Outcome of teenage-onset anorexia nervosa in a Swedish community-based sample Risperidone for the core symptom domains of autism: results from the study by the autism network of the research units on pediatric psychopharmacology. Autism in adults: symptom patterns and early childhood predictors. Use of the DISCO in a community sample followed from childhood. Managing Repetitive Behaviours in Young Children with Autism Spectrum Disorder (ASD): Pilot Randomised Controlled Trial of a New Parent Group Intervention Clinical assessment of autism in high-risk 18-month-olds Serotonergic intervention affects both social dominance and affiliative behaviour Randomized controlled trial of vitamin D supplementation in children with autism spectrum disorder Theory of Mind Training in Children with Autism: A Randomized Controlled Trial A two-year prospective follow-up study of community-based early intensive behavioural intervention and specialist nursery provision for children with autism spectrum disorders. Aetiological relationship between language performance and autistic-like traits in childhood: a twin study. Group-based cognitive behavioural psychotherapy for children and adolescents with ASD: the randomized, multicentre, controlled SOSTA-net trial. Using The Transporters DVD as a Learning Tool for Children with Autism Spectrum Disorders (ASD) A Randomized Controlled Trial of the Korean Version of the PEERS® Parent‐Assisted Social Skills Training Program for Teens With ASD ‘Everyday Memory’ Impairments in Autism Spectrum Disorders Cognitive behavior therapy for comorbid obsessive-compulsive disorder in high-functioning autism spectrum disorders: a randomized controlled trial. Impact of providing psychiatry specialty pharmacist intervention on reducing drug‐related problems among children with autism spectrum disorder related to disruptive behavioural symptoms: A prospective randomized open‐label study
Abstract . In a prospect i ve long-term outcome study of a representative sample of teenage-onset anorexia nervosa ( AN ) , 51 individuals with AN , recruited after community screening , were contrasted with 51 matched comparison cases at a mean age of 24 years ( 10 years after AN onset ) . All 102 cases had been examined at age 16 and 21 years . At 24 years all prob and s were interviewed regarding mental and physical health , and overall outcome was assessed . Ten-year outcome of teenage-onset AN seemed to be relatively favourable in that half of all cases were free from eating disorder ( ED ) and other axis I disorder . There were no deaths . However , one in four in the AN group had a persisting ED , 3 of whom still had AN . Lifetime diagnoses of affective disorders and obsessive-compulsive disorder ( OCD ) were overrepresented in the AN group . Affective disorders coincided with the ED , and were not a problem after recovery from the ED . On the other h and , OCD , OCPD ( obsessive-compulsive personality disorder ) , and /or autism spectrum disorder continued to characterise more than one-third of the AN cases . One in six of the AN group had persistent problems with social interaction and obsessive compulsive behaviours from childhood into early adult years . Half the AN group had a poor overall outcome . These were subjects with either persisting ED or lifelong problems with social interaction and obsessive compulsive behaviour OBJECTIVE Risperidone has been found efficacious for decreasing severe tantrums , aggression , and self-injurious behavior in children and adolescents with autistic disorder ( autism ) . The authors report on whether risperidone improves the core symptoms of autism , social and communication impairment and repetitive and stereotyped behavior . METHOD The data base from an 8-week double-blind , placebo-controlled trial ( N=101 ) and 16-week open-label continuation study ( N=63 ) of risperidone for children and adolescents with autism was used to test for drug effects on secondary outcome measures : scores on the Ritvo-Freeman Real Life Rating Scale , the Children 's Yale-Brown Obsessive Compulsive Scale , and the maladaptive behavior domain of the Vinel and Adaptive Behavior Scales . RESULTS Compared to placebo , risperidone led to a significantly greater reduction in the overall score on the Ritvo-Freeman Real Life Rating Scale , as well as the scores on the subscales for sensory motor behaviors ( subscale I ) , affectual reactions ( subscale III ) , and sensory responses ( subscale IV ) . No statistically significant difference was observed , however , on the subscale for social relatedness ( subscale II ) or language ( subscale V ) . Risperidone also result ed in significantly greater reductions in scores on the Children 's Yale-Brown Obsessive Compulsive Scale and Vinel and maladaptive behavior domain . This pattern of treatment response was maintained for 6 months . CONCLUSIONS Risperidone led to significant improvements in the restricted , repetitive , and stereotyped patterns of behavior , interests , and activities of autistic children but did not significantly change their deficit in social interaction and communication . Further research is necessary to develop effective treatments for the core social and communicative impairments of autism BACKGROUND Few studies have looked at the very long-term outcome of individuals with autism who were diagnosed in childhood . METHODS A longitudinal , prospect i ve , community-based follow-up study of adults who had received the diagnosis of autism ( classic and atypical ) in childhood ( n = 105 ) was conducted . A structured interview ( the Diagnostic Interview for Social and COmmunication disorders -- the DISCO ) was used in order to evaluate symptoms and symptom patterns 13 - 22 years after original diagnosis . Childhood measures , including IQ-level at time of childhood diagnosis and communicative speech registered before age 5 years , were studied in relation to the presence of autism symptoms at follow-up . RESULTS The classical and atypical autism groups were fairly homogeneously impaired in terms of symptoms in the social interaction category whereas other common childhood autism symptoms , including maladaptive and stereotyped behaviours , were more variable in the study group at follow-up . Odd responses to sensory stimuli were still extremely common . Speech before 5 years of age , IQ , gender , diagnosed medical disorder and onset of epilepsy before 5 years were variables that correlated to outcome on the DISCO algorithm for autistic spectrum disorders ( Wing & Gould , 1979 ) concerning style and quality of social interaction , communication style and pattern of self-chosen activities . CONCLUSIONS Social interaction problems were still present in the vast majority of adults with autism/atypical autism , but behavioural impairments were much more variable in adulthood . Almost all cases were reported to show persistent perceptual problems . Certain childhood measures were found to prospect ively predict adult social interaction style , communication type , and pattern of self-chosen activities , which still met diagnostic criteria for autism/atypical autism in adulthood Early intervention for autism spectrum disorder ( ASD ) tends to focus on enhancing social-communication skills . We report the acceptability , feasibility and impact on child functioning of a new 8 weeks parent-group intervention to manage restricted and repetitive behaviours ( RRB ) in young children with ASD aged 3–7 years . Forty-five families took part in the pilot RCT . A range of primary and secondary outcome measures were collected on four occasions ( baseline , 10 , 18 and 24 weeks ) to capture both independent ratings and parent-reported changes in RRB . This pilot established that parents were willing to be recruited and r and omised , and the format and content of the intervention was feasible . Fidelity of delivery was high , and attendance was 90 % . A fully powered trial is now planned Earlier intervention improves outcomes for children with autism spectrum disorders ( ASDs ) , but existing identification tools are at the limits of st and ardization with 18-month-olds . We assessed potential behavioural markers of ASD at 18 months in a high-risk cohort of infant siblings of children with ASD . Prospect i ve data were collected using the Autism Diagnostic Observation Schedule ( ADOS ) and Autism Observation Scale for Infants ( AOSI ) on 155 infant siblings and 73 low-risk controls at 18 months . Infants were classified into three groups ( ASD sibs , non-ASD sibs , controls ) based on blind best-estimate diagnosis at age 3 . Fisher 's exact tests , followed by discriminant function analyses , revealed that the majority of informative ADOS items came from the social and behavioural domains , and AOSI items measuring behavioural reactivity and motor control contributed additional information . Findings highlight the importance of considering not only social-communication deficits , but also basic dimensions of temperament including state regulation and motor control when assessing toddlers with suspected ASD Heading Abstract Rationale . Deficiencies in serotonin function have been associated with irritability and aggression but enhancing serotonin has also been shown to promote social status and affiliative behaviour in non-human primates and more recently in humans . Objectives . To investigate the effects of citalopram , a selective serotonin reuptake inhibitor ( SSRI ) , on social behaviour with a flatmate and a stranger . Methods . Ten pairs of healthy volunteers took part in a r and omized double-blind crossover study of 2 weeks treatment with citalopram ( 20 mg/day ) and placebo with a 2-week washout period . In each pair , one person ( subject ) took the tablets and the other ( flatmate ) received no treatment . On the last day of each treatment period , the subjects socially interacted with a confederate behaving as a responsive person in a stranger-dyadic social interaction paradigm . After the interaction , subjects played the Mixed-motive game , which measures cooperative behaviour and communication , with the confederate . The flatmates evaluated the social behaviour of the subjects before and at the end of the treatment periods . Results . On citalopram , the subjects were rated as significantly less su bmi ssive by their flatmates and they showed a dominant pattern of eye contact in the stranger-dyadic social interaction paradigm . They also reduced the number of points they awarded themselves and sent more cooperative messages during the game . Conclusions . These results indicate that administration of an SSRI can modify social status in different interactions and increase affiliative behaviour . They implicate a role for serotonin in modulating social aspects of behaviour BACKGROUND Autism spectrum disorder ( ASD ) is a frequent developmental disorder characterized by pervasive deficits in social interaction , impairment in verbal and nonverbal communication , and stereotyped patterns of interests and activities . It has been previously reported that there is vitamin D deficiency in autistic children ; however , there is a lack of r and omized controlled trials of vitamin D supplementation in ASD children . METHODS This study is a double-blinded , r and omized clinical trial ( RCT ) that was conducted on 109 children with ASD ( 85 boys and 24 girls ; aged 3 - 10 years ) . The aim of this study was to assess the effects of vitamin D supplementation on the core symptoms of autism in children . ASD patients were r and omized to receive vitamin D3 or placebo for 4 months . The serum levels of 25-hydroxycholecalciferol ( 25 (OH)D ) were measured at the beginning and at the end of the study . The autism severity and social maturity of the children were assessed by the Childhood Autism Rating Scale ( CARS ) , Aberrant Behavior Checklist ( ABC ) , Social Responsiveness Scale ( SRS ) , and the Autism Treatment Evaluation Checklist ( ATEC ) . TRIAL REGISTRATION NUMBER UMIN-CTR Study Design : trial number : UMIN000020281 . RESULTS Supplementation of vitamin D was well tolerated by the ASD children . The daily doses used in the therapy group was 300 IU vitamin D3/kg/day , not to exceed 5,000 IU/day . The autism symptoms of the children improved significantly , following 4-month vitamin D3 supplementation , but not in the placebo group . This study demonstrates the efficacy and tolerability of high doses of vitamin D3 in children with ASD . CONCLUSIONS This study is the first double-blinded RCT proving the efficacy of vitamin D3 in ASD patients . Depending on the parameters measured in the study , oral vitamin D supplementation may safely improve signs and symptoms of ASD and could be recommended for children with ASD . At this stage , this study is a single RCT with a small number of patients , and a great deal of additional wide-scale studies are needed to critically vali date the efficacy of vitamin D in ASD Many children with Autism Spectrum Disorders ( ASD ) participate in social skills or Theory of Mind ( ToM ) treatments . However , few studies have shown evidence for their effectiveness . The current study used a r and omized controlled design to test the effectiveness of a 16-week ToM treatment in 8–13 year old children with ASD and normal IQs ( n = 40 ) . The results showed that , compared to controls , the treated children with ASD improved in their conceptual ToM skills , but their elementary underst and ing , self reported empathic skills or parent reported social behaviour did not improve . Despite the effects on conceptual underst and ing , the current study does not indicate strong evidence for the effectiveness of a ToM treatment on the daily life mindreading skills BACKGROUND This prospect i ve study compared outcome for pre-school children with autism spectrum disorders ( ASD ) receiving autism-specific nursery provision or home-based Early Intensive Behavioural Interventions ( EIBI ) in a community setting . METHODS Forty-four 23- to 53-month-old children with ASD participated ( 28 in EIBI home-based programmes ; 16 in autism-specific nurseries ) . Cognitive , language , play , adaptive behaviour skills and severity of autism were assessed at intake and 2 years later . RESULTS Both groups showed improvements in age equivalent scores but st and ard scores changed little over time . At follow-up , there were no significant group differences in cognitive ability , language , play or severity of autism . The only difference approaching significance ( p = .06 ) , in favour of the EIBI group , was for Vinel and Daily Living Skills st and ard scores . However , there were large individual differences in progress , with intake IQ and language level best predicting overall progress . CONCLUSIONS Home-based EIBI , as implemented in the community , and autism-specific nursery provision produced comparable outcomes after two years of intervention BACKGROUND Impairments in language and communication are core features of autism spectrum disorders ( ASDs ) . The basis for this association is poorly understood . How early language is related to each of the triad of impairments characteristic of ASDs is also in need of clarification . AIMS This is the first study that aims to determine the extent to which shared genetic and environmental factors underlie the association between  early language performance and autistic-like traits ( ALTs ) in middle childhood . METHODS & PROCEDURES Data came from a population -based twin sample ( n = 6087 pairs ) assessed prospect ively at 2 , 3 , 4 and 8 years .  ALTs  measured by the Childhood Asperger Syndrome Test ( CAST )  at 8 years were investigated in relation to language assessed by the MacArthur Communicative Development Inventory ( CDI ) at 2 , 3 and 4 years . Multivariate model fitting techniques were used to analyse the origins of this association . OUTCOMES & RESULTS Total CAST scores , as well as Social and Communication subscales , at 8 years were weakly but significantly negatively correlated with language ability at 2 , 3 and 4 years . Correlations between language and restrictive and repetitive behaviours and interests ( RRBI ) were not significant . The phenotypic correlations between language and Social and Communication ALTs were almost entirely mediated by shared genetic influences . There were specific genetic influences on early language that were not shared with ALTs , and specific genetic influences on ALTs not shared with earlier language performance . CONCLUSIONS This is the first study to demonstrate shared genetic influences in relation to language performance as an early antecedent of later ALTs . These results support the idea that the triad of core features in ALTs are aetiologically heterogeneous , with early language relating to social and communication impairments but not RRBIs BACKGROUND Group-based psychotherapy in Autism Spectrum Disorder ( ASD ) has predominantly been studied in the United States by small studies in school-aged children without long-term follow-up . We report results of a large , confirmatory , multicentre r and omized-controlled phase-III trial in children and adolescents study ing the ASD specific , manualized group-based cognitive behavioural SOSTA-FRA approach . METHODS High-functioning ASD individuals aged 8 - 19 years old were r and omized to 12 sessions SOSTA-FRA or treatment as usual . Primary outcomes were change in total raw score of the parent-rated Social Responsiveness Scale ( pSRS ) between baseline ( T2 ) and end of intervention ( T4 ) , and between T2 and 3 months after end of intervention ( T5 ) . TRIAL REGISTRATION IS RCT N94863788 . RESULTS Between 20/5/2010 and 14/2/2013 , n = 320 ASD patients were screened , n = 228 patients were r and omized , and N = 209 analysed .  Mean pSRS difference between groups at T4 was -6.5 ( 95 % CI -11.6 to - 1.4 ; p = .013 ) , and at T5 -6.4 ( -11.5 to -1.3 , p = .015 ) . Pre-treatment SRS and IQ were positively associated with stronger improvement at T4 and T5 . CONCLUSIONS Short-term ASD-specific add-on group-based psychotherapy has shown postintervention efficacy with regard to parent-rated social responsiveness predominantly in male high-functioning children and adolescents with ASD . Future studies should implement blinded st and ardized observational measures of peer-related social interaction Data from two groups of children who were r and omly allocated to those groups showed that the ability of children with ASD to identify and label basic and complex facial expressions following a 3-week home based DVD intervention significantly improved when viewing The Transporters DVD . Improvements in emotion recognition appear related to the content of the DVD as participants in a control group who observed an alternate DVD showed no such improvement . Although social behaviour improved significantly as a result of watching The Transporters , a significant improvement in social behaviour was however , also observed in the Thomas the Tank Engine condition suggesting the unique content of The Transporters DVD was not pivotal to the improvement of social behaviour in general Impaired social functioning is a hallmark feature of autism spectrum disorder ( ASD ) , often requiring treatment throughout the life span . PEERS ® ( Program for the Education and Enrichment of Relational Skills ) is a parent‐assisted  social skills training for teens with ASD . Although PEERS ® has an established evidence base in improving the social skills of adolescents and young adults with ASD in North America , the efficacy of this treatment has yet to be established in cross‐cultural validation trials . The objective of this study is to examine the feasibility and treatment efficacy of a Korean version of PEERS ® for enhancing social skills through a r and omized controlled trial ( RCT ) .The English version of the PEERS ® Treatment Manual ( Laugeson & Frankel , 2010 ) was translated into Korean and review ed by 21 child mental health professionals . Items identified as culturally sensitive were surveyed by 447 middle school students , and material was modified accordingly . Participants included 47 teens between 12 and 18 years of age with a diagnosis of ASD and a verbal intelligence quotient ( IQ ) ≥ 65 . Eligible teens were r and omly assigned to a treatment group ( TG ) or delayed treatment control group ( CG ) . Primary outcome measures included question naires and direct observations quantifying social ability and problems directly related to ASD . Secondary outcome measures included scales for depressive symptoms , anxiety , and other behavioral problems . Rating scales for parental depressive symptoms and anxiety were examined to detect changes in parental psychosocial functioning throughout the PEERS ® treatment . Independent sample s t‐tests revealed no significant differences at baseline across the TG and CG conditions with regard to age ( 14.04 ± 1.64 and 13.54 ± 1.50 years ) , IQ ( 99.39 ± 18.09 & 100.67 ± 16.97 ) , parental education , socioeconomic status , or ASD symptoms ( p < 0.05 ) , respectively . Results for treatment outcome suggest that the TG showed significant improvement in communication and social interaction domain scores on the Autism Diagnostic Observation Schedule , interpersonal relationship and play/leisure time on the subdomain scores of the Korean version of the Vinel and Adaptive Behavior Scale ( p 's < 0.01 ) , social skills knowledge total scores on the Test of Adolescent Social Skills Knowledge — Revised ( p < 0.01 ) , and decreased depressive symptoms on the Child Depression Inventory following treatment ( p < 0.05 ) . Analyses of parental outcome reveal a significant decrease in maternal state anxiety in the TG after controlling for potential confounding variables ( p < 0.05 ) . Despite cultural and linguistic differences , the PEERS ® social skills intervention appears to be efficacious for teens with ASD in Korea with modest cultural adjustment . In an RCT , participants receiving the PEERS ® treatment showed significant improvement in social skills knowledge , interpersonal skills , and play/leisure skills , as well as a decrease in depressive symptoms and ASD symptoms . This study represents one of only a few cross‐cultural validation trials of an established evidence ‐based treatment for adolescents with ASD . Autism Res 2014 , 7 : 145–161 . © 2014 International Society for Autism Research , Wiley Periodicals , Abstract ‘ Everyday memory ’ is conceptualised as memory within the context of day-to-day life and , despite its functional relevance , has been little studied in individuals with autism spectrum disorders ( ASDs ) . In the first study of its kind , 94 adolescents with an ASD and 55 without an ASD completed measures of everyday memory  from the Rivermead Behavioural Memory Test ( RBMT ) and a st and ard word recall task ( Children ’s Auditory Verbal Learning Test-2 : CAVLT-2 ) . The ASD group showed significant impairments on the RBMT  , including in prospect i ve memory , alongside impaired performance on the CAVLT-2 . Social and communication ability was significantly associated with prospect i ve remembering in an everyday memory context but not with the CAVLT-2 . The complex nature of everyday memory and its relevance to ASD is discussed BACKGROUND High rates of anxiety disorders , particularly obsessive compulsive disorder ( OCD ) are reported in people with Autism spectrum disorders ( ASD ) .  Group cognitive behavioral treatment ( CBT ) has been found effective for anxiety in young people with ASD but not been OCD specific . One uncontrolled pilot study of individual CBT for OCD for adults with ASD showed good treatment efficacy . METHODS Forty-six adolescents and adults ( mean age 26.9 years , 35 Males ) with ASD and comorbid OCD were r and omized to CBT for OCD or anxiety management ( AM ) , a plausible control treatment . Treatments were matched in duration ( mean of 17.4 sessions CBT ; 14.4 sessions AM ) , the Yale-Brown Obsessive Compulsive Severity Scale ( YBOCS ) as primary outcome measure and evaluations blind to treatment group . Treatment response was defined as > 25 % reduction in YBOCS total severity scores . RESULTS Both treatments produced a significant reduction in OCD symptoms , within-group effect sizes of 1.01 CBT group and 0.6 for the AM group . There were no statistically significant differences between the two groups at end of treatment , although more responders in the CBT group ( 45 versus 20 % ) . Effect sizes for self-rated improvement were small ( 0.33 CBT group ; -0.05 AM group ) . Mild symptom severity was associated with improvement in the AM but not the CBT group . Family/carer factors were important for both groups , in that increased family accommodation was associated with poorer outcome . CONCLUSIONS Evidence -based psychological interventions , both AM and CBT , were effective in treating comorbid OCD in young people and adults with ASD WHAT IS KNOWN AND OBJECTIVES Psychopharmacologic therapy has so far focused on ameliorating disruptive behaviours to improve patient 's function and quality of life . Due to the complicated neurobiological aetiology of autism spectrum disorder ( ASD ) , a traditional pharmacist intervention may be insufficient to initiate the optimal care for this vulnerable population . We evaluate the impact of providing specialty psychiatry ( PS ) pharmacist intervention in identifying and resolving drug-related problems ( DRPs ) among children with ASD associated with disruptive behaviours . METHODS An eight-week-long , prospect i ve , r and omized open-label study was conducted . Children between 2.5 and 12 years of age with ASD and showing disruptive behaviours were included . They were r and omly assigned to an intervention or a control group . Patients in the intervention group received pharmacist interventions delivered by a PS pharmacist , while those in control group were cared by a hospital pharmacist . The primary outcome was the number of patients who resolved of at least one DRP by the end of the study . The secondary outcome was to compare the mean Aberrant Behavior Checklist-Irritability ( ABC-I ) scores between the two groups . RESULTS Twenty-five patients were r and omly assigned to either an intervention or control group . At week 8 , the total number of patients who resolved of at least one DRP was 13 ( 52 % ) in the intervention group and 4 ( 16 % ) in the control group , respectively ( P=.016 ) . Improper drug selection , medication non-adherence and subtherapeutic dosage were the most common DRPs . Mean ABC-I scores improved in the intervention group more than in the control group ( 9.8±5.6 vs 17.7±7.9 ; P<.001 ) . WHAT IS NEW AND CONCLUSION To the best of our knowledge , this is the first study which demonstrated that PS pharmacist intervention is an effective strategy to resolve DRPs in patient with ASD . The reduction in common DRPs mostly result ed from the PS pharmacist interventions , including selection of antipsychotic agent , adjustment of dosage based on ABC-I scores and provision of individualized drug counselling . Reducing DRPs led to the improvement of any disruptive behaviour . In addition , multidisciplinary team should develop drug therapy protocol s to promote the role of pharmacists in this setting
AUTHORS ' CONCLUSIONS There is no evidence of effect of SSRIs in children and emerging evidence of harm .
BACKGROUND Autism spectrum disorders ( ASD ) are characterised by abnormalities in social interaction and communication skills , as well as stereotypic behaviours and restricted activities and interests .
Selective serotonin reuptake inhibitors ( SSRIs ) are prescribed for the treatment of conditions often comorbid with ASD such as depression , anxiety and obsessive-compulsive behaviours .
OBJECTIVES To determine if treatment with an SSRI:1 .
improves the core features of autism ( social interaction , communication and behavioural problems);2 .
improves other non-core aspects of behaviour or function such as self-injurious behaviour;3 .
improves the quality of life of adults or children and their carers;4 .
has short- and long-term effects on outcome ; 5 .
causes harm .