/autism spectrum disorder (ASD) [1] as compared to a group of individuals receiving similar clinical evaluations for developmental/behavioral difficulties but whose final diagnoses were not on the autism spectrum. In no comparison were the features examined predictive of autism or autism spectrum in comparison to the non-ASD sample. Only failure to respond to noises had sensitivity above .75 in the comparison of the broader autism spectrum group, but specificity was poor. While sensory issues are relatively common in autism/ASD, they are also frequent in other disorders. These results question the rationale for including sensory items as a diagnostic criterion for autism.

In an earlier investigation, the authors assessed the reliability of the ADI-R when multiple clinicians evaluated a single case, here a female 3 year old toddler suspected of having an autism spectrum disorder (Cicchetti et al. in J Autism Dev Disord 38:764-770, 2008). Applying the clinical criteria of Cicchetti and Sparrow (Am J Men Def 86:127-137, 1981); and those of Cicchetti et al. (Child Neuropsychol 126-137, 1995): 74 % of the ADI-R items showed 100 % agreement; 6 % showed excellent agreement; 7 % showed good agreement; 3 % manifested average agreement; and the remaining 10 % evidenced poor agreement. In this follow-up investigation, the authors described and applied a novel method for determining levels of statistical significance of the reliability coefficients obtained in the earlier investigation. It is based upon a modification of the Z test for comparing a given level of inter-examiner reliability with a lower limit value of 70 % (Dixon and Massey in Introduction to statistical analysis. McGraw-Hill, New York, 1957). Results indicated that every item producing a clinically acceptable level of inter-examiner reliability was also statistically significant. However, the reverse was not true, since a number of the items with statistically significant reliability levels did not reach levels of agreement that were clinically meaningful. This indicated that clinical significance was an accurate marker of statistical significance. The generalization of these findings to other areas of diagnostic interest and importance is also examined.

The author examined critically three beliefs of S.S. Stevens pertaining to his quadripartite system of scales of measurement: (1) There are four scales of measurement in common usage (2) These scales and the scientific disciplines that use them can be incrementally graded for levels of reliability and validity or accuracy such that: Nominal scale variables produce the lowest levels of reliability and accuracy; with successively improving levels for Ordinal, Equal Interval, and Equal Ratio scales; and (3) The scale upon which a variable is measured determines the type of statistical test that one is permitted to apply. It was shown that each of the three beliefs is fundamentally flawed.

The relationship between adaptive functioning and autism symptomatology was examined in 1,089 verbal youths with ASD examining results on Vineland-II, IQ, and measures of ASD severity. Strong positive relationships were found between Vineland subscales and IQ. Vineland Composite was negatively associated with age. IQ accounted a significant amount of the variance in overall adaptive skills (55%) beyond age and ASD severity. Individuals with ASD demonstrated significant adaptive deficits and negligible associations were found between the level of autism symptomatology and adaptive behavior. The results indicate that IQ is a strong predictor of adaptive behavior, the gap between IQ and adaptive impairments decreases in lower functioning individuals with ASD, and older individuals have a greater gap between IQ and adaptive skills.

The objectives of this report are: (a) to trace the theoretical roots of the concept clinical significance that derives from Bayesian thinking, Marginal Utility/Diminishing Returns in Economics, and the "just noticeable difference", in Psychophysics. These concepts then translated into: Effect Size (ES), strength of agreement, clinical significance, and related concepts, and made possible the development of Power Analysis; (b) to differentiate clinical significance from statistical significance; and (c) to demonstrate the utility of measures of ES and related concepts for enhancing the meaning of Autism research findings. These objectives are accomplished by applying criteria for estimating clinical significance, and related concepts, to a number of areas of autism research.

Manual reticulocyte counts were examined under light microscopy, using the property whereby supravital stain precipitates residual ribosomal RNA versus the automated flow methods, with the suggestion that in the latter there is greater precision and an ability to determine both mature and immature reticulocyte fractions. Three hundred and forty-one venous blood samples of patients were analyzed of whom 224 newborn and the rest adults; 51 males and 66 females, with ages between 0 and 89 years, as part of the laboratory routine for hematological examinations at the Clinical Laboratory of the Hospital Universitário do Oeste do Paraná. This work aimed to compare manual and automated methodologies for reticulocyte countings and evaluate random and systematic errors. The results obtained showed that the difference between the two methods was very small, with an estimated 0·4% systematic error and 3·9% random error. Thus, it has been confirmed that both methods, when well conducted, can reflect precisely the reticulocyte counts for adequate clinical use.

The Prudhoe Cognitive Function Test (PCFT) directly measures the cognitive abilities of people with intellectual impairment. This study examined the relationship between this instrument and the Kaufman Brief Intelligence Test (K-BIT) and two shorter versions of the same scale. High correlations between the verbal and performance sections of the K-BIT and the Long PCFT were found with correlation coefficients of 0.85 and 0.78, respectively. Extremely high correlations between the Short versions of the PCFT and the Long version were obtained at 0.97 for Form A and 0.98 for Form B, illustrating that both Short forms and the Long form are essentially interchangeable. The PCFT is a reliable and robust schedule in the assessment of cognitive function in this population.

A consistent result in the evaluation of group-delivered intervention to promote social reciprocity in children with PDDs is that outcome data are inconclusive. Lack of robust evidence of efficacy confounds understanding of these interventions and their value to the field. It is conceivable that the construct of impaired social reciprocity in PDD presents unique circumstances that require special consideration when evaluating the evidence base. Social reciprocity and impairment in social functioning are complex constructs, which require a multi-dimensional, multi-method approach to intervention and measurement of gains. The existing paradigm for evaluating the evidence base of intervention may need modification to permit a more intricate analysis of the extant research, and increase the sophistication of future research.

The objective of this investigation was to assess the inter-examiner reliability of PTSD symptomatology by 12 clinical examiners who evaluated independently a single-case Vietnam-Era veteran, using videotaped clinician interviews with The Clinician Administered PTSD Scale-1 (CAPS-1). A second patient was utilized for cross-validation purposes. Data were analyzed using a specially designed Kappa statistic. In previous reliability assessments of the CAPS-1, a pair of examiners assessed multiple patients, and demonstrated evidence of high reliability and validity. As in previous reliability assessments, reliability was assessed both for frequency and intensity of PTSD symptomatology in both patients. Results indicated that the reliability levels of the CAPS-1 were consistently and almost exclusively in the excellent to perfect levels of inter-examiner agreement, as based upon both global assessments and on a symptom-by-symptom basis. The results of this investigation are interpreted in the broader framework of their applicability to assessing inter-examiner agreement in clinical trials or other large multi-site studies.

Although research in autism has grown more sophisticated, the gap between research knowledge and applicability of research in real world settings has grown. There have been a number of different reviews of evidence-based practices of treatments for young children with autism. Reviews which have critically evaluated the empirical evidence have not found any treatments that can be considered evidence-based. Reasons for this shortcoming are explored, and a new method for the evaluation of empirical evidence is provided. Future uses of this evaluative method are provided as well as a discussion of how this tool might aid in narrowing the research to practice gap.

Objective: To examine the validity of the Disruptive Behavior Diagnostic Observation Schedule (DB-DOS), a new observational method for assessing preschool disruptive behavior., Method: A total of 327 behaviorally heterogeneous preschoolers from low-income environments comprised the validation sample. Parent and teacher reports were used to identify children with clinically significant disruptive behavior. The DB-DOS assessed observed disruptive behavior in two domains, problems in Behavioral Regulation and Anger Modulation, across three interactional contexts: Examiner Engaged, Examiner Busy, and Parent. Convergent and divergent validity of the DB-DOS were tested in relation to parent and teacher reports and independently observed behavior. Clinical validity was tested in terms of criterion and incremental validity of the DB-DOS for discriminating disruptive behavior status and impairment, concurrently and longitudinally., Results: DB-DOS scores were significantly associated with reported and independently observed behavior in a theoretically meaningful fashion. Scores from both DB-DOS domains and each of the three DB-DOS contexts contributed uniquely to discrimination of disruptive behavior status, concurrently and predictively. Observed behavior on the DB-DOS also contributed incrementally to prediction of impairment over time, beyond variance explained by meeting DSM-IV disruptive behavior disorder symptom criteria based on parent/teacher report., Conclusions: The multidomain, multicontext approach of the DB-DOS is a valid method for direct assessment of preschool disruptive behavior. This approach shows promise for enhancing accurate identification of clinically significant disruptive behavior in young children and for characterizing subtypes in a manner that can directly inform etiological and intervention research.

Objective: To examine the reliability of the Disruptive Behavior Diagnostic Observation Schedule (DB-DOS), a new observational method for assessing preschool disruptive behavior., Method: The DB-DOS is a structured clinic-based assessment designed to elicit clinically salient behaviors relevant to the diagnosis of disruptive behavior in preschoolers. Child behavior is assessed in three interactional contexts that vary by partner (parent versus examiner) and level of support provided. Twenty-one disruptive behaviors are coded within two domains: problems in Behavioral Regulation and problems in Anger Modulation. A total of 364 referred and nonreferred preschoolers participated: interrater reliability and internal consistency were assessed on a primary sample (n = 335) and test-retest reliability was assessed in a separate sample (n = 29)., Results: The DB-DOS demonstrated good interrater and test-retest reliability. Confirmatory factor analysis demonstrated an excellent fit of the DB-DOS multidomain model of disruptive behavior., Conclusions: The DB-DOS is a reliable observational tool for clinic-based assessment of preschool disruptive behavior. This standardized assessment method holds promise for advancing developmentally sensitive characterization of preschool psychopathology.

The authors assessed the reliability of the Autism Diagnostic Interview (ADI-R). Seven Clinical Examiners evaluated a three and one half year old female toddler suspected of being on the Autism Spectrum. Examiners showed agreement levels of 94-96% across all items, with weighted kappa (K(w)) between .80 and .88. They were in 100% agreement on 74% of the items; in excellent agreement on 6% of the items (93-96%, with K(w) between .78 and .85); in good agreement on 7% (89-90%, with K(w) between .62 and 0.68); and in fair agreement on 3% (82 - 84%, with K(w) between .40 and .47). For the remaining 10% of ADI-R items, examiners showed poor agreement (50-81% with K(w )between -.67 and .37).

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.

Pages 108-117 of the current issue of Pediatric and Developmental Pathology contain a landmark interobserver investigation of some of the vagaries and vicissitudes involved in the nosological assessment of 6 histological features of childhood brain tumors. Doctor Gilles and his clinical research colleagues are to be commended for their conceptualization, reliability research design, execution, and interpretation of their findings. The piece is also uncommonly sophisticated concerning matters biostatistical. As such, it stands as a model for future nosological studies in childhood brain pathology, and can be applied more generally as well. The purpose of this Context article is to present some additional conceptual and methodologic issues that are relevant to the future design of histopathological studies in particular and of biobehavioral and biomedical diagnostic studies in general. In order to accomplish this goal, I shall discuss interexaminer reliability issues from the following viewpoints: type of reliability assessment, scales of measurement, reliability statistics, diagnostic accuracy, and the need to always differentiate levels of statistical significance from those that are both statistically and clinically meaningful, as Gilles and colleagues have also successfully accomplished.

Objective: In low- and middle-income countries, methods for clinicians to address difficulties in language, social-emotional, cognitive, behavioral, or neuromotor development during early childhood are lacking. To fill this gap, we designed, in Turkey, the Guide for Monitoring Child Development, which aims to aid clinicians in monitoring and supporting child development and the early detection and management of developmental difficulties. The Guide for Monitoring Child Development monitoring component is a practical, open-ended interview that catalyzes communication between clinicians and caregivers and obtains a portrayal of the child's development. We report on the development and psychometric properties of the Guide for Monitoring Child Development monitoring component for children aged 0 to 24 months., Methods: We examined the ages of attainment of Guide for Monitoring Child Development milestones and internal consistency in a cross-sectional study of healthy children receiving well-child care (study 1). In 2 clinical samples, we studied the interrater reliability between medical students and a child development specialist administering the guide (study 2), as well as the concurrent validity of the guide administered during a health visit and a comprehensive developmental assessment (study 3)., Results: In study 1 (N = 510), item-total scale correlations ranged from 0.28 to 0.91. An age-dependent attainment pattern was seen in all of the milestones. In study 2 (N = 92), interrater reliability between medical-student pairs and between the child development specialist and students was high (kappa scores were 0.83-0.88). In study 3 (N = 79), the sensitivity, specificity, and positive and negative predictive values were 0.88, 0.93, 0.84, and 0.94, respectively., Conclusions: The Guide for Monitoring Child Development is an innovative method for monitoring child development that is designed specifically for use by health care providers in low- and middle-income countries. Studies in Turkey provide preliminary evidence for its reliability and validity.

Background: Although there are many rating scales recording the incidence and intensity of violence there are none that are specifically concerned with the measurement and assessment of severe violence., Aims: To develop a scale sensitive to variation centred on severe violence, establish its normative values, test its feasibility, and assess its reliability and validity in different populations., Method: The Quantification of Violence Scale (QOVS) was developed in two stages. First, a list of 30 commonly experienced violent episodes in clinical psychiatric practice were evaluated and tested by weighting each episode by severity. Second, a numerical scale used to record the severity of the episode according to its degree of planning, intent and consequences. Violent episodes in two clinical populations were compared using the Modified Overt Aggression Scale (MOAS) and the preliminary version of the QOVS over periods up to 18 months, following which the numerical scale was developed., Results: Good (0.60-0.74) to Excellent (> 0.75) test-retest and inter-rater reliability agreement was obtained with both forms of the scale (intra-class correlations of 0.75 and 0.69 respectively), and similar agreement with MOAS scores was reached (0.67) in clinical populations. The scale was quick and easy to use in practice, and a score defining severe violence (9 on the numerical scale and 16 on the matched scale) was determined., Conclusions: The QOVS, in its two forms, is a useful measure of recording significant violence in clinical and forensic practice.

Purpose: This study tests the hypothesis that toddlers with autism spectrum disorders (ASD) will show differences from contrast groups in preferences for attending to speech., Method: This study examined auditory preferences in toddlers with ASD and matched groups of (a) typical age-mates, (b) age-mates with nonautistic developmental disabilities, and (c) younger children matched for language age. The experimental procedure measured time spent oriented to auditory stimuli that were created to exemplify language patterns that had been studied in typically developing infants., Results: Findings suggest that toddlers with ASD show a reduced preference for child-directed speech, compared with typical age-mates, but few differences from children with nonautistic developmental disorders. Correlational analysis revealed that time spent listening to child-directed speech by children with ASD was related to their concurrent receptive language ability as well as to receptive language abilities 1 year later. This relationship did not hold for the other groups., Conclusion: The present study supports the hypothesis that children with ASD perform differently from typical peers in auditory preference paradigms and that performance in these tasks is related to concurrent and later language development.

The relationship between adaptive functioning (ability) and autism symptomatology (disability) remains unclear, especially for higher functioning individuals with autism spectrum disorder (ASD). This study investigates ability and disability using the Vineland and Autism Diagnostic Observation Schedule (ADOS), respectively, in two clinical samples of children with ASD. Participants included 187 males with VIQ > 70. Vineland scores were substantially below VIQ, highlighting the magnitude of adaptive impairments despite cognitive potential. A weak relationship was found between ability and disability. Negative relationships were found between age and Vineland scores and no relationships were found between age and ADOS scores. Positive relationships were found between IQ and Vineland Communication. Results stress the need for longitudinal studies on ability and disability in ASD and emphasize the importance of adaptive skills intervention.

Background: Clinicians and researchers use brief instruments, such as the Mini Mental State Examination (MMSE) and the Telephone Interview for Cognitive Status (TICS), to measure cognitive functioning in patients with cerebral aneurysms. MMSE and TICS scores are often dichotomized to classify patients as cognitively impaired or not. Frequently, after an initial MMSE face-to-face evaluation, the TICS is used for follow-up assessments by telephone., Methods: A cross-sectional cohort of patients with cerebral aneurysms completed the MMSE at baseline and the MMSE or TICS at the 12-month follow-up examination. Multivariate logistic regression adjusting for demographics was used to model cognitive impairment. MMSE and TICS results were compared using the MMSE as the "gold standard.", Results: Eleven out of 171 (6%) patients had baseline MMSE scores less than 24, indicating cognitive impairment. Multivariate analysis showed that a history of subarachnoid hemorrhage was associated with cognitive impairment measured with the MMSE (odds ratio, 13.9; P = 0.021; C statistic = 0.87); there was no relationship between subarachnoid hemorrhage or treatment and TICS cognitive impairment (i.e., score < 27). In patients without recent or interim invasive interventions that might affect cognition (n = 65), raw baseline MMSE and 12-month TICS scores had fair correlations (r = 0.30, P = 0.015); however, dichotomized scores had poor agreement, and TICS sensitivity and positive predictive value was 0% compared with the MMSE., Conclusion: The MMSE may be more sensitive than the TICS to the effects of subarachnoid hemorrhage on cognitive functioning. Raw MMSE and TICS scores are well correlated, but dichotomized MMSE and TICS scores are probably not interchangeable in this patient population.

We focus upon several broad issues that are of concern to clinicians and clinical researchers in the areas of biobehavioral and biomedical research, including, but not limited to, the fields of psychiatry, psychology, neuropsychology, and neurology. These issues are the critical reassessment of S. S. Stevens' quadripartite conceptualization of scales of measurement; the application of criteria to determine the clinical significance of reliability estimates; the detection of subsets of reliable and unreliable raters, when the overall level is of little clinical import; and finally, the application of Kappa statistics when multiple raters evaluate a single case.

Objective: To develop an assessment of bed need that was as little affected by personal bias as possible., Method: The Bed Requirement Inventory (BRI) is an eight-point scale designed to identify the appropriate use of an acute psychiatric bed. This is completed by a member of the ward staff, usually a nurse, and takes 5 minutes to fill in. The reliability, validity and feasibility of using the scale in normal practice were tested in a one-year study, and variations in inappropriate bed use described., Results: The inter-rater reliability of the scale was good (intra-class correlation coefficient = 0.63) and a comparison of the need for a psychiatric bed (comparing the BRI score with the judgement of an independent multidisciplinary group of professionals) also showed good agreement (k = 0.69), suggesting reasonable validity (although when the assessment was made by the named nurse agreement was less good). Results from a year-long survey in two West London hospitals showed that 17% of admissions were inappropriate and 32% had delayed discharge, black Caribbean patients had a significantly higher proportion (25%) of inappropriate admission than others (11%) and those referred from housing charities and hostels had a higher proportion (50%) of inappropriate bed use at some time than other groups (33%)., Conclusions: The Bed Requirement Inventory is a quick and reliable method of determining the appropriate use of a psychiatric bed and could be of use in estimating local bed needs. Delayed discharge remains a serious reason for inappropriate bed use in London.

Objective: To evaluate the impact of risperidone on adaptive behavior in children with autistic disorder who have serious behavior problems and to examine different methods of scoring the Vineland Adaptive Behavior Scales to measure change., Method: Forty-eight children (5 years to 16 years, 5 months) who showed behavioral improvement during acute treatment with risperidone were followed for 6 months and assessed with the Vineland Scales., Results: Raw scores, age-equivalents, and special norm percentile scores all showed significant increases in adaptive behavior in the areas of communication, daily living skills, and socialization (p <.01). During a period of 6 to 8 months, children gained an average of 7.8 age-equivalent months in the area of socialization, a > 6% improvement beyond what would be expected based on baseline growth rates., Conclusions: Although limited by the absence of a control group, these results suggest that risperidone may improve adaptive skills in children with autistic disorder accompanied by serious behavioral problems. Vineland age-equivalent scores appear to be most useful in assessing change with treatment over time.

Shriberg et al. [Shriberg, L. et al. (2001). Journal of Speech, Language and Hearing Research, 44, 1097-1115] described prosody-voice features of 30 high functioning speakers with autistic spectrum disorder (ASD) compared to age-matched control speakers. The present study reports additional information on the speakers with ASD, including associations among prosody-voice variables and ratings of communication social abilities. Results suggest that the inappropriate sentential stress and hypernasality previously identified in some of these speakers is related to communication/sociability ratings. These findings and associated trends are interpreted to indicate important links between prosodic performance and social and communicative competence. They suggest the need for careful assessment of inappropriate prosody and voice features in speakers with ASD, and for effective intervention programs aimed at reducing the stigmatization of individuals with these conditions.

This paper presents the clinical/developmental framework underlying a new diagnostic observational tool, the Disruptive Behavior Diagnostic Observation Schedule (DB-DOS). The special importance of observation for clinical assessment during the preschool period is delineated. The developmental rationale for a multi-dimensional assessment of disruptive behavior in young children, including problems in modulation of negative affect and low competence is discussed. The ways in which the DB-DOS will elucidate distinctions between normative and atypical behavior during this developmental period via (a) the integration of qualitative and quantitative dimensions of behavior within a clinically-sensitive coding system, (b) the observation of child behavior both within, and outside of, the parent-child context and (c) the use of specially designed tasks to "press" for clinically salient behaviors are addressed. The promise of this new method for yielding a more precise, developmentally based description of the phenotype of early onset disruptive behavior problems and for providing a standardized clinical tool for observational assessment of disruptive behavior in young children is presented. Large-scale validation of the measure is currently underway.

Objective: The cross-cultural applicability of the concept of posttraumatic stress was investigated by assessing symptom frequency and levels of comorbid psychopathology in adolescents from the United States and Russia., Method: A self-report survey was conducted in representative samples of 2,157 adolescents 14 to 17 years old from urban communities of the United States (N=1,212) and Russia (N=945)., Results: In both countries, the levels of all three major clusters of posttraumatic symptoms (reexperiencing, avoidance, and arousal), as well as of internalizing psychopathology, increased along with the level of posttraumatic stress. Expectations about the future had a tendency to decrease with increasing posttraumatic stress. No differences between countries in significant interaction effects for symptom levels were found., Conclusions: The current findings suggest that posttraumatic symptoms and their associations with other adolescent mental health problems are not culture bound and that the psychological consequences of trauma follow similar dynamics cross-culturally.

Purpose: To compare three methods of data collection on case ascertainment of past chlamydia or gonorrhea diagnoses., Methods: Data collection for 361 adolescent females between 1998 and 2000 included: 1) face-to-face interviews; 2) computerized and paper medical record reviews; and 3) chlamydia and gonorrhea reports to the state health department. Statistical methods include latent class and composite reference standard analyses., Results: The estimated prevalence of past diagnoses did not differ significantly by data collection method for chlamydia (20.5%, 23.0%, and 19.7% by self-report, medical record reviews, and state health department reports, respectively) or gonorrhea (4.7%, 6.9%, and 5.5%, respectively) during the 2-year study period. The estimated latent class and composite reference standard prevalences for chlamydia were 23.5% and 26.9%, respectively (p=.04 and p < .01 for differences from self-report alone, respectively). For gonorrhea, the estimated latent class and composite reference standard prevalences were 7.8% and 6.9%, respectively (p < .01 for both differences from self-report alone). Kappa scores for self-report compared with the latent class and composite reference standard prevalences ranged from .67 to .80, and the magnitude of under-reporting ranged from 21% to 47%., Conclusions: The similar case ascertainment from the three sources separately and high reliability of self-report, coupled with its feasibility and low cost, suggest that self-report is a viable data collection method for STD diagnoses. However, using multiple sources may be preferable when time and resources permit given that under-reporting by self-report is likely to occur (particularly for gonorrhea) and that greater case ascertainment can be achieved.

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.

Objective: To examine the reliability and validity of the 42-item Brief Infant-Toddler Social and Emotional Assessment (BITSEA), a screener for social-emotional/behavioral problems and delays in competence., Method: Parents in a representative healthy birth cohort of 1,237 infants aged 12 to 36 months completed the Infant-Toddler Social and Emotional Assessment (ITSEA)/BITSEA, the Child Behavior Checklist (CBCL)/1.5-5, the MacArthur Communication Developmental Inventory vocabulary checklist, and worry questions. In a subsample, independent evaluators rated infant-toddler behavior., Results: Test-retest reliability was excellent and interrater agreement (mother/father and parent/child-care provider) was good. Supporting validity, BITSEA problems correlated with concurrent evaluator problem ratings and CBCL/1.5-5 scores and also predicted CBCL/1.5-5 and ITSEA problem scores one year later. BITSEA measures of competence correlated with concurrent observed competence and predicted later ITSEA competence measures. Supporting discriminant validity, only 23% of high BITSEA problem scorers had delayed vocabulary. Moreover, the combined BITSEA problem/competence cutpoints identified 85% of subclinical/clinical CBCL/1.5-5 scores, while maintaining acceptable specificity (75%)., Conclusions: Findings support the BITSEA as a screener for social-emotional/behavioral problems and delays in social-emotional competence.

Background: There are no specific instruments for rating dependent personality, although this may be an important subject in clinical practice, where knowledge of dependent personality features may influence treatment., Aims: To develop a simple self-rating questionnaire for dependent personality features and compare the findings in two groups, one with and one without established dependent personality disorder., Method: An 8-item Dependent Personality Questionnaire (DPQ) was developed and its acceptability and validity tested by administration to 30 psychiatric patients, half of whom had dependent personality disorder using clinical and research data, and the other 15 (pair-matched for age and sex) having other psychiatric diagnoses (including other personality disorders) but no dependent personality features., Results: The mean score on the dependent personality questionnaire (DPQ) was 13.7 in those with dependent personality disorder and 7.5 in those without such a disorder (p < .005). The DPQ was also a good predictor of the diagnosis of dependent personality disorder, with sensitivity, specificity, predicted positive, and predicted negative accuracies of 87%., Conclusions: The results suggest that the DPQ may be a suitable screening instrument for dependent personality characteristics.

Few data are available concerning the trajectories of mental and motor development across time for cocaine-exposed children compared with others. Findings are presented from individual group curve analyses of the mental and motor development measured by the Bayley Scales of Infant Development-II (BSID-II) on repeated visits from 3 through 36 months of a group of prenatally cocaine-and-other-drug-exposed children (n = 265) compared with those exposed to no drugs (n = 129) or no-cocaine-but-other-drugs (n = 66), including alcohol and/or tobacco. Across time, there was a general decline in motor performance but cocaine-exposed-infants showed a trend toward a greater decrease than children in the other two comparison groups. For mental performance, there was also a decline across age but only through 24 months and no differences in the trajectory of the cocaine-exposed group compared to the other two. And, across all assessment ages, cocaine-exposed-infants showed lower BSID-II mental performance compared to both non-drug and non-cocaine-exposed children. Results suggest that prenatally cocaine-exposed children show delayed developmental indices, particularly in their mental performance, but their trajectories across time are similar to those from impoverished, non-cocaine-exposed groups.

The concurrent validity of the Leiter International Performance Scale (Leiter) and Leiter International Performance Scale-Revised (Leiter-R) was examined in a sample of children with autism who could not be assessed with more traditional measures of intelligence (e.g., the Wechsler scales). The sample consisted of 26 children ranging in age from 4 to 16 years. The correlation between the Leiter scales was high (r = .87), and there was a difference of 3.7 points between the two mean scores, nonsignificant at both statistical and clinical levels. However, significant intraindividual discrepancies were present in 10 cases, 2 of which were both large (24 and 36 points) and clinically meaningful. The mean profile of performance on Leiter-R subtests is also presented for this sample of children with autism, to allow for comparison with other groups. Based on the results of this initial evaluation, together with the current normative data, good psychometric properties, and availability of global and subtest scores with the Leiter-R, the instrument is generally recommended for use with children with autism. However, because of changes in the design of the Leiter-R, there may be greater clinical success with the original Leiter for those children who are very low functioning and severely affected, particularly younger children.

Background: In this study, specific consideration is given to a role for the thalamus in autism., Methods: A volumetric analysis of the thalamus was conducted using magnetic resonance imaging, based on segmentation of continuous 1.2 mm(3) coronal images. The sample consisted of 12 high-functioning individuals with autism, mean age of 21.0 years (SD = 10.4) and mean IQ of 106.4 (SD = 18.3). Normal control subjects were selected to match this group; the mean age was 18.1 years (SD = 6.3); mean IQ was 108.8 (SD = 15.6)., Results: Unadjusted mean thalamic volume was not significantly different; however, there were significant differences in the relationship between thalamic volume and total brain volume (TBV). The correlation was strong and positive in the control group but statistically nonsignificant in the autism group. Group differences were found when adjustments were made for TBV, achieved by grouping subjects' measurements on this variable using a split median procedure. Mean thalamic volume was significantly reduced in the autism group relative to normal control subjects, specifically within the high TBV group., Conclusion: The increase in thalamic volume with increase in TBV was not seen in autism, suggesting underdeveloped connections between cortical and subcortical regions and indicating a need to examine this structure further.

Background: The Global Assessment of Function (GAF) scale is widely used in adult psychiatric practice and research but it has not often been used in learning disability, which is inherently more complex., Aims: To evaluate the reliability of GAF in the assessment of learning disability., Method: GAF reliability was tested by simultaneous multiple rating of unselected case vignettes (n=19-25) from health professionals of different disciplines, under controlled conditions. Analysis of reliability was made with the intraclass correlation coefficient (R(1)) with separate assessments to determine rater bias and individual performance of raters., Results: The results of three data-sets showed generally poor overall levels of agreement, with R(1) levels of 0.35 and 0.28 and somewhat better levels for current GAF scores (R(1)=0.49). However, a subset of raters was identified that achieved much higher levels (R(1)=0.54 to 0.74)., Conclusions: The GAF, in its current format, is not reliable enough to be used in the routine assessment of learning disability. A subgroup of raters, however, have ratings that are, by current biostatistical criteria, sufficiently reliable.