Defining in Detail and Evaluating Reliability of DSM-5 Criteria for Autism Spectrum Disorder (ASD) Among Children.

This paper describes a process to define a comprehensive list of exemplars for seven core Diagnostic and Statistical Manual (DSM) diagnostic criteria for autism spectrum disorder (ASD), and report on interrater reliability in applying these exemplars to determine ASD case classification. Clinicians completed an iterative process to map specific exemplars from the CDC Autism and Developmental Disabilities Monitoring (ADDM) Network criteria for ASD surveillance, DSM-5 text, and diagnostic assessments to each of the core DSM-5 ASD criteria. Clinicians applied the diagnostic exemplars to child behavioral descriptions in existing evaluation records to establish initial reliability standards and then for blinded clinician review in one site (phase 1) and for two ADDM Network surveillance years (phase 2). Interrater reliability for each of the DSM-5 diagnostic categories and overall ASD classification was high (defined as very good .60-.79 to excellent ≥ .80 Kappa values) across sex, race/ethnicity, and cognitive levels for both phases. Classification of DSM-5 ASD by mapping specific exemplars from evaluation records by a diverse group of clinician raters is feasible and reliable. This framework provides confidence in the consistency of prevalence classifications of ASD and may be further applied to improve consistency of ASD diagnoses in clinical settings.

Telomeres: the time factor in essential hypertension.

Essential hypertension, particularly systolic hypertension, can be characterized as a disorder of aging. The diverse expressions of this disorder represent the interactions of a genetic script, the environment, chance, and a temporal factor. The temporal factor, namely the telomeres, is biological, intrinsic, and dynamic. Telomere length is heritable, is inversely related to pulse pressure, and can be modified by reactive oxygen species. The incorporation of a temporal factor into models of essential hypertension may provide a heretofore missing link explaining variations in age-dependent increase in pulse pressure.

Use of positioning to reduce the severity of neonatal narcotic withdrawal syndrome.

OBJECTIVE: This study tested the hypothesis that highly fretful, narcotic-withdrawing neonates experience less distress in a prone-lying position than comparable, supine-lying neonates. STUDY DESIGN: Equivalent numbers of randomly assigned, narcotic-withdrawing newborns were assigned to prone-lying (n = 25) or supine-lying (n = 23) conditions. Subjects in the two groups were similar with regard to gestational age, birth weight, and clinical presentation. Peak and mean withdrawal severity, as measured by Neonatal Abstinence Scoring System (NASS) scores and daily caloric intake, were compared between supine and prone groups by Wilcoxon's two-sample test. RESULTS: The prone-lying neonates had lower peak NASS scores (p < 0.0001), lower mean NASS scores (p < 0.0001), and lower caloric intake (p < 0.001) than supine-lying, narcotic-withdrawing newborns. CONCLUSION: The fretfulness associated with neonatal withdrawal and other stressful conditions can be moderated by laying the affected infant prone. The pronate quieting response is a significant, endogenous source of neonatal pacification.

The neonatal withdrawal inventory: a simplified score of newborn withdrawal.

A new method for the rapid assessment of neonatal withdrawal was tested. Three studies with 80 newborns compared the reliability, sensitivity and specificity of the Neonatal Withdrawal Inventory (NWI) with that of the Neonatal Abstinence Scoring System (NASS), a widely used neonatal withdrawal scale. Interrater reliability for raters assessing neonatal withdrawal with the NWI (range, 0.89-0.98) was superior to that demonstrated by the same raters using the NASS (range, 0.70-0.88). With the NASS as the standard, the sensitivity and specificity of the NWI were 100% at syndrome detection and treatment threshold levels. With use of the NWI, the severity of neonatal withdrawal could be accurately assessed in 10 minutes under case-blinded conditions. The NWI's advantages include brevity, ease of administration, and flexibility. The NWI's simplicity and accuracy commend its wider use as a clinical and experimental tool.