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Bertelli MO, Bianco A, Deb S, Scuticchio D, Kaleci S, Scattoni ML. Autism and psychopathology - prevalence, identification, and symptoms equivalence: study protocol. Front Psychiatry 2024; 15:1447262. [PMID: 39262582 PMCID: PMC11387949 DOI: 10.3389/fpsyt.2024.1447262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Accepted: 07/29/2024] [Indexed: 09/13/2024] Open
Abstract
Objective Despite increasing evidence of high psychopathological vulnerability in people with Autism Spectrum Disorder (ASD) and/or Intellectual disability (ID), comprehensive data on prevalence and presentation of psychiatric disorders (PD) in people with significant cognitive and communication impairment are lacking. The extent to which PD can present with behavioral/observable symptoms and include Problem Behaviors (PB) has also been scarcely evaluated through population-based studies. The paper presents the protocol of a cross-sectional study aimed at filling these gaps, referred to a large multicentric Italian population-based sample of adolescents and adults. Methods A battery of validated scales, SPAIDD, DASH-II, DiBAS-R, and STA-DI, is used to support and control for clinical diagnoses of PD. Study population is stratified according to different independent variables such as the severity of ID and ASD, gender, age group, and source of recruitment. A network analysis will be carried out to identify the most central behavioral symptoms for the various PD and their relationship with PB. Overlap between psychiatric symptoms and ASD and ID phenotypes is also addressed. Results and Conclusion This study should provide valuable insight into better diagnostic accuracy, leading to well-informed interventions to improve the quality of life of people with ASD and/or ID.
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Affiliation(s)
- Marco O Bertelli
- CREA (Research and Clinical Centre), Fondazione San Sebastiano, Misericordia di Firenze, Florence, Italy
- SIDiN, Italian Society for Neurodevelopmental Disorders, Florence, Italy
| | - Annamaria Bianco
- CREA (Research and Clinical Centre), Fondazione San Sebastiano, Misericordia di Firenze, Florence, Italy
| | | | - Daniela Scuticchio
- CREA (Research and Clinical Centre), Fondazione San Sebastiano, Misericordia di Firenze, Florence, Italy
| | - Shaniko Kaleci
- Department of Surgical, Medical, Dental and Morphological Sciences with Interest in Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Maria Luisa Scattoni
- Research Coordination and Support Service, Istituto Superiore di Sanità, Rome, Italy
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Lee J, Choi A, Kim S. Effects of Psychiatric Comorbidities on the Prognosis of New-Onset Pediatric Epilepsy: A Retrospective Nationwide Cohort Study. J Clin Med 2024; 13:4500. [PMID: 39124767 PMCID: PMC11312610 DOI: 10.3390/jcm13154500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2024] [Revised: 07/24/2024] [Accepted: 07/31/2024] [Indexed: 08/12/2024] Open
Abstract
Background/Objectives: To determine the impact of psychiatric disorders on epilepsy treatment outcomes and healthcare utilization in children with epilepsy (CWE) based on the presence or timing of the onset of psychiatric disorders. Methods: This retrospective controlled study enrolled children (age < 18 years) with newly diagnosed epilepsy into four groups stratified by the presence and timing of the onset of psychiatric disorders (None: no psychiatric disorders; Before: psychiatric disorders only preceding the epilepsy diagnosis; After: new psychiatric disorders diagnosed only after the epilepsy diagnosis; Mixed: different psychiatric disorders diagnosed both before and after epilepsy diagnosis) and compared the intergroup differences in epilepsy treatment outcomes and healthcare utilization. Results: Among the CWE (n = 37,678), 13,285 (35.26%) had comorbid psychiatric disorders. The After (n = 7892), Mixed (n = 3105), and Before (n = 2288) groups had significantly longer treatment periods than those in the None group (p < 0.001). Compared with the None group, the remaining groups had significantly higher frequencies of outpatient visits, emergency room visits, and admissions and higher rates of status epilepticus and drug-resistant epilepsy (p < 0.001, respectively), with higher odds ratios [95% confidence interval] for status epilepticus (2.92 [2.68-3.18]) and drug-resistant epilepsy (3.01 [2.85-3.17]) in the After group. Conclusions: Psychiatric comorbidities, diagnosed before and after epilepsy diagnosis, negatively affected the treatment outcomes. CWE without prior psychiatric disorders that were newly diagnosed during epilepsy treatment had the worst outcomes and the highest healthcare utilization rates.
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Affiliation(s)
- Jooyoung Lee
- Department of Pediatrics, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 03312, Republic of Korea;
| | - Arum Choi
- Department of Preventive Medicine and Public Health, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea;
| | - Sukil Kim
- Department of Preventive Medicine and Public Health, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea;
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Canals J, Morales-Hidalgo P, Voltas N, Hernández-Martínez C. Prevalence of comorbidity of autism and ADHD and associated characteristics in school population: EPINED study. Autism Res 2024; 17:1276-1286. [PMID: 38695661 DOI: 10.1002/aur.3146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 04/19/2024] [Indexed: 06/20/2024]
Abstract
Autism and attention deficit hyperactivity disorder (ADHD) comorbidity in the school population have been understudied. This study estimates its prevalence considering both parents' and teachers' reports and clinical diagnosis. Sociodemographic, clinical, and cognitive data were compared by diagnostic groups: autism, ADHD, autism and ADHD, subthreshold autism spectrum disorder (ASD), subthreshold ADHD, and children without neurodevelopmental conditions. Following a two-phase design, 3727 parents and teachers (1802 preschoolers, 1925 school-age children) participated in the first phase. Subsequently, 781 participants underwent individual assessment for DSM-5 diagnoses. The estimated prevalence of the comorbid diagnosis was 0.51% (0.28%-0.74%), with significant sex differences (0.16% girls, 0.89% boys). The cooccurrence of symptoms of autism and ADHD reported by parents or teachers was 3.2% and 2.6%, respectively. ADHD comorbidity was observed in 32.8% of autistic children and 31.4% of those with subthreshold ASD. ASD comorbidity was observed in 9.8% of children with ADHD and 5.7% of those with subthreshold ADHD. Comorbidity was reported by at least one informant in 95% of children. Only 15.8% of children with autism and ADHD had been previously diagnosed with both conditions. Early detection and accurate comorbidity diagnosis are crucial to address the clinical and socio-educational needs of these children.
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Affiliation(s)
- Josefa Canals
- Research Group on Nutrition and Mental Health (NUTRISAM); Research Center for Behavioral Assessment (CRAMC); Department of Psychology, Rovira i Virgili University, Tarragona, Spain
| | - Paula Morales-Hidalgo
- Research Group on Nutrition and Mental Health (NUTRISAM); Research Center for Behavioral Assessment (CRAMC); Department of Psychology, Rovira i Virgili University, Tarragona, Spain
- Department of Psychology, Open University of Catalonia, Barcelona, Spain
| | - Núria Voltas
- Research Group on Nutrition and Mental Health (NUTRISAM); Research Center for Behavioral Assessment (CRAMC); Department of Psychology, Rovira i Virgili University, Tarragona, Spain
- Serra Húnter Fellow, Department of Psychology, Rovira i Virgili University, Tarragona, Spain
| | - Carmen Hernández-Martínez
- Research Group on Nutrition and Mental Health (NUTRISAM); Research Center for Behavioral Assessment (CRAMC); Department of Psychology, Rovira i Virgili University, Tarragona, Spain
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McQuaid GA, Duane SC, Ahmed N, Lee NR, Charlton R, Wallace GL. Increased anticholinergic medication use in middle-aged and older autistic adults and its associations with self-reported memory difficulties and cognitive decline. Autism Res 2024; 17:852-867. [PMID: 38108575 PMCID: PMC11332248 DOI: 10.1002/aur.3076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 11/18/2023] [Indexed: 12/19/2023]
Abstract
Many commonly used prescription and over-the-counter medicines have potent anticholinergic (AC) effects. Among older adults, AC medications are associated with cognitive impairment and risk for cognitive disorders, including Alzheimer's disease. Collectively, the impact of AC medications is known as anticholinergic cognitive burden (ACB). Because of the high rates of co-occurring medical and psychiatric conditions, autistic adults may have high AC exposure and, thus, may experience elevated ACB. However, no research has characterized AC exposure or examined its associations with cognitive outcomes in autistic adults. Autistic adults (40-83 years) recruited via Simons Powering Autism Research's (SPARK) Research Match service self-reported their medication use (N = 415) and memory complaints (N = 382) at Time (T)1. At T2, 2 years later, a subset of T1 participants (N = 197) self-reported on decline in cognition. Medications were coded using two scales of AC potency. A high proportion (48.2%-62.9%, depending upon the AC potency scale) of autistic adults reported taking at least one medication with AC effects, and 20.5% to 26.5% of autistic adults reported clinically-relevant levels of AC medication (potency ≥3). After controlling for birth-sex, and age, hierarchical linear regression models showed total ACB scores and AC potency values of ≥3 predicted greater memory complaints. Logistic regression models showed that AC medicines at T1 were associated with self-reported cognitive decline at follow-up 2 years later. Understanding AC medications-including potentially earlier AC polypharmacy-and their impacts on cognition (e.g., dementia risk) in autistic adults is warranted.
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Affiliation(s)
- Goldie A McQuaid
- Department of Psychology, George Mason University, Fairfax, Virginia, USA
| | - Sean C Duane
- Department of Speech, Language, and Hearing Sciences, The George Washington University, Washington, District of Columbia, USA
| | - Neha Ahmed
- Department of Speech, Language, and Hearing Sciences, The George Washington University, Washington, District of Columbia, USA
| | - Nancy Raitano Lee
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, Pennsylvania, USA
| | - Rebecca Charlton
- Department of Psychology, Goldsmiths University of London, London, UK
| | - Gregory L Wallace
- Department of Speech, Language, and Hearing Sciences, The George Washington University, Washington, District of Columbia, USA
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Bougeard C, Picarel-Blanchot F, Schmid R, Campbell R, Buitelaar J. Prevalence of Autism Spectrum Disorder and Co-Morbidities in Children and Adolescents: A Systematic Literature Review. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2024; 22:212-228. [PMID: 38680973 PMCID: PMC11046711 DOI: 10.1176/appi.focus.24022005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
Objective Individuals with autism spectrum disorder often present somatic and/or psychiatric co-morbid disorders. The DSM-5 allows for consideration of additional diagnoses besides ASD and may have impacted the prevalence of co-morbidities as well as being limited in capturing the true differences in prevalence observed between males and females. We describe the prevalence of ASD and frequently observed co-morbidities in children and adolescents (<18 years) in the United States and five European countries. Methods Two systematic literature reviews were conducted in PubMed and Embase for the period 2014-2019 and focusing on the prevalence of ASD and nine co-morbidities of interest based on their frequency and/or severity: Attention Deficit Hyperactivity Disorder (ADHD), anxiety, depressive disorders, epilepsy, intellectual disability (ID), sleep disorders, sight/hearing impairment/loss, and gastro-intestinal syndromes (GI). Results Thirteen studies on prevalence of ASD and 33 on prevalence of co-morbidities were included. Prevalence of ASD was 1.70 and 1.85% in U.S children aged 4 and 8 years respectively, while prevalence in Europe ranged between 0.38 and 1.55%. Additionally, current evidence is supportive of a global increase in ASD prevalence over the past years. Substantial heterogeneity in prevalence of co-morbidities was observed: ADHD (0.00-86.00%), anxiety (0.00-82.20%), depressive disorders (0.00-74.80%), epilepsy (2.80-77.50%), ID (0.00-91.70%), sleep disorders (2.08-72.50%), sight/hearing impairment/loss (0.00-14.90%/0.00-4.90%), and GI syndromes (0.00-67.80%). Studies were heterogeneous in terms of design and method to estimate prevalence. Gender appears to represent a risk factor for co-morbid ADHD (higher in males) and epilepsy/seizure (higher in females) while age is also associated with ADHD and anxiety (increasing until adolescence). Conclusion Our results provide a descriptive review of the prevalence of ASD and its co-morbidities in children and adolescents. These insights can be valuable for clinicians and parents/guardians of autistic children. Prevalence of ASD has increased over time while co-morbidities bring additional heterogeneity to the clinical presentation, which further advocates for personalized approaches to treatment and support. Having a clear understanding of the prevalence of ASD and its co-morbidities is important to raise awareness among stakeholders.Appeared originally in Front Psychiatry 2021; 12:744709.
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Affiliation(s)
- Clémence Bougeard
- Syneos Health, Value Access & HEOR, Montrouge, France (Bougeard); Servier Global Medical and Patients Affairs, Suresnes, France (Picarel-Blanchot); Servier, Global Value & Access, Suresnes, France (Schmid); Syneos Health, Value Access & HEOR, London, United Kingdom (Campbell); Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands (Buitelaar)
| | - Françoise Picarel-Blanchot
- Syneos Health, Value Access & HEOR, Montrouge, France (Bougeard); Servier Global Medical and Patients Affairs, Suresnes, France (Picarel-Blanchot); Servier, Global Value & Access, Suresnes, France (Schmid); Syneos Health, Value Access & HEOR, London, United Kingdom (Campbell); Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands (Buitelaar)
| | - Ramona Schmid
- Syneos Health, Value Access & HEOR, Montrouge, France (Bougeard); Servier Global Medical and Patients Affairs, Suresnes, France (Picarel-Blanchot); Servier, Global Value & Access, Suresnes, France (Schmid); Syneos Health, Value Access & HEOR, London, United Kingdom (Campbell); Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands (Buitelaar)
| | - Rosanne Campbell
- Syneos Health, Value Access & HEOR, Montrouge, France (Bougeard); Servier Global Medical and Patients Affairs, Suresnes, France (Picarel-Blanchot); Servier, Global Value & Access, Suresnes, France (Schmid); Syneos Health, Value Access & HEOR, London, United Kingdom (Campbell); Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands (Buitelaar)
| | - Jan Buitelaar
- Syneos Health, Value Access & HEOR, Montrouge, France (Bougeard); Servier Global Medical and Patients Affairs, Suresnes, France (Picarel-Blanchot); Servier, Global Value & Access, Suresnes, France (Schmid); Syneos Health, Value Access & HEOR, London, United Kingdom (Campbell); Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands (Buitelaar)
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Gonçalves CL, Doifode T, Rezende VL, Costa MA, Rhoads JM, Soutullo CA. The many faces of microbiota-gut-brain axis in autism spectrum disorder. Life Sci 2024; 337:122357. [PMID: 38123016 DOI: 10.1016/j.lfs.2023.122357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 12/02/2023] [Accepted: 12/13/2023] [Indexed: 12/23/2023]
Abstract
The gut-brain axis is gaining more attention in neurodevelopmental disorders, especially autism spectrum disorder (ASD). Many factors can influence microbiota in early life, including host genetics and perinatal events (infections, mode of birth/delivery, medications, nutritional supply, and environmental stressors). The gut microbiome can influence blood-brain barrier (BBB) permeability, drug bioavailability, and social behaviors. Developing microbiota-based interventions such as probiotics, gastrointestinal (GI) microbiota transplantation, or metabolite supplementation may offer an exciting approach to treating ASD. This review highlights that RNA sequencing, metabolomics, and transcriptomics data are needed to understand how microbial modulators can influence ASD pathophysiology. Due to the substantial clinical heterogeneity of ASD, medical caretakers may be unlikely to develop a broad and effective general gut microbiota modulator. However, dietary modulation followed by administration of microbiota modulators is a promising option for treating ASD-related behavioral and gastrointestinal symptoms. Future work should focus on the accuracy of biomarker tests and developing specific psychobiotic agents tailored towards the gut microbiota seen in ASD patients, which may include developing individualized treatment options.
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Affiliation(s)
- Cinara L Gonçalves
- Graduate Program in Health Sciences, University of Southern Santa Catarina (UNESC), Criciúma, SC, Brazil.
| | - Tejaswini Doifode
- Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health (UTHealth), Houston, TX, USA
| | - Victoria L Rezende
- Graduate Program in Health Sciences, University of Southern Santa Catarina (UNESC), Criciúma, SC, Brazil
| | - Maiara A Costa
- Graduate Program in Health Sciences, University of Southern Santa Catarina (UNESC), Criciúma, SC, Brazil
| | - J Marc Rhoads
- Department of Pediatrics, Division of Pediatric Gastroenterology, McGovern Medical School, The University of Texas Health (UTHealth), Houston, TX, USA
| | - Cesar A Soutullo
- Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health (UTHealth), Houston, TX, USA
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Yoshida K, Lunsky Y, Müller DJ, Desarkar P. Prevalence of Psychotropic Medication Use and Psychotropic Polypharmacy in Autistic Adults With or Without Intellectual Disability. J Autism Dev Disord 2024:10.1007/s10803-023-06208-y. [PMID: 38219270 DOI: 10.1007/s10803-023-06208-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2023] [Indexed: 01/16/2024]
Abstract
The aim of this study was to compare the rates of psychotropic medication use and psychotropic polypharmacy between autistic adults with and without intellectual disability (ID) and to examine factors associated with psychotropic medication use and psychotropic polypharmacy in autistic adults, stratified by the presence of ID. We conducted a retrospective medical chart review of outpatients with an autism diagnosis aged 18 years and older. The rates of psychotropic medication use and psychotropic polypharmacy were compared between autistic adults with and without ID. Subsequently, logistic regression analyses were performed to identify factors associated with psychotropic medication use and psychotropic polypharmacy in autistic adults with ID and those without ID, respectively. The rates of prevalence of psychotropic medication use and polypharmacy were significantly higher in participants with ID than those without ID (78.6% vs. 58.8% and 49.3% vs. 31.2%; p-values < 0.05). Age, gender, race, residence, presence of mood disorders, presence of schizophrenia, absence of anxiety disorder, number of psychiatric comorbidities, and presence of behaviors that challenge were significantly associated with these outcomes, depending on the presence/absence of ID. The need to optimize pharmacotherapy in autistic adults, stratifying by the presence of ID, is highlighted.
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Affiliation(s)
- Kazunari Yoshida
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, 1025 Queen Street West, Toronto, ON, M6J 1H1, Canada
- Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Yona Lunsky
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, 1025 Queen Street West, Toronto, ON, M6J 1H1, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Daniel J Müller
- Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Pushpal Desarkar
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, 1025 Queen Street West, Toronto, ON, M6J 1H1, Canada.
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
- Adult Neurodevelopmental Services, Centre for Addiction and Mental Health, Toronto, ON, Canada.
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Zavaleta-Ramírez P, Rosetti M, Albores-Gallo L, López ON, González PP. Pediatric and psychiatric models of autism care in Mexico: Differences in diagnostic tools and prescribed interventions. Clin Child Psychol Psychiatry 2024; 29:232-244. [PMID: 37541309 DOI: 10.1177/13591045231193817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/06/2023]
Abstract
Low- and middle-income countries face heterogeneity in the way clinicians' approach Autism Spectrum Disorder (ASD) diagnosis and treatment. The current study analyzes the diagnostic tools, laboratory tests, pharmacological and psychosocial interventions received by patients during the steps to diagnosis and treatment of two specialized care centers. Researchers interviewed families with a child with ASD receiving services at either a child psychiatric or a pediatric hospital. Of the total sample, 47% reported clinicians not using a diagnostic tool, 20% reported not receiving any psychosocial intervention, and 88% reported receiving a pharmacological prescription. Patients at the pediatric hospital were more likely to receive interventions with some components of Applied Behavioral Analysis, Early Start Denver Model, Treatment and Education of Autistic and Related Communication Handicapped Children, and Sensory integration therapy; while patients at the psychiatric hospital were more likely to undergo learning, daily living skills, and socialization therapies. Patients at the psychiatric hospital received significantly more requests to obtain auditory and vision tests whilst genetic testing and imaging were more common in the pediatric hospital. The range and variability in terms of diagnostic tools, laboratory tests, and treatment options observed for both sites reflect a lack of consensus. Recommendations to improve ASD diagnostic and treatment in Mexico are given.
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Affiliation(s)
- Patricia Zavaleta-Ramírez
- Hospital Psiquiátrico Infantil Dr. Juan N. Navarro, Servicios de Atención Psiquiátrica, Mexico City, Mexico
| | - Marcos Rosetti
- Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City, Mexico
- Instituto Nacional de Psiquiatría Dr. Ramón de la Fuente Muñiz, México City, México
| | - Lilia Albores-Gallo
- Hospital Psiquiátrico Infantil Dr. Juan N. Navarro, Servicios de Atención Psiquiátrica, Mexico City, Mexico
| | - Omar Nafate López
- Hospital de Especialidades Pediátricas, Tuxtla Gutiérrez, Chiapas, México
| | - Paula Padierna González
- Hospital Psiquiátrico Infantil Dr. Juan N. Navarro, Servicios de Atención Psiquiátrica, Mexico City, Mexico
- Fundación Alicia Koplowitz, Madrid, España
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Baumer NT, Capone G. Psychopharmacological treatments in Down syndrome and autism spectrum disorder: State of the research and practical considerations. AMERICAN JOURNAL OF MEDICAL GENETICS. PART C, SEMINARS IN MEDICAL GENETICS 2023; 193:e32069. [PMID: 37870763 DOI: 10.1002/ajmg.c.32069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/20/2023] [Accepted: 09/30/2023] [Indexed: 10/24/2023]
Abstract
Individuals with Down syndrome (DS) or Autism Spectrum Disorder (ASD), and especially those with both DS and co-occurring ASD (DS + ASD) commonly display behavioral and psychiatric symptoms that can impact quality of life and places increased burden on caregivers. While the mainstay of treatment in DS and ASD is focused on educational and behavioral therapies, pharmacological treatments can be used to reduce symptom burden. There is a paucity of evidence and limited clinical trials in DS and DS + ASD. Some scientific evidence is available, primarily in open label studies and case series that can guide treatment choices. Additionally, clinical decisions are often extrapolated from evidence and experience from those with ASD, or intellectual disability in those without DS. This article reviews current research in pharmacological treatment in DS, ASD, and DS + ASD, reviews co-occurring neurodevelopmental and mental health diagnoses in individuals with DS + ASD across the lifespan, and describes practical approaches to psychopharmacological management.
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Affiliation(s)
- Nicole T Baumer
- Division of Developmental Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - George Capone
- Department of Pediatrics, Johns Hopkins Medicine, Baltimore, Maryland, USA
- Kennedy Krieger Institute, Baltimore, Maryland, USA
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Carson L, Parlatini V, Safa T, Baig B, Shetty H, Phillips-Owen J, Prasad V, Downs J. The association between early childhood onset epilepsy and attention-deficit hyperactivity disorder (ADHD) in 3237 children and adolescents with Autism Spectrum Disorder (ASD): a historical longitudinal cohort data linkage study. Eur Child Adolesc Psychiatry 2023; 32:2129-2138. [PMID: 35927526 PMCID: PMC10576710 DOI: 10.1007/s00787-022-02041-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 06/25/2022] [Indexed: 11/03/2022]
Abstract
Children and young people with Autism Spectrum Disorder (ASD) have an increased risk of comorbidities, such as epilepsy and Attention-Deficit/Hyperactivity Disorder (ADHD). However, little is known about the relationship between early childhood epilepsy (below age 7) and later ADHD diagnosis (at age 7 or above) in ASD. In this historical cohort study, we examined this relationship using an innovative data source, which included linked data from routinely collected acute hospital paediatric records and childhood community and inpatient psychiatric records. In a large sample of children and young people with ASD (N = 3237), we conducted a longitudinal analysis to examine early childhood epilepsy as a risk factor for ADHD diagnosis while adjusting for potential confounders, including socio-demographic characteristics, intellectual disability, family history of epilepsy and associated physical conditions. We found that ASD children and young people diagnosed with early childhood epilepsy had nearly a twofold increase in risk of developing ADHD later in life, an association which persisted after adjusting for potential confounders (adjusted OR = 1.72, CI95% = 1.13-2.62). This study suggests that sensitive monitoring of ADHD symptoms in children with ASD who have a history of childhood epilepsy may be important to promote early detection and treatment. It also highlights how linked electronic health records can be used to examine potential risk factors over time for multimorbidity in neurodevelopmental conditions.
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Affiliation(s)
- Lauren Carson
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Valeria Parlatini
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Tara Safa
- National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Benjamin Baig
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Hitesh Shetty
- National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Jacqueline Phillips-Owen
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Vibhore Prasad
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Johnny Downs
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
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Gerber AH, Kang E, Nahmias AS, Libsack EJ, Simson C, Lerner MD. Predictors of Treatment Response to a Community-Delivered Group Social Skills Intervention for Youth with ASD. J Autism Dev Disord 2023; 53:3741-3754. [PMID: 35904648 DOI: 10.1007/s10803-022-05559-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2022] [Indexed: 10/16/2022]
Abstract
Group social skills interventions (GSSIs) are among the most commonly used treatments for improving social competence in youth with ASD, however, results remain variable. The current study examined predictors of treatment response to an empirically-supported GSSI for youth with ASD delivered in the community (Ntotal=75). Participants completed a computer-based emotion recognition task and their parents completed measures of broad psychopathology, ASD symptomatology, and social skills. We utilized generalized estimating equations in an ANCOVA-of-change framework to account for nesting. Results indicate differential improvements in emotion recognition by sex as well as ADHD-specific improvements in adaptive functioning. Youth with both co-occurring anxiety and ADHD experienced iatrogenic effects, suggesting that SDARI may be most effective for youth with ASD without multiple co-occurring issues. Findings provide important directions for addressing variability in treatment outcomes for youth with ASD.
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Affiliation(s)
- Alan H Gerber
- Department of Psychology, Stony Brook University, 11794-2500, Stony Brook, New York, United States
| | - Erin Kang
- Department of Psychology, Stony Brook University, 11794-2500, Stony Brook, New York, United States
- Department of Psychology, Montclair State University, Little Falls, New Jersey, United States
| | - Allison S Nahmias
- Department of Psychiatry and Behavioral Health, School of Medicine, Stony Brook University, Stony Brook, New York, United States
| | - Erin J Libsack
- Department of Psychology, Stony Brook University, 11794-2500, Stony Brook, New York, United States
| | - Caitlin Simson
- Department of Psychology, Stony Brook University, 11794-2500, Stony Brook, New York, United States
| | - Matthew D Lerner
- Department of Psychology, Stony Brook University, 11794-2500, Stony Brook, New York, United States.
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12
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Chihuri S, Blanchard A, DiGuiseppi CG, Li G. Epidemiologic Patterns of Autism Spectrum Disorder in Pediatric Inpatients in the United States, 1997-2019. J Autism Dev Disord 2023:10.1007/s10803-023-06091-7. [PMID: 37584769 DOI: 10.1007/s10803-023-06091-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2023] [Indexed: 08/17/2023]
Abstract
The reported prevalence of autism spectrum disorder (ASD) has more than tripled in the past two decades in the United States, due in part to improved screening and diagnostic techniques. Epidemiologic data on ASD, however, are largely limited to population-based surveillance systems. We examined epidemiologic patterns in ASD diagnoses among inpatients aged 1-20 years, using data from the Kids' Inpatient Database (KID) from 1997 to 2019. ASD cases were identified using ICD-9-CM and ICD-10-CM codes. Of 9,267,881 hospital discharges studied, 110,090 (1.19%) had a diagnosis of ASD. The prevalence of ASD was higher among males compared to females (1.53% vs. 0.54%) and was highest among non-Hispanic Whites (1.28% vs. 0.95% in non-Hispanic Blacks, 0.94% in Hispanics, and 1.18% in Other races). ASD prevalence increased from 0.18% to 1997 to 3.36% in 2019 (Z= -273.40, p < 0.001). The absolute increase was higher among males compared to females (0.26-4.90% vs. 0.08-1.77%) and among non-Hispanic Whites (0.18-2.88%) compared to non-Hispanic Blacks (0.23-2.72%), Hispanics (0.14-2.60%), and Other races (0.19-2.97%). The epidemiologic patterns of ASD based on inpatient data are generally consistent with reports from the community-based autism surveillance system. Our findings indicate that KID and other health services data might play a complementary role in ASD surveillance.
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Affiliation(s)
- Stanford Chihuri
- Department of Anesthesiology, Columbia University Vagelos College of Physicians and Surgeons, 10032, New York, NY, USA.
| | - Ashley Blanchard
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
- Department of Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Carolyn G DiGuiseppi
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Guohua Li
- Department of Anesthesiology, Columbia University Vagelos College of Physicians and Surgeons, 10032, New York, NY, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
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13
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Curnow E, Rutherford M, Maciver D, Johnston L, Prior S, Boilson M, Shah P, Jenkins N, Meff T. Mental health in autistic adults: A rapid review of prevalence of psychiatric disorders and umbrella review of the effectiveness of interventions within a neurodiversity informed perspective. PLoS One 2023; 18:e0288275. [PMID: 37440543 PMCID: PMC10343158 DOI: 10.1371/journal.pone.0288275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 06/23/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Autistic adults have high risk of mental ill-health and some available interventions have been associated with increased psychiatric diagnoses. Understanding prevalence of psychiatric diagnoses is important to inform the development of individualised treatment and support for autistic adults which have been identified as a research priority by the autistic community. Interventions require to be evaluated both in terms of effectiveness and regarding their acceptability to the autistic community. OBJECTIVE This rapid review identified the prevalence of psychiatric disorders in autistic adults, then systematic reviews of interventions aimed at supporting autistic adults were examined. A rapid review of prevalence studies was completed concurrently with an umbrella review of interventions. Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines were followed, including protocol registration (PROSPERO#CRD42021283570). DATA SOURCES MEDLINE, CINAHL, PsycINFO, and Cochrane Database of Systematic Reviews. STUDY ELIGIBILITY CRITERIA English language; published 2011-2022; primary studies describing prevalence of psychiatric conditions in autistic adults; or systematic reviews evaluating interventions for autistic adults. APPRAISAL AND SYNTHESIS Bias was assessed using the Prevalence Critical Appraisal Instrument and AMSTAR2. Prevalence was grouped according to psychiatric diagnosis. Interventions were grouped into pharmacological, employment, psychological or mixed therapies. Strength of evidence for interventions was assessed using GRADE (Grading of Recommendations, Assessment, Development and Evaluation). Autistic researchers within the team supported interpretation. RESULTS Twenty prevalence studies were identified. Many included small sample sizes or failed to compare their sample group with the general population reducing validity. Prevalence of psychiatric diagnoses was variable with prevalence of any psychiatric diagnosis ranging from 15.4% to 79%. Heterogeneity was associated with age, diagnosis method, sampling methods, and country. Thirty-two systematic reviews of interventions were identified. Four reviews were high quality, four were moderate, five were low and nineteen critically low, indicating bias. Following synthesis, no intervention was rated as 'evidence based.' Acceptability of interventions to autistic adults and priorities of autistic adults were often not considered. CONCLUSIONS There is some understanding of the scope of mental ill-health in autism, but interventions are not tailored to the needs of autistic adults, not evidence based, and may focus on promoting neurotypical behaviours rather than the priorities of autistic people.
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Affiliation(s)
- Eleanor Curnow
- School of Health Sciences, Queen Margaret University, Edinburgh, United Kingdom
| | - Marion Rutherford
- School of Health Sciences, Queen Margaret University, Edinburgh, United Kingdom
| | - Donald Maciver
- School of Health Sciences, Queen Margaret University, Edinburgh, United Kingdom
| | - Lorna Johnston
- School of Health Sciences, Queen Margaret University, Edinburgh, United Kingdom
- Additional Support for Learning Service, Communities and Families, City of Edinburgh Council, Edinburgh, United Kingdom
| | - Susan Prior
- School of Health Sciences, Queen Margaret University, Edinburgh, United Kingdom
| | - Marie Boilson
- School of Health Sciences, Queen Margaret University, Edinburgh, United Kingdom
- Fife Health and Social Care Partnership, Lynebank Hospital, Dunfermline, Fife, United Kingdom
| | - Premal Shah
- School of Health Sciences, Queen Margaret University, Edinburgh, United Kingdom
- General Adult Psychiatry, Royal Edinburgh Hospital, Edinburgh, United Kingdom
| | - Natalie Jenkins
- School of Health Sciences, Queen Margaret University, Edinburgh, United Kingdom
- University of Edinburgh, Edinburgh, United Kingdom
| | - Tamsin Meff
- School of Health Sciences, Queen Margaret University, Edinburgh, United Kingdom
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14
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Ballester P, Espadas C, Almenara S, Barrachina J, Muriel J, Ramos E, Toral N, Belda C, Peiró AM. CYP2D6 Genotype and Pharmacovigilance Impact on Autism Spectrum Disorder: A Naturalistic Study with Extreme Phenotype Analysis. Pharmaceuticals (Basel) 2023; 16:954. [PMID: 37513866 PMCID: PMC10385457 DOI: 10.3390/ph16070954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/23/2023] [Accepted: 06/28/2023] [Indexed: 07/30/2023] Open
Abstract
The long-term use of psychopharmacology medications in autism spectrum disorder (ASD) hitherto remains controversial due to a lack of evidence about safety and tolerability. In this regard, genotyping the metabolizing enzyme cytochrome P450 (CYP) 2D6, especially its extreme phenotypes, could help to prevent drug-related adverse reactions or adverse events (AEs). There are several medications warranting CYP2D6 screening that are consumed by people with ASD, such as risperidone and aripiprazole to name a few. A naturalistic observational study was carried out in participants with ASD to analyze the influence of the CYP2D6 phenotype in drug tolerability using a local pharmacovigilance system created for this study. In this case, AEs were identified from participants' electronic health records (EHRs) and paper registries. Other variables were collected: socio-demographic information, comorbidities, and psychopharmacology prescriptions (polypharmacy defined as ≥4 simultaneous prescriptions) and doses. The genetic analysis included allelic discrimination (CYP2D6*1, *2, *3, *4, *5, *6, *10, *17, and *41) and copy number variations. All of these were used to determine theoretical phenotypes of the metabolic profiles: poor (PM); intermediate (IM); normal (NM); and ultra-rapid (UM). Sex differences were analyzed. A total of 71 participants (30 ± 10 years old, 82% male, 45% CYP2D6 NM phenotype (32 participants)) with a median of 3 (IQR 2-4) comorbidities per person, mainly urinary incontinence (32%) and constipation (22%), were included. CYP2D6 UM showed the highest rate of polypharmacy, whilst, IM participants had the highest rates of neurological and psychiatric AEs, even worse if a CYP2D6 inhibitor drug was prescribed simultaneously. CYP2D6 pharmacogenomics and the monitoring of new antipsychotic prescriptions may make a difference in medication safety in adults with ASD. Particularly in those with psychopharmacology polymedication, it can help with AE avoidance and understanding.
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Affiliation(s)
- Pura Ballester
- Pharmacology Department, Pharmacy Degree, San Antonio Catholic University, 30107 Murcia, Spain
| | - Cristina Espadas
- Bioengineering Institute, Pediatrics and Organic Chemistry Department, Miguel Hernández University of Elche (UMH), 03202 Alicante, Spain
| | - Susana Almenara
- Neuropharmacology on Pain Treatment and Neurodevelopmental Disorders, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), 03010 Alicante, Spain
- Clinical Pharmacology Unit, Alicante General University Hospital, 03010 Alicante, Spain
| | - Jordi Barrachina
- Neuropharmacology on Pain Treatment and Neurodevelopmental Disorders, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), 03010 Alicante, Spain
| | - Javier Muriel
- Neuropharmacology on Pain Treatment and Neurodevelopmental Disorders, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), 03010 Alicante, Spain
- Clinical Pharmacology, Pediatrics and Organic Chemistry Department, Miguel Hernández University of Elche (UMH), 03202 Alicante, Spain
| | - Enrique Ramos
- Bioengineering Institute, Pediatrics and Organic Chemistry Department, Miguel Hernández University of Elche (UMH), 03202 Alicante, Spain
| | - Natalia Toral
- San Rafael Center-San Francisco De Borja Foundation, Residential Facility, 03559 Alicante, Spain
| | - César Belda
- Infanta Leonor Center, Autism Parents Association Valencian Community Autism Association (APACV), 03010 Alicante, Spain
| | - Ana M Peiró
- Bioengineering Institute, Pediatrics and Organic Chemistry Department, Miguel Hernández University of Elche (UMH), 03202 Alicante, Spain
- Neuropharmacology on Pain Treatment and Neurodevelopmental Disorders, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), 03010 Alicante, Spain
- Clinical Pharmacology Unit, Alicante General University Hospital, 03010 Alicante, Spain
- Clinical Pharmacology, Pediatrics and Organic Chemistry Department, Miguel Hernández University of Elche (UMH), 03202 Alicante, Spain
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15
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Di Sarro R, Varrucciu N, Di Santantonio A, Natali F, Kaleci S, Bianco A, Cappai M, Lucchi F, Bertelli MO. Appropriateness of psychopharmacological therapies to psychiatric diagnoses in persons with autism spectrum disorder with or without intellectual disabilities: a cross-sectional analytic study. Expert Opin Drug Saf 2023; 22:1271-1281. [PMID: 36681385 DOI: 10.1080/14740338.2023.2172396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 12/06/2022] [Accepted: 12/09/2022] [Indexed: 01/23/2023]
Abstract
BACKGROUND Observational studies highlighted high rates of psychotropic medication in persons with autistic spectrum disorder (ASD) with or without intellectual disability, which seems to be associated with the management of problem behaviors more than co-occurrent psychiatric disorders. The purpose of the study is to investigate psychopharmacology use and diagnoses of co-occurrent psychiatric disorder (PD) in persons with ASD attending a public mental health service in Emilia Romagna, Italy. METHODS The present study is a multicenter, cross-sectional study. RESULTS 275 persons out of 486 (56.5%) resulted to receive at least one psychotropic drug, compared to 74 persons (15.2%) that were diagnosed with a PD. 63.6% were on poly-pharmacotherapy (2-10 compounds), with 37.8% receiving 3 or more medications. Antipsychotics were the most frequently prescribed class of psychotropic drugs (89%), followed by antiepileptics/mood stabilizers/lithium (42.1%) and anxiolytics (BDZ) (38.5%). Most common psychiatric disorders were psychotic disorders (29.7%), followed by anxiety disorders (17.5%), bipolar disorders (12.2%), and depressive disorders (9.4%). CONCLUSIONS Our findings support earlier research showing that many individuals with ASD receive pharmacotherapy without being diagnosed with a co-occurring psychiatric disorder, indicating that the main reasons for prescription and the type of compound frequently have little to no link with specific psychopathology.
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Affiliation(s)
- Rita Di Sarro
- Health and Disability Integrated Program, Public Local Health Bologna, Italy
| | - Niccolò Varrucciu
- Health and Disability Integrated Program, Public Local Health Bologna, Italy
| | - Anna Di Santantonio
- Health and Disability Integrated Program, Public Local Health Bologna, Italy
| | - Francesca Natali
- Health and Disability Integrated Program, Public Local Health Bologna, Italy
| | - Shaniko Kaleci
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Annamaria Bianco
- CREA (Research and Clinical Centre), San Sebastiano Foundation, Misericordia di Firenze, Florence, Italy
| | - Michela Cappai
- Emilia-Romagna Region, Mental Health and Pathological Addictions, Italy
| | - F Lucchi
- Department of Mental Health and Pathological Addictions, Public Local Health Bologna, Italy
| | - Marco O Bertelli
- CREA (Research and Clinical Centre), San Sebastiano Foundation, Misericordia di Firenze, Florence, Italy
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16
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Penna HDM, Paiva APM, Romano AJM, Alves RL, Nascimento Junior PD, Módolo NSP. Comparison between oral midazolam versus oral ketamine plus midazolam as preanesthetic medication in autism spectrum disorder: double-blind randomized clinical trial. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2023; 73:283-290. [PMID: 36183860 DOI: 10.1016/j.bjane.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 09/19/2022] [Accepted: 09/20/2022] [Indexed: 05/28/2023]
Abstract
BACKGROUND Conventional dental care is often impossible in patients with Autism Spectrum Disorder (ASD). Non-collaborative behaviors, sometimes associated with aggressiveness, are usual justifications for premedication in this population. Thereby, this research focuses on the effects of oral midazolam versus oral ketamine plus midazolam as preanesthetic medication in ASD. METHODS The sample included 64 persons with ASD, aged 2-59 years, scheduled for dental care under general anesthesia. The primary objective of this study was to compare degrees of sedation between two parallel, double-blinded, equally proportional groups randomized to receive oral midazolam (0.5 mg.kg-1, maximum 15 mg) or oral midazolam (0.5 mg.kg-1) associated with oral S(+)-ketamine (3 mg.kg-1, maximum 300 mg). The secondary outcomes were the need of physical stabilization to obtain intravenous line, awakening time, and occurrence of adverse events. RESULTS According to the dichotomous analysis of sedation level (Ramsay score 1 and 2 versus Ramsay ≥ 3), oral association of S(+)-ketamine and midazolam improved sedation, with increased probability of Ramsay ≥ 3, Relative Risk (RR) = 3.2 (95% Confidence Interval [95% CI] = 1.32 to 7.76) compared to midazolam alone. Combined treatment also made it easier to obtain venous access without physical stabilization, RR = 2.05 (95% CI = 1.14 to 3.68). There were no differences between groups regarding awakening time and the occurrence of adverse events. CONCLUSION The association of oral S(+)-ketamine with midazolam provides better preanesthetic sedation rates than midazolam alone and facilitates intravenous line access in patients with autism.
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Affiliation(s)
- Heber de Moraes Penna
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina de Botucatu, Departamento de Anestesiologia, Botucatu, SP, Brazil; Hospital Santa Terezinha, Goiânia, GO, Brazil.
| | | | | | - Rodrigo Leal Alves
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina de Botucatu, Departamento de Anestesiologia, Botucatu, SP, Brazil
| | - Paulo do Nascimento Junior
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina de Botucatu, Departamento de Anestesiologia, Botucatu, SP, Brazil
| | - Norma Sueli Pinheiro Módolo
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina de Botucatu, Departamento de Anestesiologia, Botucatu, SP, Brazil
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17
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Lukito S, O'Daly OG, Lythgoe DJ, Hodsoll J, Maltezos S, Pitts M, Simonoff E, Rubia K. Reduced inferior fronto-insular-thalamic activation during failed inhibition in young adults with combined ASD and ADHD compared to typically developing and pure disorder groups. Transl Psychiatry 2023; 13:133. [PMID: 37087490 PMCID: PMC10122665 DOI: 10.1038/s41398-023-02431-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 04/05/2023] [Accepted: 04/12/2023] [Indexed: 04/24/2023] Open
Abstract
Autism spectrum disorder (ASD) often co-occurs with attention-deficit/hyperactivity disorder (ADHD) and people with these conditions have frontostriatal functional atypicality during motor inhibition. We compared the neural and neurocognitive correlates of motor inhibition and performance monitoring in young adult males with "pure" and combined presentations with age-and sex-matched typically developing controls, to explore shared or disorder-specific atypicality. Males aged 20-27 years with typical development (TD; n = 22), ASD (n = 21), combined diagnoses ASD + ADHD (n = 23), and ADHD (n = 25) were compared using a modified tracking fMRI stop-signal task that measures motor inhibition and performance monitoring while controlling for selective attention. In addition, they performed a behavioural go/no-go task outside the scanner. While groups did not differ behaviourally during successful stop trials, the ASD + ADHD group relative to other groups had underactivation in typical performance monitoring regions of bilateral anterior insula/inferior frontal gyrus, right posterior thalamus, and right middle temporal gyrus/hippocampus during failed inhibition, which was associated with increased stop-signal reaction time. In the behavioural go/no-go task, both ADHD groups, with and without ASD, had significantly lower motor inhibition performance compared to TD controls. In conclusion, only young adult males with ASD + ADHD had neurofunctional atypicality in brain regions associated with performance monitoring, while inhibition difficulties on go/no-go task performance was shared with ADHD. The suggests that young people with ASD + ADHD are most severely impaired during motor inhibition tasks compared to ASD and ADHD but do not reflect a combination of the difficulties associated with the pure disorders.
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Affiliation(s)
- Steve Lukito
- Department of Child and Adolescent Psychiatry, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK.
| | - Owen G O'Daly
- Department of Neuroimaging, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - David J Lythgoe
- Department of Neuroimaging, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - John Hodsoll
- Department of Biostatistics and Health Informatics, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Stefanos Maltezos
- The Adult Attention-Deficit/Hyperactivity Disorder (ADHD) and Autism National Service, Behavioural and Developmental Psychiatry Clinical Academic Group, South London and Maudsley Foundation NHS Trust, London, UK
| | - Mark Pitts
- The Adult Attention-Deficit/Hyperactivity Disorder (ADHD) and Autism National Service, Behavioural and Developmental Psychiatry Clinical Academic Group, South London and Maudsley Foundation NHS Trust, London, UK
| | - Emily Simonoff
- Department of Child and Adolescent Psychiatry, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Katya Rubia
- Department of Child and Adolescent Psychiatry, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
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18
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Fieiras C, Chen MH, Escobar Liquitay CM, Meza N, Rojas V, Franco JVA, Madrid E. Risperidone and aripiprazole for autism spectrum disorder in children: an overview of systematic reviews. BMJ Evid Based Med 2023; 28:7-14. [PMID: 35101925 DOI: 10.1136/bmjebm-2021-111804] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/09/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To assess the effectiveness and safety of risperidone and aripiprazole in children with autism spectrum disorder (ASD). DESIGN AND SETTING Overview of systematic reviews (SRs). SEARCH METHODS In October 2021, we searched Cochrane Central Register of Controlled Trials, MEDLINE, Embase, PsycInfo and Epistemonikos placing no restrictions on language or date of publication. PARTICIPANTS Children aged 12 years or less with ASD. INTERVENTIONS Risperidone and aripiprazole with no dosage restrictions. DATA COLLECTION AND ANALYSIS We rated the methodological quality of the included SRs using A Measurement Tool to Assess Systematic Reviews (AMSTAR 2). We reported the Grading of Recommendations, Assessment, Development and Evaluation certainty of the evidence according to the analysis conducted by the authors of the included SRs. MAIN OUTCOMES MEASURED A multidisciplinary group of experts agreed on analysing nine critical outcomes evolving core and non-core ASD symptoms. PATIENT AND PUBLIC INVOLVEMENT Organisations of parents of children with ASD were involved during part of the process, participating in external revision of the final version of the report for the Chilean Ministry of Health with no additional comments (ID 757-22-L120 DIPRECE, Ministry of Health, Chile). The organisations involved were: Fundación Unión Autismo y Neurodiversidad, Federación Nacional de Autismo, Vocería Autismo del Sur, and Vocería Autismo del Norte. RESULTS We identified 22 SRs within the scope of this overview, of which 16 were of critically low confidence according to AMSTAR 2 and were excluded from the analysis. Both aripiprazole and risperidone were effective for reducing autism symptoms severity, repetitive behaviours, inappropriate language, social withdrawal and behavioural problems compared with placebo. The certainty of the evidence for most outcomes was moderate. Risperidone and aripiprazole are associated with metabolic and neurological adverse events. Follow-up was short termed. CONCLUSIONS We found that aripiprazole and risperidone probably reduce symptom severity at short-term follow-up but may also cause adverse events. High-quality and updated SRs and larger randomised controlled trials with longer term follow-up are needed on this topic. OVERVIEW PROTOCOL PROSPERO CRD42020206535.
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Affiliation(s)
- Cecilia Fieiras
- School of Medicine, Instituto Universitario Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | | | - Nicolás Meza
- Interdisciplinary Centre for Health Studies (CIESAL) - Cochrane Chile Associate Centre, Universidad de Valparaíso, Viña del Mar, Chile
| | - Valeria Rojas
- School of Medicine, Universidad de Valparaíso, Viña del Mar, Chile
- Autism program, Hospital Gustavo Fricke, Viña del Mar, Chile
| | - Juan Victor Ariel Franco
- Associate Cochrane Centre-Research Department, Instituto Universitario Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Eva Madrid
- Interdisciplinary Centre for Health Studies (CIESAL) - Cochrane Chile Associate Centre, Universidad de Valparaíso, Viña del Mar, Chile
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19
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Jonkman KM, Back E, Begeer S. Predicting intervention use in autistic children: Demographic and autism-specific characteristics. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:428-442. [PMID: 35695079 DOI: 10.1177/13623613221102748] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
LAY ABSTRACT Autism is a condition that is characterised by social communication difficulties and restrictive and repetitive behaviours or interests. Autism can present in many different ways and various interventions are available. Some interventions are conventional, and they are recommended to be used for children with autism (guideline therapies) or for other disorders such as anxiety or attention-deficit hyperactivity disorder (mainstream therapies or medication), while others are less conventional (other therapies or medication, they are discouraged, unknown or alternative). Little is known about who chooses which intervention. This study found that most autistic children use some kind of intervention. Children who attend special education or have an additional diagnosis (other than autism) tend to receive more therapies, while children with a lower IQ receive fewer therapies. Older children, children with a higher IQ and girls are more likely to use conventional (mainstream or guideline) therapies. Children whose parents have a lower educational level are more likely to have used conventional medication. Whereas, children with more sensory issues (e.g. sensitivity to sound, smell or movement) were more likely to have used unconventional medication. This study found that other autism-related characteristics such as the number of autism symptoms, social skills and repetitive and restrictive behaviours were not related to the interventions used. More treatments focussed on multiple problems should be available for children with autism who have additional difficulties.
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20
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Wolpert KH, Kodish I, Kim SJ, Uspal NG. Behavioral Management of Children With Autism in the Emergency Department. Pediatr Emerg Care 2023; 39:45-50. [PMID: 36580892 DOI: 10.1097/pec.0000000000002886] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
ABSTRACT Autism spectrum disorder (ASD) is characterized by impaired social communication in conjunction with patterned behaviors. Often associated with emotional dysregulation, irritability, aggression, depression, and suicidality, ASD youth frequently present to the emergency department for behavioral and mental health evaluation. Psychiatric comorbidities, agitation, and depression are commonly encountered. During these visits, practitioners must thoughtfully consider organic etiologies for presenting symptoms, formulate plans to address risk of agitation, and understand how to effectively formulate disposition options in this patient population.
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Affiliation(s)
- Katherine H Wolpert
- From the Assistant Professor (Wolpert) and Associate Professor (Uspal), Division of Emergency Medicine, Department of Pediatrics, University of Washington
| | - Ian Kodish
- Associate Professor (Kim and Kodish), Department of Psychiatry and Behavioral Sciences, University of Washington
| | | | - Neil G Uspal
- From the Assistant Professor (Wolpert) and Associate Professor (Uspal), Division of Emergency Medicine, Department of Pediatrics, University of Washington
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21
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Parent-Child Interaction Therapy for Children with Disruptive Behaviors and Autism: A Randomized Clinical Trial. J Autism Dev Disord 2023; 53:390-404. [PMID: 35076832 PMCID: PMC9889513 DOI: 10.1007/s10803-022-05428-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2022] [Indexed: 02/04/2023]
Abstract
A relatively large number of children with autism spectrum disorder (ASD) exhibit disruptive behavioral problems. While accumulating data have shown behavioral parent training programs to be efficacious in reducing disruptive behaviors for this population, there is a dearth of literature examining the impact of such programs across the range of ASD severity. To evaluate the effectiveness of Parent-Child Interaction Therapy (PCIT), an evidence-based treatment for children with problem behaviors and their families, in reducing disruptive behaviors among children (4-10 years) with ASD (without intellectual disabilities). Fifty-five children (85.5% male, 7.15 years; SD 1.72) were enrolled from pediatric offices and educational settings into a randomized clinical trial (PCIT: N = 30; Control: N = 25). PCIT families demonstrated a significant reduction in child disruptive behaviors, increase in positive parent-child communication, improvement in child compliance, and reduction in parental stress compared to the control group. Exploratory analyses revealed no differential treatment response based on ASD severity, receptive language, and age. Results are promising for the use of PCIT with children demonstrating disruptive behaviors across the autism spectrum.
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22
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Grosse SD, Nichols P, Nyarko K, Maenner M, Danielson ML, Shea L. Heterogeneity in Autism Spectrum Disorder Case-Finding Algorithms in United States Health Administrative Database Analyses. J Autism Dev Disord 2022; 52:4150-4163. [PMID: 34581918 PMCID: PMC9077262 DOI: 10.1007/s10803-021-05269-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2021] [Indexed: 12/19/2022]
Abstract
Strengthening systems of care to meet the needs of individuals with autism spectrum disorder (ASD) is of growing importance. Administrative data provide advantages for research and planning purposes, including large sample sizes and the ability to identify enrollment in insurance coverage and service utilization of individuals with ASD. Researchers have employed varying strategies to identify individuals with ASD in administrative data. Differences in these strategies can limit the comparability of results across studies. This review describes implications of the varying strategies that have been employed to identify individuals with ASD in US claims databases, with consideration of the strengths and limitations of each approach.
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Affiliation(s)
- Scott D Grosse
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Mail Stop S106-4, Atlanta, GA, 30341, USA.
| | - Phyllis Nichols
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Mail Stop S106-4, Atlanta, GA, 30341, USA
| | - Kwame Nyarko
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Mail Stop S106-4, Atlanta, GA, 30341, USA
| | - Matthew Maenner
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Mail Stop S106-4, Atlanta, GA, 30341, USA
| | - Melissa L Danielson
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Mail Stop S106-4, Atlanta, GA, 30341, USA
| | - Lindsay Shea
- Policy and Analytics Center, A.J. Drexel Autism Institute, Drexel University, Philadelphia, PA, USA
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23
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Ramirez-Celis A, Croen LA, Yoshida CK, Alexeeff SE, Schauer J, Yolken RH, Ashwood P, Van de Water J. Maternal autoantibody profiles as biomarkers for ASD and ASD with co-occurring intellectual disability. Mol Psychiatry 2022; 27:3760-3767. [PMID: 35618885 PMCID: PMC9708563 DOI: 10.1038/s41380-022-01633-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 05/05/2022] [Accepted: 05/12/2022] [Indexed: 02/08/2023]
Abstract
Maternal autoantibody-related ASD (MAR ASD) is a subtype of autism in which pathogenic maternal autoantibodies (IgG) cross the placenta, access the developing brain, and cause neurodevelopmental alterations and behaviors associated with autism in the exposed offspring. We previously reported maternal IgG response to eight proteins (CRMP1, CRMP2, GDA LDHA, LDHB, NSE, STIP1, and YBOX) and that reactivity to nine specific combinations of these proteins (MAR ASD patterns) was predictive of ASD risk. The aim of the current study was to validate the previously identified MAR ASD patterns (CRMP1 + GDA, CRMP1 + CRMP2, NSE + STIP1, CRMP2 + STIP1, LDHA + YBOX, LDHB + YBOX, GDA + YBOX, STIP1 + YBOX, and CRMP1 + STIP1) and their accuracy in predicting ASD risk in a prospective cohort employing maternal samples collected prior to parturition. We used prenatal plasma from mothers of autistic children with or without co-occurring intellectual disability (ASD = 540), intellectual disability without autism (ID = 184) and general population controls (GP = 420) collected by the Early Markers for Autism (EMA) study. We found reactivity to one or more of the nine previously identified MAR ASD patterns in 10% of the ASD group compared with 4% of the ID group and 1% of the GP controls (ASD vs GP: Odds Ratio (OR) = 7.81, 95% Confidence Interval (CI) 3.32 to 22.43; ASD vs ID: OR = 2.77, 95% CI (1.19-7.47)) demonstrating that the MAR ASD patterns are strongly associated with the ASD group and could be used to assess ASD risk prior to symptom onset. The pattern most strongly associated with ASD was CRMP1 + CRMP2 and increased the odds for an ASD diagnosis 16-fold (3.32 to >999.99). In addition, we found that several of these specific MAR ASD patterns were strongly associated with ASD with intellectual disability (ASD + ID) and others associated with ASD without ID (ASD-no ID). Prenatal screening for these MAR patterns may lead to earlier identification of ASD and facilitate access to the appropriate early intervention services based on each child's needs.
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Affiliation(s)
- Alexandra Ramirez-Celis
- Department of Internal Medicine, Division of Rheumatology, Allergy, and Clinical Immunology, One Shields Avenue, University of California, Davis, CA, 95616, USA
| | - Lisa A Croen
- Kaiser Permanente Division of Research, 2000 Broadway, Oakland, CA, 94612, USA
| | - Cathleen K Yoshida
- Kaiser Permanente Division of Research, 2000 Broadway, Oakland, CA, 94612, USA
| | - Stacey E Alexeeff
- Kaiser Permanente Division of Research, 2000 Broadway, Oakland, CA, 94612, USA
| | - Joseph Schauer
- Department of Internal Medicine, Division of Rheumatology, Allergy, and Clinical Immunology, One Shields Avenue, University of California, Davis, CA, 95616, USA
| | - Robert H Yolken
- Department of Psychiatry and Behavioral Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Paul Ashwood
- UC Davis MIND Institute, 2825 50th St, Sacramento, CA, 95817, USA
- Department of Medical Microbiology and Immunology, One Shields Avenue, University of California, Davis, CA, 95616, USA
| | - Judy Van de Water
- Department of Internal Medicine, Division of Rheumatology, Allergy, and Clinical Immunology, One Shields Avenue, University of California, Davis, CA, 95616, USA.
- UC Davis MIND Institute, 2825 50th St, Sacramento, CA, 95817, USA.
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24
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Piersma D, Aguilar M, Seibert H, Boyle B, Griffith G, Valdovinos MG. Descriptive Longitudinal Analysis of Stereotypy and Corresponding Changes in Psychotropic Medication. Dev Neurorehabil 2022; 25:298-308. [PMID: 34865596 PMCID: PMC9166166 DOI: 10.1080/17518423.2021.2011461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Psychotropic medication is often prescribed to individuals with intellectual and developmental disabilities who engage in challenging and other behavior (e.g., aggression and stereotypy, respectively), but there is limited understanding of the effects of these medications on behavior. OBJECTIVE Within the context of a larger study that evaluated the effects of psychotropic medication regimen changes on the presentation of challenging behavior, this study describes the presentation of stereotypic behavior of three individuals diagnosed with autism spectrum disorder. METHODS Stereotypy was measured during weekly, one-hour, direct observations and during the control and ignore conditions of functional analyses of challenging behavior (which were conducted following changes in psychotropic medication regimens). RESULTS Patterns of stereotypy varied over time, but not significantly, and at times seemed to coincide with medication changes. DISCUSSION Our results suggest stereotypy persists throughout adulthood; however, additional research is needed.
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25
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Huber CR, Fanaro Z, Soti V. Gender Trends in Psychotropic Medication Use in Autism. Cureus 2022; 14:e26447. [PMID: 35800200 PMCID: PMC9245521 DOI: 10.7759/cureus.26447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2022] [Indexed: 11/29/2022] Open
Abstract
Autism is a neurodevelopmental condition that includes differences in social communication and restrictive, repetitive behavior. Its diagnosis is far more common in men than women. Therefore, a female phenotype of autism might not concern caregivers or be detected early by clinical assessments. Given that medications address problematic behaviors rather than autism, different problems associated with autism necessitate other treatments. We reviewed existing literature on gender differences in psychotropic drug usage in autism patients and found that antidepressants, anticonvulsants, and mood stabilizers were more common in females, while stimulants and antipsychotics were predominant in males. This review highlights that autistic men and women receive different pharmacologic agents, likely attributable to gender-specific trends in presenting problematic behaviors.
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Affiliation(s)
| | - Zachary Fanaro
- Anatomy and Neuroanatomy, Lake Erie College of Osteopathic Medicine, Elmira, USA
| | - Varun Soti
- Pharmacology and Therapeutics, Lake Erie College of Osteopathic Medicine, Elmira, USA
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26
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Byrne K, Sterrett K, Elias R, Bal VH, McCauley JB, Lord C. Trajectories of Seizures, Medication Use, and Obesity Status into Early Adulthood in Autistic Individuals and Those with Other Neurodevelopmental Conditions. AUTISM IN ADULTHOOD 2022; 4:110-119. [PMID: 36605975 PMCID: PMC9242707 DOI: 10.1089/aut.2020.0080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Background Physical and psychiatric health conditions affect the lives of many autistic adults. However, relatively little is known about individual trajectories in autistic individuals' physical and mental health from adolescence to adulthood. Methods This study uses a well-characterized longitudinal sample (n = 253) to investigate rates of seizures, medication use, and obesity, from early adolescence (age 10 years) into adulthood (age 30 years). Within this sample, 196 participants were diagnosed with autism spectrum disorder (ASD), whereas the remaining 57 participants never received an ASD diagnosis, but, rather, were diagnosed with other neurodevelopmental conditions. Data were collected through parent report questionnaires and in-person interviews and assessments. Results Seizure onset continued well into adulthood, with two individuals experiencing their first seizure at the age of 25 years. Seizures and neuropsychiatric medication use were both higher for those with lower intelligence quotient (IQs). In addition, medication use increased over time for these individuals, whereas those with higher IQs saw a reduction in medication use with age. Between the ages of 15 to 30 years, the predicted probability of medication use increased from 82% to 88% for those with lower IQs and decreased from 37% to 13% for those with higher IQs. Collectively, almost 70% of all participants in this study were classified as either overweight or obese. Body mass index (BMI) increased throughout adulthood, especially for those with higher IQs. The steepest increase in BMI over time occurred for those with higher IQs who also took antipsychotic medications. Conclusion Overall, continued risk for developing seizures, high rates of neuropsychiatric medication use, and significant and increasing rates of obesity from adolescence to adulthood underscore the importance of monitoring health issues in autistic individuals and those diagnosed with other neurodevelopmental conditions throughout the lifespan.
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Affiliation(s)
- Katherine Byrne
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, California, USA.,Address correspondence to: Katherine Byrne, BA, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, 760 Westwood Plaza 68-217, Los Angeles, CA 90024, USA
| | - Kyle Sterrett
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, California, USA
| | - Rebecca Elias
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, California, USA
| | - Vanessa H. Bal
- Graduate School of Applied and Professional Psychology, Rutgers University–New Brunswick, New Brunswick, New Jersey, USA
| | - James B. McCauley
- Department of Psychology, St. Mary's College of California, Moraga, California, USA
| | - Catherine Lord
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, California, USA
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27
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Simonoff E, Mowlem F, Pearson O, Anagnostou E, Donnelly C, Hollander E, King BH, McCracken JT, Scahill L, Sikich L, Pickles A. Citalopram Did Not Significantly Improve Anxiety in Children with Autism Spectrum Disorder Undergoing Treatment for Core Symptoms: Secondary Analysis of a Trial to Reduce Repetitive Behaviors. J Child Adolesc Psychopharmacol 2022; 32:233-241. [PMID: 35501967 PMCID: PMC11075077 DOI: 10.1089/cap.2021.0137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Objective: Anxiety disorders are among the most common co-occurring conditions in autism spectrum disorder (ASD). Despite their prevalence and impact, there are no randomized controlled trials (RCTs) aimed at evaluating the efficacy of selective serotonin reuptake inhibitors (SSRIs) for anxiolysis in this population, who may have a different biological basis for anxiety. Methods: Secondary analyses of the STAART double-blind, placebo-controlled RCT of citalopram in children with ASD examined whether citalopram reduced anxiety measured on the parent-reported Child and Adolescent Symptom Inventory-4 (CASI-4) as the primary outcome. An intention-to-treat analysis involving all 149 participants used multiple imputations for missing data and included baseline stratification factors of age group and site, among others. We prespecified as clinically significant a 33% reduction in anxiety in citalopram versus placebo, coinciding with 80% power. We tested whether communicative ability on the Vineland Communication score moderated treatment effect and explored whether initial anxiety was associated with greater adverse events, which could impact on dose titration and achieving optimal dose. Results: Both groups showed substantial reduction in anxiety. Citalopram was associated with a nonsignificant 16.5% greater reduction (observed coefficient = -0.181, bootstrap standard error = 0.126, p = 0.151, confidence interval = -0.428 to 0.066). Anxiety reports were significantly lower in children with reduced communicative ability, but communicative ability did not moderate the treatment effect (interaction p = 0.294). Initial anxiety levels were not associated with increased adverse effects (interaction ps 0.162-0.954). Conclusion: Citalopram did not statistically significantly improve anxiety in children with ASD. Clinicians should be cautious in their use of SSRIs for this indication. There remains a need for well-powered clinical trials testing the efficacy of SSRIs among autistic children with anxiety disorders.
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Affiliation(s)
- Emily Simonoff
- Department of Child & Adolescent Psychiatry and Institute of Psychiatry, Psychology & Neuroscience and Maudsley Biomedical Research Centre for Mental Health, King's College London, London, United Kingdom
| | - Florence Mowlem
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience and Maudsley Biomedical Research Centre for Mental Health, King's College London, London, United Kingdom
| | - Oliver Pearson
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience and Maudsley Biomedical Research Centre for Mental Health, King's College London, London, United Kingdom
| | - Evdokia Anagnostou
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
- Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Craig Donnelly
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Eric Hollander
- Autism and Obsessive Compulsive Spectrum Program, Psychiatric Research Institute of Montefiore Einstein, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Bryan H. King
- Department of Psychiatry, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California, USA
| | - James T. McCracken
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Lawrence Scahill
- Department of Pediatrics, Marcus Autism Center, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Linmarie Sikich
- Department of Psychiatry, Duke Center for Autism and Brain Development, Duke University School of Medicine, Durham, North Carolina, USA
| | - Andrew Pickles
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience and Maudsley Biomedical Research Centre for Mental Health, King's College London, London, United Kingdom
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28
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Shic F, Naples AJ, Barney EC, Chang SA, Li B, McAllister T, Kim M, Dommer KJ, Hasselmo S, Atyabi A, Wang Q, Helleman G, Levin AR, Seow H, Bernier R, Charwaska K, Dawson G, Dziura J, Faja S, Jeste SS, Johnson SP, Murias M, Nelson CA, Sabatos-DeVito M, Senturk D, Sugar CA, Webb SJ, McPartland JC. The autism biomarkers consortium for clinical trials: evaluation of a battery of candidate eye-tracking biomarkers for use in autism clinical trials. Mol Autism 2022; 13:15. [PMID: 35313957 PMCID: PMC10124777 DOI: 10.1186/s13229-021-00482-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 12/20/2021] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Eye tracking (ET) is a powerful methodology for studying attentional processes through quantification of eye movements. The precision, usability, and cost-effectiveness of ET render it a promising platform for developing biomarkers for use in clinical trials for autism spectrum disorder (ASD). METHODS The autism biomarkers consortium for clinical trials conducted a multisite, observational study of 6-11-year-old children with ASD (n = 280) and typical development (TD, n = 119). The ET battery included: Activity Monitoring, Social Interactive, Static Social Scenes, Biological Motion Preference, and Pupillary Light Reflex tasks. A priori, gaze to faces in Activity Monitoring, Social Interactive, and Static Social Scenes tasks were aggregated into an Oculomotor Index of Gaze to Human Faces (OMI) as the primary outcome measure. This work reports on fundamental biomarker properties (data acquisition rates, construct validity, six-week stability, group discrimination, and clinical relationships) derived from these assays that serve as a base for subsequent development of clinical trial biomarker applications. RESULTS All tasks exhibited excellent acquisition rates, met expectations for construct validity, had moderate or high six-week stabilities, and highlighted subsets of the ASD group with distinct biomarker performance. Within ASD, higher OMI was associated with increased memory for faces, decreased autism symptom severity, and higher verbal IQ and pragmatic communication skills. LIMITATIONS No specific interventions were administered in this study, limiting information about how ET biomarkers track or predict outcomes in response to treatment. This study did not consider co-occurrence of psychiatric conditions nor specificity in comparison with non-ASD special populations, therefore limiting our understanding of the applicability of outcomes to specific clinical contexts-of-use. Research-grade protocols and equipment were used; further studies are needed to explore deployment in less standardized contexts. CONCLUSIONS All ET tasks met expectations regarding biomarker properties, with strongest performance for tasks associated with attention to human faces and weakest performance associated with biological motion preference. Based on these data, the OMI has been accepted to the FDA's Biomarker Qualification program, providing a path for advancing efforts to develop biomarkers for use in clinical trials.
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Affiliation(s)
- Frederick Shic
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, 1920 Terry Ave, Seattle, WA, 98101, USA.
- Department of General Pediatrics, University of Washington School of Medicine, Seattle, WA, USA.
| | - Adam J Naples
- Yale Child Study Center, Yale University School of Medicine, 230 South Frontage Road, New Haven, CT, 06520, USA
| | - Erin C Barney
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, 1920 Terry Ave, Seattle, WA, 98101, USA
- Yale Child Study Center, Yale University School of Medicine, 230 South Frontage Road, New Haven, CT, 06520, USA
| | - Shou An Chang
- Department of Psychology, Yale University, 2 Hillhouse Ave, New Haven, CT, 06520, USA
| | - Beibin Li
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, 1920 Terry Ave, Seattle, WA, 98101, USA
- Paul G. Allen School of Computer Science and Engineering, University of Washington, Seattle, WA, USA
| | - Takumi McAllister
- Yale Child Study Center, Yale University School of Medicine, 230 South Frontage Road, New Haven, CT, 06520, USA
| | - Minah Kim
- Department of Psychology, University of Virginia, 102 Gilmer Hall, P.O. Box 400400, Charlottesville, VA, 22904, USA
| | - Kelsey J Dommer
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, 1920 Terry Ave, Seattle, WA, 98101, USA
| | - Simone Hasselmo
- Yale Child Study Center, Yale University School of Medicine, 230 South Frontage Road, New Haven, CT, 06520, USA
| | - Adham Atyabi
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, 1920 Terry Ave, Seattle, WA, 98101, USA
- Department of General Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
- Department of Computer Science, University of Colorado - Colorado Springs, Colorado Springs, CO, USA
| | - Quan Wang
- Yale Child Study Center, Yale University School of Medicine, 230 South Frontage Road, New Haven, CT, 06520, USA
| | - Gerhard Helleman
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - April R Levin
- Department of Neurology, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Helen Seow
- Yale Child Study Center, Yale University School of Medicine, 230 South Frontage Road, New Haven, CT, 06520, USA
| | - Raphael Bernier
- Department of Psychiatry and Behavioral Science, University of Washington School of Medicine, Seattle, WA, USA
| | - Katarzyna Charwaska
- Yale Child Study Center, Yale University School of Medicine, 230 South Frontage Road, New Haven, CT, 06520, USA
| | - Geraldine Dawson
- Duke Center for Autism and Brain Development, Duke University, Durham, NC, USA
| | - James Dziura
- Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Susan Faja
- Harvard Medical School, Boston, MA, USA
- Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | - Shafali Spurling Jeste
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Scott P Johnson
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
| | - Michael Murias
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, USA
| | - Charles A Nelson
- Harvard Medical School, Boston, MA, USA
- Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA
- Graduate School of Education, Harvard University, Boston, MA, USA
| | | | - Damla Senturk
- Department of Biostatistics, University of California Los Angeles, Los Angeles, CA, USA
| | - Catherine A Sugar
- Department of Biostatistics, University of California Los Angeles, Los Angeles, CA, USA
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Sara J Webb
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, 1920 Terry Ave, Seattle, WA, 98101, USA
- Department of Psychiatry and Behavioral Science, University of Washington School of Medicine, Seattle, WA, USA
| | - James C McPartland
- Yale Child Study Center, Yale University School of Medicine, 230 South Frontage Road, New Haven, CT, 06520, USA.
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Mutluer T, Aslan Genç H, Özcan Morey A, Yapici Eser H, Ertinmaz B, Can M, Munir K. Population-Based Psychiatric Comorbidity in Children and Adolescents With Autism Spectrum Disorder: A Meta-Analysis. Front Psychiatry 2022; 13:856208. [PMID: 35693977 PMCID: PMC9186340 DOI: 10.3389/fpsyt.2022.856208] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 04/29/2022] [Indexed: 12/22/2022] Open
Abstract
UNLABELLED Psychiatric comorbidity in autism spectrum disorder (ASD) is a subject of critical scientific importance, affecting the quality of life, prognosis, and functional outcomes. The prevalence of psychiatric disorders vary considerably according to variables such as index subject characteristics, study setting, sampling frame, diagnostic methods used, as well as country of geographic origin. To date, most studies comprise clinical or treatment referral samples in tertiary care or subjects enrolled in clinical trials and genetic cohort collections. Such samples carry the potential for overestimation of both the frequency and severity of psychiatric comorbidity. A systematic literature search was performed using PubMed and Web of Science databases restricted to population-based study publications in the English between May 1, 2015, and May 31, 2020. A comprehensive keyword list was generated to investigate co-occurrence of psychiatric disorders in children and adolescents with ASD. A wide range of DSM-5 based disorders such as anxiety, mood, ADHD, intellectual disability/intellectual developmental disorder, eating/feeding, gender dysphoria and sleep-wake disorders were assessed. Initial search revealed a total of 1674 articles after removal of duplicates. Two independent researchers conducted a parallel-blinded screening process to identify the eligible studies based on titles and abstracts; 39 studies were analyzed in the current review. The main findings show prevalence estimates of 22.9% (95% CI: 17.7- 29.2) for intellectual disability; 26.2% (22-31) for attention-deficit hyperactivity disorder; 11.1% (8.6-14.1) for anxiety disorders; 19.7% (11.9-30.7) for sleep disorders; 7% (5.2- 9.3) for disruptive disorders; 2% (1.3- 3.1) for bipolar disorders; 2.7% (1.8- 4.2) for depression; 1.8% (0.4-8.7) for obsessive-compulsive disorder; and 0.6% (0.3-1.1) for psychosis. Psychiatric comorbidity in population-based studies is lower than in clinical and referred samples. However, our results also indicate that the frequency of psychiatric comorbidity in children and adolescents with ASD in the population context is considerable, without the influence of referral bias implicit in clinical and treatment samples. There is a need for better targeted diagnostic tools to detect psychiatric comorbidity in children and youth in future population-based studies, as an essential component in providing care as well as new insights into the nature and mechanisms of its underlying associations. SYSTEMATIC REVIEW REGISTRATION [https://www.crd.york.ac.uk/prospero/], identifier [CRD42021234464].
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Affiliation(s)
- Tuba Mutluer
- Department of Psychiatry, School of Medicine, Koç University, Istanbul, Turkey.,Research Center for Translational Medicine (KUTTAM), Koç University, Istanbul, Turkey
| | - Herdem Aslan Genç
- Division of Child and Adolescent Psychiatry, Koç University Hospital, Istanbul, Turkey
| | - Aslihan Özcan Morey
- Division of Child and Adolescent Psychiatry, Koç University Hospital, Istanbul, Turkey
| | - Hale Yapici Eser
- Department of Psychiatry, School of Medicine, Koç University, Istanbul, Turkey.,Research Center for Translational Medicine (KUTTAM), Koç University, Istanbul, Turkey
| | | | - Merve Can
- Department of Child and Adolescent Psychiatry, Bakirkoy Prof. Dr. Mazhar Osman Training and Research Hospital for Mental Health and Nervous Disorders, Istanbul, Turkey
| | - Kerim Munir
- Developmental Medicine Center, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
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30
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Varcin KJ, Herniman SE, Lin A, Chen Y, Perry Y, Pugh C, Chisolm K, Whitehouse AJ, Wood SJ. Occurrence of psychosis and bipolar disorder in adults with autism: a systematic review and meta-analysis. Neurosci Biobehav Rev 2022; 134:104543. [DOI: 10.1016/j.neubiorev.2022.104543] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 11/17/2021] [Accepted: 01/15/2022] [Indexed: 12/27/2022]
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Lee J, Ha S, Ahn J, Lee ST, Choi JR, Cheon KA. The Role of Ion Channel-Related Genes in Autism Spectrum Disorder: A Study Using Next-Generation Sequencing. Front Genet 2021; 12:595934. [PMID: 34712263 PMCID: PMC8546317 DOI: 10.3389/fgene.2021.595934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 09/21/2021] [Indexed: 11/25/2022] Open
Abstract
The clinical heterogeneity of autism spectrum disorder (ASD) is closely associated with the diversity of genes related to ASD pathogenesis. With their low effect size, it has been hard to define the role of common variants of genes in ASD phenotype. In this study, we reviewed genetic results and clinical scores widely used for ASD diagnosis to investigate the role of genes in ASD phenotype considering their functions in molecular pathways. Genetic data from next-generation sequencing (NGS) were collected from 94 participants with ASD. We analyzed enrichment of cellular processes and gene ontology using the Database for Annotation, Visualization, and Integrated Discovery (DAVID). We compared clinical characteristics according to genetic functional characteristics. We found 266 genes containing nonsense, frame shift, missense, and splice site mutations. Results from DAVID revealed significant enrichment for “ion channel” with an enrichment score of 8.84. Moreover, ASD participants carrying mutations in ion channel-related genes showed higher total IQ (p = 0.013) and lower repetitive, restricted behavior (RRB)-related scores (p = 0.003) and mannerism subscale of social responsiveness scale scores, compared to other participants. Individuals with variants in ion channel genes showed lower RRB scores, suggesting that ion channel genes might be relatively less associated with RRB pathogenesis. These results contribute to understanding of the role of common variants in ASD and could be important in the development of precision medicine of ASD.
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Affiliation(s)
- Junghan Lee
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Severance Hospital, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Sungji Ha
- Department of Psychiatry, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Jaeun Ahn
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Severance Hospital, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Seung-Tae Lee
- Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Jong Rak Choi
- Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Keun-Ah Cheon
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Severance Hospital, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea
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32
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Ballester P, Espadas C, Londoño AC, Almenara S, Aguilar V, Belda C, Pérez E, Muriel J, Peiró AM. The challenge of detecting adverse events in adults with autism spectrum disorder who have intellectual disability. Autism Res 2021; 15:192-202. [PMID: 34652075 DOI: 10.1002/aur.2624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 07/15/2021] [Accepted: 09/26/2021] [Indexed: 11/09/2022]
Abstract
Adults with autism spectrum disorder (ASD) and associated intellectual disability (ID) take a high number of different psychotropic drugs simultaneously. Nowadays, little is known about this multidrug pattern efficacy and safety. The present study has endeavored to fill this gap creating a local pharmacovigilance system. A 36-month, retrospective and prospective, observational, and multicenter pharmacovigilance study was carried out in adults with ASD and ID (n = 83). Information regarding ongoing medications (polypharmacy: taking simultaneously >4 drugs; safety profile: adverse events' number, adverse drug reactions' number, and affected system; and observed-to-expected [O/E] ratio using the summary of product characteristics), and current diagnoses were recorded. A median of four ongoing medications per participant was registered, half of the sample was under polypharmacy regimen. Regarding all ongoing medications, 50% were antipsychotic drugs, and 47% of participants had >1 antipsychotic prescribed. In contrast, only 64 adverse events were identified from electronic health records, mostly due to risperidone. Half of them were related either to nervous or metabolic systems, and almost a third were not previously described in the corresponding drug summary of products characteristics. Extrapyramidalism, gynecomastia, hypercholesterolemia, and urinary retention were some AEs that occurred more frequently than expected (O/E ratio > 6 times) according to our data. The highest O/E ratio scores (>120 times) were for hypercholesterolemia and rhabdomyolysis caused by valproic acid. According to the number of adverse events and adverse drug reactions reported in electronic health records locally and nationally by clinicians, we need to increase awareness about medications safety. LAY SUMMARY: A 36-month study in adults with autism, ID, and polypharmacy (>4 drugs) was done to investigate drug safety on everyone. A median of four medications per person was registered, half were antipsychotic drugs, and 47% of participants had >1 antipsychotic medication simultaneously. Only 64 adverse events were identified from electronic health records, mostly due to risperidone. Half of them were related to nervous or metabolic systems and a third were not previously described in the drug information sheet.
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Affiliation(s)
- Pura Ballester
- Clinical Pharmacology, Paediatrics and Organic Chemistry Department, Miguel Hernández University of Elche (UMH), Alicante, Spain.,Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Cristina Espadas
- Clinical Pharmacology, Paediatrics and Organic Chemistry Department, Miguel Hernández University of Elche (UMH), Alicante, Spain
| | - Ana C Londoño
- Clinical Psychiatry and Psychology Unit, Department of Health of Alicante, General Hospital, Alicante, Spain.,Clinical Pharmacology Unit, Department of Health of Alicante, General Hospital, Alicante, Spain
| | - Susana Almenara
- Clinical Pharmacology Unit, Department of Health of Alicante, General Hospital, Alicante, Spain
| | - Victor Aguilar
- San Rafael Centre - San Francisco De Borja Foundation, Residential Facility, Alicante, Spain
| | - Cesar Belda
- Infanta Leonor Center, Autism Parents Association Valencian Community Autism Association (APACV), Alicante, Spain
| | - Enrique Pérez
- Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain.,Clinical Psychiatry and Psychology Unit, Department of Health of Alicante, General Hospital, Alicante, Spain
| | - Javier Muriel
- Clinical Pharmacology, Paediatrics and Organic Chemistry Department, Miguel Hernández University of Elche (UMH), Alicante, Spain.,Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Ana M Peiró
- Clinical Pharmacology, Paediatrics and Organic Chemistry Department, Miguel Hernández University of Elche (UMH), Alicante, Spain.,Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain.,Clinical Pharmacology Unit, Department of Health of Alicante, General Hospital, Alicante, Spain
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33
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Liu X, Sun X, Sun C, Zou M, Chen Y, Huang J, Wu L, Chen WX. Prevalence of epilepsy in autism spectrum disorders: A systematic review and meta-analysis. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 26:33-50. [PMID: 34510916 DOI: 10.1177/13623613211045029] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
LAY ABSTRACT Autistic individuals experience higher co-occurring medical conditions than the general population, and yet the estimates of autistic individuals with epilepsy are not updated. Co-occurrence of epilepsy in autistic individuals often aggravated cognitive impairment and increased the risk of poor long-term prognosis. Thus, an updated systematic review and meta-analysis was conducted to study the relevant articles published from inception to 2020, evaluate the prevalence of epilepsy in autistic individuals, and further explore the putative factors influencing the prevalence. A total of 66 studies from 53 articles were included in this study. The results showed that epilepsy is more common in autistic individuals than in the general population. The prevalence of epilepsy in autistic individuals in the clinical sample-based studies was higher than that in the population-based based cross-sectional or cohort studies. The prevalence of epilepsy in autistic adults was higher than that in autistic children. A significantly increased prevalence of epilepsy was detected in the autistic adolescent group (11-17 years old), and a higher trend of prevalence of epilepsy was observed in the autistic pre-school group (⩽ 6 -years-old) than that of the autistic school-aged group (7-10 years-old). The prevalence of epilepsy increased with age, female rate, and low intellectual function rate of autistic individuals. However, the human development index of countries was negatively associated with the pooled prevalence, which could be attributed to the different levels of awareness, diagnostic technologies, and autism-service support worldwide. About 1/10 autistic individuals also had epilepsy, which was common in the clinical setting, adolescents, adults, females, or patients with intellectual disability and less common in the country with high human development index. Thus, these findings provided critical and innovative views on the prevalence of epilepsy in autistic individuals and contributed to the targeted clinical management and preventive measures.
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Affiliation(s)
- Xian Liu
- Guangzhou Medical University, China.,Harbin Medical University, China
| | - Xin Sun
- Shanghai Jiao Tong University, China
| | | | | | | | | | - Lijie Wu
- Harbin Medical University, China
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34
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The role of microbiota-gut-brain axis in neuropsychiatric and neurological disorders. Pharmacol Res 2021; 172:105840. [PMID: 34450312 DOI: 10.1016/j.phrs.2021.105840] [Citation(s) in RCA: 233] [Impact Index Per Article: 77.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 08/14/2021] [Accepted: 08/17/2021] [Indexed: 12/12/2022]
Abstract
Emerging evidence indicates that the gut microbiota play a crucial role in the bidirectional communication between the gut and the brain suggesting that the gut microbes may shape neural development, modulate neurotransmission and affect behavior, and thereby contribute to the pathogenesis and/or progression of many neurodevelopmental, neuropsychiatric, and neurological conditions. This review summarizes recent data on the role of microbiota-gut-brain axis in the pathophysiology of neuropsychiatric and neurological disorders including depression, anxiety, schizophrenia, autism spectrum disorders, Parkinson's disease, migraine, and epilepsy. Also, the involvement of microbiota in gut disorders co-existing with neuropsychiatric conditions is highlighted. We discuss data from both in vivo preclinical experiments and clinical reports including: (1) studies in germ-free animals, (2) studies exploring the gut microbiota composition in animal models of diseases or in humans, (3) studies evaluating the effects of probiotic, prebiotic or antibiotic treatment as well as (4) the effects of fecal microbiota transplantation.
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35
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McCracken JT, Anagnostou E, Arango C, Dawson G, Farchione T, Mantua V, McPartland J, Murphy D, Pandina G, Veenstra-VanderWeele J. Drug development for Autism Spectrum Disorder (ASD): Progress, challenges, and future directions. Eur Neuropsychopharmacol 2021; 48:3-31. [PMID: 34158222 PMCID: PMC10062405 DOI: 10.1016/j.euroneuro.2021.05.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 05/13/2021] [Accepted: 05/18/2021] [Indexed: 12/11/2022]
Abstract
In 2017, facing lack of progress and failures encountered in targeted drug development for Autism Spectrum Disorder (ASD) and related neurodevelopmental disorders, the ISCTM with the ECNP created the ASD Working Group charged to identify barriers to progress and recommending research strategies for the field to gain traction. Working Group international academic, regulatory and industry representatives held multiple in-person meetings, teleconferences, and subgroup communications to gather a wide range of perspectives on lessons learned from extant studies, current challenges, and paths for fundamental advances in ASD therapeutics. This overview delineates the barriers identified, and outlines major goals for next generation biomedical intervention development in ASD. Current challenges for ASD research are many: heterogeneity, lack of validated biomarkers, need for improved endpoints, prioritizing molecular targets, comorbidities, and more. The Working Group emphasized cautious but unwavering optimism for therapeutic progress for ASD core features given advances in the basic neuroscience of ASD and related disorders. Leveraging genetic data, intermediate phenotypes, digital phenotyping, big database discovery, refined endpoints, and earlier intervention, the prospects for breakthrough treatments are substantial. Recommendations include new priorities for expanded research funding to overcome challenges in translational clinical ASD therapeutic research.
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Affiliation(s)
- James T McCracken
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA 90024, United States.
| | | | - Celso Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Univesitario Gregorio Maranon, and School of Medicine, Universidad Complutense de Madrid, CIBERSAM, Madrid, Spain
| | - Geraldine Dawson
- Duke University Medical Center, Durham, North Carolina, United States
| | - Tiffany Farchione
- Food and Drug Administration, Silver Spring, Maryland, United States
| | - Valentina Mantua
- Food and Drug Administration, Silver Spring, Maryland, United States
| | | | - Declan Murphy
- Institute of Psychiatry, Psychology and Neuroscience, King's College De Crespigny Park, Denmark Hill, London SE5 8AF, United Kingdom
| | - Gahan Pandina
- Neuroscience Therapeutic Area, Janssen Research & Development, Pennington, New Jersey, United States
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36
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Geurts HM, McQuaid GA, Begeer S, Wallace GL. Self-reported parkinsonism features in older autistic adults: A descriptive study. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 26:217-229. [PMID: 34154378 PMCID: PMC8750133 DOI: 10.1177/13623613211020183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
LAY ABSTRACT Autistic adults without a suspected intellectual disability reported several motor features such as having tremors, and stiffness in one's legs which are considered to be part of a complex of motor features called parkinsonism. This so-called parkinsonism was remarkably prevalent in middle-aged and older autistic adults in two independent studies (Dutch study: 50-81 years, 183 males, 113 females, all adulthood diagnoses; the USA study: 50-83 years, 110 females, 109 males, majority adulthood diagnosis). Parkinsonism can be part of the progressive motor disease-Parkinson's disease. Therefore, it is important that future studies, including in-person neurological assessment, determine if (and if so, why) autistic adults who report these motor features are at increased risk for developing Parkinson's disease.
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Affiliation(s)
- Hilde M Geurts
- University of Amsterdam, The Netherlands.,Leo Kannerhuis (Youz/Parnassiagroup), The Netherlands
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37
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Houghton R, van den Bergh J, Law K, Liu Y, de Vries F. Risperidone versus aripiprazole fracture risk in children and adolescents with autism spectrum disorders. Autism Res 2021; 14:1800-1814. [PMID: 34080319 DOI: 10.1002/aur.2541] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 04/26/2021] [Accepted: 05/03/2021] [Indexed: 12/19/2022]
Abstract
Risperidone and aripiprazole, commonly used antipsychotics in children with autism spectrum disorder (ASD), have previously been associated with elevated fracture risk in other populations. The aim of this study was to evaluate and compare the risk of fracture among children with ASD using risperidone or aripiprazole. This was a retrospective, propensity-score matched cohort study, set between January 2013 and December 2018. We used the MarketScan Medicaid insurance data, which covers multiple states of the United States. We included ASD children aged 2-18 years, who were new users of aripiprazole or risperidone and with no prior history of antipsychotic use or fractures. The main exposure was the continued use of aripiprazole or risperidone. The incidence rates of any fracture during follow-up were evaluated, and the risk between aripiprazole and risperidone was compared via Cox-proportional hazard models. Results were stratified by age, sex, duration of exposure and fracture site. In total, 3312 patients (78% male; mean [SD] age 11.0 [3.7] years) were identified for each cohort. Over the full duration of follow-up, fracture incidence rates per 1000 patient-years were 23.2 for risperidone and 38.4 for aripiprazole (hazard ratio and 95% confidence interval: 0.60 [0.44-0.83]). Risks were similar between cohorts throughout the first 180 days on treatment, but significantly higher in the aripiprazole group thereafter. Extremity fractures drove most of the increased risk, with the biggest differences in lower leg and ankle fractures. Differences widened for children aged 10 years or younger (HR [95% CI]: 0.47 [0.30-0.74]). In conclusion, compared to aripiprazole, risperidone was associated with 40% lower risk of fracture. Further analysis on the mechanism and long-term bone health of antipsychotic-treated children with ASD is warranted. LAY SUMMARY: We compared the risk of bone fractures among 6624 children with autism spectrum disorder (ASD), half of whom used risperidone and half of whom used aripiprazole. Taking other factors into account, risks were similar between the two groups throughout the first 180 days on treatment, but significantly higher in the aripiprazole group thereafter. The biggest differences were in lower leg and ankle fractures. Overall, compared with aripiprazole, risperidone was associated with 40% lower risk of fracture.
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Affiliation(s)
- Richard Houghton
- Personalized Health Care Data Science, F. Hoffmann-La Roche Ltd, Basel, Switzerland.,Department of Clinical Pharmacy and Toxicology, Maastricht UMC+, Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Joop van den Bergh
- Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht UMC+, Maastricht, the Netherlands.,Department of Internal Medicine, VieCuri Medical Center, Venlo, the Netherlands.,Faculty of medicine, Hasselt University, Hasselt, Belgium
| | - Kiely Law
- Kennedy Krieger Institute, Interactive Autism Network, Baltimore, Maryland, USA.,Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Yutong Liu
- Genesis Research, Real World Evidence Solutions, Hoboken, New Jersey, USA
| | - Frank de Vries
- Department of Clinical Pharmacy and Toxicology, Maastricht UMC+, Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
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38
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Hand BN, Miller JS, Guthrie W, Friedlaender EY. Healthcare utilization among children with early autism diagnoses, children with other developmental delays and a comparison group. J Comp Eff Res 2021; 10:917-926. [PMID: 34037425 DOI: 10.2217/cer-2021-0056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To describe healthcare utilization patterns among children with autism (n = 1821), and compare these patterns to children with other developmental delays (DD; n = 12,336) and a population comparison (PC; n = 18,210) cohort. Materials & methods: Retrospective study of administrative billing data. Results: Children with autism had roughly six-times more annual outpatient visits as PC children and twice as many as children with DD. Children with autism were more likely than PC children to use nearly all services, but comparisons between the autism and DD cohorts were mixed. Children with autism were more likely to have psychiatry/psychology visits, 'other' specialty care visits and psychotropic prescriptions, but less likely to have pediatric specialty care visits, immunizations and some prescriptions. Conclusion: Findings reveal opportunities to streamline, coordinate or improve care for young children with autism, particularly for outpatient services, and to give caregivers appropriate anticipatory guidance about what to expect after an autism diagnosis.
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Affiliation(s)
- Brittany N Hand
- School of Health & Rehabilitation Sciences, The Ohio State University, OH 43210, USA
| | - Judith S Miller
- Chidlren's Hospital of Philadelphia, PA 19104, USA.,Perelman School of Medicine, University of Pennsylvania, PA 19104, USA
| | - Whitney Guthrie
- Chidlren's Hospital of Philadelphia, PA 19104, USA.,Perelman School of Medicine, University of Pennsylvania, PA 19104, USA
| | - Eron Y Friedlaender
- Chidlren's Hospital of Philadelphia, PA 19104, USA.,Perelman School of Medicine, University of Pennsylvania, PA 19104, USA
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39
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Ritter C, Hewitt K, McMorris CA. Psychotropic Polypharmacy Among Children and Youth with Autism: A Systematic Review. J Child Adolesc Psychopharmacol 2021; 31:244-258. [PMID: 33970024 DOI: 10.1089/cap.2020.0110] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Objectives: Majority of youth with autism are taking two or more medications (psychotropic or nonpsychotropic) simultaneously, also known as polypharmacy. Yet the efficacy and the potential outcomes of polypharmacy in this population are widely unknown. This systematic literature review described the trends of polypharmacy among autistic youth, and identified factors associated with polypharmacy. Methods: Sixteen studies were included, encompassing over 300,000 youth with autism. Results: Rates of polypharmacy varied quite substantially across studies, ranging from 6.8% to 87% of autistic youth. Having psychiatric comorbidities, self-injurious behaviors, and physical aggression, as well as being male and older, were associated with higher rates of polypharmacy. Conclusion: Findings emphasize the importance of further research to determine appropriate practices related to the monitoring of adverse side effects, and the long-term impact of polypharmacy among autistic youth.
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Affiliation(s)
- Chantel Ritter
- Department of Psychology, University of Guelph, Guelph, Canada
| | - Katherine Hewitt
- Werklund School of Education, University of Calgary, Calgary, Canada.,Alberta Children's Hospital Research Institute, Calgary, Canada
| | - Carly A McMorris
- Werklund School of Education, University of Calgary, Calgary, Canada.,Alberta Children's Hospital Research Institute, Calgary, Canada
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40
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Wiggins LD, Nadler C, Rosenberg S, Moody E, Reyes N, Reynolds A, Alexander A, Daniels J, Thomas K, Giarelli E, Levy SE. Many Young Children with Autism Who Use Psychotropic Medication Do Not Receive Behavior Therapy: A Multisite Case-Control Study. J Pediatr 2021; 232:264-271. [PMID: 33493493 PMCID: PMC8174527 DOI: 10.1016/j.jpeds.2021.01.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 01/17/2021] [Accepted: 01/19/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To explore how many pre-school aged children with autism spectrum disorder (ASD) used psychotropic medication, child and geographic factors associated with psychotropic medication use, and how many children who used psychotropic medication did or did not ever receive behavior therapy. STUDY DESIGN Children 2-5 years of age were enrolled from 2012 to 2016 in a multisite case-control study designed to investigate the development and risk factors of ASD. Children with a positive ASD screen or ASD diagnosis upon enrollment were asked to complete a comprehensive evaluation to determine ASD status and developmental level. Caregivers completed a Services and Treatments Questionnaire and multiple self-administered questionnaires to determine child use of psychotropic medication, ever receipt of behavior therapy, and presence of co-occurring symptoms. RESULTS There were 763 children who were classified as ASD and had data collected on the Services and Treatments Questionnaire. Of those, 62 (8.1%) used psychotropic medication to treat behavioral symptoms and 28 (3.7%) were ≤3 years of age when medication was first started. Attention problems (aOR, 7.65; 95% CI, 3.41-16.1; P < .001) and study site (aOR, 2.62; 95% CI, 1.04-6.56; P = .04) were significantly associated with psychotropic medication use after controlling for maternal race/ethnicity. More than one-half (59.7%) of those who used psychotropic medication did not ever receive behavior therapy. CONCLUSIONS Many preschool-aged children with ASD who use psychotropic medication do not receive behavior therapy. Pediatricians are an important resource for children and families and can help facilitate behavioral treatment for children with ASD and other disorders.
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Affiliation(s)
- Lisa D Wiggins
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA.
| | - Cy Nadler
- School of Medicine, University of Missouri - Kansas City, Kansas City, MO
| | - Steven Rosenberg
- School of Medicine, University of Colorado-Anschutz Medical Campus, Aurora, CO
| | - Eric Moody
- Institute for Disabilities, University of Wyoming, Laramie, WY
| | - Nuri Reyes
- School of Medicine, University of Colorado-Anschutz Medical Campus, Aurora, CO
| | - Ann Reynolds
- School of Medicine, University of Colorado-Anschutz Medical Campus, Aurora, CO
| | - Aimee Alexander
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - Julie Daniels
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC
| | - Kathleen Thomas
- Center for Health Services Research, University of North Carolina, Chapel Hill, NC
| | - Ellen Giarelli
- College of Nursing and Health Professions, Drexel University, Philadelphia, PA
| | - Susan E Levy
- Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, PA
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41
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Shafer RL, Lewis MH, Newell KM, Bodfish JW. Atypical neural processing during the execution of complex sensorimotor behavior in autism. Behav Brain Res 2021; 409:113337. [PMID: 33933522 PMCID: PMC8188828 DOI: 10.1016/j.bbr.2021.113337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 04/02/2021] [Accepted: 04/27/2021] [Indexed: 11/17/2022]
Abstract
Stereotyped behavior is rhythmic, repetitive movement that is essentially invariant in form. Stereotypy is common in several clinical disorders, such as autism spectrum disorders (ASD), where it is considered maladaptive. However, it also occurs early in typical development (TD) where it is hypothesized to serve as the foundation on which complex, adaptive motor behavior develops. This transition from stereotyped to complex movement in TD is thought to be supported by sensorimotor integration. Stereotypy in clinical disorders may persist due to deficits in sensorimotor integration. The present study assessed whether differences in sensorimotor processing may limit the expression of complex motor behavior in individuals with ASD and contribute to the clinical stereotypy observed in this population. Adult participants with ASD and TD performed a computer-based stimulus-tracking task in the presence and absence of visual feedback. Electroencephalography was recorded during the task. Groups were compared on motor performance (root mean square error), motor complexity (sample entropy), and neural complexity (multiscale sample entropy of the electroencephalography signal) in the presence and absence of visual feedback. No group differences were found for motor performance or motor complexity. The ASD group demonstrated greater neural complexity and greater differences between feedback conditions than TD individuals, specifically in signals relevant to sensorimotor processing. Motor performance and motor complexity correlated with clinical stereotypy in the ASD group. These findings support the hypothesis that individuals with ASD have differences in sensorimotor processing when executing complex motor behavior and that stereotypy is associated with low motor complexity.
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Affiliation(s)
- Robin L Shafer
- Vanderbilt Brain Institute, Vanderbilt University, 6133 Medical Research Building III, 465 21(st) Avenue South, Nashville, TN, 37232, USA.
| | - Mark H Lewis
- Department of Psychiatry, University of Florida College of Medicine, PO Box 100256, L4-100 McKnight Brain Institute, 1149 Newell Drive, Gainesville, FL, 3261, USA.
| | - Karl M Newell
- Department of Kinesiology, University of Georgia, G3 Aderhold Hall, 110 Carlton Street, Athens, GA, 30602, USA.
| | - James W Bodfish
- Vanderbilt Brain Institute, Vanderbilt University, 6133 Medical Research Building III, 465 21(st) Avenue South, Nashville, TN, 37232, USA; Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, 8310 Medical Center East, 1215 21(st) Avenue South, Nashville, TN, 37232, USA.
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42
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Bougeard C, Picarel-Blanchot F, Schmid R, Campbell R, Buitelaar J. Prevalence of Autism Spectrum Disorder and Co-morbidities in Children and Adolescents: A Systematic Literature Review. Front Psychiatry 2021; 12:744709. [PMID: 34777048 PMCID: PMC8579007 DOI: 10.3389/fpsyt.2021.744709] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 09/27/2021] [Indexed: 11/21/2022] Open
Abstract
Objective: Individuals with autism spectrum disorder often present somatic and/or psychiatric co-morbid disorders. The DSM-5 allows for consideration of additional diagnoses besides ASD and may have impacted the prevalence of co-morbidities as well as being limited in capturing the true differences in prevalence observed between males and females. We describe the prevalence of ASD and frequently observed co-morbidities in children and adolescents (<18 years) in the United States and five European countries. Methods: Two systematic literature reviews were conducted in PubMed and Embase for the period 2014-2019 and focusing on the prevalence of ASD and nine co-morbidities of interest based on their frequency and/or severity: Attention Deficit Hyperactivity Disorder (ADHD), anxiety, depressive disorders, epilepsy, intellectual disability (ID), sleep disorders, sight/hearing impairment/loss, and gastro-intestinal syndromes (GI). Results: Thirteen studies on prevalence of ASD and 33 on prevalence of co-morbidities were included. Prevalence of ASD was 1.70 and 1.85% in US children aged 4 and 8 years respectively, while prevalence in Europe ranged between 0.38 and 1.55%. Additionally, current evidence is supportive of a global increase in ASD prevalence over the past years. Substantial heterogeneity in prevalence of co-morbidities was observed: ADHD (0.00-86.00%), anxiety (0.00-82.20%), depressive disorders (0.00-74.80%), epilepsy (2.80-77.50%), ID (0.00-91.70%), sleep disorders (2.08-72.50%), sight/hearing impairment/loss (0.00-14.90%/0.00-4.90%), and GI syndromes (0.00-67.80%). Studies were heterogeneous in terms of design and method to estimate prevalence. Gender appears to represent a risk factor for co-morbid ADHD (higher in males) and epilepsy/seizure (higher in females) while age is also associated with ADHD and anxiety (increasing until adolescence). Conclusion: Our results provide a descriptive review of the prevalence of ASD and its co-morbidities in children and adolescents. These insights can be valuable for clinicians and parents/guardians of autistic children. Prevalence of ASD has increased over time while co-morbidities bring additional heterogeneity to the clinical presentation, which further advocates for personalized approaches to treatment and support. Having a clear understanding of the prevalence of ASD and its co-morbidities is important to raise awareness among stakeholders.
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Affiliation(s)
| | | | | | | | - Jan Buitelaar
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands
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43
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Foster BA, Reynolds K, Callejo-Black A, Polensek N, Weill BC. Weight outcomes in children with developmental disabilities from a multidisciplinary clinic. RESEARCH IN DEVELOPMENTAL DISABILITIES 2021; 108:103809. [PMID: 33220529 PMCID: PMC7775337 DOI: 10.1016/j.ridd.2020.103809] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 10/29/2020] [Accepted: 11/02/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Children with developmental disabilities experience disparately high rates of obesity yet there are few reports detailing clinical outcomes for this population. AIM To describe outcomes of obesity treatment for children with developmental disabilities and a comparison group of children without developmental disabilities. METHODS AND PROCEDURES We examined weight outcomes of children with and without developmental disabilities seen in a family-centered, multidisciplinary treatment center over a ten-year period. We stratified by age and developmental disability diagnosis. We assessed whether intake demographic or health behavior data was associated with successful reduction of adiposity over six and twelve month follow-up periods, using a ≥5% absolute reduction in percent over the 95th percentile body mass index (BMIp95) as the primary outcome. OUTCOMES AND RESULTS Over a ten-year period, 148 of 556 children in the obesity clinic (27 %) had a developmental disability. In children <12 years of age, 36 % of children with developmental disabilities reduced their adiposity compared with 18 % of children without developmental disabilities at six months, p = .01. This pattern continued at twelve months. Active transport to school was associated with reduced adiposity for those without a disability. Older children with disabilities rarely had a significant reduction (2 of 26 children), and they took more medications with weight-related side effects. CONCLUSIONS AND IMPLICATIONS Younger children with developmental disabilities experienced relative success in reducing their adiposity. Challenges to addressing obesity in this population include structural barriers to physical activity and medications for behavioral management with weight-related side effects.
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Affiliation(s)
- Byron Alexander Foster
- Department of Pediatrics, School of Medicine, Oregon Health & Science University, and OHSU-PSU School of Public Health, United States.
| | - Kimberly Reynolds
- Department of Pediatrics, School of Medicine, Oregon Health & Science University, United States
| | | | - Natasha Polensek
- Departments of Family Medicine and Pediatrics, School of Medicine, Oregon Health & Science University, United States
| | - Beau C Weill
- Metropolitan Pediatrics, Portland, United States
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44
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Nordahl CW, Iosif AM, Young GS, Hechtman A, Heath B, Lee JK, Libero L, Reinhardt VP, Winder-Patel B, Amaral DG, Rogers S, Solomon M, Ozonoff S. High Psychopathology Subgroup in Young Children With Autism: Associations With Biological Sex and Amygdala Volume. J Am Acad Child Adolesc Psychiatry 2020; 59:1353-1363.e2. [PMID: 31972262 PMCID: PMC7369216 DOI: 10.1016/j.jaac.2019.11.022] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 10/21/2019] [Accepted: 11/22/2019] [Indexed: 01/04/2023]
Abstract
OBJECTIVE The aims of this study were to identify a subset of children with autism spectrum disorder (ASD) and co-occurring symptoms of psychopathology, and to evaluate associations between this subgroup and biological sex and amygdala volume. METHOD Participants included 420 children (ASD: 91 girls, 209 boys; typically developing controls: 57 girls, 63 boys). Latent profile analysis was used to identify ASD subgroups based on symptoms of psychopathology, adaptive functioning, cognitive development, and autism severity. Differences in the proportions of girls and boys across subgroups were evaluated. Magnetic resonance imaging scans were acquired (346 children); amygdala volumes were evaluated in relation to subgroups and problem behavior scores. RESULTS Three ASD subgroups were identified. One group was characterized by high levels of psychopathology and moderate impairment on other measures (High Psychopathology Moderate Impairments [HPMI], comprising 27% of the sample). The other two subgroups had lower symptoms of psychopathology but were differentiated by high and low levels of impairment on other measures. A higher proportion of girls were classified into the HPMI subgroup (40% of girls versus 22% of boys). Relative to controls, amygdala volumes were enlarged only in the HPMI subgroup. There was a positive association between right amygdala volume and internalizing behaviors in girls but not in boys with ASD. CONCLUSION A higher proportion of girls with ASD faced greater challenges with psychopathology, suggesting a need for closer evaluation and potentially earlier intervention to help improve outcomes. Amygdala enlargement was associated with co-occurring symptoms of psychopathology, and sex-specific correlations with symptoms were observed.
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Affiliation(s)
- Christine Wu Nordahl
- MIND Institute, Sacramento, CA, and the University of California at Davis School of Medicine, Sacramento, CA.
| | - Ana-Maria Iosif
- University of California at Davis School of Medicine, Sacramento, CA
| | - Gregory S. Young
- University of California at Davis School of Medicine, Sacramento, CA.,MIND Institute, Sacramento, CA
| | - Alexa Hechtman
- University of California at Davis School of Medicine, Sacramento, CA.,MIND Institute, Sacramento, CA
| | - Brianna Heath
- University of California at Davis School of Medicine, Sacramento, CA.,MIND Institute, Sacramento, CA
| | - Joshua K. Lee
- University of California at Davis School of Medicine, Sacramento, CA.,MIND Institute, Sacramento, CA
| | - Lauren Libero
- University of California at Davis School of Medicine, Sacramento, CA.,California Department of Developmental Services, Sacramento, CA.,MIND Institute, Sacramento, CA,,University of California at Davis School of Medicine, Sacramento, CA
| | - Vanessa P. Reinhardt
- University of California at Davis School of Medicine, Sacramento, CA.,Peel Children’s Center, Ontario, Canada.,MIND Institute, Sacramento CA,,University of California at Davis School of Medicine, Sacramento, CA
| | | | - David G. Amaral
- University of California at Davis School of Medicine, Sacramento, CA.,MIND Institute, Sacramento, CA
| | - Sally Rogers
- University of California at Davis School of Medicine, Sacramento, CA.,MIND Institute, Sacramento, CA
| | - Marjorie Solomon
- University of California at Davis School of Medicine, Sacramento, CA.,MIND Institute, Sacramento, CA
| | - Sally Ozonoff
- University of California at Davis School of Medicine, Sacramento, CA.,MIND Institute, Sacramento, CA
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45
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Ilzarbe D, Lukito S, Moessnang C, O'Daly OG, Lythgoe DJ, Murphy CM, Ashwood K, Stoencheva V, Rubia K, Simonoff E. Neural Correlates of Theory of Mind in Autism Spectrum Disorder, Attention-Deficit/Hyperactivity Disorder, and the Comorbid Condition. Front Psychiatry 2020; 11:544482. [PMID: 33240117 PMCID: PMC7677232 DOI: 10.3389/fpsyt.2020.544482] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 09/25/2020] [Indexed: 11/18/2022] Open
Abstract
Theory of mind (ToM) or mentalizing difficulties is reported in attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD), but the mechanism underpinning these apparently shared deficits is relatively unknown. Eighty-three young adult males, 19 with ASD alone, 21 with ADHD alone, 18 with dual diagnosis of ASD and ADHD, and 25 typically developing (TD) controls completed the functional magnetic resonance imaging version of the Frith-Happé animated-triangle ToM task. We compared neural function during ToM with two non-ToM conditions, random and goal directed motions, using whole-brain and region-of-interest analysis of brain activation and functional connectivity analyses. The groups showed comparable ToM task performance. All three clinical groups lacked local connectivity increase shown by TD controls during ToM in the right temporoparietal cortex, a key mentalizing region, with a differentially increased activation pattern in both ASD and comorbid groups relative to ADHD. Both ASD groups also showed reduced connectivity between right inferior lateral prefrontal and posterior cingulate cortices that could reflect an atypical information transmission to the mentalizing network. In contrast, with mentalizing both ADHD groups showed decreasing connectivity between the medial prefrontal and left temporoparietal cortices when compared to TD controls. Therefore, despite the complex pattern of atypical brain function underpinning ToM across the three disorders, some neurofunctional abnormalities during ToM are associated with ASD and appeared differentiable from those associated with ADHD, with the comorbid group displaying combined abnormalities found in each condition.
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Affiliation(s)
- Daniel Ilzarbe
- Department of Child and Adolescent Psychiatry, King's College London (KCL), Institute of Psychiatry, Psychology and Neuroscience (IoPPN), London, United Kingdom
- Department of Child and Adolescent Psychiatry and Psychology, Hospital Clínic de Barcelona, Institute of Neuroscience, Barcelona, Spain
- Child and Adolescent Psychiatry and Psychology, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
- Department of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Steve Lukito
- Department of Child and Adolescent Psychiatry, King's College London (KCL), Institute of Psychiatry, Psychology and Neuroscience (IoPPN), London, United Kingdom
| | - Carolin Moessnang
- Department of Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Mannheim, Germany
| | - Owen G. O'Daly
- Centre for Neuroimaging Sciences, King's College London, London, United Kingdom
| | - David J. Lythgoe
- Centre for Neuroimaging Sciences, King's College London, London, United Kingdom
| | - Clodagh M. Murphy
- Behavioural and Developmental Psychiatry Clinical Academic Group, Behavioural Genetics Clinic, Adult Autism and Attention Deficit Hyperactivity Disorder Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Karen Ashwood
- Behavioural and Developmental Psychiatry Clinical Academic Group, Behavioural Genetics Clinic, Adult Autism and Attention Deficit Hyperactivity Disorder Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Vladimira Stoencheva
- Behavioural and Developmental Psychiatry Clinical Academic Group, Behavioural Genetics Clinic, Adult Autism and Attention Deficit Hyperactivity Disorder Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Katya Rubia
- Department of Child and Adolescent Psychiatry, King's College London (KCL), Institute of Psychiatry, Psychology and Neuroscience (IoPPN), London, United Kingdom
| | - Emily Simonoff
- Department of Child and Adolescent Psychiatry, King's College London (KCL), Institute of Psychiatry, Psychology and Neuroscience (IoPPN), London, United Kingdom
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46
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Brooks JD, Bronskill SE, Fu L, Saxena FE, Arneja J, Pinzaru VB, Anagnostou E, Nylen K, McLaughlin J, Tu K. Identifying Children and Youth With Autism Spectrum Disorder in Electronic Medical Records: Examining Health System Utilization and Comorbidities. Autism Res 2020; 14:400-410. [PMID: 33098262 PMCID: PMC7894325 DOI: 10.1002/aur.2419] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 07/23/2020] [Accepted: 10/08/2020] [Indexed: 12/02/2022]
Abstract
Autism spectrum disorder (ASD) is a neurodevelopmental disorder requiring significant health and educational resources for affected individuals. A reference standard for ASD was generated from an existing population‐based cohort of 10,000 children and youth aged 1–24 years who were randomly selected for chart abstraction from 29,256 patients from 119 family physicians. We developed and validated an algorithm to identify children and youth with ASD within an electronic medical record system (N = 80,237, aged 1–24 years) in order to examine the prevalence of comorbidities and quantify health system utilization within the cohort. We identified 1,062 children and youth with ASD representing a prevalence of 1.32%. Compared to individuals without ASD, those with ASD had a higher prevalence of asthma, were more likely to visit a specialist, undergo surgery, and be hospitalized for psychiatric reasons. Children and youth with ASD in Ontario have complex health system needs, illustrated through a significant burden of comorbidities and increased health system utilization. Lay Summary Our paper generates population‐based estimates of health system use by children and youth with ASD, who have a higher burden of comorbidities than the general population. We developed a case‐finding algorithm and applied it in electronic medical records to create a cohort of children and youth with ASD, thereby generating an important resource to further study the health care needs of individuals with ASD.
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Affiliation(s)
- Jennifer D Brooks
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Susan E Bronskill
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | | | | | - Jasleen Arneja
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - Evdokia Anagnostou
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada.,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Kirk Nylen
- Ontario Brain Institute, Toronto, Ontario, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - John McLaughlin
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Karen Tu
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,North York General Hospital, Toronto, Ontario, Canada.,Toronto Western Hospital Family Health Team, University Health Network, Toronto, Ontario, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
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47
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Espadas C, Ballester P, Londoño AC, Almenara S, Aguilar V, Belda C, Pérez E, Peiró AM. Multimorbidity and psychotropic polypharmacy among participants with autism spectrum disorder with intellectual disability. Psychiatry Res 2020; 292:113321. [PMID: 32738553 DOI: 10.1016/j.psychres.2020.113321] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 07/20/2020] [Indexed: 12/25/2022]
Abstract
Nowadays, adults with autism spectrum disorder (ASD) experience several comorbidities whose treatment implies a wide range of psychotropic prescriptions. This study aimed to evaluate medication-related safety, drug-drug interactions, and psychotropics prescription trends. We conducted an observational and multicentric pharmacovigilance study in subjects with ASD and Intellectual disability (ID, n = 83). Clinical information (diagnoses, ongoing medications, comorbidities [multimorbidity ≥ 4 chronic health conditions]) and psychotropic prescriptions (polypharmacy ≥ 4 chronic drugs, daily drug doses, co-prescription) were registered. Ethical approval for this study was obtained. Participants (30±10 years old, 86% men, BMI 27±6 kg/m2) displayed 37% multimorbidity (mean of 3, IQR 2-4), and 57% polypharmacy (13% out of dose recommended range). Most drugs prescribed were psychotropic risperidone which is related to nervous system comorbidities (18% epilepsy, 16% insomnia, and 14% psychotic agitations). Risperidone and quetiapine were co-prescribed in 60% of the cases without any monitoring adverse event routine. The rates of multimorbidity and polypharmacy, among our young adults with ASD and ID, are concerning. Data suggest the need to develop a pharmacovigilance monitoring system to evaluate prescription accuracy, long-term safety of ongoing medications, and the fixed doses in this autistic population with associated ID.
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Affiliation(s)
- Cristina Espadas
- Occupational Observatory, Miguel Hernández University of Elche, Alicante, Spain
| | - Pura Ballester
- Neuropharmacology on Pain (NED) group, Alicante Institute for Health and Biomedical Research (ISABIAL Foundation), Alicante, Spain.
| | - Ana Carolina Londoño
- Psychiatry Service, Department of Health of Alicante - General Hospital, Alicante, Spain; Clinical Pharmacology Unit, Department of Health of Alicante - General Hospital, Alicante, Spain
| | - Susana Almenara
- Clinical Pharmacology Unit, Department of Health of Alicante - General Hospital, Alicante, Spain
| | - Víctor Aguilar
- Centro San Rafael, Residential facility, Alicante, Spain
| | - César Belda
- Centro Infanta Leonor, Autism Association, Alicante, Spain
| | - Enrique Pérez
- Psychiatry Service, Department of Health of Alicante - General Hospital, Alicante, Spain
| | - Ana María Peiró
- Neuropharmacology on Pain (NED) group, Alicante Institute for Health and Biomedical Research (ISABIAL Foundation), Alicante, Spain; Clinical Pharmacology Unit, Department of Health of Alicante - General Hospital, Alicante, Spain
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48
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Talbott MR, Miller MR. Future Directions for Infant Identification and Intervention for Autism Spectrum Disorder from a Transdiagnostic Perspective. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2020; 49:688-700. [PMID: 32701034 PMCID: PMC7541743 DOI: 10.1080/15374416.2020.1790382] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
By the time they are typically detected, neurodevelopmental disorders like autism spectrum disorder (ASD) are already challenging to treat. Preventive and early intervention strategies in infancy are critical for improving outcomes over the lifespan with significant cost savings. However, the impact of prevention and early intervention efforts is dependent upon our ability to identify infants most appropriate for such interventions. Because there may be significant overlap between prodromal symptoms across neurodevelopmental disorders and child psychopathology more broadly which may wax and wane across development, we contend that the impact of prevention and early intervention efforts will be heightened by identifying early indicators that may overlap across ASD and other commonly co-occurring disorders. This paper summarizes the existing literature on infant symptoms and identification of ASD to demonstrate the ways in which a transdiagnostic perspective could expand the impact of early identification and intervention research and clinical efforts, and to outline suggestions for future empirical research programs addressing current gaps in the identification-to-treatment pipeline. We propose four recommendations for future research that are both grounded in developmental and clinical science and that are scalable for early intervention systems: (1) development of fine-grained, norm-referenced measures of ASD-relevant transdiagnostic behavioral domains; (2) identification of shared and distinct mechanisms influencing the transition from risk to disorder; (3) determination of key cross-cutting treatment strategies (both novel and extracted from existing approaches) effective in targeting specific domains across disorders; and (4) integration of identified measures and treatments into existing service systems.
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Affiliation(s)
- Meagan R Talbott
- MIND Institute and Department of Psychiatry & Behavioral Sciences, University of California
| | - Meghan R Miller
- MIND Institute and Department of Psychiatry & Behavioral Sciences, University of California
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49
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Jennum P, Hastrup LH, Ibsen R, Kjellberg J, Simonsen E. Welfare consequences for people diagnosed with attention deficit hyperactivity disorder (ADHD): A matched nationwide study in Denmark. Eur Neuropsychopharmacol 2020; 37:29-38. [PMID: 32682821 DOI: 10.1016/j.euroneuro.2020.04.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 03/18/2020] [Accepted: 04/23/2020] [Indexed: 12/18/2022]
Abstract
There is insufficient data regarding the excess direct and indirect costs associated with attention deficit hyperactivity disorder (ADHD). Using the Danish National Patient Registry (2002-2016), we identified 83,613 people of any age with a diagnosis of ADHD or who were using central-acting medication against ADHD (primarily methylphenidate, with at least two prescriptions) and matched them to 334,446 control individuals. Additionally, 18,959 partners of patients aged ≥18 years with ADHD were identified, and compared with 74,032 control partners. Direct costs were based on data from the Danish Ministry of Health. Information about the use and costs of drugs were obtained from the Danish Medicines Agency. The frequencies of visits and hospitalizations, and costs of general practice were derived from data from the National Health Security. Indirect costs were obtained from Coherent Social Statistics. The average annual health care costs for people with ADHD and their partners were, respectively, €2636 and €477 higher than those of the matched controls. A greater percentage of people with ADHD and their partners compared with respective control subjects received social services (sick pay or disability pension). Those with ADHD had a lower income from employment than did controls for equivalent periods up to five years before the first diagnosis of ADHD. The additional direct and indirect annual costs (for those aged ≥18 years) including transfers of ADHD compared with controls were €23,072 for people with ADHD and €7,997 for their partners. ADHD has substantial socioeconomic consequences for individual patients, their partners and society.
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Affiliation(s)
- Poul Jennum
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Faculty of Health Sciences, University of Copenhagen, Rigshospitalet, DK 2600 Glostrup, Copenhagen, Denmark.
| | | | | | - Jakob Kjellberg
- VIVE - The Danish Center for Social Science Research, Copenhagen, Denmark.
| | - Erik Simonsen
- Psychiatric Research Unit, Psychiatry, Region Zealand, Denmark; Department of Clinical Medicine, Faculty of Medical and health Sciences, University of Copenhagen, Denmark.
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50
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Croteau C, Ben Amor L, Ilies D, Mottron L, Tarride JE, Dorais M, Perreault S. Impact of Psychoactive Drug Use on Developing Obesity among Children and Adolescents with Autism Spectrum Diagnosis: A Nested Case-Control Study. Child Obes 2020; 15:131-141. [PMID: 30668140 DOI: 10.1089/chi.2018.0170] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Obesity in children on the autism spectrum (AS) is becoming a significant health concern. The purpose of this study was to identify the predictors of obesity in a cohort of AS youth and to assess the impact of psychoactive medication use while exploring the second-generation antipsychotics (SGAs) dose-response curve. STUDY DESIGN A nested case-control study was conducted using Quebec public administrative databases. Subjects with AS <18 years [≥2 diagnoses International Classification of Diseases: 9th revision (ICD-9): 299.X] were identified (January 1993 to May 2011). Cases were defined as subjects with an obesity diagnosis (ICD-9: 278.X) during the coverage period and matched to 10 controls for age, gender, and follow-up duration. Potential risk factors for obesity (sociodemographic characteristics, other neuropsychiatric conditions, and psychoactive drug use) were evaluated and analyzed using conditional logistic regression. RESULTS From a cohort of 5369 AS subjects, we identified 135 obesity cases. Among the different risk factors, only SGAs [rate ratio (RR): 1.04, 95% confidence interval (CI): 1.01-1.07] increased the probability of obesity in multivariate analysis. Exposure for ≥12 months increased significantly the likelihood of obesity (RR: 2.01, 95% CI: 1.18-3.42). Higher risk was observed with chlorpromazine-equivalent daily doses ≥100 mg (RR: 2.20, 95% CI: 1.00-4.84). Among SGA users, concomitant antidepressants (per 30-day exposure) slightly increased the probability (RR: 1.08, 95% CI: 1.01-1.15). CONCLUSIONS Longer and higher SGA exposure increased the risk of obesity, which has to be considered in relation to the paucity of evidence supporting long-term psychoactive medication use in AS children. Results highlight the need to promote optimal use and interventions to mitigate metabolic side effects of SGAs in this population.
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Affiliation(s)
- Caroline Croteau
- 1 Faculty of Pharmacy, University of Montreal, Montreal, Québec, Canada
| | - Leila Ben Amor
- 2 Department of Psychiatry, CHU Sainte-Justine, University of Montreal, Montreal, Québec, Canada
| | - Drigissa Ilies
- 3 Department of Psychiatry, Hôpital Rivière-des-Prairies, University of Montreal, Montreal, Québec, Canada
| | - Laurent Mottron
- 3 Department of Psychiatry, Hôpital Rivière-des-Prairies, University of Montreal, Montreal, Québec, Canada
| | - Jean-Eric Tarride
- 4 Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.,5 Program for Assessment of Technology in Health (PATH), Research Institute of St. Joseph's Hamilton, Hamilton, Ontario, Canada
| | - Marc Dorais
- 6 StatSciences, Inc., ND Ile-Perrot, Québec, Canada
| | - Sylvie Perreault
- 1 Faculty of Pharmacy, University of Montreal, Montreal, Québec, Canada
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