Showing papers by "Michael Rutter published in 2000"

The autism diagnostic observation schedule-generic: a standard measure of social and communication deficits associated with the spectrum of autism.

Abstract: The Autism Diagnostic Observation Schedule-Generic (ADOS-G) is a semistructured, standardized assessment of social interaction, communication, play, and imaginative use of materials for individuals suspected of having autism spectrum disorders. The observational schedule consists of four 30-minute modules, each designed to be administered to different individuals according to their level of expressive language. Psychometric data are presented for 223 children and adults with Autistic Disorder (autism), Pervasive Developmental Disorder Not Otherwise Specified (PDDNOS) or nonspectrum diagnoses. Within each module, diagnostic groups were equivalent on expressive language level. Results indicate substantial interrater and test-retest reliability for individual items, excellent interrater reliability within domains and excellent internal consistency. Comparisons of means indicated consistent differentiation of autism and PDDNOS from nonspectrum individuals, with some, but less consistent, differentiation of autism from PDDNOS. A priori operationalization of DSM-IV/ICD-10 criteria, factor analyses, and ROC curves were used to generate diagnostic algorithms with thresholds set for autism and broader autism spectrum/PDD. Algorithm sensitivities and specificities for autism and PDDNOS relative to nonspectrum disorders were excellent, with moderate differentiation of autism from PDDNOS.

Developmental psychopathology: concepts and challenges.

Abstract: The defining features of developmental psychopathology concepts include attention to the understanding of causal processes, appreciation of the role of developmental mechanisms, and consideration of continuities and discontinuities between normality and psychopathology. Accomplishments with respect to these issues are reviewed in relation to attachment disorders, antisocial behavior, autism, depressive disorder, schizophrenia, and intellectual development. Major research challenges remain in relation to measurement issues, comorbidity, gender differences, cognitive processing, nature-nurture interplay, heterotypic continuity, continuities between normal variations and disorders, developmental programming, and therapeutic mechanisms in effective treatments.

Autism and Developmental Receptive Language Disorder—a Follow‐up Comparison in Early Adult Life. II: Social, Behavioural, and Psychiatric Outcomes

Abstract: This paper focuses on general social functioning in two groups of young men, one with autism and one with developmental receptive language disorders, who were first assessed at the ages of 7-8 years. At that time, although matched for nonverbal IQ (mean 92-93) and expressive language, the Language group showed significantly fewer social and behavioural problems. At follow-up, when aged on average, 23 to 24 years, the Autism group continued to show significantly more impairments in terms of stereotyped behaviour patterns, social relationships, jobs, and independence. However, problems in all these areas were also common in the Language group. Many still lived with their parents, few had close friends or permanent jobs, and ratings of social interaction indicated abnormalities in a number of different areas. On a composite measure of social competence only 10% of the Language group was assessed as having severe social difficulties compared to 74% of the Autism group. Nevertheless, 65% were rated as having moderate social problems and only 25% were rated as being of near/normal social functioning. Two individuals in the Language group, but none in the Autism group, had also developed a florid paranoid psychosis in late adolescence. As in the follow-up of cognitive and linguistic functioning (see Mawhood et al., 2000, this volume, pp. 547-559), discriminant function analysis, which had clearly distinguished between the groups as children, now showed much greater overlap between them. Regression analysis indicated that although early language ability appeared to be related to outcome in the Autism group, there was little association between any measures of childhood functioning and prognosis in the Language group. Theoretically, these findings have implications for our understanding of the nature of autism and other pervasive language disorders, and of the relationship between them. Practically, they demonstrate the very persistent problems experienced by individuals with developmental language disorders, and their need for much greater help and support than is presently available.

Attachment Disorder Behavior Following Early Severe Deprivation: Extension and Longitudinal Follow-up

Abstract: Objective To examine attachment disturbances and disorder in a sample of children adopted into the U.K. following severe early privation and in a comparison sample of nondeprived, within-country, early-placed adoptees. Method The subjects, 165 children adopted from Romania and 52 adoptees from the U.K., were assessed at age 6 years; longitudinal data (at ages 4 and 6 years) were available on the 111 Romanian adoptees placed in U.K. homes before 24 months of age and on all U.K. adoptees. Information on attachment disorder was derived from a semistructured interview with the parent; in addition, data on children's cognitive and social development were assessed using standardized assessments. Results Analyses revealed a close association between duration of deprivation and severity of attachment disorder behaviors. In addition, attachment disorder behaviors were correlated with attentional and conduct problems and cognitive level but nonetheless appeared to index a distinct set of symptoms/behaviors. Finally, there was marked stability in individual differences in attachment disorder behaviors and little evidence of a mean decrease over this 2-year period. Conclusions The findings offer construct validation for the attachment disorder construct and highlight clinical and conceptual questions that require further research.

The Effects of Global Severe Privation on Cognitive Competence: Extension and Longitudinal Follow-up

Abstract: The current study extends previous research on a sample of children adopted into the United Kingdom following severe early deprivation and a comparison sample of nondeprived, within-country, early adoptees. We assessed 165 children adopted from Romania and 52 U.K. adoptees at age 6 years. Longitudinal data (at age 4 and 6 years) were available on 111 Romanian adoptees placed into U.K. homes before 24 months of age and on all U.K. adoptees. Results indicated that there was considerable catch-up among late-placed Romanian children from entry into the United Kingdom to age 6, but as a group they exhibited lower cognitive scores and general developmental impairment compared with earlier adopted Romanian children. In addition, the resilience suggested at the assessment at age 4 years was maintained longitudinally, but there was no further evidence of catch-up or recovery.

Autism and Developmental Receptive Language Disorder—a Comparative Follow‐up in Early Adult Life. I: Cognitive and Language Outcomes

Abstract: In this paper we compare adult outcome in a group of young men with autism and a group with developmental receptive language disorders. The two groups were first assessed in early childhood, when aged 7 to 8 years of age. Although matched at that time for nonverbal IQ (mean 92-93) and expressive language ability, the Autism group was significantly more impaired on most measures of social and communication skills and stereotyped behaviours. A later follow-up, in mid-childhood, suggested that although the groups were still quite distinct, social and behavioural problems had become more apparent in the Language group. The current study was completed when the participants were aged, on average, 23 to 24 years. The findings indicated that verbal IQ and receptive language scores had improved significantly more in the Autism group than in the Language group over time. Moreover, although the Language group were less severely impaired in their social use of language, many showed a number of abnormal features in this domain. There were no differences between the groups on tests of reading or spelling. Discriminant function analysis, which had clearly distinguished between the groups as children, now showed much greater overlap between them. Regression analysis indicated that although early language ability appeared to be related to outcome in the Autism group, in the Language group there was little association between measures of childhood functioning and later progress. The implications of these findings for understanding the nature of the underlying deficit in autism and the relationship between the two disorders are discussed.

Genetic studies of autism: from the 1970s into the millennium

Abstract: Reviewers in the 1960s and early 1970s were skeptical about any substantial role for genetic factors in the etiology of autism. A realization that the 2% rate of autism in siblings (as estimated at that time) was far above the general population base rate, and that this suggested a possible high genetic liability, led to the first small-scale twin study of autism. The replicated evidence from both twin and family studies undertaken in the 1970s and 1980s indicated both strong genetic influences and the likelihood that they applied to a phenotype that was much broader than the traditional diagnostic category of autism. Medical and chromosomal findings also indicated genetic heterogeneity. Advances in molecular genetics led to genome-wide scans of affected relative pair samples with a positive log of the odds to base 10 score for a location on chromosome 7. The major remaining research challenges and the likely clinical benefits that should derive from genetic research are considered in relation to both current knowledge and that anticipated to emerge from research over the next decade.

Psychosocial influences: Critiques, findings, and research needs

Abstract: Nongenetic factors have a major influence on psychopathology. Knowledge on specific psychosocial risk and protective mechanisms is more limited because of inadequate attention to measurement issues, person effects on the environment, and the possibility of genetic mediation. Nevertheless, a range of research strategies may be used to provide rigorous tests of causal hypotheses; these have shown the importance of environmentally mediated risks. Challenges for the future include greater use of such research strategies, improved measures of psychosocial risks that can be applied to large samples, investigation of origins of risks, identification of causes of time trends in levels of psychopathology, delineation of psychosocial effects on lifetime liability, understanding of environmental effects on the organism, appreciation of processes involved in developmental programming, and understanding of individual differences in susceptibility.

Variable expression of the autism broader phenotype: findings from extended pedigrees.

Abstract: Factors influencing the rate, form, and severity of phenotypic expression among relatives of autistic probands are examined. Family history data on 3095 first- and second-degree relatives and cousins from 149 families with a child with autism and 36 families with a child with Down syndrome are studied. The results provide further evidence of an increased risk among autism relatives for the broadly defined autism phenotype. Of proband characteristics, severity of autism and obstetric optimality were confirmed as being related to familial loading for probands with speech. There was little variation in loading among probands lacking speech. The type of phenotypic profile reported in relatives appeared little influenced by characteristics of the relative or the proband, except for variation by degree of relative, parental status of relative, and perhaps proband's birth optimality score. Phenotypic rates among parents suggested reduced fitness for the severest and more communication-related forms of expression but not for the more mild and social forms of expression. Patterns of expression within the families did not support a simple X-linked nor an imprinted X-linked mode of inheritance. The basis for sex differences in rates of expression is discussed.

Personality traits of the relatives of autistic probands.

Abstract: Background. There is substantial evidence that the genetic liability to autism confers a risk for a range of more subtle social and communication impairments, as well as stereotyped and repetitive behaviours. Recent research suggests that increased expression of particular personality traits may be a manifestation of the liability to autism.Methods. To investigate this we examined the personality traits of the adult relatives of 99 autistic and 36 Down's syndrome probands, using the informant version of the Modified Personality Assessment Schedule.Results. There was significantly increased expression of the traits anxious, impulsive, aloof, shy, over-sensitive, irritable and eccentric among the autism relatives with evidence of different profiles for male and female relatives and for parents and adult children. Factor analysis revealed three broad groups of traits, two of which (‘withdrawn’ and ‘difficult’) appeared to reflect impairments in social functioning and a third group of anxiety related traits (‘tense’). Each of these factors differed in their pattern of associations with the factor we termed ‘withdrawn’ showing a similar pattern of association to that found for other autism related conditions. The ‘tense’ factor appeared in part to be related to the burden of caring for an autistic child.Conclusions. This study confirms the finding that particular personality traits may aggregate in the family members of autistic individuals and furthermore that some of these traits may be a manifestation of the liability to autism.

The Awkward Moments Test: A Naturalistic Measure of Social Understanding in Autism.

Abstract: Details are given of a new advanced theory of mind task, developed to approximate the demands of real-life mentalizing in able individuals with autism. Excerpts of films showing characters in social situations were presented, with participants required to answer questions on characters' mental states and on control, nonsocial questions. When compared with control participants, adults with high-functioning autism and Asperger syndrome were most impaired in their ability to answer the questions requiring mind-reading ability. Although the present findings have implications for task modification, such naturalistic, dynamic stimuli are held to offer an important means of studying subtle difficulties in mentalistic understanding.

Institutional care: Risk from family background or pattern of rearing?

Abstract: Previous research has shown that children receiving substitute parental care tend to have high rates of emotional/behavioural disturbance, but uncertainty remains on the extent to which this derives from genetic risk, adverse experiences before receiving substitute care, or from risks associated with substitute care experiences. In order to examine the effects of institutional rearing (as a specific form of substitute care), two groups of primary school children reared in substitute care from before the age of 12 months were compared: 19 children in residential group (institutional) care and 19 in continuous stable foster family care (matched for age and gender). The two groups were similar in coming from biological families with high rates of psychopathology and social malfunctioning, but differed with respect to pattern of rearing. Both groups were compared with classroom controls, using teacher questionnaires, systematic classroom observations, and standardised cognitive testing. Parental questionnaires were also obtained for the two substitute care groups. As found previously, the combined substitute care groups differed from controls in showing a high level of hyperactivity/inattention. The observational measures showed a similar effect, indicating that the elevated rate was not attributable to rater bias. The teacher questionnaire and observational measures showed, however, that the increased level of hyperactivity/inattention was substantially higher in the institutional group than the foster family group. Parental questionnaire ratings showed the same contrast between the groups, except that the main difference was on unsociability and emotional disturbance rather than hyperactivity/inattention. It is concluded that, against a background of genetic and early environmental risk, institutional rearing predisposes to a pattern of hyperactivity/inattention.

Children of Sick Parents: An Environmental and Psychiatric Study

Abstract: What do you do to start reading children of sick parents an environmental and psychiatric study? Searching the book that you love to read first or find an interesting book that will make you want to read? Everybody has difference with their reason of reading a book. Actuary, reading habit must be from earlier. Many people may be love to read, but not a book. It's not fault. Someone will be bored to open the thick book with small words to read. In more, this is the real condition. So do happen probably with this children of sick parents an environmental and psychiatric study.

Genetic and environmental causes of covariation in interview assessments of disruptive behavior in child and adolescent twins.

Abstract: Multirater, face-to-face, interview data relating to conduct disorder (CD), oppositional-defiant disorder (ODD), and inattentive, impulsive, and hyperactive components of attention-deficit hyperactivity disorder (ADHD) in a population-based sample of 1376 pairs of 8- to 16-year-old MZ and DZ twins are analyzed to examine (1) the genetic and environmental causes of correlation among ratings of ODD and CD symptoms and (2) the pattern of genetic and environmental correlation among the three components of ADHD. Parental ratings of ADHD showed marked sibling contrast effects, specific within raters but partly common across components. After these effects were removed, there was a modest genetic correlation between maternal and paternal ratings, but genetic effects were virtually uncorrelated across boys and girls. Genetic correlations among inattention, impulsivity, and hyperactivity were all large but fell well short of unity. There was little evidence that counts of symptoms of CD and ODD were genetically independent but the genetic correlations among ratings of twins, mothers, and fathers were all relatively modest. ODD and CD showed much higher genetic correlations across sexes than did the measures of ADHD. There was no evidence of rater contrast effects or of shared family environment influences in the twin resemblance for ODD and CD.

Familial aggregation for conduct disorder symptomatology: the role of genes, marital discord and family adaptability.

Abstract: Background There is extensive evidence of statistical associations between family discord/ maladaptation and antisocial behaviour in the children, but questions remain on the extent to which the psychopathological risks are genetically or environmentally mediated Methods Twin pairs (N = 1,350), aged 8 to 16 years, in the general population-based Virginia Twin Study of Adolescent Behavioral Development were assessed using the Child and Adolescent Psychiatric Assessment interview administered separately to both twins and both parents Structured interviews for parental lifetime psychiatric disorders were also administered to the mothers and fathers Maternal reports on Olsson's Family Adaptability and Cohesiveness questionnaire and the Dyadic Adjustment Scale were used as indices of the family environment A path analytical model based on an extended twin-family design was used to test hypotheses about parent offspring similarity for conduct disorder symptomatology Results Family discord and maladaptation, which intercorrelated at 063, were associated with a roughly two-fold increase in risk for conduct disorder symptomatology When parental conduct disorder was included in the model the environmental mediation effect for family maladaptation remained, but that for family discord was lost Conclusion It is concluded that there is true environmental mediation from family maladaptation, operating as a shared effect, which accounts for 35 % of the phenotypic variance The assumptions underlying this genetic research strategy are made explicit, together with its strengths and limitations

Antisocial children grown up.

Abstract: Diagnostic criteria for anti-social disorders have been much influenced by Robins's (1966) early findings that the central adult outcome of childhood conduct problems lies in the pattern of severe anti-social difficulties, evident across domains of functioning, typified by anti-social personality disorder (ASPD). Hyperactivity, impulsivity and attentional difficulties have consistently been identified as among the more important markers of poor long-term outcome for conduct problems, at least in males. For anti-social children and adolescents, new environmental demands, whether prompted by developmental transitions or situational stressors, may only go to reinforce deviant tendencies. For many anti-social children, adverse environments are likely to persist across development. Behaviour genetic analyses have begun to illuminate the interplay between heritable and experiential risks, and longitudinal studies are providing an increasingly detailed picture of the complex forces that shape lives through time.

Complementary approaches to the assessment of personality disorder: The PAS and APFA compared

Abstract: Background Current concepts and measures of personality disorder are in many respects unsatisfactory. Aims To establish agreement between two contrasting measures of personality disorder, and to compare subject–informant agreement on each. To examine the extent to which trait abnormality can be separated from interpersonal and social role dysfunction. Method Fifty-six subjects and their closest informants were interviewed and rated independently. Personality functioning was assessed using a modified Personality Assessment Schedule (M–PAS), and the Adult Personality Functioning Assessment (APFA). Results Subject–informant agreement on the M–PAS was moderately good, and agreement between the M–PAS and the APFA, across and within subjects and informants, was comparable to that for the M–PAS. This was equally the case when M–PAS trait plus impairment scores and trait abnormality scores were used. Conclusions The M–PAS and the APFA are probably assessing similar constructs. Trait abnormalities occur predominantly in an interpersonal context and could be assessed within that context.

Explanations for Apparent Late Onset Criminality in a High-Risk Sample of Children Followed up in Adult Life

Abstract: We examined the psychiatric and forensic histories of 13 individuals whose first officially recorded criminal conviction took place after their 22nd birthday, and compared the levels of disturbance among that group with those from the same high-risk sample who had (a) no recorded convictions, (b) convictions only up to age 21, and (c) convictions before and after age 22. Among the 13 with recorded convictions only after age 22, there was evidence of at least minor juvenile delinquency in every case but one, and of major adult mental illness whose onset preceded first conviction in four cases. Levels of childhood antisocial behaviours were significantly higher among that group than among those who had never been convicted, and levels of major mental illness were significantly higher than among those who had never been convicted and those with convictions only up to age 21. Apparent late onset criminality in the present sample was therefore associated with known risk factors for adult criminality, in the form of juvenile antisocial behaviour and/or major mental illness. Officially recorded criminality consistently shows a small but significant number of individuals whose criminal activity appears to begin relatively late in life, that is after adolescence. In one large follow-up of unselected schoolchildren in Sweden, for example, 25 per cent of the males with a criminal record had their first conviction aged 21 or older. Among the females, 52 per cent of those with a criminal record had their first conviction at 21 or older (Stattin et al. 1989). The number of males with registered criminality only after age 21 (64 out of 709) was smaller by comparison with other groups of offenders than would be predicted from a random model (Stattin and Magnusson 1996), but still represented 9 per cent of the total male sample. In another unselected birth cohort of over 6,000 females born in Stockholm, Sweden in 1953, criminal records data revealed that 237 individuals had their first criminal registration after age 18. At 3.5 per cent of the total sample this was the largest group of offenders, compared with those who began offending before age 15 and persisted throughout life, those who offended only during adolescence, and those who offended in a less persistent way before and after age 18 (Kratzer and Hodgins 1996). Similar proportions with apparent late onset criminality have been found among groups who would be expected to be at higher risk for criminality, like clinic samples and those enrolled in social interventions. In McCord’s (1978) follow-up of 506 boys in the Cambridge-Somerville Youth Study, 41 of the 317 boys (13 per cent) with no official juvenile record of delinquency were convicted of serious crimes as adults, with few

Explanations for Apparent Late Onset Criminality in a High-Risk Sample of Children Followed Up in Adult Life

Abstract: We examined the psychiatric and forensic histories of 13 individuals whose first officially recorded criminal conviction took place after their 22nd birthday, and compared the levels of disturbance among that group with those from the same high-risk sample who had (a) no recorded convictions, (b) convictions only up to age 21, and (c) convictions before and after age 22 Among the 13 with recorded convictions only after age 22, there was evidence of at least minor juvenile delinquency in every case but one, and of major adult mental illness whose onset preceded first conviction in four cases Levels of childhood antisocial behaviours were significantly higher among that group than among those who had never been convicted, and levels of major mental illness were significantly higher than among those who had never been convicted and those with convictions only up to age 21 Apparent late onset criminality in the present sample was therefore associated with known risk factors for adult criminality, in the form of juvenile antisocial behaviour and/or major mental illness

Complementary approaches to the assessment of personality disorder. The Personality Assessment Schedule and Adult Personality Functioning Assessment compared.

Abstract: Background Current concepts and measures of personality disorder are in many respects unsatisfactory. Aims To establish agreement between two contrasting measures of personality disorder, and to compare subject-informant agreement on each. To examine the extent to which trait abnormality can be separated from interpersonal and social role dysfunction. Method Fifty-six subjects and their closest informants were interviewed and rated independently. Personality functioning was assessed using a modified Personality Assessment Schedule (M-PAS), and the Adult Personality Functioning Assessment (APFA). Results Subject-informant agreement on the M-PAS was moderately good, and agreement between the M-PAS and the APFA, across and within subjects and informants, was comparable to that for the M-PAS. This was equally the case when M-PAS trait plus impairment scores and trait abnormality scores were used. Conclusions The M-PAS and the APFA are probably assessing similar constructs. Trait abnormalities occur predominantly in an interpersonal context and could be assessed within that context.

A longitudinal study of adolescent and adult conviction rates among children referred to psychiatric services for behavioural or emotional problems

Abstract: Background Previous findings suggested that associations between childhood hyper-activity and later criminality were mediated mainly by conduct disorders. Method Information recorded in case notes was used to predict officially recorded criminal convictions in later life among 148 individuals who were seen as child psychiatric patients between 1948 and 1982. Multiple Poisson and logistic regressions were used to examine the independent contributions made by symptom/behaviour counts, diagnosed conduct disorder, and social and family factors to the prediction of recorded criminality during two later periods (ages 17–21 and 22+), taking into account previous recorded criminality in each case. Results Previous convictions were highly predictive of every offending outcome examined except convictions for violent offences. Among males, symptoms of hyper-activity were independently predictive of convictions at age 17–21, multiple offending (five or more separate convictions), and having received a custodial sentence. A childhood diagnosis of conduct disorder made little additional contribution to the prediction of later offending over and above the effects of previous convictions. Conclusion Symptoms of hyperactivity increased the risk of later convictions among boys with behavioural or emotional disturbances in ways that were not mediated by previous convictions or other measures of childhood conduct problems. Copyright © 2000 Whurr Publishers Ltd.

Risks and Outcomes in Developmental Psychopathology

Abstract: The bringing together of clinical and developmental research perspectives that is intrinsic to the concept of developmental psychopathology has been one of the most important recent advances in the field of child and adolescent psychopathology. Accordingly, I approached this book with a high level