UNDERdiagnosis of Autism Spectrum Disorders in Individuals with Intellectual Disabilities

A study presented at the IMFAR 2012 conference this spring in Toronto, Underdiagnosis of Autism Spectrum Disorders in Individuals with Intellectual Disabilies, seems to provide evidence contradicting the widely propagated assertion that the DSM-IV era has seen autism incorrectly diagnosed as a substitute  diagnosis in many cases of intellectual disability.  Roeyrs and Thys actually conclude that autism is UNDER diagnosed in a large study of persons with intellectual disability.  

If the study results are confirmed it seems likely  the harmful impact of the express, and intentional,  targeting for exclusion of severe intellectually disabled from the DSM5 autism spectrum disorder will be increased to the detriment of those most severely affected by intellectual disability and autism symptoms.  The missing of co-occurring autism disorder in persons with intellectual disabilities, as the authors indicate, could have serious repercussions for their care and treatment.  

2012 International Meeting for Autism Research

Underdiagnosis of Autism Spectrum Disorders in Individuals with Intellectual Disabilities

Thursday, May 17, 2012

Sheraton Hall (Sheraton Centre Toronto)

3:00 PM

H. Roeyers and M. Thys, Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium

Background: Only a limited number of studies examined the prevalence of autism spectrum disorders (ASD) within the population with intellectual disabilities (ID) and even less studies tried to estimate the proportion of missed diagnoses of ASD in individuals with ID. It is however of great importance that the co-occurrence of ASD is recognized with a view to improving the quality of life of individuals with ASD and their social environment.

Objectives: The first goal of this study was to estimate the prevalence of ASD in a very large sample of individuals with ID. A second and equally important goal was to identify the proportion of overlooked diagnoses in various settings for individuals with ID.

Methods: The sample comprised 2798 individuals with ID and 322 individuals with borderline intellectual functioning from the 5 provinces of Flanders, the Dutch-speaking part of Belgium. The mean age was 25.6 years (SD=16.42), ranging from 1 tot 81 years. 52% of the sample was older that 18. Subjects were screened with the Scale of Pervasive Developmental Disorder in Mentally Retarded persons – Revision, a screening instrument with excellent sensitivity and specificity (Kraijer & de Bildt, 2005).

Results: 633 children and adults were classified as having ASD. This is 21.1% of our sample. When the subgroup with borderline intellectual functioning was excluded, the prevalence rate increased to 22.2%. The male-female ratio was 2:1. Occurrence of ASD was higher in subgroups with more severe forms of ID. 40% of the individuals with an ASD classification had no official diagnosis previously and another 22% was only suspected to have ASD. The proportion of supposedly missed diagnoses was significantly higher in females than in males. ASD was also significantly more often overlooked in adults compared to children. In addition, diagnoses were more likely to be missed in case of an associated genetic disorder such as Fragile X or Down syndrome, a comorbid psychiatric disorder or a severe visual impairment.

Conclusions: This is, to our knowledge, the largest sample of individuals with ID that was ever screened for ASD. Our study confirms that a substantial subgroup screens positive for ASD and that the diagnosis is often missed. Late diagnosis, or the failure to diagnose at all, may have unfavorable and long-standing effects for those affected and their families. For professionals in facilities and schools for individuals with ID it would seem important to bear the possibility of co-occuring ASD in mind. The recognition of ASD could lead to a better understanding of the overall problems of the clients and to more appropriate care and treatment.

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Individual Chicken Pot Pies

What are some of your favorite comfort foods? When I asked The Baron this question not too long ago, he mentioned that he really enjoyed chicken pot pies. It's been awhile since I've made a gluten free pie, much less a savory one, so this was a great opportunity to play with a gluten free pie dough. Rather than a larger pie, I made these Individual Chicken Pot Pies for dinner recently. The buttery, flaky crust went perfectly with the savory vegetable filling. If you're looking for some comfort on a cold winter day, this will definitely hit the spot!

The gluten free crust for this came out nice and flaky... I can only imagine how great it comes out using regular all purpose flour. This is a great dish to make in advance, especially on those winter days you may be snowed in. They freeze beautifully too, making it a nice meal to make when you just want to pop something in the oven for dinner after a long day at work.

Individual Chicken Pot Pies
recipe from Gluten Free Canteen

Pastry Crust

• 2 cups all purpose flour or 300 grams gluten free flour blend*
• 1 teaspoon kosher salt
• 1 teaspoon granulated sugar
• 1/4 teaspoon dried thyme
• 8 tablespoons chilled unsalted butter
• 7 tablespoons solid vegetable shortening
• 1/2 cup ice water

Filling

• 3 tablespoons olive oil
• 3 cups leftover chicken diced
• 3 medium carrots, chopped finely dice
• 3 small celery sticks chopped finely dice
• 3/4 cups chopped green beans
• 2 cloves garlic minced
• 1 small shallot, minced
• 1/2 teaspoon salt
• 1/4 teaspoon black pepper
• 1/2 teaspoon dry thyme
• 3/4 cup white wine
• 4 cups chicken broth, hot
• 2 tablespoons corn starch
• 1/4 cup white wine

Cooking Directions

1. In the bowl of a food processor pulse together flour, salt, sugar, and thyme. Add cubed butter and shortening. Pulse until mixture looks like coarse crumbs. Add cold water down the chute beginning with about half the water, and keep pulsing. Add more as needed and stop as soon as dough forms a very ragged ball. Do not add more water.
2. Turn dough onto plastic wrap and remove blade carefully. Knead slightly to bring all the dough together. Wrap and chill dough for at least an hour. If making one large pie, roll dough between sheets of plastic wrap just slightly bigger than the pan. If making smaller individual pies or ramekins, roll dough in pieces just larger than the circumference of each pie or ramekin. Chill dough while preparing filling.
3. For the Filling - Heat olive oil in a saute pan. Set aside diced chicken. Add carrots, celery, green beans, garlic, shallot, salt, pepper, and thyme to the heated oil. Saute until vegetables are just wilted and beginning to caramelize. Deglaze pan with 1/2 cup white wine, letting the wine almost evaporate. Add hot chicken broth and stir to combine, letting the broth reduce on a medium for about 5 minutes. Add flour to the other 1/4 cup of white wine and whisk to combine. Add to hot broth mixture and stir until it begins to boil and thicken. Remove from heat and stir in diced chicken.
4. Place equal portions of the mixture in pie dish or individual pie or ramekin dishes. Set on a baking sheet.
5. Preheat oven to 375. When oven is preheated, remove rolled dough from refrigerator. Top the pie or individual pie or ramekins with dough circles. You might have a little bit of pie dough leftover. Save it for another use. Pinch edges to seal and cut slits on top to vent. Sprinkle lightly with sea salt.
6. Bake about 35-40 minutes or until the crust is golden brown and filling is bubbling through the vents. Cool slightly for about 10-15 minutes and serve.

*Gluten free flour blend:

This is the best combination for my personal uses and has never failed me. I purchased a majority of the ingredients at an Asian market (at less than $.99/lb) and the other ingredients marked were Bob Red Mill brand. Cornstarch was Argo brand.

300 grams superfine brown rice flour (Bob's Red Mill)
250 grams sweet rice flour (Asian market)
150 grams tapioca flour (Asian market)
100 grams sorghum flour (Bob's Red Mill)
100 grams potato starch (Asian market)
100 grams cornstarch (Argo brand)

Whisk together the above flours and store in an air tight container. To use, measure out 140 grams for every cup called for in your favorite baking recipe (NOT yeast bread recipes.) Add 1/2 teaspoon xanthan gum for every cup used in the recipe as well to help with texture and binding. Voila! You can bake gluten free with confidence!

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Contest ON: Find LOVE this Valentine's at Digital Walker!

Here's something that you might want to join and get a special something this coming Valentine, Digital Walker! is having a contest where you can get a chance to win the Featured product.

This contest will require you to visit any of Digital Walker branches and taking a picture of the featured gadget and uploading it to their Facebook Page. Simple Right, Read on for the mechanics.

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A carnevale ogni chifeletto vale

Come spiega bene Giacomo Cecotti, quando a Trieste si nominano i chifeletti di patate, si parla di mezze lune di pasta di patate fritte nell’olio, contorno ideale per lo stinco arrosto o per delle bistecche impanate. Ma gli stessi chifeletti, possono essere anche in versione dolce e così li ho adottati come mio dolce carnevalesco per questa stagione!

Per realizzarli vi occorreranno un chilo di patate, un pizzico di sale, un uovo e 250g di farina, olio di arachidi per friggere, abbondante zucchero a velo per spolverare.

Lessate le patate con la buccia in acqua salata e passatele attraverso lo schiacciapatate dopo averle tagliate a metà: la buccia resterà all'interno dello strumento e le patate andranno mescolate con la farina, l'uovo intero ed il sale.

Create un impasto ben amalgamato (come quello per gli gnocchi). Lavorate quindi la pasta a formare dei filoncini, che andranno tagliati in sezioni di otto-dieci centimetri, del diametro di un centimetro abbondante da modellare poi a forma di cornetto

Friggere i chiffeletti in olio di arachidi e quando saranno ben fritti, con il colore passato da giallo chiaro a marroncino, i chifeletti saranno pronti. Serviteli caldi e spolverizzati di abbondante zucchero a velo!

Nella mia cucina
Piatto Villa d'Este Home
Padella Risolì



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CRANBERRY ORANGE PECAN MUFFINS

HUMBLE BEGINNINGS

The sky was dark and gloomy, the air was damp and raw, the streets were wet and sloppy. 

The smoke hung sluggishly above the chimney-tops as if it lacked the courage to rise, 

and the rain came slowly and doggedly down, 

as if it had not even the spirit to pour. 

– Charles Dickens, The Pickwick Papers 

While the wild, furious winter carpets the northeast with snow, as my distant friends awake to yet another morning of white silence, backyards and front stoops buried beneath glorious mounds of icy brilliance, I stand in the rain under gloomy, sluggish gray skies. Again. Not one to let that hamper my mood, I channel my inner housewife and decide that nothing sparks the baking flame like a rainy day.

Inner housewife aside, there is nothing that brings out the child in me quite like homebaked cranberry muffins. Delicate cakey muffins, just sweet enough (but not too much), dotted with deep garnet berries that burst on the tongue in a clap of fruity tartness much like the anticipated yet unexpected clap of thunder that shivers the skies. I pull out that long-ago recipe learned in the Girl Scouts or junior high Home Ec, a recipe that made me utterly once and for all fall in love with baking. And succeeded in mortifying me, making me feel completely incompetent. You see, a recipe perfectly executed under the watchful eye of teacher or Scout leader, a treat so perfect that I wanted nothing more than to rush home and duplicate the recipe for my family, somehow got flipped and shuffled around in my soft and tender young head once on my own. That original recipe, still stuck away somewhere among my youthful jottings, scratched down in my loopy grade school cursive, called for three tablespoons of Crisco. Yes, you see it coming, don’t you? By the time I gathered the ingredients and found a free afternoon to bake, in my eagerness and enthusiasm, overflowing with self-confidence, those three tablespoons became three cups.

 Years of Innocence

I pulled the tin from the oven and, much to my horror and dismay, discovered tiny muffin tops floating in a sea of grease. Alas. The experience dampened my enthusiasm, much like the weather that rages outside my windows. My brother – the brother with whom I spent Sunday afternoons pulling taffy across the kitchen expanse or pouring boiling sesame-studded caramel into parchment-lined pans for candy, the brother with whom I baked my first yeast breads - peered at the mess over my shoulder and comforted me in his own brotherly way. He told me not to give up, he urged me to just start the whole project over again.

Over the years, I have reconstructed the recipe, searched and adapted new recipes and developed the one I now make every single winter season, come rain or come shine. Oddly enough, this is one treat that all three of my men, each one more persnickety than the next, absolutely love. The tender cake is not too sweet, and this one I kicked up with the fragrance of winter’s orange. I added a handful or two of coarsely chopped pecans for the bite and doused the whole with a cinnamon-sugar topping just before sliding the tin into the oven. And once the scent of those homely, fabulous muffins fills the house, the men stop what they are doing and wander into the kitchen, expectations high. And we forget the rain and gloom, forget the endless chain of dreary days, forget the misery and boredom of being stuck inside the house, huddled together in front of the tv or laptops.

In the country, the rain would have developed a thousand fresh scents, 

and every drop would have had its bright association with some beautiful form of growth or life. 

In the city, it developed only foul stale smells, 

and was a sickly, lukewarm, dirt-stained, wretched addition to the gutters. 

– Charles Dickens, Little Dorrit 

CRANBERRY ORANGE PECAN MUFFINS
Makes 12 muffins

8 Tbs (115 g) unsalted butter, softened to room temperature
1 cup (200 g) sugar
2 large eggs
1 tsp vanilla
Finely grated zest of 1 orange
2 cups (260 g) flour
2 tsps baking powder
½ tsp salt
½ cup (125 ml) milk
1 ½ - 2 cups fresh cranberries, thawed if frozen
½ - 1 cup coarsely chopped pecans
Tbs sugar + 1 tsp ground cinnamon mixture for topping, optional

Preheat the oven to 375°F (190°C). Line a 12-muffin tin with cupcake papers or grease them well.

Coarsely chop the pecans. Pick over the cranberries and discard any rotten berries; slice any large cranberries in half. Zest the orange.

In a mixing bowl, cream together the softened butter with the sugar until light and fluffy. Add the eggs, one at a time, beating well after each addition. Briefly beat or stir in the vanilla and the orange zest.

Stir the flour, baking powder and salt together. Add the dry ingredients into the creamed batter in 3 additions alternating with the milk added in 2: dry-wet-dry-wet-dry, beating briefly but well after each addition. Do not overbeat.

Using a large spatula, fold the cranberries and pecans into the batter until evenly distributed.

Spoon the batter evenly into the 12 muffin cups. Don’t worry if they are mounded above the edge of the cups, this batter is firm enough that they will rise up and not spill over. Sprinkle the top of each muffin with the cinnamon-sugar mixture if desired.

Bake the muffins for 30 minutes until risen, the top golden; a tester inserted in the center of a muffin should come out clean. Remove from the oven and carefully lift each muffin out of the pan and transfer to a cooling rack to cool. (Use a small sharp knife or kabob spike to lift them up out of the tin so as to avoid burning fingers)

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Watch out for Samsung Galaxy Grand, 5-inch Dual-SIM Smartphone

The Samsung Galaxy Grand was announced last december, and now the long wait is over, this 5-inch, Dual-SIM Android smartphone is about to hit the Philippine market this month.

With an SRP of Php16,990 it's way more cheaper than Galaxy S-III and the Note 2, not to mention the Dual-SIM capability and it sports a 5-inch WVGA display that has a resolution of 480 x 800 pixels and Android 4.1.2 Jelly Bean out of the box.

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Cherry Mobile Thunder Php 4,999 1GHz Dual Core Processor Android 4.0 Smartphone

Cherry Mobile recently released the OMEGA and now they have another one that is exclusive to Lazada which is Cherry Mobile Thunder, a Dual-SIM, dual-core Android phone.

The Thunder sports a 4.5" Capacitive Touch screen powered by 1 GHz dual-core processor and equipped with 4GB internal memory.

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