An interesting study from the Salk Institute finds that individuals with autism process language differently from typically developing people - and very differently indeed from people with Williams Syndrome, a disorder that features unusually high social engagement. According to a Newswise article:
For their study, [researchers]... compared brain response patterns linked to language processing in individuals with Williams syndrome, autism spectrum disorders and healthy controls. They focused on the so-called N400, a distinct pattern of electrical brain activity that can be measured by electrodes placed on the scalp. Known as ERP or event-related potential, the N400 is part of the normal brain response to words and other meaningful or potentially meaningful stimuli and peaks about 400 milliseconds after the stimulus.
When presented with a typical sentence that finished with an odd ending ("I take my coffee with sugar and shoes"), individuals with Williams syndrome exhibited an abnormally large N400 response indicating that they are particularly sensitive and attuned to semantic aspects of language. In contrast, individuals with ASD did not show this negativity, suggesting that the inability to integrate lexical information into the ongoing context may underlie their communicative and language impairments. Healthy people fell between those two extremes.
This study reinforces previous thinking about differences in autistic processing and reasoning. It also provides specific information about the physical causes of the differences, and offers some insights into just what makes it so tough for people with autism to "get" verbal content, make inferences, and respond to social cues.
Of course, therapists have known for years that people with autism process and use language differently, and many therapies have been developed to support linguistic and social understanding. Perhaps this and similar findings will help to fine-tune those therapies, making them more focused on specific deficits and more effective overall.
This comment should actually go under the “Flavors of Autism” thread (which has been closed down due to, I presume, the tone of some of the comments. However, there is a piece of misinformation that needs correction: An assertion was made by a two commenters that CID is an autism spectrum disorder, along with one assertion that the initials stand for “Childhood Integrative Disorder.” Lisa, this is incorrect. The initials being bandied about should logically be CDD, not CID, standing for “Childhood Disintegrative Disorder.” – the DSM-IV(TR) lists the criteria for it.
I find such language studies very interesting and agree completely with your final comment in this blog post. My son’s largest behavioral issues when he was young appear to have been centered around two areas – his sensory processing issues and his difficulties in processing language. For him, one of the most effective therapies was standard speech therapy. I’m sure this is not the case for every person with autism, but we were lucky indeed that it worked so well for him.
Malia, you’re right. The revised DSM-IV uses CDD, which is why Lisa didn’t recognize CID. CID is sometimes used by researchers, as you can see on this WHO clinical trial site:
My Google search reveals 56,000 hits for CDD, and only 1,300 for CID.
CDD is one of five PDDs that fall under the ASD umbrella. It’s also the most rare, with an estimated prevalence of 1.5:100,000 (Fombonne, 2009)
Difficulty in communication (verbal and non-verbal) is one of the “triad of impairments” described in 1979 by Dr. Lorna Wing, and then adopted into the DSM-III (R) in 1987.
The reason I pursued research in language development was my own struggles with spoken language. I tend to mangle what I hear, unable to understand even basic directives at times. Written language works much better for me, since it allows me time to study the sentence structures.
I often read the same page two or three times, even reading fiction. My wife says I read slower than anyone she knows.
Nonsensical sentences pass right by the first time. I have to study the words to notice there is a logic problem. Then, I have to wonder if it is an editing error or actual logic, since minor typos slip into even the best novels or texts. Reading is tedious, but worth it.
ANB,
You may find the following interesting.
http://www.medlink.com/medlinkcontent.asp
It is a Clinical Summary on Medlink that gives a bit of the history of how the definition of Childhood Disintegrative Disorder came about and how it came to fall into the category of Autism Spectrum Disorders. The words “integrative” and “disintegrative” have distinctly different and not completely opposite meanings, so I’m curious how it is that researchers have come to substitute “integrative” for “disintegrative” in their thinking of this particular facet of the autism spectrum, particular since it appears to have been a category specifically set up to deal with all those cases where children have developed normally for a time and then suddenly lost developmental ground. In the proposed DSM-V, it is proposed to be subsumed into the broader autism category.
At this point there is no disorder called “regressive autism,” and there’s some debate over whether or not it’s “real,” but I wonder whether CID and “regressive autism” are the same thing??
Lisa
Yes Lisa, that’s my point… Childhood Disintegrative Disorder appears to reflect the “essence” of “regressive autism” and it has been defined in the DSM for some time. Childhood Integrative Disorder implies something completely different to mean (given the meaning of “integrative”) and it has never been defined in the DSM. So, the question is… why are researchers using the term? Did someone slip up and just drop the “dis” part by mistake… or are they understanding something besides what “Childhood Disintegrative Disorder” implies?
It seems to me, this would make some difference in how certain past study results have been interpreted.
Oops – typos… s/b “Childhood Integrative Disorder implies something completely different to me (given the meaning of “integrative” vs. “disintegrative”).”
They sound like the same thing to me. “Disintegrative” doesn’t mean the kid disintegrates, like a tomato in a blender, so I’m not getting the connection with regression. Frankly, to call something a “disintegrative disorder” has a double-negative ring to it, like the kid has trouble disintegrating his faculties, which would be a good thing. A disorder of integration sounds more precise.
autismnewsbeat,
However, a problem integrating signals is not what is discribed in the criteria for “childhood disintegrative disorder.” The criteria clearly indicate that it’s primary difference for autistic disorder is normal development until age 2 followed by a “disintegration” of already developed skills up to age 10. This is, by definition and DSM description, is a regression into autism-like behavior … not a description of a problem with integrating skills or language meanings (which, as we know, does also manifest itself as a difficulty people with autism can have). For clarity, it seems to me that CID, as it seems to be understood here, is NOT the same as CDD and is NOT described anywhere in the DSM let alone under the umbrella of Autism Spectrum Disorders.
Recent studies have indicated that “regressive autism” is merely a misread by parents of how their children developed and perhaps CDD should eventually be officially eliminated from the DSM. However, IMO, researchers do not have the unilateral authority to just drop a “dis” AND change the definition of something already clearly defined in the DSM… and CDD IS clearly associated with regression in the current DSM and is has been so since it was first introduced.
For a thorough description of CDD, see Dr. Andrew Wakefield’s article “The Devil’s in the Detail” at:
http://www.wesupportandywakefield.com/documents/Autism%20File%20USA34-Wakefield.pdf
OK, now I understand. Thanks. It appears that CID is a typo in the WHO paper and on about 1,300 other sites. Not surprising, really.
CDD usually appears around three or four years age, well past the time when some parents claim they saw regression from vaccines. It’s not just parents who misremember – Jenny McCarthy’s science advisor, Dr. Jay Gordon, claims that an eight-month old patient of his lost language and regressed after a vaccine.
According to the Mayo Clinic, CDD is often “misdiagnosed” as late onset autism… yet it is one of the autism spectrum disorders?? Perhaps they’re distinguishing CDD from classic autism – but it’s not at all clear.
Meanwhile, I can find no reference Childhood Integrative Disorder on the NIH, NIMH or Mayo sites, though the term is used elsewhere…
Here’s what Mayo says about CDD (as referenced by the NIH website):
“Definition
Childhood disintegrative disorder is a condition in which children develop normally until age 3 or 4, but then demonstrate a severe loss of social, communication and other skills.
Doctors sometimes confuse this disorder with late-onset autism. Both conditions involve normal development followed by significant loss of language, social, play and motor skills. Childhood disintegrative disorder and autism are among several disorders known as pervasive developmental disorders or autism spectrum disorders.
Autism typically occurs at an earlier age than childhood disintegrative disorder. There’s also a more dramatic loss of skills with childhood disintegrative disorder and a greater likelihood of mental retardation. In addition, childhood disintegrative disorder is far less common than autism.”
Basically, both autism and CDD are descriptions of characteristics/behavors, without any description of causation/etiology.
Someone could come down with measles (for example) at the age of one, or at the age of five, and it would still be measles, even if the course of the disease might run differently in two individuals.
Likewise, someone could lose language and develop characteristics of autism at the age of one, two, three, four, or five — perhaps because of similar toxic insults having similar impact on the brain, immune system, etc., and it would basically be the same syndrome. This type of regression is more rare after the age of two. If it sometimes occurs at age 3 or 4, that does not discredit Jenny McCarthy or Dr. Gordon, and it does not mean that it cannot occur earlier.
I don’t think there is any way to draw a clear line between autism and CDD. Some autism and some CDD includes mental retardation. (Of course, sometimes when an individual with autism learns to communicate with a device it turns out they are not so mentally impaired as previously thought – such as Chantal Sicile-Kira’s son, who recently graduated from high school.) Some autism and some CDD includes seizures. Autism is a broad spectrum, and what I have read is that CDD is on the spectrum.
I had never heard of CID until now. Not sure if the term is used interchangeably with CDD.
One site says “Several forms of pervasive developmental disorders have been identified: Autistic disorder, Rett’s Disorder, Childhood Disintegrative Disorder, Asperger Syndrome, and Pervasive Developmental Disorder not otherwise specified (PDD NOS). ..” but then goes on to say:
“Childhood integrative disorder involves qualitative impairment in social interaction; qualitative impairments in communication; and restricted, repetitive, and stereotyped patterns of behavior, interests, and activities, including motor stereotypes and mannerisms. It starts later than autism and most children have normal development until 4 years old.”
http://www.healthcentral.com/encyclopedia/408/609.html
Did they just leave the “Dis” off by accident (like Malia asked), or are the two terms used interchangeably? I don’t know.
It appears they are not interchangeable. That was a typo.