Autistische Störungen – State-of-the-Art und neuere Entwicklungen
Epidemiologie, Ätiologie, Diagnostik und Therapie
Abstract
Der vorliegende Überblicksartikel baut auf dem «State-of-the-Art»-Vortrag zu tiefgreifenden Entwicklungsstörungen bei der 32. Jahrestagung der Deutschen Gesellschaft für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie (DGKJP) im März 2011 in Essen auf und fasst die neuesten Erkenntnisse bezüglich epidemiologischer Studien (Komorbidität, Risikofaktoren), Frühdiagnose, Klassifikation und evidenzbasierter Therapieverfahren im Bereich medikamentöser Therapie sowie Autismus-spezifischer Frühförderung und Verhaltenstherapie zusammen. In allen diesen Bereichen hat die Forschung in den letzten Jahren zu einem besseren Verständnis und zu einer effektiveren Therapie von Autism Spectrum Disorders beigetragen.
This review article is based on a state-of-the-art lecture given at the 32nd meeting of the German Child Psychiatry Association in March 2011. It summarizes recent findings from epidemiological studies (comorbid disorders, risk factors), early diagnosis, classification, and evidence-based therapeutic interventions (psychopharmacology, early intervention, group-based behavioural interventions). Intensive research over the last years has led to a better understanding of, and improved therapeutic options for, autism spectrum disorders.
Literatur
2011). Autism and increased paternal age related changes in global levels of gene expression regulation. PLoS One, 6, e16715.
(2009). Medication and parent training in children with pervasive developmental disorders and serious behavior problems: Results from a randomized clinical trial. J Am.Acad.Child Adolesc.Psychiatry, 48, 1143–1154.
(2006). Atomoxetine for hyperactivity in autism spectrum disorders: Placebo-controlled crossover pilot trial. J Am.Acad.Child Adolesc.Psychiatry, 45, 1196–1205.
(2010). Maternal infection requiring hospitalization during pregnancy and autism spectrum disorders. J Autism Dev.Disord., 40, 1423–1430.
(2009). Prevalence of autism spectrum disorders – Autism and Developmental Disabilities Monitoring Network, United States, 2006. MMWR Surveill Summ., 58, 1–20.
. (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.
(1992). Can autism be detected at 18 months? The needle, the haystack, and the CHAT. Br.J.Psychiatry, 161, 839–843.
(2011). Theory of mind training in children with autism: A randomized controlled trial. J Autism Dev.Disord., 41, 997–1006.
(2001). Lamotrigine therapy for autistic disorder: A randomized, double-blind, placebo-controlled trial. J.Autism Dev.Disord., 31, 175–181.
(2011). Risk and correlates of autism spectrum disorder in children with epilepsy: A community-based study. J Child Neurol., 26, 540–547.
(2001). [
(Factor structure of the Autism Diagnostic Interview-Revised (ADI-R): A study of dimensional versus categorical classification of autistic disorders ]. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie, 29, 221–229.2002). [
(Intervention in autistic disorders: Status quo, evidence-based, questionable and doubtful techniques ]. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie, 30, 271–280.2004). [
(Diagnostic Observation Scale for Autistic Disorders: Initial results of reliability and validity ]. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie, 32, 45–50.2005). [
(Psychodiagnostic instruments for the assessment of autism spectrum disorders ]. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie, 33, 5–14.2005). [
(Relevance and results of Theory of Mind research for autism and other psychiatric disorders ]. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie, 33, 77–88.2009). Can association between preterm birth and autism be explained by maternal or neonatal morbidity? Pediatrics, 124, e817–e825.
(2011). A randomized controlled trial of Hanen’s «More Than Words» in toddlers with early autism symptoms. J Child Psychol.Psychiatry, 52, 741–752.
(2011). [
M. (Genetic analyses for identifying molecular mechanisms in autism spectrum disorders ]. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie, 39, 101–111.1999). Autism spectrum disorders at 20 and 42 months of age: Stability of clinical and ADI-R diagnosis. J.Child Psychol.Psychiatry, 40, 719–732.
(2011). Antidepressant use during pregnancy and childhood autism spectrum disorders. Arch.Gen.Psychiatry, 68, 1104–1112.
(2007). Maternal and paternal age and risk of autism spectrum disorders. Arch.Pediatr.Adolesc.Med., 161, 334–340.
(2010). Randomized, controlled trial of an intervention for toddlers with autism: The Early Start Denver Model. Pediatrics, 125, e17–e23.
(2006). Screening for autistic spectrum disorder in children aged 14–15 months. II: Population screening with the Early Screening of Autistic Traits Questionnaire (ESAT). Design and general findings. J Autism Dev.Disord., 36, 713–722.
(2010). Socioeconomic inequality in the prevalence of autism spectrum disorder: Evidence from a U. S. cross-sectional study. PLoS One, 5, e11551.
(2011). [
(Neuropsychological models of autism spectrum disorders – Behavioral evidence and functional imaging ]. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie, 39, 79–90.2010). Prenatal alcohol exposure and autistic spectrum disorders – A population-based prospective study of 80,552 children and their mothers. Int.J Epidemiol., 39, 1074–1081.
(2006). Pervasive developmental disorders in Montreal, Quebec, Canada: Prevalence and links with immunizations. Pediatrics, 118, e139–e150.
(2011). Parent-assisted group treatment for friendship problems of children with autism spectrum disorders. Brain Res., 1380, 240–245.
(2008). [
(The genetics of autistic disorders ]. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie, 36, 7–14.2010). [
(Empirically based early intervention programs for children with autistic disorders – A selective literature review ]. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie, 38, 247–256.2010). Genetics of autistic disorders: Review and clinical implications. Eur.Child Adolesc.Psychiatry, 19, 169–178.
(2010). Parent-mediated communication-focused treatment in children with autism (PACT): A randomised controlled trial. Lancet, 375, 2152–2160.
(2011). [
(Self-report and parental report of empathy in adolescents with autism ]. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie, 39, 113–121.2009). Advances in the treatment of fragile X syndrome. Pediatrics, 123, 378–390.
(2005). [
(Autism and metabolic disorders - a rational approach ]. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie, 33, 259–271.2007). Frankfurt group social communication and interaction skills training for children and adolescents with autism spectrum disorders. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie, 35, 33–40.
(2005). [
(Hans Asperger and his patients – A retrospective examination of the spectrum of autistic disorders ]. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie, 33, 35–47.2009). Psychiatric and psychosocial problems in adults with normal-intelligence autism spectrum disorders. BMC Psychiatry, 9, 35.
(2010). Divalproex sodium vs placebo for the treatment of irritability in children and adolescents with autism spectrum disorders. Neuropsychopharmacology, 35, 990–998.
(2010). Advancing paternal age and risk of autism: New evidence from a population-based study and a meta-analysis of epidemiological studies. Mol.Psychiatry, 16, 1203–1212.
(2011). Risk of autism spectrum disorders in children born after assisted conception: A population-based follow-up study. J Epidemiol.Community Health, 65, 497–502.
(2009). Incidence of gastrointestinal symptoms in children with autism: A population-based study. Pediatrics, 124, 680–686.
(2007). Risperidone for autism spectrum disorder. Cochrane Database Syst.Rev., CD005040.
(2010). Psychiatric disorders in extremely preterm children: Longitudinal finding at age 11 years in the EPICure study. J Am.Acad.Child Adolesc.Psychiatry, 49, 453–463.
(2005). [
(The Marburg Rating Scale for Asperger’s Syndrome (MBAS) – A screening instrument for high-functioning autistic disorders ]. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie, 33, 15–26.2012a). Combining information from multiple sources for the diagnosis of autism spectrum disorders for toddlers and young preschoolers from 12 to 47 months of age. J Child Psychol.Psychiatry, 53, 143–151.
(2012b). New autism diagnostic interview – revised algorithms for toddlers and young preschoolers from 12 to 47 months of age. J Autism Dev.Disord., 52, 82–93.
(2009). Diagnostic change and the increased prevalence of autism. Int.J Epidemiol., 38, 1224–1234.
(2011). Socioeconomic status and the increased prevalence of autism in California. Am.Sociol.Rev., 76, 320–346.
(2011). Prevalence and functioning of children with cerebral palsy in four areas of the United States in 2006: A report from the Autism and Developmental Disabilities Monitoring Network KIRBY2011. Res.Dev.Disabil., 32, 462–469.
(2008). The modified checklist for autism in toddlers: A follow-up study investigating the early detection of autism spectrum disorders. J Autism Dev.Disord., 38, 827–839.
(2008). Sleep problems in children with autism spectrum disorders, developmental delays, and typical development: A population-based study. J Sleep Res., 17, 197–206.
(2005). [
(Development and evaluation of a psychoeducational group training programme for teachers of autistic pupils with mental retardation ]. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie, 33, 49–58.2006). Comorbid psychiatric disorders in children with autism: Interview development and rates of disorders. J.Autism Dev.Disord., 36, 849–861.
(2009). A nationwide study on the risk of autism after prenatal stress exposure to maternal bereavement. Pediatrics, 123, 1102–1107.
(2010). The genetics of autism spectrum disorders and related neuropsychiatric disorders in childhood. Am.J Psychiatry, 167, 1357–1363.
(2008). Positive screening for autism in ex-preterm infants: Prevalence and risk factors. Pediatrics, 121, 758–765.
(2010). RCT of a manualized social treatment for high-functioning autism spectrum disorders. J Autism Dev.Disord., 40, 1297–1310.
(2011). A multisite study of the clinical diagnosis of different autism spectrum disorders. Arch.Gen.Psychiatry. epub.
(2006). Autism from 2 to 9 years of age. Arch.Gen.Psychiatry, 63, 694–701.
(2009). The autism diagnostic observation schedule – toddler module: A new module of a standardized diagnostic measure for autism spectrum disorders. J.Autism Dev.Disord., 39, 1305–1320.
(2011). Pregnancy complications and obstetric suboptimality in association with autism spectrum disorders in children of the Nurses’ Health Study II. Autism Res., epub.
L. (2011). Early diagnoses of autism spectrum disorders in Massachusetts birth cohorts, 2001–2005. Pediatrics, 127, 1043–1051.
(2009). A placebo-controlled, fixed-dose study of aripiprazole in children and adolescents with irritability associated with autistic disorder. J Am.Acad.Child Adolesc.Psychiatry, 48, 1110–1119.
(2009). Autism spectrum disorders in genetic syndromes: Implications for diagnosis, intervention and understanding the wider autism spectrum disorder population. J Intellect.Disabil.Res., 53, 852–873.
(2010). [
(Comorbidity in autism spectrum disorders – II. Genetic syndromes and neurological problems ]. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie, 38, 267–272.2010). [
(Comorbidity in autism spectrum disorders – I. Mental retardation and psychiatric comorbidity ]. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie, 38, 257–266.2005). Combined vitamin B6-magnesium treatment in autism spectrum disorder. Cochrane Database Syst.Rev., CD003497.
(2010). Randomized controlled trial of the focus parent training for toddlers with autism: 1-year outcome. J Autism Dev.Disord., 40, 1447–1458.
(2009). Aripiprazole in the treatment of irritability in children and adolescents with autistic disorder. Pediatrics, 124, 1533–1540.
(2011). Prevalence of autism spectrum disorder in adolescents born weighing < 2000 g. Pediatrics, 128, 883–891.
(2007). Positive effects of methylphenidate on inattention and hyperactivity in pervasive developmental disorders: An analysis of secondary measures. Biol.Psychiatry, 61, 538–544.
(2009). [
(Autism ]. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie, 37, 269–275.2011). [
(Personality and social responsiveness in autism spectrum disorders and attention deficit/hyperactivity disorder ]. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie, 39, 133–141.2007). [
(Psychopharmacology of autistic disorders ]. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie, 35, 87–94.2005). Characteristics of fetal anticonvulsant syndrome associated autistic disorder. Dev.Med.Child Neurol., 47, 551–555.
(2005). Randomized, controlled, crossover trial of methylphenidate in pervasive developmental disorders with hyperactivity. Arch.Gen.Psychiatry, 62, 1266–1274.
. (2007). A randomized, controlled trial of a home-based intervention program for children with autism and developmental delay. J.Dev.Behav.Pediatr., 28, 308–316.
(2009). One-year follow-up of the outcome of a randomized controlled trial of a home-based intervention programme for children with autism and developmental delay and their families. Child Care Health Dev., 35, 593–602.
(2001). Can the checklist for autism in toddlers differentiate young children with autism from those with developmental delays? J Am.Acad.Child Adolesc.Psychiatry, 40, 1457–1463.
(2010). [
(Does the Fragmented Images Test measure locally oriented visual processing in autism spectrum disorders? ]. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie, 38, 103–110.2008). Psychiatric disorders in children with autism spectrum disorders: Prevalence, comorbidity, and associated factors in a population-derived sample. J Am.Acad.Child Adolesc.Psychiatry, 47, 921–929.
(2007). [
(Age-dependent differences in neuropsychological performance profiles in ADHD and autism ]. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie, 35, 95–104.2011). [
(Comorbidities with autism spectrum disorders – Present state of research and future outlook ]. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie, 39, 91–98.2011). Sleep problems in children with autism spectrum problems: A longitudinal population-based study. Autism, epub.
(2011). Longitudinal changes in scores on the Autism Diagnostic Interview – Revised (ADI-R) in pre-school children with autism: Implications for diagnostic classification and symptom stability. Autism, 15, 545–562.
(2008). Prevalence and characteristics of autistic spectrum disorders in the ALSPAC cohort. Dev.Med.Child Neurol., 50, 672–677.
(2010). Selective serotonin reuptake inhibitors (SSRIs) for autism spectrum disorders (ASD). Cochrane Database Syst.Rev., CD004677.
(2005). Intravenous secretin for autism spectrum disorder. Cochrane Database Syst.Rev., CD003495.
(2009). Cognitive behavioral therapy for anxiety in children with autism spectrum disorders: A randomized, controlled trial. J Child Psychol.Psychiatry, 50, 224–234.
(2011). Melatonin versus placebo in children with autism spectrum conditions and severe sleep problems not amenable to behaviour management strategies: A randomised controlled crossover trial. J Autism Dev.Disord., 41, 175–184.
(