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Rajna Knez,1– 3 Dejan Stevanovic,1 Elisabeth Fernell,1 Christopher Gillberg1 1Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; 2Department of Pediatrics, Skaraborg Hospital, Skövde, Sweden; 3School of Health Sciences, University of Skövde, Skövde, SwedenCorrespondence: Rajna Knez, Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Kungsgatan 12, vån 2, Göteborg, 41119, Sweden, Email rajna.knez@gu.seAbstract: Early Symptomatic Syndromes Eliciting Neurodevelopmental Clinical Examinations (ESSENCE) is an umbrella term covering a wide range of neurodevelopmental difficulties and disorders. Thus, ESSENCE includes attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and other neurodevelopmental disorders (NDDs) and difficulties, with a variety of symptoms in cognitive, motor, sensory, social, arousal, regulatory, emotional, and behavioral developmental domains, frequently co-occurring and likely having partly common neurobiological substrates. The ESSENCE concept is a clinical paradigm that promotes organizing NDDs in everyday clinical practice according to their coexistence, symptom dimensions overlapping, and treatment possibilities. Despite increased knowledge regarding NDDs, the neurobiological mechanisms that underlie them and other ESSENCE-related problems, are not well understood. With its wide range of neural circuits and interactions with numerous neurotransmitters, the orexin/hypocretin system (Orx-S) is possibly associated with a variety of neurocognitive, psychobiological, neuroendocrine, and physiological functions and behaviors. Dysfunction of Orx-S has been implicated in various psychiatric and neurological disorders. This article provides an overview of Orx-S dysfunctions’ possible involvement in the development, presentation, and maintenance of ESSENCE. We provide a focused review of current research evidence linking orexin neuropeptides with specific clinical NDDs symptoms, mostly in ADHD and ASD, within the Research Domain Criteria (RDoC) framework. We propose that Orx-S dysfunction might have an important role in some of these neurodevelopmental symptom domains, such as arousal, wakefulness, sleep, motor and sensory processing, mood and emotional regulation, fear processing, reward, feeding, attention, executive functions, and sociability. Our perspective is presented from a clinical point of view. Further, more thorough systematic reviews are needed as well as planning of extensive new research into the Orx-S’s role in ESSENCE, especially considering RDoC elements.Keywords: attention-deficit/hyperactivity disorder, autism spectrum disorder, developmental coordination disorder, neurodevelopmental disorders, research domain criteria, orexin, hypocretin

Valdemar Landgren,1,2 Leif Svensson,3 Rajna Knez,1,3 Michail Theodosiou,1 Christopher Gillberg,1 Elisabeth Fernell,1 Magnus Landgren,1 Mats Johnson1 1Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden; 2Department of Psychiatry, Skaraborg Hospital, Skövde, Region Västra Götaland, Sweden; 3Department of Pediatrics, Skaraborg Hospital, Mariestad, Region Västra Götaland, SwedenCorrespondence: Valdemar Landgren, Department of Psychiatry, Skaraborg Hospital, Lövängsvägen, Skövde, Region Västra Götaland, 541 42, Sweden, Tel +46702960450, Email valdemar.landgren@gu.sePurpose: To determine the prevalence of parent-rated developmental concern using the ESSENCE-Q (Early Symptomatic Syndromes Eliciting Neurodevelopmental Clinical Examinations-Questionnaire, 12-items, score range 0– 24) and to ascertain the predictive validity and optimal cutoff level of the instrument in a school-based sample of 11-year-old children.Methods: In a cross-sectional, school-based study, participants underwent a clinical assessment by a physician and a psychologist, teachers and parents completed the SDQ (Strength and Difficulties Questionnaire), medical health records and national tests were reviewed, and parents independently completed the ESSENCE-Q. In a case-conference outcomes were defined as a) the need for further clinical work-up due to suspected neurodevelopmental problems (NDPs) and b) degree of investigator-rated symptoms/impairment from NDPs on the CGI-S (Clinical Global Impression-Severity instrument, range 1– 7, 4– 7 defined as clinically symptomatic). Classification and optimal cutoffs of the ESSENCE-Q were determined using ROC (Receiver Operating Characteristic) analysis.Results: Out of 343 eligible children, 223 enrolled, of whom 173 (50% of all eligible) had a parent-rated ESSENCE-Q. At least one of the 12 possible concerns was reported by parents of 36% of participants. Overall, in 101 (57%) participants a work-up was warranted, and 64 (37%) were clinically symptomatic from NDPs. The AUC of the ESSENCE-Q in detecting need for work-up was 0.70 (95% confidence interval [CI] 0.63– 0.77), and the AUC in detecting clinically symptomatic participants was 0.82 (95% CI 0.76– 0.88). ESSENCE-Q ratings correlated positively with CGI-S scores (r=0.48, p< 0.05). A cutoff of ≥ 3 had the highest accuracy (78%) with a negative predictive value of 82%. Ratings > 6 conferred few false positives cases with positive likelihood ratios > 10 and positive predictive values of 86% or more.Significance: This study of the ESSENCE-Q in 11-year-old children suggests it might be an acceptable instrument for screening of NDPs in children in middle school, optimally in conjunction with other methods.Keywords: screening, neurodevelopment, school, ESSENCE-Q

Ulrika Wester Oxelgren,1 Joakim Westerlund,2,3 Åsa Myrelid,1 Göran Annerén,4 Lotta Johansson,5 Marie Åberg,5 Jan Gustafsson,1 Elisabeth Fernell31Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden; 2Department of Psychology, Stockholm University, Stockholm, Sweden; 3Gillberg Neuropsychiatry Centre, Department of Neuroscience and Physiology, Gothenburg University, Gothenburg, Sweden; 4Department of Immunology, Genetics, and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden; 5Department of Health and Rehabilitation, Uppsala County, Kungsgärdet Center, Uppsala, SwedenPurpose: To evaluate whether an intervention, targeting deficits in social communication, interaction and restricted activities in children and adolescents with Down syndrome and autism could lead to enhanced participation in family and school activities.Methods: The intervention included education for parents and school staff about autism, and workshops to identify social-communication and daily living activities that would be meaningful for the child to practice at home and at school. Thereafter, a three-month period of training for the child followed. Outcome measures comprised evaluation of goal achievement for each child, the “Family Strain Index” questionnaire and a visual scale pertaining to the parents’ general opinion about the intervention.Results: On average, more than 90% of the goals were (to some extent or completely) achieved at home and at school. The mean scores of the “Family Strain Index” were almost identical at the follow-up to those before intervention. The evaluation supported that the use of strategies, intended to facilitate activities and communication, remained largely 18 months after start of the intervention.Conclusion: Despite the group involved in this study being composed of older children and adolescents, most of whom had severe and profound intellectual disability, the goal achievements and parents’ views on the intervention were encouraging.Keywords: Down syndrome, intellectual disability, autism, psychoeducational intervention

Liselotte Kjellmer,1,2 Elisabeth Fernell,2 Christopher Gillberg,2 Fritjof Norrelgen2–4 1Department of Special Education, Stockholm University, Stockholm, Sweden; 2Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden; 3Functional Area Speech and Language Pathology, Karolinska University Hospital, Stockholm, Sweden; 4Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden Purpose: This study aimed to present speech and language data from a community-representative group of 4- to 6-year-old children with early-diagnosed autism spectrum disorder (ASD) without intellectual disability (ID). Methods: The study group comprised 83 children 4–6 years of age with ASD without ID. They had been diagnosed with ASD before age 4.5 years and had received intervention at a specialized habilitation center. At 2-year follow-up, their language abilities were evaluated comprehensively by two speech–language pathologists using a battery of assessments. Receptive and expressive language and phonology were examined. The phonology evaluation included measures of phonological speech production and of phonological processing. Results: Results revealed that almost 60% had moderate–severe language problems. Nearly half exhibited combined expressive and receptive language problems, of which a majority also had phonology problems. Phonological speech problems were found in 21% of the total group. Conclusion: The findings underscore the importance of considering speech/language disorders in children with ASD without ID, since they usually attend mainstream classes but need specific educational adaptations. Keywords: autism spectrum disorder, language, speech, language disorders, speech–language pathology

Martina Barnevik Olsson,1,2 Anette Holm,3 Joakim Westerlund,1,4 Åsa Lundholm Hedvall,1,3 Christopher Gillberg,1 Elisabeth Fernell1 1Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Gothenburg, 2PRIMA Child and Adult Psychiatry, 3Department of Psychology, Astrid Lindgren Children’s Hospital, 4Department of Psychology, Stockholm University, Stockholm, Sweden Background: Studies on autism have tended to focus either on those with intellectual disability (ie, those with intellectual quotient [IQ] under 70) or on the group that is referred to as “high-functioning”, that is, those with borderline, average or above average IQ. The literature on cognition and daily functioning in autism spectrum disorder combined specifically with borderline intellectual functioning (IQ 70–84) is limited.Methods: From a representative group of 208 preschool children diagnosed with autism spectrum disorder, those 50 children in the group with borderline intellectual functioning at ages 4.5–6.5 years were targeted for follow-up at a median age of 10 years. A new cognitive test was carried out in 30 children. Parents were interviewed with a semi-structured interview together with the Vineland Adaptive Behavior Scales (n=41) and the Autism-Tics, attention-deficit/hyperactivity disorder (AD/HD) and other comorbidities inventory (A-TAC) (n=36).Results: Most children of interviewed parents presented problems within several developmental areas. According to A-TAC and the clinical interview, there were high rates of attention deficits and difficulties with regulating activity level and impulsivity. Vineland Adaptive Behavior Scales composite scores showed that at school age, a majority of the children had declined since the previous assessment at ages between 4.5 and 6.5 years. Almost half the tested group had shifted in their IQ level, to below 70 or above 84.Conclusion: None of the children assessed was without developmental/neuropsychiatric problems at school-age follow-up. The results support the need for comprehensive follow-up of educational, medical and developmental/neuropsychiatric needs, including a retesting of cognitive functions. There is also a need for continuing parent/family follow-up and support. Keywords: AD/HD, A-TAC, autism spectrum disorder, borderline intellectual functioning, developmental disorders, Vineland

Yuhei Hatakenaka,1,2 Hitoshi Ninomiya,3 Eva Billstedt,2 Elisabeth Fernell,2 Christopher Gillberg2 1Kochi Gillberg Neuropsychiatry Centre, Kochi Prefectural Medical and Welfare Center, Kochi, Japan; 2Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; 3Integrated Centre for Advanced Medical Technologies, Kochi University Medical School, Kochi, Japan Background: Screening for developmental disorders is an important task for Child Health Care. The concept of ESSENCE (early symptomatic syndromes eliciting neurodevelopmental clinical examinations) was created to cover all types of early developmental disorders and the ESSENCE-Questionnaire (ESSENCE-Q containing 12 questions with possible total scores ranging from 0 to 22) was developed as a tool for early detection of these disorders. The aim of this study was to perform a validation study in a public health situation in Japan.Methods: The psychometric properties of the ESSENCE-Q, completed by mothers, public health nurses (PHNs), and psychologists at 18-month (n=143 children) and 36-month (n=149 children) checkups were evaluated in a small city of Japan. Results were validated against clinical ESSENCE diagnoses. Receiver operating characteristic curves were generated and compared by using the area under the curve (AUC). Optimal cutoff values were explored.Results: At the 18-month checkup, AUC by mothers was 0.72, by PHNs 0.86, and by psychologists 0.82. An optimal cutoff was 3 with a high negative predictive value (NPV). At the 36-month checkup, AUC by mothers was 0.57, by PHNs 0.82, and by psychologists 0.87. Optimal cutoff was 2 with high NPV.Conclusion: The ESSENCE-Q completed by PHNs and psychologists had good diagnostic validity. The results suggested that almost all children scoring under cutoff would not have any ESSENCE problems/diagnoses. Keywords: ESSENCE, questionnaire, public health nurse, receiver operating characteristic, ROC, area under the curve, AUC, optimal cutoff, negative predictive value, NPV

Magnus Landgren,1,2 Salmir Nasic,3 Mats Johnson,1,2 Trygve Lövoll,1 Daniel Holmgren,4,5 Elisabeth Fernell2 1Department of Pediatrics, Unit of Developmental Disorders, Skaraborg’s Hospital, Mariestad, 2Gillberg Neuropsychiatry Centre, University of Gothenburg, Gothenburg, 3Research and Development Centre, 4Department of Pediatrics, Skaraborg’s Hospital, Skövde, 5University of Gothenburg, Gothenburg, Sweden Background: Knowledge about the long-term effects on blood pressure (BP) and body mass index (BMI) when treating young patients for attention-deficit/hyperactivity disorder (AD/HD) with stimulants is limited. Most of the studies have reported mean and not individual values for anthropometrics and BP in treatment with stimulants. This seems to be the first study of changes based on the analyses of individual data measured over time. Patients and methods: Seventy young patients (aged 8–18 years) diagnosed with AD/HD and responding well to treatment with stimulants were followed for a mean period of 3 years and 3 months. BP, heart rate, height, weight, and BMI were transformed to standard deviations or z-scores from before treatment to the last registered visit. Results: The mean dose of methylphenidate was 0.95 mg/kg. The mean increase of systolic and diastolic BP was 0.4 z-score and 0.1 z-score, respectively. The systolic BP was associated with BMI; a higher BMI at baseline increased the risk for an increase in systolic BP. Ten percent of the total group had a weight at follow-up of +1.5 SD at baseline, 50% had a significantly reduced BMI. Conclusion: Consequences of stimulant treatment must be evaluated individually. Besides significant effects on core AD/HD symptoms, some patients have lower BMI and BP and some increase/maintain their BMI and/or increase their systolic BP. The risk of reduced height trajectory needs further research. Keywords: AD/HD, treatment, heart rate, long-term follow-up, methylphenidate, improvement, cardiovascular, overweight, height, BMI, health

Birgitta Spjut Jansson,1–3 Carmela Miniscalco,1,4 Joakim Westerlund,1,5 Anne-Katrin Kantzer,1,6 Elisabeth Fernell,1 Christopher Gillberg1 1Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, Institute of Neuroscience and Physiology, University of Gothenburg, 2Unit of Child and Adolescent Habilitation, 3Department of Psychology, University of Gothenburg, 4Division of Speech and Language Pathology, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, 5Department of Psychology, University of Stockholm, Stockholm, 6Department of Child and Adolescent Psychiatry, NU Hospital Organization, Trollhättan, Sweden Background: Previous research has stressed the importance of early identification and intervention for children with autism spectrum disorders. Methods: Children who had screened positive for autism at the age of 2.5 years in a general population screening and then received a diagnosis of autism spectrum disorder were enrolled in an intervention program provided by Swedish habilitation services. The following interventions were available: a comprehensive intervention based on Applied Behavior Analysis – Intensive Learning (IL) – in two settings, which included home- and preschool-based (IL Regular) and only home-based (IL Modified) and eclectic interventions.Results: There was considerable variability in terms of outcome, but intervention group status was not associated with any of the chosen outcome variables. Conclusion: The main finding was that the type of intervention was not critical for outcome of adaptive or global functioning. The variability in outcome demonstrates the need for continuous assessments and evaluation of the child’s function and behavior throughout the intervention period. Keywords: autism spectrum disorder, preschool children, early intervention, ABA, cognitive function, follow-up

Yuhei Hatakenaka,1,2 Elisabeth Fernell,2 Masahiko Sakaguchi,3 Hitoshi Ninomiya,3 Ichiro Fukunaga,1 Christopher Gillberg2 1Kochi Gillberg Neuropsychiatry Centre, Kochi Prefectural Medical and Welfare Centre, Kochi, Japan; 2Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; 3Integrated Centre for Advanced Medical Technologies, Kochi University Medical School, Kochi, Japan Background: Early identification of autism spectrum disorder, intellectual developmental disorder, attention-deficit/hyperactivity disorder, and other neurodevelopmental disorders/problems is crucial, yet diagnosis is often delayed for years under the often misguided “wait-and-see” paradigm. The early symptomatic syndromes eliciting neurodevelopmental clinical examinations-questionnaire (ESSENCE-Q) is a brief (12-item) screening questionnaire developed specifically for the purpose of speeding up the identification process of a wide variety of neurodevelopmental problems. The aims were to 1) estimate the reliability of the ESSENCE-Q, 2) evaluate the clinical cutoff levels suggested by the author of the ESSENCE-Q, and 3) propose optimal cutoff levels based on receiver operating characteristic analysis.Methods: The ESSENCE-Q was used for 1 year by a psychiatrist in Kochi, Japan, assessing children under the age of 6 years referred for developmental problems. The children were also clinically assessed with regard to whether or not they met criteria for a developmental disorder (diagnosis positive and diagnosis negative groups). We contrasted the results of the ESSENCE-Q and those of clinical diagnostic assessments in 130 cases.Results: Cronbach’s alpha was 0.82, sensitivity was 0.94 (95% confidence interval [CI]: [0.88, 0.98]), and specificity 0.53 (95% CI: [0.28, 0.77]), which are reasonable psychometrics for a first-step screening tool. Based on receiver operating characteristic analysis, we recommended an optimal cutoff level of yes ≥2 or maybe/a little ≥3 on the ESSENCE-Q (0.87 (95% CI: [0.79, 0.92]) sensitivity and 0.77 (95% CI: [0.50, 0.93]) specificity).Conclusion and implication: The ESSENCE-Q can be a good instrument for use as a screening tool for aiding in the process of early identification of neurodevelopmental disorders in clinical settings. To establish the broader validity and reliability of the ESSENCE-Q, case–control studies and general population studies of children in different age groups are needed. Keywords: ESSENCE, ESSENCE-Q, cutoff levels, receiver operating characteristic analysis

Martina Barnevik Olsson,1,2 Joakim Westerlund,1,3 Sebastian Lundström,1 MaiBritt Giacobini,2,4 Elisabeth Fernell,1,5 Christopher Gillberg1 1Gillberg Neuropsychiatry Centre, Institution of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden; 2PRIMA Child and Adult Psychiatry, Stockholm, Sweden; 3Department of Psychology, Stockholm University, Stockholm, Sweden; 4Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; 5Research and Development Centre, Skaraborg’s Hospital, Skövde, Sweden Background: The aim of this study was to follow up the 17 children, from a total group of 208 children with autism spectrum disorder (ASD), who “recovered from autism”. They had been clinically diagnosed with ASD at or under the age of 4 years. For 2 years thereafter they received intervention based on applied behavior analysis. These 17 children were all of average or borderline intellectual functioning. On the 2-year follow-up assessment, they no longer met criteria for ASD.Methods: At about 10 years of age they were targeted for a new follow-up. Parents were given a semistructured interview regarding the child’s daily functioning, school situation, and need of support, and were interviewed using the Vineland Adaptive Behavior Scales (VABS) and the Autism – Tics, Attention-deficit/hyperactivity disorder (AD/HD), and other Comorbidities (A-TAC) telephone interview.Results: The vast majority of the children had moderate-to-severe problems with attention/activity regulation, speech and language, behavior, and/or social interaction. A majority of the children had declined in their VABS scores. Most of the 14 children whose parents were A-TAC-interviewed had problems within many behavioral A-TAC domains, and four (29%) had symptom levels corresponding to a clinical diagnosis of ASD, AD/HD, or both. Another seven children (50%) had pronounced subthreshold indicators of ASD, AD/HD, or both.Conclusion: Children diagnosed at 2–4 years of age as suffering from ASD and who, after appropriate intervention for 2 years, no longer met diagnostic criteria for the disorder, clearly needed to be followed up longer. About 3–4 years later, they still had major problems diagnosable under the umbrella term of ESSENCE (Early Symptomatic Syndromes Eliciting Neurodevelopmental Clinical Examinations). They continued to be in need of support, educationally, from a neurodevelopmental and a medical point of view. According to parent interview data, a substantial minority of these children again met diagnostic criteria for ASD. Keywords: autism spectrum disorder, autistic traits, AD/HD, A-TAC, Vineland, cure

Elisabeth Fernell,1 Mats Anders Eriksson,1,2 Christopher Gillberg11Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; 2Department of Women's and Children's Health, Karolinska Institute, Stockholm, SwedenAbstract: Autism spectrum disorders involve a set of clinical phenotypes that mirror an early onset of neurodevelopmental deviations, with core symptoms that can probably be related to a deficiency in the social instinct. Underlying the cognitive impairments there are physiological brain problems, caused by a large number of medical factors. This narrative review of systematic reviews and meta-analyses from the last 5 years (2008–2012) presents aspects from many areas in autism spectrum disorder research, with a particular focus on early intervention and the subsequent impact on prognosis. Other major areas discussed are epidemiology, early symptoms and screening, early diagnosis, neuropsychology, medical factors, and the existence of comorbidities. There is limited evidence that any of the broadband “early intervention” programs are effective in changing the natural long-term outcome for many individuals with an early diagnosis of autism. However, there is some evidence that Early Intensive Behavioral Intervention (EIBI) is an effective treatment for some children with ASD. Nevertheless, there is emerging consensus that early diagnosis and information are needed in order that an autism-friendly environment be “created” around affected individuals.Keywords: autism spectrum disorder, epidemiology, screening, etiology, intervention, outcome

Ulla Ek,1 Joakim Westerlund,2 Elisabeth Fernell31Department of Special Education, 2Department of Psychology, Stockholm University, Stockholm, 3Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg and the Research and Development Centre, Skaraborg Hospital Skövde, SwedenBackground: The aim of this study was to analyze two main types of cognitive domains in school children with different types and severities of attention-related problems. The cognitive domains examined were general cognitive ability and executive abilities.Methods: Three different clinical samples of pupils with school problems were analyzed to assess their cognitive Wechsler Intelligence Scale for Children profiles. In particular, the general cognitive ability index and the executive markers (ie, verbal memory index and processing speed index) were of interest. Of the total sample (n = 198), two main groups were contrasted; one met the full criteria for attention deficit hyperactivity disorder (ADHD)/subthreshold ADHD, and one was comprised of those with milder attention problems, insufficient to meet the criteria for ADHD/subthreshold ADHD.Results: It could be demonstrated that both groups had a significantly higher score on the general cognitive ability index than on measures of working memory and processing speed. This difference was more pronounced for boys.Conclusion: These types of cognitive differences need to be considered in children with different kinds of learning, behavior, and attention problems; this is also true for children presenting with an average general intelligence quotient and with milder attention problems. Current educational expectations are demanding for children with mild difficulties, and such cognitive information will add to the understanding of the child's learning problems, hopefully leading to a better adapted education than that conventionally available.Keywords: working memory, processing speed, children, learning and attention problems, attention deficit hyperactivity disorder, subthreshold

Ulla Ek1, Fritjof Norrelgen3,4, Joakim Westerlund2, Andrea Dahlman5, Elizabeth Hultby5, Elisabeth Fernell61Department of Special Education, 2Department of Psychology, Stockholm University, Stockholm, Sweden; 3Department of Speech and Language Pathology, Karolinska University Hospital, Stockholm, Sweden; 4Department of Clinical Neuroscience, 5CLINTEC/Division of Speech and Language Pathology, Karolinska Institutet, Stockholm, Sweden; 6The Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg and the Research and Development Centre, Skaraborg Hospital, Skövde, SwedenAim: Ten years ago, we published developmental data on a representative group of children (n = 25) with moderate or severe speech and language impairment, who were attending special preschools for children. The aim of this study was to perform a follow-up of these children as teenagers.Methods: Parents of 23 teenagers participated in a clinical interview that requested information on the child's current academic achievement, type of school, previous clinical assessments, and developmental diagnoses. Fifteen children participated in a speech and language evaluation, and 13 participated in a psychological evaluation.Results: Seven of the 23 teenagers had a mild intellectual disability, and another three had borderline intellectual functioning. Nine had symptoms of disorders on the autism spectrum; five of these had an autism spectrum disorder, and four had clear autistic traits. Six met criteria for attention-deficit hyperactivity disorder (ADHD)/subthreshold ADHD. Thirteen of 15 teenagers had a moderate or severe language impairment, and 13 of 15 had a moderate or severe reading impairment. Overlapping disorders were frequent. None of the individuals who underwent the clinical evaluation were free from developmental problems.Conclusion: A large number of children with speech and language impairment at preschool age had persistent language problems and/or met the criteria for developmental diagnoses other than speech and language impairment at their follow-up as teenagers. Language impairment in young children is a marker for several developmental disorders, particularly intellectual disability and autism spectrum disorder.Keywords: language impairment, dyslexia, developmental disorders, autism spectrum disorder, ADHD, follow-up

Aim: Study the outcomes in terms of registered neurodevelopmental diagnoses and out‐of‐home placements in children whose parents had been diagnosed with mild intellectual disability (ID) in childhood. Methods: The study groups consist of (1) a population‐based sample of 78 individuals, born in 1979–1985, meeting criteria for mild ID during childhood, and (2) their 88 children. From national registers, data on outcomes were retrieved in 2020 regarding psychosocial and psychiatric outcomes for the adults, and neurodevelopmental diagnoses and out‐of‐home placements for the children. Results: Of the 78 adults with mild ID, 31 were parents of 88 children, aged 0–21. The age‐adjusted prevalence of neurodevelopmental disorders among the children was 67%. Of the 27 children aged between 13 and 21 years at follow‐up, 16 had at least one registered neurodevelopmental diagnosis; 11 had ADHD and 7 had ID. Nine of these 27 children had experienced out of home placement. Conclusion: Children of parents with mild ID are at high risk of neurodevelopmental disorders, in particular ADHD and ID, and out‐of‐home placements. Our findings indicate that individuals with mild ID who become parents routinely should be offered individually tailored parent support and their children offered assessment regard neurodevelopmental disorders. [ABSTRACT FROM AUTHOR]

Background: Very few longitudinal psychiatric and psychosocial outcome studies of children with mild intellectual disability (MID) have been performed. Methods: The study group was population based and consisted of 82 individuals, born in 1979–1985 and diagnosed in childhood at ages between 3 and 15 years with MID. In the present study, register data regarding school attendance, employment, economic situation, psychiatric diagnoses and criminal sentences were retrieved for the years 1997–2018, when the individuals were up to 39 years old. Results: At follow‐up, data were obtained for 78 of the 82 individuals (47 male and 31 female). Mean age at follow‐up was 36 years. Of the 78 individuals, 57 (73%) had exclusively received education for pupils with MID, but 21 (27%) had graduated from regular education of some sort (at least 9 years). Forty‐four (56%) had never been employed, and 34 (44%) had been registered as employed for at least a shorter period. Forty‐seven (60%) had received a sick pension at some point in adulthood. Of the 78 individuals, 44 (56%) had any psychiatric disorder recorded and about half of these (n = 21) had had inpatient treatment. A total of 31 of the 44 individuals in psychiatric care (70%) had ID noted as one of their diagnoses. Of the 78 individuals, 48 (62%) had support from the Act concerning Support and Service for Persons with Certain Functional Impairments (Swedish LSS law) as adults. Twenty‐one individuals (27%) had had a criminal conviction, of whom five male individuals had been incarcerated. Conclusions: Individuals with MID constitute a heterogeneous group with regard to severity of functional impairment, co‐occurring psychiatric disorders and need of support from society. Primary health care, psychiatry and habilitation services need to work together in order to meet the multiple needs of this group. [ABSTRACT FROM AUTHOR]

The study presents neuropsychiatric profiles of children aged 11 with autism spectrum disorder, assessed before 4.5 years, and after interventions. The original group comprised a community sample of 208 children with ASD. Parents of 128 participated-34 with average intellectual function, 36 with borderline intellectual function and 58 with intellectual disability. They were interviewed using the Autism-Tics, AD/HD and other Comorbidities interview. Criteria for a clinical/subclinical proxy of ASD were met by 71, 89 and 95 %, respectively. Criteria for at least one of ASD, AD/HD, Learning disorder or Developmental Coordination Disorder were met by 82, 94 and 97 %. More than 90 % of children with a preschool diagnosis of ASD have remaining neuropsychiatric problems at 11, despite early intervention., Author(s): M. Barnevik Olsson[sup.1] [sup.2] , S. Lundstrom[sup.1] , J. Westerlund[sup.1] [sup.3] , M. B. Giacobini[sup.2] , C. Gillberg[sup.1] , E. Fernell[sup.1] Author Affiliations: (1) Gillberg Neuropsychiatry Centre, Institute of [...]

Aim: To draw attention to groups of children and adolescents with borderline intellectual functioning, especially with respect to their school-situation.Methods: In one study, population-based, children with borderline intellectual functioning at age 10 years were followed until they finished compulsory school when their final certificates could be analysed. In a second study parents of 20 individuals in the upper secondary school for pupils with mild mental retardation were interviewed according to the Vineland adaptive scales and school health records were reviewed. In a third study pupils attending an individual programme in upper secondary school were assessed and we report one representative case.Results: (1) Pupils with borderline intellectual functioning, assessed in grade 4, received significantly lower grades when finishing the compulsory school. (2) In the group of pupils in the upper secondary school for the mildly mentally retarded, compiled data indicated that a considerable number did not fulfil the combined IQ and adaptive criteria for mild mental retardation. (3) The subtle nature of borderline intellectual functioning may delay appropriate measures at school, which our case illustrates.Conclusion: Borderline intellectual functioning seldom attracts attention. Our studies indicate that school and also society at large must be prepared to adapt educational and working conditions for the large minority of individuals with borderline intellectual functioning. [ABSTRACT FROM AUTHOR]

Aim: To study different developmental profiles and auditory perception in a representative group of children with language impairment (LI).Methods: A multidisciplinary investigation was carried out in a group of 25 children attending units specifically for language-impaired children. An assessment of the cognitive level, motor performance, behaviour and auditory perception was performed and the results were compared with those for age-matched groups of children.Results: Among those with moderate or severe language impairment (LI), around 90% had additional developmental disorders. In three tests of auditory perception, children with LI had problems with working memory and speech discrimination. No problems were found with the children's temporal resolution in auditory perception. Another conclusion from the auditory perceptual tests was that the children's cognitive abilities were important for their success in these tests.Conclusion: Neurodevelopmental deviations are very common in LI children. The optimal route for the assessment and treatment of these children would be a multidisciplinary approach. [ABSTRACT FROM AUTHOR]