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The aim of this study was to examine the Autism Diagnostic Observation Schedule (ADOS) as it is commonly used in clinical practice. ADOS classifications were compared to final diagnoses given by a multidisciplinary team to 584 children referred for evaluation for possible autism spectrum disorder (ASD) at the Cincinnati Children's Hospital Medical Center. A total of 177 children were evaluated with a Module 1 (87 No Words), 198 with a Module 2 (90 less than 5 years) and 209 with a Module 3. Of these, 142 (26%) were diagnosed with autism, 185 (32%) with non-autism ASD, and 257 (44%) with non-spectrum disorders. Sensitivities were moderate to high on both original and revised algorithms, while specificities were substantially lower than those previously reported. This difference is likely attributable to the composition of the sample that included many children with a broad array of developmental and behavioral disorders. The clinical impression of the team member who administered the ADOS was critical to the accuracy of the overall diagnosis. Using numeric scores alone resulted in misclassification from false positive results. The study highlights the importance of the qualitative interactions of the ADOS activities as well as the score in diagnostic decision making. (Contains 5 tables and 1 figure.)

Bone development, casein-free diet use, supplements, and medications were assessed for 75 boys with autism or autism spectrum disorder, ages 4-8 years. Second metacarpal bone cortical thickness (BCT), measured on hand-wrist radiographs, and % deviations in BCT from reference medians were derived. BCT increased with age, but % deviations evidenced a progressive fall-off (p = 0.02): +3.1 [plus or minus] 4.7%, -6.5 [plus or minus] 4.0%, -16.6 [plus or minus] 3.4%, -19.4 [plus or minus] 3.7%, -24.1 [plus or minus] 4.4%, at ages 4-8, respectively, adjusting for height. The 12% of the boys on casein-free diets had an overall % deviation of -18.9 [plus or minus] 3.7%, nearly twice that of boys on minimally restricted or unrestricted diets (-10.5 [plus or minus] 1.3%, p less than 0.04), although even for boys on minimally restricted or unrestricted diets the % deviation was highly significant (p less than 0.001). Our data suggest that the bone development of autistic boys should be monitored as part of routine care, especially if they are on casein-free diets.

A multicenter study of 308 children with Autism Spectrum Disorder (ASD) was conducted through the Collaborative Programs of Excellence in Autism (CPEA), sponsored by the National Institute of Child Health and Human Development, to compare the family history of autoimmune disorders in children with ASD with and without a history of regression. A history of regression was determined from the results of the Autism Diagnostic Interview-Revised (ADI-R). Family history of autoimmune disorders was obtained by telephone interview. Regression was significantly associated with a family history of autoimmune disorders (adjusted OR=1.89; 95% CI: 1.17, 3.10). The only specific autoimmune disorder found to be associated with regression was autoimmune thyroid disease (adjusted OR=2.09; 95% CI: 1.28, 3.41).

In a sample of 137 children (ages 24-96 months) classified as having autism, 24% had a history of at least one chronic gastrointestinal symptom. The most common symptom was diarrhea, which occurred in 17%. There was no association between chronic gastrointestinal symptoms and a history of developmental regression. (Contains references.) (Author/CR)

Forty-two children (ages 2-15) with autism were randomized in to two groups. One group received 2 IU/kg of intravenous synthetic human secretin at the first visit, followed by a saline placebo at week 6. The other group received treatment in the reverse order. Children showed no differences on assessments. (Contains references.) (Author/CR)