Peng, C., Hatlestad, P., Klug, M.G., Kerbeshian, J., & Burd, L Health Care Costs and Utilization Rates for Children with Pervasive Developmental Disorders in North Dakota From 1998 to 2004: Impact on Medicaid.Journal of Child Neurology.2009. 24(2): 140-147.

Kerbeshian, J., Burd, L., & Tait, A. Chain Reaction or Time Bomb: A Neuropsychiatric-Developmental/Neurodevelopmental Formulation of Tourettisms, Pervasive Developmental Disorder, and Schizophreniform Symptomatology Associated with PANDAS.World Journal of Biological Psychiatry.2007. 8(3): 201-207.

Kerbeshian, J. & Burd, L. Letter to the Editor: Tourette Syndrome and Prognosis in Autism.European Child and Adolescent Psychiatry.2003. 12(2): 103.

Klug, M.G., Burd, L., Kerbeshian, J., Benz, B., & Martsolf, J.T. A Comparison of the Effects of Parental Risk Markers on Pre- and Perinatal Variables in Multiple Patient Cohorts with Fetal Alcohol Syndrome, Autism, Tourette Syndrome, and Sudden Infant Death Syndrome: An Enviromic Analysis.Neurotoxicology and Teratology.2003. 25(6): 707-717.

Burd, L., Kerbeshian, J., Westerland, A., LaBine, J., Barth, A., Klug, M.G., & Wagner, K.J. Prospective Long-Term Follow-Up of Patients with Pervasive Developmental Disorders.Journal of Child Neurology .2002. 17(9): 681-688.

Kerbeshian, J., Burd, L., & Avery, K. Pharmacotherapy of Autism: A Review and Clinical Approach.Journal of Developmental and Physical Disabilities.2001. 13(3): 199-227.

Burd, L., Stenehjem, A., Franceschini, L., & Kerbeshian, J. A Fifteen Year Follow-Up of a Boy with Pyridoxine (Vitamin B6) Dependent Seizures with Autism, Breath Holding, and Severe Mental Retardation.Journal of Child Neurology.2000. 15(11): 763-765.

Kerbeshian, J. & Burd, L. Peek-A-Boo Fragile Site? Or a Peek-A-Boo Paper?American Journal of Medical Genetics.2000. 96(3): 430-431.

Kerbeshian, J., Severud, R., Burd, L., & Larson, L. Peek-A-Boo Fragile Site at 16D Associated with Tourette Syndrome, Bipolar Disorder, Autistic Disorder, and Mental Retardation.American Journal of Medical Genetics.2000. 96(1): 69-73.

Burd, L., Severud, R., Kerbeshian, J., & Klug, M. Prenatal and Perinatal Risk Factors for Autism.Journal of Perinatal Medicine.1999. 27(6): 441-450.

Burd, L., Ivey, M., Barth, A., & Kerbeshian, J. Two Males With Childhood Disintegrative Disorder: A Prospective 14-Year Outcome Study.Developmental Medicine and Child Neurology.1998. 40: 702-707.

Kerbeshian, J. & Burd, L. Case Study: Comorbidity Among Tourette’s Syndrome, Autistic Disorder and Bipolar Disorder.Journal of the American Academy of Child and Adolescent Psychiatry.1996. 35(5): 681-685.

Kerbeshian, J. & Burd, L. A Clinical Pharmacological Approach to the Treatment of Autism.The Habilitative Mental Health Care Newsletter.1991. 10(6): 33-36.

Kerbeshian, J., Burd, L., & Fisher W. Asperger's Syndrome: To Be or Not to Be?The British Journal of Psychiatry.1990. 156: 721-725.

Kerbeshian, J., Burd, L., Randall, T., Martsolf, J.T., & Jalal S. Autism, Profound Mental Retardation, and Atypical Bipolar Disorder in a 33-Year-Old Female With a Deletion of 15q12.Journal of Mental Deficiency Research.1990. 34: 205-210.

Burd, L. Research on Autism and Other Pervasive Developmental Disorders.Developmental Disabilities Network News .1989. 3(1): 10-12.

Burd, L., Fisher, W., & Kerbeshian J. Pervasive Disintegrative Disorder: Are Rett Syndrome and Heller Dementia Infantalis Subtypes?Developmental Medicine and Child Neurology.1989. 31: 609-616.

Burd, L. & Kerbeshian J. Case Study: Psychogenic and Neurodevelopmental Factors in Autism.Journal of the American Academy of Child and Adolescent Psychiatry .1988. 27: 252-253.

Burd, L. & Kerbeshian J. Familial Pervasive Development Disorder, Tourette Disorder and Hyperlexia.Neuroscience and Bio¬behavioral Reviews.1988. 12: 233-234.

Burd, L. & Kerbeshian J. Diagnosis of Autism and Other Pervasive Developmental Disorders.Neuroscience and Biobehavioral Reviews.1988. 12: 275-282.

Burd, L., Fisher, W., & Kerbeshian J. Childhood Onset jPervasive Development Disorder.Journal of Child Psychology, Psychiatry and Allied Disciplines.1988. 29(2): 155-163.

Burd, L., Fisher, W., Kerbeshian, J., Vesely, B., Durgin, B., & Reep P. A Comparison of Breastfeeding Rates Among Children with Pervasive Developmental Disorder and Controls.Journal of Developmental and Behavioral Pediatrics.1988. 9(5): 247-251.

Burd, L., Martsolf, J.T., Kerbeshian, J., & Jalal S.M. Partial 6p Trisomy Associated with Infantile Autism.Clinical Genetics.1988. 33: 356-359.

Fisher, W., Burd, L., & Kerbeshian J. Markers for Improvement in Children with Pervasive Developmental Disorders.Journal of Mental Deficiency Research.1988. 32: 357-364.

Burd, L. The Fragile X Chromosome.The New England Journal of Medicine.1987. 316: 483.

Burd, L., Fisher, W., & Kerbeshian J. A Prevalence Study of Pervasive Developmental Disorders in North Dakota.Journal of the American Academy of Child and Adolescent Psychiatry.1987. 26: 700-703.

Burd, L., Fisher, W., Kerbeshian, J., & Arnold M.E. Is Development of Tourette Disorder a Marker for Improvement in Patients with Autism and Other Pervasive Developmental Disorders?Journal of the American Academy of Child and Adolescent Psychiatry.1987. 26: 162-165.

Burd, L., Fisher, W., Knowlton, D., & Kerbeshian J. Hyperlexia: A Marker for Improvement in Children with Pervasive Developmental Disorders?Journal of the American Academy of Child and Adolescent Psychiatry.1987. 26: 407-412.

Fisher, W., Burd, L., & Kerbeshian J. Comparisons of DSM-III Defined Pervasive Developmental Disorders in North Dakota Children.Journal of the American Academy of Child and Adolescent Psychiatry.1987. 26: 704-710.

Kerbeshian, J., Burd, L., & Fisher W. Lithium Carbonate in the Treatment of Two Patients with Infantile Autism and Atypical Bipolar Symptomatology.Journal of Clinical Psychopharmacology.1987. 7(6): 401-405.

Burd, L. Bornhoeft, D.M., & Kerbeshian J. Fragile X Syndrome: Developmental Aspects.Child Study Journal.1986. 16(4): 285-296.

Fisher, W., Kerbeshian, J., & Burd L. A Treatable Language Disorder: Pharmacological Treatment of Pervasive Developmental Disorder.Journal of Developmental and Behavioral Pediatrics.1986. 7(2): 73-76.

Fisher, W., Kerbeshian, J., Burd, L. & Kolstoe, P. Tuberous Sclerosis and Autism.Developmental Medicine and Child Neurology .1986. 28: 814-815.

Kerbeshian, J. & Burd L. Asperger's Syndrome and Tourette Syndrome: The Case of the Pinball Wizard.British Journal of Psychiatry.1986. 148: 731-736.

Kerbeshian, J. & Burd L. A Second Visually Impaired, Mentally Retarded Male With Pervasive Developmental Disorder, Tourette Disorder and Ganser’s Syndrome: Diagnostic Classification and Treatment.Interna¬tional Journal of Psychiatry in Medicine.1986. 16(1): 67-75.

Burd, L. & Kerbeshian J. Tourette Syndrome, Atypical Pervasive Developmental Disorder, and Ganser Syndrome in a 15-year-old, Visually Impaired, Mentally Retarded Boy.Canadian Journal of Psychiatry.1985. 30(1): 74-76.

Burd, L., Fisher, W., & Kerbeshian J. Pervasive Developmental Disorders in Multiply Disabled Children.Rehabilitation Literature.1985. 46(9-10): 246-249.

Burd, L., Kerbeshian, J., & Fisher W Inquiry into the Incidence of Hyperlexia in a Statewide Population of Children with Pervasive Developmental Disorder.Psychological Reports.1985. 57: 236-238.

Burd, L., Kerbeshian, J., Fisher, W., & Martsolf, J.T. A Case of Autism and Mosaic of Trisomy 8.Journal of Autism and Developmental Disorders.1985. 15: 351-352.

Kerbeshian, J. & Burd L. Auditory Hallucinosis and Atypical Tic Disorder: Case Reports.Journal of Clinical Psychiatry.1985. 46(9): 189-197.

Kerbeshian, J., Burd, L. & Martsolf, J. The Multipotential Outcome of Fragile X Syndrome.Journal of Developmental and Behavioral Pediatrics.1985. 6: 322.

Kerbeshian, J., Burd, L., & Martsolf J. Fragile X Syndrome Associated with Tourette Symptomatology in A Male with Moderate Mental Retardation and Autism.Journal of Developmental Behavioral Pediatrics .1984. 5(4): 201-203.

Kerbeshian, J., Burd, L., & Martsolf J. A Family with Fragile X Syndrome.The Journal of Nervous and Mental Disease.1984. 172(9): 549-551.

Peng, C., Hatlestad, P., Klug, M.G., Kerbeshian, J., & Burd, L Health Care Costs and Utilization Rates for Children with Pervasive Developmental Disorders in North Dakota From 1998 to 2004: Impact on Medicaid.Journal of Child Neurology.2009. 24(2): 140-147.

Kerbeshian, J., Burd, L., & Tait, A. Chain Reaction or Time Bomb: A Neuropsychiatric-Developmental/Neurodevelopmental Formulation of Tourettisms, Pervasive Developmental Disorder, and Schizophreniform Symptomatology Associated with PANDAS.World Journal of Biological Psychiatry.2007. 8(3): 201-207.

Kerbeshian, J. & Burd, L. Letter to the Editor: Tourette Syndrome and Prognosis in Autism.European Child and Adolescent Psychiatry.2003. 12(2): 103.

Klug, M.G., Burd, L., Kerbeshian, J., Benz, B., & Martsolf, J.T. A Comparison of the Effects of Parental Risk Markers on Pre- and Perinatal Variables in Multiple Patient Cohorts with Fetal Alcohol Syndrome, Autism, Tourette Syndrome, and Sudden Infant Death Syndrome: An Enviromic Analysis.Neurotoxicology and Teratology.2003. 25(6): 707-717.

• The prevalence and magnitude of effect of individual risk markers for specific developmental varies widely across diagnostic category. The four study cohorts for this project were patients from four diagnostic registries in North Dakota for fetal alcohol syndrome, autism, sudden infant death syndrome (SIDS), and tourette syndrome. These four cohorts were used to estimate prevalence and magnitude of effect of parental risk markers in patients with developmental disabilities. Cases with North Dakota birth certificates were matched with controls. Using birth certificate data, we then examined five parental risk markers for each cohort and estimated direct and indirect effects for each risk marker by cohort. The authors found two significant paternal risk markers (age in SIDS and education in fetal alcohol syndrome.) Significant maternal markers were (age in SIDS, education in fetal alcohol syndrome, autism and SIDS). Marital status was a significant risk marker in fetal alcohol syndrome. Effect size using paired t-tests, odds ratios, and population attributable risk for both direct and indirect effects for each marker. We estimated to allow for direct comparisons of the differential effect estimates of each of these markers. The direct effect of parental markers differs across diagnostic cohorts of patients. Use of cohorts from similar denominator populations primarily obtained from prevalence studies of the cohort is a useful methodologic tool for estimating the prevalence and magnitude of effect of risk markers

Burd, L., Kerbeshian, J., Westerland, A., LaBine, J., Barth, A., Klug, M.G., & Wagner, K.J. Prospective Long-Term Follow-Up of Patients with Pervasive Developmental Disorders.Journal of Child Neurology .2002. 17(9): 681-688.

• Introduction We conducted a 12-year prospective study of children with PDD from North Dakota. Method Prospective longitudinal follow up. Subjects Of the 59 patients, we found 52 (88%). Ten (17%) declined to participate. We collected data on 42 (71%) of the original cohort. Results Of the 42 subjects, one died (1.7%). The other 41 were followed up for 492 person years. Severity scores for DSM III declined 20% and for DSM IV 23%. Global Assessment of Functioning improved 19% and the average number of comorbidities decreased 45%. Thirty seven percent of patients improved in all four measures, while only 5 % improved in only one measure. Conclusion PDD are developmental disorders with a long-term course of limited improvement for most patients. Males demonstrated substantially more variability in improvement but overall demonstrated more improvement than females.

Kerbeshian, J., Burd, L., & Avery, K. Pharmacotherapy of Autism: A Review and Clinical Approach.Journal of Developmental and Physical Disabilities.2001. 13(3): 199-227.

• Although there is a proliferating literature on the pharmacotherapy of autism, the results of these studies are often conflicting. A definitive medical intervention for the core symptoms of autism continues to elude us. In the absence of a research based pathway for the pharmacotherapeutic treatment of autism, our approach is necessarily clinically based. Common medication side effects also may confound the clinical picture. A major factor in the application of our approach is an awareness of conditions comorbid with autism in an individual patient. These comorbid conditions then serve as a guide in choice of specific drug therapies. Use of medication must be informed by an awareness of habilitative, behavioral, social, administrative, and ethical issues.

Burd, L., Stenehjem, A., Franceschini, L., & Kerbeshian, J. A Fifteen Year Follow-Up of a Boy with Pyridoxine (Vitamin B6) Dependent Seizures with Autism, Breath Holding, and Severe Mental Retardation.Journal of Child Neurology.2000. 15(11): 763-765.

• Pyridoxine (vitamin B6) (2q31) dependency is a rare autosomal-recessive disorder that causes a severe seizure disorder of prenatal or neonatal onset. The abnormality appears to inhibit the binding of vitamin B6 to the enzyme glutamic acid decarboxylase-1, which is needed for the biosynthesis of gamma-aminobutyric acid (GABA). Most patients with pyridoxine-dependent seizures require lifelong treatment with pyridoxine. The full range of associated symptomatology is unknown since fewer than 100 cases have been reported. A majority of cases are mentally retarded. We report a 15-year-old boy with pyridoxine-dependent seizures, nonpyridoxine-dependent seizures, severe mental retardation, autistic disorder, aerophagia, breath holding, and self-injury. This complex outcome should alert clinicians to the wide range of neuropsychiatric outcomes associated with this disorder.

Kerbeshian, J. & Burd, L. Peek-A-Boo Fragile Site? Or a Peek-A-Boo Paper?American Journal of Medical Genetics.2000. 96(3): 430-431.

Kerbeshian, J., Severud, R., Burd, L., & Larson, L. Peek-A-Boo Fragile Site at 16D Associated with Tourette Syndrome, Bipolar Disorder, Autistic Disorder, and Mental Retardation.American Journal of Medical Genetics.2000. 96(1): 69-73.

• Five patients with a fragile site at 16q22-23 and neuropsychiatric disorders are reported. Three of five had Tourette disorder, three had mental retardation, two had bipolar disorder, and one had autistic disorder. During our attempts to study the fragile sites in more detail we were unable to reproduce the fragile sites found several years earlier. The potential relationship between the fragile sites and the neuropsychiatric disorders in these patients is discussed. Am. J. Med. Genet. (Neuropsychiatr. Genet.) 96:69-73, 2000. Copyright 2000 Wiley-Liss, Inc.

Burd, L., Severud, R., Kerbeshian, J., & Klug, M. Prenatal and Perinatal Risk Factors for Autism.Journal of Perinatal Medicine.1999. 27(6): 441-450.

• Objective: To identify pre- and perinatal risk factors for autism. Method: Case control study. We matched names of patients who met DSM criteria for autism, a pervasive developmental disorder, and autistic disorder with their birth certificates. Five matched controls were selected for each case. Results: Univariate analysis of the 78 cases and 390 controls identified seven risk factors. Logistic modeling to control for confounding produced a five variable model. The model parameters were c2 = 36.6 and p < 0.001. The five variables in the model were decreased birth weight, low maternal education, later start of prenatal care, and having a previous termination of pregnancy. Increasing father's age was associated with increased risk of autism. Discussion: This methodology may provide an inexpensive method for clinics and public health providers to identify risk factors and to identify maternal characteristics of patients with mental illness and developmental disorders.

Burd, L., Ivey, M., Barth, A., & Kerbeshian, J. Two Males With Childhood Disintegrative Disorder: A Prospective 14-Year Outcome Study.Developmental Medicine and Child Neurology.1998. 40: 702-707.

• We present a prospective outcome study over a 14-year period of two children meeting DSM-IV criteria for Childhood Disintegrative Disorder. Their ages at first evaluation were UF, four years, seven months; NL, six years, three months. Both of these men are adults now. Both continue to have a severe pervasive developmental disorder, mental retardation, seizure disorder and both are nonverbal. Both require residential care.

Kerbeshian, J. & Burd, L. Case Study: Comorbidity Among Tourette’s Syndrome, Autistic Disorder and Bipolar Disorder.Journal of the American Academy of Child and Adolescent Psychiatry.1996. 35(5): 681-685.

• Objective: Several studies report a greater than expected concurrence for Tourette syndrome (TS) with autistic disorder (AD). TS and bipolar disorder (BD) also may co-occur at a greater than expected rate. In this report we assess whether there is a greater than expected concurrence for TS+AD+BD. Method: We identified 4 patients who had at some time in their lives diagnoses of TS, AD, and BD. Three of these had concurrent TS+AD+BD. Diagnoses were made utilizing DSM-III-R criteria. Each of these patients was living in North Dakota and was in our care at the time of this study. Results: The point prevalence (risk) for concurrent TS+AD+BD in North Dakota is not less than 4.6 x 10-6. The developmental sequence of syndromes in these 4 patients was AD, then TS and then BD. Using data from our previously published population based prevalence studies we find that TS+AD+BD co-occur at a greater than chance expectation. Conclusions Common etiologic factors may be involved in the greater than chance concurrence of TS+AD+BD.

Kerbeshian, J. & Burd, L. A Clinical Pharmacological Approach to the Treatment of Autism.The Habilitative Mental Health Care Newsletter.1991. 10(6): 33-36.

Kerbeshian, J., Burd, L., & Fisher W. Asperger's Syndrome: To Be or Not to Be?The British Journal of Psychiatry.1990. 156: 721-725.

• It has been questioned whether Asperger's syndrome (AS) is in fact a specific (high-functioning) subgroup of autism, rather than a distinct entity. Thirteen AS patients were compared with 13 autistic patients and 13 developmentally disordered controls. While there was symptom overlap between AS and autism, patients could be separated into one or the other group. However, current criteria are based on symptoms, and it is argued that studies of genetics and treatment response are needed to elucidate the relationship between these developmental disorders.

Kerbeshian, J., Burd, L., Randall, T., Martsolf, J.T., & Jalal S. Autism, Profound Mental Retardation, and Atypical Bipolar Disorder in a 33-Year-Old Female With a Deletion of 15q12.Journal of Mental Deficiency Research.1990. 34: 205-210.

• A case report of a 33-year-old woman with atypical bipolar disorder, autistic disorder, profound mental retardation and a chromosomal anomaly is presented. This patient is behaviourally similar to a patient reported by Akuffo et al. (1986), who apparently did not have a chromosomal investigation. The chromosomal anomaly and similarities between the two patients are discussed.

Burd, L. Research on Autism and Other Pervasive Developmental Disorders.Developmental Disabilities Network News .1989. 3(1): 10-12.

Burd, L., Fisher, W., & Kerbeshian J. Pervasive Disintegrative Disorder: Are Rett Syndrome and Heller Dementia Infantalis Subtypes?Developmental Medicine and Child Neurology.1989. 31: 609-616.

• Children with developmental regression and emerging symptoms of autism have been given a variety of classifications. The authors compare two boys with Heller dementia with six girls with Rett syndrome. They all differed from children with classic autism in that they had normal prenatal and perinatal periods, followed by marked developmental regression, after which they acquired few or no skills. The boys differed from the girls in terms of estimated prevalence, age at onset, stereotypic breathing patterns, midline hand stereotypies, hand and gait apraxia and speech development. It is suggested that these children should be distinguished from those with classic autism, and should be classified as 'pervasive disintegrative disorder, Heller type' and 'pervasive disintegrative disorder, Rett type'.

Burd, L. & Kerbeshian J. Case Study: Psychogenic and Neurodevelopmental Factors in Autism.Journal of the American Academy of Child and Adolescent Psychiatry .1988. 27: 252-253.

Burd, L. & Kerbeshian J. Familial Pervasive Development Disorder, Tourette Disorder and Hyperlexia.Neuroscience and Bio¬behavioral Reviews.1988. 12: 233-234.

• Four children and one adult have been found to have pervasive Developmental Disorder, Tourette disorder and hyperlexia in North Dakota, a state with a population of 204,161 children ages ?18. Assuming that these are independent disorders the probability of these three disorders occurring by chance in one child is 3.39x10-12. Two of these individuals are from the same family. This suggests evidence for genetic linkage among these three disorders.

Burd, L. & Kerbeshian J. Diagnosis of Autism and Other Pervasive Developmental Disorders.Neuroscience and Biobehavioral Reviews.1988. 12: 275-282.

• Problems in the diagnosis of autism and other pervasive developmental disorders are reviewed. Modification and application of recent developments in neuro-imaging, molecular genetics and population studies are presented. A prioritized list of needed investigations is discussed.

Burd, L., Fisher, W., & Kerbeshian J. Childhood Onset jPervasive Development Disorder.Journal of Child Psychology, Psychiatry and Allied Disciplines.1988. 29(2): 155-163.

• Two male children meeting criteria for Childhood Onset Pervasive Developmental Disorder (COPDD) are described. The current DSM-III category of COPDD may have value in separating these children from others with PDD. The authors suggest that these two children, and other children described in the literature as having dementia infantalis and/or disintegrative psychosis, have a disintegrative disorder resulting in muteness. Profound mental retardation and severe autistic symptomatology. The term "pervasive disintegrative disorder" may be appropriate for such children and specific diagnostic criteria are suggested. The disorder appears to be extremely rare, with a prevalence estimate of 0.11 per 10,000.

Burd, L., Fisher, W., Kerbeshian, J., Vesely, B., Durgin, B., & Reep P. A Comparison of Breastfeeding Rates Among Children with Pervasive Developmental Disorder and Controls.Journal of Developmental and Behavioral Pediatrics.1988. 9(5): 247-251.

Burd, L., Martsolf, J.T., Kerbeshian, J., & Jalal S.M. Partial 6p Trisomy Associated with Infantile Autism.Clinical Genetics.1988. 33: 356-359.

• Partial trisomy 6p with duplications ranging from 6p21 to 6p25-pter is emerging as an established syndrome. We report a case of duplication of 6p (6p23-pter) and deletion of 2q37-qter. Features characteristic of 6p partial trisomy present in the patient are low birth-weight, and mental and developmental retardation. Major facial features include prominent forehead, flat occiput, multiple ocular abnormalities, low-set ears, prominent nasal bridge, long philtrum and small pointed mouth. Repeated examinations for the patient from birth to the age of over 5 years revealed that he has infantile autism. Since autistic children are generally not associated with chromosome anomalies, in view of the present case, it is suggested that karyotypic analysis be considered for such children. Where possible, extended study for autism in 6p trisomic children may also be desirable.

Fisher, W., Burd, L., & Kerbeshian J. Markers for Improvement in Children with Pervasive Developmental Disorders.Journal of Mental Deficiency Research.1988. 32: 357-364.

• In a series of prevalence and follow-up studies on North Dakota's 59 children with pervasive developmental disorders, the patient characteristics of hyperlexia, Tourette disorder (TD), and the absence of seizures were found to be associated with improved outcome or higher IQ. We entered these and 17 other characteristics into a regression model using forward, step-wise inclusion to identify the smallest set of predictor variables which were significantly associated with the dependent variables of IQ, and receptive and expressive language. Of the 20 predictor variables used in the regression analysis, the same four variables met inclusion criteria for each of the dependent variables. These predictor variables were: hyperlexia, and known aetiology, TD and age. The relevance of these findings is discussed.

Burd, L. The Fragile X Chromosome.The New England Journal of Medicine.1987. 316: 483.

Burd, L., Fisher, W., & Kerbeshian J. A Prevalence Study of Pervasive Developmental Disorders in North Dakota.Journal of the American Academy of Child and Adolescent Psychiatry.1987. 26: 700-703.

• To determine prevalence rates for the pervasive developmental disorders (PDD) in North Dakota, all relevant health and service providers were asked to provide names and records of all patients who had autistic symptoms. All identified patients were seen by the authors for a comprehensive evaluation. Of North Dakota's 180,986 children, ages 2 through 18, 21 met DSM-III criteria for infantile autism (IA), two met criteria for childhood onset pervasive developmental disorder (COPDD),and 36 were diagnosed as having atypical pervasive developmental disorder (APDD) because they met behavioral criteria for COPDD before age 30 months but never met criteria for IA. The prevalence rates were estimated at 1.16 per 10,000 for IA, 0.11 per 10,000 for COPDD, and 1.99 per 10,000 for APDD. The combined rate for all PDD was 3.26 per 10,000 with a male to female ratio of 2.7 to 1. Results are discussed in relation to previous prevalence studies using other diagnostic criteria.

Burd, L., Fisher, W., Kerbeshian, J., & Arnold M.E. Is Development of Tourette Disorder a Marker for Improvement in Patients with Autism and Other Pervasive Developmental Disorders?Journal of the American Academy of Child and Adolescent Psychiatry.1987. 26: 162-165.

• Fifty-nine patients were identified whose early history was consistent with infantile autism or other pervasive developmental disorders (PDD). Twelve of these patients, later in their history, developed symptoms consistent with Tourette disorder (TD). The group of patients who developed TD scored significantly higher on measures of IQ and receptive and expressive language. It is suggested that the development of the symptoms of TD subsequent to the onset of PDD may serve as a marker for improved developmental outcome and that children with PDD who also meet criteria for TD may constitute a distinct subgroup of children with PDD. Implications for diagnosis and management are discussed.

Burd, L., Fisher, W., Knowlton, D., & Kerbeshian J. Hyperlexia: A Marker for Improvement in Children with Pervasive Developmental Disorders?Journal of the American Academy of Child and Adolescent Psychiatry.1987. 26: 407-412.

• In a population of 59 patients with pervasive developmental disorders, four patients manifested hyperlexia. These four patients had improved outcomes when contrasted with other patients with pervasive developmental disorders who had similar cognitive ability and levels of behavioral dysfunction. In children with hyperlexia the average IQ at first evaluation was 43 and the most recent IQs averaged 94.7. This change over time was significant (x2 - 8.0, p - 0.02). All patients with hyperlexia demonstrated this improved outcome. The authors speculate that hyperlexia may reflect an island of skills relating to generalized language function and may be a marker for children who have the potential to achieve an improved cognitive outcome. A trend for behavioral improvement was also observed. Treatment differences between groups were not identified. Possible explanations for this improved outcome are discussed.

Fisher, W., Burd, L., & Kerbeshian J. Comparisons of DSM-III Defined Pervasive Developmental Disorders in North Dakota Children.Journal of the American Academy of Child and Adolescent Psychiatry.1987. 26: 704-710.

• The authors have maintained a roster and data base on North Dakota children with PDD, with data on some patients dating back 9 years. From this data base they have reported on the coexistence of PDD and other conditions, prognostic markers in PDD patients, and predictive response to pharmacological treatment. In this paper, the authors compare and contrast the three different DSM-III defined PDDs along the dimensions of associated conditions, cognitive functioning, language functioning, possible etiologies, and other organic factors. The authors discuss the data generated from the North Dakota roster of PDD patients and other studies reported in the literature. The implications for nosological classification are also examined.

Kerbeshian, J., Burd, L., & Fisher W. Lithium Carbonate in the Treatment of Two Patients with Infantile Autism and Atypical Bipolar Symptomatology.Journal of Clinical Psychopharmacology.1987. 7(6): 401-405.

• Two patients with infantile autism by DSM-III criteria and with atypical bipolar symptomatology were treated with lithium carbonate. Both children demonstrated a significant response with levels above 1.0mEq/liter. Factors that may be useful in discovering patients with autism who may respond to lithium treatment include a family history of bipolar illness; extreme hyperactivity not responsive to a stimulant; a definite cyclic component to symptomatic behaviors; sustained laughter, irritability, or giddiness that is not stereotypic; and/or the presence of many or all of the symptom criteria for bipolar disorder.

Burd, L. Bornhoeft, D.M., & Kerbeshian J. Fragile X Syndrome: Developmental Aspects.Child Study Journal.1986. 16(4): 285-296.

Fisher, W., Kerbeshian, J., & Burd L. A Treatable Language Disorder: Pharmacological Treatment of Pervasive Developmental Disorder.Journal of Developmental and Behavioral Pediatrics.1986. 7(2): 73-76.

• Results of treatment of four patients are described. All of the patients had pervasive developmental disorder (PDD), a tic disorder, and a characteristic pattern of speech and language impairment. The patients were treated with haloperidol for their tic disorders, and concomitant with the reduction of the frequency and severity of tics was marked improvement in language. The patients averaged 3 months of language gain for each week of speech therapy directly after the initiation of haloperidol treatment for tics. Progress in speech and language therapy was extremely slow during the years prior to treatment with haloperidol. To the authors' knowledge, no language disorder has been described in the literature which shows such a predictable and marked response to pharmacological treatment. The authors hypothesize that tic disorders in individuals with PDD may be a marker for a more positive response to dopamine antagonists like haloperidol.

Fisher, W., Kerbeshian, J., Burd, L. & Kolstoe, P. Tuberous Sclerosis and Autism.Developmental Medicine and Child Neurology .1986. 28: 814-815.

Kerbeshian, J. & Burd L. Asperger's Syndrome and Tourette Syndrome: The Case of the Pinball Wizard.British Journal of Psychiatry.1986. 148: 731-736.

• yndrome (AS), with particular reference to diagnostic criteria and differentiation from infantile autism and personality disorders, and describe six cases seen in practice: all met DSM-III criteria for atypical pervasive developmental disorder'. Three also developed Tourette syndrome: the co-occurrence of the two disorders, and methods of intervention, are discussed.

Kerbeshian, J. & Burd L. A Second Visually Impaired, Mentally Retarded Male With Pervasive Developmental Disorder, Tourette Disorder and Ganser’s Syndrome: Diagnostic Classification and Treatment.Interna¬tional Journal of Psychiatry in Medicine.1986. 16(1): 67-75.

Burd, L. & Kerbeshian J. Tourette Syndrome, Atypical Pervasive Developmental Disorder, and Ganser Syndrome in a 15-year-old, Visually Impaired, Mentally Retarded Boy.Canadian Journal of Psychiatry.1985. 30(1): 74-76.

• This is a case report of a 15-year-old visually impaired, mentally retarded male who presents with symptoms consistent with Tourette Syndrome, a Syndrome of approximate answers (Ganser's Syndrome) and Atypical pervasive Developmental Disorder. The authors feel that this follow-up on the case presented earlier by Parraga and Butterfield raises the possibility of a link between a number of the symptoms of adult schizophrenia, appearing in attenuated form in these two cases, and Tourette Syndrome.

Burd, L., Fisher, W., & Kerbeshian J. Pervasive Developmental Disorders in Multiply Disabled Children.Rehabilitation Literature.1985. 46(9-10): 246-249.

• The pervasive developmental disorders, including autism, are found in 3 to 4 per 10,000 children. Very little data has been accumulated with reference to the prevalence rate of pervasive developmental disorders in multiply disabled children. Diagnosis and management of pervasive developmental disorders is a complex process that becomes even more complicated in children with multiple disabilities. This article reports preliminary prevalence data and suggestions for diagnosis and treatment of pervasive developmental disorders in this group.

Burd, L., Kerbeshian, J., & Fisher W Inquiry into the Incidence of Hyperlexia in a Statewide Population of Children with Pervasive Developmental Disorder.Psychological Reports.1985. 57: 236-238.

• Hyperlexia is a condition occurring in a group of children who traditionally have been described as having word-recognition reading skills which far exceed their other language and cognitive abilities. The incidence of this particular skill in a group of children with pervasive developmental disorders had not previously been documented. In the state of north Dakota 68 children who meet DSM-III criteria for pervasive developmental disorders (including autism) have been identified. Four of these children show hyperlexia. This computes to a prevalence rate of 6.6% of school-aged children with pervasive developmental disorders.

Burd, L., Kerbeshian, J., Fisher, W., & Martsolf, J.T. A Case of Autism and Mosaic of Trisomy 8.Journal of Autism and Developmental Disorders.1985. 15: 351-352.

Kerbeshian, J. & Burd L. Auditory Hallucinosis and Atypical Tic Disorder: Case Reports.Journal of Clinical Psychiatry.1985. 46(9): 189-197.

• Two patients with tic disorders and intermediate hallucinatory experiences are described. It is suggested that clinicians evaluating patients with tic disorders may wish to inquire routinely about unusual auditory experiences. Further research will be necessary to determine the implications of these experiences among children with tic disorders.

Kerbeshian, J., Burd, L. & Martsolf, J. The Multipotential Outcome of Fragile X Syndrome.Journal of Developmental and Behavioral Pediatrics.1985. 6: 322.

Kerbeshian, J., Burd, L., & Martsolf J. Fragile X Syndrome Associated with Tourette Symptomatology in A Male with Moderate Mental Retardation and Autism.Journal of Developmental Behavioral Pediatrics .1984. 5(4): 201-203.

• A case of fragile X syndrome and Tourette symptomatology in an 11-year-old mentally retarded male with autism is reported. The coexistence of these multiple disorders has apparently not been previously reported.

Kerbeshian, J., Burd, L., & Martsolf J. A Family with Fragile X Syndrome.The Journal of Nervous and Mental Disease.1984. 172(9): 549-551.

• A family with fragile-X syndrome is reported. One sibling has atypical pervasive developmental disorder and moderate mental retardation. A second sibling has Tourette's syndrome, moderate mental retardation. A second sibling has Tourette's syndrome, moderate mental retardation, seizure disorder, and autism. A third sibling has attention deficit disorder, moderate mental retardation, and developmental language disorder, expressive type. The authors believe that this family represents a classic example of the differential outcome of interactions of common biogenetic and environmental influences. We propose that in this family the multipotential outcome is at least influenced by if not caused by a common genetic defect.