Skip to main content

Advertisement

SpringerLink
Log in

Medical conditions affect the outcome of early intervention in preschool children with autism spectrum disorders

  • Original Contribution
  • Published:
European Child & Adolescent Psychiatry Aims and scope Submit manuscript

Abstract

The aim was to explore the frequency of genetic and other medical conditions, including epilepsy, in a population-based group of 208 preschool children with early diagnosis of Autism spectrum disorders (ASD) and to relate outcome at a 2-year follow-up to the co-existing medical findings. They had all received early intervention. The Vineland Adaptive Behaviour Scales (VABS-II) composite score served as the primary outcome measure. In the total group, 38/208 children (18 %) had a significant medical or genetic condition. Epilepsy was present in 6.3 % at the first assessment and in 8.6 % at follow-up and was associated with more severe intellectual impairment. A history of regression was reported in 22 %. Children with any medical/genetic condition, including epilepsy, as well as children with a history of regression had significantly lower VABS-II scores at the 2-year follow-up. Children with a medical/genetic condition, including epilepsy, had been diagnosed with ASD at an earlier age than those without such conditions, and early age at diagnosis also correlated negatively with adaptive functioning outcome. The results underscore the importance of considering medical/genetic aspects in all young children with ASD and the requirement to individualize and tailor interventions according to their specific needs.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Abrahams BS, Geschwind DH (2008) Advances in autism genetics: on the threshold of a new neurobiology. Nat Rev Genet 9:341–355

    Article  PubMed  CAS  Google Scholar 

  2. Adelow C, Andell E, Amark P, Andersson T, Hellebro E, Ahlbom A, Tomson T (2009) Newly diagnosed single unprovoked seizures and epilepsy in Stockholm, Sweden: first report from the Stockholm Incidence Registry of Epilepsy (SIRE). Epilepsia 50:1094–1101

    Article  PubMed  Google Scholar 

  3. Amiet C, Gourfinkel-An I, Bouzamondo A, Tordjman S, Baulac M, Lechat P, Mottron L, Cohen D (2008) Epilepsy in autism is associated with intellectual disability and gender: evidence from a meta-analysis. Biol Psychiatry 64:577–582

    Article  PubMed  Google Scholar 

  4. Aronson M, Hagberg B, Gillberg C (1997) Attention deficits and autistic spectrum problems in children exposed to alcohol during gestation: a follow-up study. Dev Med Child Neurol 39:583–587

    Article  PubMed  CAS  Google Scholar 

  5. Baird G, Charman T, Pickles A, Chandler S, Loucas T, Meldrum D, Carcani-Rathwell I, Serkana D, Simonoff E (2008) Regression, developmental trajectory and associated problems in disorders in the autism spectrum: the SNAP study. J Autism Dev Disord 38:1827–1836

    Article  PubMed  Google Scholar 

  6. Baird G, Simonoff E, Pickles A, Chandler S, Loucas T, Meldrum D, Charman T (2006) Prevalence of disorders of the autism spectrum in a population cohort of children in South Thames: the Special Needs and Autism Project (SNAP). Lancet 368:210–215

    Article  PubMed  Google Scholar 

  7. Berg AT, Langfitt JT, Testa FM, Levy SR, DiMario F, Westerveld M, Kulas J (2008) Global cognitive function in children with epilepsy: a community-based study. Epilepsia 49:608–614

    Article  PubMed  Google Scholar 

  8. Bernabei P, Cerquiglini A, Cortesi F, D’Ardia C (2007) Regression versus no regression in the autistic disorder: developmental trajectories. J Autism Dev Disord 37:580–588

    Article  PubMed  CAS  Google Scholar 

  9. Betancur C (2011) Etiological heterogeneity in autism spectrum disorders: more than 100 genetic and genomic disorders and still counting. Brain Res 1380:42–77

    Article  PubMed  CAS  Google Scholar 

  10. Coleman M, Gillberg C (2012) The autisms. Oxford University Press, Oxford

    Google Scholar 

  11. Danielsson S, Gillberg IC, Billstedt E, Gillberg C, Olsson I (2005) Epilepsy in young adults with autism: a prospective population-based follow-up study of 120 individuals diagnosed in childhood. Epilepsia 46:918–923

    Article  PubMed  Google Scholar 

  12. Dawson G, Rogers S, Munson J, Smith M, Winter J, Greenson J, Donaldson A, Varley J (2010) Randomized, controlled trial of an intervention for toddlers with autism: the early start Denver model. Pediatrics 125:e17–e23

    Article  PubMed  Google Scholar 

  13. Dodds L, Fell DB, Shea S, Armson BA, Allen AC, Bryson S (2011) The role of prenatal, obstetric and neonatal factors in the development of autism. J Autism Dev Disord 41:891–902

    Article  PubMed  Google Scholar 

  14. Eldevik S, Jahr E, Eikeseth S, Hastings RP, Hughes CJ (2010) Cognitive and adaptive behavior outcomes of behavioral intervention for young children with intellectual disability. Behav Modif 34:16–34

    Article  PubMed  Google Scholar 

  15. Engman ML, Lewensohn-Fuchs I, Mosskin M, Malm G (2010) Congenital cytomegalovirus infection: the impact of cerebral cortical malformations. Acta Paediatr 99:1344–1349

    Article  PubMed  Google Scholar 

  16. Fernell E, Hedvall A, Norrelgen F, Eriksson M, Hoglund-Carlsson L, Barnevik-Olsson M, Svensson L, Holm A, Westerlund J, Gillberg C (2010) Developmental profiles in preschool children with autism spectrum disorders referred for intervention. Res Dev Disabil 31:790–799

    Article  PubMed  Google Scholar 

  17. Fernell E, Hedvall A, Westerlund J, Hoglund Carlsson L, Eriksson M, Barnevik Olsson M, Holm A, Norrelgen F, Kjellmer L, Gillberg C (2011) Early intervention in 208 Swedish preschoolers with autism spectrum disorder. A prospective naturalistic study. Res Dev Disabil 32:2092–2101

    Article  PubMed  Google Scholar 

  18. Fombonne E (2009) Epidemiology of pervasive developmental disorders. Pediatr Res 65:591–598

    Article  PubMed  Google Scholar 

  19. Fong CY, Baird G, Wraige E (2008) Do children with autism and developmental regression need EEG investigation in the absence of clinical seizures? Arch Dis Child 93:998–999

    Article  PubMed  CAS  Google Scholar 

  20. Freitag CM, Feineis-Matthews S, Valerian J, Teufel K, Wilker C (2012) The Frankfurt early intervention program FFIP for preschool aged children with autism spectrum disorder: a pilot study. J Neural Transm [Epub ahead of print]

  21. Gardener H, Spiegelman D, Buka SL (2009) Prenatal risk factors for autism: comprehensive meta-analysis. Br J Psychiatry 195:7–14

    Article  PubMed  Google Scholar 

  22. Hayward D, Eikeseth S, Gale C, Morgan S (2009) Assessing progress during treatment for young children with autism receiving intensive behavioural interventions. Autism 13:613–633

    Article  PubMed  Google Scholar 

  23. Howlin P, Magiati I, Charman T (2009) Systematic review of early intensive behavioral interventions for children with autism. Am J Intellect Dev Disabil 114:23–41

    PubMed  Google Scholar 

  24. Hultman CM, Sparen P, Cnattingius S (2002) Perinatal risk factors for infantile autism. Epidemiology 13:417–423

    Article  PubMed  Google Scholar 

  25. Jensen FE (2011) Epilepsy as a spectrum disorder: implications from novel clinical and basic neuroscience. Epilepsia 52(Suppl 1):1–6

    Article  PubMed  Google Scholar 

  26. Kolevzon A, Gross R, Reichenberg A (2007) Prenatal and perinatal risk factors for autism: a review and integration of findings. Arch Pediatr Adolesc Med 161:326–333

    Article  PubMed  Google Scholar 

  27. Landgren M, Svensson L, Stromland K, Andersson Gronlund M (2010) Prenatal alcohol exposure and neurodevelopmental disorders in children adopted from eastern Europe. Pediatrics 125:e1178–e1185

    Article  PubMed  Google Scholar 

  28. Lord C, Shulman C, DiLavore P (2004) Regression and word loss in autistic spectrum disorders. J Child Psychol Psychiatry 45:936–955

    Article  PubMed  Google Scholar 

  29. Maimburg RD, Vaeth M (2006) Perinatal risk factors and infantile autism. Acta Psychiatr Scand 114:257–264

    Article  PubMed  CAS  Google Scholar 

  30. Mefford HC, Muhle H, Ostertag P, von Spiczak S, Buysse K, Baker C, Franke A, Malafosse A, Genton P, Thomas P, Gurnett CA, Schreiber S, Bassuk AG, Guipponi M, Stephani U, Helbig I, Eichler EE (2010) Genome-wide copy number variation in epilepsy: novel susceptibility loci in idiopathic generalized and focal epilepsies. PLoS Genet 6:e1000962

    Article  PubMed  Google Scholar 

  31. Meilleur AA, Fombonne E (2009) Regression of language and non-language skills in pervasive developmental disorders. J Intell Disabil Res 53:115–124

    Article  Google Scholar 

  32. Miller DT, Adam MP, Aradhya S, Biesecker LG, Brothman AR, Carter NP, Church DM, Crolla JA, Eichler EE, Epstein CJ, Faucett WA, Feuk L, Friedman JM, Hamosh A, Jackson L, Kaminsky EB, Kok K, Krantz ID, Kuhn RM, Lee C, Ostell JM, Rosenberg C, Scherer SW, Spinner NB, Stavropoulos DJ, Tepperberg JH, Thorland EC, Vermeesch JR, Waggoner DJ, Watson MS, Martin CL, Ledbetter DH (2010) Consensus statement: chromosomal microarray is a first-tier clinical diagnostic test for individuals with developmental disabilities or congenital anomalies. Am J Hum Genet 86:749–764

    Article  PubMed  CAS  Google Scholar 

  33. Moore SJ, Turnpenny P, Quinn A, Glover S, Lloyd DJ, Montgomery T, Dean JC (2000) A clinical study of 57 children with fetal anticonvulsant syndromes. J Med Genet 37:489–497

    Article  PubMed  CAS  Google Scholar 

  34. Neville BG, Gindner D (2010) Febrile seizures—semiology in humans and animal models: evidence of focality and heterogeneity. Brain Dev 32:33–36

    Article  PubMed  Google Scholar 

  35. Ozonoff S, Williams BJ, Landa R (2005) Parental report of the early development of children with regressive autism: the delays-plus-regression phenotype. Autism 9:461–486

    Article  PubMed  Google Scholar 

  36. Parmeggiani A, Barcia G, Posar A, Raimondi E, Santucci M, Scaduto MC (2010) Epilepsy and EEG paroxysmal abnormalities in autism spectrum disorders. Brain Dev 32:783–789

    Article  PubMed  Google Scholar 

  37. Rasalam AD, Hailey H, Williams JH, Moore SJ, Turnpenny PD, Lloyd DJ, Dean JC (2005) Characteristics of fetal anticonvulsant syndrome associated autistic disorder. Dev Med Child Neurol 47:551–555

    Article  PubMed  CAS  Google Scholar 

  38. Reddy KS (2005) Cytogenetic abnormalities and fragile-X syndrome in Autism Spectrum Disorder. BMC Med Genet 6:3

    Article  PubMed  Google Scholar 

  39. Reichenberg A, Gross R, Weiser M, Bresnahan M, Silverman J, Harlap S, Rabinowitz J, Shulman C, Malaspina D, Lubin G, Knobler HY, Davidson M, Susser E (2006) Advancing paternal age and autism. Arch Gen Psychiatry 63:1026–1032

    Article  PubMed  Google Scholar 

  40. Saemundsen E, Ludvigsson P, Rafnsson V (2008) Risk of autism spectrum disorders after infantile spasms: a population-based study nested in a cohort with seizures in the first year of life. Epilepsia 49:1865–1870

    Article  PubMed  Google Scholar 

  41. Sebat J, Lakshmi B, Malhotra D, Troge J, Lese-Martin C, Walsh T, Yamrom B, Yoon S, Krasnitz A, Kendall J, Leotta A, Pai D, Zhang R, Lee YH, Hicks J, Spence SJ, Lee AT, Puura K, Lehtimaki T, Ledbetter D, Gregersen PK, Bregman J, Sutcliffe JS, Jobanputra V, Chung W, Warburton D, King MC, Skuse D, Geschwind DH, Gilliam TC, Ye K, Wigler M (2007) Strong association of de novo copy number mutations with autism. Science 316:445–449

    Article  PubMed  CAS  Google Scholar 

  42. Shen Y, Dies KA, Holm IA, Bridgemohan C, Sobeih MM, Caronna EB, Miller KJ, Frazier JA, Silverstein I, Picker J, Weissman L, Raffalli P, Jeste S, Demmer LA, Peters HK, Brewster SJ, Kowalczyk SJ, Rosen-Sheidley B, McGowan C, Duda AW 3rd, Lincoln SA, Lowe KR, Schonwald A, Robbins M, Hisama F, Wolff R, Becker R, Nasir R, Urion DK, Milunsky JM, Rappaport L, Gusella JF, Walsh CA, Wu BL, Miller DT (2010) Clinical genetic testing for patients with autism spectrum disorders. Pediatrics 125:e727–e735

    Article  PubMed  Google Scholar 

  43. Spence SJ, Schneider MT (2009) The role of epilepsy and epileptiform EEGs in autism spectrum disorders. Pediatr Res 65:599–606

    Article  PubMed  Google Scholar 

  44. Steffenburg S, Steffenburg U, Gillberg C (2003) Autism spectrum disorders in children with active epilepsy and learning disability: comorbidity, pre- and perinatal background, and seizure characteristics. Dev Med Child Neurol 45:724–730

    Article  PubMed  Google Scholar 

  45. Szatmari P, Paterson AD, Zwaigenbaum L, Roberts W, Brian J, Liu XQ, Vincent JB, Skaug JL, Thompson AP, Senman L, Feuk L, Qian C, Bryson SE, Jones MB, Marshall CR, Scherer SW, Vieland VJ, Bartlett C, Mangin LV, Goedken R, Segre A, Pericak-Vance MA, Cuccaro ML, Gilbert JR, Wright HH, Abramson RK, Betancur C, Bourgeron T, Gillberg C, Leboyer M, Buxbaum JD, Davis KL, Hollander E, Silverman JM, Hallmayer J, Lotspeich L, Sutcliffe JS, Haines JL, Folstein SE, Piven J, Wassink TH, Sheffield V, Geschwind DH, Bucan M, Brown WT, Cantor RM, Constantino JN, Gilliam TC, Herbert M, Lajonchere C, Ledbetter DH, Lese-Martin C, Miller J, Nelson S, Samango-Sprouse CA, Spence S, State M, Tanzi RE, Coon H, Dawson G, Devlin B, Estes A, Flodman P, Klei L, McMahon WM, Minshew N, Munson J, Korvatska E, Rodier PM, Schellenberg GD, Smith M, Spence MA, Stodgell C, Tepper PG, Wijsman EM, Yu CE, Roge B, Mantoulan C, Wittemeyer K, Poustka A, Felder B, Klauck SM, Schuster C, Poustka F, Bolte S, Feineis-Matthews S, Herbrecht E, Schmotzer G, Tsiantis J, Papanikolaou K, Maestrini E, Bacchelli E, Blasi F, Carone S, Toma C, Van Engeland H, de Jonge M, Kemner C, Koop F, Langemeijer M et al (2007) Mapping autism risk loci using genetic linkage and chromosomal rearrangements. Nat Genet 39:319–328

    Article  PubMed  CAS  Google Scholar 

  46. Tuchman R, Cuccaro M (2011) Epilepsy and autism: neurodevelopmental perspective. Curr Neurol Neurosci Rep 11:428–434

    Article  PubMed  Google Scholar 

  47. Tuchman R, Cuccaro M, Alessandri M (2010) Autism and epilepsy: historical perspective. Brain Dev 32:709–718

    Article  PubMed  Google Scholar 

  48. Warren Z, McPheeters ML, Sathe N, Foss-Feig JH, Glasser A, Veenstra-Vanderweele J (2011) A systematic review of early intensive intervention for autism spectrum disorders. Pediatrics 127:e1303–e1311

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors are grateful to all parents and children participating in the study. Financial support was given from Frimurare Barnhuset Foundation, Sunnerdahls Foundation, Samariten Foundation, Karolinska Institutet Center of Neurodevelopmental Disorders and Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden

    Mats Anders Eriksson & Per Åmark

  2. Department of Psychology, Stockholm University, Stockholm, Sweden

    Joakim Westerlund

  3. Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden

    Åsa Hedvall, Christopher Gillberg & Elisabeth Fernell

  4. Department of Neuropaediatrics, Astrid Lindgren’s Children’s Hospital, Karolinska University Hospital, 17176, Stockholm, Sweden

    Mats Anders Eriksson

Authors
  1. Mats Anders Eriksson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Joakim Westerlund
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Åsa Hedvall
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Per Åmark
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Christopher Gillberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Elisabeth Fernell
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mats Anders Eriksson.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Eriksson, M.A., Westerlund, J., Hedvall, Å. et al. Medical conditions affect the outcome of early intervention in preschool children with autism spectrum disorders. Eur Child Adolesc Psychiatry 22, 23–33 (2013). https://doi.org/10.1007/s00787-012-0312-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00787-012-0312-7

Keywords

Search

Navigation