Současné údaje o vysoké prevalenci (až 1% populace) poruch autistického spektra (PAS) stimulují výzkum časné identifikace těchto poruch. Článek představuje přehled současných poznatků o časné autistické symptomatologii a metodách časné diagnostiky PAS. Podrobně jsou popsány hlavní screeningové studie provedené celopopulačně či na souboru mladších rizikových sourozenců dětí s PAS. Diskutovány jsou parametry screeningových nástrojů Checklist for Autism in Toddlers (CHAT), Modified – Checklist for Autism in Toddlers (M-CHAT), Quantitative Checklist for Autism in Toddlers (Q-CHAT), Early Screening of Autistic Traits (ESAT), Infant Toddler Checklist (ITC) a First Year Inventory (FYI). V závěru je shrnut význam časné intervence., Current findings on high prevalence (up to 1%) of autism spectrum disorders (ASD) encourage further research in the field of early identifica(ion of these disorders. The article presents a review of current knowledge on early autistic symptomatology as well as on the methods of early diagnosis of ASD. Main screening studies carried out both on general population and sam- pies of high-risk siblings of children already diagnosed with ASD are analysed. Pararneters of following screening tests are discussed - Checklist for Autism in Toddlers (CHAT), Modified- Checklist for Autism in Toddlers (M-CHAT), Quantitative Checklist for Autism in Toddlers (Q-CHAT), Early Screening of Autistic Traits (ESAT), Infant Toddler Checklist (ITC) and First Year Inventory (FYI). In the end of the article the importance of early intervention is emphasized., Štěpánka Beranová, Michal Hrdlička., and Obsahuje seznam literatury
Autism spectrum disorders (ASD) are neurodevelopmental disorders characterized by impaired social interaction and communication, as well as repetitive behavior and restricted interests. There is convincing evidence that the intestinal inflammation is involved in etiology of ASD. Increased levels of inflammatory markers were shown to be associated with more aberrant behaviors and communication of subjects with ASD. Calprotectin in the feces is produced by activated neutrophils and epithelial cells of the gut mucosa, and its levels reflect local inflammation of the gastrointestinal tract. Concentration of fecal calprotectin was determined by ELISA method in 87 individuals with ASD and 51 controls, of that 29 siblings of children with ASD and 22 non-related controls. In non-relatives significantly lower values of fecal calprotectin were observed than in both subjects with ASD and their siblings. In the group with ASD significant correlations of fecal calprotectin with all domains of the ADI-R diagnostic tool were found: qualitative abnormalities in reciprocal social interaction and communication, restrictive and repetitive patterns of behavior. Results suggest that low grade intestinal inflammation may be one of factors implicated in the pathophysiology of ASD.
Autoři představují dvě metody tzv. zlatého standardu v diagnostice poruch autistického spektra: diagnostický rozhovor ADI-R (Autism Diagnostic Interview - Revised) a observační metodu ADOS (Autism Diagnostic Observation Schedule) a přinášejí přehled porovnávacích studií obou nástrojů. Některé studie nalezly diagnostickou ekvivalenci obou nástrojů zlatého standardu, některé studie mírně favorizovaly ADOS. Senzitivita obou nástrojů je i při jejich samostatném užití vysoká. Kombinované užití ADI-R a ADOS vede k přesnějším výsledkům především v oblasti specificity. Autoři presentují dvě kazuistiky paralelního klinického užití nástrojů ADI-R a ADOS v diagnostice dvou chlapců ve věku 8,8 a 4,2 let. Oba případy dobře dokumentují teoretický předpoklad, že zatímco v optimálních podmínkách je spolehlivost obou metod srovnatelná, pak tam, kde je spolupráce rodiče či pečovatele jakkoli nespolehlivá, omezená či dokonce nemožná, je užití ADI-R významně limitováno a přednost má vyšetření nástrojem ADOS., The authors discuss two “gold standard” methods for the diagnosis of autism spectrum disorders: ADI-R (Autism Diagnostic Interview - Revised) and ADOS (Autism Diagnostic Observation Schedule), and review comparative studies that evaluate the methods. Some of the studies found the instruments to be diagnostically equivalent, other studies slightly favored ADOS. Sensitivity of both methods was high even when used alone. However, the combined use of ADI-R and ADOS led to higher diagnostic specificity. The authors also present two cases describing the parallel clinical use of ADI-R and ADOS as part of the diagnosis of two boys aged 8.8 and 4.2 years, respectively. Both cases effectively demonstrate the following theoretical assumption: whereas the reliability of both methods is comparable under optimal conditions, the use of ADI-R is significantly limited in cases when the cooperation of the parent(s) or caregiver is unreliable, limited, or impossible. In such cases, examination using ADOS is preferred., and Iva Dudová, Michal Hrdlička.
Autism spectrum disorders (ASD) are neurodevelopmental conditions characterized by impairment in social communication and presence of stereotyped/restricted behaviors. Children with ASD very often demonstrate co-morbid psychiatric problems, problems known to be affected by testosterone in neurotypical populations. However, there are few reports investigating relationships between testosterone and psychiatric conditions in children with ASD. The aim of this study was to determine the relationship between plasmatic levels of testosterone and behavioral/emotional problems in pre-pubertal boys with ASD. The study sample consisted of 31 pre-pubertal boys (ages 3-10) with ASD. Parents completed the Nisonger Child Behavior Rating Form (NCBRF) to assess specific behavioral/emotional problems as observed in the previous 2 months. Plasmatic testosterone levels were determined in boys according to standardized procedures. It was found that there were positive correlations between testosterone levels and the conduct problems subscale (p=0.034, rs=0.382) of NCBRF and also between testosterone levels and the hyperactive subscale (p=0.025, rs=0.402) of NCBRF. Findings in this study are in line with research conducted in the neurotypical population. This is the first large study investigating testosterone and emotional/behavioral problems in ASD and warrants further research in this field in order to clarify the etiopathogenesis of psychiatric co-morbidities and improve their treatment., A. Pivovarciova, J. Durdiakova, S. Hnilicova, D. Filcikova, D. Ostatnikova., and Obsahuje bibliografii