Original articleBody Length and Head Growth in the First Year of Life in Autism
Introduction
Autism spectrum disorders are neurodevelopmental disorders characterized by severe difficulties in social interaction and communication, and with restricted or stereotyped patterns of behavior and interests [1]. Autism spectrum disorders include autistic disorder, Asperger’s syndrome, and pervasive developmental disorder-not otherwise specified. The abnormal functioning generally starts before 3 years of age. Although there is abundant evidence of functional and morphologic abnormalities in the brains of subjects with autism spectrum disorders, the pathophysiologic processes underlying autism spectrum disorders are unknown [2]. One of the most consistent findings in children with autism spectrum disorders >3 years of age is an increased rate (14-34%) of macrocephaly (head circumference >97th percentile) and a larger mean head circumference compared with normally developing children [3], [4]. Because head growth is strongly related to brain growth during infancy and early childhood [5], [6], an increased head size at a very young age is suggestive of early abnormal development of the brain in autism [3]. The rate of macrocephaly in children with autism spectrum disorders at birth is about 7%, higher than the expected value of 3%, but lower than that seen in older autistic children. Further, most studies report that the mean head circumference of autistic individuals at birth is normal [7], [8], [9], [10], [11] or even smaller [5] than that of control subjects. To examine the growth pattern of head circumference in children with autism spectrum disorders and to localize the timing of abnormal growth, longitudinal studies were performed in which information about head circumference between birth and age 3 years was extracted from medical records (Table 1). Four studies found an increased rate of head growth (three in the first year of life [5], [10], [11], and one between 2-3 years [12]), and two found that growth in body length of children with autism spectrum disorders between birth and age 3 years was more abnormal than that of head circumference, and reported an increased growth of body length around 4 months [9] and between 2-3 years [12].
However, these studies had a number of limitations, such as small sample size, the use of either a reference group or a normal control group but not both, the small number of measurements of head circumference and height per child, and the use of referred versus population-based samples. For these reasons, we investigated a population-based sample of children with autism spectrum disorders, and compared the increase in head circumference and body length with that of normally developing children from the same population, and with population norms. The study was based on the well-organized infrastructure of well-baby clinics in the Netherlands, where children up to age 4 years are assessed at regular routine visits, and head circumference, body length, and weight are recorded.
Section snippets
Study Population
From October 1999 up to April 2002, 31,724 children from the general population were screened with the Early Screening for Autism Traits Questionnaire at their routine 14-month developmental check at well-baby clinics in the province of Utrecht [13]. Children who scored positive at the population screening, and children up to age 36 months identified as having social or communication problems by the monitoring system of the well-baby clinics, were invited for a comprehensive psychiatric
Univariate Analyses
The head-circumference z-scores of children with autism spectrum disorders and of children with normal development were not significantly different from the population norms (Fig 1a,b). The z-scores for length of children with autism spectrum disorders were significantly higher than the population norms from age 4 months onward. The test statistic chance level was <0.01 at ages 4 months, 6 months, 8 months, and 11 months (Fig 2a). The z-scores for length of the control children with normal
Discussion
Our study was distinctive in several respects. We used a sample of children with autism spectrum disorders, identified through population-based screening and the monitoring system of well-baby clinics, and we had access to data on head circumference and body length measurements recorded several times throughout the first year of life. We compared these data with both population norms and data for normally developing children. Further, by using multilevel analyses, we took into account small
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2015, Psychiatry Research - NeuroimagingCitation Excerpt :The following exclusion criteria were then applied: (1) case reports, commentaries and reviews; (2) studies not in English, German, French, Italian, or Spanish; (3) studies on animal models or studies using a genetic approach; (4) reports on known syndromic forms of autism, Rett syndrome or specific diagnoses other than idiopathic ASD; (5) publications lacking measures of head circumference, including clinical, neurocognitive, biochemical, brain imaging and post-mortem studies; (6) retrospective or longitudinal studies of head circumference trajectory providing multiple data points per each individual; (7) reporting head circumference measurements of healthy individuals only. At the end of this process, 27 studies were selected, each assessing patients with idiopathic autism (i.e., DSM-IV diagnoses of either Autistic Disorder, Asperger's Disorder or Pervasive Developmental Disorder Not Otherwise Specified, PDD-NOS), measuring head circumference in autistic patients and providing the percentage of macrocephalic individuals (Bolton et al., 1994; Bailey et al., 1995; Woodhouse et al., 1996; Davidovitch et al., 1996; Stevenson et al., 1997; Lainhart et al., 1997; Skjeldal et al., 1998; Fombonne et al., 1999; Ghaziuddin et al., 1999; Fidler et al., 2000; Miles et al., 2000; Gillberg and de Souza, 2002; Deutsch and Joseph, 2003; Torrey et al., 2004; Dementieva et al., 2005; Lainhart et al., 2006; Sacco et al., 2007; Van Daalen et al., 2007; Webb et al., 2007; Miles et al., 2008; Chawarska et al., 2011; Davidovitch et al., 2011; Ververi et al., 2012; Chaste et al., 2013; Froehlich et al., 2013; Grandgeorge et al., 2013; Cederlund et al., 2014). For each selected study, macrocephaly was defined as a head circumference above the 97th percentile.
Overweight and Obesity in a Sample of Children With Autism Spectrum Disorder
2015, Academic PediatricsA review of physical growth in children and adolescents with Autism Spectrum Disorder
2015, Developmental ReviewCitation Excerpt :Physical measurements were converted to percentiles based on CDC norms from the US, and no significant differences were found on any of these measures; however, given the ethnically different control population, the conclusions drawn from these results are limited. Along with increased stature reported in many studies, children with an ASD also displayed increased weight and body mass index (BMI), which correlates with other increased physical growth measurements (Chawarska et al., 2011; Dissanayake et al., 2006; Fukumoto et al., 2008; Gillberg, 2002; Mills et al., 2007; Mraz et al., 2007; van Daalen et al., 2007; Xiong et al., 2009). Mraz et al. found increased weight at only 1–2 months of age in children with ASD, while Fukumoto et al. reported increased weight at 3, 6, and 12 months in children with HFA, and at 3 and 12 months in children with low-functioning autism (IQ < 70) compared with TD children.
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