Developmental functioning and medical Co-morbidity profile of children with complex and essential autism.
Measure head size and scan for facial differences—kids with “complex” autism need tighter medical and adaptive support.
01Research in Context
What this study did
Flor et al. (2017) sorted children with autism into two groups. One group had small heads or unusual facial features. The other group looked typical.
They compared IQ scores, daily-living skills, stomach problems, and medicine use between the two groups.
What they found
Kids labeled “complex” scored lower on thinking and self-care tests. They also had more tummy trouble and took more drugs.
The “essential” group did better on almost every measure.
How this fits with other research
Lifshitz et al. (2014) saw the same link: more odd features meant lower language and motor scores in preschoolers.
Jennett et al. (2003) found the opposite end of the head-size curve. Kids with big heads often had high non-verbal scores. Together the papers show both extremes—small or large—flag different autism sub-types.
Mukherjee et al. (2021) tried to copy the dysmorphology check in Indian toddlers but got messy results. Age and ancestry changed the scores, so the tool needs caution outside North-American clinics.
Why it matters
Grab a tape measure. Note any unusual ear placement, wide-set eyes, or a head below the third percentile. These quick clues warn you the child may need a GI work-up, seizure watch, and stronger adaptive goals. Share the photo with the pediatrician so medical care and ABA plans match the child’s true profile.
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02At a glance
03Original abstract
Children with Autism Spectrum Disorders (ASD) may be characterized as "complex" (those with microcephaly and/or dysmorphology) or "essential" (those with neither of these two). Previous studies found subjects in the complex group exhibited lower IQ scores, poorer response to behavioral intervention, more seizures and more abnormal EEGs and brain MRIs compared to the essential group. The objective of this study was to determine if there are differences in complex versus essential subjects based on several developmental/psychological measures as well as certain medical comorbidities. This study utilized data from 1,347 individuals (2-17 years old) well-characterized subjects enrolled in Autism Treatment Network (ATN) Registry. Head circumference measurement and the Autism Dysmorphology Measure (ADM) were used by trained physicians to classify subjects as complex or essential. Significantly lower scores were seen for complex subjects in cognitive level, adaptive behavior and quality of life. Complex subjects showed significantly increased physician-documented GI symptoms and were on a higher number of medications. No significant differences in autism severity scores, behavioral ratings and parent-reported sleep problems were found. After adjusting for multiple comparisons made, adaptive scores remained significantly lower for the complex group, and the complex group used a significantly higher number of medications and had increased GI symptoms. Complex and essential autism subtypes may have distinct developmental and medical correlates and thus underlines the importance of looking for microcephaly and dysmorphology, when evaluating a child with autism. Determining this distinction in autism may have implications in prognosis, identifying medical co-morbidities, directing diagnostic evaluations and treatment interventions. Autism Res 2017, 10: 1344-1352. © 2017 International Society for Autism Research, Wiley Periodicals, Inc.
Autism research : official journal of the International Society for Autism Research, 2017 · doi:10.1002/aur.1779