HOME VIDEOS SUGGEST REGRESSION OCCURS IN SOME AUTISTIC CHILDREN

CHICAGO—Home videos of first and second year birthday parties provide support for parents' reports of children whose behavior seemed normal when they were one-year-olds but then display symptoms of autism at the age of two years, according to a study in the August issue of the Archives of General Psychiatry, one of the JAMA/Archives journals.

Although symptoms of autism have been observed in children as young as eight to 12 months, some parents report that their child had normal or near-normal development and then experienced a regression, as their communication and/or social skills worsened, according to background information in the article. Estimates of the prevalence of this "regressive pattern" vary widely and depend for the most part on parental memories that may be biased by later events, the authors suggest.

Emily Werner, Ph.D., and Geraldine Dawson, Ph.D., of the University of Washington, Seattle, analyzed home videotapes of first and second year birthday parties for children without autism and for children who have been diagnosed with autism spectrum disorder (ASD). Of the 56 children included in the study, 15 were children diagnosed with ASD whose parents reported a worsening in social and/or communication skills during the second year of life, 21 were children with ASD whose parents reported that they had had impairments before age one year (early onset) and 20 were typically developing children. All the children in the study were younger than seven and all but three were younger than four years old.

The researchers coded the frequency and duration of a number of behaviors seen on the videotape, including language, gaze, repetitive behavior, emotion and playing with toys. In addition, they conducted an interview with the child's primary caregiver designed to help the caregiver recall the child's early development, including questions about social responsiveness, language skills and temperamental differences.

Infants with ASD with regression showed more frequent use of words and babble at 12 months compared to normal infants. Early onset ASD infants showed the least frequent use of words and babble. The level of joint attention (frequency of pointing) was the same for normal infants and infants with ASD with regression at 12 months. "In contrast, infants with ASD with early onset of symptoms and no regression displayed fewer joint attention and communicative behaviors at 12 months of age," the authors report. "By 24 months of age, both groups of toddlers with ASD displayed fewer instances of word use, vocalizations, declarative pointing, social gaze, and orienting to name [responding to the use of their name] as compared with typically developing 24-month-olds."

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INDIVIDUALS WITH SEVERE MENTAL ILLNESS AT HIGH RISK TO BE VICTIMS OF CRIME

CHICAGO—More than one fourth of individuals with severe mental illness (SMI) were victims of violent crime in the past year, eleven times the rate in the general population, according to a study in the August issue of the Archives of General Psychiatry, one of the JAMA/Archives journals.

Prior studies suggest that individuals with mental disorders who live in the community are a vulnerable population at high risk of becoming victims of crime, according to background information in the article. Symptoms associated with severe mental illness, such as disorganized thought processes, impulsivity and poor planning and problem solving may compromise one's ability to perceive risks and protect oneself, the authors suggest. Other factors correlated with victimization, including substance abuse, conflicted social relationships, poverty and homelessness, are also common among persons with severe mental illness.

Linda A. Teplin, Ph.D., of the Feinberg School of Medicine, Northwestern University, Chicago, and colleagues administered the National Crime Victimization Survey (NCVS) to 936 randomly selected patients from 16 outpatient, day or residential mental health agencies in Chicago, comparing the results to data from the 32,449 participants in the annual NCVS conducted by the Bureau of the Census for the Bureau of Justice Statistics. The surveys of the individuals with severe mental illness were conducted by clinical research interviewers with master's level training.

"Over one quarter of the SMI sample had been victims of a violent crime (attempted or completed) in the past year, 11.8 times higher than the NCVS rates; nearly 17 percent of the SMI sample had been victims of completed violence," the authors report. "More that 21 percent of persons with SMI had been victims of personal theft (theft of an item from one's person), more that 140 times higher than the NCVS rates. ...Nearly 28 percent of persons with SMI had been victims of property crimes, approximately four times higher than the NCVS rates."

"In the general population, crime victimization can cause anxiety, depression, substance use disorders, and post-traumatic stress disorder," the authors write. "Among persons with mental disorders, victimization can exacerbate existing disorders, increase the likelihood of service use and hospitalization, and substantially diminish quality of life. Moreover, victimization increases the likelihood of revictimization and is associated with perpetration of violence among persons with SMI, just as in the general population."

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GIRLS WHO WERE VICTIMS OF VIOLENCE MORE LIKELY TO COMMIT VIOLENT ACTS

CHICAGO—Girls who report previous violence victimization are more than twice as likely to report engaging in violent behavior, according to a study in the August issue of the Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.

Violence experienced and perpetrated by adolescents is a serious public health problem, affecting individuals, families and communities, according to background information in the article. Exposure to violence in adolescents' homes and communities has been associated with their own perpetration of violence. A 2004 study reported that arrest rates for violent crimes by adolescent girls have either increased or have decreased less than boys, from 1994 to 2002, giving rise to concern that girls were becoming more violent. However, self-reported data by both male and female teenagers show a decrease in violent behavior over the past decade. The true extent of violence perpetrated by girls is unknown.

Beth E. Molnar, Sc.D., of the Harvard School of Public Health, Boston, and colleagues examined data from the Project on Human Development in Chicago Neighborhoods to assess the relationship between individual victimization and neighborhood violence and subsequent violence. Three in-home interviews were conducted approximately two years apart between November 1995 and January 2002 with 637 girls, ages nine to 15 years at baseline, and their caregivers. Community data were collected in 1995 from a random sample of Chicago residents.

The researchers found that at the baseline interview, 38 percent of the girls interviewed reported committing at least one type of violent act in the 12 months prior to that interview. Twenty-eight percent of the girls reported committing a violent act in the 12 months prior to the first follow-up interview, and 14 percent reported violent behavior at the third interview. The odds of violent behavior were 2.2 times higher among girls who reported previous violence victimization. Violent behavior peaked at 14 years. The probability of violence perpetrated by girls was higher in neighborhoods with higher homicide rates and concentrated poverty.

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WAIST SIZE IS ASSOCIATED WITH THE METABOLIC SYNDROME IN CHILDREN

CHICAGO—Waist circumference is associated with insulin resistance in children and may offer a simple way to identify children with risk factors for cardiovascular disease and type 2 diabetes, according to a study in the August issue of the Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.

The prevalence of childhood obesity has doubled in the past two decades, accompanied by an epidemic of type 2 diabetes mellitus (T2DM) and potentially devastating cardiovascular disease (CVD) consequences, according to background information in the article. Some studies suggest that in adults, measurement of waist circumference (WC), an indicator of intra-abdominal fat, is a better indication of CVD risk than body mass index (BMI), a measure of overall obesity. Waist circumference is one component of the metabolic syndrome, a combination of health conditions, including type 2 diabetes, high blood pressure and high levels of lipids (fat) in the blood, that place a person at high risk for heart disease.

Valeria Hirschler, M.D., of the Durand Hospital of Buenos Aires, Argentina, and colleagues measured the waist circumference of children aged six to 13 years and compared waist circumference to measurements of components of the metabolic syndrome, including obesity (BMI), insulin resistance, lipid profile (fats in the blood, including cholesterol and triglyceride levels) and blood pressure.

Of the 84 children evaluated (44 girls), 28 were overweight, 40 were obese and 16 were normal weight. Statistical analysis showed that waist circumference was an independent predictor for elevated blood pressure, insulin resistance and elevated high-density lipoprotein cholesterol level. "In our study, there was a significant correlation between WC and all the components of the metabolic syndrome," the authors report.