The Vineland Adaptive Behavior Scales: supplementary norms for individuals with autism.

Vineland Adaptive Behavior Scales Special Population norms are presented for four groups of individuals with autism: (a) mute children under 10 years of age; (b) children with at least some verbal skills under 10 years of age; (c) mute individuals who are 10 years of age or older; and (d) individuals with at least some verbal skills who are 10 years of age or older. The sample included 684 autistic individuals ascertained from cases referred for the DSM-IV autism/PDD field trial collaborative study and five university sites with expertise in autism. Young children had higher standard scores than older individuals across all Vineland domains. In the Communication domain, younger verbal children were least impaired, older mute individuals most impaired, and younger mute and older verbal individuals in the midrange. Verbal individuals achieved higher scores in Daily Living Skills than mute individuals. The expected profile of a relative weakness in Socialization and relative strength in Daily Living Skills was obtained with age-equivalent but not standard scores. Results high-light the importance of employing Vineland special population norms as well as national norms when evaluating individuals with autism.

Treatment of autistic disorder.

OBJECTIVE: To present an overview of a variety of treatment approaches in individuals with autistic disorder. METHOD: Selected studies and articles are reviewed. RESULTS: In the past three decades, great progress has been made in the treatment of autistic disorder, particularly in the area of education and parental involvement, with the objective to transfer to home and in other situations learning acquired in school. A role for psychoactive agents, when combined with psychosocial treatments, has been identified. CONCLUSIONS: Although considerable advances have been made in a variety of interventions-educational, psychosocial, and biological-knowledge about the comparative and combined efficacy of the various treatment modalities is lacking. From the parents' perspective, particularly, support and continuity of services require improvement.

Sex differences in higher functioning people with autism.

Though a sex difference in the incidence of autism has frequently been reported, few studies have considered sex differences in the severity of features associated with autism. The Autism Diagnostic Interview was used to assess the difference between a group of 21 females and 21 males with autism with equivalent chronological nonverbal IQ greater than 60. Males were rated to be more severely autistic than females on several measures of early social development, but not in any other areas. Results are discussed in relationship to hypotheses based on sex differences in other populations.

Aggression and self-injurious behaviors in persons with autism--the TEACCH (Treatment and Education of Autistic and related Communications Handicapped Children) approach.

Aggression and self injurious behaviors are associated with some clients with autism and other forms of pervasive developmental disorder. These behaviors are not well understood, and treatment interventions are often ineffective. This article describes these behaviors in terms of the underlying deficits of autism, suggesting that interventions may be more effective if targeted at the underlying causes of the actions. The article presents behaviors and underlying causes within an "iceberg" conceptualization with visible behaviors depicted as occurring "above the water line" and hypothesized causes hidden "below the water line" of the iceberg. Examples of clinical cases are presented to illustrate the usefulness of the conceptualization.

Classification of pervasive developmental disorders: some concepts and practical considerations.

Classifications have to meet a variety of purposes. Clinical and research needs are different and there is much to be said for separate clinical and research schemes. Care is needed to ensure that classifications provide an appropriate medium for teaching about diagnosis and do not cause difficulties when used as a "passport" to resources. Principles of classification are considered in relation to the need to take course, as well as symptomatology, into account, and with respect to the neuropsychiatric interface. The value of a multiaxial approach is noted. The pros and cons of autism and pervasive developmental disorders (PDD) as an overall descriptive term, of lumping or splitting, and of different choices with respect to PDD subcategories are discussed.

Comparison of DSM-III-R and childhood autism rating scale diagnoses of autism.

The purpose of this study was to clarify the issue of whether DSM-III-R (American Psychological Association [APA], 1987) over- or underdiagnoses autism by comparing this diagnostic system to a well-established objective measure of diagnosis, the Childhood Autism Rating Scale (CARS). A secondary goal was to determine which of the 16 criteria are the best discriminators of autism. DSM-III-R, CARS, and clinical diagnoses of 138 consecutive admissions to a statewide program for the diagnosis and treatment of autistic and related communication-handicapped individuals (Division TEACCH in North Carolina) were compared. Results indicated a generally high degree of agreement on the diagnosis of autism using the three systems. Within this treatment-oriented program, the CARS and clinical ratings diagnosed a greater number of cases as autistic than did the DSM-III-R criteria, suggesting that DSM-III-R slightly underdiagnosed autism. The criteria that most strongly related to the diagnosis of autism regardless of the system were lack of awareness of others, abnormal social play, an impaired ability to make friends, abnormal nonverbal communication, stereotypic body movements, and restricted range of interests.

A follow-up study of high-functioning autistic children.

Fifty-eight high-functioning autistic children were assessed during preschool and early school years and followed over a period of 8 years. Early and current psychometric and language tests, parent interviews concerning autistic symptomatology, and direct observations were examined as predictors of the Vineland Adaptive Behavior Scales and scores on standardized achievement tests. Verbal skills emerged as the strongest predictor of social-adaptive functioning. Clear, positive relationships also emerged between intellectual functioning, and academic attainment. Early non-verbal IQ also showed a positive relationship with outcome. Academic performance appeared considerably stronger than in earlier studies.

Pre- and perinatal factors in high-functioning females and males with autism.

Pregnancy and delivery complications as indicated in medical records and maternal reports for 23 high-functioning autistic females and 23 high-functioning males of similar IQ and age were compared with those of 54 of their normally developing siblings. Autistic subjects of both sexes had higher non-optimality scores than their siblings. Much of this difference was accounted for by a higher incidence of firstborns and fourth- or later-borns in the autistic group. Of factors found in previous research with mentally handicapped, autistic samples, only estimated weeks of gestation greater than 42 occurred more often in autistic subjects than siblings. The only sex difference specific to the autistic group was that autistic males came from larger families than females. These data provide slight support for the contribution of nonspecific pre- and perinatal factors to other etiological bases of autism. It is proposed that pre- and perinatal factors may play less of a role in autism in high-functioning individuals than suggested in studies of autism associated with severe retardation.

Past and present trends in residential treatment.

The history of residential care for those with autism and other developmental handicaps is summarized for the past 200 years. Residential trends toward community integration in the past three decades are traced for autism in general and for one state institution in particular. Parallel cycles for residential care from previous periods are identified. Some negative side effects of current trends are identified if the needs of the population with handicaps and the community are not better integrated in the future.

Critical issues in the residential care of people with autism.

There is an ever-growing need to expand both the number and range of residential services for individuals with autism while developing strategies for assuring the quality of these programs. Future program development will be facilitated by an empirical approach to the critical elements that have been identified throughout the articles in this issue.

The role of age at assessment, developmental level, and test in the stability of intelligence scores in young autistic children.

Longitudinal comparisons were made of intelligence and developmental quotient (IQ/DQ) scores for three age groups of 70-72 autistic children aged 2 to 3, 4 to 5, and 6 to 7 years at initial assessment and reassessed at least 2 years later. Stability and predictability over a mean follow-up period of 5 years were related to age, developmental level, and test used at initial assessment. IQ/DQs during preschool years were quite stable and predictive of later IQ scores, except when early scores on the Bayley Scales of Mental Development were compared with later scores on performance or nonverbal tests. As for other populations, predictability for young autistic children was strongest when the same test was used at both assessments, and when children were 4 years or older at initial assessment.

Use of the childhood autism rating scale with autistic adolescents and adults.

The suitability of the Childhood Autism Rating Scale (CARS) for diagnosing adolescents and adults with autism was tested and CARS ratings over time were examined to assess how the characteristics of autism change during adolescence. Subjects (N = 89) had been rated with the CARS before age 10 and again after age 13. A cutoff score of 27 was used; of 59 diagnosed as autistic prior to age 10, 92% were diagnosed as autistic after age 13. Moreover, 9 CARS categories showed significant improvements over time; only 1 showed a significant decrement. The CARS is thought to be a useful screening device for adolescents and adults with autism. Implications of this research for the understanding of autism and how it changes with development are discussed.

Stability of assessment results of autistic and non-autistic language-impaired children from preschool years to early school age.

The predictability, consistency in group means, and intra-individual stability of developmental quotients and performance IQs were assessed from preschool to school age for 71 autistic children and 71 non-autistic communication-handicapped children, matched on chronological age, sex and initial performance IQ/DQ. DQs/performance IQs at age 4 yrs were found to be highly correlated with performance IQ at age 10 yrs for both groups. Absolute difference scores and group means were also equivalent for both samples, with no difference in patterns of change or the relationship between performance IQ and language status, as measured on the PPVT. Differences between diagnostic groups occurred only for scores on the Vineland Social Maturity Scale and the relationship between these scores and IQ.

Autism diagnostic observation schedule: a standardized observation of communicative and social behavior.

The Autism Diagnostic Observation Schedule (ADOS), a standardized protocol for observation of social and communicative behavior associated with autism, is described. The instrument consists of a series of structured and semistructured presses for interaction, accompanied by coding of specific target behaviors associated with particular tasks and by general ratings of the quality of behaviors. Interrater reliability for five raters exceeded weighted kappas of .55 for each item and each pair of raters for matched samples of 15 to 40 autistic and nonautistic, mildly mentally handicapped children (M IQ = 59) between the ages of 6 and 18 years. Test-retest reliability was adequate. Further analyses compared these groups to two additional samples of autistic and nonautistic subjects with normal intelligence (M IQ = 95), matched for sex and chronological age. Analyses yielded clear diagnostic differences in general ratings of social behavior, specific aspects of communication, and restricted or stereotypic behaviors and interests. Clinical guidelines for the diagnosis of autism in the draft version of ICD-10 were operationalized in terms of abnormalities on specific ADOS items. An algorithm based on these items was shown to have high reliability and discriminant validity.

The Adolescent and Adult Psychoeducational Profile: assessment of adolescents and adults with severe developmental handicaps.

The purpose of this study was to determine the reliability and validity of the Adolescent and Adult Psychoeducational Profile (AAPEP), an assessment instrument designed for adolescents and adults with severe developmental handicaps. Subjects were 60 adolescents and adults, 30 with autism and 30 with mental retardation but without autism. The groups were matched on age and IQ. Results suggested high interrater reliability on all function areas of the AAPEP (Vocational Skills, Independent Functioning, Leisure Skills, Vocational Behavior, Functional Communication, Interpersonal Behavior) and on all three scales (Direct Observation, Home, School/Work). Validity measures suggested that the recommendations generated from the AAPEP were viewed by blind experts as more helpful than those already generated for the individual clients and contained in their Individual Education Programs (IEPs) or Individual Habilitation Plans (IHPs). Informal measures indicated that parents and/or group home staff also found AAPEP recommendations helpful. Finally, reliability and validity measures were also encouraging for moderately and severely handicapped adolescents and adults without autism. The AAPEP appears to be an effective new instrument for those working with older handicapped clients.