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Peters BC, Gabriels R, Schmid AA, Lassell RKF, Pan Z, Hoffman A, Hepburn S. Occupational Therapy Using Zones of Regulation™ Concepts: A Feasibility Study. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2024; 44:597-609. [PMID: 38659367 DOI: 10.1177/15394492241246549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
There is a lack of peer-reviewed research on occupational therapy using Zones of Regulation™ concepts for autistic youth. The purpose of this article is to describe the feasibility of a newly-developed occupational therapy intervention using Zones of Regulation™ concepts (OT-ZOR) for autistic youth. Specifically, we aimed to evaluate: (a) participant recruitment, retention, and attendance; (b) intervention fidelity, safety, and assessment completion; (c) intervention acceptability; and (d) preliminary participant outcomes. A single-arm feasibility study was completed with outcome measures before and after 10 weeks of OT-ZOR. Fourteen autistic youth ages 6 to 13 completed the study. Youth attended 94% of OT-ZOR sessions. Providers achieved 97% fidelity to the intervention. Occupational therapists and caregivers expressed overall satisfaction with the OT-ZOR intervention. Youth demonstrated significant decreases in irritability, hyperactivity, emotional reactivity, and dysphoria. OT-ZOR is feasible to implement, acceptable to providers and caregivers, and may improve self-regulation in autistic youth.
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McAllister CA, Rausch MA, Kress VE. Trauma-informed counseling for individuals who have an intellectual developmental disorder: Considerations for mental health counselors. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2024:17446295241278477. [PMID: 39226548 DOI: 10.1177/17446295241278477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/05/2024]
Abstract
Individuals with an intellectual developmental disorder are four times more likely to have a co-occurring mental health diagnosis, as compared to the general population, and 60%-80% of individuals with IDDs have experienced at least one form of abuse. However, counselors receive little training to adequately help this population. In this article, counseling considerations related to individuals who have intellectual development disorder are discussed, with a particular focus on the presence of trauma in this population. Trauma-focused treatment, potential mental health issues, counseling considerations, general issues related to counseling this population, and common associated mental health experiences among this population are addressed. Specific evidence-based counseling approaches, modifications to counseling, and best practices that can be helpful when counseling this population are presented. Due to the unique challenges that individuals with IDDs face, it is essential that counselors address the counseling and mental health needs of this population.
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Affiliation(s)
- Christine A McAllister
- Department of Counseling and Educational Development, University of North Carolina at Greensboro, USA
| | - Meredith A Rausch
- Department of Research, Counseling, and Curriculum, Augusta University, USA
| | - Victoria E Kress
- Department of Counseling, Psychology, and Educational Leadership, Youngstown State University, USA
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Peters BC, Gabriels RL, Schmid AA, Pan Z, Merritt T, Hoffman A, Hepburn S. The feasibility of occupational therapy using Zones of Regulation™ Concepts in an equine environment. Front Psychiatry 2024; 15:1401222. [PMID: 39290298 PMCID: PMC11405308 DOI: 10.3389/fpsyt.2024.1401222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 08/13/2024] [Indexed: 09/19/2024] Open
Abstract
Introduction The current paper aimed to assess the feasibility of a modified intervention protocol named "Occupational Therapy using Zones of Regulation Concepts in an Equine Environment" (OT-ZOR Equine). Methods A single arm A-B feasibility study was conducted, involving 14 autistic youth ages 6-13 years who first received 10-weeks of occupational therapy without horses (OT-ZOR Clinic) followed by 10-weeks of OT-ZOR Equine. Results All participants completed the study and attended 95% of OT-ZOR Equine sessions. Occupational therapists maintained 91% fidelity to the OT-ZOR Equine intervention protocol and there were no serious adverse events. All participants' caregivers and study occupational therapists rated being satisfied or very satisfied with the OT-ZOR Equine intervention. Youth demonstrated improved self-regulation following participation in the OT-ZOR Clinic and OT-ZOR Equine interventions. However, participants' social functioning only improved after OT-ZOR Equine. Discussion This study demonstrated that OT-ZOR Equine is feasible to implement, acceptable to recipients and providers, and may offer additive benefits in social functioning compared to occupational therapy intervention without horses. The current study provides a foundation for future efficacy research aimed at quantifying additive benefits of integrating horses into occupational therapy for autistic youth.
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Affiliation(s)
- B Caitlin Peters
- Temple Grandin Equine Center, Department of Animal Sciences, Colorado State University, Fort Collins, CO, United States
- Department of Occupational Therapy, Colorado State University, Fort Collins, CO, United States
| | - Robin L Gabriels
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Arlene A Schmid
- Department of Occupational Therapy, Colorado State University, Fort Collins, CO, United States
| | - Zhaoxing Pan
- Biostatistics Core of Children's Hospital Colorado Research Institute, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Tamara Merritt
- Hearts & Horses, Inc. Director of Program Innovation and Research, Loveland, CO, United States
| | - Arielle Hoffman
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, United States
| | - Susan Hepburn
- Department of Human Development and Family Studies, Colorado State University, Fort Collins, CO, United States
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Kang N, Sargsyan S, Chough I, Petrick L, Liao J, Chen W, Pavlovic N, Lurmann FW, Martinez MP, McConnell R, Xiang AH, Chen Z. Dysregulated metabolic pathways associated with air pollution exposure and the risk of autism: Evidence from epidemiological studies. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2024; 361:124729. [PMID: 39147228 DOI: 10.1016/j.envpol.2024.124729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 07/24/2024] [Accepted: 08/13/2024] [Indexed: 08/17/2024]
Abstract
Autism spectrum disorder (ASD) is a developmental disorder with symptoms that range from social and communication impairments to restricted interests and repetitive behavior and is the 4th most disabling condition for children aged 5-14. Risk factors of ASD are not fully understood. Environmental risk factors are believed to play a significant role in the ASD epidemic. Research focusing on air pollution exposure as an early-life risk factor of autism is growing, with numerous studies finding associations of traffic and industrial emissions with an increased risk of ASD. One of the possible mechanisms linking autism and air pollution exposure is metabolic dysfunction. However, there were no consensus about the key metabolic pathways and corresponding metabolite signatures in mothers and children that are altered by air pollution exposure and cause the ASD. Therefore, we performed a review of published papers examining the metabolomic signatures and metabolic pathways that are associated with either air pollution exposure or ASD risk in human studies. In conclusion, we found that dysregulated lipid, fatty acid, amino acid, neurotransmitter, and microbiome metabolisms are associated with both short-term and long-term air pollution exposure and the risk of ASD. These dysregulated metabolisms may provide insights into ASD etiology related to air pollution exposure, particularly during the perinatal period in which neurodevelopment is highly susceptible to damage from oxidative stress and inflammation.
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Affiliation(s)
- Ni Kang
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Suzan Sargsyan
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Ino Chough
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Lauren Petrick
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Jiawen Liao
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Wu Chen
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | | | | | - Mayra P Martinez
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Rob McConnell
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Anny H Xiang
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Zhanghua Chen
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA.
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5
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Lin PI, John JR, Masi A, Ong LK, Mathew NE, Moni MA, Eapen V, Walker AK. The relationship between hair cortisol concentration and autism diagnosis. J Psychiatr Res 2024; 176:68-76. [PMID: 38850580 DOI: 10.1016/j.jpsychires.2024.05.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 04/18/2024] [Accepted: 05/29/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND Autistic children are prone to experience heightened levels of distress and physiological reactivity to a range of sensory, social, and emotional stimuli. In line with this, multiple studies have demonstrated that autistic children have higher acute cortisol stress responses to adverse or threatening stimuli and altered cortisol awakening responses. However, few studies have examined whether this sensitivity may relate to heightened levels of chronic stress and persistently elevated hypothalamic-pituitary-adrenal (HPA) axis activity. The measurement of cortisol accumulation in hair is considered a non-invasive biomarker of chronic stress and has been associated with several childhood diseases. Here, we investigated whether hair cortisol concentration in a large sample of autistic children differed from non-autistic children, and after accounting for a range of child, parental and family-level characteristics. METHODS Hair cortisol concentration was measured in 307 autistic children and 282 non-autistic controls aged between 2 and 17 years recruited from four Australian states who participated in providing hair samples and demographic data to the Australian Autism Biobank. Independent samples t-test or one-way analysis of variance (ANOVA) were conducted to determine significant differences in the mean hair cortisol concentration (pg/mg) between potential covariates. Primary analysis included multivariable regression modelling of the collapsed sample to identify variables that were significantly associated with hair cortisol concentration after controlling for covariates. We also accounted for the potential interaction of multiple biological (e.g., age, sex, BMI) and psychosocial characteristics at the level of the child, the mother and the father, and the family unit. RESULTS Our findings suggest that the diagnosis of autism was not a significant predictor of chronic stress, as measured by hair cortisol concentration. However, findings of the multivariable regression analysis showed that key factors such as area of residence (Queensland vs Victorian state of residence) and decrease in child's age were significantly associated with higher hair cortisol concentration whereas lower family income was significantly associated with higher hair cortisol concentration. CONCLUSION To our knowledge, this is the first study to show that socioeconomic factors such as family annual income affect hair cortisol status in autistic children, indicating that the psychosocial environment may be a potential mediator for chronic stress in autistic children just as it has been demonstrated in non-autistic children.
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Affiliation(s)
- Ping-I Lin
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia; Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, MO, USA
| | - James Rufus John
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia; Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia
| | - Anne Masi
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Lin Kooi Ong
- School of Health and Medical Sciences & Centre for Health Research, University of Southern Queensland, Toowoomba, QLD, 4350, Australia; School of Pharmacy, Monash University Malaysia, Selangor, Malaysia; School of Biomedical Sciences and Pharmacy, The University of Newcastle, Callaghan, NSW, Australia; Heart and Stroke Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Nisha E Mathew
- Laboratory of ImmunoPsychiatry, Neuroscience Research Australia, Randwick, NSW, Australia
| | - Mohammed Ali Moni
- School of Health and Rehabilitation Sciences, The University of Queensland, QLD, Australia
| | - Valsamma Eapen
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia; Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia; Academic Unit of Child and Adolescent Psychiatry, South Western Sydney Local Health District (AUCS), Liverpool, NSW, Australia
| | - Adam K Walker
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia; Laboratory of ImmunoPsychiatry, Neuroscience Research Australia, Randwick, NSW, Australia; Drug Discovery Biology Theme, Monash Institute of Pharmaceutical Sciences, Parkville, VIC, Australia.
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Nadeem NJ, Moawad A, Howatson S, Ahmed A, Cassell D. Case report: Diagnostic challenges in an adolescent case of autistic catatonia. Front Psychiatry 2024; 15:1386949. [PMID: 38859882 PMCID: PMC11163276 DOI: 10.3389/fpsyt.2024.1386949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 04/12/2024] [Indexed: 06/12/2024] Open
Abstract
Catatonia is a complex neuropsychiatric syndrome involving a constellation of psychomotor disturbances including catalepsy, waxy flexibility, stupor, mutism, negativism, agitation, posturing, stereotypes, mannerisms, grimacing, echolalia, and echopraxia. Catatonia occurs in several conditions including psychotic, affective and neurodevelopmental disorders such as autism spectrum disorder (ASD). ASD is a neurodevelopmental disorder characterized by persistent deficits in communication, social interaction, restricted interests, repetitive behaviours and sensory sensitivities. Catatonia can occur in response to life stressors such as extreme fear or threat, interpersonal conflict, tragic events or following significant loss. Those with ASD may be particularly vulnerable to the negative impact of stressors and the link between catatonia and ASD is being increasingly recognized. The overlapping features of catatonia and ASD make it difficult to differentiate often resulting in delayed or missed diagnosis. Catatonia in ASD remains a significant clinical challenge; it is difficult to diagnose and can pose debilitating difficulties for those affected. Catatonia is a treatable condition and prompt recognition is vital in securing the best possible outcome. We report a complex and unique case of a 15-year-old boy who presented with severe cognitive and functional decline with a background history of significant bullying and deterioration in his mental state. This case posed a diagnostic conundrum leading to a diagnosis of underlying ASD, anxiety and trauma.
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Affiliation(s)
- Nighat J. Nadeem
- General Adolescent Inpatient Unit, South West London and St George’s Mental Health National Health Service (NHS) Trust, London, United Kingdom
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Hung LY, Margolis KG. Autism spectrum disorders and the gastrointestinal tract: insights into mechanisms and clinical relevance. Nat Rev Gastroenterol Hepatol 2024; 21:142-163. [PMID: 38114585 DOI: 10.1038/s41575-023-00857-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/11/2023] [Indexed: 12/21/2023]
Abstract
Autism spectrum disorders (ASDs) are recognized as central neurodevelopmental disorders diagnosed by impairments in social interactions, communication and repetitive behaviours. The recognition of ASD as a central nervous system (CNS)-mediated neurobehavioural disorder has led most of the research in ASD to be focused on the CNS. However, gastrointestinal function is also likely to be affected owing to the neural mechanistic nature of ASD and the nervous system in the gastrointestinal tract (enteric nervous system). Thus, it is unsurprising that gastrointestinal disorders, particularly constipation, diarrhoea and abdominal pain, are highly comorbid in individuals with ASD. Gastrointestinal problems have also been repeatedly associated with increased severity of the core symptoms diagnostic of ASD and other centrally mediated comorbid conditions, including psychiatric issues, irritability, rigid-compulsive behaviours and aggression. Despite the high prevalence of gastrointestinal dysfunction in ASD and its associated behavioural comorbidities, the specific links between these two conditions have not been clearly delineated, and current data linking ASD to gastrointestinal dysfunction have not been extensively reviewed. This Review outlines the established and emerging clinical and preclinical evidence that emphasizes the gut as a novel mechanistic and potential therapeutic target for individuals with ASD.
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Affiliation(s)
- Lin Y Hung
- Department of Molecular Pathobiology, College of Dentistry, New York University, New York, NY, USA
| | - Kara Gross Margolis
- Department of Molecular Pathobiology, College of Dentistry, New York University, New York, NY, USA.
- Department of Cell Biology, NYU Grossman School of Medicine and Langone Medical Center, New York, NY, USA.
- Department of Pediatrics, NYU Grossman School of Medicine and Langone Medical Center, New York, NY, USA.
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Almulla AF, Thipakorn Y, Tunvirachaisakul C, Maes M. The tryptophan catabolite or kynurenine pathway in autism spectrum disorder; a systematic review and meta-analysis. Autism Res 2023; 16:2302-2315. [PMID: 37909397 DOI: 10.1002/aur.3044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 10/09/2023] [Indexed: 11/03/2023]
Abstract
Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by impaired social communication and interaction, as well as rigid and unchanging interests and behaviors. Several studies have reported that activated immune-inflammatory and nitro-oxidative pathways are accompanied by depletion of plasma tryptophan (TRP), increased competing amino acid (CAAs) levels, and activation of the TRP catabolite (TRYCAT) pathway. This study aims to systematically review and meta-analyze data on peripheral TRP, CAAs, TRYCAT pathway activity, and individual TRYCATs, including kynurenine (KYN) and kynurenic acid (KA) levels, in the blood and urine of ASD patients. After extensively searching PubMed, Google Scholar, and SciFinder, a total of 25 full-text papers were included in the analysis, with a total of 6653 participants (3557 people with ASD and 3096 healthy controls). Our results indicate that blood TRP and the TRP/CAAs ratio were not significantly different between ASD patients and controls (standardized mean difference, SMD = -0.227, 95% confidence interval, CI: -0.540; 0.085, and SMD = 0.158, 95% CI: -0.042; 0.359), respectively. The KYN/TRP ratio showed no significant difference between ASD and controls (SMD = 0.001, 95% CI: -0.169; 0.171). Blood KYN and KA levels were not significantly changed in ASD. Moreover, there were no significant differences in urine TRP, KYN, and KA levels between ASD and controls. We could not establish increases in neurotoxic TRYCATs in ASD. In conclusion, this study demonstrates no abnormalities in peripheral blood TRP metabolism, indoleamine 2,3-dioxygenase enzyme (IDO) activity, or TRYCAT production in ASD. Reduced TRP availability and elevated neurotoxic TRYCAT levels are not substantial contributors to ASD's pathophysiology.
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Affiliation(s)
- Abbas F Almulla
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Medical Laboratory Technology Department, College of Medical Technology, The Islamic University, Najaf, Iraq
| | - Yanin Thipakorn
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Chavit Tunvirachaisakul
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Cognitive Impairment and Dementia Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Michael Maes
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Cognitive Impairment and Dementia Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Department of Psychiatry, Medical University of Plovdiv, Plovdiv, Bulgaria
- Research Institute, Medical University of Plovdiv, Plovdiv, Bulgaria
- Kyung Hee University, Seoul, Korea
- Sichuan Provincial Center for Mental Health, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Key Laboratory of Psychosomatic Medicine, Chinese Academy of Medical Sciences, Chengdu, China
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Schröder SS, Danner UN, Spek AA, van Elburg AA. Exploring the intersection of autism spectrum disorder and eating disorders: understanding the unique challenges and treatment considerations for autistic women with eating disorders. Curr Opin Psychiatry 2023; 36:419-426. [PMID: 37781983 DOI: 10.1097/yco.0000000000000894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
PURPOSE OF REVIEW Autistic women struggle with high levels of both autistic eating behaviours and disordered eating behaviours , which might make them particularly vulnerable to develop eating disorders. Research investigating the presence and characteristics of eating disorders in autistic women is however limited, as is research examining the role of autism in the treatment and recovery of an eating disorder in autistic women. RECENT FINDINGS The link between autism and eating disorders has mainly been investigated from the field of eating disorder research, with studies finding an overrepresentation of autism or autistic traits in eating disorders populations. Findings also suggest that autism or autistic traits are associated with a more serious presentation of the eating disorders, including a higher chance of a chronic course of the eating disorders. Most studies however lack comprehensive autism assessments, making it difficult to determine the actual prevalence of autism and its role in women with eating disorders. SUMMARY Autistic women with an eating disorder seem to suffer from more complex eating disorders and seem to not benefit from current treatment modalities. This could be partly related to specific autism characteristics such as sensory sensitivities, which are not being considered by current treatment protocols. Future research needs to shed light on what underlies the eating behaviours of autistic women with an eating disorder, in order to help to adapt current treatment modalities to meet the unique needs of these women.
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Affiliation(s)
- Sabrina S Schröder
- Altrecht Eating Disorders Rintveld, Zeist
- Department of Clinical Psychology, Utrecht University, Utrecht
| | - Unna N Danner
- Altrecht Eating Disorders Rintveld, Zeist
- Department of Clinical Psychology, Utrecht University, Utrecht
| | - Annelies A Spek
- Autism Expert Center, Goyergracht Zuid 39, Eemnes, The Netherlands
| | - Annemarie A van Elburg
- Altrecht Eating Disorders Rintveld, Zeist
- Department of Clinical Psychology, Utrecht University, Utrecht
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de Lange S, Muller D, Dafkin C. The relationship between balance and urinary cortisol and neopterin in autistic children. COMPREHENSIVE PSYCHONEUROENDOCRINOLOGY 2023; 16:100216. [PMID: 38023738 PMCID: PMC10651439 DOI: 10.1016/j.cpnec.2023.100216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 10/27/2023] [Accepted: 10/27/2023] [Indexed: 12/01/2023] Open
Abstract
Autism Spectrum Disorder (ASD) is a neurodevelopmental condition characterized by stereotyped behavior, restricted interests and social/communicative deficits. The physiological etiology of ASD is not currently understood, however recent research has implicated dysregulation of the immune system as a central feature. The interplay between the stress systems, the immune system and the brain has been well-documented and implicated in other psychiatric and neurological disorders. This interplay suggests a role for the hypothalamic-pituitary-adrenal (HPA) axis in the etiology of ASD. We assessed levels of urinary cortisol and neopterin as markers of immune function and HPA activation in a cohort of 50 children from the central Johannesburg region. Additionally, we used the Autism Treatment Evaluation Checklist to assess autistic symptomatology and the Bruininks-Oseretsky Motor Proficiency Test (Second Edition) (BOT-2) to assess motor skills. No relationships were found between cortisol and autistic symptomatology. No relationships were found between neopterin and any of the other measures. However, a relationship was observed between urinary cortisol and performance on balance-related tasks from the BOT-2 (P < 0.05). Our findings support a theory of neurological interconnectedness between postural modulation and activation of the stress system, which has not previously been documented in children with ASD.
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Affiliation(s)
- Siobhan de Lange
- Movement Physiology Research Laboratory, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Dee Muller
- Stress Laboratory, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Chloe Dafkin
- Movement Physiology Research Laboratory, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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11
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Bemmouna D, Weiner L. Linehan's biosocial model applied to emotion dysregulation in autism: a narrative review of the literature and an illustrative case conceptualization. Front Psychiatry 2023; 14:1238116. [PMID: 37840783 PMCID: PMC10570453 DOI: 10.3389/fpsyt.2023.1238116] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 09/11/2023] [Indexed: 10/17/2023] Open
Abstract
Emotion dysregulation (ED) is a transdiagnostic difficulty prevalent in autism spectrum condition (ASC). Importantly, recent research has suggested that ED is involved in self-harm and suicidality. Pre-existing models on the etiology of ED in ASC focus mainly on biological factors to ASC features, such as sensory sensitivities, poor flexibility, and sensitivity to change. However, although psychosocial factors seem to play a role in the emergence of ED in ASC as well (e.g., childhood maltreatment and camouflaging), there is a lack of a comprehensive model conceptualizing biosocial factors involved in ED in autistic people. Linehan's biosocial model (1993) is one of the leading etiological models of ED in borderline personality disorder (BPD). It conceptualizes ED as emerging from transactions between a pre-existing emotional vulnerability in the child and an invalidating developmental environment. Beyond its clinical relevance, Linehan's model has gathered empirical evidence supporting its pertinence in BPD and in other psychiatric disorders. Although ASC and BPD are two distinct diagnoses, because they may share ED, Linehan's biosocial model might be useful for understanding the development of ED in ASC. Hence, this article aims to provide an application and extension of Linehan's model to conceptualize ED in ASC. To do so, we conducted a narrative review of the literature on ED and its underlying factors in ASC from a developmental perspective. To investigate the pertinence of the biosocial model applied to ED in autistic people, we were interested on data on (i) ED and its behavioral correlates in ASC, in relation to the biosocial model, (ii) the potential biological and psychosocial correlates of ED in ASC and (iii) the overlapping difficulties in ASC and BPD. Finally, to assess the pertinence of the model, we applied it to the case of an autistic woman presenting with ED and suicidal behaviors. Our review and application to the case of an autistic woman suggest that ED in ASC encompasses factors related to both biological and psychosocial risk factors as conceptualized in the BPD framework, although in both domains ASC-specific factors might be involved.
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Affiliation(s)
- Doha Bemmouna
- Faculté de Psychologie, Université de Strasbourg, Strasbourg, France
| | - Luisa Weiner
- Faculté de Psychologie, Université de Strasbourg, Strasbourg, France
- Département de Psychiatrie Adulte, Hôpitaux Universitaires de Strasbourg, Strasbourg, Alsace, France
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12
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Seker A, Qirko-Gurakuqi A, Tabaku M, Javate KRP, Rathwell I. Maternal atopic conditions and autism spectrum disorder: a systematic review. Eur Child Adolesc Psychiatry 2023:10.1007/s00787-023-02285-7. [PMID: 37661216 DOI: 10.1007/s00787-023-02285-7] [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: 11/27/2022] [Accepted: 08/14/2023] [Indexed: 09/05/2023]
Abstract
Autism spectrum disorder (ASD) is a disabling neurodevelopmental condition with complex etiology. Emerging evidence has pointed to maternal atopy as a possible risk factor. It is hypothesized that maternal atopic disease during pregnancy can lead to increased levels of inflammatory cytokines in fetal circulation via placental transfer or increased production. These cytokines can then pass through the immature blood-brain barrier, causing aberrant neurodevelopment via mechanisms including premature microglial activation. The objective of this study is to systematically review observational studies that investigate whether a maternal history of atopic disease (asthma, allergy, or eczema/atopic dermatitis) is associated with a diagnosis of ASD in offspring. A search was conducted in Ovid MEDLINE, PsycINFO, and Embase databases for relevant articles up to November 2021; this was later updated in January 2022. Observational studies published in peer-reviewed journals were included. Data were synthesized and qualitatively analyzed according to the specific atopic condition. Quality assessment was done using the Newcastle-Ottawa Scale. Nine articles were identified, with all including asthma as an exposure, alongside four each for allergy and eczema. Findings were inconsistent regarding the association between a maternal diagnosis of either asthma, allergy, or eczema, and ASD in offspring, with variations in methodology contributing to the inconclusiveness. More consistent associations were demonstrated regarding maternal asthma that was treated or diagnosed during pregnancy. Evidence suggests that symptomatic maternal asthma during pregnancy could be associated with ASD in offspring, underscoring the importance of effective management of atopic conditions during pregnancy. Further research is needed, particularly longitudinal studies that use gold-standard assessment tools and correlate clinical outcomes with laboratory and treatment data.PROSPERO Registration Number and Date: CRD42018116656, 26.11.2018.
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Affiliation(s)
- Asilay Seker
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
- South London and Maudsley NHS Foundation Trust, London, UK.
| | - Anxhela Qirko-Gurakuqi
- Department of Biomedical and Experimental Subjects, University of Medicine, Tirana, Albania
| | - Mirela Tabaku
- Paediatric Department, University of Medicine, Tirana, Albania
| | - Kenneth Ross P Javate
- Department of Psychiatry, The Medical City Hospital, Manila, Philippines
- School of Medicine and Public Health, Ateneo de Manila University, Manila, Philippines
| | - Iris Rathwell
- South London and Maudsley NHS Foundation Trust, London, UK
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13
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Griffioen RE, van Boxtel GJM, Verheggen T, Enders-Slegers MJ, Van Der Steen S. Group Changes in Cortisol and Heart Rate Variability of Children with Down Syndrome and Children with Autism Spectrum Disorder during Dog-Assisted Therapy. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1200. [PMID: 37508697 PMCID: PMC10378440 DOI: 10.3390/children10071200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 07/05/2023] [Accepted: 07/09/2023] [Indexed: 07/30/2023]
Abstract
Dog-assisted therapy is hypothesized to lower stress in children with autism spectrum disorder (ASD) and children with Down syndrome (DS), which may be visible on a physiological level. In this study, we measured heart rate variability (HRV) and salivary cortisol of 20 children with DS or ASD at the beginning and end of six weekly sessions of dog-assisted therapy. We found a decrease of cortisol levels during single sessions, but no overall effect after six sessions (six weeks). The effect of dog-assisted therapy on the increase of HRV could not be confirmed. This study is one of the first to use physiological measurements to test the effects of DAT.
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Affiliation(s)
- Richard E Griffioen
- Department of Animal Assisted Interventions, Aeres University of Applied Sciences, De Drieslag 4, 8251 JZ Dronten, The Netherlands
| | - Geert J M van Boxtel
- Tilburg School of Social and Behavioral Sciences, Tilburg University, Professor Cobbenhagenlaan, 5037 AB Tilburg, The Netherlands
| | - Theo Verheggen
- Department of Psychology and Education, Open University The Netherlands, Valkenburgerweg 177, 6419 AT Heerlen, The Netherlands
| | - Marie-Jose Enders-Slegers
- Department of Psychology and Education, Open University The Netherlands, Valkenburgerweg 177, 6419 AT Heerlen, The Netherlands
| | - Steffie Van Der Steen
- Faculty of Behavioural and Social Sciences, University of Groningen, Grote Kruisstraat 2/1, 9712 TS Groningen, The Netherlands
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14
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Hotez E, Rava J, Russ S, Ware A, Halfon N. Using a life course health development framework to combat stigma-related health disparities for individuals with intellectual and/or developmental disability (I/DD). Curr Probl Pediatr Adolesc Health Care 2023; 53:101433. [PMID: 37867057 DOI: 10.1016/j.cppeds.2023.101433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
In the U.S., 1 in 6 children has an intellectual and/or developmental disability (I/DD). This population experiences a multitude of negative health outcomes across the life course, relative to the general population. Stigma-the social devaluation of individuals with certain characteristics, identities, or statuses within interpersonal, educational, healthcare, and policy contexts-is a potentially preventable contributor to health disparities. To date, existing approaches for addressing and preventing stigma are limited to discrete and siloed interventions that often fail to address the lifelong, cumulative impacts of the specific types of stigma experienced by the I/DD population. In the current paper, we describe three elements of Life Course Health Development (LCHD)-a novel translational framework that draws on evidence from biology, sociology, epidemiology, and psychology-that healthcare providers can use to prevent stigma-related health disparities and improve outcomes for individuals with I//DDs. We discuss the utility of targeting prevention to sensitive periods; prioritizing interventions for the most damaging types of stigmas; and leveraging supports from multiple service systems and sectors. By incorporating evidence from life course science into efforts to address stigma-related health disparities, providers can more effectively and strategically prevent and combat stigma-related health disparities for the I/DD population in childhood and across the life course.
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Affiliation(s)
- Emily Hotez
- University of California, Los Angeles (UCLA), David Geffen School of Medicine, Department of General Internal Medicine / Health Services Research, 911 Broxton Ave, Los Angeles, CA, 90095, United States; University of California, Los Angeles (UCLA), David Geffen School of Medicine, Department of Pediatrics, Center for Healthier Children, Families, & Communities, 10960 Wilshire Blvd., Suite 960, Los Angeles, CA 90024-3913, United States.
| | - Julianna Rava
- University of California, Los Angeles (UCLA), David Geffen School of Medicine, Department of General Internal Medicine / Health Services Research, 911 Broxton Ave, Los Angeles, CA, 90095, United States; University of California, Los Angeles (UCLA), David Geffen School of Medicine, Department of Pediatrics, Center for Healthier Children, Families, & Communities, 10960 Wilshire Blvd., Suite 960, Los Angeles, CA 90024-3913, United States
| | - Shirley Russ
- University of California, Los Angeles (UCLA), David Geffen School of Medicine, Department of General Internal Medicine / Health Services Research, 911 Broxton Ave, Los Angeles, CA, 90095, United States; University of California, Los Angeles (UCLA), David Geffen School of Medicine, Department of Pediatrics, Center for Healthier Children, Families, & Communities, 10960 Wilshire Blvd., Suite 960, Los Angeles, CA 90024-3913, United States
| | - Allysa Ware
- Family Voices, 110 Hartwell Avenue, Lexington, MA, 02421, United States
| | - Neal Halfon
- University of California, Los Angeles (UCLA), David Geffen School of Medicine, Department of Pediatrics, Center for Healthier Children, Families, & Communities, 10960 Wilshire Blvd., Suite 960, Los Angeles, CA 90024-3913, United States; Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, United States; Department of Public Policy, UCLA Luskin School of Public Affairs, Los Angeles, CA, United States
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15
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Abstract
Children with autism spectrum disorder frequently present with atypical behavioral responses to sensory stimuli, as well as differences in autonomic nervous system (ANS) and neuroendocrine activity. However, no one consistent pattern appears to explain these differences within this heterogeneous population. To conceptualize more homogenous ASD subgroups, sensory-based subtypes have been explored. One subtyping mechanism groups children by sensory responsivity pattern in addition to sensory domain. Differences in nervous system responsivity to sensory input within this sensory-based subtyping scheme have not yet been investigated. This exploratory study used ANS indices (respiratory sinus arrhythmia [RSA], skin conductance level) and neuroendocrine (salivary cortisol) response to examine patterns differentiating these subtypes. Significant differences in RSA were found during baseline, and during tactile, tone and movement stimuli (p < 0.05). Subtype membership was predicted by RSA changes during auditory stimulation and recovery periods (p < 0.05). Results confirm that children with an adaptive sensory responsivity subtype differ from those children with sensory processing dysfunction, however, physiological variables did not distinguish between children with different patterns of sensory processing dysfunction.
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16
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A comparison of stress reactivity between BTBR and C57BL/6J mice: an impact of early-life stress. Exp Brain Res 2023; 241:687-698. [PMID: 36670311 DOI: 10.1007/s00221-022-06541-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 12/28/2022] [Indexed: 01/21/2023]
Abstract
Early-life stress (ELS) is associated with hypothalamic-pituitary-adrenal (HPA) axis dysregulation and can increase the risk of psychiatric disorders later in life. The aim of this study was to investigate the influence of ELS on baseline HPA axis functioning and on the response to additional stress in adolescent male mice of strains C57BL/6J and BTBR. As a model of ELS, prolonged separation of pups from their mothers (for 3 h once a day: maternal separation [MS]) was implemented. To evaluate HPA axis activity, we assessed serum corticosterone levels and mRNA expression of corticotropin-releasing hormone (Crh) in the hypothalamus, of steroidogenesis genes in adrenal glands, and of an immediate early gene (c-Fos) in both tissues at baseline and immediately after 1 h of restraint stress. HPA axis activity at baseline did not depend on the history of ELS in mice of both strains. After the exposure to the acute restraint stress, C57BL/6J-MS mice showed less pronounced upregulation of Crh and of corticosterone concentration as compared to the control, indicating a decrease in stress reactivity. By contrast, BTBR-MS mice showed stronger upregulation of c-Fos in the hypothalamus and adrenal glands as compared to controls, thus pointing to greater activation of these organs in response to the acute restraint stress. In addition, we noted that BTBR mice are more stress reactive (than C57BL/6J mice) because they exhibited greater upregulation of corticosterone, c-Fos, and Cyp11a1 in response to the acute restraint stress. Taken together, these results indicate strain-specific and situation-dependent effects of ELS on HPA axis functioning and on c-Fos expression.
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17
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Mintz Hemed N, Melosh NA. An integrated perspective for the diagnosis and therapy of neurodevelopmental disorders - From an engineering point of view. Adv Drug Deliv Rev 2023; 194:114723. [PMID: 36746077 DOI: 10.1016/j.addr.2023.114723] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 12/14/2022] [Accepted: 01/29/2023] [Indexed: 02/05/2023]
Abstract
Neurodevelopmental disorders (NDDs) are complex conditions with largely unknown pathophysiology. While many NDD symptoms are familiar, the cause of these disorders remains unclear and may involve a combination of genetic, biological, psychosocial, and environmental risk factors. Current diagnosis relies heavily on behaviorally defined criteria, which may be biased by the clinical team's professional and cultural expectations, thus a push for new biological-based biomarkers for NDDs diagnosis is underway. Emerging new research technologies offer an unprecedented view into the electrical, chemical, and physiological activity in the brain and with further development in humans may provide clinically relevant diagnoses. These could also be extended to new treatment options, which can start to address the underlying physiological issues. When combined with current speech, language, occupational therapy, and pharmacological treatment these could greatly improve patient outcomes. The current review will discuss the latest technologies that are being used or may be used for NDDs diagnosis and treatment. The aim is to provide an inspiring and forward-looking view for future research in the field.
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Affiliation(s)
- Nofar Mintz Hemed
- Department of Materials Science and Engineering, Stanford University, Stanford, CA 94305, USA.
| | - Nicholas A Melosh
- Department of Materials Science and Engineering, Stanford University, Stanford, CA 94305, USA
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18
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Casten LG, Thomas TR, Doobay AF, Foley-Nicpon M, Kramer S, Nickl-Jockschat T, Abel T, Assouline S, Michaelson JJ. The combination of autism and exceptional cognitive ability is associated with suicidal ideation. Neurobiol Learn Mem 2023; 197:107698. [PMID: 36450307 PMCID: PMC10088461 DOI: 10.1016/j.nlm.2022.107698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 10/04/2022] [Accepted: 10/31/2022] [Indexed: 11/29/2022]
Abstract
Autism with co-occurring exceptional cognitive ability is often accompanied by severe internalizing symptoms and feelings of inadequacy. Whether cognitive ability also translates into greater risk for suicidal ideation is unclear. To investigate this urgent question, we examined two samples of high-ability autistic individuals for factors that were predictive of suicidal ideation. In the first sample (N = 1,074 individuals seen at a clinic specializing in gifted/talented youth), we observed a striking excess of parent-reported suicidal ideation in autistic individuals with IQ ≥ 120 (Odds Ratio = 5.9, p=0.0007). In a separate sample of SPARK participants, we confirmed higher rates of suicidal thoughts compared to non-autistic children from the ABCD cohort (combined N = 16,049, Odds Ratio = 6.8, p<2.2e-16), and further that autistic children with suicidal thoughts had significantly higher cognitive ability (p<2.2e-16) than those without. Elevated polygenic scores (PGS) for cognitive performance were associated with increased suicidal thoughts (N = 1,983, Z=2.16,p=0.03), with PGS for educational attainment trending in the same direction (Z=1.4,p=0.17). Notably, similar results were found in parents of these autistic youth, where higher PGS for educational attainment was associated with increasing thoughts of suicide (N = 736, Z=2.28,p=0.02). Taken together, these results suggest that on a phenotypic and genetic level, increasing cognitive ability is an unexpected risk factor for suicidal ideation in individuals diagnosed with, or at risk for autism.
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Affiliation(s)
- Lucas G Casten
- Department of Psychiatry, University of Iowa, United States; Interdisciplinary Graduate Program in Genetics, University of Iowa, United States; Iowa Neuroscience Institute, University of Iowa, United States
| | - Taylor R Thomas
- Department of Psychiatry, University of Iowa, United States; Interdisciplinary Graduate Program in Genetics, University of Iowa, United States; Iowa Neuroscience Institute, University of Iowa, United States
| | - Alissa F Doobay
- Belin-Blank Center, University of Iowa, United States; Department of Psychological and Quantitative Foundations, University of Iowa, United States
| | - Megan Foley-Nicpon
- Belin-Blank Center, University of Iowa, United States; Department of Psychological and Quantitative Foundations, University of Iowa, United States
| | - Sydney Kramer
- Department of Psychiatry, University of Iowa, United States; Iowa Neuroscience Institute, University of Iowa, United States
| | - Thomas Nickl-Jockschat
- Department of Psychiatry, University of Iowa, United States; Iowa Neuroscience Institute, University of Iowa, United States; Department of Neuroscience and Pharmacology, University of Iowa, United States
| | - Ted Abel
- Iowa Neuroscience Institute, University of Iowa, United States; Department of Neuroscience and Pharmacology, University of Iowa, United States
| | - Susan Assouline
- Belin-Blank Center, University of Iowa, United States; Department of Psychological and Quantitative Foundations, University of Iowa, United States
| | - Jacob J Michaelson
- Department of Psychiatry, University of Iowa, United States; Iowa Neuroscience Institute, University of Iowa, United States.
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19
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Mahony C, O'Ryan C. A molecular framework for autistic experiences: Mitochondrial allostatic load as a mediator between autism and psychopathology. Front Psychiatry 2022; 13:985713. [PMID: 36506457 PMCID: PMC9732262 DOI: 10.3389/fpsyt.2022.985713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 11/07/2022] [Indexed: 11/27/2022] Open
Abstract
Molecular autism research is evolving toward a biopsychosocial framework that is more informed by autistic experiences. In this context, research aims are moving away from correcting external autistic behaviors and toward alleviating internal distress. Autism Spectrum Conditions (ASCs) are associated with high rates of depression, suicidality and other comorbid psychopathologies, but this relationship is poorly understood. Here, we integrate emerging characterizations of internal autistic experiences within a molecular framework to yield insight into the prevalence of psychopathology in ASC. We demonstrate that descriptions of social camouflaging and autistic burnout resonate closely with the accepted definitions for early life stress (ELS) and chronic adolescent stress (CAS). We propose that social camouflaging could be considered a distinct form of CAS that contributes to allostatic overload, culminating in a pathophysiological state that is experienced as autistic burnout. Autistic burnout is thought to contribute to psychopathology via psychological and physiological mechanisms, but these remain largely unexplored by molecular researchers. Building on converging fields in molecular neuroscience, we discuss the substantial evidence implicating mitochondrial dysfunction in ASC to propose a novel role for mitochondrial allostatic load in the relationship between autism and psychopathology. An interplay between mitochondrial, neuroimmune and neuroendocrine signaling is increasingly implicated in stress-related psychopathologies, and these molecular players are also associated with neurodevelopmental, neurophysiological and neurochemical aspects of ASC. Together, this suggests an increased exposure and underlying molecular susceptibility to ELS that increases the risk of psychopathology in ASC. This article describes an integrative framework shaped by autistic experiences that highlights novel avenues for molecular research into mechanisms that directly affect the quality of life and wellbeing of autistic individuals. Moreover, this framework emphasizes the need for increased access to diagnoses, accommodations, and resources to improve mental health outcomes in autism.
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Affiliation(s)
| | - Colleen O'Ryan
- Department of Molecular and Cell Biology, University of Cape Town, Cape Town, South Africa
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20
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Rinaldi A, Martins MCM, Maioli M, Rinaldi S, Fontani V. REAC Noninvasive Neurobiological Stimulation in Autism Spectrum Disorder for Alleviating Stress Impact. ADVANCES IN NEURODEVELOPMENTAL DISORDERS 2022; 7:244-251. [PMID: 36213521 PMCID: PMC9525921 DOI: 10.1007/s41252-022-00293-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/23/2022] [Indexed: 05/05/2023]
Abstract
Objectives Autism spectrum disorder (ASD) symptoms can become more evident because of different factors. Among these, depression, anxiety, and stress play an important role. Additionally, several studies have revealed the impact of the COVID-19 pandemic on participants with ASD. In previous studies, two noninvasive neurobiological stimulation treatments with radio electric asymmetric conveyer (REAC) technology, called neuropostural optimization (NPO) and neuropsychophysical optimization (NPPO), were shown to be effective in improving the subjective response to environmental stressors in the general population and in ASD population. Based on the proven efficacy of REAC NPO and NPPOs treatments in alleviating anxiety, stress, and depression, the purpose of this study is to verify how these treatments can reduce the severity of ASD symptoms expression, which is aggravated by depression, anxiety, and stress. The treatments' effects were perceived by caregivers and assessed by the Autism Treatment Evaluation Checklist (ATEC). Methods This study involved 46 children with a previous diagnosis of ASD made using the Autism Diagnostic Observation Schedule and Autism Diagnostic Interview-Revised. The participants received one session of NPO treatment and one NPPOs treatment cycle of 18 sessions, administered within approximately 3 weeks. The Autism Treatment Evaluation Checklist (ATEC) was used to evaluate the efficacy of the REAC treatments. ATEC allows to evaluate four clusters (speech or language communication; sociability; sensory or cognitive awareness; and health/physical/behavior) through a numerical scale that measures increasing levels of ASD severity. Results The comparison between the scores of the ATEC administered pre- and post-REAC treatments highlighted an improvement of ASD symptoms in each of the four clusters of ATEC. Conclusions The results confirm the usefulness of REAC treatments to optimize the individual response to environmental stressors and reduce the symptomatic expression and deficits present in ASD.
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Affiliation(s)
- Arianna Rinaldi
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
- Department of Adaptive Neuro Psycho Physio Pathology and Neuro Psycho Physical Optimization, Rinaldi Fontani Institute, Florence, Italy
| | - Márcia C. Marins Martins
- International Scientific Society of Neuro Psycho Physical Optimization With REAC Technology, Brazilian Branch, São Paulo, Brazil
| | - Margherita Maioli
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Salvatore Rinaldi
- Department of Adaptive Neuro Psycho Physio Pathology and Neuro Psycho Physical Optimization, Rinaldi Fontani Institute, Florence, Italy
- Research Department, Rinaldi Fontani Foundation, Florence, Italy
| | - Vania Fontani
- Department of Adaptive Neuro Psycho Physio Pathology and Neuro Psycho Physical Optimization, Rinaldi Fontani Institute, Florence, Italy
- Research Department, Rinaldi Fontani Foundation, Florence, Italy
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21
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Dal Pai J, Wolff CG, Aranchipe CS, Kepler CK, dos Santos GA, Canton LAL, de Carvalho AB, Richter SA, Nunes ML. COVID-19 Pandemic and Autism Spectrum Disorder, Consequences to Children and Adolescents - a Systematic Review. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2022; 11:1-26. [PMID: 36189101 PMCID: PMC9510314 DOI: 10.1007/s40489-022-00344-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 08/27/2022] [Indexed: 11/13/2022]
Abstract
In this systematic review, we aimed to identify the impact of the COVID-19 pandemic on children/adolescents with a diagnosis of autism spectrum disorder (ASD). The protocol was registered on PROSPERO CRD42021255848. Articles were selected from PubMed, Embase, and LILACS according to these characteristics: patients from zero to 18 years old, exposed to the COVID-19 pandemic, impact on social communication/interaction and restricted/repetitive behavior domains. The Newcastle-Ottawa Scale was used to assess methodological quality and the risk of bias. Of the 351 articles initially identified, 26 were finally included with information on 8,610 patients. Although the studies were heterogeneous, they indicated that the pandemic-related issues experienced by patients with ASD were mostly manifested in their behavior and sleep patterns. Supplementary Information The online version contains supplementary material available at 10.1007/s40489-022-00344-4.
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Affiliation(s)
- Janise Dal Pai
- Brain Institute of Rio Grande Do Sul, Pontifical Catholic University of Rio Grande do Sul (InsCer/PUCRS), Porto Alegre, Brazil
| | - Cecília Gatti Wolff
- Extension and Management of Continuing Education Activities Program, Pontifical Catholic University of Rio Grande do Sul (PEGA/PUCRS), Porto Alegre, Brazil
| | - Carolina Siciliani Aranchipe
- Extension and Management of Continuing Education Activities Program, Pontifical Catholic University of Rio Grande do Sul (PEGA/PUCRS), Porto Alegre, Brazil
| | - Carolina Knorst Kepler
- Extension and Management of Continuing Education Activities Program, Pontifical Catholic University of Rio Grande do Sul (PEGA/PUCRS), Porto Alegre, Brazil
| | - Gabriele Alves dos Santos
- Extension and Management of Continuing Education Activities Program, Pontifical Catholic University of Rio Grande do Sul (PEGA/PUCRS), Porto Alegre, Brazil
| | - Luiz Augusto Leal Canton
- Extension and Management of Continuing Education Activities Program, Pontifical Catholic University of Rio Grande do Sul (PEGA/PUCRS), Porto Alegre, Brazil
| | - Antonella Brun de Carvalho
- Extension and Management of Continuing Education Activities Program, Pontifical Catholic University of Rio Grande do Sul (PEGA/PUCRS), Porto Alegre, Brazil
| | - Samanta Andresa Richter
- Brain Institute of Rio Grande Do Sul, Pontifical Catholic University of Rio Grande do Sul (InsCer/PUCRS), Porto Alegre, Brazil
| | - Magda Lahorgue Nunes
- School of Medicine, Pontifical Catholic University of Rio Grande do Sul (InsCer/PUCRS), Av Ipiranga 6690, building 63, 2nd floor, 90610-000 Porto Alegre, Brazil
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22
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Nakamura M, Nakagami A, Nakagaki K, Yasue M, Kawai N, Ichinohe N. Prenatal valproic acid-induced autism marmoset model exhibits higher salivary cortisol levels. Front Behav Neurosci 2022; 16:943759. [PMID: 36035018 PMCID: PMC9405662 DOI: 10.3389/fnbeh.2022.943759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 07/14/2022] [Indexed: 11/13/2022] Open
Abstract
Individuals with autism spectrum disorder (ASD) are exposed to a variety of stressors owing to their behavioral traits. Cortisol is a hormone typically associated with stress, and its concentration and response to stress are higher in individuals with ASD than in controls. The mechanisms underlying cortisol dysregulation in ASD have been explored in rodents. Although rodent models have successfully replicated the major symptoms of autism (i.e., impaired vocal communication, social interaction deficits, and restricted/repetitive patterns of behavior), evidence suggests that the hypothalamic-pituitary-adrenal (HPA) axis system differs between rodents and primates. We developed an ASD model in the common marmoset (Callithrix jacchus), a New World monkey, utilizing prenatal exposure to valproic acid (VPA). In this study, we collected the salivary cortisol levels in VPA-exposed and unexposed marmosets in the morning and afternoon. Our results revealed that both VPA-exposed and unexposed marmosets showed similar diurnal changes in cortisol levels, which were lower in the afternoon than in the morning. However, heightened cortisol levels were observed throughout the day in VPA-exposed marmosets. These results are consistent with those of ASD in humans. Our results suggest that VPA-exposed marmosets show similarities not only in their behavioral patterns and brain pathologies, which we have reported previously, but also in hormonal regulation, validating the usefulness of VPA-exposed marmosets also as a tool for ASD stress research.
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Affiliation(s)
- Madoka Nakamura
- Department of Cognitive and Psychological Sciences, Graduate School of Informatics, Nagoya University, Nagoya, Japan
- Laboratory for Ultrastructure Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Akiko Nakagami
- Department of Cognitive and Psychological Sciences, Graduate School of Informatics, Nagoya University, Nagoya, Japan
- Laboratory for Ultrastructure Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Kodaira, Japan
- Department of Psychology, Japan Women’s University, Tokyo, Japan
| | - Keiko Nakagaki
- Laboratory for Ultrastructure Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Miyuki Yasue
- Department of Cognitive and Psychological Sciences, Graduate School of Informatics, Nagoya University, Nagoya, Japan
- Laboratory for Ultrastructure Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Nobuyuki Kawai
- Department of Cognitive and Psychological Sciences, Graduate School of Informatics, Nagoya University, Nagoya, Japan
- Academy of Emerging Science, Chubu University, Kasugai, Japan
- *Correspondence: Nobuyuki Kawai,
| | - Noritaka Ichinohe
- Laboratory for Ultrastructure Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Kodaira, Japan
- Noritaka Ichinohe,
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23
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Androgens Tend to Be Higher, but What about Altered Progesterone Metabolites in Boys and Girls with Autism? Life (Basel) 2022; 12:life12071004. [PMID: 35888093 PMCID: PMC9324026 DOI: 10.3390/life12071004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 06/21/2022] [Accepted: 07/04/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Evidence exists that steroid hormones are altered in individuals with autism, especially androgens. Despite lower prevalence in girls than boys, evidence of potential alterations in progesterone metabolites is sparse, so the aim of this study was to elucidate different progesterone metabolites in affected children with autism versus healthy controls. Material and Methods: Circadian urine samples from 48 boys and 16 girls with autism spectrum disorders and a matched case−control group were analysed for progesterone metabolites by gas chromatography−mass spectrometry and normalised for creatinine excretion. Results: In boys with autism, the majority of progesterone metabolites were reduced, such as progesterone, 6a-OH-3a5b-TH-progesterone, or 20a-DH-progesterone (p < 0.01 for all). In girls with autism, a similar pattern of reduction in progesterone metabolites was detected; however, potentially due to the relatively small sample, this pattern was only detectable on the level of a trend. Discussion: As stated, androgen levels are higher in boys and girls with autism, but evidence for progesterone metabolites is much sparser. The pattern of a decrease in progesterone metabolites suggests the existence of an altered routing of steroid metabolites, probably in combination with a dysregulation of the HPAG axis. As, recently, increased CYP17A1 activity has been suggested, the stronger routing towards androgens is further implied in line with our findings of lower progesterone concentrations in boys and girls with autism than healthy controls.
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24
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Wong ASK, Burns S, Woodruff E. Examining the impact of social stressor stimuli in eliciting physiological reactivity in children and adolescents with autism spectrum disorder: a systematic review and meta-analysis protocol. BMJ Open 2022; 12:e060048. [PMID: 35768097 PMCID: PMC9244685 DOI: 10.1136/bmjopen-2021-060048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 06/17/2022] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Stress is not experienced the same by everyone. Some individuals, such as individuals with autism spectrum disorder (ASD), are at risk of heightened sensitivity to stress responses. ASD is a neurodevelopmental disorder commonly characterised by deficits in social communication and social interaction. Among different stressor stimuli, social stressors are particularly worth our attention due to the social and communication challenges inherent in ASD. This study aims to systematically evaluate different social stressor stimuli in eliciting physiological reactivity in ASD, focusing on the children and adolescent population. METHODS AND ANALYSIS We designed a study protocol for this study and submitted it to PROSPERO for systematic review registration. Any studies with children and adolescents with ASD between the ages of 0 and 18 in clinical and community settings will be included. All types of social stressor interventions will be included. The outcome of interest will include studies with physiological activity of the participants being measured, for example, measures related to autonomic functioning, electrodermal functioning and cortisol level. The primary literature sources will be across four electronic databases: MEDLINE, Embase, PsycInfo and CINAHL in August 2021. The second source of literature will be across grey literature, including ProQuest Dissertations & Theses Global and across clinical trial registries in August 2021. Hand searching of references will be performed on the reference lists of all included studies. Two volunteers pursuing postgraduate-level studies will independently search and screen potential studies for eligibility. Finally, all references considered by hand searching will be reviewed by two researchers. The methodological quality of the research will be assessed by adopting the quality assessment used by a previous study. The assessment consists of four primary categories: descriptive validity, internal validity, external validity and statistical conclusion validity. ETHICS AND DISSEMINATION No ethical approval is required for this study. Results will be disseminated through conferences and publications in relevant peer-reviewed journals. PROSPERO REGISTRATION NUMBER CRD42021244039.
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Affiliation(s)
- Agnes S K Wong
- Ontario Institute for Studies in Education, University of Toronto, Toronto, Ontario, Canada
| | - Samantha Burns
- Ontario Institute for Studies in Education, University of Toronto, Toronto, Ontario, Canada
| | - Earl Woodruff
- Ontario Institute for Studies in Education, University of Toronto, Toronto, Ontario, Canada
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Peters BC, Pan Z, Christensen H, Gabriels RL. Self-Regulation Mediates Therapeutic Horseback Riding Social Functioning Outcomes in Youth With Autism Spectrum Disorder. Front Pediatr 2022; 10:884054. [PMID: 35837236 PMCID: PMC9273942 DOI: 10.3389/fped.2022.884054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 06/06/2022] [Indexed: 11/15/2022] Open
Abstract
Emerging evidence suggests therapeutic horseback riding improves self-regulation behaviors, social functioning, and language in youth with autism spectrum disorder (ASD). It has been theorized that interacting with horses is calming for youth with ASD, which may influence social and language outcomes. The current study is an exploratory secondary mediation analysis of a previously published randomized controlled trial of therapeutic horseback riding for youth with ASD. We hypothesized that self-regulation would mediate therapeutic horseback riding's effect on social and language outcomes in youth with ASD. Results indicate that self-regulation mediates therapeutic horseback riding's effect on social, but not language outcomes. This paper provides support for the hypothesis that interacting with horses may have a calming effect that serves as a platform for improving social outcomes in youth with autism.
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Affiliation(s)
- B. Caitlin Peters
- Temple Grandin Equine Center, Department of Animal Sciences, Colorado State University, Fort Collins, CO, United States
| | - Zhaoxing Pan
- Department of Pediatrics, School of Medicine, University of Colorado Denver, Denver, CO, United States
| | - Hannah Christensen
- Department of Psychiatry, School of Medicine, University of Colorado Denver, Denver, CO, United States
| | - Robin L. Gabriels
- Department of Pediatrics, School of Medicine, University of Colorado Denver, Denver, CO, United States
- Department of Psychiatry, School of Medicine, University of Colorado Denver, Denver, CO, United States
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26
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Can dogs reduce stress levels in school children? effects of dog-assisted interventions on salivary cortisol in children with and without special educational needs using randomized controlled trials. PLoS One 2022; 17:e0269333. [PMID: 35704561 PMCID: PMC9200172 DOI: 10.1371/journal.pone.0269333] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 05/18/2022] [Indexed: 11/19/2022] Open
Abstract
Prolonged or excessive stress negatively affects learning, behavior and health across the lifespan. To alleviate adverse effects of stress in school children, stressors should be reduced, and support and effective interventions provided. Animal-assisted interventions (AAI) have shown beneficial effects on health and wellbeing, however, robust knowledge on stress mediation in children is lacking. Despite this, AAIs are increasingly employed in settings world-wide, including schools, to reduce stress and support learning and wellbeing. This study is the first randomized controlled trial to investigate dog-assisted interventions as a mediator of stress in school children with and without special educational needs (SEN) over the school term. Interventions were carried out individually and in small groups twice a week for 20 minutes over the course of 4 weeks. We compared physiological changes in salivary cortisol in a dog intervention group with a relaxation intervention group and a no treatment control group. We compared cortisol level means before and after the 4 weeks of interventions in all children as well as acute cortisol in mainstream school children. Dog interventions lead to significantly lower stress in children with and without special educational needs compared to their peers in relaxation or no treatment control groups. In neurotypical children, those in the dog interventions showed no baseline stress level increases over the school term. In addition, acute cortisol levels evidenced significant stress reduction following the interventions. In contrast, the no treatment control group showed significant rises in baseline cortisol levels from beginning to end of school term. Increases also occurred in the relaxation intervention group. Children with SEN showed significantly decreased cortisol levels after dog group interventions. No changes occurred in the relaxation or no treatment control groups. These findings provide crucial evidence that dog interventions can successfully attenuate stress levels in school children with important implications for AAI implementation, learning and wellbeing.
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Al-Safory OA, Hussein HA, Mowafy MAR, Sarhan MD. The Impact of Emotional Expressions of Parents on their Children with Specific Learning Disorders: The Role of Parental Educational Counseling Program. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.7710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Children are the world’s real treasures; they should be cherished, well raised, and given the chance to develop properly. Some of them in different countries worldwide are suffering from various forms of specific learning disorders (SLDs), which can be extremely frustrating the school child, especially if associated with parental high emotional expression (EE).
OBJECTIVES: The purpose of the study is to identify the relation between parents’ EEs and anxiety rate in their children with SLDs and its correlation with serum cortisol level of the children. The effect of parental educational counseling program (PECP) on the anxiety rate of children and parental EE was studied.
METHODS: The study was carried out on 140 children with SLD to evaluate their anxiety rate using Taylor anxiety scale of children, and measuring serum cortisol level. Data were collected from parents by EE scale (EES). Taylor anxiety scale and EES were repeated for children and parents after conducting sessions of PECP.
RESULTS: Results of Taylor anxiety scale showed that 60% of studied children were suffering from morbid anxiety. Results of EES showed that 80% of parents were practicing high EE. Scores of children on Taylor anxiety scale demonstrated a significant drop from 33.06 ± 10.4 to 25.85 ± 10.4 after applying the intervention (p < 0.001). More than two-thirds of parents became practicing low EE after receiving sessions of the interventional program PECP. Scores of parents on EES showed a significant drop from 61.31 ± 16.84 to 36.51 ± 13.89 after PECP (p < 0.001). A statistically significant positive correlation between scores of Taylor anxiety scale and EES before PECP was found (r = 0.533) and after PECP (r = 0.309). Average level of serum cortisol of children with SLD was 8.973 ± 1.784 mcg/dl, and it was significantly higher in boys than girls (p < 0.05). Serum cortisol level of studied children was higher in children with morbid and severe anxiety (p < 0.001). Cortisol levels of children were significantly higher in those whose parents were practicing high EE. Serum cortisol level of children revealed a positive correlation with each of their scores on Taylor anxiety scale (r = 0.771) and scores of parents on EES (r = 0.468).
CONCLUSION: Results of this study proved the presence of direct relation between anxiety in school children with SLDs and high EEs of their parents. Results concluded the effectiveness of PECP in the management of children’s anxiety and parental EE.
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Kotajima-Murakami H, Hagihara H, Sato A, Hagino Y, Tanaka M, Katoh Y, Nishito Y, Takamatsu Y, Uchino S, Miyakawa T, Ikeda K. Exposure to GABA A Receptor Antagonist Picrotoxin in Pregnant Mice Causes Autism-Like Behaviors and Aberrant Gene Expression in Offspring. Front Psychiatry 2022; 13:821354. [PMID: 35185658 PMCID: PMC8850354 DOI: 10.3389/fpsyt.2022.821354] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 01/11/2022] [Indexed: 12/11/2022] Open
Abstract
Autism spectrum disorder (ASD) is a neurodevelopmental disorder that is characterized by impairments in social interaction and restricted/repetitive behaviors. The neurotransmitter γ-aminobutyric acid (GABA) through GABAA receptor signaling in the immature brain plays a key role in the development of neuronal circuits. Excitatory/inhibitory imbalance in the mature brain has been investigated as a pathophysiological mechanism of ASD. However, whether and how disturbances of GABA signaling in embryos that are caused by GABAA receptor inhibitors cause ASD-like pathophysiology are poorly understood. The present study examined whether exposure to the GABAA receptor antagonist picrotoxin causes ASD-like pathophysiology in offspring by conducting behavioral tests from the juvenile period to adulthood and performing gene expression analyses in mature mouse brains. Here, we found that male mice that were prenatally exposed to picrotoxin exhibited a reduction of active interaction time in the social interaction test in both adolescence and adulthood. The gene expression analyses showed that picrotoxin-exposed male mice exhibited a significant increase in the gene expression of odorant receptors. Weighted gene co-expression network analysis showed a strong correlation between social interaction and enrichment of the "odorant binding" pathway gene module. Our findings suggest that exposure to a GABAA receptor inhibitor during the embryonic period induces ASD-like behavior, and impairments in odorant function may contribute to social deficits in offspring.
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Affiliation(s)
- Hiroko Kotajima-Murakami
- Addictive Substance Project, Tokyo Metropolitan Institute of Medical Science, Setagaya-Ku, Japan
- Department of Biosciences, School of Science and Engineering, Teikyo University, Utsunomiya-Shi, Japan
| | - Hideo Hagihara
- Division of Systems Medical Science, Institute for Comprehensive Medical Science, Fujita Health University, Toyoake-Shi, Japan
| | - Atsushi Sato
- Addictive Substance Project, Tokyo Metropolitan Institute of Medical Science, Setagaya-Ku, Japan
- Department of Pediatrics, Graduate School of Medicine, The University of Tokyo, Bunkyo-Ku, Japan
| | - Yoko Hagino
- Addictive Substance Project, Tokyo Metropolitan Institute of Medical Science, Setagaya-Ku, Japan
| | - Miho Tanaka
- Addictive Substance Project, Tokyo Metropolitan Institute of Medical Science, Setagaya-Ku, Japan
- Department of Psychiatry, The University of Tokyo Hospital, Bunkyo-Ku, Japan
| | - Yoshihisa Katoh
- Department of Obstetrics and Gynecology, Graduate School of Medicine, The University of Tokyo, Bunkyo-Ku, Japan
| | - Yasumasa Nishito
- Center for Basic Technology Research, Tokyo Metropolitan Institute of Medical Science, Setagaya-Ku, Japan
| | - Yukio Takamatsu
- Center for Basic Technology Research, Tokyo Metropolitan Institute of Medical Science, Setagaya-Ku, Japan
| | - Shigeo Uchino
- Addictive Substance Project, Tokyo Metropolitan Institute of Medical Science, Setagaya-Ku, Japan
- Department of Biosciences, School of Science and Engineering, Teikyo University, Utsunomiya-Shi, Japan
| | - Tsuyoshi Miyakawa
- Division of Systems Medical Science, Institute for Comprehensive Medical Science, Fujita Health University, Toyoake-Shi, Japan
| | - Kazutaka Ikeda
- Addictive Substance Project, Tokyo Metropolitan Institute of Medical Science, Setagaya-Ku, Japan
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Lord C, Charman T, Havdahl A, Carbone P, Anagnostou E, Boyd B, Carr T, de Vries PJ, Dissanayake C, Divan G, Freitag CM, Gotelli MM, Kasari C, Knapp M, Mundy P, Plank A, Scahill L, Servili C, Shattuck P, Simonoff E, Singer AT, Slonims V, Wang PP, Ysrraelit MC, Jellett R, Pickles A, Cusack J, Howlin P, Szatmari P, Holbrook A, Toolan C, McCauley JB. The Lancet Commission on the future of care and clinical research in autism. Lancet 2022; 399:271-334. [PMID: 34883054 DOI: 10.1016/s0140-6736(21)01541-5] [Citation(s) in RCA: 278] [Impact Index Per Article: 139.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 06/22/2021] [Accepted: 06/24/2021] [Indexed: 12/13/2022]
Affiliation(s)
| | - Tony Charman
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Alexandra Havdahl
- Nic Waals Institute, Lovisenberg Diaconal Hospital, Oslo, Norway; Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway; Department of Psychology, University of Oslo, Oslo, Norway
| | - Paul Carbone
- Department of Pediatrics at University of Utah, Salt Lake City, UT, USA
| | - Evdokia Anagnostou
- Holland Bloorview Kids Rehabilitation Hospital, Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | | | - Themba Carr
- Rady Children's Hospital San Diego, Encinitas, CA, USA
| | - Petrus J de Vries
- Division of Child & Adolescent Psychiatry, University of Cape Town, Cape Town, South Africa
| | - Cheryl Dissanayake
- Olga Tennison Autism Research Centre, La Trobe University, Melbourne, VIC, Australia
| | | | | | | | | | | | - Peter Mundy
- University of California, Davis, Davis, CA, USA
| | | | | | - Chiara Servili
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | | | - Emily Simonoff
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | | | - Vicky Slonims
- Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Paul P Wang
- Simons Foundation Autism Research Initiative, Simons Foundation, New York, NY, USA; Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | | | - Rachel Jellett
- Olga Tennison Autism Research Centre, La Trobe University, Melbourne, VIC, Australia
| | - Andrew Pickles
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | | | - Patricia Howlin
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Peter Szatmari
- Holland Bloorview Kids Rehabilitation Hospital, Department of Pediatrics, University of Toronto, Toronto, ON, Canada
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Makris G, Agorastos A, Chrousos GP, Pervanidou P. Stress System Activation in Children and Adolescents With Autism Spectrum Disorder. Front Neurosci 2022; 15:756628. [PMID: 35095389 PMCID: PMC8793840 DOI: 10.3389/fnins.2021.756628] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 12/27/2021] [Indexed: 11/13/2022] Open
Abstract
The mission of the human stress system is the maintenance of homeostasis in the presence of real or perceived, acute or chronic stressors. The hypothalamic–pituitary–adrenal (HPA) axis and the autonomic nervous system (ANS) are the stress system-related neuroendocrine pathways. There is abundant evidence that children and adolescents with autism spectrum disorder (ASD) may exhibit atypical function within the HPA axis and the ANS both at the resting state and during the presence of social and/or non-social stressors. The aim of this review is to provide an up-to-date summary of the findings regarding stress system alterations in children and adolescents with ASD. We focus on the variations of stress hormones circadian rhythms, specifically cortisol and alpha-amylase (i.e., a surrogate index of epinephrine/norepinephrine secretion), and on the alterations of stress system responsivity to different stressors. Also, we present imaging and immunological findings that have been associated with stress system dysregulation in children and adolescents with ASD. Finally, we review the pivotal role of HPA axis-ANS coordination, the developmental trajectory of the stress system in ASD, and the possible role of early life stress in the dysregulation of the stress system demonstrated in children and adolescents with ASD. This synthesis will hopefully provide researchers with a foundation for an integrated approach to future research into stress system variations in children and adolescents with ASD.
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Affiliation(s)
- Gerasimos Makris
- Unit of Developmental and Behavioral Pediatrics, First Department of Pediatrics, “Aghia Sophia” Children’s Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- *Correspondence: Gerasimos Makris,
| | - Agorastos Agorastos
- Department of Psychiatry II, Division of Neurosciences, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George P. Chrousos
- University Research Institute of Maternal and Child Health and Precision Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiota Pervanidou
- Unit of Developmental and Behavioral Pediatrics, First Department of Pediatrics, “Aghia Sophia” Children’s Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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31
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Gao J, Zou J, Yang L, Zhao J, Wang L, Liu T, Fan X. Alteration of peripheral cortisol and autism spectrum disorder: A meta-analysis. Front Psychiatry 2022; 13:928188. [PMID: 35911217 PMCID: PMC9334910 DOI: 10.3389/fpsyt.2022.928188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 06/27/2022] [Indexed: 11/13/2022] Open
Abstract
Cortisol is the main HPA axis hormone secreted by the adrenal cortex, and influences metabolism, cognition, and behavior. Recently, a plethora of studies have tried to confirm the correlation between peripheral cortisol and autism spectrum disorder (ASD). However, the results were controversial. We assessed the effects of peripheral cortisol on ASD in this study. The included studies were identified according to the inclusion and exclusion criteria. The pooled Hedges' g and its 95% confidence interval were selected to evaluate the association between peripheral cortisol and ASD. Subgroup analyses, sensitivity analyses, meta-regression, and publication bias tests were also undertaken based on the obtained information. There were a total of twelve studies with 375 ASD patients and 335 controls included in our meta-analysis. Obvious heterogeneity across studies was found in the overall analysis. Peripheral cortisol levels were significantly elevated in ASD patients compared with controls in the absence of obvious heterogeneity. A single study did not influence the overall comparison results. Meta-regression analyses revealed that age and gender of the included subjects, sample size, and publication year did not moderate effects on the present results. These findings may provide us some targeted strategies to the diagnosis and treatment of ASD.
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Affiliation(s)
- Junwei Gao
- Department of Military Cognitive Psychology, School of Psychology, Army Medical University, Chongqing, China
| | - Jiao Zou
- Department of Military Cognitive Psychology, School of Psychology, Army Medical University, Chongqing, China
| | - Ling Yang
- Department of Military Cognitive Psychology, School of Psychology, Army Medical University, Chongqing, China
| | - Jinghui Zhao
- Department of Military Cognitive Psychology, School of Psychology, Army Medical University, Chongqing, China
| | - Lian Wang
- Department of Military Cognitive Psychology, School of Psychology, Army Medical University, Chongqing, China
| | - Tianyao Liu
- Department of Military Cognitive Psychology, School of Psychology, Army Medical University, Chongqing, China
| | - Xiaotang Fan
- Department of Military Cognitive Psychology, School of Psychology, Army Medical University, Chongqing, China
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32
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Löscher W, Kaila K. CNS pharmacology of NKCC1 inhibitors. Neuropharmacology 2021; 205:108910. [PMID: 34883135 DOI: 10.1016/j.neuropharm.2021.108910] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 11/25/2021] [Accepted: 11/26/2021] [Indexed: 12/21/2022]
Abstract
The Na-K-2Cl cotransporter NKCC1 and the neuron-specific K-Cl cotransporter KCC2 are considered attractive CNS drug targets because altered neuronal chloride regulation and consequent effects on GABAergic signaling have been implicated in numerous CNS disorders. While KCC2 modulators are not yet clinically available, the loop diuretic bumetanide has been used off-label in attempts to treat brain disorders and as a tool for NKCC1 inhibition in preclinical models. Bumetanide is known to have anticonvulsant and neuroprotective effects under some pathophysiological conditions. However, as shown in several species from neonates to adults (mice, rats, dogs, and by extrapolation in humans), at the low clinical doses of bumetanide approved for diuresis, this drug has negligible access into the CNS, reaching levels that are much lower than what is needed to inhibit NKCC1 in cells within the brain parenchyma. Several drug discovery strategies have been initiated over the last ∼15 years to develop brain-permeant compounds that, ideally, should be selective for NKCC1 to eliminate the diuresis mediated by inhibition of renal NKCC2. The strategies employed to improve the pharmacokinetic and pharmacodynamic properties of NKCC1 blockers include evaluation of other clinically approved loop diuretics; development of lipophilic prodrugs of bumetanide; development of side-chain derivatives of bumetanide; and unbiased high-throughput screening approaches of drug discovery based on large chemical compound libraries. The main outcomes are that (1), non-acidic loop diuretics such as azosemide and torasemide may have advantages as NKCC1 inhibitors vs. bumetanide; (2), bumetanide prodrugs lead to significantly higher brain levels than the parent drug and have lower diuretic activity; (3), the novel bumetanide side-chain derivatives do not exhibit any functionally relevant improvement of CNS accessibility or NKCC1 selectivity vs. bumetanide; (4) novel compounds discovered by high-throughput screening may resolve some of the inherent problems of bumetanide, but as yet this has not been achieved. Thus, further research is needed to optimize the design of brain-permeant NKCC1 inhibitors. In parallel, a major challenge is to identify the mechanisms whereby various NKCC1-expressing cellular targets of these drugs within (e.g., neurons, oligodendrocytes or astrocytes) and outside the brain parenchyma (e.g., the blood-brain barrier, the choroid plexus, and the endocrine system), as well as molecular off-target effects, might contribute to their reported therapeutic and adverse effects.
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Affiliation(s)
- Wolfgang Löscher
- Dept. of Pharmacology, Toxicology, and Pharmacy, University of Veterinary Medicine Hannover, Germany; Center for Systems Neuroscience Hannover, Germany.
| | - Kai Kaila
- Molecular and Integrative Biosciences and Neuroscience Center (HiLIFE), University of Helsinki, Finland
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Lin R, Learman LN, Bangash MA, Melnikova T, Leyder E, Reddy SC, Naidoo N, Park JM, Savonenko A, Worley PF. Homer1a regulates Shank3 expression and underlies behavioral vulnerability to stress in a model of Phelan-McDermid syndrome. Cell Rep 2021; 37:110014. [PMID: 34788607 DOI: 10.1016/j.celrep.2021.110014] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 09/13/2021] [Accepted: 10/26/2021] [Indexed: 11/17/2022] Open
Abstract
Mutations of SHANK3 cause Phelan-McDermid syndrome (PMS), and these individuals can exhibit sensitivity to stress, resulting in behavioral deterioration. Here, we examine the interaction of stress with genotype using a mouse model with face validity to PMS. In Shank3ΔC/+ mice, swim stress produces an altered transcriptomic response in pyramidal neurons that impacts genes and pathways involved in synaptic function, signaling, and protein turnover. Homer1a, which is part of the Shank3-mGluR-N-methyl-D-aspartate (NMDA) receptor complex, is super-induced and is implicated in the stress response because stress-induced social deficits in Shank3ΔC/+ mice are mitigated in Shank3ΔC/+;Homer1a-/- mice. Several lines of evidence demonstrate that Shank3 expression is regulated by Homer1a in competition with crosslinking forms of Homer, and consistent with this model, Shank3 expression and function that are reduced in Shank3ΔC/+ mice are rescued in Shank3ΔC/+;Homer1a-/- mice. Studies highlight the interaction between stress and genetics and focus attention on activity-dependent changes that may contribute to pathogenesis.
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Affiliation(s)
- Raozhou Lin
- Solomon Snyder Department of Neuroscience, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Lisa N Learman
- Solomon Snyder Department of Neuroscience, Johns Hopkins University, Baltimore, MD 21205, USA
| | - M Ali Bangash
- Solomon Snyder Department of Neuroscience, Johns Hopkins University, Baltimore, MD 21205, USA; Molecular Nociception Group, Wolfson Institute for Biomedical Research, University College London, London WC1E 6BT, UK
| | - Tatiana Melnikova
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Erica Leyder
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Sai C Reddy
- Solomon Snyder Department of Neuroscience, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Nirinjini Naidoo
- Division of Sleep Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Joo Min Park
- Center for Cognition and Sociality, Institute for Basic Science, Daejeon 34126, Republic of Korea; University of Science and Technology, Daejeon 34113, Republic of Korea.
| | - Alena Savonenko
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
| | - Paul F Worley
- Solomon Snyder Department of Neuroscience, Johns Hopkins University, Baltimore, MD 21205, USA.
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Proskurnina E, Portnova G, Ivanova M, Sokolova S. Chemiluminescence analysis of saliva for the assessment of emotional stress in autistic children undergoing a medical examination. ADVANCES IN AUTISM 2021. [DOI: 10.1108/aia-09-2020-0056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
An electroencephalography (EEG) examination may cause psychological stress in children with autism that can interfere with the examination results. The objective information on the presence or absence of psycho-emotional stress in patients can help interpret electroencephalograms. This paper aimed to demonstrate the potential of noninvasive objective diagnostics of emotional stress in autistic children undergoing an EEG examination based on analysis of saliva.
Design/methodology/approach
This study involved 19 children with autism spectrum disorder (ASD) (ICD-10 F84.0); the mean age was seven years. During EEG examination of the children, behavioral parameters were assessed. The activity of cytochrome P450 reductase (CYPOR) in saliva was measured before and after the EEG procedure using lucigenin-enhanced nicotinamide adenine dinucleotide phosphate-stimulated chemiluminescence assay.
Findings
Significant differences in CYPOR activity were found between the children who were distressed during an EEG examination and the children without behavioral disturbances (Mann–Whitney test, p = 0.002). Thus, the EEG examination resulted in an increase in CYPOR activity in saliva cells, which may prove the stressful effect of this procedure on autistic children.
Originality/value
The chemiluminescent indices reflecting the activity of microsomal CYPOR in cells presenting in saliva correlate with the absence or presence of psychological stress in children; this phenomenon can be explained by an increased metabolism of the stress hormone, cortisol, by the cytochrome P450 microsomal system. Furthermore, the proposed method is completely safe, noninvasive, rapid (recording time is 20 min), inexpensive and promising for an objective assessment of psycho-emotional stress in autistic children undergoing medical examinations.
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35
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Potential of Salivary Biomarkers in Autism Research: A Systematic Review. Int J Mol Sci 2021; 22:ijms221910873. [PMID: 34639213 PMCID: PMC8509590 DOI: 10.3390/ijms221910873] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/27/2021] [Accepted: 10/05/2021] [Indexed: 12/14/2022] Open
Abstract
The diagnostic process for autism spectrum disorders (ASD) is based on a behavioral analysis of the suspected individual. Despite intensive research, no specific and valid biomarker has been identified for ASD, but saliva, with its advantages such as non-invasive collection, could serve as a suitable alternative to other body fluids. As a source of nucleic acid of both human and microbial origin, protein and non-protein molecules, saliva offers a complex view on the current state of the organism. Additionally, the use of salivary markers seems to be less complicated not only for ASD screening but also for revealing the etiopathogenesis of ASD, since enrolling neurotypical counterparts willing to participate in studies may be more feasible. The aim of the presented review is to provide an overview of the current research performed on saliva in relation to ASD, mutual complementing, and discrepancies that result in difficulties applying the observed markers in clinical practice. We emphasize the methodological limitations of saliva collection and processing as well as the lack of information regarding ASD diagnosis, which is critically discussed.
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Davenport MA, Romero ME, Lewis CD, Lawson T, Ferguson B, Stichter J, Kahng S. An Initial Development and Evaluation of a Culturally Responsive Police Interactions Training for Black Adolescents with Autism Spectrum Disorder. J Autism Dev Disord 2021; 53:1375-1390. [PMID: 34448996 DOI: 10.1007/s10803-021-05181-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2021] [Indexed: 11/24/2022]
Abstract
The purpose of the current study was to conduct a qualitative and experimental analysis of a culturally informed police safety skills training for adolescents with autism spectrum disorder (ASD). The current study focused primarily on meeting the unique training needs of Black adolescents with autism spectrum disorder (ASD). A single case design was used to evaluate the initial efficacy and acceptability of a culturally responsive training method. Preliminary evidence about the physiological ramifications of police contact were also collected to begin to examine the broader behavioral and psychophysiological nature of youth's experiences. The current experimental design included in-person simulated contexts that youth, and caregivers, endorsed as relevant to their normal lives, which greatly strengthened the ecological validity of the approach.
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Affiliation(s)
- Mattina A Davenport
- Nationwide Children's Hospital, Columbus, OH, USA. .,Department of Educational, School, and Counseling Psychology, University of Missouri-Columbia, Columbia, MO, USA.
| | - Monica E Romero
- Department of Educational, School, and Counseling Psychology, University of Missouri-Columbia, Columbia, MO, USA
| | - Christopher D Lewis
- Department of Educational, School, and Counseling Psychology, University of Missouri-Columbia, Columbia, MO, USA
| | - Tamara Lawson
- Department of Counseling and School Psychology, University of Massachusetts-Boston, Boston, MA, USA
| | - Brad Ferguson
- Departments of Health Psychology, Radiology, & the Thompson Center for Autism & Neurodevelopmental Disorders, University of Missouri-, Columbia, Columbia, MO, USA
| | - Janine Stichter
- Department of Special Education, University of Missouri-Columbia, Columbia, MO, USA
| | - SungWoo Kahng
- Department of Applied Psychology, Rutgers University, New Brunswick, NJ, USA
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Zhao X, Zhao B, Li W, Cai Y, Shi W, Li C. Autistic traits and gender modulate emotion changes before and during the COVID-19 pandemic. CURRENT PSYCHOLOGY 2021; 41:8181-8191. [PMID: 34393463 PMCID: PMC8346342 DOI: 10.1007/s12144-021-02170-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2021] [Indexed: 11/30/2022]
Abstract
Individuals with autism spectrum disorder (ASD) show an enhanced response to stressors, and gender plays an important role in stress response. Thus, autistic traits (ATs) in the general population and gender may regulate the emotion changes before and during the COVID-19 pandemic. In the present study, participants were divided into higher and lower ATs groups. The generalized linear models were used to estimate the effects of the independent variables (e.g. the COVID-19 pandemic status (before, during), gender (male, female), and AT groups (higher ATs, lower ATs) and their interactions on emotions measured by the Positive and Negative Affect scales. The results showed that the COVID-19 pandemic reduced positive emotions and increased fear and anger. Furthermore, compared with the status before the COVID-19 pandemic, individuals with higher ATs and females experienced stronger anger and fear than individuals with lower ATs and males during the pandemic. The present study revealed the emotional impacts of the COVID-19 pandemic and greater emotional susceptibility to the pandemic among individuals with higher ATs and females. Our findings provide prospective evidence for understanding the ASD/ATs-related enhanced response to pathogen threat-related stressors and have implications for COVID-19 crisis interventions.
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Affiliation(s)
- Xudong Zhao
- Department of Psychology, School of Education, Shanghai Normal University, Shanghai, China
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Binglei Zhao
- Institute of Psychology and Behavioral Science, Shanghai Jiao Tong University, Shanghai, China
| | - Wenrui Li
- Department of Psychology, School of Education, Shanghai Normal University, Shanghai, China
| | - Yang Cai
- Department of Psychology, School of Education, Shanghai Normal University, Shanghai, China
| | - Wendian Shi
- Department of Psychology, School of Education, Shanghai Normal University, Shanghai, China
| | - Chunbo Li
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Psychology and Behavioral Science, Shanghai Jiao Tong University, Shanghai, China
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Bozkurt H, Şimşek Ş, Şahin S. Elevated levels of cortisol, brain-derived neurotropic factor and tissue plasminogen activator in male children with autism spectrum disorder. Autism Res 2021; 14:2078-2084. [PMID: 34291889 DOI: 10.1002/aur.2582] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 07/04/2021] [Accepted: 07/12/2021] [Indexed: 12/12/2022]
Abstract
Several studies demonstrated biological effects of cortisol, brain-derived neurotrophic factor (BDNF) and tissue plasminogen activator (tPA) on human metabolism and central nervous system. Our study investigated the serum levels of tPA along with BDNF and cortisol in children with autism spectrum disorder (ASD). Thirty three male children with ASD ranging in age from 2 to 15 years were selected for the study group and 27 age-matched healthy male children were selected for the control group. The ASD severity was determined by the score on the Autism Behavior Checklist (ABC). The mean cortisol levels for the study group and the control group were 79.1 ± 30.2 ng/ml and 60.0 ± 25.1 ng/ml, respectively. The mean BDNF levels for the study group and the control group were 5.9 ± 2.8 ng/ml and 3.7 ± 1.8 ng/ml, respectively. The mean tPA levels for the study group and the control group were 32.9 ± 18.5 ng/ml and 25.5 ± 15.1 ng/ml, respectively. Cortisol, BDNF and tPA levels were significantly higher in the study group compared to the control group (p < 0.001). There was no statistically significant effect in terms of age, ABC total and subscale scores on serum cortisol, BDNF and tPA levels in the study group (p > 0.05). It may be suggested that elevations may indicate a role in the pathogenesis of ASD or it may be the case that ASD may alter the levels or pathways of these metabolic factors. LAY SUMMARY: The underlying mechanism or a specific metabolic target relevant to autism spectrum disorder (ASD) has not yet been identified. Cortisol, brain-derived neurotrophic factor (BDNF) and tissue plasminogen activator (tPA) have biological effects on neuroplasticity but little is known about the role of cortisol and tPA-BDNF pathway in ASD. In the present study focused on male children with ASD, we have found higher blood levels of cortisol, BDNF and tPA than their healthy peers. This is the first clinical study to evaluate the serum tPA levels along with BDNF and cortisol in ASD. The results suggest that several neurotrophic and other related markers should be born in mind while examining children with ASD.
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Affiliation(s)
- Hasan Bozkurt
- Department of Child and Adolescent Psychiatry, Gaziosmanpasa University School of Medicine, Tokat, Turkey
| | - Şeref Şimşek
- Department of Child and Adolescent Psychiatry, Dicle University School of Medicine, Diyarbakır, Turkey
| | - Serkan Şahin
- Department of Child and Adolescent Psychiatry, Gaziosmanpasa University School of Medicine, Tokat, Turkey
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Phan ML, Liu TT, Vollbrecht MS, Mansour MH, Nikodijevic I, Jadav N, Patibanda N, Dang J, Shekaran G, Reisler RC, Kim WS, Zhou X, DiCicco-Bloom E, Samuels BA. Engrailed 2 deficiency and chronic stress alter avoidance and motivation behaviors. Behav Brain Res 2021; 413:113466. [PMID: 34271036 DOI: 10.1016/j.bbr.2021.113466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 06/18/2021] [Accepted: 07/09/2021] [Indexed: 12/16/2022]
Abstract
Autism spectrum disorder (ASD) is a pervasive neurodevelopmental disorder characterized by impairments in social interaction, cognition, and communication, as well as the presence of repetitive or stereotyped behaviors and interests. ASD is most often studied as a neurodevelopmental disease, but it is a lifelong disorder. Adults with ASD experience more stressful life events and greater perceived stress, and frequently have comorbid mood disorders such as anxiety and depression. It remains unclear whether adult exposure to chronic stress can exacerbate the behavioral and neurodevelopmental phenotypes associated with ASD. To address this issue, we first investigated whether adult male and female Engrailed-2 deficient (En2-KO, En2-/-) mice, which display behavioral disturbances in avoidance tasks and dysregulated monoaminergic neurotransmitter levels, also display impairments in instrumental behaviors associated with motivation, such as the progressive ratio task. We then exposed adult En2-KO mice to chronic environmental stress (CSDS, chronic social defeat stress), to determine if stress exacerbated the behavioral and neuroanatomical effects of En2 deletion. En2-/- mice showed impaired instrumental acquisition and significantly lower breakpoints in a progressive ratio test, demonstrating En2 deficiency decreases motivation to exert effort for reward. Furthermore, adult CSDS exposure increased avoidance behaviors in En2-KO mice. Interestingly, adult CSDS exposure also exacerbated the deleterious effects of En2 deficiency on forebrain-projecting monoaminergic fibers. Our findings thus suggest that adult exposure to stress may exacerbate behavioral and neuroanatomical phenotypes associated with developmental effects of genetic En2 deficiency.
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Affiliation(s)
- Mimi L Phan
- Behavioral and Systems Neuroscience Area, Department of Psychology, Rutgers University-New Brunswick, Piscataway, NJ, 08854, USA
| | - Tonia T Liu
- Behavioral and Systems Neuroscience Area, Department of Psychology, Rutgers University-New Brunswick, Piscataway, NJ, 08854, USA
| | - Mallory S Vollbrecht
- Department of Neuroscience and Cell Biology, Rutgers Robert Wood Johnson Medical School, Rutgers University, Piscataway, NJ, 08854, USA
| | - Mark H Mansour
- Behavioral and Systems Neuroscience Area, Department of Psychology, Rutgers University-New Brunswick, Piscataway, NJ, 08854, USA
| | - Ivana Nikodijevic
- Behavioral and Systems Neuroscience Area, Department of Psychology, Rutgers University-New Brunswick, Piscataway, NJ, 08854, USA
| | - Nikita Jadav
- Behavioral and Systems Neuroscience Area, Department of Psychology, Rutgers University-New Brunswick, Piscataway, NJ, 08854, USA
| | - Neeharika Patibanda
- Behavioral and Systems Neuroscience Area, Department of Psychology, Rutgers University-New Brunswick, Piscataway, NJ, 08854, USA
| | - Jenny Dang
- Behavioral and Systems Neuroscience Area, Department of Psychology, Rutgers University-New Brunswick, Piscataway, NJ, 08854, USA
| | - Gopna Shekaran
- Behavioral and Systems Neuroscience Area, Department of Psychology, Rutgers University-New Brunswick, Piscataway, NJ, 08854, USA
| | - Robert C Reisler
- Behavioral and Systems Neuroscience Area, Department of Psychology, Rutgers University-New Brunswick, Piscataway, NJ, 08854, USA
| | - Won S Kim
- Behavioral and Systems Neuroscience Area, Department of Psychology, Rutgers University-New Brunswick, Piscataway, NJ, 08854, USA
| | - Xiaofeng Zhou
- Department of Neuroscience and Cell Biology, Rutgers Robert Wood Johnson Medical School, Rutgers University, Piscataway, NJ, 08854, USA
| | - Emanuel DiCicco-Bloom
- Department of Neuroscience and Cell Biology, Rutgers Robert Wood Johnson Medical School, Rutgers University, Piscataway, NJ, 08854, USA
| | - Benjamin A Samuels
- Behavioral and Systems Neuroscience Area, Department of Psychology, Rutgers University-New Brunswick, Piscataway, NJ, 08854, USA.
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Fitzgerald E, Sinton MC, Wernig-Zorc S, Morton NM, Holmes MC, Boardman JP, Drake AJ. Altered hypothalamic DNA methylation and stress-induced hyperactivity following early life stress. Epigenetics Chromatin 2021; 14:31. [PMID: 34193254 PMCID: PMC8247254 DOI: 10.1186/s13072-021-00405-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/17/2021] [Indexed: 12/22/2022] Open
Abstract
Exposure to early life stress (ELS) during childhood or prenatally increases the risk of future psychiatric disorders. The effect of stress exposure during the neonatal period is less well understood. In preterm infants, exposure to invasive procedures is associated with altered brain development and future stress responses suggesting that the neonatal period could be a key time for the programming of mental health. Previous studies suggest that ELS affects the hypothalamic epigenome, making it a good candidate to mediate these effects. In this study, we used a mouse model of early life stress (modified maternal separation; MMS). We hypothesised MMS would affect the hypothalamic transcriptome and DNA methylome, and impact on adult behaviour. MMS involved repeated stimulation of pups for 1.5 h/day, whilst separated from their mother, from postnatal day (P) 4-6. 3'mRNA sequencing and DNA methylation immunoprecipitation (meDIP) sequencing were performed on hypothalamic tissue at P6. Behaviour was assessed with the elevated plus, open field mazes and in-cage monitoring at 3-4 months of age. MMS was only associated with subtle changes in gene expression, but there were widespread alterations in DNA methylation. Notably, differentially methylated regions were enriched for synapse-associated loci. MMS resulted in hyperactivity in the elevated plus and open field mazes, but in-cage monitoring revealed that this was not representative of habitual hyperactivity. ELS has marked effects on DNA methylation in the hypothalamus in early life and results in stress-specific hyperactivity in young adulthood. These results have implications for the understanding of ELS-mediated effects on brain development.
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Affiliation(s)
- Eamon Fitzgerald
- University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, The Queens Medical Research Institute, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK.
- The Douglas Research Center, 6875 Boulevard LaSalle, Montréal, QC, H4H 1R3, Canada.
| | - Matthew C Sinton
- University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, The Queens Medical Research Institute, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
| | - Sara Wernig-Zorc
- Department of Biochemistry III, University of Regensburg, 93040, Regensburg, Germany
| | - Nicholas M Morton
- University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, The Queens Medical Research Institute, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
| | - Megan C Holmes
- University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, The Queens Medical Research Institute, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
| | - James P Boardman
- MRC Centre for Reproductive Health, University of Edinburgh, The Queens Medical Research Institute, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Amanda J Drake
- University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, The Queens Medical Research Institute, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
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Benítez-Burraco A, Ferretti F, Progovac L. Human Self-Domestication and the Evolution of Pragmatics. Cogn Sci 2021; 45:e12987. [PMID: 34170029 DOI: 10.1111/cogs.12987] [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: 11/03/2020] [Revised: 04/25/2021] [Accepted: 04/26/2021] [Indexed: 12/11/2022]
Abstract
As proposed for the emergence of modern languages, we argue that modern uses of languages (pragmatics) also evolved gradually in our species under the effects of human self-domestication, with three key aspects involved in a complex feedback loop: (a) a reduction in reactive aggression, (b) the sophistication of language structure (with emerging grammars initially facilitating the transition from physical aggression to verbal aggression); and (c) the potentiation of pragmatic principles governing conversation, including, but not limited to, turn-taking and inferential abilities. Our core hypothesis is that the reduction in reactive aggression, one of the key factors in self-domestication processes, enabled us to fully exploit our cognitive and interactional potential as applied to linguistic exchanges, and ultimately to evolve a specific form of communication governed by persuasive reciprocity-a trait of human conversation characterized by both competition and cooperation. In turn, both early crude forms of language, well suited for verbal aggression/insult, and later more sophisticated forms of language, well suited for persuasive reciprocity, significantly contributed to the resolution and reduction of (physical) aggression, thus having a return effect on the self-domestication processes. Supporting evidence for our proposal, as well as grounds for further testing, comes mainly from the consideration of cognitive disorders, which typically simultaneously present abnormal features of self-domestication (including aggressive behavior) and problems with pragmatics and social functioning. While various approaches to language evolution typically reduce it to a single factor, our approach considers language evolution as a multifactorial process, with each player acting upon the other, engaging in an intense mutually reinforcing feedback loop. Moreover, we see language evolution as a gradual process, continuous with the pre-linguistic cognitive abilities, which were engaged in a positive feedback loop with linguistic innovations, and where gene-culture co-evolution and cultural niche construction were the main driving forces.
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Affiliation(s)
- Antonio Benítez-Burraco
- Department of Spanish, Linguistics and Theory of Literature (Linguistics), Faculty of Philology, University of Seville
| | - Francesco Ferretti
- Department of Philosophy, Communication and Performing Arts. Roma Tre University
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Abdul F, Sreenivas N, Kommu JVS, Banerjee M, Berk M, Maes M, Leboyer M, Debnath M. Disruption of circadian rhythm and risk of autism spectrum disorder: role of immune-inflammatory, oxidative stress, metabolic and neurotransmitter pathways. Rev Neurosci 2021; 33:93-109. [PMID: 34047147 DOI: 10.1515/revneuro-2021-0022] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 05/01/2021] [Indexed: 12/27/2022]
Abstract
Circadian rhythms in most living organisms are regulated by light and synchronized to an endogenous biological clock. The circadian clock machinery is also critically involved in regulating and fine-tuning neurodevelopmental processes. Circadian disruption during embryonic development can impair crucial phases of neurodevelopment. This can contribute to neurodevelopmental disorders like autism spectrum disorder (ASD) in the offspring. Increasing evidence from studies showing abnormalities in sleep and melatonin as well as genetic and epigenetic changes in the core elements of the circadian pathway indicate a pivotal role of circadian disruption in ASD. However, the underlying mechanistic basis through which the circadian pathways influence the risk and progression of ASD are yet to be fully discerned. Well-recognized mechanistic pathways in ASD include altered immune-inflammatory, nitro oxidative stress, neurotransmission and synaptic plasticity, and metabolic pathways. Notably, all these pathways are under the control of the circadian clock. It is thus likely that a disrupted circadian clock will affect the functioning of these pathways. Herein, we highlight the possible mechanisms through which aberrations in the circadian clock might affect immune-inflammatory, nitro-oxidative, metabolic pathways, and neurotransmission, thereby driving the neurobiological sequelae leading to ASD.
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Affiliation(s)
- Fazal Abdul
- Department of Human Genetics, National Institute of Mental Health and Neurosciences, Hosur Road, Bangalore, 560029, Karnataka, India
| | - Nikhitha Sreenivas
- Department of Human Genetics, National Institute of Mental Health and Neurosciences, Hosur Road, Bangalore, 560029, Karnataka, India
| | - John Vijay Sagar Kommu
- Department of Child and Adolescent Psychiatry, National Institute of Mental Health and Neurosciences, Hosur Road, Bangalore, 560029, Karnataka, India
| | - Moinak Banerjee
- Human Molecular Genetics Division, Rajiv Gandhi Centre for Biotechnology, Thycaud Post, Poojappura, Trivandrum, 695014, Kerala, India
| | - Michael Berk
- School of Medicine, IMPACT Strategic Research Centre, Deakin University, Barwon Health, PO Box 281, Geelong, Victoria, 3220, Australia.,Orygen, The Centre of Excellence in Youth Mental Health, The Department of Psychiatry, The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, 30 Royal Parade, Parkville, Victoria, 3052, Australia
| | - Michael Maes
- School of Medicine, IMPACT Strategic Research Centre, Deakin University, Barwon Health, PO Box 281, Geelong, Victoria, 3220, Australia.,Department of Psychiatry, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Pathum Wan, Pathum Wan District, Bangkok, 10330, Thailand.,Department of Psychiatry, Medical University of Plovdiv, bul. "Vasil Aprilov" 15A, 4002 Tsetar, Plovdiv, Bulgaria
| | - Marion Leboyer
- Université Paris Est Creteil (UPEC), AP-HP, Hôpitaux Universitaires "H. Mondor", DMU IMPACT, INSERM, IMRB, Translational Neuropsychiatry, Fondation FondaMental, 8, rue du Général Sarrail, 94010, Creteil, France
| | - Monojit Debnath
- Department of Human Genetics, National Institute of Mental Health and Neurosciences, Hosur Road, Bangalore, 560029, Karnataka, India
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Mugo SM, Lu W, Wood M, Lemieux S. Wearable microneedle dual electrochemical sensor for simultaneous pH and cortisol detection in sweat. ELECTROCHEMICAL SCIENCE ADVANCES 2021. [DOI: 10.1002/elsa.202100039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Affiliation(s)
- Samuel M. Mugo
- Physical Sciences Department MacEwan University Edmonton Canada
| | - Weihao Lu
- Physical Sciences Department MacEwan University Edmonton Canada
| | - Marika Wood
- Physical Sciences Department MacEwan University Edmonton Canada
| | - Stephane Lemieux
- Department of Decision Sciences MacEwan University Edmonton Canada
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Lorsung E, Karthikeyan R, Cao R. Biological Timing and Neurodevelopmental Disorders: A Role for Circadian Dysfunction in Autism Spectrum Disorders. Front Neurosci 2021; 15:642745. [PMID: 33776640 PMCID: PMC7994532 DOI: 10.3389/fnins.2021.642745] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 02/03/2021] [Indexed: 01/07/2023] Open
Abstract
Autism spectrum disorders (ASDs) are a spectrum of neurodevelopmental disorders characterized by impaired social interaction and communication, as well as stereotyped and repetitive behaviors. ASDs affect nearly 2% of the United States child population and the worldwide prevalence has dramatically increased in recent years. The etiology is not clear but ASD is thought to be caused by a combination of intrinsic and extrinsic factors. Circadian rhythms are the ∼24 h rhythms driven by the endogenous biological clock, and they are found in a variety of physiological processes. Growing evidence from basic and clinical studies suggest that the dysfunction of the circadian timing system may be associated with ASD and its pathogenesis. Here we review the findings that link circadian dysfunctions to ASD in both experimental and clinical studies. We first introduce the organization of the circadian system and ASD. Next, we review physiological indicators of circadian rhythms that are found disrupted in ASD individuals, including sleep-wake cycles, melatonin, cortisol, and serotonin. Finally, we review evidence in epidemiology, human genetics, and biochemistry that indicates underlying associations between circadian regulation and the pathogenesis of ASD. In conclusion, we propose that understanding the functional importance of the circadian clock in normal and aberrant neurodevelopmental processes may provide a novel perspective to tackle ASD, and clinical treatments for ASD individuals should comprise an integrative approach considering the dynamics of daily rhythms in physical, mental, and social processes.
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Affiliation(s)
- Ethan Lorsung
- Department of Biomedical Sciences, University of Minnesota Medical School, Duluth, MN, United States
| | - Ramanujam Karthikeyan
- Department of Biomedical Sciences, University of Minnesota Medical School, Duluth, MN, United States
| | - Ruifeng Cao
- Department of Biomedical Sciences, University of Minnesota Medical School, Duluth, MN, United States
- Department of Neuroscience, University of Minnesota Medical School, Minneapolis, MN, United States
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45
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Corbett BA, Muscatello RA, Kim A, Patel K, Vandekar S. Developmental effects in physiological stress in early adolescents with and without autism spectrum disorder. Psychoneuroendocrinology 2021; 125:105115. [PMID: 33352474 PMCID: PMC7904615 DOI: 10.1016/j.psyneuen.2020.105115] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 11/10/2020] [Accepted: 12/13/2020] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Humans place high value on how they are socially evaluated by others. The Trier Social Stress Test (TSST) is a well-established measure of social evaluative threat that promotes activation of the hypothalamic pituitary adrenal (HPA) axis and release of cortisol. Higher cortisol responses in typically developing (TD) adolescents are influenced by age and pubertal development especially in later stages. Children with ASD have been shown to exhibit blunted cortisol in response to the TSST although adults with ASD show a more prototypical response. The current study examined physiological stress in early adolescents with ASD and TD. It was hypothesized that TD youth would show elevated cortisol in response to the TSST influenced by age and pubertal stage. In contrast, youth with ASD would show a more diminished stress response yet still show effects for age and pubertal development METHODS: The sample included 241 youth, 138 with ASD (median age=11.25) and 103 TD (median age=11.67). Standardized diagnostic and pubertal development (genital/breast (GB), and pubic hair (PH) stage) physical exams were performed. Salivary cortisol was collected before and after the TSST. Linear mixed effects models examined the effects of baseline cortisol, time, age, sex, pubertal stage, and diagnosis. RESULTS We did not find an effect of early pubertal development stage (GB or PH) on cortisol response. There was an interaction between age and TSST timepoint, showing stronger effects for older children across the timeline especially during the stressor. Finally, there was a significant diagnosis by TSST timepoint interaction characterized by a blunted cortisol stress response in youth with ASD compared to TD participants who showed higher cortisol. DISCUSSION We found evidence that age contributes to an increase in cortisol in response to social evaluative threat during early adolescence. TD youth exhibit an adaptive elevated stress response to psychosocial threat whereas youth with ASD do not. There may exist a developmental lag in the perception of and stress responsivity to social evaluation which may emerge in older adolescents with ASD.
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Affiliation(s)
- Blythe A. Corbett
- Vanderbilt University Medical Center, Department of Psychiatry and Behavioral Sciences,Vanderbilt University Medical Center, Vanderbilt Kennedy Center,Vanderbilt University, Department of Psychology
| | - Rachael A. Muscatello
- Vanderbilt University Medical Center, Department of Psychiatry and Behavioral Sciences
| | - Ahra Kim
- Vanderbilt University Medical Center, Department of Biostatistics
| | | | - Simon Vandekar
- Vanderbilt University Medical Center, Department of Biostatistics
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Anesiadou S, Makris G, Michou M, Bali P, Papassotiriou I, Apostolakou F, Korkoliakou P, Papageorgiou C, Chrousos G, Pervanidou P. Salivary cortisol and alpha-amylase daily profiles and stress responses to an academic performance test and a moral cognition task in children with neurodevelopmental disorders. Stress Health 2021; 37:45-59. [PMID: 32608561 DOI: 10.1002/smi.2971] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 04/16/2020] [Accepted: 06/11/2020] [Indexed: 11/07/2022]
Abstract
There is evidence that children with neurodevelopmental disorders may exhibit atypical responses to stress and alterations in concentrations and diurnal secretion of stress hormones. We assessed diurnal profiles and stress responses of salivary cortisol and alpha-amylase (sAA) in children with attention-deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD) and specific learning disorder (SLD) compared to typically developing children (TD). A total of 157 children of both sexes, aged between 6 and 12 years old, took part in the study distributed into four groups: ADHD (N = 34), ASD (N = 56), SLD (N = 43) and TD (N = 24). Salivary samples were collected at three time points during a day, as well as before and 5 min after an academic performance test and a moral cognition task. ADHD children had lower evening and diurnal sAA levels, adjusted for age. Also, ASD children showed lower diurnal sAA secretion, adjusted for age. The mean percentage change for salivary cortisol and sAA after both tests did not differ between the groups. In conclusion, we demonstrated alterations in diurnal autonomic functioning in children with ADHD and ASD, while hypothalamic-pituitary-adrenal axis functioning did not differ between the clinical and the comparison groups.
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Affiliation(s)
- Sophia Anesiadou
- Laboratory of Developmental Psychophysiology and Stress Research, Unit of Developmental and Behavioral Pediatrics, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, 'Aghia Sophia' Children's Hospital, Athens, Greece
| | - Gerasimos Makris
- Laboratory of Developmental Psychophysiology and Stress Research, Unit of Developmental and Behavioral Pediatrics, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, 'Aghia Sophia' Children's Hospital, Athens, Greece
| | - Maria Michou
- Human Ecology Laboratory, Department of Home Economics and Ecology, Harokopio University, Athens, Greece
| | - Paraskevi Bali
- Laboratory of Developmental Psychophysiology and Stress Research, Unit of Developmental and Behavioral Pediatrics, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, 'Aghia Sophia' Children's Hospital, Athens, Greece
| | - Ioannis Papassotiriou
- Department of Clinical Biochemistry, 'Aghia Sophia' Children's Hospital, Athens, Greece
| | - Filia Apostolakou
- Department of Clinical Biochemistry, 'Aghia Sophia' Children's Hospital, Athens, Greece
| | - Panagiota Korkoliakou
- Second Department of Psychiatry, School of Medicine, National and Kapodistrian University of Athens, 'Attikon' University Hospital, Athens, Greece
| | - Charalampos Papageorgiou
- First Department of Psychiatry, School of Medicine, National and Kapodistrian University of Athens, 'Eginition' University Hospital, Athens, Greece
| | - George Chrousos
- Laboratory of Developmental Psychophysiology and Stress Research, Unit of Developmental and Behavioral Pediatrics, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, 'Aghia Sophia' Children's Hospital, Athens, Greece
| | - Panagiota Pervanidou
- Laboratory of Developmental Psychophysiology and Stress Research, Unit of Developmental and Behavioral Pediatrics, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, 'Aghia Sophia' Children's Hospital, Athens, Greece
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Muscatello RA, Vandekar SN, Corbett BA. Evidence for decreased parasympathetic response to a novel peer interaction in older children with autism spectrum disorder: a case-control study. J Neurodev Disord 2021; 13:6. [PMID: 33422008 PMCID: PMC7797088 DOI: 10.1186/s11689-020-09354-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 12/26/2020] [Indexed: 12/22/2022] Open
Abstract
Background Individuals with autism spectrum disorder (ASD) often experience elevated stress during social interactions and may have difficulty forming and maintaining peer relationships. The autonomic nervous system (ANS) directs physiological changes in the body in response to a number of environmental stimuli, including social encounters. Evidence suggests the flexibility of the ANS response is an important driving factor in shaping social behavior. For youth with ASD, increased stress response and/or atypical ANS regulation to benign social encounters may therefore influence social behaviors, and, along with developmental and experiential factors, shape psychological outcomes. Methods The current study measured ANS response to a peer-based social interaction paradigm in 50 typically developing (TD) children and 50 children with ASD (ages 10–13). Respiratory sinus arrhythmia (RSA), a cardiac measure of parasympathetic influence on the heart, and pre-ejection period (PEP), a sympathetic indicator, were collected. Participants engaged in a friendly, face-to-face conversation with a novel, same-aged peer, and physiological data were collected continuously before and during the interaction. Participants also reported on state anxiety following the interaction, while parents reported on the child’s social functioning and number of social difficulties. Results Linear mixed models revealed that, while there were no diagnostic effects for RSA or PEP, older youth with ASD appeared to demonstrate a blunted parasympathetic (RSA) response. Further, increased severity of parent-reported social symptoms was associated with lower RSA. Youth with ASD reported more anxiety following the interaction; however, symptoms were not related to RSA or PEP response based on linear mixed modeling. Conclusions Physiological regulation, age, and social functioning likely influence stress responses to peer interactions for youth with ASD. Parasympathetic functioning, as opposed to sympathetic arousal, may be especially important in behavioral regulation, as older youth with ASD demonstrated atypical regulation and response to the social interaction paradigm. Future studies should help to further elucidate the developmental factors contributing to stress responses in ASD, the impact of physiological response on observable social behavior, and potential long-term consequences of chronic social stress in youth with ASD. Supplementary Information The online version contains supplementary material available at 10.1186/s11689-020-09354-x.
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Affiliation(s)
- Rachael A Muscatello
- Neuroscience Graduate Program, Vanderbilt University, Village at Vanderbilt, Suite 2200, 1500 21st Avenue South, Nashville, TN, 37212, USA. .,Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, PMB 40, 230 Appleton Place, Nashville, TN, 37203, USA.
| | - Simon N Vandekar
- Department of Biostatistics, Vanderbilt University Medical Center, 2525 West End, Suite 1130, Office 1136, Nashville, TN, 37203, USA
| | - Blythe A Corbett
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, PMB 40, 230 Appleton Place, Nashville, TN, 37203, USA.,Department of Psychology, Vanderbilt University, PMB 40, 230 Appleton Place, Nashville, TN, 37203, USA.,Vanderbilt Kennedy Center, Vanderbilt University Medical Center, PMB 40, 230 Appleton Place, Nashville, TN, 37203, USA
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48
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Scott SR, Nealey-Moore JB, Zylstra SE. Relationship Between Parental Attachment and Stress Elevation and Synchrony in Pediatric Occupational Therapy Patient-Parent Dyads. Am J Occup Ther 2021; 75:7501205100p1-7501205100p9. [PMID: 33399058 DOI: 10.5014/ajot.2021.041483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Populations already experiencing chronic stress, such as families with children who are neurologically atypical, are at particular risk for developing stress-related disease. OBJECTIVE To establish feasibility of collecting salivary samples from pediatric occupational therapy patients and their parents in a clinical setting and at home and to examine associations among parental attachment style, parent self-reported stress, and physiological stress (i.e., cortisol) in pediatric occupational therapy patients who were neurologically atypical and their parents (N = 10 dyads). DESIGN Cross-sectional pilot study to test feasibility. SETTING Sliding-scale university clinic. PARTICIPANTS Participants were 10 children undergoing occupational therapy treatment and their parent. Families were approached and told the study was voluntary and would not affect their treatment. Families provided informed consent. OUTCOMES AND MEASURES Parents completed measures to assess their own attachment style, general and parenting stress, and stress in their child. Children and parents provided saliva samples during an occupational therapy clinic visit and collected samples at home to measure cortisol level. RESULTS Parent attachment avoidance was related to increased parent cortisol levels in the clinic and increased child cortisol levels at home. Parent and child cortisol levels had a strong, positive relationship in the clinic but not at home. We did not observe a difference between cortisol levels in children or parents in the clinic or at home. CONCLUSIONS AND RELEVANCE We concluded that this protocol is feasible and provide suggestions for future research. WHAT THIS ARTICLE ADDS Stress physiology in pediatric occupational therapy clients should be considered within the context of the family system. Family-based interventions may be particularly helpful for reducing client stress in this population.
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Affiliation(s)
- Samantha R Scott
- Samantha R. Scott, BA, is PhD Student, Department of Psychology, University of Denver, Denver, CO, and Department of Psychology, University of Puget Sound, Tacoma, WA;
| | - Jill B Nealey-Moore
- Jill B. Nealey-Moore, PhD, is Associate Professor of Psychology, Department of Psychology, University of Puget Sound, Tacoma, WA
| | - Sheryl E Zylstra
- Sheryl E. Zylstra, DOT, OTR/L, BCP, is Assistant Clinical Professor of Occupational Therapy, Department of Occupational Therapy, University of Puget Sound, Tacoma, WA
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Worsham W, Dalton S, Bilder DA. The Prenatal Hormone Milieu in Autism Spectrum Disorder. Front Psychiatry 2021; 12:655438. [PMID: 34276434 PMCID: PMC8280339 DOI: 10.3389/fpsyt.2021.655438] [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: 01/19/2021] [Accepted: 05/17/2021] [Indexed: 01/03/2023] Open
Abstract
Though the etiology of autism spectrum disorder (ASD) remains largely unknown, recent findings suggest that hormone dysregulation within the prenatal environment, in conjunction with genetic factors, may alter fetal neurodevelopment. Early emphasis has been placed on the potential role of in utero exposure to androgens, particularly testosterone, to theorize ASD as the manifestation of an "extreme male brain." The relationship between autism risk and obstetric conditions associated with inflammation and steroid dysregulation merits a much broader understanding of the in utero steroid environment and its potential influence on fetal neuroendocrine development. The exploration of hormone dysregulation in the prenatal environment and ASD development builds upon prior research publishing associations with obstetric conditions and ASD risk. The insight gained may be applied to the development of chronic adult metabolic diseases that share prenatal risk factors with ASD. Future research directions will also be discussed.
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Affiliation(s)
- Whitney Worsham
- University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Susan Dalton
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, United States
| | - Deborah A Bilder
- Division of Child & Adolescent Psychiatry, Department of Psychiatry, University of Utah, Salt Lake City, UT, United States
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50
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Gernert C, Falkai P, Falter-Wagner CM. The Generalized Adaptation Account of Autism. Front Neurosci 2020; 14:534218. [PMID: 33122985 PMCID: PMC7573117 DOI: 10.3389/fnins.2020.534218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 09/15/2020] [Indexed: 12/12/2022] Open
Abstract
The heterogeneous phenomenology of autism together with diverse patterns of comorbidities led in the past to formulation of manifold theories and hypotheses on different explanatory levels. We scrutinize most recent findings from genetics, neurobiology and physiology and derive testable hypotheses about possible physiological links between domains. With focus on altered sensory perception and neuronal processing in ASD, we assume two intertwined regulatory feedback circuits under the umbrella of genetics and environmental factors. Both regulatory circuits are highly variable between individuals in line with the heterogeneous spectrum of ASD. The circuits set off from altered pathways and connectivity in ASD, fueling HPA-axis activity and distress. In the first circuit altered tryptophan metabolism leads to higher neurotoxic substances and reinforces the excitation:inhibition imbalance in the brain. The second circuit focuses on the impact and interaction with the environment and its rhythms in ASD. With lower melatonin levels, as the pacemaker molecule of the circadian system, we assume misalignment to outer and inner states corroborated from the known comorbidities in ASD. Alterations of the microbiome composition in ASD are supposed to act as a regulatory linking factor for both circuits. Overall, we assume that altered internal balance on cellular and neurophysiological levels is one of the main reasons leading to a lower ability in ASD to adapt to the environment and own internal changing states, leading to the conceptualization of autism as a condition of generalized imbalance in adaptation. This comprehensive framework opens up new perspectives on possible intervention and prevention strategies.
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Affiliation(s)
- Clara Gernert
- Department of Psychiatry, Medical Faculty, LMU Munich, Munich, Germany
| | - Peter Falkai
- Department of Psychiatry, Medical Faculty, LMU Munich, Munich, Germany
| | - Christine M Falter-Wagner
- Department of Psychiatry, Medical Faculty, LMU Munich, Munich, Germany.,Department of Psychology, University of Cologne, Cologne, Germany
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