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Leuning EM, van den Berk-Smeekens I, van Dongen-Boomsma M, Staal WG. Eye Movement Desensitization and Reprocessing in adolescents with autism; Efficacy on ASD symptoms and stress. Front Psychiatry 2023; 14:981975. [PMID: 36873194 PMCID: PMC9975260 DOI: 10.3389/fpsyt.2023.981975] [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: 06/29/2022] [Accepted: 01/16/2023] [Indexed: 02/17/2023] Open
Abstract
INTRODUCTION Eye Movement Desensitization and Reprocessing (EMDR) is a well-established and thoroughly researched treatment method for posttraumatic stress symptoms. When patients with an autism spectrum disorder (ASD) are treated with EMDR for their Posttraumatic Stress Disorder (PTSD), they sometimes report a decrease in the core symptoms of ASD. This explorative pre-post-follow up design study is designed to investigate whether EMDR with a focus on daily experienced stress, is effective in reducing ASD symptoms and stress in adolescents with ASD. METHODS Twenty-one adolescents with ASD (age 12 to 19) were treated with ten sessions EMDR, focusing on events of daily experienced stress. RESULTS No significant decrease of ASD symptoms was found on the total score of the Social Responsiveness Scale (SRS) as reported by caregivers from baseline to end measurement. However, there was a significant decrease on total caregivers SRS score comparing the baseline to the follow-up measurement. On two subscales, Social Awareness and Social Communication, a significant decrease was found from baseline to follow-up. On the subscales Social Motivation and Restricted Interests and Repetitive Behavior, no significant effects were found. On pre- and posttest scores of total ASD symptoms measured by the Autism Diagnostic Observation Schedule (ADOS-2), no significant effects were found. On the contrary, scores on self-reported Perceived Stress Scale (PSS) showed a significant decrease from baseline to follow-up. Also, 52% of adolescents showed a significant improvement of global clinical functioning at endpoint measurement on the Clinical Global Impression Improvement, rated by an independent child psychiatrist. DISCUSSION In sum, these results of this uncontrolled study suggest a partial effect of EMDR in adolescents with ASD on ASD symptoms, rated by their caregivers. In addition, the results of this study show that EMDR treatment on daily experienced stress significantly reduce perceived stress as reported by the participants, and improves global clinical functioning. The results also suggest a 'sleeper effect', since no significant effects were found between baseline- and post- treatment measurements, but only between baseline- and follow up three months after the treatment. This finding is in line with other studies investigating psychotherapeutic effects in ASD. Implications for clinical practice and suggestions for future research are discussed.
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Affiliation(s)
| | - Iris van den Berk-Smeekens
- Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, Netherlands.,Donders Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands
| | - Martine van Dongen-Boomsma
- Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, Netherlands.,Donders Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands
| | - Wouter G Staal
- Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, Netherlands.,Donders Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands.,Leiden Institute for Brain and Cognition, Leiden University, Leiden, Netherlands
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Genetic Variants in Folate and Cobalamin Metabolism-Related Genes in Pregnant Women of a Homogeneous Spanish Population: The Need for Revisiting the Current Vitamin Supplementation Strategies. Nutrients 2022; 14:nu14132702. [PMID: 35807880 PMCID: PMC9268853 DOI: 10.3390/nu14132702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/23/2022] [Accepted: 06/27/2022] [Indexed: 02/05/2023] Open
Abstract
Polymorphisms of genes involved in the metabolism and transport of folate and cobalamin could play relevant roles in pregnancy outcomes. This study assessed the prevalence of genetic polymorphisms of folate and cobalamin metabolism-related genes such as MTHFR, MTR, CUBN, and SLC19A1 in pregnant women of a homogeneous Spanish population according to conception, pregnancy, delivery, and newborns complications. This study was conducted on 149 nulliparous women with singleton pregnancies. Sociodemographic and obstetrics variables were recorded, and all patients were genotyped in the MTHFR, MTR, CUBN, and SLC10A1 polymorphisms. The distribution of genotypes detected in this cohort was similar to the population distribution reported in Europe, highlighting that more than 50% of women were carriers of risk alleles of the studied genes. In women with the MTHFR risk allele, there was a statistically significant higher frequency of assisted fertilisation and a higher frequency of preeclampsia and preterm birth. Moreover, CUBN (rs1801222) polymorphism carriers showed a statistically significantly lower frequency of complications during delivery. In conclusion, the prevalence of genetic variants related to folic acid and vitamin B12 metabolic genes in pregnant women is related to mother and neonatal outcomes. Knowing the prevalence of these polymorphisms may lead to a personalised prescription of vitamin intake.
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Kalb LG, Singh V, Hong JS, Holingue C, Ludwig NN, Pfeiffer D, Reetzke R, Gross AL, Landa R. Analysis of Race and Sex Bias in the Autism Diagnostic Observation Schedule (ADOS-2). JAMA Netw Open 2022; 5:e229498. [PMID: 35471566 PMCID: PMC9044110 DOI: 10.1001/jamanetworkopen.2022.9498] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE There are long-standing disparities in the prevalence of autism spectrum disorder (ASD) across race and sex. Surprisingly, few studies have examined whether these disparities arise partially out of systematic biases in the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2), the reference standard measure of ASD. OBJECTIVE To examine differential item functioning (DIF) of ADOS-2 items across sex and race. DESIGN, SETTING, AND PARTICIPANTS This is a cross-sectional study of children who were evaluated for ASD between 2014 and 2020 at a specialty outpatient clinic located in the Mid-Atlantic region of the US. Data were analyzed from July 2021 to February 2022. EXPOSURES Child race (Black/African American vs White) and sex (female vs male). MAIN OUTCOMES AND MEASURES Item-level biases across ADOS-2 harmonized algorithm items, including social affect (SA; 10 items) and repetitive/restricted behaviors (RRBs; 4 items), were evaluated across 3 modules. Measurement bias was identified by examining DIF and differential test functioning (DTF), within a graded response, item response theory framework. Statistical significance was determined by a likelihood ratio χ2 test, and a series of metrics was used to examine the magnitude of DIF and DTF. RESULTS A total of 6269 children (mean [SD] age, 6.77 [3.27] years; 1619 Black/African American [25.9%], 3151 White [50.3%], and 4970 male [79.4%]), were included in this study. Overall, 16 of 140 ADOS-2 diagnostic items (11%) had a significant DIF. For race, 8 items had a significant DIF, 6 of which involved SA. No single item showed DIF consistently across all modules. Most items with DIF had greater difficulty and poorer discrimination in Black/African American children compared with White children. For sex, 5 items showed significant DIF. DIF was split across SA and RRB. However, hand mannerisms evidenced DIF across all 5 algorithms, with generally greater difficulty. The magnitude of DIF was only moderate to large for 2 items: hand mannerisms (among female children) and repetitive interests (among Black/African American children). The overall estimated effect of DIF on total DTF was not large. CONCLUSIONS AND RELEVANCE These findings suggest that the ADOS-2 does not have widespread systematic measurement bias across race or sex. However, the findings raise some concerns around underdetection that warrant further research.
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Affiliation(s)
- Luther G. Kalb
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, Maryland
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, Maryland
| | - Vini Singh
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, Maryland
| | - Ji Su Hong
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, Maryland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Calliope Holingue
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, Maryland
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, Maryland
| | - Natasha N. Ludwig
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, Maryland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Danika Pfeiffer
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, Maryland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rachel Reetzke
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, Maryland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alden L. Gross
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Center on Aging and Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Rebecca Landa
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, Maryland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Kato S, Hanawa K, Linh VP, Saito M, Iimura R, Inui K, Nakamura K. Toward mapping pragmatic impairment of autism spectrum disorder individuals through the development of a corpus of spoken Japanese. PLoS One 2022; 17:e0264204. [PMID: 35213580 PMCID: PMC8880787 DOI: 10.1371/journal.pone.0264204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 02/05/2022] [Indexed: 11/19/2022] Open
Abstract
The central symptom of autism spectrum disorder (ASD) is deficiency in social communication, which is generally viewed as being caused by pragmatic impairment (PI). PI is difficulty in using language appropriately in social situations. Studies have confirmed that PI is the result of neurological, cognitive, linguistic, and sensorimotor dysfunctions involving intricately intertwined factors. To elucidate the whole picture of this impairment, an approach from a multifaceted perspective fusing those factors is necessary. To this end, comprehensive PI mapping is a must, since no comprehensive mapping has yet been developed. The aim of this research is to present a model of annotation scheme development and corpus construction to efficiently visualize and quantify for statistical investigation occurrences of PI, which enables comprehensive mapping of PI in the spoken language of Japanese ASD individuals. We constructed system networks (lexicogrammatical option systems speakers make choices from) in the theoretical framework of Systemic Functional Linguistics, from which we developed an annotation scheme to comprehensively cover PI. Since system network covers all possible lexicogrammatical choices in linguistic interaction, it enables a comprehensive view of where and in what lexicogrammar PI occurs. Based on this annotation scheme, we successfully developed the Corpus of ASD + Typically Developed Spoken Language consisting of texts from 1,187 audiotaped tasks performed by 186 ASD and 106 typically developed subjects, accommodating approximately 1.07 million morphemes. Moreover, we were successful in the automatization of the annotation process by machine learning, accomplishing a 90 percent precision rate. We exemplified the mapping procedure with a focus on the spoken use of negotiating particles. Our model corpus is applicable to any language by incorporating our method of constructing the annotation scheme, and would give impetus to defining PI from a cross-linguistic point of view, which is needed because PI of ASD reflects cross-linguistic differences.
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Affiliation(s)
- Sumi Kato
- Department of Neuropsychiatry, Graduate School of Medicine, Hirosaki University, Hirosaki, Japan
- Faculty of Management and Law, Aomori Chuo Gakuin University, Aomori, Japan
| | - Kazuaki Hanawa
- Natural Language Understanding Team, RIKEN Center for Advanced Intelligence Project, Tokyo, Japan
- Natural Language Processing Lab, Graduate School of Information Sciences, Tohoku University, Sendai, Japan
| | - Vo Phuong Linh
- School of Global Studies, University of Sussex, Brighton, United Kingdom
| | - Manabu Saito
- Department of Neuropsychiatry, Graduate School of Medicine, Hirosaki University, Hirosaki, Japan
- Research Center for Child Mental Development, Graduate School of Medicine, Hirosaki University, Hirosaki, Japan
| | - Ryuichi Iimura
- Department of International Management, College of Business Administration, Tamagawa University, Tokyo, Japan
| | - Kentaro Inui
- Natural Language Understanding Team, RIKEN Center for Advanced Intelligence Project, Tokyo, Japan
- Natural Language Processing Lab, Graduate School of Information Sciences, Tohoku University, Sendai, Japan
| | - Kazuhiko Nakamura
- Department of Neuropsychiatry, Graduate School of Medicine, Hirosaki University, Hirosaki, Japan
- Research Center for Child Mental Development, Graduate School of Medicine, Hirosaki University, Hirosaki, Japan
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Chisholm AK, Haebich KM, Pride NA, Walsh KS, Lami F, Ure A, Maloof T, Brignell A, Rouel M, Granader Y, Maier A, Barton B, Darke H, Dabscheck G, Anderson VA, Williams K, North KN, Payne JM. Delineating the autistic phenotype in children with neurofibromatosis type 1. Mol Autism 2022; 13:3. [PMID: 34983638 PMCID: PMC8729013 DOI: 10.1186/s13229-021-00481-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 12/14/2021] [Indexed: 12/15/2022] Open
Abstract
Background Existing research has demonstrated elevated autistic behaviours in children with neurofibromatosis type 1 (NF1), but the autistic phenotype and its relationship to other neurodevelopmental manifestations of NF1 remains unclear. To address this gap, we performed detailed characterisation of autistic behaviours in children with NF1 and investigated their association with other common NF1 child characteristics. Methods Participants were drawn from a larger cross-sectional study examining autism in children with NF1. The population analysed in this study scored above threshold on the Social Responsiveness Scale-Second Edition (T-score ≥ 60; 51% larger cohort) and completed the Autism Diagnostic Interview-Revised (ADI-R) and/or the Autism Diagnostic Observation Schedule-Second Edition (ADOS-2). All participants underwent evaluation of their intellectual function, and behavioural data were collected via parent questionnaires. Results The study cohort comprised 68 children (3–15 years). Sixty-three per cent met the ADOS-2 ‘autism spectrum’ cut-off, and 34% exceeded the more stringent threshold for ‘autistic disorder’ on the ADI-R. Social communication symptoms were common and wide-ranging, while restricted and repetitive behaviours (RRBs) were most commonly characterised by ‘insistence on sameness’ (IS) behaviours such as circumscribed interests and difficulties with minor changes. Autistic behaviours were weakly correlated with hyperactive/impulsive attention deficit hyperactivity disorder (ADHD) symptoms but not with inattentive ADHD or other behavioural characteristics. Language and verbal IQ were weakly related to social communication behaviours but not to RRBs. Limitations Lack of genetic validation of NF1, no clinical diagnosis of autism, and a retrospective assessment of autistic behaviours in early childhood. Conclusions Findings provide strong support for elevated autistic behaviours in children with NF1. While these behaviours were relatively independent of other NF1 comorbidities, the importance of taking broader child characteristics into consideration when interpreting data from autism-specific measures in this population is highlighted. Social communication deficits appear similar to those observed in idiopathic autism and are coupled with a unique RRB profile comprising prominent IS behaviours. This autistic phenotype and its relationship to common NF1 comorbidities such as anxiety and executive dysfunction will be important to examine in future research. Current findings have important implications for the early identification of autism in NF1 and clinical management. Supplementary Information The online version contains supplementary material available at 10.1186/s13229-021-00481-3.
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Affiliation(s)
- Anita K Chisholm
- Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC, 3052, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, 3010, Australia.,The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC, 3052, Australia
| | - Kristina M Haebich
- Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC, 3052, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, 3010, Australia
| | - Natalie A Pride
- Kids Neuroscience Centre, The Children's Hospital at Westmead, 178A Hawkesbury Road, Westmead, NSW, 2145, Australia
| | - Karin S Walsh
- Center for Neuroscience and Behavioral Medicine, Children's National Hospital, Michigan Avenue NW, Washington, DC, 20310, USA
| | - Francesca Lami
- Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC, 3052, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, 3010, Australia
| | - Alex Ure
- Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC, 3052, Australia.,Department of Paediatrics, School of Clinical Sciences, Monash University, 246 Clayton Road, Clayton, VIC, 3168, Australia.,Developmental Paediatrics, Monash Children's Hospital, 246 Clayton Road, Clayton, VIC, 3168, Australia
| | - Tiba Maloof
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, 3010, Australia.,The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC, 3052, Australia
| | - Amanda Brignell
- Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC, 3052, Australia.,Department of Paediatrics, School of Clinical Sciences, Monash University, 246 Clayton Road, Clayton, VIC, 3168, Australia
| | - Melissa Rouel
- Kids Neuroscience Centre, The Children's Hospital at Westmead, 178A Hawkesbury Road, Westmead, NSW, 2145, Australia
| | - Yael Granader
- Center for Neuroscience and Behavioral Medicine, Children's National Hospital, Michigan Avenue NW, Washington, DC, 20310, USA
| | - Alice Maier
- Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC, 3052, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, 3010, Australia
| | - Belinda Barton
- Kids Neuroscience Centre, The Children's Hospital at Westmead, 178A Hawkesbury Road, Westmead, NSW, 2145, Australia.,Sydney Medical School, University of Sydney, Camperdown, NSW, 2050, Australia.,Children's Hospital Education Research Institute, The Children's Hospital at Westmead, 178A Hawkesbury Road, Westmead, NSW, 2145, Australia
| | - Hayley Darke
- Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC, 3052, Australia
| | - Gabriel Dabscheck
- Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC, 3052, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, 3010, Australia.,The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC, 3052, Australia
| | - Vicki A Anderson
- Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC, 3052, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, 3010, Australia.,The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC, 3052, Australia
| | - Katrina Williams
- Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC, 3052, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, 3010, Australia.,Department of Paediatrics, School of Clinical Sciences, Monash University, 246 Clayton Road, Clayton, VIC, 3168, Australia.,Developmental Paediatrics, Monash Children's Hospital, 246 Clayton Road, Clayton, VIC, 3168, Australia
| | - Kathryn N North
- Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC, 3052, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, 3010, Australia
| | - Jonathan M Payne
- Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC, 3052, Australia. .,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, 3010, Australia. .,The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC, 3052, Australia.
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Kobinia GS, Zaknun JJ, Pabinger C, Laky B. Case Report: Autologous Bone Marrow Derived Intrathecal Stem Cell Transplant for Autistic Children - A Report of Four Cases and Literature Review. Front Pediatr 2021; 9:620188. [PMID: 34692600 PMCID: PMC8526924 DOI: 10.3389/fped.2021.620188] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 09/08/2021] [Indexed: 11/24/2022] Open
Abstract
Despite steadily growing numbers of children diagnosed with autism spectrum disorders (ASD), causative treatment is unavailable. Recently, biological cell therapies involving pluripotent cells have raised hopes towards sustained beneficial outcome. We herein report data of four children diagnosed with ASD, who were treated with autologous, bone marrow (BM)-derived, intrathecally and simultaneously intravenously applied, point-of-care stem cell transplant (SCT). The three boys and one girl received the diagnosis at ages between 2-4 years. The decision to perform the procedure was preceded by limited beneficiary impact of conventional symptom-based, psychological and pharmacological interventions. At ages of 4-14 years the children received their SCT, no immediate or late adverse events were reported. Disappearance of symptoms were observed by the parents during the following year and consequently improved Autism Treatment Evaluation Checklist (ATEC) scores were reported. The SCT procedure, in trained hands, can be a safe and promising treatment option in children with ASD, responding in a non-satisfactory manner to conventional treatments. It is postulated that SCT may, among others, assert its positive effect by counteracting a cerebral inflammatory autoimmune process which in turn supports the responsiveness to behavioral and pharmacological interventions. Our results in this small group are encouraging, but certainly need further investigation in larger cohorts.
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Affiliation(s)
- Georg S. Kobinia
- Austrian Society of Regenerative Medicine, Vienna, Austria
- Institute of Regenerative Medicine (IRM), Graz, Austria
| | - John J. Zaknun
- Primary Pediatric Care Centre – Kinderkompetenzzentrum, Vienna, Austria
| | | | - Brenda Laky
- Austrian Society of Regenerative Medicine, Vienna, Austria
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Hong JS, Singh V, Kalb L, Ashkar A, Landa R. Replication study of ADOS-2 Toddler Module cut-off scores for autism spectrum disorder classification. Autism Res 2021; 14:1284-1295. [PMID: 33683018 DOI: 10.1002/aur.2496] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 02/08/2021] [Accepted: 02/21/2021] [Indexed: 01/27/2023]
Abstract
The Autism Diagnostic Observation Schedule, Second Edition (ADOS-2) has been regarded as the gold standard assessment of autism spectrum disorder (ASD). While clinical validity of ADOS-2 Modules 1-4 have been extensively studied, there has been very limited research examining the clinical validity of ADOS-2 Toddler Module. The goal of this study was to examine alignment of the ADOS-2 Toddler Module classification with clinicians' determination of ASD, with assessing cut-off scores for diagnosing ASD in toddlers. A total of 412 toddlers ages 12-30 months who received ADOS-2 Toddler Module as well as a best estimate clinical (BEC) diagnosis, were included in this study. ADOS-2 Toddler Module cut-off scores were determined using the appropriate algorithms (Algorithm 1 for toddlers aged 12-20 months and those aged 21-30 months with <5 words, Algorithm 2 for toddlers aged 21-30 months with 5 words or more). Receiver operating characteristic (ROC) curves were used to assess cut-off scores that optimized sensitivity and specificity when compared against BEC diagnosis. The selected cut-off scores were examined using frequency tables to compare ADOS-2 classification against BEC diagnosis. For Algorithm 1, classification statistics were optimized at the cut-off score of 12 with an area under the curve (AUC) of 0.92. For Algorithm 2, classification statistics were optimized at the cut-off score of 10 with an AUC of 0.96. The ADOS-2 Toddler Module classification is strongly aligned with BEC diagnosis. The optimal cut-off scores identified in the current study reflect the same results configured by the prior study. LAY SUMMARY: ADOS-2 Toddler Module has been widely used for the ASD assessment, but there have been limited research on its clinical validity. This study is the first replication of the ADOS-2 Toddler Module with a large independent sample. We examined alignment of the ADOS-2 Toddler Module classification with clinicians' determination of ASD, with assessing cut-off scores, and confirmed the clinical validity of ADOS-2 Toddler Module. Cut-off scores of ADOS-2 Toddler Module cited in the manual yielded best clinical utility for diagnosing ASD in toddlers.
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Affiliation(s)
- Ji Su Hong
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, Maryland, USA.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Vini Singh
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Luke Kalb
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, Maryland, USA.,Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ahlam Ashkar
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Rebecca Landa
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, Maryland, USA.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Adamou M, Jones SL, Wetherhill S. Predicting diagnostic outcome in adult autism spectrum disorder using the autism diagnostic observation schedule, second edition. BMC Psychiatry 2021; 21:24. [PMID: 33423664 PMCID: PMC7798323 DOI: 10.1186/s12888-020-03028-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 12/22/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Autism Diagnostic Observation Schedule, Second Edition (ADOS-2) module four assessment for diagnosing autism spectrum disorder in adults has shown good sensitivity and specificity in research settings. METHOD This study aimed to evaluate the predictive accuracy of the ADOS-2 module four by investigating the components of the assessment, in relation to diagnostic outcome in a clinical setting. Data from 88 service users referred to a Specialist Adult Autism Service was explored. RESULTS ADOS-2 scores failed to predict the diagnostic outcome (overall sensitivity = 92%, specificity = 57%). Interestingly, scores from the 'restricted interests' component of the ADOS-2 have the potential to predict diagnostic outcome, despite this domain not been included in the scoring algorithm. CONCLUSIONS Based on our findings, we recommend clinicians are cautious when interpreting results of the ADOS-2 assessment.
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Affiliation(s)
| | - Sarah L. Jones
- grid.499523.00000 0000 8880 3342South West Yorkshire Partnership NHS Foundation Trust, Wakefield, UK ,Manygates Clinic, Belle Isle Health Park, Portobello Road, Wakefield, WF1 5PN UK
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9
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Waizbard-Bartov E, Ferrer E, Young GS, Heath B, Rogers S, Wu Nordahl C, Solomon M, Amaral DG. Trajectories of Autism Symptom Severity Change During Early Childhood. J Autism Dev Disord 2021; 51:227-242. [PMID: 32410098 PMCID: PMC7810617 DOI: 10.1007/s10803-020-04526-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Autism symptom severity change was evaluated during early childhood in 125 children diagnosed with autism spectrum disorder (ASD). Children were assessed at approximately 3 and 6 years of age for autism symptom severity, IQ and adaptive functioning. Each child was assigned a change score, representing the difference between ADOS Calibrated Severity Scores (CSS) at the two ages. A Decreased Severity Group (28.8%) decreased by 2 or more points; a Stable Severity Group (54.4%) changed by 1 point or less; and an Increased Severity Group (16.8%) increased by 2 or more points. Girls tended to decrease in severity more than boys and increase in severity less than boys. There was no clear relationship between intervention history and membership in the groups.
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Affiliation(s)
- Einat Waizbard-Bartov
- Department of Psychology, University of California Davis, Davis, CA, USA
- The MIND Institute and Department of Psychiatry and Behavioral Sciences, University of California Davis, 2825 50th Street, Sacramento, CA, 95817, USA
| | - Emilio Ferrer
- Department of Psychology, University of California Davis, Davis, CA, USA
| | - Gregory S Young
- The MIND Institute and Department of Psychiatry and Behavioral Sciences, University of California Davis, 2825 50th Street, Sacramento, CA, 95817, USA
| | - Brianna Heath
- The MIND Institute and Department of Psychiatry and Behavioral Sciences, University of California Davis, 2825 50th Street, Sacramento, CA, 95817, USA
| | - Sally Rogers
- The MIND Institute and Department of Psychiatry and Behavioral Sciences, University of California Davis, 2825 50th Street, Sacramento, CA, 95817, USA
| | - Christine Wu Nordahl
- The MIND Institute and Department of Psychiatry and Behavioral Sciences, University of California Davis, 2825 50th Street, Sacramento, CA, 95817, USA
| | - Marjorie Solomon
- The MIND Institute and Department of Psychiatry and Behavioral Sciences, University of California Davis, 2825 50th Street, Sacramento, CA, 95817, USA
| | - David G Amaral
- The MIND Institute and Department of Psychiatry and Behavioral Sciences, University of California Davis, 2825 50th Street, Sacramento, CA, 95817, USA.
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Individual and Environmental Factors Affecting Adaptive Behavior of Toddlers with Autism Spectrum Disorder: Role of Parents' Socio-cultural Level. J Autism Dev Disord 2020; 51:3469-3482. [PMID: 33355882 PMCID: PMC8460517 DOI: 10.1007/s10803-020-04803-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2020] [Indexed: 01/22/2023]
Abstract
The effects of environmental factors [including Socio-Economic Status, Cultural Capital, and Social Capital (Socio-Cultural Level) of both parents] on the Vineland-II adaptive behavior dimensions of toddlers with autism spectrum disorder (ASD), in addition to individual factors, was investigated in 148 Italian toddlers (82% males), aged 18 to 37 months with ASD. Toddlers’ age and Griffiths Mental Development Scales general development affected all of the adaptive behavior dimensions, with negative and positive associations, respectively. The Child Behavior Checklist comorbid conditions were negatively associated with some adaptive behavior dimensions while the ADOS-2 Social affect only with the communication dimension. Mothers’ and fathers’ specific Socio-Cultural Level dimensions were positively associated with toddlers’ specific adaptive behavior dimensions with the same magnitude as comorbid conditions.
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11
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Atypical communication characteristics among clinic-referred youth with and without autism spectrum disorder: Stability and associations with clinical correlates. Dev Psychopathol 2020; 32:1240-1253. [PMID: 32938518 DOI: 10.1017/s095457942000070x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Atypical communication characteristics (ACCs), such as speech delay, odd pitch, and pragmatic difficulties, are common features of autism spectrum disorder (ASD) as are the symptoms of a wide range of psychiatric disorders. Using a simple retrospective method, this study aimed to better understand the relation and stability of ACCs with a broad range of psychiatric symptoms among large, well-characterized samples of clinic-referred children and adolescents with and without ASD. Youth with ASD had higher rates and a more variable pattern of developmental change in ACCs than the non-ASD diagnostic group. Latent class analysis yielded three ACC stability subgroups within ASD: Stable ACCs, Mostly Current-Only ACCs, and Little Professors. Subgroups exhibited differences in severity of ASD symptomatology, co-occurring psychiatric symptoms, and other correlates. Our findings provide support for the clinical utility of characterizing caregiver-perceived changes in ACCs in identifying children at risk for co-occurring psychopathology and other clinically relevant variables.
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12
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Boterberg S, Van Coster R, Roeyers H. Characteristics, Early Development and Outcome of Parent-Reported Regression in Autism Spectrum Disorder. J Autism Dev Disord 2020; 49:4603-4625. [PMID: 31463633 DOI: 10.1007/s10803-019-04183-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
This study explored regression patterns in 100 children with ASD (3-11 years) using several approaches to enhance the validity of retrospective parent report. Both early development and outcome were examined in regression groups defined by 36 months age cut-off and two underlying empirical patterns based on type and onset age. Results over regression groups were generally consistent. During early development, children with regression showed a similar amount of social atypicalities and stereotyped behaviour as compared to children without regression. However, parents indicated less communication skills which could be a valuable predictor of regression. Development after regression was characterised by early language delay and more restricted and repetitive behaviour. The findings provide insight into the diagnosis and prognosis of regression in ASD.
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Affiliation(s)
- Sofie Boterberg
- Department of Experimental Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Henri Dunantlaan 2, 9000, Ghent, Belgium.
| | - Rudy Van Coster
- Department of Paediatric Neurology and Metabolism, Faculty of Medicine and Health Sciences, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium
| | - Herbert Roeyers
- Department of Paediatric Neurology and Metabolism, Faculty of Medicine and Health Sciences, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium
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13
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Kang E, Gadow KD, Lerner MD. Atypical Communication Characteristics, Differential Diagnosis, and the Autism Spectrum Disorder Phenotype in Youth. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2019; 49:251-263. [DOI: 10.1080/15374416.2018.1539912] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Erin Kang
- Department of Psychology, Stony Brook University
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14
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Zou M, Sun C, Wang J, Kang J, Xu Z, Ma Y, Chen L, Zhang X, Xia W, Wu L. Factors influencing the severity of behavioral phenotype in autism spectrum disorders: Implications for research. Psychiatry Res 2018; 261:290-297. [PMID: 29329050 DOI: 10.1016/j.psychres.2017.12.084] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 11/25/2017] [Accepted: 12/31/2017] [Indexed: 11/26/2022]
Abstract
The phenotypic heterogeneity of Autism Spectrum Disorders (ASD) presents particular research challenges in the assessment of symptom severity, while the standardized Autism Diagnostic Observation Schedule (ADOS) scores present a severity metric, namely calibrated severity scores (CSS) that are relatively impervious to individual characteristics. To date, no studies have examined the convergent validity of CSS in Chinese sample populations. The present study investigated the validity of the ADOS-CSS using a sample of 321 children aged 2-18 years with ASD, and developed upon existing literature examining the influence of non-ASD-specific characteristics on other types of measures including Autism Diagnostic Interview-Revised (ADI-R), Social Responsiveness Scale (SRS), and Vineland Adaptive Behavior Scales (VABS). As expected, the findings revealed that the CSS were less influenced than ADOS-RAW scores by the demographic and developmental-level variables. Moreover, compared to the ADOS-CSS, the ADI-R, SRS and VABS were still strongly correlated with confounding factors, such as chronological age, intelligence quotients, and language-level. The results of this study corroborate the utilization of CSS as a more valid indicator of ASD severity than raw scores from ADOS and other instruments.
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Affiliation(s)
- Mingyang Zou
- Department of Children's and Adolescent Health, Public Health College, Harbin Medical University, Harbin 150081, China
| | - Caihong Sun
- Department of Children's and Adolescent Health, Public Health College, Harbin Medical University, Harbin 150081, China
| | - Jia Wang
- Department of Children's and Adolescent Health, Public Health College, Harbin Medical University, Harbin 150081, China
| | - Jing Kang
- Department of Children's and Adolescent Health, Public Health College, Harbin Medical University, Harbin 150081, China
| | - Zhanbin Xu
- Department of Children's and Adolescent Health, Public Health College, Harbin Medical University, Harbin 150081, China
| | - Yongjuan Ma
- Department of Children's and Adolescent Health, Public Health College, Harbin Medical University, Harbin 150081, China
| | - Lei Chen
- Department of Child Health Care, Dalian Maternal and Child Health Care Hospital, Dalian 116033, China
| | - Xinxi Zhang
- Department of Child Health Care, Yangzhou Maternal and Child Health Care Hospital, Yangzhou 225002, China
| | - Wei Xia
- Department of Children's and Adolescent Health, Public Health College, Harbin Medical University, Harbin 150081, China.
| | - Lijie Wu
- Department of Children's and Adolescent Health, Public Health College, Harbin Medical University, Harbin 150081, China.
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15
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Gentile I, Zappulo E, Riccio MP, Binda S, Bubba L, Pellegrinelli L, Scognamiglio D, Operto F, Margari L, Borgia G, Bravaccio C. Prevalence of Congenital Cytomegalovirus Infection Assessed Through Viral Genome Detection in Dried Blood Spots in Children with Autism Spectrum Disorders. ACTA ACUST UNITED AC 2018; 31:467-473. [PMID: 28438881 DOI: 10.21873/invivo.11085] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 03/22/2017] [Accepted: 03/24/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND/AIM Autism spectrum disorders (ASD) are neurodevelopmental disorders without a definitive etiology in most cases. Environmental factors, such as viral infections, have been linked with anomalies in brain growth, neuronal development, and functional connectivity. Congenital cytomegalovirus (CMV) infection has been associated with the onset of ASD in several case reports. The aim of this study was to evaluate the prevalence of congenital CMV infection in children with ASD and in healthy controls. PATIENTS AND METHODS The CMV genome was tested by polymerase chain reaction (PCR) on dried blood spots collected at birth from 82 children (38 with ASD and 44 controls). RESULTS The prevalence of congenital CMV infection was 5.3% (2/38) in cases and 0% (0/44) in controls (p=0.212). CONCLUSION The infection rate was about 10-fold higher in patients with ASD than in the general Italian population at birth. For this reason, detection of CMV-DNA on dried blood spots could be considered in the work-up that is usually performed at ASD diagnosis to rule-out a secondary form. Given the potential prevention and treatment of CMV infection, this study could have intriguing consequences, at least for a group of patients with ASD.
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Affiliation(s)
- Ivan Gentile
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples "Federico II", Naples, Italy
| | - Emanuela Zappulo
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples "Federico II", Naples, Italy
| | - Maria Pia Riccio
- Department of Physical and Mental Health and Preventive Medicine, Second University of Naples, Naples, Italy
| | - Sandro Binda
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Laura Bubba
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Laura Pellegrinelli
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Domenico Scognamiglio
- Screening Center for Metabolic Diseases, AORN Santobono - Pausilipon - Hospital Annunziata, Naples, Italy
| | - Francesca Operto
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Lucia Margari
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Guglielmo Borgia
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples "Federico II", Naples, Italy
| | - Carmela Bravaccio
- Department of Medical Translational Science, University of Naples "Federico II", Naples, Italy
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Riccio MP, Franco C, Negri R, Ferrentino RI, Maresca R, D'alterio E, Greco L, Bravaccio C. Is food refusal in autistic children related to TAS2R38 genotype? Autism Res 2017; 11:531-538. [PMID: 29282878 DOI: 10.1002/aur.1912] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 11/01/2017] [Accepted: 12/06/2017] [Indexed: 12/26/2022]
Abstract
Several studies suggest that atypical eating behaviors, in particular food selectivity, are more frequent in children with autism spectrum disorder (ASD). A link between bitter taste perception, namely PROP/PTC sensitivity and food preferences is known in healthy children. The aim of this study is to investigate whether genetic variants of the TAS2R38 taste receptor responsible for different bitter sensitivity could affect foods preferences and consequently food refusal in ASD children. We recruited 43 children with ASD and 41 with normotypic development (TD) with or without food selectivity, aged between 2 and 11 years. Children were characterized for bitter sensitivity by means of PROP strips and FACS analysis and genotyped for TAS2R38 polymorphisms. Food selectivity was assessed by a validated food preference questionnaire filled by parents. A statistically significant correlation between PROP sensitivity and food refusal was observed. Furthermore, a prevalence of the PAV-sensitive haplotype compared to the AVI-insensitive one was seen in ASD children with food selectivity. In agreement with the initial hypothesis the results show that food refusal in ASD children is mediated by bitter taste sensitivity thus suggesting that the bitter sensitivity test may be used as a device to orientate tailored food proposals for the practical management of food selectivity in ASD. Autism Res 2018, 11: 531-538. © 2017 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY A variation of the gene TAS2R38, associated with bitter taste sensitivity, can cause a different perception of some foods. In particular, some children are hypersensitive to bitterness and show a more restricted repertoire of accepted foods. We evaluate bitter sensitivity in ASD children with or without food selectivity, through a simple bitter taste test with edible strips. The results show that food refusal in ASD children can be mediated by bitter taste sensitivity thus suggesting that the bitter sensitivity test may be used as a device to orientate tailored food proposals for the practical management of food selectivity in ASD.
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Affiliation(s)
- Maria Pia Riccio
- Department of Medical and Translational Sciences, Section of Child Psychiatry, University of Federico II Naples, Italy
| | - Chiara Franco
- Department of Medical and Translational Sciences, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Rossella Negri
- Department of Medical and Translational Sciences, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Roberta Ida Ferrentino
- Department of Mental and Physical Health and Preventive Medicine, Section of Child and Adolescent Psychiatry, University of Naples "L. Vanvitelli", Naples, Italy
| | - Roberta Maresca
- Department of Mental and Physical Health and Preventive Medicine, Section of Child and Adolescent Psychiatry, University of Naples "L. Vanvitelli", Naples, Italy
| | - Elisa D'alterio
- Department of Mental and Physical Health and Preventive Medicine, Section of Child and Adolescent Psychiatry, University of Naples "L. Vanvitelli", Naples, Italy
| | - Luigi Greco
- Department of Medical and Translational Sciences, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Carmela Bravaccio
- Department of Medical and Translational Sciences, Section of Child Psychiatry, University of Federico II Naples, Italy
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17
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Chojnicka I, Pisula E. Adaptation and Validation of the ADOS-2, Polish Version. Front Psychol 2017; 8:1916. [PMID: 29163293 PMCID: PMC5681938 DOI: 10.3389/fpsyg.2017.01916] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 10/16/2017] [Indexed: 11/13/2022] Open
Abstract
Autism Diagnostic Observation Schedule (ADOS) is one of the most popular instruments used world-widely in the diagnosis of autism spectrum disorders (ASD). Unfortunately, there are only a few studies of the psychometric properties of non-English language versions of this instrument and none of the adaptation of its second edition (ADOS-2). The objective of this study was to verify the psychometric properties of the Polish version of the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2-PL). The authors recruited 401 participants: 193 with ASDs (ASD group) and 78 with non-spectrum disorders, plus 130 typically developing participants (control group). ADOS-2-PL was found to have high interrater reliability, internal consistency and test-retest reliability. Confirmatory factor analysis confirmed a good fit of the Polish data to the two-factor model of ADOS-2. As no significant differences were found between participants with childhood autism and other ASDs, only one cut-off was established for Modules 1-4. The sensitivity, specificity and positive predictive value of ADOS-2-PL are high: sensitivity was over 90% (only for the "Older with some words" algorithm in the Toddler Module the sensitivity was 71% and "Aged 5 years or older" algorithm in Module 2 sensitivity was 84%), specificity was above 80% (with the exception of the Module 4 and Module 2 "Aged 5 years or older" algorithm where it was above 70%). The results support the use of ADOS-2-PL in clinical practice and scientific research. To the best of our knowledge, there have been no reports to date about adaptations of ADOS-2 and the psychometric properties of non-English language versions. As such, this constitutes the first attempt at adapting ADOS-2, and its results could be of interest for researchers outside of Poland.
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Affiliation(s)
| | - Ewa Pisula
- Faculty of Psychology, University of Warsaw, Warsaw, Poland
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18
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Bieleninik Ł, Posserud MB, Geretsegger M, Thompson G, Elefant C, Gold C. Tracing the temporal stability of autism spectrum diagnosis and severity as measured by the Autism Diagnostic Observation Schedule: A systematic review and meta-analysis. PLoS One 2017; 12:e0183160. [PMID: 28934215 PMCID: PMC5608197 DOI: 10.1371/journal.pone.0183160] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 07/31/2017] [Indexed: 12/27/2022] Open
Abstract
Background Exploring ways to improve the trajectory and symptoms of autism spectrum disorder is prevalent in research, but less is known about the natural prognosis of autism spectrum disorder and course of symptoms. The objective of this study was to examine the temporal stability of autism spectrum disorder and autism diagnosis, and the longitudinal trajectories of autism core symptom severity. We furthermore sought to identify possible predictors for change. Methods We searched PubMed, PsycInfo, EMBASE, Web of Science, Cochrane Library up to October 2015 for prospective cohort studies addressing the autism spectrum disorder/autism diagnostic stability, and prospective studies of intervention effects. We included people of all ages with autism spectrum disorder/autism or at risk of having autism spectrum disorder, who were diagnosed and followed up for at least 12 months using the Autism Diagnostic Observation Schedule (ADOS). Both continuous ADOS scores and dichotomous diagnostic categories were pooled in random-effects meta-analysis and meta-regression. Results Of 1443 abstracts screened, 44 were eligible of which 40 studies contained appropriate data for meta-analysis. A total of 5771 participants from 7 months of age to 16.5 years were included. Our analyses showed no change in ADOS scores across time as measured by Calibrated Severity Scores (mean difference [MD] = 0.05, 95% CI -0.26 to 0.36). We observed a minor but statistically significant change in ADOS total raw scores (MD = -1.51, 95% CI -2.70 to -0.32). There was no improvement in restricted and repetitive behaviours (standardised MD [SMD] = -0.04, 95% CI -0.19 to 0.11), but a minor improvement in social affect over time (SMD = -0.31, 95% CI -0.50 to -0.12). No changes were observed for meeting the autism spectrum disorder criteria over time (risk difference [RD] = -0.01, 95% CI -0.03 to 0.01), but a significant change for meeting autism criteria over time (RD = -0.18, 95% CI -0.29 to -0.07). On average, there was a high heterogeneity between studies (I2 range: 65.3% to 93.1%). Discussion While 18% of participants shifted from autism to autism spectrum disorder diagnosis, the overall autism spectrum disorder prevalence was unchanged. Overall autism core symptoms were remarkably stable over time across childhood indicating that intervention studies should focus on other areas, such as quality of life and adaptive functioning. However, due to high heterogeneity between studies and a number of limitations in the studies, the results need to be interpreted with caution.
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Affiliation(s)
- Łucja Bieleninik
- GAMUT–The Grieg Academy Music Therapy Research Centre, Uni Research Health, Bergen, Norway
| | - Maj-Britt Posserud
- Department of Child and Adolescent Psychiatry, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | - Monika Geretsegger
- GAMUT–The Grieg Academy Music Therapy Research Centre, Uni Research Health, Bergen, Norway
| | - Grace Thompson
- Melbourne Conservatorium of Music, the University of Melbourne, Melbourne, Australia
| | - Cochavit Elefant
- School for Creative Arts Therapies, University of Haifa, Haifa, Israel
| | - Christian Gold
- GAMUT–The Grieg Academy Music Therapy Research Centre, Uni Research Health, Bergen, Norway
- * E-mail:
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Longitudinal Study of Sensory Features in Children with Autism Spectrum Disorder. AUTISM RESEARCH AND TREATMENT 2017; 2017:1934701. [PMID: 28932599 PMCID: PMC5592014 DOI: 10.1155/2017/1934701] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 07/19/2017] [Accepted: 07/24/2017] [Indexed: 01/23/2023]
Abstract
BACKGROUND Between 45 and 95% of children with Autism Spectrum Disorder (ASD) present sensory features that affect their daily functioning. However, the data in the scientific literature are not conclusive regarding the evolution of sensory features in children with ASD. The main objective of this study was to analyze the sensory features of children within the age of 3-4 (T1) when they received their ASD diagnosis and two years later (T2) when they started school. METHODS We conducted a prospective cohort study to assess sensory features in 34 children with ASD over time. The data were collected using a standardized assessment tool, the Sensory Profile. RESULTS Our analyses show that sensory features in children with ASD are stable from the age of three to six years. The stability of sensory scores is independent of correction by covariates, such as cognitive level and autism severity scores. CONCLUSIONS Children with ASD have sensory features that persist from the time of diagnosis at the age of 3 to 4 years to school age. This persistence of sensory features from an early age underscores the need to support these children and their parents. Sensory features should be detected early and managed to improve functional and psychosocial outcomes.
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Gentile I, Zappulo E, Riccio MP, Binda S, Limauro R, Scuccimarra G, Borgia G, Bravaccio C. No evidence of congenital varicella zoster virus infection assessed through dried blood spot in children with autism spectrum disorders. Future Virol 2017. [DOI: 10.2217/fvl-2017-0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Aim: Several authors have hypothesized an association between congenital viral infections and the onset of autism spectrum disorders (ASD). We aimed to assess the prevalence of congenital varicella zoster virus (VZV) infection in patients with ASD. Patients & methods: Congenital infection by VZV was evaluated in a cohort of 38 children with ASD and in 44 healthy controls. PCR for VZV-DNA performed on dried blood spots collected at birth. Results & conclusion: No VZV infection was detected in both groups. With the limitation of the small sample size of this study, the results are not in favor of a role of VZV in the etiology of ASD.
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Affiliation(s)
- Ivan Gentile
- Department of Clinical Medicine & Surgery, Section of Infectious Diseases, University of Naples “Federico II”, Naples, Italy
| | - Emanuela Zappulo
- Department of Clinical Medicine & Surgery, Section of Infectious Diseases, University of Naples “Federico II”, Naples, Italy
| | - Maria Pia Riccio
- Department of Medical Translational Science, University of Naples “Federico II”, Naples, Italy
| | - Sandro Binda
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | | | | | - Guglielmo Borgia
- Department of Clinical Medicine & Surgery, Section of Infectious Diseases, University of Naples “Federico II”, Naples, Italy
| | - Carmela Bravaccio
- Department of Medical Translational Science, University of Naples “Federico II”, Naples, Italy
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21
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Budimirovic DB, Berry-Kravis E, Erickson CA, Hall SS, Hessl D, Reiss AL, King MK, Abbeduto L, Kaufmann WE. Updated report on tools to measure outcomes of clinical trials in fragile X syndrome. J Neurodev Disord 2017; 9:14. [PMID: 28616097 PMCID: PMC5467057 DOI: 10.1186/s11689-017-9193-x] [Citation(s) in RCA: 112] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 02/22/2017] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE Fragile X syndrome (FXS) has been the neurodevelopmental disorder with the most active translation of preclinical breakthroughs into clinical trials. This process has led to a critical assessment of outcome measures, which resulted in a comprehensive review published in 2013. Nevertheless, the disappointing outcome of several recent phase III drug trials in FXS, and parallel efforts at evaluating behavioral endpoints for trials in autism spectrum disorder (ASD), has emphasized the need for re-assessing outcome measures and revising recommendations for FXS. METHODS After performing an extensive database search (PubMed, Food and Drug Administration (FDA)/National Institutes of Health (NIH)'s www.ClinicalTrials.gov, etc.) to determine progress since 2013, members of the Working Groups who published the 2013 Report evaluated the available outcome measures for FXS and related neurodevelopmental disorders using the COSMIN grading system of levels of evidence. The latter has also been applied to a British survey of endpoints for ASD. In addition, we also generated an informal classification of outcome measures for use in FXS intervention studies as instruments appropriate to detect shorter- or longer-term changes. RESULTS To date, a total of 22 double-blind controlled clinical trials in FXS have been identified through www.ClinicalTrials.gov and an extensive literature search. The vast majority of these FDA/NIH-registered clinical trials has been completed between 2008 and 2015 and has targeted the core excitatory/inhibitory imbalance present in FXS and other neurodevelopmental disorders. Limited data exist on reliability and validity for most tools used to measure cognitive, behavioral, and other problems in FXS in these trials and other studies. Overall, evidence for most tools supports a moderate tool quality grading. Data on sensitivity to treatment, currently under evaluation, could improve ratings for some cognitive and behavioral tools. Some progress has also been made at identifying promising biomarkers, mainly on blood-based and neurophysiological measures. CONCLUSION Despite the tangible progress in implementing clinical trials in FXS, the increasing data on measurement properties of endpoints, and the ongoing process of new tool development, the vast majority of outcome measures are at the moderate quality level with limited information on reliability, validity, and sensitivity to treatment. This situation is not unique to FXS, since reviews of endpoints for ASD have arrived at similar conclusions. These findings, in conjunction with the predominance of parent-based measures particularly in the behavioral domain, indicate that endpoint development in FXS needs to continue with an emphasis on more objective measures (observational, direct testing, biomarkers) that reflect meaningful improvements in quality of life. A major continuous challenge is the development of measurement tools concurrently with testing drug safety and efficacy in clinical trials.
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Affiliation(s)
- Dejan B. Budimirovic
- Departments of Psychiatry and Behavioral Sciences, Kennedy Krieger Institute and Child Psychiatry, Johns Hopkins University School of Medicine, 716 N. Broadway, Baltimore, MD 21205 USA
| | - Elizabeth Berry-Kravis
- Departments of Pediatrics, Neurological Sciences, Biochemistry, Rush University Medical Center, 1725 West Harrison, Suite 718, Chicago, IL 60612 USA
| | - Craig A. Erickson
- Division of Child and Adolescent Psychiatry, Cincinnati Children’s Hospital Medical Center and the University of Cincinnati College of Medicine, 3333 Burnet Avenue MLC 4002, Cincinnati, OH 45229 USA
| | - Scott S. Hall
- Division of Interdisciplinary Brain Sciences, Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Road, Stanford, CA 94305 USA
| | - David Hessl
- MIND Institute and Department of Psychiatry and Behavioral Sciences, University of California Davis Medical Center, 2825 50th Street, Sacramento, CA 95817 USA
| | - Allan L. Reiss
- Division of Interdisciplinary Brain Sciences, Departments of Psychiatry and Behavioral Sciences, Radiology and Pediatrics, Stanford University, 401 Quarry Road, Stanford, CA 94305 USA
| | - Margaret K. King
- Autism & Developmental Medicine Institute, Geisinger Health System, Present address: Novartis Pharmaceuticals Corporation, US Medical, One Health Plaza, East Hanover, NJ 07936 USA
| | - Leonard Abbeduto
- MIND Institute and Department of Psychiatry and Behavioral Sciences, University of California Davis Medical Center, 2825 50th Street, Sacramento, CA 95817 USA
| | - Walter E. Kaufmann
- Center for Translational Research, Greenwood Genetic Center, 113 Gregor Mendel Circle, Greenwood, SC 29646 USA
- Department of Neurology, Boston Children’s Hospital, Boston, MA 02115 USA
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Pijl MKJ, Rommelse NNJ, Hendriks M, De Korte MWP, Buitelaar JK, Oosterling IJ. Does the Brief Observation of Social Communication Change help moving forward in measuring change in early autism intervention studies? AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2016; 22:216-226. [DOI: 10.1177/1362361316669235] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The field of early autism research is in dire need of outcome measures that adequately reflect subtle changes in core autistic behaviors. This article compares the ability of a newly developed measure, the Brief Observation of Social Communication Change (BOSCC), and the Autism Diagnostic Observation Schedule (ADOS) to detect changes in core symptoms of autism in 44 toddlers. The results provide encouraging evidence for the Brief Observation of Social Communication Change as a candidate outcome measure, as reflected in sufficient inter- and intra-rater reliability, independency from other child characteristics, and sensitivity to capture change. Although the Brief Observation of Social Communication Change did not evidently outperform the Autism Diagnostic Observation Schedule on any of these quality criteria, the instrument may be better able to capture subtle, individual changes in core autistic symptoms. The promising findings warrant further study of this new instrument.
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Affiliation(s)
- Mirjam KJ Pijl
- Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands
- Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Nanda NJ Rommelse
- Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands
- Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Monica Hendriks
- Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands
- Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Manon WP De Korte
- Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands
- Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Jan K Buitelaar
- Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands
- Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Iris J Oosterling
- Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands
- Radboud University Medical Centre, Nijmegen, The Netherlands
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The Autism Diagnostic Observation Schedule, Toddler Module: Standardized Severity Scores. J Autism Dev Disord 2016; 45:2704-20. [PMID: 25832801 DOI: 10.1007/s10803-015-2432-7] [Citation(s) in RCA: 160] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Standardized calibrated severity scores (CSS) have been created for Autism Diagnostic Observation Schedule, 2nd edition (ADOS-2) Modules 1-4 as a metric of the relative severity of autism-specific behaviors. Total and domain CSS were created for the Toddler Module to facilitate comparison to other modules. Analyses included 388 children with ASD age 12-30 months and were replicated on 435 repeated assessments from 127 children with ASD. Compared to raw scores, associations between total and domain CSS and participant characteristics were reduced in the original sample. Verbal IQ effects on Social Affect-CSS were not reduced in the replication sample. Toddler Module CSS increases comparability of ADOS-2 scores across modules and allows studies of symptom trajectories to extend to earlier ages.
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Postorino V, Fatta LM, De Peppo L, Giovagnoli G, Armando M, Vicari S, Mazzone L. Longitudinal comparison between male and female preschool children with autism spectrum disorder. J Autism Dev Disord 2016; 45:2046-55. [PMID: 25633919 DOI: 10.1007/s10803-015-2366-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Epidemiological studies have highlighted a strong male bias in autism spectrum disorder (ASD), however few studies have examined gender differences in autism symptoms, and available findings are inconsistent. The aim of the present study is to investigate the longitudinal gender differences in developmental profiles of 30 female and 30 male age-matched preschool children with ASD. All the children underwent a comprehensive evaluation at T0 and at T1. Our results have shown no significant interaction between time and gender for predicting autism symptoms, developmental quotient, parental stress, children's adaptive skills and behavior problems. Shedding light on the developmental trajectories in ASD could help clinicians to recognize children with ASD at an earlier age and contribute to the development of appropriate treatments.
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Affiliation(s)
- Valentina Postorino
- Child Neuropsychiatry Unit, Department of Neuroscience, I.R.C.C.S. Children's Hospital Bambino Gesù, Piazza S. Onofrio, 4, 00165, Rome, Italy
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25
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Giovagnoli G, Postorino V, Fatta LM, Sanges V, De Peppo L, Vassena L, Rose PD, Vicari S, Mazzone L. Behavioral and emotional profile and parental stress in preschool children with autism spectrum disorder. RESEARCH IN DEVELOPMENTAL DISABILITIES 2015; 45-46:411-421. [PMID: 26318505 DOI: 10.1016/j.ridd.2015.08.006] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 07/21/2015] [Accepted: 08/05/2015] [Indexed: 06/04/2023]
Abstract
Parents of children with autism spectrum disorder (ASD) were shown to experience more stress than parents of typically developing peers, although little is known about risk factors predicting stress in this population. The aim of this study was to evaluate parental stress levels and behavioral and emotional problems in a sample of preschool children with ASD as compared to typically developing (TD) peers and to investigate the role of several factors, including the severity of autistic symptoms, adaptive skills, cognitive abilities and behavioral and emotional problems, on parental stress. Results confirmed that parents of children with ASD experience higher stress levels than parents of TD and that children with ASD show more behavioral and emotional problems than controls. Moreover, our results showed that behavioral and emotional problems are strong predictors of parental stress, while stress related to a parent-child dysfunctional relationship was associated with daily living and communication skills as well as cognitive abilities. Findings revealed different behavioral and emotional problems affecting parental stress in ASD and TD samples. No association between the severity of autism symptoms and parental stress was detected. These results suggest that dysfunctional behaviors in preschool children with ASD have a strong impact on parental stress, profoundly affecting the well-being of the entire family. Therefore, strategies aimed at the early detection and management of these behavioral and emotional problems are crucial in order to prevent parental stress and to develop the most appropriate treatment interventions.
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Affiliation(s)
- Giulia Giovagnoli
- I.R.C.C.S. Children's Hospital Bambino Gesù, Child Neuropsychiatry Unit, Department of Neuroscience, Piazza S. Onofrio, 4, 00165 Rome, Italy; L.U.M.S.A. Dipartimento di Scienze Umane della Libera Università Maria SS. Assunta (L.U.M.S.A.), Rome, Italy
| | - Valentina Postorino
- I.R.C.C.S. Children's Hospital Bambino Gesù, Child Neuropsychiatry Unit, Department of Neuroscience, Piazza S. Onofrio, 4, 00165 Rome, Italy
| | - Laura M Fatta
- I.R.C.C.S. Children's Hospital Bambino Gesù, Child Neuropsychiatry Unit, Department of Neuroscience, Piazza S. Onofrio, 4, 00165 Rome, Italy; I.R.C.C.S. Centro Neurolesi "Bonino-Pulejo", Via Provinciale Palermo, S.S.113, Contrada Casazza, Messina 98124, Italy
| | - Veronica Sanges
- I.R.C.C.S. Children's Hospital Bambino Gesù, Child Neuropsychiatry Unit, Department of Neuroscience, Piazza S. Onofrio, 4, 00165 Rome, Italy
| | - Lavinia De Peppo
- I.R.C.C.S. Children's Hospital Bambino Gesù, Child Neuropsychiatry Unit, Department of Neuroscience, Piazza S. Onofrio, 4, 00165 Rome, Italy; L.U.M.S.A. Dipartimento di Scienze Umane della Libera Università Maria SS. Assunta (L.U.M.S.A.), Rome, Italy
| | - Lia Vassena
- I.R.C.C.S. Children's Hospital Bambino Gesù, Child Neuropsychiatry Unit, Department of Neuroscience, Piazza S. Onofrio, 4, 00165 Rome, Italy
| | - Paola De Rose
- I.R.C.C.S. Children's Hospital Bambino Gesù, Child Neuropsychiatry Unit, Department of Neuroscience, Piazza S. Onofrio, 4, 00165 Rome, Italy
| | - Stefano Vicari
- I.R.C.C.S. Children's Hospital Bambino Gesù, Child Neuropsychiatry Unit, Department of Neuroscience, Piazza S. Onofrio, 4, 00165 Rome, Italy
| | - Luigi Mazzone
- I.R.C.C.S. Children's Hospital Bambino Gesù, Child Neuropsychiatry Unit, Department of Neuroscience, Piazza S. Onofrio, 4, 00165 Rome, Italy.
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26
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Network Approach to Autistic Traits: Group and Subgroup Analyses of ADOS Item Scores. J Autism Dev Disord 2015. [DOI: 10.1007/s10803-015-2537-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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McConachie H, Parr JR, Glod M, Hanratty J, Livingstone N, Oono IP, Robalino S, Baird G, Beresford B, Charman T, Garland D, Green J, Gringras P, Jones G, Law J, Le Couteur AS, Macdonald G, McColl EM, Morris C, Rodgers J, Simonoff E, Terwee CB, Williams K. Systematic review of tools to measure outcomes for young children with autism spectrum disorder. Health Technol Assess 2015; 19:1-506. [PMID: 26065374 PMCID: PMC4781156 DOI: 10.3310/hta19410] [Citation(s) in RCA: 161] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The needs of children with autism spectrum disorder (ASD) are complex and this is reflected in the number and diversity of outcomes assessed and measurement tools used to collect evidence about children's progress. Relevant outcomes include improvement in core ASD impairments, such as communication, social awareness, sensory sensitivities and repetitiveness; skills such as social functioning and play; participation outcomes such as social inclusion; and parent and family impact. OBJECTIVES To examine the measurement properties of tools used to measure progress and outcomes in children with ASD up to the age of 6 years. To identify outcome areas regarded as important by people with ASD and parents. METHODS The MeASURe (Measurement in Autism Spectrum disorder Under Review) research collaboration included ASD experts and review methodologists. We undertook systematic review of tools used in ASD early intervention and observational studies from 1992 to 2013; systematic review, using the COSMIN checklist (Consensus-based Standards for the selection of health Measurement Instruments) of papers addressing the measurement properties of identified tools in children with ASD; and synthesis of evidence and gaps. The review design and process was informed throughout by consultation with stakeholders including parents, young people with ASD, clinicians and researchers. RESULTS The conceptual framework developed for the review was drawn from the International Classification of Functioning, Disability and Health, including the domains 'Impairments', 'Activity Level Indicators', 'Participation', and 'Family Measures'. In review 1, 10,154 papers were sifted - 3091 by full text - and data extracted from 184; in total, 131 tools were identified, excluding observational coding, study-specific measures and those not in English. In review 2, 2665 papers were sifted and data concerning measurement properties of 57 (43%) tools were extracted from 128 papers. Evidence for the measurement properties of the reviewed tools was combined with information about their accessibility and presentation. Twelve tools were identified as having the strongest supporting evidence, the majority measuring autism characteristics and problem behaviour. The patchy evidence and limited scope of outcomes measured mean these tools do not constitute a 'recommended battery' for use. In particular, there is little evidence that the identified tools would be good at detecting change in intervention studies. The obvious gaps in available outcome measurement include well-being and participation outcomes for children, and family quality-of-life outcomes, domains particularly valued by our informants (young people with ASD and parents). CONCLUSIONS This is the first systematic review of the quality and appropriateness of tools designed to monitor progress and outcomes of young children with ASD. Although it was not possible to recommend fully robust tools at this stage, the review consolidates what is known about the field and will act as a benchmark for future developments. With input from parents and other stakeholders, recommendations are made about priority targets for research. FUTURE WORK Priorities include development of a tool to measure child quality of life in ASD, and validation of a potential primary outcome tool for trials of early social communication intervention. STUDY REGISTRATION This study is registered as PROSPERO CRD42012002223. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Helen McConachie
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Jeremy R Parr
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Magdalena Glod
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Jennifer Hanratty
- School of Sociology, Social Policy and Social Work, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Nuala Livingstone
- School of Sociology, Social Policy and Social Work, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Inalegwu P Oono
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Shannon Robalino
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Gillian Baird
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Tony Charman
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Deborah Garland
- National Autistic Society North East Autism Resource Centre, Newcastle upon Tyne, UK
| | - Jonathan Green
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - Paul Gringras
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Glenys Jones
- School of Education, University of Birmingham, Birmingham, UK
| | - James Law
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Ann S Le Couteur
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Geraldine Macdonald
- School of Sociology, Social Policy and Social Work, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Elaine M McColl
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Christopher Morris
- PenCRU, Child Health Group, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Jacqueline Rodgers
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Emily Simonoff
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Caroline B Terwee
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Katrina Williams
- University of Melbourne, Royal Children's Hospital and Murdoch Childrens Research Institute, Melbourne, Australia
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28
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Postorino V, Sanges V, Giovagnoli G, Fatta LM, De Peppo L, Armando M, Vicari S, Mazzone L. Clinical differences in children with autism spectrum disorder with and without food selectivity. Appetite 2015; 92:126-32. [PMID: 25998237 DOI: 10.1016/j.appet.2015.05.016] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 04/09/2015] [Accepted: 05/13/2015] [Indexed: 01/08/2023]
Abstract
Several studies have described the atypical eating behaviors frequently occurring in children with Autism Spectrum Disorder (ASD), and food selectivity is the most frequent of these problems. The everyday management of mealtime behaviors among children with ASD can have a negative impact on family routines and become a significant stressor for families. However, much remains unknown about why food selectivity is so prevalent among individuals with ASD. The objective of this study was to investigate clinical and behavioral features in individuals with ASD with the aim of identifying distinctive clinical profiles in children with and without food selectivity. A total of 158 children with ASD were enrolled in this study: 79 participants with food selectivity (FS) were age and sex matched with 79 participants without food selectivity (No FS). All participants and their parents completed a battery of psychological tests for a comprehensive evaluation of ASD symptoms, cognitive abilities, adaptive skills, behavioral problems and parental stress level. No statistically significant difference on gastrointestinal symptoms and growth adequacy was found between the FS group and the No FS group. Overall, the FS group showed significantly higher rates of ASD symptoms as compared to the No FS group in the questionnaires completed by parents. Furthermore, parents of the FS group reported significantly higher levels of parental stress and a larger degree of their children's behavioral problems as compared to the No FS group. Finally, there were no differences between the FS and the No FS group on any adaptive skill domain. Our findings suggest that the identification of distinctive clinical and behavioral patterns in children with ASD and food selectivity is a crucial issue for parents and therapists in the daily management.
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Affiliation(s)
- Valentina Postorino
- Department of Neuroscience, Child Neuropsychiatry Unit, I.R.C.C.S. Children's Hospital Bambino Gesù, Piazza S. Onofrio 4, 00165, Rome, Italy.
| | - Veronica Sanges
- Department of Neuroscience, Child Neuropsychiatry Unit, I.R.C.C.S. Children's Hospital Bambino Gesù, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Giulia Giovagnoli
- Department of Neuroscience, Child Neuropsychiatry Unit, I.R.C.C.S. Children's Hospital Bambino Gesù, Piazza S. Onofrio 4, 00165, Rome, Italy; L.U.M.S.A., Libera Università Maria SS. Assunta, Dipartimento di Scienze Umane, Piazza delle Vaschette 101, 00193, Rome, Italy
| | - Laura Maria Fatta
- Department of Neuroscience, Child Neuropsychiatry Unit, I.R.C.C.S. Children's Hospital Bambino Gesù, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Lavinia De Peppo
- Department of Neuroscience, Child Neuropsychiatry Unit, I.R.C.C.S. Children's Hospital Bambino Gesù, Piazza S. Onofrio 4, 00165, Rome, Italy; L.U.M.S.A., Libera Università Maria SS. Assunta, Dipartimento di Scienze Umane, Piazza delle Vaschette 101, 00193, Rome, Italy
| | - Marco Armando
- Department of Neuroscience, Child Neuropsychiatry Unit, I.R.C.C.S. Children's Hospital Bambino Gesù, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Stefano Vicari
- Department of Neuroscience, Child Neuropsychiatry Unit, I.R.C.C.S. Children's Hospital Bambino Gesù, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Luigi Mazzone
- Department of Neuroscience, Child Neuropsychiatry Unit, I.R.C.C.S. Children's Hospital Bambino Gesù, Piazza S. Onofrio 4, 00165, Rome, Italy
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Choque Olsson N, Bölte S. Brief report: "Quick and (not so) dirty" assessment of change in autism: cross-cultural reliability of the Developmental Disabilities CGAS and the OSU autism CGI. J Autism Dev Disord 2014; 44:1773-8. [PMID: 24379174 DOI: 10.1007/s10803-013-2029-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
There are few evaluated economic tools to assess change in autism. This study examined the inter-rater reliability of the Developmental Disabilities Children's Global Assessment Scale (DD-CGAS), and the OSU Autism Clinical Global Impression (OSU Autism CGI) in a European setting. Using these scales, 16 clinicians with multidisciplinary background and varying experience independently rated eight vignettes of autism spectrum disorder for severity and general psychosocial functioning at referral and discharge. Intraclass correlation coefficient (ICCs) for experienced clinicians were .75 for the DD-CGAS and .72 for the OSU Autism CGI. In inexperienced clinicians these ICCs were .58 and .59. Results confirm previous North American studies, and further extents the reliability of the instruments to untrained, less experienced clinicians with different professions.
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Affiliation(s)
- Nora Choque Olsson
- Pediatric Neuropsychiatry Unit, Department of Women's and Children's Health, CAP Research Center, Center of Neurodevelopmental Disorders (KIND), Karolinska Institutet, Gävlegatan 22, 11330, Stockholm, Sweden,
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30
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Venker CE, Ray-Subramanian CE, Bolt DM, Ellis Weismer S. Trajectories of autism severity in early childhood. J Autism Dev Disord 2014; 44:546-63. [PMID: 23907710 DOI: 10.1007/s10803-013-1903-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Relatively little is known about trajectories of autism severity using calibrated severity scores (CSS) from the Autism Diagnostic Observation Schedule, but characterizing these trajectories has important theoretical and clinical implications. This study examined CSS trajectories during early childhood. Participants were 129 children with autism spectrum disorder evaluated annually from ages 2½ to 5½. The four severity trajectory classes that emerged--Persistent High (n = 47), Persistent Moderate (n = 54), Worsening (n = 10), and Improving (n = 18)-were strikingly similar to those identified by Gotham et al. (Pediatrics 130(5):e1278-e1284, 2012). Children in the Persistent High trajectory class had the most severe functional skill deficits in baseline nonverbal cognition and daily living skills and in receptive and expressive language growth.
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Affiliation(s)
- Courtney E Venker
- Department of Communication Sciences and Disorders and Waisman Center, University of Wisconsin-Madison, 1500 Highland Avenue, Waisman Center Room 475, Madison, WI, 53705, USA,
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Poslawsky IE, Naber FB, Bakermans-Kranenburg MJ, van Daalen E, van Engeland H, van IJzendoorn MH. Video-feedback Intervention to promote Positive Parenting adapted to Autism (VIPP-AUTI): A randomized controlled trial. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2014; 19:588-603. [PMID: 24919961 DOI: 10.1177/1362361314537124] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
In a randomized controlled trial, we evaluated the early intervention program Video-feedback Intervention to promote Positive Parenting adapted to Autism (VIPP-AUTI) with 78 primary caregivers and their child (16-61 months) with Autism Spectrum Disorder. VIPP-AUTI is a brief attachment-based intervention program, focusing on improving parent-child interaction and reducing the child's individual Autism Spectrum Disorder-related symptomatology in five home visits. VIPP-AUTI, as compared with usual care, demonstrated efficacy in reducing parental intrusiveness. Moreover, parents who received VIPP-AUTI showed increased feelings of self-efficacy in child rearing. No significant group differences were found on other aspects of parent-child interaction or on child play behavior. At 3-months follow-up, intervention effects were found on child-initiated joint attention skills, not mediated by intervention effects on parenting. Implementation of VIPP-AUTI in clinical practice is facilitated by the use of a detailed manual and a relatively brief training of interveners.
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Affiliation(s)
| | - Fabiënne Ba Naber
- Leiden University, The Netherlands Erasmus University Rotterdam, The Netherlands
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32
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Jansen R, Ceulemans E, Grauwels J, Maljaars J, Zink I, Steyaert J, Noens I. Young children with language difficulties: a dimensional approach to subgrouping. RESEARCH IN DEVELOPMENTAL DISABILITIES 2013; 34:4115-4124. [PMID: 24051364 DOI: 10.1016/j.ridd.2013.08.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Revised: 08/12/2013] [Accepted: 08/14/2013] [Indexed: 06/02/2023]
Abstract
A dimensional approach was used to create bottom-up constructed subgroups that captured the behavioral heterogeneity in 36 Dutch-speaking children with language difficulties. Four subgroups were delineated based upon differences in cognitive ability, symbol understanding, joint attention and autism spectrum disorder related characteristics. Children with a different developmental disorder were found within a single cluster. Therefore, the results of this study suggest that bottom-up constructed subgroups might capture the heterogeneous behavioral profiles of young children with developmental difficulties in a more meaningful way. Furthermore, joint attention and symbol understanding seem important skills to assess in young children presenting with language difficulties.
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Affiliation(s)
- Rianne Jansen
- KU Leuven, Parenting and Special Education Research Unit, Belgium; KU Leuven, Leuven Autism Research (LAuRes), Belgium.
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Charman T, Gotham K. Measurement Issues: Screening and diagnostic instruments for autism spectrum disorders - lessons from research and practise. Child Adolesc Ment Health 2013; 18:52-63. [PMID: 23539140 PMCID: PMC3607539 DOI: 10.1111/j.1475-3588.2012.00664.x] [Citation(s) in RCA: 104] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/09/2012] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND SCOPE Significant progress has been made over the past two decades in the development of screening and diagnostic instruments for autism spectrum disorders (ASDs). This article reviews this progress, including recent innovations, focussing on those instruments for which the strongest research data on validity exists, and then addresses issues arising from their use in clinical settings. FINDINGS Research studies have evaluated the ability of screens to prospectively identify cases of ASD in population-based and clinically referred samples, as well as the accuracy of diagnostic instruments to map onto 'gold standard' clinical best estimate diagnosis. However, extension of the findings to clinical services must be done with caution, with a full understanding that instrument properties are sample-specific. Furthermore, we are limited by the lack of a true test for ASD which remains a behaviourally defined disorder. In addition, screening and diagnostic instruments help clinicians least in the cases where they are most in want of direction, as their accuracy will always be lower for marginal cases. CONCLUSION Instruments help clinicians to collect detailed, structured information and increase accuracy and reliability of referral for in-depth assessment and recommendations for support, but further research is needed to refine their effective use in clinical settings.
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Affiliation(s)
- Tony Charman
- Centre for Research in Autism and Education (CRAE), Institute of Education, University of London, UK
| | - Katherine Gotham
- University of Michigan Autism and Communication Disorders Center (UMACC), Ann Arbor, Michigan, USA
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34
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Andersson GW, Gillberg C, Miniscalco C. Pre-school children with suspected autism spectrum disorders: do girls and boys have the same profiles? RESEARCH IN DEVELOPMENTAL DISABILITIES 2013; 34:413-422. [PMID: 23023300 DOI: 10.1016/j.ridd.2012.08.025] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Revised: 08/30/2012] [Accepted: 08/30/2012] [Indexed: 06/01/2023]
Abstract
The male to female ratio is raised in autism spectrum disorders (ASD). Previous studies have suggested that girls with ASD have more problems with communication than boys, but boys show more repetitive behaviours than girls. In this study, 20 girls, 1.8-3.9 years of age were matched for chronological and developmental age with 20 boys with suspected ASD. All the children were recruited after population screening and referral by Child Health Care Services to a specialised neuropsychiatry clinic, where they underwent comprehensive neuropsychiatric assessments. Comparisons were made with regard to diagnosis, developmental profiles and global disability. No significant gender differences were found. There were strong correlations between results obtained in different developmental areas. The results suggest that either (1) previous studies finding clear gender differences may have overrated discrepancies between girls and boys in ASD, or that (2) there may be girls, who will not be identified in the early years with our current screening instruments. More research with a much larger population representative study samples is required.
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35
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Jones RM, Lord C. Diagnosing autism in neurobiological research studies. Behav Brain Res 2012; 251:113-24. [PMID: 23153932 DOI: 10.1016/j.bbr.2012.10.037] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Revised: 10/18/2012] [Accepted: 10/22/2012] [Indexed: 12/27/2022]
Abstract
Autism spectrum disorder (ASD) is by definition a complex and heterogeneous disorder. Variation in factors such as developmental level, language ability and IQ further complicate the presentation of symptoms. Clinical research and basic science must continue to inform each other's questions to help address the heterogeneity inherent to the disorder. This review uses a clinical perspective to outline the common tools and best practices for diagnosing and characterizing ASD in a research setting. We discuss considerations for classifying research populations, including language ability and IQ and examine the advantages and disadvantages of different psychometric measurements. Ultimately, the contribution of multiple sources of data representing different perspectives is crucial for interpreting and understanding the ASD phenotype.
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Affiliation(s)
- Rebecca M Jones
- Weill-Cornell Medical College, Center for Autism and the Developing Brain, New York Presbyterian Hospital/Westchester Division, 21 Bloomingdale Road, White Plains, NY 10605, USA.
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Dereu M, Roeyers H, Raymaekers R, Meirsschaut M, Warreyn P. How useful are screening instruments for toddlers to predict outcome at age 4? General development, language skills, and symptom severity in children with a false positive screen for autism spectrum disorder. Eur Child Adolesc Psychiatry 2012; 21:541-51. [PMID: 22580987 DOI: 10.1007/s00787-012-0280-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Accepted: 04/23/2012] [Indexed: 11/27/2022]
Abstract
Screening instruments for autism spectrum disorder (ASD) often generate many false positives. It is argued that these children may have other developmental difficulties and are also in need of thorough assessment and early intervention. The current study looked at the predictive validity of positive screens on the Checklist for Early Signs of Developmental Disorders (CESDD) and the Early Screening of Autistic Traits questionnaire (ESAT) at age 2 towards language, cognitive function, and symptom severity at age 4. Children who screened positive on the ESAT scored lower for both language and cognitive functioning at age 4 compared with children who screened negative on the ESAT. Also, the more signs of ASD that were recognized on the CESDD or ESAT, the lower the scores for language and cognitive functioning at age 4. False positive screens could be differentiated from true positive screens on the CESDD only in symptom severity score on the Autism Diagnostic Observation Schedule (ADOS). It seems that early screeners for ASD also detect children with other developmental disorders and that diagnostic instruments such as the ADOS are warranted to differentiate between children with ASD and other developmental problems.
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Affiliation(s)
- Mieke Dereu
- Research Group Developmental Disorders, Department of Experimental Clinical and Health Psychology, Ghent University, Henri Dunantlaan 2, 9000 Ghent, Belgium.
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Shumway S, Farmer C, Thurm A, Joseph L, Black D, Golden C. The ADOS calibrated severity score: relationship to phenotypic variables and stability over time. Autism Res 2012; 5:267-76. [PMID: 22628087 PMCID: PMC3422401 DOI: 10.1002/aur.1238] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Accepted: 04/16/2012] [Indexed: 11/09/2022]
Abstract
Measurement of the severity of autism at a single time point, and over time, is a widespread challenge for researchers. Recently, Gotham, Pickles, and Lord published a severity metric (calibrated severity scores; CSS) that takes into account age and language level and is based on raw total scores of the Autism Diagnostic Observation Schedule (ADOS), a standardized measure commonly used in autism diagnosis. The present study examined psychometric characteristics of the CSS compared to raw scores in an independent sample of 368 children aged 2 to 12 years with autism, pervasive developmental disorder-not otherwise specified (PDD-NOS), non-spectrum delay, or typical development. Reflecting the intended calibration, the CSS were more uniformly distributed within clinical diagnostic category and across ADOS modules than were raw scores. Cross-sectional analyses examining raw and severity scores and their relationships to participant characteristics revealed that verbal developmental level was a significant predictor of raw score but accounted for significantly less variance in the CSS. Longitudinal analyses indicated overall stability of the CSS over 12 to 24 months in children with autism. Findings from this study support the use of the CSS as a more valid indicator of autism severity than the ADOS raw total score, and extend the literature by examining the stability over 12 to 24 months of the CSS in children with ASD.
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Affiliation(s)
- Stacy Shumway
- Pediatrics and Developmental Neuroscience Branch, National Institute of Health, Bethesda, MD 20892, USA
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Abstract
BACKGROUND The nosology of autism spectrum disorders (ASD) is at a critical point in history as the field seeks to better define dimensions of social-communication deficits and restricted/repetitive behaviors on an individual level for both clinical and neurobiological purposes. These different dimensions also suggest an increasing need for quantitative measures that accurately map their differences, independent of developmental factors such as age, language level and IQ. METHOD Psychometric measures, clinical observation as well as genetic, neurobiological and physiological research from toddlers, children and adults with ASD are reviewed. RESULTS The question of how to conceptualize ASDs along dimensions versus categories is discussed within the nosology of autism and the proposed changes to the DSM-5 and ICD-11. Differences across development are incorporated into the new classification frameworks. CONCLUSIONS It is crucial to balance the needs of clinical practice in ASD diagnostic systems, with neurobiologically based theories that address the associations between social-communication and restricted/repetitive dimensions in individuals. Clarifying terminology, improving description of the core features of ASD and other dimensions that interact with them and providing more valid and reliable ways to quantify them, both for research and clinical purposes, will move forward both practice and science.
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Affiliation(s)
- Catherine Lord
- Center for Autism and the Developing Brain, Weill-Cornell Medical College and New York Presbyterian Hospital/Westchester Division, White Plains, NY, USA
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