Clinical Features of Children With Autism Who Passed 18-Month Screening.

OBJECTIVES: We compared sex-stratified developmental and temperamental profiles at 18 months in children screening negative for autism spectrum disorder (ASD) on the Modified Checklist for Autism in Toddlers (M-CHAT) but later receiving diagnoses of ASD (false-negative group) versus those without later ASD diagnoses (true-negative group). METHODS: We included 68 197 screen-negative cases from the Norwegian Mother and Child Cohort Study (49.1% girls). Children were screened by using the 6 critical items of the M-CHAT at 18 months. Groups were compared on domains of the Ages and Stages Questionnaire and the Emotionality Activity Sociability Temperament Survey. RESULTS: Despite passing M-CHAT screening at 18 months, children in the false-negative group exhibited delays in social, communication, and motor skills compared with the true-negative group. Differences were more pronounced in girls. However, with regard to shyness, boys in the false-negative group were rated as more shy than their true-negative counterparts, but girls in the false-negative group were rated as less shy than their counterparts in the true-negative group. CONCLUSIONS: This is the first study to reveal that children who pass M-CHAT screening at 18 months and are later diagnosed with ASD exhibit delays in core social and communication areas as well as fine motor skills at 18 months. Differences appeared to be more pronounced in girls. With these findings, we underscore the need to enhance the understanding of early markers of ASD in boys and girls, as well as factors affecting parental report on early delays and abnormalities, to improve the sensitivity of screening instruments.

Sex-Differences in Children Referred for Assessment: An Exploratory Analysis of the Autism Mental Status Exam (AMSE).

The autism mental status exam is an eight-item observational assessment that structures the way we observe and document signs and symptoms of ASD. Investigations of test performance indicate strong sensitivity and specificity using gold-standard assessment as reference standard. This study aims to explore potential sex differences in AMSE test performance and observations of 123 children referred for autism assessment. Results indicates more language deficits in females with ASD than in males with ASD and less sensory symptoms in females compared to males with ASD. The AMSE performance is similar in identifying ASD and non-ASD in females compared to males. Less disruptive behaviors in females, might cause a need for a bigger hit to other areas of development to raise concern.

Parent-Endorsed Sex Differences in Toddlers with and Without ASD: Utilizing the M-CHAT.

Sex differences in typical development can provide context for understanding ASD. Baron-Cohen (Trends Cogn Sci 6(6):248-254, 2002) suggested ASD could be considered an extreme expression of normal male, compared to female, phenotypic profiles. In this paper, sex-specific M-CHAT scores from N = 53,728 18-month-old toddlers, including n = 185 (32 females) with ASD, were examined. Results suggest a nuanced view of the "extreme male brain theory of autism". At an item level, almost every male versus female disadvantage in the broader population was consistent with M-CHAT vulnerabilities in ASD. However, controlling for total M-CHAT failures, this male disadvantage was more equivocal and many classically ASD-associated features were found more common in non-ASD. Within ASD, females showed relative strengths in joint attention, but impairments in imitation.

Brief Report: Parent-Reported Problems Related to Communication, Behavior and Interests in Children with Autistic Disorder and Their Impact on Quality of Life.

Parents of children with Autism spectrum disorders often report elevated levels of stress, depression and anxiety compared to parents of children with other developmental disorders. The present study investigated experiences of mothers of children with autistic disorder, both boys and girls. The results show that mothers report problems related to communication, behavior and interests of their child, which impact their quality of life. There were also differences between boys and girls.

Uptake and adherence of a self-directed internet-based mental health intervention with tailored e-mail reminders in senior high schools in Norway.

BACKGROUND: Internet-based cognitive behavioural therapy (ICBT) is a promising approach to the prevention and reduction of depressive symptoms among adolescents. This study aimed to evaluate the feasibility and efficacy of disseminating a self-directed internet-based mental health intervention (MoodGYM) in senior high schools. It also sought to investigate possible effects of tailored and weekly e-mail reminders on initial uptake and adherence to the intervention. METHOD: A baseline survey was conducted in four senior high schools in two Norwegian municipalities (n = 1337). 52.8% (707/1337) of the students consented to further participation in the trial and were randomly allocated to one of three MoodGYM intervention groups (tailored weekly e-mail reminder (n = 175), standardized weekly e-mail reminder (n = 176 ) or no e-mail reminder (n = 175)) or a waitlist control group (n = 180). We tested for effects of the intervention on depression and self-esteem using multivariate analysis of variance, effects of tailored e-mail and self-reported current need of help on initial uptake of the intervention using logistic regression and the effect of weekly e-mails on adherence using ordinal regression. RESULTS: There was substantial non-participation from the intervention, with only 8.5% (45/527) participants logging on to MoodGYM, and few proceeding beyond the first part of the programme. No significant effect on depression or self-esteem was found among the sample as a whole or among participants with elevated depression scores at baseline. Having a higher average grade in senior high school predicted initial uptake of the intervention, but tailored e-mail and self-reported current need of help did not. Weekly e-mail prompts did not predict adherence. The main reasons for non-use reported were lack of time/forgetting about it and doubt about the usefulness of the program. CONCLUSION: Overall, disseminating a self-directed internet-based intervention to a school population proved difficult despite steps taken to reduce barriers in terms of tailoring feedback and dispatching weekly e-mail reminders. Providing mental health interventions within the school environment is likely to ensure better uptake among senior high school students, but there is a need to effectively communicate that such programmes can be helpful. TRIAL REGISTRATION: The trial was registered retrospectively as ACTRN12612001106820.

Time-trends in the utilization of decentralized mental health services in Norway - A natural experiment: The VELO-project.

BACKGROUND: There are few reports on the effects of extensive decentralization of mental health services. We investigated the total patterns of utilization in a local-bed model and a central-bed model. METHODS: In a time-trend case-registry design, 7635 single treatment episodes, from the specialist and municipality services in 2003-2006, were linked to 2975 individual patients over all administrative levels. Patterns of utilization were analyzed by univariate comparisons and multivariate regressions. RESULTS: Total treated prevalence was consistently higher for the central-bed system. Outpatient utilization increased markedly, in the central-bed system. Utilization of psychiatric beds decreased, only in the central-bed system. Utilization of highly supported municipality units increased in both systems. Total utilization of all types of services, showed an additive pattern in the local-bed system and a substitutional pattern in the central-bed system. Only severe diagnoses predicted inpatient admission in the central-bed system, whereas also anxiety-disorders and outpatient consultations predicted inpatient admission in the local-bed system. Characteristics of the inpatient populations changed markedly over time, in the local-bed system. CONCLUSIONS: Geographical availability is not important as a filter in patients' pathway to inpatient care, and the association between distance to hospital and utilization of psychiatric beds may be an historical artefact. Under a public health-insurance system, local psychiatric personnel as gatekeepers for inpatient care may be of greater importance than the availability of local psychiatric beds. Specialist psychiatric beds and highly supported municipality units for people with mental health problems do not work together in terms of utilization. Outpatient and day-hospital services may be filters in the pathway to inpatient care, however this depends on the structure of the whole service-system. Local integration of psychiatric services may bring about additive, rather than substitutional patterns of total utilization. A large proportion of decentralized psychiatric beds may hinder the development of various local psychiatric services, with negative consequences for overall treated prevalence.

Is parental rearing an associated factor of quality of life in adulthood?

OBJECTIVE: To examine the hypothesis that favorable parental rearing is associated with better quality of life in adulthood. METHODS: Two hundred and ninety seven university students answered questions on quality of life (WHOQOL-BREF), parenting style (s-EMBU), coping strategies (Coping Strategies Inventory), life events (Social Readjustment Rating Scale) and depressive symptoms (Beck Depression Inventory). Data was analyzed by means of hierarchical multiple linear regression. RESULTS: The remote variable of perceived child rearing practices was significantly associated with the quality of life of the students. Maternal emotional warmth was associated with two quality of life domains, psychological and social relationships, in addition to global quality of life. CONCLUSION: These results strengthen the empirical notion that favorable parental care may be associated with better quality of life in adulthood.

Decision-making in the treatment of elderly people: a cross-cultural comparison between Swedish and German physicians and nurses.

Decision-making in the treatment of elderly people: a cross-cultural comparison between Swedish and German physicians and nurses The aim of the study was to evaluate the comparability of decisions in the treatment of severely ill incompetent elderly patients among physicians and nurses from a cross-cultural perspective. Convenience samples of 192 doctors and 182 nurses from Germany and 104 doctors and 122 nurses from Sweden have been investigated by a questionnaire in a cross-sectional study. Between 39 and 58% of the subjects in the various groups have chosen treatment options, which are not consistent with the patient's will. However, nurses showed a significantly higher compliance than doctors. The probability of choosing cardio-pulmonary resuscitation decreased with increasing information about the patient's wish. Ethical concerns and the patient's wishes appeared as the most important determinants of treatment decisions, whereas the hospital costs as well as the physicians' religion were of minor importance. The inconsistencies concerning decision- making within and between the groups reflect differences in underlying values and lack of societal consensus, which represent a prerequisite for the improvement of patient autonomy. To focus more frequently and to a larger extent onto the problems related to the treatment of severely ill elderly patients as well as onto the training of communication skills with an orientation towards informed consent in the medical training seems to be warranted.

Doctors' attitudes and end-of-life decisions in the elderly: a comparative study between Sweden, Germany and Russia.

The study was performed in order to determine cross-culturally to what extent various attitudes (legal and ethical concerns, hospital costs, level of dementia, patient's age, patient's wishes, family wishes, doctor's religion) influence the treatment decisions of doctors in face of a critically ill incompetent elderly patient. Convenience samples of doctors in Sweden (n=104), Germany (n=191) and Russia (n=232) were surveyed by means of a self-administered questionnaire comprising a case-vignette of an incompetent elderly patient. The importance of various attitudes attributed to the treatment decision varied between countries. The differences were mostly pronounced for the importance of hospital costs (highest in Russia), patient and family wishes (both highest in Sweden) and level of dementia (highest in Sweden). They reflect diverging clinical practice and underlying societal values. They point to the necessity of the development of uniform standards and training of doctors in ethical issues.