Duodenal Brunner's gland adenoma causing chronic small intestinal obstruction in a dog.

An eight-year-old, neutered, female English springer spaniel was presented with a 14-month history of vomiting, marked weight loss and lethargy, all of which were non-responsive to medical therapy. Abdominal radiographs and ultrasonography showed an intraluminal soft tissue mass extending from the pyloric antrum to the proximal duodenum. Two spherical masses both approximately 8 cm in diameter were removed via a duodenotomy. Histopathological examination showed the first mass to be a trichobezoar and the aboral mass to be a Brunner's gland adenoma. Surgery resulted in a complete resolution of the clinical signs.

[Can we cure autism? From outcome to intervention]. / Podemos curar el autismo? Del desenlace clinico a la intervención.

Outcome in autism is variable but with a significant trend toward a poor prognosis and despite reports that outcome in individuals with autism may be improving secondary to early intensive interventions there is still much to be learned about the natural history and the effects of intervention in autism spectrum disorders. While there may not be a known cure for autism, there are a number of viable treatment options available. The primary models of treatment are non pharmacological interventions that include intervention models such as applied behavior analysis and developmental and structured teaching. The role of pharmacological interventions is limited to treating specific symptoms that may be interfering with a child's ability to learn or function within a particular environment. The question of whether or not we can cure autism needs to be discussed in terms of the need to overcome the as of yet poorly understood fundamental disturbance in autism and the need to develop treatment protocols specifically targeting social deficits. At the present time, it is more appropriate to speak of our quest to understand autism than it is to speak of a cure.

[The social deficit in autism: focus on joint attention]. / Déficit social en el autismo: un enfoque en la atención conjunta.

INTRODUCTION AND DEVELOPMENT: Autism is best thought of as a spectrum disorder with the dimensional components of social cognition, communication and flexibility varying between individuals meeting the criteria of autism. The core clinical feature that defines autism is a disturbance in social interaction which is not absolute and differs depending on a child's cognitive level, developmental stage, and the type of social structure in which they are observed. Social skills are under strong genetic influence with a continuous distribution of social interaction deficits in the general population with arbitrary cutoffs defining who is and is not affected with an autism spectrum disorder; this is the result of a complex interplay between numerous biological and environmental factors. Joint attention refers to the capacity of individuals to coordinate attention with a social partner in relation to some object or event and a disturbance in this early skill and in particular impairment in the ability to initiate joint attention, is a central symptom of autism. CONCLUSIONS: There are data to suggest that dorso-medial frontal cortex and anterior cingulate contribute to the development of an infant's ability to maintain representations of self, a social partner and an interesting object. The ability to engage frequently in social orienting behaviors and ultimately in numerous episodes of social attention coordination, or joint attention, may be a critical experience during a particular developmental window that serves to organize social neurodevelopment. A neurodevelopmental model explaining how these early deficits in social cognition may lead to autism is reviewed.

¿Podemos curar el autismo? Del desenlace clínico a la intervención / Can we cure autism? From outcome to intervention

El desenlace clínico en el autismo varía, pero hay una tendencia significativa hacia un pronóstico desfavorable y, aunque se haya dicho que el desenlace de los pacientes con autismo puede experimentar una mejoría a consecuencia de la realización de intervenciones intensivas precoces, todavía queda mucho que aprender sobre la evolución natural y los efectos de las intervenciones en los trastornos del espectro autista. Si bien el autismo no tiene cura conocida, sí que existen varias opciones terapéuticas. Los principales modelos de tratamiento son intervenciones no farmacológicas que incluyen modelos de intervención como el análisis conductual aplicado, la teoría del desarrollo y la enseñanza estructurada. El papel de las intervenciones farmacológicas se limita al tratamiento de síntomas específicos que pueden obstaculizar la capacidad del niño para aprender o funcionar bien en un medio determinado. La cuestión de si podemos curar el autismo o no debe plantearse sobre la base de la necesidad que existe de superar la alteración fundamental del autismo –de la cual todavía se conoce muy poco– y la necesidad de desarrollar protocolos terapéuticos dirigidos de manera específica hacia las insuficiencias sociales. Actualmente sería más apropiado hablar de nuestra intención de comprender el autismo antes que hablar de una curación (AU)

Outcome in autism is variable but with a significant trend toward a poor prognosis and despite reports that outcome in individuals with autism may be improving secondary to early intensive interventions there is still much to be learned about the natural history and the effects of intervention in autism spectrum disorders. While there may not be a known cure for autism, there are a number of viable treatment options available. The primary models of treatment are non pharmacological interventions that include intervention models such as applied behavior analysis and developmental and structured teaching. The role of pharmacological interventions is limited to treating specific symptoms that may be interfering with a child’s ability to learn or function within a particular environment. The question of whether or not we can cure autism needs to be discussed in terms of the need to overcome the as of yet poorly understood fundamental disturbance in autism and the need to develop treatment protocols specifically targeting social deficits. At the present time, it is more appropriate to speak of our quest to understand autism than it is to speak of a cure (AU)

Déficit social en el autismo: un enfoque en la atención conjunta / The social déficit in autism: focus on joint attention

Introducción y desarrollo. La mejor manera de considerar el autismo es como un trastorno del espectro en el cual los componentes dimensionales de la cognición social, la comunicación y la flexibilidad presentan variaciones entre individuos que satisfacen los criterios del autismo. La característica clínica fundamental que define el autismo es una alteración de la interacción social que no es absoluta y que cambia según el nivel cognitivo del niño, la etapa del desarrollo en que se encuentra y el tipo de estructura social en la cual se observa. La genética ejerce una influencia poderosa sobre las aptitudes sociales y las deficiencias de interacción social se distribuyen constantemente entre la población general con cortes aleatorios que definen quién está afectado por trastornos del espectro autista y quién no. Esto es consecuencia de una interacción compleja entre varios factores biológicos y ambientales. El término ‘atención conjunta’ se refiere a la capacidad que demuestran los individuos para coordinar la atención con un interlocutor social con respecto a algún objeto o acontecimiento; una alteración en esta habilidad temprana, y especialmente una capacidad deficitaria para iniciar la atención conjunta, es uno de los síntomas principales del autismo. Conclusiones. Existen datos que sugieren que la corteza frontal dorsomedial y el cíngulo anterior contribuyen al desarrollo de la capacidad del niño para mantener representaciones de sí mismo, de un interlocutor social y de un objeto de interés. La habilidad para participar con frecuencia en conductas de orientación social y, en última instancia, en numerosos episodios de coordinación de la atención social, o atención conjunta, quizá sea una experiencia crítica durante un período determinado del desarrollo que sirve para que se organice el neurodesarrollo social. También se revisa un modelo del neurodesarrollo que explica cómo estas deficiencias tempranas en la cognición social pueden llevar al autismo (AU)

Introduction and development. Autism is best thought of as a spectrum disorder with the dimensional components of social cognition, communication and flexibility varying between individuals meeting the criteria of autism. The core clinical feature that defines autism is a disturbance in social interaction which is not absolute and differs depending on a child’s cognitive level, developmental stage, and the type of social structure in which they are observed. Social skills are under strong genetic influence with a continuous distribution of social interaction deficits in the general population with arbitrary cutoffs defining who is and is not affected with an autism spectrum disorder; this is the result of a complex interplay between numerous biological and environmental factors. Joint attention refers to the capacity of individuals to coordinate attention with a social partner in relation to some object or event and a disturbance in this early skill and in particular impairment in the ability to initiate joint attention, is a central symptom of autism. Conclusions. There are data to suggest that dorso-medial frontal cortex and anterior cingulate contribute to the development of an infant’s ability to maintain representations of self, a social partner and an interesting object. The ability to engage frequently in social orienting behaviors and ultimately in numerous episodes of social attention coordination, or joint attention, may be a critical experience during a particular developmental window that serves to organize social neurodevelopment. A neurodevelopmental model explaining how these early deficits in social cognition may lead to autism is reviewed (AU)

Vocal atypicalities of preverbal autistic children.

This study was designed to evaluate the nature of early vocal behaviors in young children with autism. Recent methodological and conceptual advances in the study of infant preverbal vocalizations were used to provide a detailed examination of the vocal behavior of young preverbal children with autism and comparison children with developmental delays. Results revealed that children with autism did not have difficulty with the expression of well-formed syllables (i.e., canonical babbling). However, children with autism did display significant impairments in vocal quality (i.e., atypical phonation). Specifically, autistic children produced a greater proportion of syllables with atypical phonation than did comparison children. Consistent with prior reports, the children with autism also displayed a deficit in joint attention behaviors. Furthermore, the atypicalities in the vocal behavior of children with autism appeared to be independent of individual differences in joint attention skill, suggesting that a multiple process model may be needed to describe early social-communication impairments in children with autism. Data are discussed in terms of their implications for future theoretical and applied research, including efforts to enhance the specificity of early diagnostic procedures.

EEG correlates of the development of infant joint attention skills.

The development of the capacity for social attention coordination, or "joint attention," is a major milestone of infancy. Data from a recent study of handicapped infants have raised the hypothesis that the tendency to initiate bids for joint attention may reflect processes associated with the frontal cortex to a greater extent than other forms of infant attention coordination (R. Caplan et al., 1993). This hypothesis was examined in a longitudinal study of 32 normally developing infants. The results indicated that EEG data at 14 months indicative of left frontal, as well as left and right central cortical activity, was associated with the tendency to initiate joint attention bids (IJA) at 14 and 18 months. In contrast, a pattern of left parietal activation and right parietal deactivation at 14 months was associated with the development of the capacity to respond to the joint attention bids (RJA) of others at 14 and 18 months. These results were interpreted to be consistent with a general anterior-posterior model of attention development (M. Posner & S. Petersen, 1990). The implications of these results for current conceptualizations of joint attention development, as well as for understanding the disturbance of joint attention skill development in autism are discussed.

Social and nonsocial factors in the Childhood Autism Rating Scale.

The Childhood Autism Rating Scale (CARS) was factor analyzed to determine if distinct and independent "subgroups" of symptoms could be derived, which would be consistent with the current multidimensional theory and nosology for autism. To address this issue, the CARS was factor analyzed for a sample of 90 children with diagnoses of either autism or PDDNOS, based on DSM-III-R diagnostic criteria. Five factors emerged: Social Communication, Emotional Reactivity, Social Orienting, Cognitive and Behavioral Consistency, and Odd Sensory Exploration. Factor-based scales were created. These factor-based scales were demonstrated to distinguish subjects with autism from subjects with PDDNOS and nonautistic subjects. Factor-based scores were examined to determine the degree to which they were associated with individual differences (such as age, IQ, gender, history of regression, and history of abnormal EEGs) among children with pervasive developmental disorders (PDDs). The application of these distinct and independent factors may have important clinical and research implications. The generation of factor-based scales may provide information on the nature of the individual differences that are thought to be present among children with autism. Additionally, the use of factor-based scale scores may increase the sensitivity of the CARS for identifying younger and/or higher functioning individuals within the PDD spectrum.

Subclinical hallucinations and delusions in nonpsychotic adolescents.

A number of studies have suggested that clinical populations of adolescents may report hallucinations and/or delusions without meeting criteria for a psychotic disorder. The purpose of this study was to provide information about the prevalence and symptom correlates of these subclinical hallucinations and delusions that occur in a nonpsychotic population of adolescents. Thirty-eight adolescents from a residential program and day treatment center were assessed with respect to hallucinatory experiences, ideas of reference, paranoid ideation, dissociative experiences, depressive symptomatology, and schizotypal cognitions. Results of this study indicated that 33% of the participants reported having experienced auditory hallucinations, and 24% reported having had delusional ideas. In addition, the results suggest that subclinical auditory hallucinations may have an especially strong relation with dissociative processes, whereas subclinical delusions appeared to be most strongly correlated with schizotypal thought processes. The results of this study begin to clarify the phenomenon of hallucinatory and delusional experiences in a nonpsychotic population.

Joint attention and early social communication: implications for research on intervention with autism.

Highly structured, intensive early intervention may lead to significant developmental gains for many children with autism. However, a clear understanding of early intervention effects may currently be hampered by a lack of precision in outcome measurement. To improve the precision and sensitivity of outcome assessment it may be useful to integrate research on the nature of the social disturbance of autism with research on early intervention. In this regard, it may be that measures of nonverbal social communication skills are especially important in the study of preschool intervention programs. This is because these measures appear to tap into a cardinal component of the early social disturbance of autism, and because these measures have been directly related to neurological, cognitive, and affective processes that may play a role in autism. The research and theory that support the potential utility of these types of measures for early intervention research are reviewed. Examples are provided to illustrate how these types of measures may assist in addressing current issues and hypotheses about early intervention with autism including the "recovery hypothesis," the "pivotal skill hypothesis," and the relative effectiveness of discrete trial versus incidental learning approaches to early intervention. A cybernetic model of autism is also briefly described in an effort to better understand one potential component of early psychoeducational treatment effects with children with autism.

Attention regulation by children with Down syndrome: coordinated joint attention and social referencing looks.

We examined attention regulation of children in two different situations designed to elicit triadic interactions (i.e., between self, other, and object). Thirty-five children with Down syndrome and 23 children with typical development were observed in a semi-structured adult-child interaction designed to elicit coordinated joint attention and an ambiguous situation in which a moving robot prompted an emotional response from the adults in order to elicit social referencing looks from the child. Children with Down syndrome engaged in significantly fewer social referencing looks. Group differences were not found for coordinated joint attention looks, suggesting that the difficulty for children with Down syndrome is in cognitive appraisal abilities.

Nonverbal communication and early language acquisition in children with Down syndrome and in normally developing children.

Many children with Down syndrome display asynchrony in development with the acquisition of language preceding at a slower pace than the acquisition of other cognitive skills. Recent research suggests that the expressive language delays that are displayed by these children may be associated with an earlier disturbance in the development of nonverbal requesting skills (Mundy, Sigman, Kasari, & Yirmiya, 1988; Smith & von Tetzchner, 1986). To test this hypothesis, a longitudinal study of 37 children with Down syndrome and 25 children with normal development was conducted. The results of the study indicated that this sample of children with Down syndrome exhibited a disturbance in nonverbal requesting. Furthermore, individual differences in nonverbal requesting were associated with the subsequent development of expressive language in these children. This association was observed even after taking into account initial variance in developmental level and language status. These data suggested that some of the processes involved in the expressive language delay of children with Down syndrome were not unique to linguistic development. Instead, some aspects of this delay appeared to be associated with problems in an earlier nonverbal phase of communication development. Additionally, the results suggested that measures of nonverbal communication skills also made a unique contribution to the prediction of language development among children with normal development. These data supported the hypothesis that the acquisition of nonverbal communication skills provides an important foundation for the emergence of language in atypical as well as typical development.

Attention to people and toys during social and object mastery in children with Down syndrome.

Attention to people versus objects by children with Down syndrome was examined. Subjects were presented with situations in which the primary focus alternated between an object stimulus (a toy) and a social stimulus (a singing experimenter). The children with Down syndrome monitored their environment in the same manner as did MA-matched typically developing children during object mastery and had a more focused attention style during social mastery. Reasons for this difference in attention across the two situations were discussed.

Object mastery motivation of children with Down syndrome.

Mastery motivation of children with Down syndrome and MA-matched typically developing children was examined. The two groups performed similarly with respect to the quality of their play but differed in level of task engagement and causality pleasure. The children with Down syndrome appeared to be less engaged in the task than were the typically developing group as indicated by shorter sequences of goal-directed behavior and higher rates of toy rejection. In addition, the children with Down syndrome displayed less causality pleasure with object exploration than did the typically developing children.

Hemispherectomy for intractable seizures: presurgical cerebral glucose metabolism and post-surgical non-verbal communication.

This study examined the presurgical 2-deoxy-2[18F]-fluoro-D-glucose positron emission tomography (PET) patterns of regional cerebral glucose metabolism in the non-resected hemisphere of 13 children who underwent hemispherectomy for early-onset intractable seizures. These patterns were compared with the rate of change in the children's non-verbal communication scores, measured before and after surgery. Irrespective of the side of surgery, the pre-operative glucose metabolism in the non-resected prefrontal cortex correlated significantly with the postoperative rate of change in the children's ability to focus the attention of an adult on an object or event (joint attention). These preliminary findings suggest that pre-operative PET patterns might be associated with certain aspects of the developmental outcome of children undergoing hemispherectomy.

Early onset intractable seizures: nonverbal communication after hemispherectomy.

The nonverbal communication skills of 10 children (mean age = 44.2 months) who underwent hemispherectomy for early onset intractable seizures were tested before and after surgery. A within-group analysis suggests that the 10 seizure-free children used more nonverbal communication after a mean follow-up period of 11.2 months than before surgery. Young normal language age matches were available for the 4 older and higher functioning subjects in the sample. Before surgery, the surgical subjects used less requesting gestures than did the normal children. After surgery, these differences were no longer apparent. The patients also employed more gestures to focus an adult's attention on objects and events than language-age-matched normal children. The children who underwent left or right hemispherectomy used similar nonverbal communication behaviors. The study's findings suggest that children with early onset intractable seizures have impaired early social communication that improves to some extent after hemispherectomy.

Non-verbal communication skills of surgically treated children with infantile spasms.

The authors present preliminary findings on the effects of surgery on the development of early non-verbal social communication skills in eight children with intractable infantile spasms. After a mean follow-up of 15.2 months, there was no statistically significant change in the post-surgical non-verbal communication behavior of these children beyond the expected developmental change. Implications of these findings for the developmental impairment associated with infantile spasms are discussed.

Empathy and cognition in high-functioning children with autism.

This study compares the ability of nonretarded autistic children (9-16 years of age) with the ability of normally developing children (9-14 years of age) to discriminate between various emotional states, to take the perspective of another regarding emotional states, and to respond affectively. The children's understanding of conservation was also assessed. While the children with autism did surprisingly well on the empathy-related measures, they performed less well than the normal children on these measures and on conservation. There was a closer association between cognitive abilities and affective understanding in the group of autistic children than in the control group.