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Parents of children with ASD are at risk for chronic stress due to challenging parenting. It is unknown whether stress is already present in early parenthood, similar for mothers and fathers and if this impacts quality of life (QoL). Parental stress and QoL were assessed in 56 mothers and 51 fathers of young children (aged 3 to 7) with autism. Associations between parental stress (OBVL) and QoL (WHOQoL-BREF) were examined. Parents of young children with ASD appear to have high parental stress from conflicting feelings towards their child and from difficulties with parenting. Mothers have higher stress from feeling confined in their motherly role than fathers compared to the OBVL norm population. Both mothers and fathers have a low QoL. Increased maternal conflicting feelings towards the child associated with lower psychological QoL, while high maternal feelings of role confinement associated with low physical QoL. Increased paternal conflicting feelings towards their child related to lower physical and social QoL, while fathers with more parenting difficulties reported less satisfaction with their psychological and environmental wellbeing. Thus, already at young age, parenting children with ASD is a major challenge for both mothers and fathers.

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Evidence of the effectivity of play-based interventions in children with autism spectrum disorder (ASD) was evaluated by PRISMA-based literature study and a Risk of Bias (RoB) assessment. Many of the 32 eligible randomized controlled trials (RCT) reported improved social interaction, communication, daily functioning and play behaviour. They also reported decreased problem behaviour, better parental attunement and parent-child interaction. We assessed 25/32 of the RCTs with high RoB, mainly related to homogeneity of the study population, lack of power, and performance bias. We concluded with due care that the effectivity of play-based interventions differed across RCTs, most reported improvements are found in ASD symptoms, everyday functioning, and parental attunement. In future research, findings should be replicated, taking account of the RoB.

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Local information processing in 42 adults with high functioning autism, 41 adults with Asperger syndrome and 41 neurotypical adults was examined. Contrary to our expectations, the disorder groups did not outperform the neurotypical group in the neuropsychological measures of local information processing. In line with our hypotheses, the self-reports did show higher levels of local information processing and a stronger tendency to use systemizing strategies in the two disorder groups. Absent and weak correlations were found between the self-reports and the two neuropsychological tasks in the three groups. The neuropsychological tests and the self-reports seem to measure different underlying constructs. The self-reports were most predictive of the presence of an autism spectrum diagnosis.

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BACKGROUND: Parenting stress was investigated in mothers with a child with Angelman syndrome (AS) or Prader-Willi syndrome (PWS), which are genetically related. METHOD: Mothers of 24 children with AS and 23 children with PWS (2-12 years) completed the Nijmegen Parenting Stress Index-Short, Developmental Behaviour Checklist, and Vineland Screener 0-12. RESULTS: Parenting stress was high for 58% of AS and 26% of PWS cases. For both syndromes, no relationship existed with the child's gender, age, or behavioural problems. In PWS there was no effect on level of functioning. Overall, more mothers with a child with AS perceived high parenting stress. When children showed low levels of behavioural problems this difference was contained. However, when children exhibited severe behavioural problems, parenting stress was the same for both syndromes. CONCLUSION: In AS professional family support is essential, since parenting is stressful for many mothers. In PWS, this is especially the case when behavioural problems are present.

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Only case reports have described the co-occurrence of gender identity disorder (GID) and autism spectrum disorders (ASD). This study examined this co-occurrence using a systematic approach. Children and adolescents (115 boys and 89 girls, mean age 10.8, SD = 3.58) referred to a gender identity clinic received a standardized assessment during which a GID diagnosis was made and ASD suspected cases were identified. The Dutch version of the Diagnostic Interview for Social and Communication Disorders (10th rev., DISCO-10) was administered to ascertain ASD classifications. The incidence of ASD in this sample of children and adolescents was 7.8% (n = 16). Clinicians should be aware of co-occurring ASD and GID and the challenges it generates in clinical management.

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Theory of mind was assessed in 32 adults with HFA, 29 adults with Asperger syndrome and 32 neurotypical adults. The HFA and Asperger syndrome groups were impaired in performance of the Strange stories test and the Faux-pas test and reported more theory of mind problems than the neurotypical adults. The three groups did not differ in performance of the Eyes test. Furthermore, correlations between the Eyes test and the three other theory of mind tests were low or absent. Therefore one can question the ability of the Eyes test to measure theory of mind. Of all theory of mind tests used, the self-report questionnaire had the largest discriminating power in differentiating the two disorder groups from the neurotypical group.

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According to the major classification systems it is not possible to diagnose a comorbid autistic disorder in persons with Rett syndrome. However, this is a controversial issue, and given the level of functioning of persons with Rett syndrome, the autistic disorder is expected to be present in a comparable proportion as in people with the same level of functioning. To investigate, parents of 52 females with classical and atypical Rett syndrome (2.4-49.3 years) completed the Developmental Behavior Checklist (DBC), the Diagnostic Interview for Social and Communication Disorders (DISCO) and the Dutch Vineland Screener 0-6 (VS 0-6). All participants had a severe to profound intellectual disability (ID) according to the VS 0-6. Behavior indicated an autistic disorder in 42 (DBC) to 58 percent (DISCO) of the Rett cases. Autistic behavior had decreased in 19 percent such that they no longer met the criteria for autistic disorder. Some participants were suspected of having a comorbid autistic disorder, though not more often than can be expected at their level of functioning. Clinicians should be aware of the possibility of a comorbid autistic disorder as much as they should be in other people with this level of functioning.

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This study investigates the parental perception of stress related to the upbringing of children with CHARGE syndrome and its association with behavioral and physical child characteristics. Parents of 22 children completed the Nijmegen Parenting Stress Index-Short, Developmental Behavior Checklist, and Dutch Vineland Screener 0-12 and reported their child's problems with hearing, vision and ability to speak. Parenting stress was high in 59% of the subjects. Behavioral problems on the depression, autism, self-absorbed and disruptive behavior scales correlated positively with parenting stress. A non-significant trend was found, namely higher stress among the parents of non-speaking children. No associations were found with other child characteristics, i.e. level of adaptive functioning and intellectual disability, auditory and visual problems, deafblindness, gender, and age. Raising a child with CHARGE syndrome is stressful; professional support is therefore essential for this population. More research into other possible influencing characteristics is needed to improve family-oriented interventions. Since CHARGE is a rare syndrome, closer international collaboration is needed, not only to expand the group of study subjects to increase statistical power, but also to harmonize research designs and measurement methods to improve the validity, the reliability, and the generalization of the findings.

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BACKGROUND: Questions about the international reliability and validity of aspects of psychopathy have been raised for adults, but hardly considered when applying the constructs to children. AIMS/OBJECTIVES: Our aim was to compare the psychometrics of a new instrument to measure psychopathic traits in children between two countries - the Netherlands and Greece. We also tested the hypothesis that, in both countries, both narcissistic-egocentric and callous-unemotional dimensions would be related to observed behavioural disorders. METHODS: The Social and Emotional Detachment Questionnaire was used to assess narcissistic-egocentric and callous-unemotional dimensions of personality in representative national and community samples of 4-12-year-old children in the Netherlands and Greece, respectively. Parents filled in the questionnaires anonymously and also provided ratings of conduct disorders. RESULTS: A two-dimensional construct of the psychopathic syndrome depicting, respectively, narcissistic and unemotional traits was reliable and valid in both countries, although there was considerable correlation between these two dimensions, which we designated 'social detachment' and 'emotional detachment', respectively. In both countries, the composite of social and emotional detachment was associated with aggressive and antisocial conduct disorders. CONCLUSIONS/IMPLICATIONS: The reliability, validity and predictive value of this questionnaire must be tested further, for example, through multiple informants and longitudinally, but our findings that the tool performs robustly in two very different European countries is encouraging in terms of its potential value as a clinical screening tool and a tool for furthering the understanding of serious behavioural disorders in children.

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The WAIS III was administered to 16 adults with high functioning autism (HFA) and 27 adults with Asperger syndrome. Differences between Verbal Intelligence (VIQ) and Performance Intelligence (PIQ) were not found. Processing Speed problems in people with HFA appeared. At the subtest level, the Asperger syndrome group performed weak on Digit Span. Comprehension and Block Design were relative strengths. In the HFA group, performance on Digit-Symbol Coding and Symbol Search was relatively poor. Strengths were found on Information and Matrix Reasoning. The results suggest that the VIQ-PIQ difference cannot distinguish between HFA and Asperger syndrome. WAIS III Factor Scale and Subtest patterning provides a more valid indicator.

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The number of children displaying childhood disorders in the Netherlands is estimated through a questionnaire referencing DSM-IV symptoms filled out by the parents of 2,563 4- 18-year-old Dutch children randomly taken from the general Dutch Youth population in 2004. The number of impaired children was estimated by applying the DSM-IV criteria for impairment by symptoms. It was found that 14% of all Dutch children display developmental difficulties, with 8% at risk of moderate behavioral and emotional difficulties and 6% at risk of a childhood psychiatric disorder. These prevalence figures based upon parental observations of DSM-IV symptoms in children are in agreement with the findings of other studies estimating psychiatric disorders in childhood in Western countries.

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UNLABELLED: The communication of people with autism spectrum disorder (ASD) is characterized by a qualitative impairment in verbal and non-verbal communication. In past decades a growing body of descriptive studies has appeared on language and communication problems in ASD. Reviews suggest that the development of formal and semantic aspects is relatively spared, whereas pragmatic skills are considered to be specifically impaired. This unique profile was interpreted mainly within the framework of the theory of mind hypothesis, which links the social-communicative problems of people with autism to an incapacity to attribute mental states to themselves and others. This approach has proven useful, but has also left many questions unanswered. In more recent publications, limited intentionality and symbol formation have been identified as core problems in ASD. Problems in symbol formation in particular might be better understood from the viewpoint of the central coherence hypothesis, which conceptualizes ASD as a weaker drive for the integration of information. Possible links between cognitive findings and communication evoke new perspectives with respect to the complex of communication problems in ASD. LEARNING OUTCOMES: The reader of this manuscript will be able to (1) describe the communication deficit in ASD; (2) discuss the central coherence account of ASD in relation to problems in sense-making; and (3) explain how these difficulties might lead to problems in communication in autism.

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METHOD: Sixteen studies on attachment in children with autism were reviewed, and ten studies with data on observed attachment security (N = 287) were included in a quantitative meta-analysis. RESULTS: Despite the impairments of children with autism in reciprocal social interaction, the majority of the studies found evidence for attachment behaviours in these children. In four samples using the Strange Situation procedure the average percentage of secure attachments amounted to 53% (n = 72). Meta-analytic results showed that children with autism were significantly less securely attached to their parents than comparison children, and the combined effect size for this difference was moderate (r =.24). Children with autism displayed less attachment security than comparisons without autism, but this difference disappeared in samples with children with higher mental development, and in samples in which autism was mixed with less severe symptoms of autistic spectrum disorders. CONCLUSIONS: It is concluded that attachment security is compatible with autism, and can be assessed with Strange Situation type of procedures. The co-morbidity of autism and mental retardation appears to be associated with attachment insecurity.

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