Autism and Associated Medical and Familial Factors: A Case Control Study

Gail Williams1, Julie M. Oliver1, AnnaMary Allard1, Lonnie Sears1
1Child Evaluation Center, Department of Pediatrics, University of Louisville School of Medicine, Louisville

Tóm tắt

To systematically review medical and familial conditions in autistic subjects (AU) as compared to other developmentally disabled controls (DD). Data was gathered prospectively for 102 AUs and 106 DDs who were comparable for age, sex, and nonverbal intelligence. Chi-square and t test analyses were used to evaluate the data collected for AUs and DDs. Demographic data for AUs and DDs was similar for age, sex, and nonverbal IQ scores. The only statistically significant demographic differences were higher educational levels in mothers of AUs and increased number of firstborn AUs. Family history data revealed a greater number of reported maternal learning disabilities for DDs and increased paternal mental retardation for AUs but no differences in familial medical or psychiatric disorders. No prenatal or perinatal risk factors were identified in the AU group although increased alcohol use during pregnancy and decreased gestational age was found in the DD group. Review of developmental and behavioral issues revealed delayed toileting, tantrums, strong food preferences, and preoccupations to be significantly increased in AUs as compared to DDs. No significant differences were noted between the two groups in health problems or doctor visits. However, AUs had significantly larger mean head size than DDs. This study confirmed several previously established findings in autism including 4 to 1 male prevalence, increased head size, strong food preferences, and lack of prenatal/perinatal findings specifically associated with autism. However, the data suggested no increased prevalence of health problems among AUs or their family members compared to DDs. Several biologic interventions and etiologic theories of autism have been based on the assumption of medical differences in this population, an assumption called into question by current data.

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Tài liệu tham khảo

Bailey, A., LeCouteur, A., Gottesman, I., Bolton, P., Simonoff, E., Yuzda, E., and Rutter, M. (1995). Autism as a strongly genetic disorder: Evidence from a British twin study. Psychol. Med. 25: 63-77.

Bailey, A., Phillips, W., and Rutter, M. (1996). Autism: Towards an integration of clinical, genetic, neuropsychological perspectives. J. Child. Psychol. Psychiatry 37: 89-126.

Barak, Y., Ring, A., Sulkes, J., Cabbaj, V., and Elizur, A. (1995). Season of birth and autistic disorders in Israel. Am. J. Psychiatry 152: 798-802.

Bartlik, B. D. (1981). Monthly variations in births of autistic children in North Carolina. J. Am. Med. Womens. Assoc. 36: 363-368.

Barton, M., and Volkmar, F. R. (1998). How commonly are known medical conditions associated with autism? J. Autism. Dev. Disord. 28(4): 273-278.

Bolton, P. J., Murphy, M., MacDonald, H., Whitlock, B., Pickles, A., and Rutter, M. (1997). Obstetric complications in autism: Consequences or causes of the condition? J. Am. Acad. Child. Adolesc. Psychiatry 36: 272-281.

Bolton, P. E., Pickles, A., Murphy, M., and Rutter, M. (1998). Autism, affective and other psychiatric disorders: Patterns of familial aggregation. Psychol. Med. 28: 385-395.

Comi, A. M., Zimmerman, A. W., Frye, V. H., Law, P. A., and Peeden, J. N. (1999). Familial clustering of autoimmune disorders and evaluation of medical risk factors in autism. J. Child. Neurol. 14: 388-394.

Dalrymple, N. J., and Ruble, L. A. (1992). Toilet training and behaviors of people with autism: Parent views. J. Autism Dev. Disord. 22: 265-275.

Davidovitch, M., Patterson, B., and Gartside, P. (1996). Head circumference measurements in children with autism. J. Child. Neurol. 11: 389-393.

Delong, G. R., and Dwyer, J. T. (1988). Correlation of family history with specific autistic subgroups: Asperger's syndrome and bipolar affective disorders. J. Autism Dev. Disord. 18: 593-600.

Fombonne, E., Bolton, P., Prior, J., Jordan, H., and Rutter, M. (1997). A family study of autism: Cognitive patterns and levels in parents and siblings. J. Child. Psychol. Psychiatry 38: 667-683.

Gillberg, C., Gillberg, I. C., and Steffenberg, S. (1992). Siblings and parents of children with autism: A controlled population-based study. Dev. Med. Child. Neurol. 34: 389-398.

Hering, E., Epstein, R., Elroy, S., Ianev, D. R., and Zelnik, N. (1999). Sleep patterns in autistic children. J. Autism Dev. Disord. 29: 143-147.

Horvath, K., Stefanatos, G., Sokolski, K. N., Wachtel, R., Nabor, L., and Tildon, J. (1998). Improved social and language skills after secretin administration in patients with autistic spectrum disorders. J. Assoc. Acad. Minor Phys. 9: 9-15.

Jones, M. B., and Szatmari, P. (1988). Stoppage rules and genetic studies of autism. J. Autism Dev. Disord. 18: 31-40.

Konstantareas, M., Hauser, P., Lerox, C., and Homatidis, S. (1986). Season of birth in infantile autism. Child. Psychiatry Hum. Dev. 17: 53-65.

Konstantareas, M., and Homatidis, S. (1987). Brief report: Ear infections in autistic and normal children. J. Autism Dev. Disord. 17: 585-593.

Landa, R., Piven, J., Wzorek, M. M., Gayli, J., Chase, G. A., and Folstein, S. E. (1992). Social language in parents of autistic individuals. J. Speech. Hear. Res. 34: 1339-1345.

Landau, E. C., Cicchetti, D. V., Klin, A., and Volmar, F. R. (1999). Season of birth in autism: A fiction revisited. J. Autism Dev. Disord. 29: 385-393.

Leboyer, M., Plumet, M. H., Goldblum, M., Perez-Dias, F., & Marchaland, C. (1995). Verbal versus visuospatial abilities in relatives of autistic females. Dev. Neuropsychol. 11: 139-155.

LeCouteur, A., Bailey, A., Goode, S., Pickles, A., Robertson, S., Gottesman, I., and Rutter, M. (1996). A broader phenotype of autism: The clinical spectrum in twins. J. Child. Psychol. Psychiatry 37: 785-801.

Minton, J., Cambell, M., Green, W. H., Jennings, S., and Samit, C. (1982). Cognitive assessment of siblings of autistic children. J. Am. Acad. Child Adolesc. Psychiatry 21: 256-261.

Mouridsen, S. E., Nielsen, S., Rich, B., and Isager, T. (1994). Season of birth in infantile autism and other types of childhood psychoses. Child Psychiatry Hum. Dev. 25: 31-43.

Nelson, K. B. (1991). Prenatal and perinatal factors in the etiology of autism. Pediatrics 87(Suppl): 761-766.

Patterson, B., Ekvall, S., and Mayes, S. D. (1993). Autism. In Ekvalls, S. (ed.), Pediatric Nutrition in Chronic Diseases and Developmental Disorders—Prevention, Assessment and Treatment, New York: Oxford University Press; pp. 131-136.

Piven, J., Arndt, S., and Bailey, J. (1996). Regional brain enlargement in autism: A magnetic resonance imaging study. J. Am. Acad. Child Adolesc. Psychiatry 35: 530-536.

Piven, J., Chase, G. A., Landa, R., Wzorek, M., Gayle, J., and Cloud, D. (1991a). Psychiatric disorders in the parents of autistic individuals. J. Am. Acad. Child Adolesc. Psychiatry 29: 177-183.

Piven, J., Chase, G. A., and Nelson, K. B. (1991b). Prenatal and perinatal factors in the etiology of autism. Pediatrics 87(Suppl.): 761-766.

Piven, J., and Palmer, P. (1997). Cognitive deficits in parents from multiple incidence autism families. J. Child Psychol. Psychiatry 38: 1011-1022.

Piven, J., Palmer, P., Jacobi, D., Childress, D., and Arndt, S. (1997a). Broader autism phenotype: Evidence from a family history study of multiple incidence autism families. Am. J. Psychiatry 154: 185-190.

Piven, J., Wzorek, M., Landa, R., Lainhart, J., Bolton, P., Chase, G. A., and Folstein, S. (1994). Personality characteristics of the parents of autistic individuals. Psychol. Med. 24: 783-795.

Piven, J., Palmer, P., Landa, R., Santangelo, S., Jacobi, D., and Childress, D. (1997b). Personality and language characteristics in parents from multiple-incidence autistic families. Am. J. Med. Genet. 74: 398-411.

Rapin, I. (1997). Autism. N. Engl. J. Med. 337(2): 97-103.

Richdale, A. L. (1999). Sleep problems in autism: Prevalence, cause and intervention. Dev. Med. Child Neurol. 41: 60-66.

Ritvo, E. R., Freeman, B. J., Pingree, C., Mason-Brothers, A., Jorde, L., Jenson, W. R., and McMahon, W. M. (1989). The UCLA-University of Utah epidemiologic study of autism: Prevalence. Am. J. Psychiatry 146: 194-199.

Ritvo, E. R., Spence, M. A., Freeman, B. J., Brothers, A., Mo, A., and Marazita, M. L. (1985). Evidence for autosomal recessive inheritance in 46 families with multiple incidence autism. Am. J. Psychiatry 142: 187-192.

Rosenthal, V., Nordin, V., Sandstrom, M., Ahlsen, G., and Gillberg, C. (1999). Autism and hearing loss. J. Autism Dev. Disord. 29: 349-357.

Shearer, T. R., Larson, K., Neuschwander, J., and Gedney, B. (1982). Minerals in the hair and nutrient intake of autistic children. J. Autism Dev. Disord. 72: 25.

Smalley, S. L., Asarnow, R. F., and Spence, A. M. (1988). Autism and genetics. Arch. Gen. Psychiatry 45: 953-961.

Smalley, S. L., McCracken, K., and Tanguay, P. (1995). Autism, affective disorders and social phobia. Am. J. Med. Genet. 60: 19-26.

Szatmari, P., Jones, M. B., Fisman, S., Tuff, L., Bartolucci, G., Mahoney, W. J., and Bryson, S. E. (1995). Parents and collateral relatives of children with pervasive developmental disorders: A family history study. Am. J. Med. Genet. 60: 282-289.

Tsai, L. Y., and Stewart, M. A. (1983). Etiologic implications of maternal age and birth order in infantile autism. J. Autism Dev. Disord. 13: 57-65.

Wakefield, A. J., Murch, S. H., Anthony, A., Linnell, J., Casson, P. M., Malik, M., Berelowitz, M., Dhillon, A. P., Thomson, M. A., Harvey, P., Valentine, A., Davies, S. E., and Walker-Smith, J. A. (1998). Ileal-lymphoid-nodular hyperplasia, nonspecific colitis, and pervasive developmental disorder in children. Lancet. 351: 637-641.

Williams, P. G., and Bloom, A. S. (1999). Case reports in autism: Issues in diagnosis and treatment. J. Ky. Med. Assoc. 97: 56-60.

Williams, P. G., Dalrymple, N. J., and Neal, J. (2000). Eating habits of children with autism. Pediatr. Nurs. 26: 259-264.

Woodhouse, W., Bailey, A., Rutter, M., Bolton, P., Baird, G., and LeCouteur, A. (1996). Head circumference in autism and other pervasive developmental disorders. J. Child. Psychol. Psychiatry 37: 665-671.