Validation of the Finnish Autism Spectrum Screening Questionnaire (ASSQ) for clinical settings and total population screening.

We assessed the validity and determined cut-off scores for the Finnish Autism Spectrum Screening Questionnaire (ASSQ). A population sample of 8-year-old children (n = 4,408) was rated via the ASSQ by parents and/or teachers, and a subgroup of 104 children was examined via structured interview, semi-structured observation, IQ measurement, school observation, and medical records. Autism spectrum disorders (ASDs) were diagnosed following DSM-IV-TR criteria. A search for hospital-registered ASDs was performed. For Finnish higher-functioning primary school-aged, 7- to 12-year-olds, the optimal cut-off score was 30 in clinical settings and 28 in total population screening using summed ASSQ scores of parents' and teachers' ratings. Determining appropriate cut-off scores in ASD screening in different languages and in different cultures is of utmost importance.

Autism spectrum disorders according to DSM-IV-TR and comparison with DSM-5 draft criteria: an epidemiological study.

OBJECTIVE: The latest definitions of autism spectrum disorders (ASDs) were specified in DSM-IV-TR in 2000. DSM-5 criteria are planned for 2013. Here, we estimated the prevalence of ASDs and autism according to DSM-IV-TR, clarified confusion concerning diagnostic criteria, and evaluated DSM-5 draft criteria for ASD posted by the American Psychiatry Association (APA) in February 2010. METHOD: This was an epidemiological study of 5,484 eight-year-old children in Finland, 4,422 (81%) of them rated via the Autism Spectrum Screening Questionnaire by parents and/or teachers, and 110 examined by using a structured interview, semi-structured observation, IQ measurement, school-day observation, and patient records. Diagnoses were assigned according to DSM-IV-TR criteria and DSM-5 draft criteria in children with a full-scale IQ (FSIQ) ≥50. Patient records were evaluated in children with an FSIQ <50 to discover diagnoses of ASDs. RESULTS: The prevalence of ASDs was 8.4 in 1,000 and that of autism 4.1 in 1,000 according to DSM-IV-TR. Of the subjects with ASDs and autism, 65% and 61% were high-functioning (FSIQ ≥70), respectively. The prevalence of pervasive developmental disorder not otherwise specified was not estimated because of inconsistency in DSM-IV-TR criteria. DSM-5 draft criteria were shown to be less sensitive in regard to identification of subjects with ASDs, particularly those with Asperger's syndrome and some high-functioning subjects with autism. CONCLUSIONS: DSM-IV-TR helps with the definition of ASDs only up to a point. We suggest modifications to five details of DSM-5 draft criteria posted by the APA in February 2010. Completing revision of DSM criteria for ASDs is a challenging task.

Comorbid psychiatric disorders associated with Asperger syndrome/high-functioning autism: a community- and clinic-based study.

The present study identifies the prevalence and types of comorbid psychiatric disorders associated with Asperger syndrome (AS)/high-functioning autism (HFA) in a combined community- and clinic-based sample of fifty 9- to 16-year-old subjects using the Schedule for Affective Disorders and Schizophrenia for School-Age Children, Present and Lifetime Version. The level of functioning was estimated using the Children's Global Assessment Scale. The results support common (prevalence 74%) and often multiple comorbid psychiatric disorders in AS/HFA; behavioral disorders were shown in 44%, anxiety disorders in 42% and tic disorders in 26%. Oppositional defiant disorder, major depressive disorder and anxiety disorders as comorbid conditions indicated significantly lower levels of functioning. To target interventions, routine evaluation of psychiatric comorbidity in subjects with AS/HFA is emphasized.

When does the Autism Spectrum Screening Questionnaire (ASSQ) predict autism spectrum disorders in primary school-aged children?

The aims of this study were, firstly, to study the association between parents' and teachers' ratings for the Finnish version of the Autism Spectrum Screening Questionnaire (ASSQ), secondly, to find out whether the original cut-off scores of the ASSQ identify primary school-aged children with Asperger syndrome (AS) or autism by using the Finnish ASSQ, and thirdly, to evaluate the validity of the ASSQ. Parents and/or teachers of higher-functioning (full-scale intelligence quotient > or = 50) 8-year-old total population school children (n = 4,408) and 7-12-year-old outpatients with AS/autism (n = 47) completed the Finnish version of the ASSQ. Agreement between informants was slight. In the whole total population, low positive correlation was found between parents' and teachers' ratings, while in the sample of high-scoring children the correlation turned out to be negative. A cut-off of 30 for parents' and teacher's summed score and 22 for teachers' single score is recommended. A valid cut-off for parents' single score could not been estimated. The clinicians are reminded that the ASSQ is a screening instrument, not a diagnosing instrument. The importance of using both parents' and teachers' ratings for screening in clinical settings is underlined.

Variations in prenatal sociodemographic factors associated with intellectual disability: a study of the 20-year interval between two birth cohorts in northern Finland.

The authors followed two cohorts of children born in northern Finland in 1966 (n = 12,058) and 1985-1986 (n = 9,432) to examine whether associations between maternal sociodemographic factors assessed during pregnancy and intellectual disability in the offspring changed over a 20-year interval. Both of the cohorts were followed up to the age of 11.5 years using similar methods and definitions of intellectual disability. Data on sociodemographic factors were based on comparable questionnaires returned by the mothers during the 25th week of gestation. Despite an interval of 20 years between the cohorts, the main indicators of socioeconomic disadvantage and maternal multiparity remained as having the largest impact on the incidence of intellectual disability, while single factors such as older maternal age at delivery, being single, and living in a remote area lost their association with intellectual disability. Over 20 years, prepregnancy maternal obesity (body mass index > or =30) became a newly associated factor (adjusted odds ratio = 2.8, 95% confidence interval: 1.5, 5.3). A future challenge is to explore the mediating mechanisms between intellectual disability and its associated preventable intergenerational environmental or lifestyle factors.

An epidemiological and diagnostic study of Asperger syndrome according to four sets of diagnostic criteria.

OBJECTIVE: This study evaluated the diagnostic process and prevalence rates of Asperger syndrome (AS) according to the DSM-IV, ICD-10, and criteria developed by Gillberg and Gillberg and by Szatmari and colleagues and clarified confusion about AS. METHOD: An epidemiological study of 5,484 eight-year-old children in Finland, 4,422 (80.6%) of whom rated on the high-functioning Autism Spectrum Screening Questionnaire by parents and/or teacher, 125 of them screened and 110 examined by using structured interview, semistructured observation, IQ measurement, school day observation, and patient records. Diagnoses were performed by following the DSM-IV, ICD-10, and criteria developed by Gillberg and Gillberg and by Szatmari and colleagues in detail. RESULTS: The prevalence rates per 1,000 were 2.5 according to the DSM-IV, 2.9 to ICD-10, 2.7 to Gillberg and Gillberg's criteria, and 1.6 to the criteria of Szatmari et al. CONCLUSIONS: The results emphasize the need to reconsider the diagnostic criteria of AS. The importance of multi-informant sources came up, and the need of several informants was highlighted, especially when diagnosing the broader pervasive developmental disorders.

Factors associated with ideation and acts of deliberate self-harm among 18-year-old boys. A prospective 10-year follow-up study.

BACKGROUND: The aims of the study were: (1) to identify the prevalence of ideation and acts of deliberate self-harm in 18-year-old boys; (2) to report the use of mental health services among these boys; (3) to identify risk factors assessed at age 8 and (4) to identify associated cross-sectional factors at age 18 of self-reported ideation and acts of deliberate self-harm. METHODS: The participants in this community-based 10-year follow-up study consisted of 2,348 boys born during 1981. At baseline, three informant sources were used: parents, teachers and the children themselves. The questionnaires used were the Rutter Parents Scale, the Rutter Teacher Scale and the Children's Depressive Inventory. At follow-up, boys' psychopathology, adaptive functioning and substance use were studied using the Young Adult Self-Report questionnaire. Further questions about demographic factors and life events were added at both stages. RESULTS: The prevalence of ideation of deliberate self-harm was 4.0%, and of acts 2.2%, during the preceding 6 months. Of the subjects who reported ideation, 9.7%, and of those who reported acts, 16.0%, had used mental health services during the previous year. Self-reported depressive symptoms at age 8 predicted ideation and acts of deliberate self-harm 10 years later. Suicidal boys' problems in many life areas were linked with suicidal tendency through psychiatric symptoms, especially anxious/depressed symptoms and aggressive behaviour. CONCLUSIONS: The connection between self-reported depressive symptoms at age 8 and ideation and acts of deliberate self-harm at age 18 is a good reason to already pay special attention to children's own intimations of distress in elementary school. It is likely that an effective way to prevent suicidality among adolescents is to search for and treat psychiatric problems among young people. Self-reported screening questionnaires used, e.g. in school healthcare, may provide an opportunity to recognize these problems.

Etiological survey on intellectual disability in the northern Finland birth cohort 1986.

The etiology of intellectual disability was studied both in incident (n = 9,432) and prevalent (n = 9,351) populations in a one-year birth cohort born in Northern Finland in 1985-1986. Data from multiple sources were used to follow the children until the age of 11.5 years. Of the incident cases (n=119) with intellectual disabilities, 66.4% had etiologically biomedical associative factor. Paranatal factors were relatively fewer and prenatal more common compared with earlier studies. We found nearly double the prevalence of genetic factors leading to intellectual disabilities compared with a contemporary study from Norway. The differences between the populations, despite random variation, some dissimilarities between etiological categorization and diagnostic accuracy, are in most part due to true differences between the study populations and genetic pool.

Factors associated with depressive symptoms among 18-year-old boys: a prospective 10-year follow-up study.

BACKGROUND: The aim is to study associative and predictive factors for self-reported depressive symptoms among 18-year-old boys. METHODS: The participants in this community-based 10-year follow-up study consisted of 2348 boys born during 1981. At baseline, three informant sources were used: parents, teachers, and the children themselves. At follow-up, self-report questionnaires were used to study boys' family factors, life events, adaptive functioning, and substance use. Depressive symptoms at age 18 were established using Beck's Depression Inventory (BDI). RESULTS: Poor adaptive functioning within family and in education, having fewer than two close friends, somatic health problems, and using illicit drugs were all independently associated with a high level of depressive symptoms in the cross-sectional data at age 18. Self-reported depressive symptoms (Children's Depression Inventory, CDI) at age 8 independently predicted an increased number of depressive symptoms 10 years later. LIMITATIONS: Only self-reported questionnaires were used at follow-up. CONCLUSIONS: The high association between depressive symptoms at age 8 and at age 18 gives grounds for paying special attention to children's own intimations of distress already in the early school years. Using self-report screening questionnaires in school health care may help identify children's depressive symptoms.

Mental health service use among 18-year-old adolescent boys: a prospective 10-year follow-up study.

OBJECTIVE: To study prevalence and factors associated with mental health service use among 18-year-old adolescent boys. METHOD: Predictors at age 8 and factors at age 18 associated with mental health service use during the preceding 12 months were studied in a general population sample of 2,316 Finnish boys born in 1981 attending military call-up (79% of the original sample). RESULTS: Within the preceding 12 months, 2.1% of the boys had used mental health services. At age 18, internalizing, anxious-depressive, and withdrawal symptoms; health problems; not living with parents; use of illicit drugs; high level of alcohol use; and regular smoking were independently associated with service use. At age 8, a high level of emotional and behavioral symptoms, need for referral, and low school performance according to teacher evaluations predicted service use 10 years later. CONCLUSIONS: Only a minority of adolescents with severe problems had used mental health services. Because of the wide range of problems and comorbidity among service users, there is a need for integration of different services. Education services have a central role in the early detection of those who will later use mental health services.

Associated medical disorders and disabilities in children with autistic disorder: a population-based study.

A population-based survey was conducted among 152,732 Finnish children and adolescents aged under 16 years and living in northern Finland. Diagnoses and associated medical conditions were derived from the hospital and institutional records of this area. One hundred and eighty-seven children with DSM-IV autistic disorder were identified. Associated medical disorders or associated disorders of known or suspected genetic origin were found in 12.3 percent, including tuberous sclerosis, Down syndrome, fragile X syndrome, Klinefelter syndrome, XYY syndrome, chromosome 17 deletion, chromosome 46, XX, dup(8) (p) and mitochondriopathy. Other associated medical disorders identified were epilepsy, hydrocephalus, foetal alcohol syndrome and cerebral palsy. Hearing impairments were found in 8.6 percent and severe impairment of vision in 3.7 percent of the individuals with autistic disorder. Medical disorders seem to have a special impact on the genesis of autistic disorder and need to be thoroughly examined in each child with autistic disorder.

Deficient auditory processing in children with Asperger Syndrome, as indexed by event-related potentials.

Asperger Syndrome (AS) is characterized by normal language development but deficient understanding and use of the intonation and prosody of speech. While individuals with AS report difficulties in auditory perception, there are no studies addressing auditory processing at the sensory level. In this study, event-related potentials (ERP) were recorded for syllables and tones in children with AS and in their control counterparts. Children with AS displayed abnormalities in transient sound-feature encoding, as indexed by the obligatory ERPs, and in sound discrimination, as indexed by the mismatch negativity. These deficits were more severe for the tone stimuli than for the syllables. These results indicate that auditory sensory processing is deficient in children with AS, and that these deficits might be implicated in the perceptual problems encountered by children with AS.

Psychiatric disorders of children and adolescents--a growing problem at school.

The purpose is to present the views of comprehensive school and senior secondary school teachers working in the Oulu province in Northern Finland concerning the behavioural and emotional disorders of their pupils, the actions taken by teachers to refer pupils for consultation, and the functionality of mental health services. The data were collected by questionnaires in 1998 and 2000. According to the teachers' estimates, the behavioural and emotional disorders of pupils have both increased in number and become more severe at all levels of primary and secondary education. The teachers of comprehensive schools and special schools mostly contacted the parents when a pupil was found to have psychiatric symptoms. At the early stages of referral the teachers often also consulted with the pupil welfare team for support. The teachers of senior secondary schools contacted primarily the school nurse and secondarily the parents. Teachers were content with the psychiatric health care services if their pupils benefited from them, but the availability of services and the flow of information were problems. It was also difficult to decide when to refer a pupil for consultation and treatment. The responsibilities and obligations for the availability and functionality of mental health services for children and adolescents were re-defined and specified in a statute enforced as of January 2001. The question is how can we convert responsibilities and obligations into practical action?

Some aspects of treatment and habilitation of children and adolescents with autistic disorder in Northern-Finland.

Hospital records and data on the treatment/habilitation status of 187 children with autism aged 3-18 years were gathered from Northern Finland. The treatment programs and therapies varied, depending on the trained staff available. One-hundred and fifty-two (82.9%) children and adolescents with autism received more than one therapeutic intervention or specific training program. The most common therapies were physiotherapy as well as speech, occupational and music therapy. 43.9% of the children and adolescents with autism received specific training according to TEACCH (Treatment and Education of Autistic and related Communication-Handicapped Children), 10.2% according to Lovaas and 30.5% according to the Portage program. Antiepileptic medication had been prescribed to 23.9% and psychopharmacological interventions to 14.9% of the individuals with autistic disorder (AD). One hundred and seventy-eight subjects out of 187 showed some improvement on the Childhood Autism Rating Scale (CARS), even if no statistically significant difference was found between the outcome of the available habilitation methods.