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Can we distinguish the consequences of early maltreatment on child behaviour from idiopathic autism?
  1. Jeanne Wolstencroft1,
  2. William Mandy2,
  3. Lucy Brown-Wright3,
  4. Marianna Murin4,
  5. David Skuse1,
  6. Margaret DeJong5
  1. 1BRC Great Ormond Street Institute of Child Health, University College London, London, UK
  2. 2Psychology and Language Sciences, University College London, London, UK
  3. 3Psychological and Mental Health Services, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
  4. 4Anna Freud Centre, University College London, London, UK
  5. 5Psychological and Mental Health Services, Queen Anne Street Clinic, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
  1. Correspondence to Dr Jeanne Wolstencroft, Great Ormond Street Institute of Child Health, UCL, London, UK; j.wolstencroft{at}


Objective To identify clinical features that could distinguish children presenting with autistic-like features and a history of severe early maltreatment from children with idiopathic autism spectrum disorders (ASDs).

Design Matched-comparison study.

Setting Great Ormond Street Hospital, UK.

Participants 46 children with a history of early maltreatment, mean (SD) age 10.6 (3.3) years and 47 children with an ASD, mean (SD) age 10.4 (2.9) years.

Main outcome measures A range of standardised interview and observational measures that are designed to quantify autistic traits. Caregiver and teacher reports were obtained on broader aspects of behavioural and emotional adjustment.

Results Both groups had normal range IQ and were predominantly male. On the basis of autistic traits alone, caregiver interview and structured observation concurred that over 60% of the formerly maltreated children met criteria for an ASD. Autistic symptom profiles were very similar in both groups, although children with idiopathic ASD had significantly more marked repetitive and stereotyped behaviours. Teacher and caregiver reports indicated that children from both groups had an increased and broadly similar prevalence of emotional and behavioural disorders.

Conclusion Children presenting with a history of early maltreatment, who show autistic traits of behaviour, have a high risk of meeting diagnostic criteria for ASD. Their symptom profiles are virtually indistinguishable from children with idiopathic autism.

  • autism
  • child abuse
  • child development
  • paediatrics
  • psychology

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  • Contributors DS and MDJ conceived the project. LB-W and MM acquired and interpreted the data in this study. JW and WM performed the data analysis. DS, MDJ, LB-W, MM, JW and WM assisted with study design, supervised data collection and revised the article. All authors contributed to the manuscript. MDJ is the guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. All research at Great Ormond Street Hospital NHS Foundation Trust and UCL Great Ormond Street Institute of Child Health is made possible by the NIHR Great Ormond Street Hospital Biomedical Research Centre. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.