Journal of Child Psychology and Psychiatry, Jul 1, 2004
Increasing numbers of children are referred to Child and Adolescent Mental Health Services becaus... more Increasing numbers of children are referred to Child and Adolescent Mental Health Services because of disruptive behaviour. Recent reviews on the origins of conduct problems indicate that the most severe and persistent forms are found predominantly among males with a range of neurodevelopmental vulnerabilities, which are likely to have biological substrates. In this study, we tested the hypothesis that many children who are identified with conduct disorder actually have a primary deficit in pragmatic language skills, of a quality and degree that is similar to children on the autistic spectrum. We hypothesised that pragmatic difficulties may underlie the antisocial behaviour in a proportion of children who are labelled as conduct disordered. Using the Children's Communication Checklist (Bishop, 1998), we surveyed 142 children who had been referred for clinical investigation, with a predominant diagnosis of either an autistic spectrum condition (n = 87) or conduct disorder (n = 55), and 60 typically developing comparison children. Among children with conduct disorders, males predominated 9:1. On the basis of parent and teacher ratings, two-thirds of those with conduct disorders had pragmatic language impairments and other behavioural features similar in nature and degree to those of children with autism, independent of IQ. In a further study, we surveyed 54 children who had been excluded from elementary schools in a socio-economically disadvantaged inner-London borough and found over two-thirds to have comparable deficits. These findings have both theoretical and practical implications. First, they indicate the presence of communicative problems in a sub-group of children in whom conduct rather than language had been the major concern. Second, they indicate that severe deficits in pragmatic abilities and autistic-like behaviours can coexist with psychiatric conditions other than autism, especially in boys. Third, they imply that the management of many disruptive children could profitably be addressed to ameliorating their social and communicative skill deficits.
Pervasive developmental disordernot otherwise specified (PDD-NOS) is the most common and least sa... more Pervasive developmental disordernot otherwise specified (PDD-NOS) is the most common and least satisfactory of the PDD diagnoses. It is not clearly defined in the diagnostic manuals, limiting the consistency with which it is used by researchers and clinicians. This in turn limits the amount that we have learnt about people with PDD-NOS. In a sample of 256 young people (mean age = 9.1 years) we aimed to implement a clear, transparent definition of PDD-NOS, and then to describe those receiving this diagnosis (n=66), investigating whether they differed from people with autistic disorder (n=97) and Asperger's disorder (n=93). Groups were compared on measures of core PDD symptomatology, associated autistic features, and intelligence. Contrary to the assumption that PDD-NOS is heterogeneous, almost all (97%) of those with PDD-NOS had one distinct symptom pattern, namely impairments in social communication, without significant repetitive and stereotyped behaviours (RSB). Compared to autistic disorder and Asperger's disorder, they had comparably severe but more circumscribed social communication difficulties, with fewer non-social features of autism, such as sensory, feeding and visuo-spatial problems. These individuals appear to have a distinct variant of autism that does not merely sit at the less severe end of the same continuum of symptoms. The current draft guidelines for DSM-V, which insist on the presence of RSBs for any PDD diagnosis, would exclude such people from the autistic spectrum.
Pervasive developmental disordernot otherwise specified (PDD-NOS) is the most common and least sa... more Pervasive developmental disordernot otherwise specified (PDD-NOS) is the most common and least satisfactory of the PDD diagnoses. It is not clearly defined in the diagnostic manuals, limiting the consistency with which it is used by researchers and clinicians. This in turn limits the amount that we have learnt about people with PDD-NOS. In a sample of 256 young people (mean age = 9.1 years) we aimed to implement a clear, transparent definition of PDD-NOS, and then to describe those receiving this diagnosis (n=66), investigating whether they differed from people with autistic disorder (n=97) and Asperger's disorder (n=93). Groups were compared on measures of core PDD symptomatology, associated autistic features, and intelligence. Contrary to the assumption that PDD-NOS is heterogeneous, almost all (97%) of those with PDD-NOS had one distinct symptom pattern, namely impairments in social communication, without significant repetitive and stereotyped behaviours (RSB). Compared to autistic disorder and Asperger's disorder, they had comparably severe but more circumscribed social communication difficulties, with fewer non-social features of autism, such as sensory, feeding and visuo-spatial problems. These individuals appear to have a distinct variant of autism that does not merely sit at the less severe end of the same continuum of symptoms. The current draft guidelines for DSM-V, which insist on the presence of RSBs for any PDD diagnosis, would exclude such people from the autistic spectrum.
Short children are often described as having psychosocial problems. These reports may be inaccura... more Short children are often described as having psychosocial problems. These reports may be inaccurate as former studies have relied largely on parental report. Psychosocial functioning of short children was assessed with the aim of using them and their peers as informants. Twenty two short (mean (SD) height-2.53 (0.28) SD score) prepubertal children aged between 6 and 11 years were recruited from growth clinics. Comparison children were recruited from each case child's class at school. Cognitive and psychosocial functioning was assessed. Peer relationships were measured using sociometry. There were no significant group differences in terms of peer acceptance, self perception, and social competence. Although cases described themselves as receiving less social support from teachers, no differences were evident in other areas of social support. little evidence was found to suggest clinic referred prepubertal short children are psychosocially maladjusted. Further analysis revealed cognitive ability was a better predictor than height for most aspects of behavioural and emotional adjustment.
BACKGROUND Tourette syndrome (TS) is reported in all cultures, although is speculated to be rare ... more BACKGROUND Tourette syndrome (TS) is reported in all cultures, although is speculated to be rare among those of Sub-Saharan African descent. A lack of research exploring TS in the context of Sub-Saharan Africa has meant that it is not yet established whether this apparent rarity is due to a true low prevalence or if identification of the condition merely is unrecognized. The present study aimed to explore health professionals' knowledge and attitudes of the identification, diagnosis and management of TS in Uganda. METHOD A mixed-methods design was used to collect data from 152 Ugandan healthcare professionals by survey. Of these, 6 professionals took part in semi-structured interviews. Data gathered were analyzed with descriptive statistics and qualitatively using thematic analysis. RESULTS Professionals' views and experiences led to conclusions addressing (a) perceived challenges in diagnosing and treating TS in a Ugandan healthcare setting, (b) the role of cultural factors in help-seeking behaviors, and (c) ways by which efforts can be made to build capacity in awareness and clinical care. CONCLUSIONS The findings suggest that TS is present in Uganda, but a number of factors hinder detection rates causing it to be under-reported in the population. This study highlights the need for more focused and adequate training for all healthcare professionals in Uganda and education campaigns to increase awareness among the general public. KEY PRACTITIONER MESSAGE Little is currently known about the presentation of or understanding by professionals around Tourette syndrome in Sub-Saharan Africa. This study found health professionals in Uganda indicated a number of factors which interact and negatively impact recognition rates of tic disorders. This included limited training, exposure, and misconceptions, contributing to a lack of clinical awareness and attention. They also reported a lack of help-seeking behaviors due to parental perceptions and Ugandan traditional, cultural and religious beliefs. Professionals perceive that there are likely large numbers of undiagnosed and untreated children with Tourette syndrome in Uganda. This supports existing literature regarding the diagnostic challenges of neurodevelopmental disorders in Africa and provides an alternative explanation for the assumption that tic disorders may be rare and possible absent in Sub-Saharan Africa. There is a need to develop adequate training regarding tic disorders for all healthcare professionals working in Uganda as well as education campaigns for the general public to increase awareness.
Background The study examined a UK sample of 57 young people with Tourette syndrome (TS). Aims Th... more Background The study examined a UK sample of 57 young people with Tourette syndrome (TS). Aims The purpose of this study was to consider the impact of TS on young people's Quality of Life (QoL). Methods The study used a mixed methods design, combining focus groups and questionnaire data. Child report questionnaires measured QoL and TS symptom severity. Results The results showed that the QoL of children with TS was significantly worse than that of children in a UK normative sample. Analysis of transcripts from the groups identified four main themes; 'TS can be distressing and disabling' , 'struggling to fit into society's expectations of normal behaviour' , 'needing to control tics' and 'TS is one part of who I am'. Conclusions Poorer QoL was associated with increased symptom severity in terms of tics, Attention Deficit Hyperactivity Disorder diagnosis and obsessive compulsive behaviours.
Background: Recent evidence suggests that domains of autistic impairment often occur independentl... more Background: Recent evidence suggests that domains of autistic impairment often occur independently, in the absence of other elements of the syndrome. This raises the possibility that autism is a disorder of multiple underlying impairments, not explicable by one underlying abnormality. Particular impairments may be associated with specific behavioural domains. One domain of interest is ‘Insistence on Sameness’, an empirically derived, heritable dimension that is a component of the repetitive, stereotyped behaviour element of the autism triad. It has been suggested that executive function difficulties underlie some of the repetitive interests and behaviours seen in autism. Objectives: We aimed to investigate whether cognitive inflexibility was associated with one specific element of autistic behaviour, insistence on sameness (IS), but not with the other elements of the syndrome. In a general sense, we aimed to test a ‘multiple underlying impairments’ model of autism. Methods: Cognitiv...
BACKGROUND: Growth failure without organic aetiology but associated with behavioural disturbance ... more BACKGROUND: Growth failure without organic aetiology but associated with behavioural disturbance and psychosocial stress has been termed psychosocial short stature. This condition is not a valid diagnostic entity, but encompasses failure to thrive, stunting ...
ABSTRACT The psychosocial adaptation of children with normal short stature is a matter of concern... more ABSTRACT The psychosocial adaptation of children with normal short stature is a matter of concern to their parents, paediatricians and teachers. Potential areas of dysfunction include cognition, social behaviour, emotional adjustment and self-concept. We have studied a sample of 22 children who were referred to specialists for investigation of short stature (mean height below -2 standard deviation score (SDS)), aged between 6 to 11 years. We gathered parent, teacher and self-reports. Uniquely, we have also used sociometry to measure those children's social adjustment within their classrooms, as perceived by their peers. A closely matched comparison group of normally growing children was also recruited from the same school classes as the cases. We found little evidence that untreated short prepubertal children are psychosocially maladjusted, compared to peers of normal stature. They do not differ in terms of peer acceptance, self-perception or social competence. Children with short stature regarded themselves as well supported socially by parents, teachers, peers and friends. All subjects had intelligence guotients (IQ) within the normal range of ability, yet we found cognitive ability was a better predictor than height for most aspects of behavioural and emotional adjustment.
Recently a type of growth failure (Hyperphagic Short Stature) has been described, in which there ... more Recently a type of growth failure (Hyperphagic Short Stature) has been described, in which there is potentially reversible severe impairment of growth hormone secretion, in association with excessively high levels of psychosocial stress. This condition is a variant of the disorder formerly known as Psychosocial Dwarfism. In the present study we compared children with Hyperphagic Short Stature (N = 25, aged 9.04 years+/-3.78, 72% male) and a closely matched sample with normal height, drawn from comparably stressful family circumstances (N = 25, aged 10.61+/-3.04, 60% male). Measures of the psychosocial environment, anthropometry, and developmental history from infancy were obtained. Many symptoms thought previously to be characteristics of psychosocial dwarfism were found to be nonspecific stress responses. Hypotonia (p < .05), enuresis/encopresis (p < .01), and sleep cycle disruption (p < .05) did differentiate the groups. Growth, appetite, and sleep are all influenced by hypothalamic nuclei, suggesting hypothalamic pathology could account for most of the clinical features of Hyperphagic Short Stature.
Increasing numbers of children are referred to Child and Adolescent Mental Health Services becaus... more Increasing numbers of children are referred to Child and Adolescent Mental Health Services because of disruptive behaviour. Recent reviews on the origins of conduct problems indicate that the most severe and persistent forms are found predominantly among males with a range of neurodevelopmental vulnerabilities, which are likely to have biological substrates. In this study, we tested the hypothesis that many children who are identified with conduct disorder actually have a primary deficit in pragmatic language skills, of a quality and degree that is similar to children on the autistic spectrum. We hypothesised that pragmatic difficulties may underlie the antisocial behaviour in a proportion of children who are labelled as conduct disordered. Using the Children's Communication Checklist (Bishop, 1998), we surveyed 142 children who had been referred for clinical investigation, with a predominant diagnosis of either an autistic spectrum condition (n = 87) or conduct disorder (n = 55), and 60 typically developing comparison children. Among children with conduct disorders, males predominated 9:1. On the basis of parent and teacher ratings, two-thirds of those with conduct disorders had pragmatic language impairments and other behavioural features similar in nature and degree to those of children with autism, independent of IQ. In a further study, we surveyed 54 children who had been excluded from elementary schools in a socio-economically disadvantaged inner-London borough and found over two-thirds to have comparable deficits. These findings have both theoretical and practical implications. First, they indicate the presence of communicative problems in a sub-group of children in whom conduct rather than language had been the major concern. Second, they indicate that severe deficits in pragmatic abilities and autistic-like behaviours can coexist with psychiatric conditions other than autism, especially in boys. Third, they imply that the management of many disruptive children could profitably be addressed to ameliorating their social and communicative skill deficits.
Journal of Child Psychology and Psychiatry, Jul 1, 2004
Increasing numbers of children are referred to Child and Adolescent Mental Health Services becaus... more Increasing numbers of children are referred to Child and Adolescent Mental Health Services because of disruptive behaviour. Recent reviews on the origins of conduct problems indicate that the most severe and persistent forms are found predominantly among males with a range of neurodevelopmental vulnerabilities, which are likely to have biological substrates. In this study, we tested the hypothesis that many children who are identified with conduct disorder actually have a primary deficit in pragmatic language skills, of a quality and degree that is similar to children on the autistic spectrum. We hypothesised that pragmatic difficulties may underlie the antisocial behaviour in a proportion of children who are labelled as conduct disordered. Using the Children's Communication Checklist (Bishop, 1998), we surveyed 142 children who had been referred for clinical investigation, with a predominant diagnosis of either an autistic spectrum condition (n = 87) or conduct disorder (n = 55), and 60 typically developing comparison children. Among children with conduct disorders, males predominated 9:1. On the basis of parent and teacher ratings, two-thirds of those with conduct disorders had pragmatic language impairments and other behavioural features similar in nature and degree to those of children with autism, independent of IQ. In a further study, we surveyed 54 children who had been excluded from elementary schools in a socio-economically disadvantaged inner-London borough and found over two-thirds to have comparable deficits. These findings have both theoretical and practical implications. First, they indicate the presence of communicative problems in a sub-group of children in whom conduct rather than language had been the major concern. Second, they indicate that severe deficits in pragmatic abilities and autistic-like behaviours can coexist with psychiatric conditions other than autism, especially in boys. Third, they imply that the management of many disruptive children could profitably be addressed to ameliorating their social and communicative skill deficits.
Pervasive developmental disordernot otherwise specified (PDD-NOS) is the most common and least sa... more Pervasive developmental disordernot otherwise specified (PDD-NOS) is the most common and least satisfactory of the PDD diagnoses. It is not clearly defined in the diagnostic manuals, limiting the consistency with which it is used by researchers and clinicians. This in turn limits the amount that we have learnt about people with PDD-NOS. In a sample of 256 young people (mean age = 9.1 years) we aimed to implement a clear, transparent definition of PDD-NOS, and then to describe those receiving this diagnosis (n=66), investigating whether they differed from people with autistic disorder (n=97) and Asperger's disorder (n=93). Groups were compared on measures of core PDD symptomatology, associated autistic features, and intelligence. Contrary to the assumption that PDD-NOS is heterogeneous, almost all (97%) of those with PDD-NOS had one distinct symptom pattern, namely impairments in social communication, without significant repetitive and stereotyped behaviours (RSB). Compared to autistic disorder and Asperger's disorder, they had comparably severe but more circumscribed social communication difficulties, with fewer non-social features of autism, such as sensory, feeding and visuo-spatial problems. These individuals appear to have a distinct variant of autism that does not merely sit at the less severe end of the same continuum of symptoms. The current draft guidelines for DSM-V, which insist on the presence of RSBs for any PDD diagnosis, would exclude such people from the autistic spectrum.
Pervasive developmental disordernot otherwise specified (PDD-NOS) is the most common and least sa... more Pervasive developmental disordernot otherwise specified (PDD-NOS) is the most common and least satisfactory of the PDD diagnoses. It is not clearly defined in the diagnostic manuals, limiting the consistency with which it is used by researchers and clinicians. This in turn limits the amount that we have learnt about people with PDD-NOS. In a sample of 256 young people (mean age = 9.1 years) we aimed to implement a clear, transparent definition of PDD-NOS, and then to describe those receiving this diagnosis (n=66), investigating whether they differed from people with autistic disorder (n=97) and Asperger's disorder (n=93). Groups were compared on measures of core PDD symptomatology, associated autistic features, and intelligence. Contrary to the assumption that PDD-NOS is heterogeneous, almost all (97%) of those with PDD-NOS had one distinct symptom pattern, namely impairments in social communication, without significant repetitive and stereotyped behaviours (RSB). Compared to autistic disorder and Asperger's disorder, they had comparably severe but more circumscribed social communication difficulties, with fewer non-social features of autism, such as sensory, feeding and visuo-spatial problems. These individuals appear to have a distinct variant of autism that does not merely sit at the less severe end of the same continuum of symptoms. The current draft guidelines for DSM-V, which insist on the presence of RSBs for any PDD diagnosis, would exclude such people from the autistic spectrum.
Short children are often described as having psychosocial problems. These reports may be inaccura... more Short children are often described as having psychosocial problems. These reports may be inaccurate as former studies have relied largely on parental report. Psychosocial functioning of short children was assessed with the aim of using them and their peers as informants. Twenty two short (mean (SD) height-2.53 (0.28) SD score) prepubertal children aged between 6 and 11 years were recruited from growth clinics. Comparison children were recruited from each case child's class at school. Cognitive and psychosocial functioning was assessed. Peer relationships were measured using sociometry. There were no significant group differences in terms of peer acceptance, self perception, and social competence. Although cases described themselves as receiving less social support from teachers, no differences were evident in other areas of social support. little evidence was found to suggest clinic referred prepubertal short children are psychosocially maladjusted. Further analysis revealed cognitive ability was a better predictor than height for most aspects of behavioural and emotional adjustment.
BACKGROUND Tourette syndrome (TS) is reported in all cultures, although is speculated to be rare ... more BACKGROUND Tourette syndrome (TS) is reported in all cultures, although is speculated to be rare among those of Sub-Saharan African descent. A lack of research exploring TS in the context of Sub-Saharan Africa has meant that it is not yet established whether this apparent rarity is due to a true low prevalence or if identification of the condition merely is unrecognized. The present study aimed to explore health professionals' knowledge and attitudes of the identification, diagnosis and management of TS in Uganda. METHOD A mixed-methods design was used to collect data from 152 Ugandan healthcare professionals by survey. Of these, 6 professionals took part in semi-structured interviews. Data gathered were analyzed with descriptive statistics and qualitatively using thematic analysis. RESULTS Professionals' views and experiences led to conclusions addressing (a) perceived challenges in diagnosing and treating TS in a Ugandan healthcare setting, (b) the role of cultural factors in help-seeking behaviors, and (c) ways by which efforts can be made to build capacity in awareness and clinical care. CONCLUSIONS The findings suggest that TS is present in Uganda, but a number of factors hinder detection rates causing it to be under-reported in the population. This study highlights the need for more focused and adequate training for all healthcare professionals in Uganda and education campaigns to increase awareness among the general public. KEY PRACTITIONER MESSAGE Little is currently known about the presentation of or understanding by professionals around Tourette syndrome in Sub-Saharan Africa. This study found health professionals in Uganda indicated a number of factors which interact and negatively impact recognition rates of tic disorders. This included limited training, exposure, and misconceptions, contributing to a lack of clinical awareness and attention. They also reported a lack of help-seeking behaviors due to parental perceptions and Ugandan traditional, cultural and religious beliefs. Professionals perceive that there are likely large numbers of undiagnosed and untreated children with Tourette syndrome in Uganda. This supports existing literature regarding the diagnostic challenges of neurodevelopmental disorders in Africa and provides an alternative explanation for the assumption that tic disorders may be rare and possible absent in Sub-Saharan Africa. There is a need to develop adequate training regarding tic disorders for all healthcare professionals working in Uganda as well as education campaigns for the general public to increase awareness.
Background The study examined a UK sample of 57 young people with Tourette syndrome (TS). Aims Th... more Background The study examined a UK sample of 57 young people with Tourette syndrome (TS). Aims The purpose of this study was to consider the impact of TS on young people's Quality of Life (QoL). Methods The study used a mixed methods design, combining focus groups and questionnaire data. Child report questionnaires measured QoL and TS symptom severity. Results The results showed that the QoL of children with TS was significantly worse than that of children in a UK normative sample. Analysis of transcripts from the groups identified four main themes; 'TS can be distressing and disabling' , 'struggling to fit into society's expectations of normal behaviour' , 'needing to control tics' and 'TS is one part of who I am'. Conclusions Poorer QoL was associated with increased symptom severity in terms of tics, Attention Deficit Hyperactivity Disorder diagnosis and obsessive compulsive behaviours.
Background: Recent evidence suggests that domains of autistic impairment often occur independentl... more Background: Recent evidence suggests that domains of autistic impairment often occur independently, in the absence of other elements of the syndrome. This raises the possibility that autism is a disorder of multiple underlying impairments, not explicable by one underlying abnormality. Particular impairments may be associated with specific behavioural domains. One domain of interest is ‘Insistence on Sameness’, an empirically derived, heritable dimension that is a component of the repetitive, stereotyped behaviour element of the autism triad. It has been suggested that executive function difficulties underlie some of the repetitive interests and behaviours seen in autism. Objectives: We aimed to investigate whether cognitive inflexibility was associated with one specific element of autistic behaviour, insistence on sameness (IS), but not with the other elements of the syndrome. In a general sense, we aimed to test a ‘multiple underlying impairments’ model of autism. Methods: Cognitiv...
BACKGROUND: Growth failure without organic aetiology but associated with behavioural disturbance ... more BACKGROUND: Growth failure without organic aetiology but associated with behavioural disturbance and psychosocial stress has been termed psychosocial short stature. This condition is not a valid diagnostic entity, but encompasses failure to thrive, stunting ...
ABSTRACT The psychosocial adaptation of children with normal short stature is a matter of concern... more ABSTRACT The psychosocial adaptation of children with normal short stature is a matter of concern to their parents, paediatricians and teachers. Potential areas of dysfunction include cognition, social behaviour, emotional adjustment and self-concept. We have studied a sample of 22 children who were referred to specialists for investigation of short stature (mean height below -2 standard deviation score (SDS)), aged between 6 to 11 years. We gathered parent, teacher and self-reports. Uniquely, we have also used sociometry to measure those children's social adjustment within their classrooms, as perceived by their peers. A closely matched comparison group of normally growing children was also recruited from the same school classes as the cases. We found little evidence that untreated short prepubertal children are psychosocially maladjusted, compared to peers of normal stature. They do not differ in terms of peer acceptance, self-perception or social competence. Children with short stature regarded themselves as well supported socially by parents, teachers, peers and friends. All subjects had intelligence guotients (IQ) within the normal range of ability, yet we found cognitive ability was a better predictor than height for most aspects of behavioural and emotional adjustment.
Recently a type of growth failure (Hyperphagic Short Stature) has been described, in which there ... more Recently a type of growth failure (Hyperphagic Short Stature) has been described, in which there is potentially reversible severe impairment of growth hormone secretion, in association with excessively high levels of psychosocial stress. This condition is a variant of the disorder formerly known as Psychosocial Dwarfism. In the present study we compared children with Hyperphagic Short Stature (N = 25, aged 9.04 years+/-3.78, 72% male) and a closely matched sample with normal height, drawn from comparably stressful family circumstances (N = 25, aged 10.61+/-3.04, 60% male). Measures of the psychosocial environment, anthropometry, and developmental history from infancy were obtained. Many symptoms thought previously to be characteristics of psychosocial dwarfism were found to be nonspecific stress responses. Hypotonia (p < .05), enuresis/encopresis (p < .01), and sleep cycle disruption (p < .05) did differentiate the groups. Growth, appetite, and sleep are all influenced by hypothalamic nuclei, suggesting hypothalamic pathology could account for most of the clinical features of Hyperphagic Short Stature.
Increasing numbers of children are referred to Child and Adolescent Mental Health Services becaus... more Increasing numbers of children are referred to Child and Adolescent Mental Health Services because of disruptive behaviour. Recent reviews on the origins of conduct problems indicate that the most severe and persistent forms are found predominantly among males with a range of neurodevelopmental vulnerabilities, which are likely to have biological substrates. In this study, we tested the hypothesis that many children who are identified with conduct disorder actually have a primary deficit in pragmatic language skills, of a quality and degree that is similar to children on the autistic spectrum. We hypothesised that pragmatic difficulties may underlie the antisocial behaviour in a proportion of children who are labelled as conduct disordered. Using the Children's Communication Checklist (Bishop, 1998), we surveyed 142 children who had been referred for clinical investigation, with a predominant diagnosis of either an autistic spectrum condition (n = 87) or conduct disorder (n = 55), and 60 typically developing comparison children. Among children with conduct disorders, males predominated 9:1. On the basis of parent and teacher ratings, two-thirds of those with conduct disorders had pragmatic language impairments and other behavioural features similar in nature and degree to those of children with autism, independent of IQ. In a further study, we surveyed 54 children who had been excluded from elementary schools in a socio-economically disadvantaged inner-London borough and found over two-thirds to have comparable deficits. These findings have both theoretical and practical implications. First, they indicate the presence of communicative problems in a sub-group of children in whom conduct rather than language had been the major concern. Second, they indicate that severe deficits in pragmatic abilities and autistic-like behaviours can coexist with psychiatric conditions other than autism, especially in boys. Third, they imply that the management of many disruptive children could profitably be addressed to ameliorating their social and communicative skill deficits.
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Papers by Jane Gilmour