Emotion recognition of static and dynamic faces in autism spectrum disorder.

There is substantial evidence for facial emotion recognition (FER) deficits in autism spectrum disorder (ASD). The extent of this impairment, however, remains unclear, and there is some suggestion that clinical groups might benefit from the use of dynamic rather than static images. High-functioning individuals with ASD (n = 36) and typically developing controls (n = 36) completed a computerised FER task involving static and dynamic expressions of the six basic emotions. The ASD group showed poorer overall performance in identifying anger and disgust and were disadvantaged by dynamic (relative to static) stimuli when presented with sad expressions. Among both groups, however, dynamic stimuli appeared to improve recognition of anger. This research provides further evidence of specific impairment in the recognition of negative emotions in ASD, but argues against any broad advantages associated with the use of dynamic displays.

Bias due to left truncation and left censoring in longitudinal studies of developmental and disease processes.

In longitudinal studies of developmental and disease processes, participants are followed prospectively with intermediate milestones identified as they occur. Frequently, studies enroll participants over a range of ages including ages at which some participants' milestones have already passed. Ages at milestones that occur prior to study entry are left censored if individuals are enrolled in the study or left truncated if they are not. The authors examined the bias incurred by ignoring these issues when estimating the distribution of age at milestones or the time between 2 milestones. Methods that account for left truncation and censoring are considered. Data on the menopausal transition are used to illustrate the problem. Simulations show that bias can be substantial and that standard errors can be severely underestimated in naïve analyses that ignore left truncation. Bias can be reduced when analyses account for left truncation, although the results are unstable when the fraction truncated is high. Simulations suggest that a better solution, when possible, is to modify the study design so that information on current status (i.e., whether or not a milestone has passed) is collected on all potential participants, analyzing those who are past the milestone at the time of recruitment as left censored rather than excluding such individuals from the analysis.

Extracting more information from behaviour checklists by using components of mean based scores.

Sums of responses to behaviour checklist items are commonly used as outcome measures. We argue for the use of mean scores. For sets of responses registering absence and presence at different levels of intensity of behaviours we also show that mean scores may usefully be 'decomposed' into separate measures of the range and the intensity of problematic behaviours. These separate measures are the proportion of items positively endorsed and the 'intensity index' - the proportion of positive scores that are above one. We illustrate their use with primary outcome scores from the Developmental Behaviour Checklist (DBC) in the Australian Child to Adult Development Study. The low mean scores of young people with profound intellectual disability are shown to be a function of the narrow range of behaviours they display rather than of the level of intensity of these behaviours, which is relatively high. Change over time in mean scores is shown to be attributable to change in both the range and the intensity of behaviours as young people age in the study. We show how the technique of measuring these two separate strands contributing to mean scores may be applied to checklists with sets of responses longer than the zero, one, two of the DBC.

Short form of the developmental behaviour checklist.

A 24-item short form of the 96-item Developmental Behaviour Checklist was developed to provide a brief measure of Total Behaviour Problem Score for research purposes. The short form Developmental Behaviour Checklist (DBC-P24) was chosen for low bias and high precision from among 100 randomly selected item sets. The DBC-P24 was developed from epidemiological data in the first three waves of the Australian Child to Adult Development study, and cross validated for groups with autism, fragile X, Prader-Willi, and Williams in this longitudinal study and in cross sectional Dutch, English, and Finnish samples of young people with intellectual disability. The DBC-P24 has low bias and high precision in cross-validation samples and achieves high sensitivity and specificity to full DBC-P based caseness decisions.

A cross-syndrome evaluation of a new attention rating scale: The Scale of Attention in Intellectual Disability.

Whilst neuropsychological research has enhanced our understanding of inattentive and hyperactive behaviours among children with intellectual disability (ID), the absence of rating scales developed for this group continues to be a gap in knowledge. This study examined these behaviours in 176 children with autism spectrum disorder (ASD), Down Syndrome (DS), or idiopathic ID using a newly developed teacher rating scale, the Scale of Attention in Intellectual Disability. Findings suggested that children with ASD had a significantly greater breadth of hyperactive/impulsive behaviours than those with DS or idiopathic ID. These findings support existing research suggesting differing profiles of attention and activity across groups. Understanding disorder-specific profiles has implications for developing strategies to support students with ID in the classroom.

Hot flushes during the menopause transition: a longitudinal study in Australian-born women.

OBJECTIVE: To investigate factors associated with the presence, severity, and frequency of hot flushes. DESIGN: A 9-year prospective study of 438 Australian-born women, aged 45 to 55 years and menstruating at baseline. Annual fasting blood collection, physical measurements, and interviews including questions about bothersome hot flushes in previous 2 weeks were performed. A "hot flush index" score was calculated from the product of the severity and frequency data. Data were analyzed using random-effects time-series regression models. RESULTS: A total of 381 women supplied complete data over the follow-up years. A total of 350 women experienced the menopause transition, of whom 60 (17%) never reported bothersome hot flushes. At baseline, women who reported hot flushes were significantly more likely to have higher negative moods, not be in full- or part-time paid work, smoke, and not report exercising every day. Over the 9-year period of the study, variables significantly associated with reporting bothersome hot flushes were relatively young age (P < 0.001), low exercise levels (P < 0.05), low estradiol levels (P < 0.001), high follicle-stimulating hormone (FSH) levels (P < 0.001), smoking (P < 0.01), being in the late menopause transition (P < 0.001), or being postmenopausal (P < 0.001). In women reporting hot flushes, the hot flush index score increased as their FSH levels increased (P < 0.01), as they entered the late stage of the menopause transition (P < 0.001), and as they became postmenopausal (P < 0.05), and decreased with as their age (P < 0.001) and exercise level (P < 0.05) increased. Between-women analyses found that the hot flush index score was greater in women with higher average FSH levels over time (P < 0.05). CONCLUSION: Menopause status, FSH and estradiol levels, age, exercise level, and smoking status all contributed to the experience of bothersome hot flushes.

Development of a New Attention Rating Scale for Children With Intellectual Disability: The Scale of Attention in Intellectual Disability (SAID).

Difficulties with attention, impulsivity, and hyperactivity are thought to be as common among children with intellectual disability (ID) as they are in children without ID. Despite this, there is a lack of scales to specifically assess ADHD symptomatology in children and adolescents with ID. This article describes the development and evaluation of a teacher-completed measure; the Scale of Attention in Intellectual Disability (SAID). A community survey of 176 teachers of children 5-13 years of age, with ID at all levels of impairment indicated that the T-SAID is a reliable and valid measure. Integrating this scale with neuropsychological and clinical research holds exciting promise for enhancing our understanding of the nature of attention difficulties within populations with ID.

Menstrual patterns leading to the final menstrual period.

OBJECTIVE: To characterize premenopausal menstrual regularity and the patterns of divergence from regularity associated with the approach of the final menstrual period. DESIGN: Two samples of individual cycle length sequences contributed by participants in a population-based longitudinal study of the menopausal transition were examined. The first sample, of "early" sequences, is used to characterize menstrual regularity. The second shows how cycle length patterns change as the final menstrual period (FMP) is approached. Regression slopes are used to measure trend in cycle length, and changes in cycle length variability are registered by a simply calculated measure, the "running range." RESULTS: Sequences in the early cycles sample rarely varied outside the 21-35 day range and did not show a rising or falling trend. In contrast, pre-FMP sequences generally became increasingly variable in length, while rising above 35 days in mean during the last 10 cycles. The variability measure remained below 40 days throughout the early sequences, but characteristically rose above 42 days during sequences including the last 20 pre-FMP cycles. In early sequences, but not in pre-FMP sequences, long and short cycles tended to alternate. CONCLUSIONS: Increased variability is the dominant feature of cycle length pattern for most women as their final menstrual period approaches. Underlying this is a steady trend toward mean cycle lengths above 35 days. An indicator of the approach of menopause is a rise in running range of cycle lengths to 42 days.

Association between hormonal changes at menopause and the risk of a coronary event: a longitudinal study.

OBJECTIVE: To investigate the association of hormone levels at menopause, lifestyle variables, and body composition with the predicted 10-year risk of a coronary event, calculated using the PROCAM scoring system, in a population-based sample of Australian-born, middle-aged women. DESIGN: A 9-year prospective study of 438 Australian-born women, who at baseline were aged 45 to 55 years and had menstruated in the prior 3 months. Interviews, fasting blood, and physical measurements were taken annually. The risk of an acute coronary event was calculated using the PROCAM scoring system (includes: age, low-density lipoprotein cholesterol, smoking, high-density lipoprotein cholesterol, systolic blood pressure, family history of premature myocardial infarction, diabetes mellitus, and triglycerides). RESULTS: Retention rate after 8 years of follow-up was 88% (n = 387). In women not using hormone therapy (HT): higher than average body mass index (BMI) (P < 0.001), BMI that increased (P < 0.005), lower than average estradiol levels (P < 0.005), estradiol levels that decreased (P < 0.001), and high free testosterone levels (P < 0.05) were associated with increased risk of a coronary event. There was a trend for high exercise frequency to be associated with a decreased risk (P < 0.07). After BMI and lifestyle variables were taken into account, use of HT did not have a significant effect on risk of a coronary event. CONCLUSION: In this longitudinal observational study of middle-aged Australian-born women, high BMI, an increase in BMI, high free testosterone, low estradiol, and a decrease in estradiol levels were the main determinants of increased risk of an acute coronary event, based on the PROCAM scoring system calculation. More frequent exercise tended to lower the risk.

Central abdominal fat and endogenous hormones during the menopausal transition.

OBJECTIVE: To investigate the effect of endogenous hormone levels on central abdominal fat during the menopausal transition in a population-based cohort of Australian-born women. DESIGN: Prospective observational study. SETTING: Population-based sample. Body composition was assessed in the Royal Melbourne Hospital, and interviews were conducted at the patient's home. SUBJECT(S): One hundred two women from the Melbourne Women's Midlife Health Project. Data, physical measures, and blood were obtained by interview when the longitudinal study commenced (baseline) and at the time of the total body scan approximately 5 years later. Body composition was measured using dual-energy X-ray absorptiometry. INTERVENTION(S): None. MAIN OUTCOME MEASURES: Total body fat and central abdominal fat. RESULT(S): The 102 women were either premenopausal or in the early menopausal transition at baseline. At the time of their dual-energy X-ray absorptiometry scan, 31 were in the early menopausal transition, 22 were in the late menopausal transition, and 49 were postmenopausal. Multiple regression analysis found that total percentage of body fat was associated with weight measures, whereas central abdominal fat was also positively associated with baseline free T index (FTI) and with the increase in FTI since baseline. CONCLUSION(S): The major hormonal change associated with central adiposity during the menopausal transition is the increase in the FTI. This effect is significant even after allowing for baseline and final weight.

Adult outcomes in autism: community inclusion and living skills.

Longitudinal research has demonstrated that social outcomes for adults with autism are restricted, particularly in terms of employment and living arrangements. However, understanding of individual and environmental factors that influence these outcomes is far from complete. This longitudinal study followed a community sample of children and adolescents with autism into adulthood. Social outcomes in relation to community inclusion and living skills were examined, including the predictive role of a range of individual factors and the environment (socio-economic disadvantage). Overall, the degree of community inclusion and living skills was restricted for the majority, and while childhood IQ was an important determinant of these outcomes, it was not the sole predictor. The implications of these findings in relation to interventions are discussed.

Validation of the emotion regulation and social skills questionnaire for young people with autism spectrum disorders.

The current study aims to evaluate the psychometric properties of the Emotion Regulation and Social Skills Questionnaire (ERSSQ), a rating scale designed specifically to assess the social skills of young people with Autism Spectrum Disorder (ASD). The participants were 84 children and young adolescents with ASD, aged between 7.97 and 14.16 years with a mean IQ score of 90.21 (SD = 18.82). The results provide evidence for the concurrent and criterion validity of the ERSSQ Parent form, and the concurrent validity of the ERSSQ Teacher form. The clinical and theoretical implications are discussed, including the necessity of ratings across multiple contexts and the potential use of the ERSSQ in identifying individuals most in need of intervention and for planning and assessing the outcomes of social skills interventions.

Do planning and visual integration difficulties underpin motor dysfunction in autism? A kinematic study of young children with autism.

This paper examines the upper-limb movement kinematics of young children (3-7 years) with high-functioning autism using a point-to-point movement paradigm. Consistent with prior findings in older children, a difference in movement preparation was found in the autism group (n = 11) relative to typically developing children. In contrast to typically developing children, the presence of a visual distractor in the movement task did not appear to impact on early movement planning or execution in children with autism, suggesting that this group were not considering all available environmental cues to modulate movement. The findings from this study are consistent with the possibility that autism is associated with a difficulty using visual information to prime alternative movements in a responsive way to environmental demands.

Morphological and syntactic skills in language samples of pre school aged children with autism: atypical development?

This study investigated whether children with autism have atypical development of morphological and syntactic skills, including whether they use rote learning to compensate for impaired morphological processing and acquire grammatical morphemes in an atypical order. Participants were children aged from 3-6 years who had autism (n = 17), developmental delay without autism (n = 7), and typically-developing children (n = 19). Language samples were taken from participants during the administration of the Autism Diagnostic Observation Schedule, and transcripts were coded using the Index of Productive Syntax, and for usage of Brown's grammatical morphemes. Participants were also administered an elicitation task requiring the application of inflections to non-words; the Wugs Task. The main finding of this study was that children with autism have unevenly developed morphological and syntactic sub-skills; they have skills which are a combination of intact, delayed, and atypical. It was also found that children with autism and children with developmental delays can acquire and use morphological rules. The implications of these findings are that, in order to maximize language acquisition for these children, clinicians need to utilize comprehensive language assessment tools and design interventions that are tailored to the child's strengths and weaknesses.

Brief report: The relationship between language skills, adaptive behavior, and emotional and behavior problems in pre-schoolers with autism.

This study investigated the relationship between structural language skills, and communication skills, adaptive behavior, and emotional and behavior problems in pre-school children with autism. Participants were aged 3-5 years with autism (n = 27), and two comparison groups of children with developmental delay without autism (n = 12) and typically developing children (n = 20). The participants were administered standardised tests of structural language skills, and parents completed the Vineland Adaptive Behavior Scales and the Developmental Behaviour Checklist. Results indicated that for children with autism, communication skills, and in particular receptive communication skills, were associated with social and daily living skills, and behavior problems. Receptive structural language skills were associated with expressive communication skills. There were no associations found between structural language skills and social or daily living skills, nor behavior problems. The results of this study suggest that communication skills are more closely linked to functional and behavioral outcomes in autism than structural language skills.

Mirror neuron activity associated with social impairments but not age in autism spectrum disorder.

BACKGROUND: The neurobiology of autism spectrum disorder (ASD) is not particularly well understood, and biomedical treatment approaches are therefore extremely limited. A prominent explanatory model suggests that social-relating symptoms may arise from dysfunction within the mirror neuron system, while a recent neuroimaging study suggests that these impairments in ASD might reduce with age. METHODS: Participants with autism spectrum disorder (i.e., DSM-IV autistic disorder or Asperger's disorder) (n = 34) and matched control subjects (n = 36) completed a transcranial magnetic stimulation study in which corticospinal excitability was assessed during the observation of hand gestures. RESULTS: Regression analyses revealed that the ASD group presented with significantly reduced corticospinal excitability during the observation of a transitive hand gesture (relative to observation of a static hand) (p < .05), which indicates reduced putative mirror neuron system activity within ventral premotor cortex/inferior frontal gyrus. Among the ASD group, there was also a negative association between putative mirror neuron activity and self-reported social-relating impairments, but there was no indication that mirror neuron impairments in ASD decrease with age. CONCLUSIONS: These data provide general support for the mirror neuron hypothesis of autism; researchers now must clarify the precise functional significance of mirror neurons to truly understand their role in the neuropathophysiology of ASD and to determine whether they should be used as targets for the treatment of ASD.

"Persistence" improves the 60-day amenorrhea marker of entry to late-stage menopausal transition for women aged 40 to 44 years.

OBJECTIVE: The ReSTAGE collaboration evaluated four menstrual markers of entry to late-stage menopausal transition. The aim of this study was to assess the additional usefulness of "persistence" in relation to a clinically accessible menstrual marker of late menopausal transition, taking age into account. METHODS: In this study, a secondary analysis of menstrual calendar data in two ReSTAGE-collaborating studies with comparatively low age at beginning of menstrual calendar observation was performed. RESULTS: Sixty days of amenorrhea is as useful for predicting time to the final menstrual period as the currently accepted 90-day marker for women older than 45 years. For those aged between 40 and 44 years, recurrence of the 60-day marker within the next 10 cycles is a better indicator than a single occurrence of the 60-day marker or the 90-day marker. CONCLUSIONS: Sixty-day amenorrhea is as reliable a marker of late menopausal transition as the traditional 90-day marker for women older than 45 years. For those aged 40 to 44 years, keeping menstrual records to check for a recurrence of the 60-day marker will be useful.

Factor analytic study of repetitive behaviours in young children with Pervasive Developmental Disorders.

The aim of the current study was to investigate the manifestation of repetitive behaviour profiles in young children with a Pervasive Developmental Disorder. The sample consisted of 137 developmentally delayed children with a DSM-IV-TR Pervasive Developmental Disorder (PDD) and 61 developmentally delayed children without a PDD. An exploratory factor analytic investigation using 12 ADI-R repetitive behaviour items from parent report of children with a PDD reported the emergence of two factors. The first factor consisted of higher-level, "insistence on sameness" behaviours, and the second of lower-level, repetitive "sensory-motor" behaviours. This factor structure was also applicable to a more general group of young children with developmental delay, regardless of their diagnosis. Correlational analyses highlighted contrasting relationships between developmental variables and the different repetitive behaviour factors. These relationships were different for children with a PDD and those without a PDD. The findings have potential implications for the early assessment and diagnosis of PDDs in young children.

Are aspects of study design associated with the reported prevalence of female sexual difficulties?

OBJECTIVE: To investigate associations between the prevalence of sexual difficulties reported in published studies and design features of those studies to determine if differences in design contribute to variation in prevalence estimates. DESIGN: Systematic review, multivariate analysis. SETTING: Studies published internationally in English. PATIENT(S): Not applicable. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Prevalence estimates of difficulty with desire, arousal, orgasm, and sexual pain reported in published studies. RESULT(S): Our systematic literature search identified 1,380 publications. Fifty-five studies met our inclusion criteria (reporting prevalence, sample size and response rate, sample size greater than 100, not clinic based). Reported prevalence of sexual difficulty varied across studies (up to tenfold). Eleven aspects of research conduct in these studies were included in our multivariate analysis as explanatory variables. Five aspects of study design and conduct (data collection procedures, inclusion criteria, duration of sexual difficulty recorded, sample size, and response rate) were associated with the reported prevalence of at least one type of sexual difficulty independently of likely predictors of true variation in prevalence: study location, study year, and age range of participants. CONCLUSION(S): This review provides evidence that study design may influence reported prevalence estimates of female sexual difficulties and contribute to the wide variation in published estimates.