Synnve Schjølberg

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Background: ESAT and M-CHAT are instruments designed for the screening of ASD in very young children in the general population. Objectives: To describe the response to the ESAT and M-CHAT and explore overlap and difference in screen-positive childen identified with ESAT and M-CHAT. Further to examine the external validity of ESAT and M-CHAT, by exploring relationship with proxy-measures of clinical caseness, in the absence of more final data of children identified with ASD.

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Review of the current literature suggests that children who receive early intervention services by age 3 years show significant developmental gains. Autism is rarely diagnosed before three years of age despite evidence suggesting prenatal abnormalities. Little is known about when or how development becomes disrupted in the first years of life in autism. In 2001, the American Academy of Pediatrics released a policy statement recommending that primary health care workers should use developmental surveillance and screening to identify children at risk for an autism spectrum disorder (ASD). There is still no screening instrument for ASD that is validated in large unselected samples and with good psychometric properties. Some suggest that screening should all together be abandoned when the false-positive rates are high. Recently changed guidelines for child health surveillance in the United Kingdom suggest targeted checks only, instead of the previously conducted routine or universal screening at 2 years and 3.5 years. Screening for ASD in an unselected population is a far more challenging task than identifying ASD in clinically referred children. Too little research is concerned about how parents perceive behaviours asked for in the screening instrument and how it depends on the child’s developmental status.

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Objectives: We propose that there are group differences that can highlight the different nature of the dyads of children with DLD and their mothers, which are interdependent on both the language skills of the children and the following maternal responses. Methods: Subjects are recruited during pregnancy into the MoBa study. As part of the Autism Birth Cohort study, a sub-study in MoBa, parents complete a mailed questionnaire that screen for social and communication disorders at 36 months. Children who screen positive are invited for a full clinical assessment. In addition a control group of randomly drawn children from all participants is invited for assessment. The present study includes 30 children diagnosed with DLD as well as 20 children from a control group (mean age 42 months). Language transcriptions of a 10 minute mother-child play interactions will be conducted. Through a subsequent analysis, specific codes of child-mother sequential measures will be applied, controlling for age, gender and socio-economic status.

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Background: There is a growing body of research suggesting that children with delayed development, and more specific language disorder (LD), will have persistent difficulties into later childhood and adolescent. Obstetric complications are related to increased risk for ASD and early language delay is a prime feature of ASD. However it is not clear whether it is the same risk factors in ASD and LD are operating through the common feature, language delay. Objectives: The study evaluates the relationship between risk factors and language delay in a total population pregnancy cohort study, the Norwegian Mother and Child study (MoBa). Methods: Subjects are recruited during pregnancy into the MoBa study. Parents complete questionnaires through pregnancy as well as when the child is 6, 18 and 36 months of age. Language delay is determined by questions from the 36 months questionnaire on language competence and syntax complexity (Dorothy Bishop, Jane Squires) Risk factors are determined by parental questionnaire report of obstetric complications as well as adverse pregnancy outcomes as reported in the Norwegian Medical Birth Registry.

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Subjects are recruited during pregnancy into the MoBa study. As part of the Autism Birth Cohort study, a sub-study in MoBa, parents complete a mailed questionnaire that screen for social and communication disorders at 36 months. Children who screen positive are invited for a full clinical assessment. In addition a control group of randomly drawn children from all participants is invited for assessment. Our study includes 30 children diagnosed with a developmental language disorder as well as 20 children from a control group. In order to differentiate the language abilities within the groups, a language transcription of a DVD-recorded play situation with the mother is conducted. This identifies mean length of utterance, %intelligibility and other measures. The ADHD-symptoms are assessed using the diagnostic interview Preschool Age Psychiatric Assessment (PAPA).

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The ABC study is a subproject in Mother and child study. The cohort is comprised of approximately 75 000 children followed from week 17 of gestation. Questionnaires are completed by mothers during pregnancy, and at child age 6, 18 and 36 months. In spring 2007 the oldest children in this cohort will turn 7 years old and a new questionnaire will be completed in the cohort. At 36 months the total cohort is screened for possible ASD using several strategies. Based on the questionnaire, children scoring above cut-offs on the Social Communication Questionnaire (SCQ), or report of certain referral or treatment histories are invited for a full clinical assessment at Nic Waals Institute at Lovisenberg Hospital. A same aged randomly drawn control group is invited for a full assessment as well. Children whose parents indicate in the 36 months questionnaire that their child has autism, and self-referrals meeting criteria are also invited. The minimum expected number of children with ASD and who will be ascertained through a clinical examination, is approximately 150 cases. The clinical examination includes structured and semi-structured assessments with the PAPA (Preschool Age Psychiatric Assessment), ADI-R (Autism Diagnostic Interview-Revised), ADOS (Autism Diagnostic Observation Schedule), Vineland, Mullen scales and Stanford-Binet IV tests.

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Subjects are recruited during pregnancy into the MoBa study. As part of the Autism Birth Cohort study, a substudy in MoBa, parents complete a mailed questionnaire that screen for social and communication disorders at 36 months. Children who screen positive are invited for a full clinical assessment. In addition a control group of randomly drawn children from all participants in MoBa are invited for assessment. This study includes 30 children diagnosed with a developmental language disorder as well as 20 children from the control group (mean age 42 months). Analysis of children’s language in a 10 minute mother-child play situation is conducted. Measures of intelligibility and mean length of utterance (MLU) are compared to socio-emotional behaviour as measured by the Preschool Age Psychiatric Assessment (PAPA).

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Considerably attention has been devoted to developing standardized methods for diagnosing autism. Research instruments such as ADI-R and ADOS-G have contributed to our knowledge regarding behavioral characteristics in preschool children. Both tools are considered as gold standard in diagnosing autism. However, in specific instances the instruments are over or under diagnosing autism and for these reasons it is established that using clinical diagnosis takes precedence in cases of disagreement. However little research has explored the characteristics of children for whom there are diagnostic disagreement, either between clinicians or between different diagnostic measures of autism. There is still little information about inter-rater reliability for diagnosing autism in young children. Forty-seven children (33 M:14 F) were recruited through the healthcare services in Oslo County. None had a diagnosis at the time of their assessment. 76.6 % were first met at the primary health care level and had not been evaluated by specialists earlier. The mean chronological age for the total sample was 27.0 months (sd=6.2), and the mean mental age (MA) was 13.2 months (sd=3.4). Data were collected during the children's evaluations and two clinicians made independent clinical diagnostic judgments of the children. The other clinician observed the administration of the ADOS and rated each child according to a checklist based on the DSM-IV criteria for Autism as well as scoring presence/absence of behaviors. The clinicians agreed in 88% of the children whether the child was within or outside the autism spectrum. The Corrected Kappa for expected value was 0.83 of 0.85 maximum possible. When comparing children within the autism spectrum, the clinicians agreed in 79.1% of the children concerning subgroups in the spectrum. The Corrected Kappa for expected value was 0.53 of maximum possible 0.89. The children with diagnostic disagreement had specific characteristics.

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Test retest reliability of a screening checklist for Autism spectrum disorders in young children

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Autism spectrum disorders (ASD) are rarely diagnosed before 36 months. Deficits in use of gestures and lack of gaze monitoring are considered early signs of ASD. The study focused on identifying children younger than 36 months with delayed nonverbal skills, hypothesizing high risk of being within the ASD. Professionals at well-baby clinics (WBC) were asked to refer all children younger than 30 months causing their concern about delayed nonverbal behaviour. The scores on a 10-item checklist (the Non-Verbal Communication-Checklist; NVCChecklist) were used as a basis for referrals. The referred group comprised of 41 children born in 98/99, 30 boys and 11 girls, mean age 27.0 months (sd 6.2). Eighty two percent (N=34) received a diagnosis within the autistic spectrum. Their average NVCC total score was 9.88 (sd 4.01). Two independent raters agreed in the diagnosis in 88 % of all the cases (Kappa=0.83). In order to obtain information about normal development and individual differences in the early use of non-verbal communication, all parents of children aged 12 to 36 months were asked during a four months period to fill out the NVCC at their regular visit to the WBC. The total WBC screened group were 1247, mean age 18.8 months (sd 6.2). Their scores on the NVCChecklist showed a clear age trend, from < 12- month-olds scoring an average of 3.34 (sd 2.87) to 36 months olds scoring 0.29 (0.61). Test-retest reliability was 0.85. Children with ASD were identified from the general population at a prevalence rate of 29/10.000. The fact that many of the referred children had not been assessed by any developmental specialist prior to filling out the checklist indicates that it may in fact contribute to earlier identification.

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Artikkelen tar oppforekomst av og årsaker til autisme generelt og kommenterer diskusjonen rundt MMR-vaksinen som mulig årsak til autisme, blant annet med bakgrunn i TV-programmet "Dokument 2" som ble sendt på TV2 tildligere i år.