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Yu YT, Lin CH, Li HJ, Tsai CH, Chen KL. Different mediators of applied theory-of-mind competence in children with autism spectrum disorder. RESEARCH IN DEVELOPMENTAL DISABILITIES 2022; 130:104335. [PMID: 36126533 DOI: 10.1016/j.ridd.2022.104335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 09/06/2022] [Accepted: 09/09/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Children with autistic spectrum disorder (ASD) with mild and moderate symptom levels have significant differences in applied theory of mind (ToM) competence. However, their mediators of applied ToM competence have not been documented. AIMS This study aimed to identify the mediators of applied ToM competence in these two clinically distinct groups. METHODS A total of 163 children with ASD aged 3-12 years old (88 and 75 children respectively in the mild and moderate groups) and their caregivers participated in this study. Data of children's verbal comprehension, explicit ToM knowledge and applied ToM competence were collected and then analyzed using mediation analysis. RESULTS The results of mediation analysis showed that verbal comprehension (95% confidence interval [CI] of indirect effect: 0.02 - 0.19) and explicit ToM knowledge (95% CI of indirect effect: 0.01 - 0.07) were the mediators of applied ToM competence in children with mild and those with moderate symptoms, respectively. CONCLUSIONS AND IMPLICATIONS Our findings demonstrate that the mediators of applied ToM competence differ by symptom level in children with ASD. Applied ToM competence and the mediators should be assessed for designing tailored and effective intervention plans for these children according to their symptom level.
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Affiliation(s)
- Yen-Ting Yu
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chien-Ho Lin
- Department of Psychiatry, Chi Mei Medical Center, Tainan, Taiwan
| | - Hsing-Jung Li
- Department of Child & Adolescent Psychiatry, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan
| | - Ching-Hong Tsai
- Department of Child & Adolescent Psychiatry, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan
| | - Kuan-Lin Chen
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Institute of Allied Health Sciences, National Cheng Kung University, Tainan, Taiwan; Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Vitamin D status is primarily associated with core symptoms in children with autism spectrum disorder: A multicenter study in China. Psychiatry Res 2022; 317:114807. [PMID: 36063750 DOI: 10.1016/j.psychres.2022.114807] [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: 03/07/2022] [Revised: 08/19/2022] [Accepted: 08/20/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE We aimed to investigate the relationship between vitamin D status and core symptoms and neurodevelopmental levels in children with ASD with a multicenter survey. METHODS We enrolled 1321 ASD children and 1279 typically developing (TD) children aged 2-7 years from 13 cities in China. ASD symptoms were assessed with the Autism Behavior Checklist (ABC), Social Responsiveness Scale (SRS) and Childhood Autism Rating Scale (CARS), and neurodevelopmental levels were evaluated with the Children Neuropsychological and Behavior Scale-Revision 2016 (CNBS-R2016). RESULTS Children with ASD had lower serum 25(OH)D levels than TD children. Serum 25(OH)D levels were negatively associated with CARS and communication warning behavior of CNBS-R2016 scores, and were not associated with the development quotients of ASD children. ASD Children were grouped based on the quartiles for 25(OH)D levels in the controls, and children in the first to third quartiles had higher SRS social communication and/or CARS and communication warning behavior of CNBS-R2016 scores than those in the fourth quartile. CONCLUSIONS Serum 25(OH)D levels were primarily associated with core symptoms in children with ASD, and individuals with relatively lower 25(OH)D levels displayed worse autistic symptomatology. More research is needed to determine whether vitamin D supplements would be a useful treatment for ASD.
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Screening for Intellectual Disabilities and/or Autism Amongst Older Children and Young Adults: a Systematic Review of Tools for Use in Africa. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2022. [DOI: 10.1007/s40489-022-00342-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Abstract
There are many well-developed screening tools for both intellectual disabilities and autism, but they may not be culturally appropriate for use within Africa. Our specific aims were to complete a systematic review to (1) describe and critically appraise short screening tools for the detection of intellectual disabilities and autism for older children and young adults, (2) consider the psychometric properties of these tools, and (3) judge the cultural appropriateness of these tools for use within Africa. Six screening tools for intellectual disabilities and twelve for autism were identified and appraised using the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) guidelines. We identified two screening tools which appeared appropriate for validation for use within African nations.
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Zhang B, Liang S, Chen J, Chen L, Chen W, Tu S, Hu L, Jin H, Chu L. Effectiveness of peer-mediated intervention on social skills for children with autism spectrum disorder: a randomized controlled trial. Transl Pediatr 2022; 11:663-675. [PMID: 35685075 PMCID: PMC9173870 DOI: 10.21037/tp-22-110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 05/18/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Peer-mediated intervention (PMI) is an intervention that teaches normally developing peers to help children with autism spectrum disorder (ASD) actively participate in social interactions. Previous studies have shown that PMI applied to school settings is effective for children with ASD, but more multiple-baseline single-subject design. Many questions are still not clear due to the large clinical variability in children with ASD. This study investigated the effectiveness of PMI on social skills of children with ASD at varying symptom levels and analyzed the specific changes. METHODS This study used a randomized, single-blind, parallel-controlled design to analyze the effect of PMI in a hospital setting. Fifty-five children aged 4-12 years were diagnosed with ASD by clinicians using the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and stratified randomly allocated to either the experimental group or the control group using the envelope method. The experimental group utilized PMI, whereas the control group utilized behavioral therapy based on applied behavior analysis (ABA) [early intensive behavioral intervention (EIBI)]. This study primarily utilized the Social Responsiveness Scale (SRS) to evaluate the social performance of autistic children prior to and after the intervention. RESULTS Fifty-five participants were recruited and analyzed, the experimental group (n=29; mild to moderate n=18, severe n=11) and the control group (n=26; mild to moderate n=15, severe n=11). After the intervention, the experimental group's SRS score fell significantly more than the control group's (t=-3.918, P=0.000), d=-1.043; the mild to moderate subgroup experienced the same situation (H=17.811, P=0.009), d=-1.642. At the same time, the decline in social communication scores was significantly greater in the experimental group compared to the control group (t=-3.869, P=0.000), and the 95% confidence interval was -10.067 to -3.193. The social motivation of the mild-to-moderate subgroup of the experimental group (H=16.894, P=0.011), -3.000 (25th percentile, 75th percentile: -3.000, 0.000), and the behavioral patterns of autism (H=18.150, P=0.006), -3.000 (25th percentile, 75th percentile: -5.000, 0.000), the decreased value was significantly larger. CONCLUSIONS PMI therapy can increase social motivation in children with mild to moderate ASD, minimize undesirable behavior patterns, effectively improve overall social skills and enhance effective social communication with others. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR2100049185.
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Affiliation(s)
- Beihua Zhang
- School of Medicine, Tongji University, Shanghai, China.,Department of Pediatric Rehabilitation, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), Tongji University School of Medicine, Shanghai, China
| | - Shan Liang
- Department of Pediatric Rehabilitation, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), Tongji University School of Medicine, Shanghai, China
| | - Jingze Chen
- Department of Pediatric Rehabilitation, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), Tongji University School of Medicine, Shanghai, China
| | - Lin Chen
- Department of Pediatric Rehabilitation, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), Tongji University School of Medicine, Shanghai, China
| | - Weimin Chen
- Department of Pediatric Rehabilitation, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), Tongji University School of Medicine, Shanghai, China
| | - Shunshun Tu
- Department of Pediatric Rehabilitation, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), Tongji University School of Medicine, Shanghai, China
| | - Linyan Hu
- Department of Pediatric Rehabilitation, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), Tongji University School of Medicine, Shanghai, China
| | - Huimin Jin
- Department of Pediatric Rehabilitation, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), Tongji University School of Medicine, Shanghai, China.,Department of Occupational Therapy, School of Health Sciences, Duquesne University, Pittsburgh, PA, USA
| | - Lixi Chu
- School of Medicine, Tongji University, Shanghai, China.,Department of Science and Education, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), Tongji University School of Medicine, Shanghai, China
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Flores-Rodríguez Y, Roldán Ceballos O, Albores-Gallo L. Assessing autism with DSM-IV and DSM-5 criteria using the Childhood Autism Rating Scale (CARS). SALUD MENTAL 2022. [DOI: 10.17711/sm.0185-3325.2022.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Introduction. The Childhood Autism Rating Scale (CARS) is an observational instrument for assessing autism. It is the most widely used instrument for the diagnosis of autism in Mexico. Objective. To study the psychometric properties in the Mexican population using DSM-IV and DSM-5 criteria. Method. This is an observational, cross-sectional study. Participants (N = 137) were 78.8% male, with an age range between 2 and 18 years, mean 8.5. Parents completed the M-CHAT, the ABC, the ADI-R, and semi-structured clinical interviews with DSM-IV. We inferred DSM-5 criteria by selecting atypical sensory items from the ABC. Results. The internal consistency for the total CARS items was α = .88. The concurrent validity of the CARS and the DSM-IV criteria showed a Spearman coefficient of correlation of rs = .62. The convergent validity with the ADI-R showed moderate correlations, rs = .32 to .61, with the DSM-IV k = .33 and DSM-5 k = .36. The concordance with the DSM-IV and DSM-5 was 71% and 84.5%, sensitivity was 58.1% and 46-7%, and specificity 76.6% and 90.5%, respectively. The discriminant analysis showed that the CARS correctly classified 97% of children with autism, 70% with pervasive developmental disorders not otherwise specified (PDD-NOS), and 12.5% with Asperger’s syndrome. Discussion and conclusion. The Mexican version of the CARS is a valid and reliable instrument for diagnosing autism in Mexican children and adolescents.
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Stevanovic D, Costanzo F, Fucà E, Valeri G, Vicari S, Robins DL, Samms-Vaughan M, Ozek Erkuran H, Yaylaci F, Deshpande SN, Deshmukh V, Arora NK, Albores-Gallo L, García-López C, Gatica-Bahamonde G, Gabunia M, Zirakashvili M, Machado FP, Radan M, Samadi SA, Toh TH, Gayle W, Brennan L, Zorcec T, Auza A, de Jonge M, Shoqirat N, Marini A, Knez R. Measurement invariance of the Childhood Autism Rating Scale (CARS) across six countries. Autism Res 2021; 14:2544-2554. [PMID: 34346193 DOI: 10.1002/aur.2586] [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: 04/01/2020] [Revised: 07/21/2021] [Accepted: 07/23/2021] [Indexed: 11/07/2022]
Abstract
The Childhood Autism Rating Scale (CARS) is a simple and inexpensive tool for Autism spectrum disorder (ASD) assessments, with evidenced psychometric data from different countries. However, it is still unclear whether ASD symptoms are measured the same way across different societies and world regions with this tool, since data on its cross-cultural validity are lacking. This study evaluated the cross-cultural measurement invariance of the CARS among children with ASD from six countries, for whom data were aggregated from previous studies in India (n = 101), Jamaica (n = 139), Mexico (n = 72), Spain (n = 99), Turkey (n = 150), and the United States of America (n = 186). We analyzed the approximate measurement invariance based on Bayesian structural equation modeling. The model did not fit the data and its measurement invariance did not hold, with all items found non-invariant across the countries. Items related to social communication and interaction (i.e., relating to people, imitation, emotional response, and verbal and nonverbal communication) displayed lower levels of cross-country non-invariance compared to items about stereotyped behaviors/sensory sensitivity (i.e., body and object use, adaptation to change, or taste, smell, and touch response). This study found that the CARS may not provide cross-culturally valid ASD assessments. Thus, cross-cultural comparisons with the CARS should consider first which items operate differently across samples of interest, since its cross-cultural measurement non-invariance could be a source of cross-cultural variability in ASD presentations. Additional studies are needed before drawing valid recommendations in relation to the cultural sensitivity of particular items.
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Affiliation(s)
- Dejan Stevanovic
- Department of Psychiatry, Clinic for Neurology and Psychiatry for Children and Youth, Belgrade, Serbia
| | - Floriana Costanzo
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | - Elisa Fucà
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | - Giovanni Valeri
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | - Stefano Vicari
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | - Diana L Robins
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania, USA
| | | | - Handan Ozek Erkuran
- Child and Adolescent Psychiatry Unit, Dr Behcet Uz Children's Research and Training Hospital, Izmir, Turkey
| | - Ferhat Yaylaci
- Child Psychiatry Unit, Bursa Dortcelik Children's Hospital, Bursa, Turkey
| | - Smita N Deshpande
- Department of Psychiatry, Centre of Excellence in Mental health, Atal Bihari Vajpayee Institute of Medical Sciences; Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | | | | | - Lilia Albores-Gallo
- Research Division, Hospital Psiquiátrico Infantil "Dr. Juan N. Navarro," Secretaría de Salud, Mexico City, Mexico
| | | | | | | | | | | | - Miruna Radan
- National Institute for Maternal and Child Health, Bucharest, Romania
| | - Sayyed Ali Samadi
- Institute of Nursing and Health Research, University of Ulster, Coleraine, UK
| | - Teck-Hock Toh
- Clinical Research Centre & Department of Pediatrics, Sibu Hospital, Ministry of Health Malaysia, Sibu, Malaysia
| | - Windham Gayle
- Environmental Health Investigations Branch, California Department of Public Health, Richmond, California, USA
| | | | - Tatjana Zorcec
- Developmental Department, University Children's Hospital, Skopje, Macedonia
| | - Alejandra Auza
- Language and Cognition Laboratory, Hospital General Dr. Manuel Gea González, Mexico City, Mexico
| | - Maretha de Jonge
- Faculty of Social Science, Education and Child Studies, Clinical Neuroscience and Developmental Disorders, Leiden University, Leiden, The Netherlands
| | | | | | - Rajna Knez
- Department of Women's and Children's Health, Skaraborgs Hospital, Skövde, Sweden.,Sahlgrenska Academy, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
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Wen J, Yang T, Zhu J, Guo M, Lai X, Tang T, Chen L, Chen J, Xue M, Li T. Vitamin a deficiency and sleep disturbances related to autism symptoms in children with autism spectrum disorder: a cross-sectional study. BMC Pediatr 2021; 21:299. [PMID: 34217246 PMCID: PMC8254303 DOI: 10.1186/s12887-021-02775-0] [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: 07/26/2020] [Accepted: 06/08/2021] [Indexed: 12/03/2022] Open
Abstract
Background Vitamin A deficiency (VAD) and sleep disturbances have been reported in children with autism spectrum disorder (ASD). The influence of vitamin A (VA) levels on sleep regulation and sleep disturbances in ASD has garnered concern. The present study aimed to characterize the association of VA levels with sleep disturbances in children with ASD. Methods This cross-sectional study compared children with ASD (n = 856) to typically developing children (TDC; n = 316). We used the Children’s Sleep Habits Questionnaire to assess sleep disturbances, Childhood Autism Rating Scale to evaluate the severity of autism symptoms, and Autism Behavior Checklist and Social Responsiveness Scale to assess autism behaviors. Serum VA levels were estimated using high-performance liquid chromatography. Multivariable linear regression and two-way analysis of variance were performed to investigate if VAD was related to sleep disturbances in children with ASD. Results Children with ASD had lower serum VA levels and a higher prevalence of sleep disturbances than TDC did. The incidence of VAD in ASD children with sleep disturbances was higher, and the symptoms more severe than those without sleep disturbances and TDC. Interestingly, the interaction between VAD and sleep disturbances was associated with the severity of autism symptoms. Conclusion VAD and sleep disturbances are associated with the core symptoms of ASD in children. Regular monitoring of sleep and VA levels may be beneficial for children with ASD. Trial registration Chinese Clinical Trial Registry, registration number: ChiCTR-ROC-14005442, registration date: December 9th 2014.
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Affiliation(s)
- Jing Wen
- Children's Nutrition Research Center, Children's Hospital of Chongqing Medical University, Chongqing Key Laboratory of Child Nutrition and Health, Chongqing, PR China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, PR China.,National Clinical Research Center for Child Health and Disorder, Chongqing, PR China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, PR China
| | - Ting Yang
- Children's Nutrition Research Center, Children's Hospital of Chongqing Medical University, Chongqing Key Laboratory of Child Nutrition and Health, Chongqing, PR China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, PR China.,National Clinical Research Center for Child Health and Disorder, Chongqing, PR China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, PR China
| | - Jiang Zhu
- Children's Nutrition Research Center, Children's Hospital of Chongqing Medical University, Chongqing Key Laboratory of Child Nutrition and Health, Chongqing, PR China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, PR China.,National Clinical Research Center for Child Health and Disorder, Chongqing, PR China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, PR China
| | - Min Guo
- Children's Nutrition Research Center, Children's Hospital of Chongqing Medical University, Chongqing Key Laboratory of Child Nutrition and Health, Chongqing, PR China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, PR China.,National Clinical Research Center for Child Health and Disorder, Chongqing, PR China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, PR China
| | - Xi Lai
- Children's Nutrition Research Center, Children's Hospital of Chongqing Medical University, Chongqing Key Laboratory of Child Nutrition and Health, Chongqing, PR China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, PR China.,National Clinical Research Center for Child Health and Disorder, Chongqing, PR China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, PR China
| | - Ting Tang
- Children's Nutrition Research Center, Children's Hospital of Chongqing Medical University, Chongqing Key Laboratory of Child Nutrition and Health, Chongqing, PR China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, PR China.,National Clinical Research Center for Child Health and Disorder, Chongqing, PR China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, PR China
| | - Li Chen
- Children's Nutrition Research Center, Children's Hospital of Chongqing Medical University, Chongqing Key Laboratory of Child Nutrition and Health, Chongqing, PR China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, PR China.,National Clinical Research Center for Child Health and Disorder, Chongqing, PR China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, PR China
| | - Jie Chen
- Children's Nutrition Research Center, Children's Hospital of Chongqing Medical University, Chongqing Key Laboratory of Child Nutrition and Health, Chongqing, PR China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, PR China.,National Clinical Research Center for Child Health and Disorder, Chongqing, PR China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, PR China
| | - Ming Xue
- Department of Neurosciences and Neurology, Rutgers New Jersey Medical School, Newark, NJ, USA.
| | - Tingyu Li
- Children's Nutrition Research Center, Children's Hospital of Chongqing Medical University, Chongqing Key Laboratory of Child Nutrition and Health, Chongqing, PR China. .,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, PR China. .,National Clinical Research Center for Child Health and Disorder, Chongqing, PR China. .,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, PR China.
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Dandil Y, Smith K, Kinnaird E, Toloza C, Tchanturia K. Cognitive Remediation Interventions in Autism Spectrum Condition: A Systematic Review. Front Psychiatry 2020; 11:722. [PMID: 32793009 PMCID: PMC7393993 DOI: 10.3389/fpsyt.2020.00722] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/09/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Autism spectrum condition (ASC) is a lifelong neurodevelopmental condition characterized by difficulties in social cognition and heterogeneity of executive function which are suggested to be underpinned by neurobiological, prenatal and genetic factors. Cognitive remediation (CR) interventions are frequently used to address cognitive characteristics and improve cognitive and general functioning. However, the evidence is limited for ASC. This systematic review is the first to provide a narrative synthesis of all studies of CR interventions and ASC. The review aimed to delineate the development of research in this area in both adolescents and adults, with implications for clinical practice and future research. METHOD The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement. The literature was reviewed using the PubMed, PsycINFO, Web of Science, Scopus and Embase from inception to 1st April 2020. Out of 1,503 publications, a total of 13 papers were identified as being relevant for the review. RESULTS The 13 studies meeting the inclusion criteria were: four randomized control trials (RCTs); two non-randomized control trials, four case series, two feasibility studies and one case study. A narrative synthesis of the data suggested that CR interventions are potentially effective in improving social cognition and cognitive functioning in ASC. RCTs supported the efficacy of CR interventions in improving social cognition and executive functioning. Non-randomized control trials provided evidence for the effectiveness of social cognition remediation interventions in ASC. Case series and a case study have also supported the feasibility of CR interventions, including reflections on their adaptation for ASC populations and the positive feedback from participants. CONCLUSIONS CR interventions are potentially effective in improving social cognition and cognitive functioning in ASC. However, the generalizability of the included empirical studies was hampered by several methodological limitations. To further strengthen understandings of the effectiveness of CR interventions for ASC, future RCTs are needed with larger sample sizes in exploring the long-term effectiveness of CR interventions, using age-appropriate valid and reliable outcome measures. They should also consider the heterogeneity in neuropsychological functioning in ASC and the mediating and moderating mechanisms of the CR intervention for ASC.
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Affiliation(s)
- Yasemin Dandil
- Department of Psychological Medicine, Institute of Psychology, Psychiatry and Neuroscience, King’s College London, London, United Kingdom
| | - Katherine Smith
- Department of Psychological Medicine, Institute of Psychology, Psychiatry and Neuroscience, King’s College London, London, United Kingdom
| | - Emma Kinnaird
- Department of Psychological Medicine, Institute of Psychology, Psychiatry and Neuroscience, King’s College London, London, United Kingdom
| | - Cindy Toloza
- Department of Psychology, National Eating Disorder Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Kate Tchanturia
- Department of Psychological Medicine, Institute of Psychology, Psychiatry and Neuroscience, King’s College London, London, United Kingdom
- Department of Psychology, National Eating Disorder Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
- Department of Psychology, Illia State University, Tbilisi, Georgia
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Moulton E, Bradbury K, Barton M, Fein D. Factor Analysis of the Childhood Autism Rating Scale in a Sample of Two Year Olds with an Autism Spectrum Disorder. J Autism Dev Disord 2019; 49:2733-2746. [PMID: 27743321 DOI: 10.1007/s10803-016-2936-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The Childhood Autism Rating Scale (CARS), (Schopler et al. in J Autism Dev Disord 10(1):91-103, 1980) is a 15-item observation-based rating scale that yields a total score reflective of autism symptom severity. This study investigated the factor structure of the CARS in a sample of 2-year-old children with DSM-IV-TR (American Psychiatric Association in Diagnostic and statistical manual of mental disorders, 4th edn. American Psychiatric Publishing, Washington, 2000) diagnoses of AD or PDD-NOS. Following a preliminary internal cross-validation, principal axis factor analysis was completed (N = 282). The results indicate a three-factor solution: Social Communication, Stereotyped Behaviors and Sensory Sensitivities, and Emotional Reactivity. The factors are meaningful, with the first two reflective of DSM-5 symptom domains. This study supports the continued relevance of the CARS in ASD assessment, and extends its utility in 2-year-old children.
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Affiliation(s)
- Emily Moulton
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA.
| | - Kathryn Bradbury
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
| | - Marianne Barton
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
| | - Deborah Fein
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
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Vasilevska Petrovska I, Trajkovski V. Effects of a Computer-Based Intervention on Emotion Understanding in Children with Autism Spectrum Conditions. J Autism Dev Disord 2019; 49:4244-4255. [DOI: 10.1007/s10803-019-04135-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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11
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Lai SS, Tsai CH, Wu CC, Chen CT, Li HJ, Chen KL. Identifying the Cognitive Correlates of Reciprocity in Children with Autism Spectrum Disorder. J Autism Dev Disord 2019; 50:2007-2018. [PMID: 30847708 DOI: 10.1007/s10803-019-03957-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This study examined the cognitive correlates of reciprocity in children with autism spectrum disorder (ASD). A total of 59 children with ASD were assessed with the Interactive Drawing Task, Theory of Mind Task Battery, Children's Card Change Sort Task, and Children's Gambling Task respectively for their reciprocity, theory of mind, cool executive function (EF), and hot EF. The correlational findings revealed that cool EF (r = .482 and - .501, p < .01) and hot EF (r = .396, p < .05) were significantly correlated with children's total reciprocity. The regression models also showed that cool and hot EF abilities were significant predictors. Conclusively, cool and hot EF abilities are the correlates of reciprocity rather than of ToM in children with ASD.
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Affiliation(s)
- Szu-Shen Lai
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, No. 1, University Rd., Tainan City, 701, Taiwan, R.O.C
- Occupational Therapy, Department of Rehabilitation, Taoyuan Chang Gung Memorial Hospital, No. 123, Dinghu Rd., Guishan Dist., Taoyuan City, Taiwan, R.O.C
| | - Ching-Hong Tsai
- Department of Child & Adolescent Psychiatry, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, No. 130, Kaisyuan 2nd. Rd., Lingya Dist., Kaohsiung City, 802, Taiwan, R.O.C
| | - Chin-Chin Wu
- Department of Psychology, Kaohsiung Medical University, No. 100, Shiquan 1st Rd., Sanmin Dist., Kaohsiung City, Taiwan, R.O.C
- Department of Medical Research, Kaohsiung Medical University Hospital, No. 100, Ziyou 1st Rd., Sanmin Dist., Kaohsiung City, Taiwan, R.O.C
| | - Cheng-Te Chen
- Department of Educational Psychology and Counseling, National Tsing Hua University, No. 101, Section 2, Kuang-Fu Rd., Hsinchu, Taiwan, R.O.C
| | - Hsing-Jung Li
- Department of Child & Adolescent Psychiatry, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, No. 130, Kaisyuan 2nd. Rd., Lingya Dist., Kaohsiung City, 802, Taiwan, R.O.C
| | - Kuan-Lin Chen
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, No. 1, University Rd., Tainan City, 701, Taiwan, R.O.C..
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 1, University Rd., Tainan City, 701, Taiwan, R.O.C..
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12
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Marlow M, Servili C, Tomlinson M. A review of screening tools for the identification of autism spectrum disorders and developmental delay in infants and young children: recommendations for use in low- and middle-income countries. Autism Res 2019; 12:176-199. [DOI: 10.1002/aur.2033] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 06/08/2018] [Accepted: 06/27/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Marguerite Marlow
- Department of Psychology; Stellenbosch University; Stellenbosch South Africa
| | - Chiara Servili
- Department of Mental Health and Substance Abuse; World Health Organization; Geneva Switzerland
| | - Mark Tomlinson
- Department of Psychology; Stellenbosch University; Stellenbosch South Africa
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13
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Al-Otaish H, Al-Ayadhi L, Bjørklund G, Chirumbolo S, Urbina MA, El-Ansary A. Relationship between absolute and relative ratios of glutamate, glutamine and GABA and severity of autism spectrum disorder. Metab Brain Dis 2018; 33:843-854. [PMID: 29397522 DOI: 10.1007/s11011-018-0186-6] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Accepted: 01/08/2018] [Indexed: 11/22/2022]
Abstract
Autism spectrum disorder (ASD) is a neurodevelopmental pathology characterized by an impairment in social interaction, communication difficulties, and repetitive behaviors. Glutamate signaling abnormalities are thought to be considered as major etiological mechanisms leading to ASD. The search for amino-acidic catabolytes related to glutamate in patients with different levels of ASD might help current research to clarify the mechanisms underlying glutamate signaling and its disorders, particularly in relation to ASD. In the present study, plasma levels of the amino acids and their derivatives glutamate, glutamine, and γ-aminobutyric acid (GABA), associated with their relative ratios, were evaluated using an enzyme-linked immunosorbent assay (ELISA) technique in 40 male children with ASD and in 38 age- and gender-matched neurotypical health controls. The Social Responsiveness Scale (SRS) was used to evaluate social cognition, and the Childhood Autism Rating Scale (CARS) was used to assess subjects' behaviors. Children with ASD exhibited a significant elevation of plasma GABA and glutamate/glutamine ratio, as well as significantly lower levels of plasma glutamine and glutamate/GABA ratios compared to controls. No significant correlation was found between glutamate levels and the severity of autism, measured by CARS and SRS. In receiver operating characteristic (ROC) curve analysis, the area under the curve for GABA compared to other parameters was close to one, indicating its potential use as a biomarker. Glutamine appeared as the best predictive prognostic markers in the present study. The results of the present study indicate a disturbed balance between GABAergic and glutamatergic neurotransmission in ASD. The study also indicates that an increased plasma level of GABA can be potentially used as an early diagnostic biomarker for ASD.
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Affiliation(s)
- Hanoof Al-Otaish
- Biochemistry Department, Science College, King Saud University, Riyadh, Saudi Arabia
| | - Laila Al-Ayadhi
- Autism Research and Treatment Center, Riyadh, Saudi Arabia
- Shaik AL-Amodi Autism Research Chair, King Saud University, Riyadh, Saudi Arabia
- Department of Physiology, Faculty of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Geir Bjørklund
- Council for Nutritional and Environmental Medicine, Toften 24, 8610, Mo i Rana, Norway.
| | - Salvatore Chirumbolo
- Department of Neurological and Movement Sciences, University of Verona, Verona, Italy
| | | | - Afaf El-Ansary
- Autism Research and Treatment Center, Riyadh, Saudi Arabia
- Shaik AL-Amodi Autism Research Chair, King Saud University, Riyadh, Saudi Arabia
- Central Laboratory, Female Center for Medical Studies and Scientific Section, King Saud University, Riyadh, Saudi Arabia
- Medicinal Chemistry Department, National Research Centre, Dokki, Cairo, Egypt
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14
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Chan PC, Chen CT, Feng H, Lee YC, Chen KL. Theory of Mind Deficit is Associated with Pretend Play Performance, but not Playfulness, in Children with Autism Spectrum Disorder. Hong Kong J Occup Ther 2016; 28:43-52. [PMID: 30186066 PMCID: PMC6091989 DOI: 10.1016/j.hkjot.2016.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 08/31/2016] [Accepted: 09/24/2016] [Indexed: 11/16/2022] Open
Abstract
Objective/Background This study aimed to examine the relationships of theory of mind (ToM) to both
pretend play and playfulness in children with autism spectrum disorder
(ASD). Methods Twenty children with ASD aged between 3 years and 7.11 years were assessed
with the ToM test, and then placed in a free play condition and a pretend
play condition to assess pretend play and playfulness with the
Child-Initiated Pretend Play Assessment and Test of Playfulness,
respectively. In addition, the children's symptom severities of ASD and
verbal abilities were also assessed with the Childhood Autism Rating Scale
(CARS) and Receptive and Expressive Vocabulary Test—second edition,
respectively. Results The results of the regression analysis confirmed that ToM significantly
predicted pretend play variables, namely, Number of Object Substitutions
(R2 = .158, p = .002) and Number of Imitated Actions
(R2 = .175, p = .001), but not playfulness. The CARS score
was a significant predictor of the Percentage of Elaborate Pretend Play
Actions of pretend play (R2 = .075, p = .034), as well as the
internal control (R2 = .125, p = .006) and framing (R2
= .071, p = .039) variables of playfulness. Conclusion The findings support the idea that children with ASD who have better ToM
might be able to develop better pretend play, but not better playfulness,
which might be more strongly related to their autistic severity.
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Affiliation(s)
- Ping-Chen Chan
- Department of Physical Medicine and Rehabilitation Center, Lin-Shin Medical Corporation Lin-Shin Hospital, Taichung City, Taiwan
| | - Cheng-Te Chen
- Center for Teacher Education, National Tsing Hua University, Hsinchu, Taiwan
| | - Hua Feng
- Graduate Institute of Rehabilitation Counseling, National Changhua University of Education, Changhua, Taiwan
| | - Ya-Chen Lee
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan City, Taiwan.,Department of Occupational Therapy, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Kuan-Lin Chen
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan City, Taiwan.,Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
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15
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Du L, Shan L, Wang B, Li H, Xu Z, Staal WG, Jia F. A Pilot Study on the Combination of Applied Behavior Analysis and Bumetanide Treatment for Children with Autism. J Child Adolesc Psychopharmacol 2015; 25:585-8. [PMID: 26258842 DOI: 10.1089/cap.2015.0045] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE The purpose of this study was to investigate the therapeutic effects of combined bumetanide and applied behavior analysis (ABA) treatment in children with autism. METHODS Sixty children diagnosed with autism according to the International Classification of Diseases, Tenth Revision (ICD-10) criteria (mean age of 4.5 years) were randomly divided into two groups: A single treatment group (n=28) and a combined treatment group (n=32). The combined treatment group received ABA training combined with oral bumetanide (0.5 mg twice a day). The single treatment group received ABA training only. Autism symptoms were evaluated with the Autism Behavior Checklist (ABC) and the Childhood Autism Rating Scale (CARS), whereas severity of disease (SI) and global improvement (GI) were measured with the Clinical Global Impressions (CGI). Assessment of ABC, CARS, and CGI was performed immediately before and 3 months after initiation of the treatment(s). RESULTS Prior to intervention(s) no statistically significant differences in scores on the ABC, CARS, SI, or GI were found between the two groups. Total scores of the ABC, CARS, and SI were decreased in both groups after 3 months (p<0.05) compared with the scores prior to treatment. The total scores of the ABC and the CGI were significantly (p<0.05) lower in the combined treatment group than in the single treatment group. Although the total and item scores of the CARS in the combined treatment group were lower than in the single treatment group after a 3 month intervention, they did not reach statistical significance. No adverse effects of bumetanide were observed. CONCLUSIONS Treatment with bumetanide combined with ABA training may result in a better outcome in children with autism than ABA training alone.
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Affiliation(s)
- Lin Du
- 1 Department of Pediatric Neurology and Neurorehabilitation, The First Hospital of Jilin University , Changchun, China
| | - Ling Shan
- 1 Department of Pediatric Neurology and Neurorehabilitation, The First Hospital of Jilin University , Changchun, China
| | - Bing Wang
- 1 Department of Pediatric Neurology and Neurorehabilitation, The First Hospital of Jilin University , Changchun, China
| | - Honghua Li
- 1 Department of Pediatric Neurology and Neurorehabilitation, The First Hospital of Jilin University , Changchun, China
| | - Zhida Xu
- 2 Department of Psychiatry, University Medical Center , Utrecht, the Netherlands
| | - Wouter G Staal
- 3 Department of Psychiatry, Radboud University Nijmegen Medical Centre, Karakter, University Center , Nijmegen, the Netherlands
| | - Feiyong Jia
- 1 Department of Pediatric Neurology and Neurorehabilitation, The First Hospital of Jilin University , Changchun, China .,4 Institute of Pediatrics of First Hospital of Jilin University , Changchun, China .,5 Neurological Research Center of First Hospital of Jilin University , Changchun, China
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16
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Gleaves DH, Pearson CA, Ambwani S, Morey LC. Measuring eating disorder attitudes and behaviors: a reliability generalization study. J Eat Disord 2014; 2:6. [PMID: 24764530 PMCID: PMC3984738 DOI: 10.1186/2050-2974-2-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 02/25/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although score reliability is a sample-dependent characteristic, researchers often only report reliability estimates from previous studies as justification for employing particular questionnaires in their research. The present study followed reliability generalization procedures to determine the mean score reliability of the Eating Disorder Inventory and its most commonly employed subscales (Drive for Thinness, Bulimia, and Body Dissatisfaction) and the Eating Attitudes Test as a way to better identify those characteristics that might impact score reliability. METHODS Published studies that used these measures were coded based on their reporting of reliability information and additional study characteristics that might influence score reliability. RESULTS Score reliability estimates were included in 26.15% of studies using the EDI and 36.28% of studies using the EAT. Mean Cronbach's alphas for the EDI (total score = .91; subscales = .75 to .89), EAT-40 (total score = .81) and EAT-26 (total score = .86; subscales = .56 to .80) suggested variability in estimated internal consistency. Whereas some EDI subscales exhibited higher score reliability in clinical eating disorder samples than in nonclinical samples, other subscales did not exhibit these differences. Score reliability information for the EAT was primarily reported for nonclinical samples, making it difficult to characterize the effect of type of sample on these measures. However, there was a tendency for mean score reliability to be higher in the adult (vs. adolescent) samples and in female (vs. male) samples. CONCLUSIONS Overall, this study highlights the importance of assessing and reporting internal consistency during every test administration because reliability is affected by characteristics of the participants being examined.
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Affiliation(s)
- David H Gleaves
- School of Psychology, Social Work and Social Policy, University of South Australia, Magill Campus, GPO Box 2471, Adelaide, SA 5001, Australia
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