Showing papers by "Michael Rutter published in 2011"

Epilepsy in autism: features and correlates

Abstract: Background Epilepsy occurs in a significant minority of individuals with autism, but few long-term follow-up studies have been reported, so the prevalence, features (type of seizures, age at onset and severity, etc.) and correlates (IQ history of regression, family history) have only partially been identified. Aims To undertake a long-term follow-up study of individuals with autism in order to better characterise the features and correlates of epilepsy in individuals with autism. Method One hundred and fifty individuals diagnosed with autism in childhood were followed up when they were 21+ years of age. All individuals were screened for a history of possible seizures by parental/informant questionnaire. An epilepsy interview was undertaken and medical notes reviewed for individuals with a history of possible seizures. The features and correlates of epilepsy were examined using survival and regression analysis. Results Epilepsy developed in 22% of participants. In the majority, seizures began after 10 years of age. Generalised tonic–clonic seizures predominated (88%). In over a half (19/33), seizures occurred weekly or less frequently and in the majority of individuals (28/31) they were controlled with the prescription of one to two anticonvulsants. Epilepsy was associated with gender (female), intellectual disability and poorer verbal abilities. Although the presence of epilepsy in the probands was not associated with an increased risk of epilepsy in their relatives, it was associated with the presence of the broader autism phenotype in relatives. This indicates that the familial liability to autism was associated with the risk for epilepsy in the proband. Conclusions Epilepsy is an important medical complication that develops in individuals with autism. Seizures may first begin in adolescence or adulthood. Putative risk factors for epilepsy in autism were identified and these will require further investigation in future studies.

Research Review: Child psychiatric diagnosis and classification: concepts, findings, challenges and potential

Abstract: The conceptual issues are briefly noted with respect to the distinctions between classification and diagnosis; the question of whether mental disorders can be considered to be 'diseases'; and whether descriptive psychiatry is outmoded. The criteria for diagnosis are reviewed, with the conclusion that, at present, there are far too many diagnoses, and a ridiculously high rate of supposed comorbidity. It is concluded that a separate grouping of disorders with an onset specific to childhood should be deleted, the various specific disorders being placed in appropriate places, and the addition for all diagnoses of the ways in which manifestations vary by age. A new group should be formed of disorders that are known to occur but for which further testing for validity is needed. The overall number of diagnoses should be drastically reduced. Categorical and dimensional approaches to diagnosis should be combined. The requirement of impairment should be removed from all diagnoses. Research and clinical classifications should be kept separate. Finally, there is a need to develop a primary care classification for causes of referral to both medical and non-medical primary care.

Progress in Understanding Autism: 2007-2010

Abstract: Scientific progress is discussed in relation to clinical issues; genetic issues; environmental issues; and the state of play on psychological treatments. It is concluded that substantial gains in knowledge have been achieved during the last 3 years, and there have been some unexpected findings, but major puzzles remain. We should be hopeful of ever greater gains in the years ahead, but both prevention and cure remain elusive.

Early Developmental Regression in Autism Spectrum Disorder: Evidence from an International Multiplex Sample

Abstract: The characteristics of early developmental regression (EDR) were investigated in individuals with ASD from affected relative pairs recruited to the International Molecular Genetic Study of Autism Consortium (IMGSAC). Four hundred and fifty-eight individuals with ASD were recruited from 226 IMGSAC families. Regression before age 36 months occurred in 23.9% of individuals. The observed concordance rate for EDR within sibling pairs (18.9%) was not significantly above the rate expected under independence (13.5%, p = 0.10). The rate of regression in individuals with ASD from multiplex families was similar to that reported in singleton and epidemiological samples. Regression concordance data were not supportive of a separate familial influence on EDR, other than as a part of autism itself.

The Role of Pre- and Postnatal Timing of Family Risk Factors on Child Behavior at 36 months

Abstract: Children growing up in disharmonious families with anxious/depressed mothers are at risk for emotional and behavioral difficulties, however whether these associations reflect postnatal environment, prenatal exposure, or an overall liability is still unclear. This study used prospectively collected data from 24,259 participants of the Norwegian Mother and Child Cohort Study (MoBa). Mothers reported on anxiety/depression and family disharmony twice in pregnancy and twice post pregnancy, as well as on their child’s physical aggression and crying behavior at age 36 months. First, results from an autoregressive cross-lagged model showed a substantial stability in both maternal anxiety/depression and family disharmony from pregnancy to 18 months postnatal, but there was no indication that family disharmony led to maternal anxiety/depression, or the other way around. Second, structural equation models further suggests that the main risk derived from an overall liability, that is, a lasting effect of family risks that spanned the two time periods.

Assessing the Concept of the ‘Insecure-Other’ Category in the Cassidy–Marvin Scheme: Changes Between 4 and 6 Years in the English and Romanian Adoptee Study

Abstract: We set out to explore the meaning of the attachment categories in the Cassidy/Marvin strange situation procedure, as employed in the home, using data from a longitudinal study of children adopted into UK families up to the age of 42 months from Romanian institutions, and of adopted children without the experience of institutional care––both groups being assessed at 4 and 6 years of age. Inter-rater reliability was found to be good. Security (meaning the use of the parent as a secure base and no negative behavior on reunion) was the modal categorical rating in both the institution-reared and comparison groups, but the category of anomalous non-normative behavior (meaning a lack of any ordered attachment behavior as covered by the standard ratings), previously labeled 'insecure-other', was more common in the institution-reared children. Because this was unassociated with the usual manifestations of insecurity (such as avoidance or resistance) and because it was largely evident in interactions with the stranger, it is concluded that the adjective 'insecure' was not appropriate. Although this 'insecure-other' category was associated with disinhibited attachment as reported by parents (meaning a lack of differentiation among adults, a willingness to go off with strangers and a lack of checking back with parents in anxiety-provoking situations), it did not prove to be a good index of disinhibited attachment because changes over time in the 'insecure-other' category were not associated with changes in the rate of disinhibited attachment. Also, whereas the rate of 'insecure-other' fell markedly in the institution-reared group between 4 and 6 years of age, it rose in the comparison group, raising queries over its meaning

The effects of group daycare in the context of paid maternal leave and high-quality provision

Abstract: Social benefits and quality of group daycare vary greatly across countries; the effects on children may depend on the social context. This study used the prospective Norwegian cohort of 24,259 (MoBa; Norwegian Mother and Child Cohort Study) to examine predictors of group daycare, and the effects of family risk and group daycare on child behaviour at 36 months. The results showed that virtually all 9-month-olds remained in maternal care; while at 18 months over two-thirds attended some form of group daycare. High maternal education and family income very strongly predicted children's attendance in group daycare—a social selection opposite to that found in North America. Group daycare had a statistically significant effect on both distress and aggression, but the effect was very weak. Family risk was associated with both distress and aggression, but this did not differ according to type of care. The findings show a marked difference from those in North America, suggesting that social selection worked in the...

Against Le Packing: A Consensus Statement

Abstract: To the Editor: C oinciding with the Ninth International Autism–Europe Congress held in Catania, Sicily from October 8 through 10, 2010, the undersigned keynote speakers of the meeting, a group of recognized professionals in the field, were greatly disturbed by the news that in some areas of the world—notably francophone countries—an alleged form of therapy labeled le packing is being applied and recommended for children and adolescents with autism spectrum disorders, especially those showing associated severe behavioral problems This alleged therapy consists of wrapping the patient (wearing only underclothes or naked in the case of young children) several times a week during weeks or months in towels soaked in cold water (10°C to 15°C) The individual is wrapped with blankets to help the body warm up in a process lasting 45 minutes, during which time the child or adolescent is accompanied by two to four staff persons The alleged goal of this technique, as defined by proponents of this therapy, is to “allow the child to rid himor herself progressively of its pathological defense mechanisms against archaic anxieties,” by achieving “a greater perception and integration of the body, and a growing sense of containment” The French Public Health High Council, although purposely avoiding reviewing indications and ethical aspects, has recently established that, although psychological risks have not been excluded, performing le packing does not carry risks that would justify its prohibition We have reached the consensus that practitioners and families around the world should consider this approach unethical Furthermore, this “therapy” ignores current knowledge about autism spectrum disorders; goes against evidence-based practice parameters and treatment guidelines published in the United States, Canada, United Kingdom, Spain, Italy, Hungary, and Australia; and, in our view, poses a risk of preventing these children and adolescents from accessing their basic human rights to health and education

Integrating Science and Clinical Practice

Abstract: t i n T he examination of the Journal of the American Academy of Child and Adolescent Psychiatry over the course of the previous half-century quickly indicates that there was precious little in the way of science in the early years, whereas in recent times science comes into most of the studies in one way or another. Accordingly, I have chosen as my starting point three articles from the early years that were different in providing a clear identification of the challenges and possible ways ahead. These are not necessarily the best articles in that period, if judged in terms of specific research that they describe, but they are outstanding in their view of the issues. Each author was a leader in the field and, in different ways, each was an iconoclast who was willing to challenge the given wisdom of the day. In each case, the author is, regrettably, no longer with us. The first article is by Chess and colleagues. It provided an early description of the New York longitudinal study of children’s temperamental features (called primary reaction patterns in the initial publications). The study proposed a way of conceptualizing individual differences in temperamental features and outlined a method of interviewing that provides the information needed for the relevant ratings. The study was important in setting the topic of temperament firmly on the map and in using the findings (mainly in later studies) to discuss the clinical importance of such features. Among other things, they argued that these individual differences were not simply a function of socialization experiences and they pointed to the need to consider the effect of children on parents and of parents on children. Also, although Chess had psychoanalytic training, she and her colleagues were sharply critical of the psychoanalytic formulations. Four years later, Leon Eisenberg published a commentary on an article by Al Solnit. In this essay, Eisenberg was critical of the notion that psychoanalysis should constitute the basis of i