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Background: The need for early treatment of autism spectrum disorders (ASD) necessitates early screening. Very few tools have been prospectively tested with infants of less than 12 months of age. The PREAUT grid is based on dyadic assessment through interaction and shared emotion and showed good metrics for predicting ASD in very-high-risk infants with West syndrome., Methods: We assessed the ability of the PREAUT grid to predict ASD in low-risk individuals by prospectively following and screening 12,179 infants with the PREAUT grid at four (PREAUT-4) and nine (PREAUT-9) months of age. A sample of 4,835 toddlers completed the Checklist for Autism in Toddlers (CHAT) at 24 months (CHAT-24) of age. Children who were positive at one screening (N = 100) were proposed a clinical assessment (including the Children Autism Rating Scale, a Developmental Quotient, and an ICD-10-based clinical diagnosis if appropriate) in the third year of life. A randomly selected sample of 1,100 individuals who were negative at all screenings was followed by the PMI team from three to five years of age to identify prospective false negative cases. The clinical outcome was available for 45% (N = 45) of positive children and 52.6% (N = 579) of negative children., Results: Of the 100 children who screened positive, 45 received a diagnosis at follow-up. Among those receiving a diagnosis, 22 were healthy, 10 were diagnosed with ASD, seven with intellectual disability (ID), and six had another developmental disorder. Thus, 50% of infants positive at one screening subsequently received a neurodevelopmental diagnosis. The PREAUT grid scores were significantly associated with medium and high ASD risk status on the CHAT at 24 months (odds ratio of 12.1 (95%CI: 3.0-36.8), p < 0.001, at four months and 38.1 (95%CI: 3.65-220.3), p < 0.001, at nine months). Sensitivity (Se), specificity, negative predictive values, and positive predictive values (PPVs) for PREAUT at four or nine months, and CHAT at 24 months, were similar [PREAUT-4: Se = 16.0 to 20.6%, PPV = 25.4 to 26.3%; PREAUT-9: Se = 30.5 to 41.2%, PPV = 20.2 to 36.4%; and CHAT-24: Se = 33.9 to 41.5%, PPV = 27.3 to 25.9%]. The repeated use of the screening instruments increased the Se but not PPV estimates [PREAUT and CHAT combined: Se = 67.9 to 77.7%, PPV = 19.0 to 28.0%]., Conclusions: The PREAUT grid can contribute to very early detection of ASD and its combination with the CHAT may improve the early diagnosis of ASD and other neurodevelopmental disorders.

West syndrome (WS) is a rare epileptic encephalopathy with early onset and a high risk of autistic outcome. The PréAut grid assesses this risk following WS onset by taking into account synchrony and emotion in interactions and by evaluating the baby's active desire to engage in pleasant interactions (especially the infant's early active behaviors that encourage being gazed at or kissed by the mother or to share joy with her). We followed a sample of 25 WS patients prospectively from disease onset and assessed whether the PréAut grid before 9 months, and the checklist for autism in toddlers (CHAT) at 18 and 24 months predicted autism or intellectual disability (ID) outcomes at 4 years. We found that the PréAut grid at 9 months (sensitivity = 0.83; specificity = 1) had similar prediction parameters as the CHAT at 18 months (sensitivity = 0.90; specificity = 0.83) and 24 months (sensitivity = 0.92; specificity = 1). WS patients with a positive PréAut screening at 9 months had a risk of having autism or ID at 4 years, which is 38 times that of children with a negative PréAut grid [OR = 38.6 (95 % CI 2.2-2961); p = 0.006]. We conclude that the PréAut grid could be a useful tool for the early detection of autism or ID risk in the context of WS. Further research is needed to assess the PréAut grid in other contexts (e.g. infants at high-risk for non-syndromic autism).

Learning by doing and learning by observing are two facets of the tight coupling between perception and action discovered at the brain level. Developmental studies of observational learning still remain rare and even more rare are studies documenting the capacities of low-functioning children with autism to learn by observation. In the first investigation of this question, twenty nonverbal children with autism with a developmental age of 24 and 36 months, and twenty matched typical children, were presented with an experimental box requiring that a hierarchical sequence of subgoals be performed before it could be opened. A 9-day testing procedure included four presentations of the red box and two video demonstrations of how to open it. Two scores were computed, one concerning the number of sub-goals fulfilled and the other the relevant manipulations of the material. Within-group analyses revealed that only the typical children learned partly or fully the sequence of subgoals after the first video-demonstration. The addition of a second demonstration allowed the two subgroups with autism to learn partly or fully the sequence of subgoals. The differences between learning to manipulate and learning to produce a goal are discussed in terms of relationships between understanding actions and understanding action-effect relations.

Introduction: Autism is an early developmental disorder with cognitive impairments that leads to learning and social integration disabilities. The characterization of memory functions in individuals with autism has been the subject of numerous investigations, with widely varying conclusions. The notable differences between these studies can be attributed to variations in the age, intelligence and level of severity of the participants with autism., Literature Findings: The purpose of our review of the recent literature is to describe the memory function of individuals with autism. Some of the different memory subtypes are intact, others are impaired. Short-term memory (digit span) is not impaired while working memory is impaired in some of its components, but the findings are inconsistent. More recent studies demonstrate reduced spatial working memory abilities in autism and extend previous findings by demonstrating that these deficits are significant when tasks impose heavier demands on working memory. Episodic long-term memory, as measured by free recall, cued recall or recognition tasks, is intact, but participants with autism perform significantly less well than controls as the complexity of the verbal or visual material to be recalled increases. Source or contextual memory involves a variety of characteristics specifying the conditions under which specific items or facts are acquired: it has been investigated in individuals with autism with different methods. Deficits in source memory for temporal information have been found, but there were no reality monitoring deficits. Recent findings indicate that the nature of source memory confusion in autism does not appear to reflect a generalized deficit in attaching context to memories, but rather is dependant on the specific to-be-remembered information that involves social aspects of context. The self-reference effect is missing, with individuals with autism recalling events performed by themselves less well than the events performed by a peer, suggesting they have difficulties in relation to processes involving the self. Studies involving assessment of subjective states of awareness during recognition show less conscious recollection and more feelings of familiarity. Recent investigations are consistent in demonstrating memory impairments related to the failure of subjects with autism to use organizing strategies or meaning to support memory, an effect which grows with the increasing complexity of the material. Memory deficits in autism may be related more to retrieval and less to encoding, as deficit in source memory in participants with autism is largely eliminated when source was supported at test., Discussion: The neuroanatomical basis of the specificities of memory impairment in autism is still uncertain, but it is suggested that autism involves an impairment in the conversion of limbic inputs into medial prefrontal outputs. Memory deficits found in individuals with autism may explain some of the clinical symptoms. Failure to encode all the information, especially its social aspects, may therefore contribute to dysfunction in the social, communication, and reasoning domains. Abnormal memory functioning in autism is also related to more general cognitive impairments, including executive function deficits and central coherence weakness. Evidence of the normality of certain memory capacities, at least in individuals with moderate autistic symptomatology, is encouraging for adaptive improvements in cognitive functioning.

Episodic memory, i.e. memory for specific episodes situated in space and time, seems impaired in individuals with autism. According to weak central coherence theory, individuals with autism have general difficulty connecting contextual and item information which then impairs their capacity to memorize information in context. This study investigated temporal context memory for visual information in individuals with autism. Eighteen adolescents and adults with high-functioning autism (HFA) or Asperger syndrome (AS) and age- and IQ-matched typically developing participants were tested using a recency judgement task. The performance of the autistic group did not differ from that of the control group, nor did the performance between the AS and HFA groups. We conclude that autism in high-functioning individuals does not impair temporal context memory as assessed on this task. We suggest that individuals with autism are as efficient on this task as typically developing subjects because contextual memory performance here involves more automatic than organizational processing.

Objectives: To adapt the Helping Alliance Questionnaires for Child and Parents (HAQ-CP) into French and to assess their validity and reproducibility for use with the child, parent, and therapist., Method: First, the 3 US versions of the questionnaires were translated into French by 3 French-English bilingual translators (who were native speakers), and the translations were then discussed by an expert committee to ensure that the concept explored within the French context was efficiently targeted. Second, the psychometric properties of the French version were investigated in a cross-sectional, multicentre study. The questionnaires were completed by 148 children and adolescents, aged 9 years or older and with various conditions, who were followed in 3 university hospital outpatient clinics and 2 ambulatory psychiatry units, and also by their parents and therapists., Results: The instruments were quick and easy to administer, and acceptability was good. All 3 versions proved unidimensional in factorial analysis (80% of variance was explained) with high internal construct validity (Cronbach's alpha = 0.8). Reproducibility was satisfactory (intraclass correlation coefficients were as follows: child, 0.84; parent, 0.84; and therapist, 0.87). Concordance of the 3 alliance assessments was moderate., Conclusion: This work provides child psychiatrists with a valid measure of the therapeutic alliance. Its predictive value, while recognized in adults, remains to be demonstrated in children.

Unlabelled: Autism is the best defined category among PDD. Its high prevalence, its onset in very young children and its persistence in adulthood arise many questions about early screening and early diagnosis. The aim of the study was to identify professional best practices about screening and diagnosis of autism in order to propose clinical guidelines and actions for the future. Scientific experts and parents take part to this procedure. Literature and previous guidelines were analyzed, experts in various fields were interviewed, a national study about the medical practices of the diagnosis of autism was made and questionnaires were send to 1600 psychiatrists and pediatricians. Guidelines built around 2 levels were proposed about screening and diagnosis., Conclusion: Diagnosis needs a multidisciplinary approach, validated instruments and more communication between professionals and parents. Finally one of the more important aims of the diagnosis of autism is to facilitate intervention program.

The records of 144 patients of Child Psychiatry Units of Alsace (France), with childhood psychosis (CP) or pervasive developmental disorders (PDD) have been systematically screened for previous or associated pathological events. Half of the children studied have been or are still affected by severe somatic disorders, but none of the diagnostic subcategories (referring to DSM III or CFTMEA) appeared significantly more frequently affected. In our population, the severity of organic disorders was positively correlated with: the age of the mother: more severe cases were reported when the mother was younger than 20 or older than 40 at the moment of childbirth; pathological events during pregnancy; early mother-child separation during the first year of life. The most frequent associated disorders however (neonatal pathology 45% of the cases, epilepsy 17% of the cases, neurological or neurosensorial pathology 15% of the cases) were associated neither with a specific diagnostic nor with a clinical and social specific pattern. The only statistically significant correlation was found between neurological pathology and a relatively low level of cognitive and social functioning. All these results were confirmed by multivariate statistical analysis. A main component analysis integrating all quantified data concerning organic pathology was performed: it emphasizes the independence of the different pathological events reported. The factorial analysis including the clinical, diagnostical and somatic event-related data failed to show any statistical profile associating functional features of the children with any particular previous or existing somatic disorders. Our results suggest that a history of organic pathological events is frequent not only in autistic disorders but in any kind of PDD or early CP - associated with moderate to severe mental retardation, in most cases of our study. However, this does not demonstrate that this type of pathological events constitute the direct and unique cause of PDD and CP: the concept of the aetiology of these severe diseases must take account of other factors - such as relational disruption -, also frequently seen in these children.

Memory, and particularly short-term memory or "working memory" (Baddeley), is involved in language acquisition in children. We have studied short-term memory, with verbal-and non verbal tests, of 8 children suffering from developmental dysphasia compared with other ones, matched in terms of age and performance I.Q. (W.I.S.C.-R.). The digit span did not significantly differ in the two groups, while the visuo-spatial span was lower in the dysphasic group. The memorization of a list of monosyllabic words by dysphasic children was poor in the absence of visual presentation and improved by it. Differences between dysphasic and control-children are unlikely to be due to speech rate which does not significantly differ from one group to the other one. The results suggest the existence, in language disordered children, of cognitive functions disorders much more important than those directly involved in the speech production.

The relatively recent development of research on memory has considerably improved knowledge on the subject. The cognitive approach allowed to consider memory as a multiform phenomenon, implicating separate processes and based on independent systems. Memory presently appears as an active process, beginning to get organized as soon as the first interactions between child and environment. Recent research data show that infants memory seems to present specific characteristics, different from those of older subjects. This is a further argument to the theory of independent mnemonic systems, growing at different periods of development.

Bone marrow transplantation (BMT) is the last chance of recovery for some children suffering from malignant hemopathy or congenital blood disease. BMT with related donor radically alters previous family relationships: each member of the nuclear family becomes actively involved. Parents and siblings all undergo HLA typing. Only 30% of those who would benefit from bone marrow transplantation are lucky enough to have an HLA matched related donor, brother or sister. Our retrospective study concerned related donors and their parents. This paper reports the parents study. It was carried out at Strasbourg University Hospital. Parents were invited to speak about the child's illness, the graft reasons and their own position to regarding the choice of donor. Semi-structured interviews were used and their content analysed. The results highlight the expression by the parents of the need to maintain some control over the action which will save their child and establish an other gift system to keep their parental status.

Three cases of fragile X (fra X) have been identified in a systematic survey of 30 boys, aged 3 to 14, with infantile autism or psychotic disorders, associated with mental retardation. Only one of these children exhibited a dysmorphy characterizing the Martin-Bell syndrome. Two fra X cases fulfilled the DSM III criteria for autism; none corresponded to the Kanner's description of infantile autism. The prevalence of fra X among children with psychotic disorders (6%) is much higher than in the general population; however it is close to the prevalence observed in non psychotic mentally retarded patients. Given the inconsistency of the somatic phenotype, the screening should benefit from the recent discovery of abnormal methylation of DNA.

After reviewing epidemiological literature on the relationships between depression in parents and onset of a psychiatric disturbance in children as well as investigations of the interactions between a depressed mother and her infant, the authors discuss the psychoanalytical concepts of these interactions and the findings of their research. This epidemiological research is based on the assumption that depression in the mother during pregnancy and the first few months of the post-partum constitutes a risk factor for the onset of an early psychosis in the child. This research is a comparative study between a group of mothers with early onset psychotic children and a group of mothers with non patient children, the age and sex of the children in both groups being equally distributed. The methodology includes two instruments aimed at a retrospective assessment of mothers' depression: the SADS-LA questionnaire and a standardized scoring system for semi-structured interviews investigating the mother's feelings during pregnancy and early development of her baby. Results show that there is a statistically significant relationship between a major depressive condition in the mother during pregnancy and/or during the first year of the infant's life and the onset of an autism in the child. It might be that major depressive conditions starting before delivery could by themselves account for the risk. Depression in the mother therefore constitutes a risk factor for early psychosis, the relative risk being about four. This study also emphasizes particular features of the mother's depressive conditions: difficulties to accept the real child, difficulties in perceiving the infant's psychic evolution, decrease of interactive skills. The statistically significant relationship in no way points to a linear causal relationship, which hypothesis seems to be negated by the statistical findings of this research.

The psychopathological studies on adolescence underline the paradoxical behaviours during this period of life. After the analysis of its concept we show in which way the paradox helps to maintain the continuity of psychological life during the crisis. Thus impossible choices which are part of the contradiction in adolescents be avoided. It will be necessary to provoke the emergence of the paradox from the contradictions linked with hospitalization through on hospitalization to make the most of the letter in the therapeutic process.