Early sensory over-responsivity in toddlers with autism spectrum disorders as a predictor of family impairment and parenting stress.

BACKGROUND: Sensory over-responsivity (SOR) affects many individuals with autism spectrum disorders (ASD), often leading to stressful encounters during daily routines. METHODS: This study describes the associations between early SOR symptoms and the longitudinal course of restrictions in family life activities and parenting stress across three time-points in families raising a child with ASD (n = 174). Covariates were child diagnostic severity, emotional problems, and maternal affective symptoms. At time 1 mean chronological age was 28.5 months. Children were administered the Autism Diagnostic Observation Schedule (ADOS) and Mullen Scales of Early Learning (MSEL). Parents completed the Infant Toddler Sensory Profile (ITSP), Infant-Toddler Social Emotional Assessment (ITSEA), Beck Anxiety Index (BAI), and the Center for Epidemiologic Studies Depression Inventory (CES-D) at time 1; and the Parenting Stress Index (PSI) and Family Life Impairment Scale (FLIS) at the three annual time-points. RESULTS: Latent Growth Curve Models indicated that higher SOR scores on the ITSP at time 1 were associated with higher initial levels of family life impairment and parenting stress and with a smaller magnitude of change over time. These associations were independent of severity of ADOS social-communication symptoms, MSEL composite score, ITSEA externalizing and anxiety symptoms, and maternal affective symptoms as measured by the BAI and CES-D. On average FLIS and PSI did not change over time, however, there was significant individual variability. Concurrently, SOR at time 1 explained 39-45% of the variance in family stress and impairment variables. CONCLUSIONS: An evaluation of SOR should be integrated into the assessment of toddlers with ASD considering their role in family life impairment and stress.

Sensory over-responsivity in elementary school: prevalence and social-emotional correlates.

Sensory over-responsivity (SOR) towards tactile and auditory input can impact children's participation in academic and social activities; however the prevalence of SOR behaviors and their relation to social-emotional problems and competence has not been rigorously studied. This study investigated SOR in a representative sample of elementary school-aged children (n = 925, 50% boys, ages 7-11 years) who were followed from infancy. Sixteen percent of parents reported that at least four tactile or auditory sensations bothered their children. Being bothered by certain sensations was common while others were relatively rare. Parents of children with versus without elevated SOR in school-age reported higher frequencies of early and co-occurring internalizing, externalizing, and dysregulation problems, and lower levels of concurrent adaptive social behaviors. Early identification of elevated SOR and assessment of concurrent social-emotional status are important to minimize their impact on social adaptive behaviors at school age.

Sensory clusters of toddlers with autism spectrum disorders: differences in affective symptoms.

BACKGROUND: Individuals with autism spectrum disorders (ASDs) show variability in their sensory behaviors. In this study we identified clusters of toddlers with ASDs who shared sensory profiles and examined differences in affective symptoms across these clusters. METHOD: Using cluster analysis 170 toddlers with ASDs were grouped based on parent rating of the Infant Toddler Sensory Profile (Dunn, 2002) under-responsivity, over-responsivity, and seeking scales. Affective symptoms were evaluated with the Infant Toddler Social Emotional Assessment (Carter & Briggs-Gowan, 2005). RESULTS: Three clusters were identified: (1) low frequency of sensory symptoms (n = 44); (2) high frequency of symptoms (n = 49); and (3) mixed (n = 77); high frequency of under-and over-responsivity and low frequency of seeking). Relative to the low frequency cluster, parents rated toddlers in the high frequency and mixed clusters (both characterized by high frequencies of sensory under- and over-responsivity) as higher on negative emotionality, depression, and anxiety symptoms. Sensory and affective differences among clusters remained after co-varying severity of ASD symptoms. CONCLUSIONS: Interdisciplinary assessments are recommended for toddlers with ASDs in order to identify the interplay of sensory and affective symptoms.

Anxiety sensitivity and auditory perception of heartbeat.

Anxiety sensitivity (AS) is the fear of sensations associated with autonomic arousal. AS has been associated with the development and maintenance of panic disorder. Given that panic patients often rate cardiac symptoms as the most fear-provoking feature of a panic attack, AS individuals may be especially responsive to cardiac stimuli. Consequently, we developed a signal-in-white-noise detection paradigm to examine the strategies that high and low AS individuals use to detect and discriminate normal and abnormal heartbeat sounds. Compared to low AS individuals, high AS individuals demonstrated a greater propensity to report the presence of normal, but not abnormal, heartbeat sounds. High and low AS individuals did not differ in their ability to perceive normal heartbeat sounds against a background of white noise; however, high AS individuals consistently demonstrated lower ability to discriminate abnormal heartbeats from background noise and between abnormal and normal heartbeats. AS was characterized by an elevated false alarm rate across all tasks. These results suggest that heartbeat sounds may be fear-relevant cues for AS individuals, and may affect their attention and perception in tasks involving threat signals.

Prevalence of social-emotional and behavioral problems in a community sample of 1- and 2-year-old children.

OBJECTIVE: To examine the prevalence of infant-toddler social-emotional and behavioral problems and associations with social-emotional competence, interference in family life, and parental worry. METHOD: The sample consisted of 1- and 2-year-old children (mean [MN] age = 24.8 months) from the baseline survey of a representative sample of healthy births (N= 1,280). Parent questionnaires included the Child Behavior Checklist (CBCL/2-3), Parenting Stress Index Short Form (PSI/SF), and Infant-Toddler Social and Emotional Assessment social-emotional competence scales, as well as questions about parental worry and family activities. RESULTS: Approximately 80% of eligible subjects participated. The weighted prevalence of parent-reported subclinical/clinical CBCL/2-3 scores was 11.8% for 2-year-olds. Approximately 6% of parents of 1- and 2-year-olds reported clinical-level scores on the PSI Difficult Child (PSI/DC) scale, which was included as a proxy for behavior problems among 1-year-olds, for whom measures were limited. Sex differences were not observed. CBCL/2-3 and PSI/DC scores were uniquely associated with economic disadvantage (relative risk = 1.89 and 2.24, respectively). Approximately 32% of 2-year-olds with subclinical/clinical CBCL2-3 scores had delayed social-emotional competence. Problems were also associated with parental worry about child behavior and interference in family activities. CONCLUSIONS: A significant need for early identification of emotional/behavioral problems in very young children is highlighted by associations with delayed competence and disruptions in family life that may further contribute to risk for persistent problems.

Listeners who prefer monaural to binaural hearing aids.

Four patients who preferred monaural as compared with binaural amplification were evaluated. For these patients, audiometric data, recognition performance on a dichotic digit task, and monaural and binaural hearing aid performance using four amplification strategies (National Acoustic Laboratories-Revised, a speech in noise algorithm, multiple-microphone arrays, and frequency modulated [FM]) are described. The results of dichotic testing using a one-, two-, and three-pair dichotic digit task in free- and directed-recall conditions indicated a left-ear deficit for all subjects that could not be explained by peripheral auditory findings or by a cognitive-based deficit. The results of soundfield testing using a speech in multitalker babble paradigm indicated that when listening in noise, there was little difference between aided and unaided word-recognition performance, suggesting that the binaural hearing aids originally fit for each patient were not providing substantial benefit when listening in a competing babble background. Word-recognition performance when aided monaurally in the right ear was superior to performance when aided monaurally in the left ear and when aided binaurally. The only successful binaural amplification strategy was the FM system. The results indicate that listeners with an auditory-based deficit in dichotic listening may function better with a monaural hearing aid fitting or with an assistive listening device such as an FM system. The findings also suggest that a test of dichotic listening is an important component in the evaluation of patients being considered for amplification.

Lexical effects on dichotic word recognition in young and elderly listeners.

Dichotic listening was evaluated using monosyllabic word pairs that differed in lexical difficulty as defined by the Neighborhood Activation Model of spoken word recognition. Four combinations of lexically EASY and lexically HARD words were evaluated (same pair: EASY-EASY, HARD-HARD; or mixed pair: EASY-HARD, HARD-EASY) in young adult listeners with normal hearing and older adult listeners with mild-to-moderate hearing loss. The same-pair data indicated that for all subjects, EASY words were identified correctly more often than HARD words, and recognition performance on words presented to the right ear was better than performance on words presented to the left ear. Overall performance was lower and the right-ear advantage was larger for the older group. The mixed-pair data for the young group revealed that EASY words were recognized more accurately than HARD words, regardless of the ear to which they were presented. For the older adults, the words presented to the right ear were recognized more accurately than were the words presented to the left ear, regardless of the type of word. The efficiency of the processing of stimuli from the left ear is discussed as an explanation of the results for the mixed-pair conditions.

Relation between slopes of word recognition psychometric functions and homogeneity of the stimulus materials.

This tutorial paper examines the relation between the slope of a mean word recognition function and the homogeneity or variability (with respect to recognition) of the individual stimulus items that compose the test materials. This was studied in terms of both the location (Cartesian) and slope of the psychometric functions of the individual words that compose the materials. Word recognition performances were measured for 100 CID W-22 (Hirsh) words and 100 PB-50 (Rush Hughes) words in quiet (0 to 56 dB HL in 8-dB steps) on 12 subjects with normal hearing. The functions for the individual W-22 words were more homogeneous (less variable) than were the functions for the individual PB-50 words. The mean function for the W-22 words was steeper (3.1%/dB) than the function for the PB-50 words (1.9%/dB). This evaluation of the individual words demonstrates the direct relation between variability of the test items and the slope of the mean psychometric function. The more homogeneous performance is on the individual test items with respect to both location and slope, the steeper the slope of the mean psychometric function.

Maternal depression and comorbidity: predicting early parenting, attachment security, and toddler social-emotional problems and competencies.

OBJECTIVE: To examine relations between maternal depression (in pure and comorbid forms) and mother-infant interactions, infant attachment, and toddler social-emotional problems and competencies. A second objective was to explore sex differences. METHOD: Sixty-nine mother-infant dyads were followed from pregnancy to 30 months postpartum. Depression was measured at multiple times with self-report and interview assessments. Play was assessed at 4 months and attachment status at 14 months postpartum. At 30 months, mothers completed the Child Behavior Checklist and Infant-Toddler Social and Emotional Assessment. RESULTS: Lifetime maternal depression predicted less optimal mother-infant interactions and insecure infant attachment. However, this "depression effect" was accounted for by mothers with comorbid diagnoses, who had less optimal interactions, and infants with higher rates of insecurity than either mothers with depression only or mothers with no psychopathology. Prenatal and postpartum depressive symptoms were associated with problem behaviors and lower competencies for boys. In contrast, quality of early interactions predicted problem behaviors in girls. CONCLUSIONS: It is important to examine the context of maternal depression with respect to additional psychopathology and environmental risks. Maternal depression in the presence of other psychopathology confers risk to the mother-child dyad. Consistent with previous work, risk pathways appear to differ for boys and girls. Early identification and prevention efforts are warranted.

CD44 expression in the developing and growing rat intervertebral disc.

CD44 has been identified at the time of extracellular matrix formation and expansion in several sites of the developing embryo (Wheatley et al. [1993] Development 119:295-306). The nucleus pulposus, consisting of a hydrated extracellular matrix tissue at birth, not previously closely analyzed, was examined for expression of CD44 in the developing and aging rat intervertebral disc. CD44 was identified solely on notochordal cells from the first onset of intervertebral disc formation (day 15 embryo) through the loss of notochordal cells from the nucleus pulposus (12-24 months of age). No CD44 expression was found in the notochordal cells prior to disc formation or in any cells other than the notochordal cells in the annulus fibrosus or nucleus pulposus of the intervertebral disc. Using reverse transcriptase-polymerase chain reaction methodology, the single 365 amino acid CD44 standard, CD44s, open reading frame was amplified from notochordal cells isolated from the nucleus pulposus. Western blot analysis of a cultured nucleus pulposus notochordal cells total protein extract identified a single CD44 species devoid of chondroitin sulfate with a mass of approximately 85 kDa, characteristic of CD44s. Cell surface detection for CD44 was co-localized with hyaluronan and proteoglycans at first appearance of disc formation in the nucleus pulposus.

Toward a developmental operational definition of autism.

Traditional approaches to diagnosing autism emphasize delays in communication and socialization. Traditional diagnostic schemes typically list symptoms (e.g., lack of eye contact), but provide little guidance on how to incorporate information about developmental level in making a diagnosis. Because standardized measures of adaptive behavior can provide information about children's communication, socialization, and other behavior relative to their age, they may be useful tools for diagnosing autism. This study investigated the ability of the Vineland Adaptive Behavior Scales to identify children with autism. Vineland scores and measures of intellectual functioning were obtained for children with autism, PDDNOS, and other developmental disorders (DD). Discriminant function analyses indicated that the autism and combined nonautism (PDDNOS and DD) groups could be differentiated on the basis of socialization, daily living skills, and serious maladaptive behaviors. Socialization alone accounted for 48% of the variance in diagnosis. Using regression analyses derived from a large normative sample, adaptive behavior scores were predicted from chronological age (CA) and mental age (MA). Socialization scores in the autism group were substantially below the level predicted from CA or MA. An index derived from the ratio of actual to predicted socialization scores correctly classified 86% of both autism and nonautism cases. Findings suggest that comparison of obtained Vineland socialization scores to those predicted by CA or MA may be useful in clarifying the diagnosis of autism.

Obsessive compulsive disorder in childhood.

Obsessive compulsive disorder (OCD) involves obsessions and compulsions that cause impairment and distress, and which interfere with children's developmental adaptation and daily functioning. Furthermore, OCD often disrupts peer and family relationships and school performance and may compromise physical health. Once considered rare, recent epidemiologic studies report prevalence rates ranging from 1% in prepubertal children to 4% in adolescents. In addition, children with OCD are at high risk for comorbid psychopathology. Recent theoretic formulations for OCD encourage the integration of both psychological and biological perspectives. To fully understand the cause and course of OCD, integrated assessment of psychological and biological vulnerability as well as prospective longitudinal studies are needed.

Verbal bias in recognition of facial emotions in children with Asperger syndrome.

Thirteen children and adolescents with diagnoses of Asperger syndrome (AS) were matched with 13 nonautistic control children on chronological age and verbal IQ. They were tested on their ability to recognize simple facial emotions, as well as facial emotions paired with matching, mismatching, or irrelevant verbal labels. There were no differences between the groups at recognizing simple emotions but the Asperger group performed significantly worse than the control group at recognizing emotions when faces were paired with mismatching words (but not with matching or irrelevant words). The results suggest that there are qualitative differences from nonclinical populations in how children with AS process facial expressions. When presented with a more demanding affective processing task, individuals with AS showed a bias towards visual-verbal over visual-affective information (i.e., words over faces). Thus, children with AS may be utilizing compensatory strategies, such as verbal mediation, to process facial expressions of emotion.

Body mass index, eating attitudes, and symptoms of depression and anxiety in pregnancy and the postpartum period.

OBJECTIVE: This report describes associations between body mass index (BMI; kg/m2), eating attitudes, and affective symptoms across pregnancy and the postpartum period in a sample of 64 women. METHODS: As part of a larger study, women were recruited during pregnancy and followed prospectively to 14 months postpartum. Measures included self-reported prepregnancy and 4-month postpartum BMI as well as pregnancy, 4-month, and 14-month postpartum eating attitudes (EAT), depressive symptoms (CES-D), and anxiety symptoms (STAI). RESULTS: During pregnancy, symptoms of depression or anxiety were not significantly correlated with concurrent eating attitudes or measures of BMI. However, at 14 months postpartum, measures of eating attitudes and both depression and anxiety symptoms were associated. Measures of BMI were associated with depressive and anxiety symptoms at both 4 and 14 months postpartum. Four-month eating attitudes and BMI predicted 14-month postpartum depressive symptoms, beyond pregnancy, and 4-month postpartum measures of affective symptoms. Results suggested that overweight women were at risk for elevated anxiety at 4 months and depressive symptoms at both 4 and 14 months postpartum. CONCLUSIONS: These results provide evidence for a significant, albeit moderate, relationship between BMI, eating attitudes, and symptoms of depression and anxiety in the postpartum period that are not present during pregnancy.

Social and emotional adjustment in children affected with Gilles de la Tourette's syndrome: associations with ADHD and family functioning. Attention Deficit Hyperactivity Disorder.

This study examined social-emotional functioning in children with Gilles de la Tourette's syndrome (TS) alone and children with TS and Attention Deficit Hyperactivity Disorder (ADHD). In addition, the contribution of family functioning to social competence was examined. Children with a clinical diagnosis of TS were recruited from the Yale Child Study Center TS specialty clinic. Unaffected control children were recruited through newspaper advertisements and announcements within the university and at area schools. The final sample consisted of 72 children (45 boys and 27 girls) between the ages of 8 and 14. Sixteen children met DMS-III-R criteria for TS, 33 children met criteria for TS and ADHD, and 23 children had no psychiatric diagnoses. Children with TS and ADHD evidenced more externalizing and internalizing behavior problems and poorer social adaptation than children with TS only or unaffected controls. Children with TS only were not significantly different from unaffected controls on most measures of externalizing behaviors and social adaptation but did exhibit more internalizing symptoms. Tic symptom severity was not associated with social, behavioral, or emotional functioning among children with TS, even after stratifying by medication status. However, ADHD diagnosis, obsessional symptom severity, and family functioning were significantly associated with social and emotional adjustment among TS children. Moreover, family functioning was associated with social and emotional adjustment even after controlling for TS and ADHD diagnostic status. These findings demonstrate that much of the social and behavioral dysfunction in children with TS is ADHD-specific and children with TS alone have a very different social-emotional profile than do those with TS plus ADHD. Finally, social-emotional adjustment in children with TS is best understood within the family context.

The effect of filtering and inter-digit interval on the recognition of dichotic digits.

The new compact disc from the Department of Veterans Affairs, Tonal and Speech Materials for Auditory, Perceptual Assessment, Disc 2.0 (1998), contains two lists of randomly interleaved 1-, 2-, and 3-pair dichotic digits. Two experiments are reported, in which the effects of low-pass filtering and inter-digit interval on dichotic digit recognition were investigated in adult listeners with normal hearing and with mild-to-moderate cochlear hearing loss. Results demonstrated that in the filtered condition, as the low-pass cutoff was increased, there was an increase in recognition performance for 1-, 2-, and 3-pair dichotic digits. When compared to normative data for the materials, findings indicate that the interleaved 1-, 2-, and 3-pair dichotic digit materials were essentially resistant to the effects of hearing loss. There was no significant change in recognition performance as a function of inter-digit interval. The studied 625-ms range of inter-digit intervals studied produced consistent recognition performance with both groups of listeners.

Cross-species reactivity of a panel of antibodies with monkey and porcine tissue.

The continuing shortage of organs available for transplantation limits the number of patients able to benefit from this highly successful form of therapy. Interest in alternative sources of organs has now turned towards the pig because of its physiological similarity to human. There is a requirement therefore for reagents not only for research purposes but possibly for studying xenotransplants in the clinical situation in the future. In this study, we have concentrated on determining the cross-species reactivity of a large panel of antibodies directed against human leukocyte markers, testing peripheral blood leukocytes and also including renal tissue to determine non-leukocyte cross-reactivity. A total of 63 out of 127 antibodies cross-reacted with cynomolgus monkey cells. Twenty of these antibodies stained similar populations of leukocytes to human, whereas the remaining 43 reacted with clearly different populations. The majority of antibodies (108/127) were unreactive with porcine leukocytes, reflecting the evolutionary differences between pig and man. Of the 19 antibodies cross-reactive with porcine cells, seven reacted with similar proportions of leukocytes to human, whereas the remaining 12 antibodies stained entirely different populations. The most interesting, and potentially most useful, antibodies were four that reacted with human, cynomolgus monkey and porcine tissue in a similar manner, suggesting that the epitopes recognized are present on similar molecules. These antibodies were directed against CD29 (MEM1O1A, K20) and CD18 (BU87, 7E4), the common beta1- and beta2-integrin subunits respectively. This study demonstrates that there are antigens common to cynomolgus monkey, pig and man that react with currently available antibodies. Nevertheless, when determining cross-species reactivity of human antibodies, it is important to consider the possibility that there may be additional non-leukocyte reactivity in other tissues.

Eating attitudes and behaviors in pregnancy and postpartum: global stability versus specific transitions.

Global changes in eating attitudes were examined prospectively across pregnancy and 4 months postpartum in a sample of 90 women. In addition, specific changes in dieting behavior and weight/shape satisfaction were assessed at 4 months postpartum for concurrent and retrospective time points. Measures included the Eating Attitudes Test (EAT) and weight/shape satisfaction in pregnancy and at 4 months postpartum, as well as prepregnancy, pregnancy, and postpartum weight loss efforts. While global EAT scores were stable across time, dieting scores (Factor I) increased between pregnancy and postpartum. Weight/shape satisfaction was higher in pregnancy, and satisfaction was related to EAT scores at 4 months postpartum but not during pregnancy. Prepregnancy dieters and nondieters were best discriminated by higher weights, elevated pregnancy dieting scores, and lower postpartum weight/shape satisfaction. Results emphasize the importance of looking beyond changes in global eating attitudes and behaviors to more specific eating concerns or behaviors. Lastly, the results have implications for identifying women at risk for eating- and weight-related concerns during this period of rapid physical change.

The familial and developmental context of obsessive-compulsive disorder.

This article discusses developmental and familial factors in childhood obsessive-compulsive disorder (OCD) highlighting the spectrum of normative to pathologic obsessions and rituals. In addition, it explores the possible role of family functioning in the emergence and maintenance of OCD in childhood and adolescence. Finally, it posits a developmental model that integrates genetic and neurobiologic vulnerability, cognitive models of information processing, behavioral coping strategies, and familial and peer relationships.