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Differentiating Autism in a Chinese Population

Differentiating Autism in a Chinese Population. Grace Hao, M. D., Ph.D., CCC-SLP Thomas Layton, Ph.D., CCC-SLP ASHA November 17, 2012 Atlanta, Georgia.

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Differentiating Autism in a Chinese Population

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  1. Differentiating Autism in a Chinese Population Grace Hao, M. D., Ph.D., CCC-SLP Thomas Layton, Ph.D., CCC-SLP ASHA November 17, 2012 Atlanta, Georgia

  2. Dr Hao is a Professor in the Department of Communication Disorders at North Carolina Central University. She has both a medical degree from China and a Ph.D. in speech-language pathology. Dr. Layton is currently the President/Co-owner of a private Center in Durham NC. He, Dr. Hao, and Dr. Zou,a developmental pediatrician in China, are standardizing a new unpublished diagnostic test in China. We do not have financial interests in the diagnostic tool, as it is currently used as part of the current research.

  3. DSM-IV Criteria for Diagnosis • At least 6 characteristics from the following 3 domains to qualify for diagnosis of autism • 1- Social skills • 2- Communication • 3- Behavior

  4. Literature Review • LFASD versus HFASD • Bartak & Rutter (1976) found more language delay, severe personal relationships and more disruptive behavior than HFASD • HFASD versus Typically Developing • Steinhausen & Metzke (2004) more disruptive behavior • Tsatsanis (2005) more weakness in cognitive functions • Baranek et al. (2005) problems in motor development • Tager-Flushberg (2004) problems in complex language • Ozonoff et al. (2004) problems in Executive Function

  5. Literature Review • One study with Chinese children (Zhang & Ji, 2005) • LFASD versus Intellectually Disabled • LFASD had 25% prenatal birth problems vs 62.5% of ID • LFASD only 1 child had cerebral palsy vs 31% had “other developmental disorders”

  6. Purpose of the study • To compare HFASD children to Typically Developing children (TD) • To compare Moderate/severe ASD (LFASD) children to Intellectually Disabilities (ID) • To measure individual items within seven behavior Domains

  7. Subjects • LFASD (n=236; mean age 46.7 m) • HFASD (n = 96; mean age 53.1 m) • Intellectual/Developmental Disabilities (n = 33; mean age 55.7 m) • Typically Develop. (n = 103; mean age 43.9 m)

  8. ASD groups • Previously diagnosed by developmental pediatricians using the ADI-R, SRS, and/or a behavioral protocol. • All subjects spoke Mandarin • Non-ASD groups • Recruited from well-baby-care clinics throughout China • ID group administered WISC-Chinese, scores below 70 IQ

  9. Research Team: Centers Involved • Guangzhou: • Third Affiliated Hospital & Guangzhou Center for Children with ASD • Shenzhen Hospital for Children and Pregnant Woman • Chongqing Children’s Hospital • Hainan Children’s Hospital • Harbin Medical University Autism Center • Shanghai Children’s Hospital • ShiJia-Zhuang Medical University • Tianjin Medical University • Nanjing Medical University

  10. CADS Domains used for comparisons

  11. (CADS)Chinese Autism Diagnostic Scale First Autism Diagnostic test designed, developed, and standardized in China for Chinese population Takes into account the cultural and language aspects Addresses needs and frequently asked questions found in China

  12. CADS Seven Domains • Motor/Vocal Imitation • Stereotyped behaviors • Sensory behaviors • Play behaviors • Social Interaction • Receptive Language • Expressive Language

  13. Motor Area (3 Domains) • Motor/Vocal Imitation Domain (11 items) • Stereotyped Behavior Domain (13 items) • Sensory Domain (10 items)

  14. 19

  15. Social Area (2 Domains) • Play Domain (10 items) • Social Interaction Domain (21 items)

  16. 21

  17. Language Area (2 Domains) • Receptive Language Domain (10 items) • Expressive Language Domain (17 items)

  18. Supplemental Area (2 Domains) • Academic & Educational Domain (15 items) • Executive Function Domain (30 items)

  19. Executive Functions • Planning • Organizing • Time Management • Flexibility/Attention • Affect • Working Memory

  20. Individual Item scoring for group comparisons • Used group percentages due to unequal sample sizes • A difference of 9 percentage points or greater between groups were required for points given • A difference at Moderately Impaired level was given 1 point • A difference at Severely Impaired level was given 2 points • Individual items required 2 or 3 total points to be considered different

  21. LFASDResults

  22. LFASDResults • LFASD versus Intellectually Disabled • Six Domains were significantly different • The LFASD group performed less well on all six Domains

  23. Individual Item contrasts • LFASD versus ID

  24. Play Behavior items for LFASD • No independent play skills • Tends to play alone • No interest in social play • No interest in others • Shows inappropriate play with children • Has no regular playmates • Has limited attention span

  25. Stereotyped Behavior items for LFASD • Squeals more • Unusual interest in certain part of a toy • Peculiar interests in objects • Has a particular, or unusual way of ordering toys or things • Excessively rigid

  26. Sensory Behavior items for LFASD • Over reaction to noise • Inappropriate reaction to a pinch • Inappropriate reaction to textures • Eats restricted foods • Inappropriate reaction to visual stimuli

  27. Social Interactive Behaviors LFASD • Does not look in faces • Does not smile • No understanding of gestures • Does not hand a toy to adult • Does not share food • No empathy • Does Not look at objects of interest with others • Does not point • Reacts negatively to familiar people who approach him/her • Does not help others • Does not recognize social errors • Does not understand playful remark • Does not understand hints or indirect remarks • Gets upset when left at unfamiliar places • Does not seek parents or others for support

  28. Receptive Language items for LFASD • Does not select objects upon command • Does not point to nose, eyes, ears • Does not point to pictures • Inappropriate response to verbal command • Inappropriately nods and responds to speaker • Does not correctly respond to “wh” questions

  29. Expressive Language items for LFASD • Echoes or repeats words • Prosody of speech not normal • Difficulty labeling or naming objects • Gets words out of order • Frequently talks to him/herself • Inappropriate use of pronouns • Inability to initiate or direct discourse • Makes socially inappropriate comments

  30. HFASDResults

  31. HFASDResults • HFASD group versus Typically Developing children • Three Domains were significantly different • The HFASD group performed less well on all three Domains

  32. Individual Item contrasts • HFASD versus TD

  33. Stereotyped Behavior items for HFASD • Stares to side • Rocks back/forth • Flaps hands/fingers • Squeals

  34. Sensory Interactive Behavior items for HFASD • Over reaction to noise • Eats restricted foods

  35. Play Behavior items for HFASD • Plays alone • Has inappropriate play behavior with other children • No turn taking in social play • Does not seek help from others

  36. Profile of Four Children • CADS profile 4 children • HFASD, LFASD, TD, ID

  37. Remember: Higher the score--more severe the problem

  38. Future Analysis and Contrasts • Comparing three levels of ASD • Mild Functioning • Moderate Functioning • Severe Functioning

  39. Bell Shape Curve For ASD Group

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