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Reliable Classification of Case-Control Studies of Autistic Disorder and Obstetric Complications

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Several reports have suggested an association between obstetric complications and autistic disorder. Since conclusions may be drawn from case-control studies, a methodology to identify case-control studies of autistic disorder and obstetric complications for qualitative and quantitative reviews is needed. We sought to establish the feasibility of blinding of reports as a means to remove biases in meta-analyses of case-control studies of autism and obstetric complications. Therefore, we located published reports of case-control studies of autistic disorder and obstetric complications by a literature search and additional articles. The methods or other appropriate portions of the articles were blindly reviewed for the presence or absence of obstetric complications in cases with autistic disorder matched with at least one control without autistic disorder. Good inter-rater reliability was obtained for case-control studies of autistic disorder (74.6% agreement and κ=.451) and for obstetric complications (84.0% agreement and κ=.658).

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ACKNOWLEDGMENTS

This research is sponsored by the The Essel Foundation, the National Alliance for Research on Schizophrenia and Depression (NARSAD), the Rett Syndrome Research Foundation (RSRF), and the Tourette Syndrome Association (TSA), Inc., and the Department of Psychiatry of Bellevue Hospital Center and the New York University School of Medicine. We gratefully acknowledge the cooperation of Bellevue Hospital Center and the Health and Hospitals Corporation of the City of New York. We thank the Ehrman Medical Library of the New York University School of Medicine and the Medical Library of Bellevue Hospital Center for assistance with the literature search and with obtaining the articles. Dr. Brašić is a member of the Medical Advisory Board of the Greater Washington Chapter of the Tourette Syndrome Association in Silver Spring, Maryland. Dr. Brašić is a fellow of the American Academy of Child and Adolescent Psychiatry (AACAP) in Washington, DC.

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Correspondence to James Robert Brašić.

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An earlier version of this paper was presented at the 97th Annual Scientific Assembly of the Southern Medical Association in Atlanta, Georgia, on November 6 to 8, 2003 (Brasic et al., 2003b).

An asterisk (*) indicates the 17 articles fulfilling the criteria and providing data for case-controlstudies of autistic disorder and obstetric complications.

Appendix I

Appendix I

Instructions to blind reviewer of articles to be classified for the presence or absence of a rating of obstetric complications in cases with autistic disorder with at least one control without autistic disorder.

You will be given the methods section or the most appropriate section of articles to determine if the article is an autistic disorder case-control study with ratings of obstetric complications. Please follow these definitions precisely.

An autistic disorder case-control study must include at least one case with autistic disorder matched with at least one control without autistic disorder. If groups of subjects all of whom have autistic disorder are studied without any nonautistic control group, then there is not an autistic case-control study. However, if a group of subjects with autistic disorder are compared with a group of people with Asperger disorder, mental retardation, developmental delay, or any other group without autistic disorder, then there is an autistic disorder case-control study. If an article discusses subjects none of whom are explicitly labeled as having autistic disorder, autism, infantile autism, early infantile autism, infantile psychosis, early infantile psychosis, or Kanner disorder, it is not an autistic disorder case-control study; such a paper should be classified as an other paper for this report. Subjects diagnosed with schizophrenia, childhood schizophrenia, psychosis, developmental delay, or Asperger, Heller, or Rett disorder, or mental retardation should not be classified as autistic for the purposes of this study unless they explicitly have an additional diagnosis of autistic disorder, autism, infantile autism, early infantile autism, infantile psychosis, early infantile psychosis, or Kanner disorder.

Please classify all reports which have at least one subject with autistic disorder, as having an obstetric complications rating scale. For the purposes of this study, there must be at least a notation of the presence or absence of at least one complication of pregnancy or labor in order to be classified as an obstetric complications rating scale. Therefore, more sophisticated descriptions of problems of pregnancy and labor are obstetric complications rating scales.

Thus, please rate every paper as autistic disorder case-control study with obstetric complications rating scale, autistic disorder case-control study without obstetric complications ratings scale, autistic disorder case report without control with obstetric complications rating scale, autistic disorder case report without control without obstetric complications ratings scale, or other.

Appendix II

Translation of Abstract (Mnoukhine et al., 1967) from French to English for classification of the presence or absence of a rating of obstetric complications in cases with autistic disorder with at least one control without autistic disorder.

Mnoukhine, S. S., Zélénetskaja, A. E., and Issaev, D. N. (1967). A propos du syndrome de “l’autisme infantile précoce” ou “syndrome de Kanner” chez les enfants [On the syndrome of “early infantile autism” or “Kanner's syndrome” in children]. Zh. Nevropatol. Psikhiatri. Im. S. S. Korsakova. 67(10): 1501–1506.

The present study represents the first communication in the U. S. S. R. dedicated to the syndrome of infantile autism. The results of observation of 44 children aged 2 to 14 years stricken with this syndrome are reported. These children with weakened contact with the environment are deprived of interests and adequate emotional reactions, goal-directed activity, and the capacity for spontaneous psychic effort.

Speech is well enough developed, but nearly devoid of its informative role. Complex motor acts appear difficult. At the base of the symptoms is found diminution of psychic tone, weakening of instinctive unconditional reactions associated with congenital or precociously acquired insufficiency of the reticular substance, leading to trouble with cortical activity. Associated with this fact the cerebral cortex represents only a passive recording device having lost the capacity of an active elective attitude in relation to the environment. The authors exclude this syndrome from that of schizophrenia and consider it a particular variety of mental immaturity in which in the beginning is observed trouble with affect and volition. The structure of the intellectual deficit in this form of immaturity differs qualitatively from that in the case of true oligophrenia.

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Brašić, J.R., Holland, J.A. Reliable Classification of Case-Control Studies of Autistic Disorder and Obstetric Complications. J Dev Phys Disabil 18, 355–381 (2006). https://doi.org/10.1007/s10882-006-9021-9

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