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Schielen SJC, Pilmeyer J, Aldenkamp AP, Zinger S. The diagnosis of ASD with MRI: a systematic review and meta-analysis. Transl Psychiatry 2024; 14:318. [PMID: 39095368 PMCID: PMC11297045 DOI: 10.1038/s41398-024-03024-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 06/25/2024] [Accepted: 07/15/2024] [Indexed: 08/04/2024] Open
Abstract
While diagnosing autism spectrum disorder (ASD) based on an objective test is desired, the current diagnostic practice involves observation-based criteria. This study is a systematic review and meta-analysis of studies that aim to diagnose ASD using magnetic resonance imaging (MRI). The main objective is to describe the state of the art of diagnosing ASD using MRI in terms of performance metrics and interpretation. Furthermore, subgroups, including different MRI modalities and statistical heterogeneity, are analyzed. Studies that dichotomously diagnose individuals with ASD and healthy controls by analyses progressing from magnetic resonance imaging obtained in a resting state were systematically selected by two independent reviewers. Studies were sought on Web of Science and PubMed, which were last accessed on February 24, 2023. The included studies were assessed on quality and risk of bias using the revised Quality Assessment of Diagnostic Accuracy Studies tool. A bivariate random-effects model was used for syntheses. One hundred and thirty-four studies were included comprising 159 eligible experiments. Despite the overlap in the studied samples, an estimated 4982 unique participants consisting of 2439 individuals with ASD and 2543 healthy controls were included. The pooled summary estimates of diagnostic performance are 76.0% sensitivity (95% CI 74.1-77.8), 75.7% specificity (95% CI 74.0-77.4), and an area under curve of 0.823, but uncertainty in the study assessments limits confidence. The main limitations are heterogeneity and uncertainty about the generalization of diagnostic performance. Therefore, comparisons between subgroups were considered inappropriate. Despite the current limitations, methods progressing from MRI approach the diagnostic performance needed for clinical practice. The state of the art has obstacles but shows potential for future clinical application.
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Affiliation(s)
- Sjir J C Schielen
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.
| | - Jesper Pilmeyer
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Albert P Aldenkamp
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
- Department of Behavioral Sciences, Epilepsy Center Kempenhaeghe, Heeze, the Netherlands
| | - Svitlana Zinger
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
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2
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Zhao M, You Y, Gao X, Li L, Li J, Cao M. The effects of a web-based 24-hour movement behavior lifestyle education program on mental health and psychological well-being in parents of children with autism spectrum disorder: A randomized controlled trial. Complement Ther Clin Pract 2024; 56:101865. [PMID: 38824831 DOI: 10.1016/j.ctcp.2024.101865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 05/29/2024] [Accepted: 05/29/2024] [Indexed: 06/04/2024]
Abstract
BACKGROUND AND PURPOSE Compared with parents of neurotypical children or children diagnosed with other disabilities, parents of children with autism spectrum disorder (ASD) often experience poorer mental health, greater stress, and more depression and anxiety symptoms. This study aimed to assess the effects of a web-based 24-h movement behavior lifestyle education program on mental health and psychological well-being in parents of children with ASD. METHODS This study employed a randomized controlled trial utilizing the Health Action Process Approach (HAPA) as a theoretical framework. A total of 318 parents of children with ASD were enrolled and randomly assigned to the experimental or control group. The experimental group received an 8-week web-based 24-h movement behavior lifestyle education program, while the control group followed their usual routine. Two instruments, the Depression Anxiety and Stress Scale (DASS-21) and the Satisfaction With Life Scale (SWLS), were used to measure mental health and psychological well-being, respectively. The data were collected at two time points-at the beginning and the end of the intervention. RESULTS Compared with the baseline and control groups, the experimental group demonstrated significant improvements in all outcome measures (p < 0.01). There were significant differences in the DASS-21 and SWLS scores between the two groups before and after the intervention (p ≤ 0.01). CONCLUSION This study represents the first randomized controlled trial involving a web-based 24-h movement behavior lifestyle education program specifically designed to address the mental health and psychological well-being of parents of children with ASD. The findings confirm the potential impact of 24-h movement behavior lifestyle education as a functional and effective strategy for parents of children with ASD.
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Affiliation(s)
- Mengxian Zhao
- School of Physical Education, Shenzhen University, Shenzhen, 518060, China
| | - Yonghao You
- Department of Sports Science, Hefei Normal University, Hefei, 230061, China
| | - Xinsong Gao
- School of Physical Education, Shenzhen University, Shenzhen, 518060, China
| | - Linlin Li
- School of Sports Social Science, Shandong Sport University, Jinan, 250102, China
| | - Jiayun Li
- School of Physical Education, Shenzhen University, Shenzhen, 518060, China
| | - Meng Cao
- School of Physical Education, Shenzhen University, Shenzhen, 518060, China.
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3
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Dou JF, Schmidt RJ, Volk HE, Nitta MM, Feinberg JI, Newschaffer CJ, Croen LA, Hertz-Picciotto I, Fallin MD, Bakulski KM. Exposure to heavy metals in utero and autism spectrum disorder at age 3: a meta-analysis of two longitudinal cohorts of siblings of children with autism. Environ Health 2024; 23:62. [PMID: 38970053 PMCID: PMC11225197 DOI: 10.1186/s12940-024-01101-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 06/25/2024] [Indexed: 07/07/2024]
Abstract
BACKGROUND Autism spectrum disorder (ASD) is a prevalent and heterogeneous neurodevelopmental disorder. Risk is attributed to genetic and prenatal environmental factors, though the environmental agents are incompletely characterized. METHODS In Early Autism Risk Longitudinal Investigation (EARLI) and Markers of Autism Risk in Babies Learning Early Signs (MARBLES), two pregnancy cohorts of siblings of children with ASD, urinary metals concentrations during two pregnancy time periods (< 28 weeks and ≥ 28 weeks of gestation) were measured using inductively coupled plasma mass spectrometry. At age three, clinicians assessed ASD with DSM-5 criteria. In an exposure-wide association framework, using multivariable log binomial regression, we examined each metal for association with ASD status, adjusting for gestational age at urine sampling, child sex, age at pregnancy, race/ethnicity and education. We meta-analyzed across the two cohorts. RESULTS In EARLI (n = 170) 17% of children were diagnosed with ASD, and 44% were classified as having non-neurotypical development (Non-TD). In MARBLES (n = 231), 21% were diagnosed with ASD, and 14% classified as Non-TD. During the first and second trimester period (< 28 weeks), having cadmium concentration over the level of detection was associated with 1.69 (1.08, 2.64) times higher risk of ASD, and 1.29 (0.95, 1.75)times higher risk of Non-TD. A doubling of first and second trimester cesium concentration was marginally associated with 1.89 (0.94, 3.80) times higher risk of ASD, and a doubling of third trimester cesium with 1.69 (0.97, 2.95) times higher risk of ASD. CONCLUSION Exposure in utero to elevated levels of cadmium and cesium, as measured in urine collected during pregnancy, was associated with increased risk of developing ASD.
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Affiliation(s)
- John F Dou
- University of Michigan, Ann Arbor, MI, USA
| | | | | | | | | | | | - Lisa A Croen
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | | | - M Daniele Fallin
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
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4
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Kilburn TR, Rapee RM, Lyneham HJ, Thastum M, Thomsen PH. Testing a cognitive behavioural therapy program for anxiety in autistic adolescents: a feasibility study. Nord J Psychiatry 2024; 78:421-430. [PMID: 38690784 DOI: 10.1080/08039488.2024.2338206] [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: 08/28/2023] [Accepted: 03/28/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Autism includes core symptoms affecting general and social development. Up to 60% of autistic adolescents experience co-occurring anxiety disorders negatively influencing educational, social, and general development together with quality of life. A manualised cognitive behavioural therapy (CBT) program 'Cool Kids - Autism Spectrum Adaptation (ASA)' has previously demonstrated efficacy in reducing anxiety in children with co-occurring autism. The current study investigates the feasibility of adapting this program for adolescents. METHODS Fifteen autistic adolescents, aged 14-17 years, with co-occurring anxiety disorders were enrolled in the study. Outcome measures collected from both adolescents and parents pre-, post-treatment and at 3-month follow-up included participant evaluation of the program, scores from a semi-structured anxiety interview, and questionnaires on anxiety symptoms, life interference, and quality of life. RESULTS 92% of the families who completed the program found it useful and would recommend it to other families in a similar situation. At follow-up, 55% no longer met the criteria for their primary anxiety diagnosis and 34% of adolescents were free of all anxiety diagnoses. Of the five adolescents who did not attend school before treatment three (60%) had returned to school after treatment. CONCLUSION This study suggests that the adaptation of the program 'Cool Kids - ASA' into an adolescent version is feasible and has the potential to show good effects thus enhancing the possibility of education, development and independence in future life for this group. Larger RCTs studies are, however, needed to examine the efficacy of the adolescent version.
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Affiliation(s)
- Tina R Kilburn
- Department of Child and Adolescent Psychiatry, Research Unit, Aarhus University Hospital, Aarhus, Denmark
| | - Ronald M Rapee
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, NSW, Australia
| | - Heidi J Lyneham
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, NSW, Australia
| | - Mikael Thastum
- Centre for the Psychological Treatment of Children and Adolescents (CEBU), Department of Psychology, Aarhus University, Aarhus, Denmark
| | - Per Hove Thomsen
- Department of Child and Adolescent Psychiatry, Research Unit, Aarhus University Hospital, Aarhus, Denmark
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McGrew J, Yu Y, Ruble L, Murray DS. Predictive Analysis of Parent Activation and Autism. J Autism Dev Disord 2024; 54:2471-2483. [PMID: 37133611 DOI: 10.1007/s10803-023-05985-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2023] [Indexed: 05/04/2023]
Abstract
We examined parent activation in families with autistic children over time. Activation is one's belief, knowledge, and persistence in obtaining and managing one's care (e.g., patient activation) and others (e.g., parent activation) and is associated with better outcomes. Four aims were examined: the associations between baseline parent activation and follow up treatment/outcome, between changes in activation and changes in treatment/outcome, differences in activation and treatment/outcome across demographic groups (e.g., gender, race, ethnicity, and income) and comparison of results using three different assessment approaches of parent activation, the Guttman scale (standard approach) and two factor subscales (Yu et al., in J Autism Dev Disord 53:110-120, 2023). The first factor tapped into behaviors aligned with highly active, assertive parental actions (Factor 1: Activated). The second tapped into behaviors representative of uncertainty, passivity, being overwhelmed, with growing awareness of the need for activation (Factor 2: Passive). Findings varied with assessment methods applied. The two subscales assessment approach produced the strongest effect sizes. Baseline activation was related to improved child outcomes at follow-up for Factor 1: Activated and to poorer child outcomes at follow-up for Factor 2: Passive. Changes in activation were unrelated to changes in treatment/outcomes. Outcomes differed based on the activation assessment approach used. Against expectations, activation remained the same over time. Further, no differences in outcomes were observed based on race, ethnicity, or family income. The results suggest that parent activation may behave differently than patient activation based on prior studies. More research is warranted on activation of parents of autistic children.
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Affiliation(s)
- John McGrew
- Department of Psychology, Indiana University Purdue University Indianapolis, 402 N. Blackford St., LD124, Indianapolis, IN, 46202, USA
| | - Yue Yu
- MIND Institute, University of California-Davis, 2825 50th Street, Sacramento, CA, 95817, USA
| | - Lisa Ruble
- Teachers College, TC745, Ball State University, Muncie, IN, 47306, USA.
| | - Donna S Murray
- Autism Speaks, 88 Broad Street, 5th Floor, Boston, MA, 02110, USA
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 4002, Cincinnati, OH, 45229, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, 3230 Eden Ave, Cincinnati, OH, 45267, USA
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Zheng RM, Chan SP, Law EC, Chong SC, Aishworiya R. Validity and feasibility of using the Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F) in primary care clinics in Singapore. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:1758-1771. [PMID: 37882198 PMCID: PMC11191374 DOI: 10.1177/13623613231205748] [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] [Indexed: 10/27/2023]
Abstract
LAY ABSTRACT Systematic screening for autism in early childhood has been suggested to improve eventual outcomes by facilitating earlier diagnosis and access to intervention. However, clinical implementation of screening has to take into account effectiveness and feasibility of use within a healthcare setting for accurate diagnosis of autism. In Singapore, autism screening using a structured screening tool is not currently employed as a part of routine well-child visits for children in primary care clinics. In this study, 5336 children (aged 17-20 months) were screened for autism using the Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F) during their 18-month well-child visit in seven primary care clinics. Screening and follow-up interviews were administered by nursing staff at each clinic. Children screened positive and a portion of those screened negative then underwent diagnostic assessments to determine whether they met the diagnostic criteria for autism. In total, 113 (2.1%) were screened positive, of which 54 (1.0%) met the criteria for autism. Children who screened positive and received a diagnosis accessed autism-specific intervention at an average age of 22 months. Nurses and physicians rated the acceptability and practicality of the M-CHAT-R/F highly. Therefore, the M-CHAT-R/F questionnaire was an effective and feasible tool for autism screening among 18-month-old children in this study. Future studies will be designed to determine the optimal age of screening and role of repeated screening in Singapore, as well as to better understand any potential improved outcomes nationwide compared with pre-implementation of autism screening.
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Affiliation(s)
| | - Siew Pang Chan
- National University Heart Centre, Singapore
- National University of Singapore, Singapore
| | - Evelyn C Law
- National University of Singapore, Singapore
- Agency for Science, Technology and Research (A*STAR), Singapore
- National University Hospital, Singapore
| | - Shang Chee Chong
- National University of Singapore, Singapore
- National University Hospital, Singapore
| | - Ramkumar Aishworiya
- National University of Singapore, Singapore
- National University Hospital, Singapore
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Shen J, Liu L, Yang Y, Zhou M, Xu S, Zhang W, Zhang C. Insulin-Like Growth Factor 1 Has the Potential to Be Used as a Diagnostic Tool and Treatment Target for Autism Spectrum Disorders. Cureus 2024; 16:e65393. [PMID: 39188438 PMCID: PMC11346671 DOI: 10.7759/cureus.65393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2024] [Indexed: 08/28/2024] Open
Abstract
Autism spectrum disorder (ASD), a heterogeneous group of neurodevelopmental disorders, is characterized by social impairment and repetitive and stereotypic behaviors. Because of the lack of approved laboratory diagnostic markers and effective therapeutic medications, it is one of the most challenging diseases. Therefore, it is urgent to explore potential diagnosis markers or therapeutic targets. Insulin-like growth factor 1 (IGF-1) is a neurotrophic growth factor that enhances brain development. IGF-1 levels in body fluids are lower in preschool children with ASD than in typically developing children, which may serve as a potential diagnostic marker. In various ASD models associated with genetic or environmental exposure, IGF-1 treatment can improve core symptoms or pathological changes, including neuronal development, neural cell survival, balance of synaptic excitation and inhibition, neuroimmunology, and oxidative stress status. In March 2023 an IGF-1 derivative was approved as the first drug for treating Rett syndrome, an ASD-related neurodevelopmental disorder, to improve fundamental symptoms such as social communication. Thus, in this review, we present accumulating evidence of altered IGF-1 levels in ASD patients and the possible mechanisms, as well as evidence that IGF-1 treatment improves the pathophysiology in various ASD models. IGF-1 has the potential to be an early diagnosis marker and an effective therapeutic for ASD.
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Affiliation(s)
- Jiamin Shen
- Department of Children Health Care, Jingmen Maternity and Child Health Care Hospital, Jingmen, CHN
| | - Lijuan Liu
- Department of Medical Microbiology, School of Basic Medical Sciences, Wuhan University, Wuhan, CHN
| | - Yifan Yang
- Department of Children Health Care, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital) Tongji Medical College, Huazhong University of Science and Technology, Wuhan, CHN
| | - Miao Zhou
- Department of Children Health Care, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital) Tongji Medical College, Huazhong University of Science and Technology, Wuhan, CHN
| | - Shan Xu
- Department of Children Health Care, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital) Tongji Medical College, Huazhong University of Science and Technology, Wuhan, CHN
| | - Wanqing Zhang
- Department of Children Health Care, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital) Tongji Medical College, Huazhong University of Science and Technology, Wuhan, CHN
| | - Chuanjie Zhang
- Department of Children Health Care, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital) Tongji Medical College, Huazhong University of Science and Technology, Wuhan, CHN
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8
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Thielman J, Orr S, Naraentheraraja S, Harrington D, Carsley S. Cross-sectional analysis of the association between household food insecurity and mental health conditions in children aged 5-11 years in Canada. BMJ Open 2024; 14:e081538. [PMID: 38925691 PMCID: PMC11202637 DOI: 10.1136/bmjopen-2023-081538] [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: 10/30/2023] [Accepted: 06/05/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Children living in food insecure households have poorer mental health outcomes compared with their food-secure peers; however, the relationship between the severity of food insecurity and diagnosed mental health conditions in young children remains unknown. This study examined the association between household food insecurity and reported diagnosed mental health conditions among children aged 5-11 years in Canada. METHODS This study included 16 216 children aged 5-11 years living in Canada, from the 2019 Canadian Health Survey on Children and Youth. We measured household food insecurity using the Household Food Security Survey Module. We measured diagnosed mental health conditions by parent/caregiver report of health professional-diagnosed anxiety, depression, autism spectrum disorder or attention-deficit/hyperactive disorder. We developed a multivariable logistic regression model to assess the association between severities of food insecurity and mental health, controlling for potentially confounding variables. RESULTS 17.0% of children lived in households reporting some level of food insecurity (5.4% marginal, 8.0% moderate and 3.6% severe). The prevalence of at least one diagnosed mental health condition in the same population was 10.9%. After adjusting for sociodemographic characteristics, children from marginal, moderate and severe food insecure households had a 1.39 (95% CI 0.99 to 1.97), 1.46 (95% CI 1.13 to 1.89) and 1.67 (95% CI 1.18 to 2.35) increased odds of having a diagnosed mental health condition, respectively. CONCLUSION Household food insecurity is associated with an increased presence of diagnosed mental health conditions in children aged 5-11 years. This study adds to the body of research showing that social and economic inequities, including household food insecurity, negatively impact the health of children.
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Affiliation(s)
- Justin Thielman
- Health Promotion, Chronic, Disease and Injury Prevention, Public Health Ontario, Toronto, Ontario, Canada
| | - Sarah Orr
- Health Promotion, Chronic, Disease and Injury Prevention, Public Health Ontario, Toronto, Ontario, Canada
| | | | - Daniel Harrington
- Health Promotion, Chronic, Disease and Injury Prevention, Public Health Ontario, Toronto, Ontario, Canada
| | - Sarah Carsley
- Health Promotion, Chronic, Disease and Injury Prevention, Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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9
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Coulter HL, Donnelly MP, Yakkundi A, McAneney H, Barr OG, Kernohan WG. Heart rate variability biofeedback to reduce anxiety in autism spectrum disorder - a mini review. Front Psychiatry 2024; 15:1409173. [PMID: 38938467 PMCID: PMC11208699 DOI: 10.3389/fpsyt.2024.1409173] [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: 03/29/2024] [Accepted: 05/29/2024] [Indexed: 06/29/2024] Open
Abstract
There is a reported high prevalence of anxiety in people with autism spectrum disorder. This mini review appraises existing research investigating heart rate variability biofeedback to help manage symptoms of anxiety in people with autism spectrum disorder. A thorough search of electronic databases was conducted to find relevant literature. Consultation with experts and a librarian helped develop search terms following the PICO framework. Five databases were searched, and screening was undertaken using Covidence software, with the process outlined in a PRISMA flowchart. The latest review showed positive short-term effects but there is a need for long-term follow-up. Future investigations should consider device type, training settings, and control interventions. Accurate heart rate variability assessment independent of biofeedback devices is crucial. Additional measures like cortisol assessment and user feedback are recommended for comprehensive evaluation. The findings highlight progress in the evidence base and offer insight to future directions.
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Affiliation(s)
- Helen L. Coulter
- Doctoral College, Ulster University, Belfast, United Kingdom
- Institute of Nursing and Health Research, Faculty of Life and Health Sciences, Ulster University, Belfast, United Kingdom
| | - Mark P. Donnelly
- School of Computing, Faculty of Computing, Engineering and the Built Environment, Ulster University, Belfast, United Kingdom
| | - Anita Yakkundi
- School of Health Sciences, Faculty of Life and Health Sciences, Ulster University, Belfast, United Kingdom
- Northern Ireland Public Health Research Network, Belfast, United Kingdom
| | - Helen McAneney
- Northern Ireland Public Health Research Network, Belfast, United Kingdom
- School of Medicine, Faculty of Life and Health Sciences, University of Ulster, Belfast, United Kingdom
| | - Owen G. Barr
- Institute of Nursing and Health Research, Faculty of Life and Health Sciences, Ulster University, Belfast, United Kingdom
- School of Nursing and Paramedic Science, Faculty of Life and Health Sciences, Ulster University, Londonderry, United Kingdom
| | - W. George Kernohan
- Institute of Nursing and Health Research, Faculty of Life and Health Sciences, Ulster University, Belfast, United Kingdom
- School of Nursing and Paramedic Science, Faculty of Life and Health Sciences, Ulster University, Londonderry, United Kingdom
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Baloyi O, Jarvis MA, Chironda G, Mbeje P, Ngcobo SJ, Gqaleni T, Mhlongo EM, Ngcobo WB, Brysiewicz P. Experiences of families with children diagnosed with Autism Spectrum Disorder in World Health Organization Afro-Regions: A scoping review. Nurs Health Sci 2024; 26:e13123. [PMID: 38692580 DOI: 10.1111/nhs.13123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/13/2024] [Accepted: 04/09/2024] [Indexed: 05/03/2024]
Abstract
A scoping review on Autism Spectrum Disorder (ASD) and its impact on the families of affected children was undertaken due to insufficient information available on the diverse experiences impacting their lives. Using the Joanna Briggs Institute methodology, eligibility criteria were guided by Population (families), Concept (family experiences), and Context (African region). English-language articles were sought from a variety of databases and search engines. The publication date of the identified articles ranged from 2003 to 2021 with most published in 2020 (n = 10), and the majority using qualitative methodologies (n = 51). Most family members involved were parents (n = 51) and their ages ranged from 18 to 75 years. The families experienced various challenges related to their child with regard to education, healthcare, and the broader community including lack of support. Family coping strategies included believing in God, attending counseling sessions, adapting, and accepting the situation. Healthcare professionals should be prepared and positioned to educate families and siblings on various aspects of ASD. There is a need for active, continued research on families within most countries of World Health Organization Afro-region.
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Affiliation(s)
- Olivia Baloyi
- Department of Nursing, College of Health Sciences, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Mary Ann Jarvis
- Department of Nursing, College of Health Sciences, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Geldine Chironda
- Department of Nursing, College of Health Sciences, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Pretty Mbeje
- Department of Nursing, College of Health Sciences, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Silingene Joyce Ngcobo
- Department of Nursing, College of Health Sciences, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Thusile Gqaleni
- Department of Nursing, College of Health Sciences, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Euphemia Mbali Mhlongo
- Department of Nursing, College of Health Sciences, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Winnie Baphumelele Ngcobo
- Department of Nursing, College of Health Sciences, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Petra Brysiewicz
- Department of Nursing, College of Health Sciences, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
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11
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Pesch MH, Leung J, Lanzieri TM, Tinker SC, Rose CE, Danielson ML, Yeargin-Allsopp M, Grosse SD. Autism Spectrum Disorder Diagnoses and Congenital Cytomegalovirus. Pediatrics 2024; 153:e2023064081. [PMID: 38808409 PMCID: PMC11153325 DOI: 10.1542/peds.2023-064081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 03/19/2024] [Accepted: 03/21/2024] [Indexed: 05/30/2024] Open
Abstract
OBJECTIVE To examine the association between congenital cytomegalovirus (cCMV) and autism spectrum disorder (ASD) administrative diagnoses in US children. METHODS Cohort study using 2014 to 2020 Medicaid claims data. We used diagnosis codes to identify cCMV (exposure), ASD (outcome), and covariates among children enrolled from birth through ≥4 to <7 years. Covariates include central nervous system (CNS) anomaly or injury diagnosis codes, including brain anomaly, microcephaly within 45 days of birth, cerebral palsy, epilepsy, or chorioretinitis. We used Cox proportional hazards regression models to estimate hazard ratios and 95% confidence intervals, overall and stratified by sex, birth weight and gestational age outcome (low birth weight or preterm birth), and presence of CNS anomaly or injury. RESULTS Among 2 989 659 children, we identified 1044 (3.5 per 10 000) children with cCMV and 74 872 (25.0 per 1000) children with ASD. Of those with cCMV, 49% also had CNS anomaly or injury diagnosis codes. Children with cCMV were more likely to have ASD diagnoses (hazard ratio: 2.5; 95% confidence interval: 2.0-3.2, adjusting for birth year, sex, and region). This association differed by sex and absence of CNS anomaly or injury but not birth outcome. CONCLUSIONS Children with (versus without) cCMV diagnoses in Medicaid claims data, most of whom likely had symptomatic cCMV, were more likely to have ASD diagnoses. Future research investigating ASD risk among cohorts identified through universal cCMV screening may help elucidate these observed associations.
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Affiliation(s)
- Megan H. Pesch
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
| | - Jessica Leung
- National Center for Immunization and Respiratory Diseases
| | | | - Sarah C. Tinker
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Charles E. Rose
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Melissa L. Danielson
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Marshalyn Yeargin-Allsopp
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Scott D. Grosse
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
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Hu Y, Callander E. Long-Term Effect of Having a Child at Risk of Developmental Delays on Parental Labor Force Participation. Matern Child Health J 2024; 28:1052-1060. [PMID: 38334864 PMCID: PMC11058796 DOI: 10.1007/s10995-024-03897-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 02/10/2024]
Abstract
OBJECTIVE This study aimed to examine the long-term influence of having a child at risk of different developmental delays (communication, mobility, self-care, relating, learning, coping, or behaving) on parental labor force participation as the child grows. METHOD A retrospective cohort was conducted using data from the Longitudinal Study of Australian Children survey, Waves 1-8 covering birth to 15 years of age of children. Multivariable logistic regressions were used to explore the odds ratio of mothers being out of the labor force at different children's ages. Cox proportional hazards models were utilized to identify the 'risk' of mothers returning to the workforce after leaving. All models were adjusted for the mother's age, education attainment, and employment status at time of birth, as well as marital status at the current wave. RESULTS There were 5,107 records of children, and 266 of them were at risk of any developmental delays at age 4-5 years. This sample represents 243, 026 children born in Australia in 2003/04. After adjusting for potential confounders, mothers of children at risk of each type of developmental delay (except mobility and self-care) had greater odds of being out of, and not returning to the labor force from children aged 2-3 to 14-15 years, when compared to mothers of children who are not at risk of developmental delays. Similar differences were found for fathers but were distinctly small and with narrower fluctuations, compared to mothers. CONCLUSION Policies and programs funded by the government are greatly needed to support the mothers of children at risk of developmental delays.
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Affiliation(s)
- Yanan Hu
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Emily Callander
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
- University of Technology Sydney, Building 10, Level 8, Room 109 235-253 Jones Street, Ultimo, NSW, 2007, Australia.
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Guo B, Liu T, Choi S, Mao H, Wang W, Xi K, Jones C, Hartley ND, Feng D, Chen Q, Liu Y, Wimmer RD, Xie Y, Zhao N, Ou J, Arias-Garcia MA, Malhotra D, Liu Y, Lee S, Pasqualoni S, Kast RJ, Fleishman M, Halassa MM, Wu S, Fu Z. Restoring thalamocortical circuit dysfunction by correcting HCN channelopathy in Shank3 mutant mice. Cell Rep Med 2024; 5:101534. [PMID: 38670100 PMCID: PMC11149412 DOI: 10.1016/j.xcrm.2024.101534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 12/11/2023] [Accepted: 04/04/2024] [Indexed: 04/28/2024]
Abstract
Thalamocortical (TC) circuits are essential for sensory information processing. Clinical and preclinical studies of autism spectrum disorders (ASDs) have highlighted abnormal thalamic development and TC circuit dysfunction. However, mechanistic understanding of how TC dysfunction contributes to behavioral abnormalities in ASDs is limited. Here, our study on a Shank3 mouse model of ASD reveals TC neuron hyperexcitability with excessive burst firing and a temporal mismatch relationship with slow cortical rhythms during sleep. These TC electrophysiological alterations and the consequent sensory hypersensitivity and sleep fragmentation in Shank3 mutant mice are causally linked to HCN2 channelopathy. Restoring HCN2 function early in postnatal development via a viral approach or lamotrigine (LTG) ameliorates sensory and sleep problems. A retrospective case series also supports beneficial effects of LTG treatment on sensory behavior in ASD patients. Our study identifies a clinically relevant circuit mechanism and proposes a targeted molecular intervention for ASD-related behavioral impairments.
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Affiliation(s)
- Baolin Guo
- Department of Neurobiology, School of Basic Medicine, Fourth Military Medical University, Xi'an 710032, China; Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Tiaotiao Liu
- School of Biomedical Engineering and Technology, Tianjin Medical University, Tianjin 300070, China
| | - Soonwook Choi
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA; McGovern Institute for Brain Research, Department of Brain and Cognitive Sciences, MIT, Cambridge, MA 02139, USA
| | - Honghui Mao
- Department of Neurobiology, School of Basic Medicine, Fourth Military Medical University, Xi'an 710032, China
| | - Wenting Wang
- Department of Neurobiology, School of Basic Medicine, Fourth Military Medical University, Xi'an 710032, China
| | - Kaiwen Xi
- Department of Neurobiology, School of Basic Medicine, Fourth Military Medical University, Xi'an 710032, China
| | - Carter Jones
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Nolan D Hartley
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA; McGovern Institute for Brain Research, Department of Brain and Cognitive Sciences, MIT, Cambridge, MA 02139, USA
| | - Dayun Feng
- Department of Neurobiology, School of Basic Medicine, Fourth Military Medical University, Xi'an 710032, China
| | - Qian Chen
- McGovern Institute for Brain Research, Department of Brain and Cognitive Sciences, MIT, Cambridge, MA 02139, USA
| | - Yingying Liu
- Department of Neurobiology, School of Basic Medicine, Fourth Military Medical University, Xi'an 710032, China
| | - Ralf D Wimmer
- McGovern Institute for Brain Research, Department of Brain and Cognitive Sciences, MIT, Cambridge, MA 02139, USA
| | - Yuqiao Xie
- Department of Neurobiology, School of Basic Medicine, Fourth Military Medical University, Xi'an 710032, China
| | - Ningxia Zhao
- Xi'an TCM Hospital of Encephalopathy, Shaanxi University of Chinese Medicine, Xi'an 710032, China
| | - Jianjun Ou
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, National Clinical Research Center for Mental Disorders, Changsha 410011, China
| | - Mario A Arias-Garcia
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Diya Malhotra
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Yang Liu
- Department of Neurobiology, School of Basic Medicine, Fourth Military Medical University, Xi'an 710032, China
| | - Sihak Lee
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Sammuel Pasqualoni
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Ryan J Kast
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA; McGovern Institute for Brain Research, Department of Brain and Cognitive Sciences, MIT, Cambridge, MA 02139, USA
| | - Morgan Fleishman
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Michael M Halassa
- McGovern Institute for Brain Research, Department of Brain and Cognitive Sciences, MIT, Cambridge, MA 02139, USA
| | - Shengxi Wu
- Department of Neurobiology, School of Basic Medicine, Fourth Military Medical University, Xi'an 710032, China.
| | - Zhanyan Fu
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA; McGovern Institute for Brain Research, Department of Brain and Cognitive Sciences, MIT, Cambridge, MA 02139, USA.
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14
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Marsack-Topolewski CN, Samuel PS. Experiences of Parental Caregivers of Adults with Autism in Navigating the World of Employment. J Autism Dev Disord 2024:10.1007/s10803-024-06381-8. [PMID: 38764071 DOI: 10.1007/s10803-024-06381-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2024] [Indexed: 05/21/2024]
Abstract
PURPOSE Caregiving often presents challenges for parents, particularly for parents of loved ones with disabilities or health challenges, who need and/or want to be employed. This study describes the employment experiences of aging parents as they continue to balance engagement in the paid workforce with the ongoing provision of care for their adult children with autism spectrum disorder (ASD). The purpose of this study was to examine the lived experiences of parents of adult children with ASD in the context of balancing career and caregiving responsibilities. METHODS The current study uses a qualitative phenomenological research approach to describe the lived experiences of 51 parents who were caring for an adult child with ASD. The parents participated in telephone interviews to obtain information about their career experiences while providing care and support to their adult children with ASD. RESULTS Three caregiving themes emerged including: (a) difficulty balancing caregiving with work responsibilities, (b) reasons for working, not working, or working intermittently, and (c) work as an escape or wanting to work more. CONCLUSION As more individuals with ASD reach adulthood, often relying to varying extents on their families for daily support, parental employment will continue to be impacted as they juggle their career with caregiving responsibilities. Economically, one or more family members typically need to work to sustain the family's needs and employment support should be considered. As a society, families often need to make choices even with an adult child with ASD of who will work, how, and when.
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Affiliation(s)
- Christina N Marsack-Topolewski
- School of Social Work, Eastern Michigan University, 206H Everett L. Marshall Building, Ypsilanti, Ypsilanti, MI, 48197, USA.
| | - Preethy S Samuel
- College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Avenue, Detroit, MI, 48201, USA
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Kata A, McPhee PG, Chen YJ, Zwaigenbaum L, Singal D, Roncadin C, Bennett T, Carter M, Di Rezze B, Drmic I, Duku E, Fournier S, Frei J, Gentles SJ, Georgiades K, Hanlon-Dearman A, Hoult L, Kelley E, Koller J, de Camargo OK, Lai J, Mahoney B, Mesterman R, Ng O, Robertson S, Rosenbaum P, Salt M, Zubairi MS, Georgiades S. The Pediatric Autism Research Cohort (PARC) Study: protocol for a patient-oriented prospective study examining trajectories of functioning in children with autism. BMJ Open 2024; 14:e083045. [PMID: 38684247 PMCID: PMC11086431 DOI: 10.1136/bmjopen-2023-083045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 04/04/2024] [Indexed: 05/02/2024] Open
Abstract
INTRODUCTION The developmentally variable nature of autism poses challenges in providing timely services tailored to a child's needs. Despite a recent focus on longitudinal research, priority-setting initiatives with stakeholders highlighted the importance of studying a child's day-to-day functioning and social determinants of health to inform clinical care. To address this, we are conducting a pragmatic multi-site, patient-oriented longitudinal investigation: the Pediatric Autism Research Cohort (PARC) Study. In young children (<7 years of age) newly diagnosed with autism, we will: (1) examine variability in trajectories of adaptive functioning from the point of diagnosis into transition to school; and (2) identify factors associated with trajectories of adaptive functioning. METHODS AND ANALYSIS We aim to recruit 1300 children under 7 years of age with a recent (within 12 months) diagnosis of autism from seven sites: six in Canada; one in Israel. Participants will be followed prospectively from diagnosis to age 8 years, with assessments at 6-month intervals. Parents/caregivers will complete questionnaires administered via a customized online research portal. Following each assessment timepoint, families will receive a research summary report describing their child's progress on adaptive functioning and related domains. Analysis of the longitudinal data will map trajectories and examine child, family and service characteristics associated with chronogeneity (interindividual and intraindividual heterogeneity over time) and possible trajectory turning points around sensitive periods like the transition to school. ETHICS AND DISSEMINATION Ethics approvals have been received by all sites. All parents/respondents will provide informed consent when enrolling in the study. Using an integrated knowledge translation approach, where stakeholders are directly engaged in the research process, the PARC Study will identify factors associated with trajectories of functioning in children with autism. Resulting evidence will be shared with government policy makers to inform provincial and national programs. Findings will be disseminated at conferences and published in peer-reviewed journals.
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Affiliation(s)
- Anna Kata
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Offord Centre for Child Studies, McMaster University, Hamilton, Ontario, Canada
| | - Patrick G McPhee
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Offord Centre for Child Studies, McMaster University, Hamilton, Ontario, Canada
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Yun-Ju Chen
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Offord Centre for Child Studies, McMaster University, Hamilton, Ontario, Canada
| | - Lonnie Zwaigenbaum
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Deepa Singal
- Autism Alliance of Canada, Toronto, Ontario, Canada
| | - Caroline Roncadin
- McMaster Children's Hospital Autism Program, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Teresa Bennett
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Offord Centre for Child Studies, McMaster University, Hamilton, Ontario, Canada
| | - Melissa Carter
- Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Briano Di Rezze
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada
| | - Irene Drmic
- McMaster Children's Hospital Autism Program, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Eric Duku
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Offord Centre for Child Studies, McMaster University, Hamilton, Ontario, Canada
| | | | - Julia Frei
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Stephen J Gentles
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Offord Centre for Child Studies, McMaster University, Hamilton, Ontario, Canada
| | - Kathy Georgiades
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Offord Centre for Child Studies, McMaster University, Hamilton, Ontario, Canada
| | - Ana Hanlon-Dearman
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Elizabeth Kelley
- Department of Psychology, Queen's University, Kingston, Ontario, Canada
- Department of Psychiatry, Queen's University, Kingston, Ontario, Canada
| | - Judah Koller
- Seymour Fox School of Education, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Olaf Kraus de Camargo
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Jonathan Lai
- Autism Alliance of Canada, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Bill Mahoney
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Ronit Mesterman
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Olivia Ng
- McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Sue Robertson
- McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Peter Rosenbaum
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Mackenzie Salt
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Offord Centre for Child Studies, McMaster University, Hamilton, Ontario, Canada
- Autism Alliance of Canada, Toronto, Ontario, Canada
| | - Mohammad S Zubairi
- McMaster Children's Hospital Autism Program, Hamilton Health Sciences, Hamilton, Ontario, Canada
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Stelios Georgiades
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Offord Centre for Child Studies, McMaster University, Hamilton, Ontario, Canada
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Seyed-Alipour S, Alaghband-Rad J, Faraji S, Hooshyari Z, Tehranidoost M, Motamed M. Cognitive functioning in adults with autism spectrum disorder. APPLIED NEUROPSYCHOLOGY. ADULT 2024:1-8. [PMID: 38635408 DOI: 10.1080/23279095.2024.2336201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
INTRODUCTION Neuropsychological deficits in areas of Executive Functioning (EF), theory of mind, and central coherence have been well-documented among children and adolescents with autism spectrum disorder (ASD); however, there remains a significant gap in knowledge with regards to neuropsychological profile in adults with ASD. This study aims to investigate the intellectual functioning and neuropsychological profiles of a clinical population of adults with ASD. METHODS This cross-sectional study included 40 available autistic individuals referred to an adult developmental disorders clinic at a hospital between 2021 and 2022. All participants were assessed using the Stanford-Binet Intelligence Scale (SBIS), Autism Spectrum Quotient (AQ), Ritvo Autism Asperger Diagnostic Scale-Revised (RAADS-R), and Social Responsiveness Scale (SRS). RESULTS Individuals with ASD exhibited lower IQ scores across all domains of the Stanford-Binet Intelligence Scale, compared to the general population, although the mean IQ scores remained within the normal range. Significant differences were observed in Full Scale IQ, Verbal IQ, Non-Verbal IQ, Fluid Reasoning, Knowledge, Quantitative Reasoning, Visual-Spatial Processing, and Working Memory compared to the general population. Additionally, autistic individuals' performance on verbal knowledge was higher compared to non-verbal knowledge. No significant correlations were found between the total and subscale scores of verbal and nonverbal IQ and AQ, RAADS-R, and SRS scores. CONCLUSION Considering the significant impacts of cognitive and executive function on the social and occupational aspects of autistic adults, further investigations in this area are warranted.
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Affiliation(s)
- Sajedeh Seyed-Alipour
- Roozbeh Hospital, Faculty of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran
| | - Javad Alaghband-Rad
- Roozbeh Hospital, Faculty of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran
| | - Saba Faraji
- Roozbeh Hospital, Faculty of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Hooshyari
- Ziaeian Hospital, Faculty of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Tehranidoost
- Roozbeh Hospital, Faculty of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahtab Motamed
- Roozbeh Hospital, Faculty of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran
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Tovin MM, Núñez-Gaunaurd A. Implementation of Peer-Assisted Physical Activity Via Telehealth for Adults on the Autism Spectrum: A Mixed Methods Feasibility Study. Phys Ther 2024; 104:pzae005. [PMID: 38236176 DOI: 10.1093/ptj/pzae005] [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: 11/07/2022] [Revised: 09/02/2023] [Accepted: 12/01/2023] [Indexed: 01/19/2024]
Abstract
OBJECTIVE Adults on the autism spectrum are at risk for physical inactivity, obesity, and related health conditions. Physical activity provides physical, social, and mental health benefits across the lifespan. Previous research examined feasibility and effectiveness of physical activity intervention in autistic children, but very few studies target autistic adults. This study examined the feasibility and acceptability of Physical Activity Connections via Telehealth, implemented during the coronavirus disease 2019 (COVID-19) pandemic lockdown as an alternative to in-person programming for autistic adults aged 18 to 32. METHODS The 10-week intervention utilized telehealth and remote technologies to deliver a theoretically grounded program to improve physical activity. Strategies included peer-guidance, coaching, individualized wellness goals, customized exercise programs, and wearable activity trackers. Feasibility and acceptability were examined using a mixed-methods design including observational and survey data collection, as well as participant interviews. Data were analyzed using descriptive statistics and content analysis. RESULTS Findings support feasibility and acceptability of telehealth to promote physical activity among autistic adults who have cognitive capacity and ability to utilize remote technology, with applicability beyond pandemic-imposed challenges. CONCLUSION Telehealth delivery of physical activity interventions is a viable alternative to in-person programs and may enable autistic adults to overcome barriers to physical activity participation and access. IMPACT As the rate of autism continues to rise globally, rehabilitation professionals will play a significant role in promoting health and wellness for autistic individuals across the lifespan. Findings promote informed practice based on the health needs of this growing segment of society.
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Affiliation(s)
- Melissa M Tovin
- Department of Physical Therapy, Nova Southeastern University, Fort Lauderdale, Florida, USA
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Crowson S, Poole D, Scargill K, Freeth M. Understanding the post-diagnostic support priorities of autistic adults in the United Kingdom: A co-produced modified Delphi study. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:854-865. [PMID: 37776060 PMCID: PMC10981182 DOI: 10.1177/13623613231196805] [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: 10/01/2023]
Abstract
LAY ABSTRACT Autistic adults in the United Kingdom report that support for themselves and their peers is not suitable for their needs. There has been an increase in adults receiving an autism diagnosis, which many have reported as having a positive impact on their lives. However, the lack of support and understanding after diagnosis, combined with long wait times for an assessment to obtain a diagnosis and to access follow-on support, is having a negative impact on people's lives. This study took place to find out what support autistic people need and want after receiving their diagnosis. It was co-designed with a group of 10 autistic adults which means that the researchers and group members collaboratively designed the research. For the study, 43 autistic adults, diagnosed aged 18 or older, completed three questionnaires. A fourth questionnaire followed that was completed by 139 autistic people who received their diagnosis in adulthood. These questionnaires aimed to help people identify their own priorities when it came to the support they would have liked to receive after being given their autism diagnosis. Participants ranked access to support where they live, training of professionals, support to process the impact of a late diagnosis, use of their preferred mode of contact and a personalised support plan as their top priorities. This demonstrates that local support is highly valued by autistic adults, as are well-trained professionals who offer a range of contact options, support to process a late-in-life autism diagnosis and help to develop and implement support plans.
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Hrdlicka M, Urbanek T, Rotreklova A, Kultova A, Valek O, Dudova I. Predictors of age at diagnosis in autism spectrum disorders: the use of multiple regression analyses and a classification tree on a clinical sample. Eur Child Adolesc Psychiatry 2024; 33:1171-1177. [PMID: 36933152 PMCID: PMC10024300 DOI: 10.1007/s00787-023-02189-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 03/08/2023] [Indexed: 03/19/2023]
Abstract
The increasing prevalence of autism spectrum disorders (ASD) has led to worldwide interest in factors influencing the age of ASD diagnosis. Parents or caregivers of 237 ASD children (193 boys, 44 girls) diagnosed using the Autism Diagnostic Observation Schedule (ADOS) completed a simple descriptive questionnaire. The data were analyzed using the variable-centered multiple regression analysis and the person-centered classification tree method. We believed that the concurrent use of these two methods could produce robust results. The mean age at diagnosis was 5.8 ± 2.2 years (median 5.3 years). Younger ages for ASD diagnosis were predicted (using multiple regression analysis) by higher scores in the ADOS social domain, higher scores in ADOS restrictive and repetitive behaviors and interest domain, higher maternal education, and the shared household of parents. Using the classification tree method, the subgroup with the lowest mean age at diagnosis were children, in whom the summation of ADOS communication and social domain scores was ≥ 17, and paternal age at the delivery was ≥ 29 years. In contrast, the subgroup with the oldest mean age at diagnosis included children with summed ADOS communication and social domain scores < 17 and maternal education at the elementary school level. The severity of autism and maternal education played a significant role in both types of data analysis focused on age at diagnosis.
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Affiliation(s)
- Michal Hrdlicka
- Department of Child Psychiatry, Second Faculty of Medicine, Charles University, University Hospital Motol, V Uvalu 84, 15006, Prague, Czech Republic.
- Institute of Psychology, Faculty of Arts, Masaryk University, Brno, Czech Republic.
| | - Tomas Urbanek
- Institute of Psychology, Academy of Sciences, Brno, Czech Republic
| | - Adela Rotreklova
- Department of Child Psychiatry, Second Faculty of Medicine, Charles University, University Hospital Motol, V Uvalu 84, 15006, Prague, Czech Republic
| | - Aneta Kultova
- Military University Hospital, Prague, Czech Republic
| | - Ondrej Valek
- Military University Hospital, Prague, Czech Republic
| | - Iva Dudova
- Department of Child Psychiatry, Second Faculty of Medicine, Charles University, University Hospital Motol, V Uvalu 84, 15006, Prague, Czech Republic
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Micai M, Fulceri F, Salvitti T, Romano G, Scattoni ML. Access and cost of services for autistic children and adults in Italy: a carers' perspective. Front Psychiatry 2024; 15:1299473. [PMID: 38532989 PMCID: PMC10963481 DOI: 10.3389/fpsyt.2024.1299473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 02/28/2024] [Indexed: 03/28/2024] Open
Abstract
Background Limited information exists on autistic service access and costs in Italy. Objectives This study aims to investigate access to educational, healthcare, social, and related services for autistic individuals in Italy as part of the Autism Spectrum Disorder in the European Union (ASDEU) project. Methods Italian carers of autistic individuals completed an online survey regarding services and costs in the 6 months before completion. Results Three hundred and three carers of autistic people participated in the survey. The majority of those receiving care were children, males, and lived at home with their parents. Autistic adults were often students (17%) or unemployed but willing to work (17%). Employed carers (49%) worked on average 32.23 ± 9.27 hours per week. A significant portion (82%) took work or school absences to care for autistic individuals, averaging 15.56 ± 14.70 days. On average, carers spent 58.84 ± 48.36 hours per week on caregiving duties. Fifty-five of the autistic individuals received some form of support, 5% utilized residential care, and 6% were hospitalized. Thirty-four percent received outpatient hospital care, and 20% underwent some form of autism-related psychopharmacological therapy. School support was primarily provided by support teachers (18.16 ± 7.02 hours/week). Educational psychologists (80.73%), psychomotor therapists/physiotherapists (53.85%), and speech therapists (50.91%) were frequently paid by carers who paid more per hour. Autistic children received support from educators (73.96 hours/week), group therapy (32.36 hours/week), and speech therapists (31.19 hours/week). Psychologists (76.00%) and counseling/individual therapists (89.13%) were often paid by carers. Carers reported high costs for psychiatrists and psychologists, with frequent use of psychiatric services (8 ± 8 times in 6 months). Conclusions Carers' perspectives on the access and costs of services for autistic individuals in Italy can provide insights into areas for improvement in the delivery of autism services.
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Affiliation(s)
- Martina Micai
- Research Coordination and Support Service, Istituto Superiore di Sanità, Rome, Italy
| | - Francesca Fulceri
- Research Coordination and Support Service, Istituto Superiore di Sanità, Rome, Italy
| | - Tommaso Salvitti
- Research Coordination and Support Service, Istituto Superiore di Sanità, Rome, Italy
| | - Giovanna Romano
- Directorate General of Health Prevention, Ministry of Health, Rome, Italy
| | - Maria Luisa Scattoni
- Research Coordination and Support Service, Istituto Superiore di Sanità, Rome, Italy
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Danielson EC, Smith MJ, Ross B, Sherwood K, Smith JD, Atkins M, Jordan N. Implementation Preparation Costs of Virtual Interview Training in Pre-Employment Transition Services: A Budget Impact Analysis. JOURNAL OF SPECIAL EDUCATION TECHNOLOGY : A PUBLICATION OF UTAH STATE UNIVERSITY, THE ASSOCIATION FOR SPECIAL EDUCATION TECHNOLOGY, AND THE TECHNOLOGY AND MEDIA DIVISION OF THE COUNCIL FOR EXCEPTIONAL CHILDREN 2024; 39:27-40. [PMID: 38975255 PMCID: PMC11225931 DOI: 10.1177/01626434231175372] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/09/2024]
Abstract
Virtual Reality Job Interview Training (VR-JIT) and Virtual Interview Training for Transition Age Youth (VIT-TAY) demonstrated initial effectiveness at increasing employment among transition-age youth with disabilities engaged in pre-employment transition services. We characterized activities and estimated the labor and non-labor costs required to prepare schools to implement VR-JIT or VIT-TAY. Implementation preparation and support teams reported labor hours throughout the implementation preparation process. Implementation preparation labor hours at 43 schools cost approximately $1,427 per school, while non-labor costs were $100 per trainee (student). We estimated the replication of implementation preparation labor activities would cost $1,024 per school (range: $841-$1,208). Most costs were spent in delivery planning and teacher training. Given that implementation preparation costs can be barriers to intervention adoption, our results provide critical information for contemplating future implementation of VR-JIT or VIT-TAY.
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Affiliation(s)
- Elizabeth C. Danielson
- Center for Education in Health Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Matthew J. Smith
- School of Social Work, University of Michigan, Ann Arbor, Michigan
| | - Brittany Ross
- School of Social Work, University of Michigan, Ann Arbor, Michigan
| | - Kari Sherwood
- School of Social Work, University of Michigan, Ann Arbor, Michigan
- Department of Psychology, University of Michigan, Ann Arbor, Michigan
| | - Justin D. Smith
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, Utah
| | - Marc Atkins
- Institute for Juvenile Research, Department of Psychiatry, University of Illinois, Chicago, Illinois
| | - Neil Jordan
- Center for Education in Health Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Hines, Illinois
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22
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Anderson KA, Roux AM, Rast JE, Garfield T, Shea L. Low-Income Households of Children With Autism and the Economic Safety Net. Acad Pediatr 2024; 24:258-266. [PMID: 37931804 DOI: 10.1016/j.acap.2023.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 10/13/2023] [Accepted: 11/01/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVE This paper examines the distribution, parameters, and determinants of safety net program use among a nationally representative sample of low-income children with autism spectrum disorder (ASD). METHODS We used data from the 2021 National Survey of Children's Health to produce population estimates of material hardship and safety net program use among 554 low-income households of children with ASD, ages 3 to 17 years, relative to 2831 children with other special health care needs (SHCN) and 8758 children with no SHCN of the same age. Design-adjusted multivariate logistic regression models identified predictors of cash assistance, Supplemental Nutrition Assistance Program, and disconnection from both. RESULTS There were few significant differences in material hardship between children with ASD and those with other SHCN, although children with ASD experienced significantly higher levels of hardships compared to children with no SHCN. Having a child with ASD did not significantly increase the odds of safety net use. Health insurance and household income were stronger predictors of use than disability. Nine percent of disconnected children lived in households under 100% federal poverty level and experienced some type of material hardship. CONCLUSIONS Future research about the economic security of children with ASD and their families could focus on the following 3 areas of inquiry: assess how race, ethnicity, or socioeconomic position interact with disability to influence safety net program use; examine the intersection between Medicaid and safety net programs at the state and national levels; and identify specific subgroups of children at risk for disconnection and understand why they are not accessing benefits.
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Affiliation(s)
- Kristy A Anderson
- College of Social Work (KA Anderson), Florida State University, Tallahassee, FL.
| | - Anne M Roux
- A.J. Drexel ASD Institute (AM Roux, JE Rast, T Garfield, and L Shea), Drexel University, Philadelphia, Pa.
| | - Jessica E Rast
- A.J. Drexel ASD Institute (AM Roux, JE Rast, T Garfield, and L Shea), Drexel University, Philadelphia, Pa.
| | - Tamara Garfield
- A.J. Drexel ASD Institute (AM Roux, JE Rast, T Garfield, and L Shea), Drexel University, Philadelphia, Pa.
| | - Lindsay Shea
- A.J. Drexel ASD Institute (AM Roux, JE Rast, T Garfield, and L Shea), Drexel University, Philadelphia, Pa.
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23
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Shamabadi A, Karimi H, Arabzadeh Bahri R, Motavaselian M, Akhondzadeh S. Emerging drugs for the treatment of irritability associated with autism spectrum disorder. Expert Opin Emerg Drugs 2024; 29:45-56. [PMID: 38296815 DOI: 10.1080/14728214.2024.2313650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/30/2024] [Indexed: 02/02/2024]
Abstract
INTRODUCTION Autism spectrum disorder (ASD) is an early-onset disorder with a prevalence of 1% among children and reported disability-adjusted life years of 4.31 million. Irritability is a challenging behavior associated with ASD, for which medication development has lagged. More specifically, pharmacotherapy effectiveness may be limited against high adverse effects (considering side effect profiles and patient medication sensitivity); thus, the possible benefits of pharmacological interventions must be balanced against potential adverse events in each patient. AREAS COVERED After reviewing the neuropathophysiology of ASD-associated irritability, the benefits and tolerability of emerging medications in its treatment based on randomized controlled trials were detailed in light of mechanisms and targets of action. EXPERT OPINION Succeeding risperidone and aripiprazole, monotherapy with memantine may be beneficial. In addition, N-acetylcysteine, galantamine, sulforaphane, celecoxib, palmitoylethanolamide, pentoxifylline, simvastatin, minocycline, amantadine, pregnenolone, prednisolone, riluzole, propentofylline, pioglitazone, and topiramate, all adjunct to risperidone, and clonidine and methylphenidate outperformed placebo. These effects were through glutamatergic, γ-aminobutyric acidergic, inflammatory, oxidative, cholinergic, dopaminergic, and serotonergic systems. All medications were reported to be safe and tolerable. Considering sample size, follow-up, and effect size, further studies are necessary. Along with drug development, repositioning and combining existing drugs supported by the mechanism of action is recommended.
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Affiliation(s)
- Ahmad Shamabadi
- Psychiatric Research Center, Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hanie Karimi
- Psychiatric Research Center, Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Razman Arabzadeh Bahri
- Psychiatric Research Center, Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Shahin Akhondzadeh
- Psychiatric Research Center, Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, Tehran, Iran
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24
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Anderson KA, Radey M, Rast JE, Roux AM, Shea L. The Economic Impacts of COVID-19 on Autistic Children and Their Families. J Autism Dev Disord 2024:10.1007/s10803-024-06280-y. [PMID: 38393434 DOI: 10.1007/s10803-024-06280-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2024] [Indexed: 02/25/2024]
Abstract
PURPOSE We used data from the National Survey of Children's Health to (1) examine differences in economic hardship and safety net program use after the implementation of federal relief efforts, and (2) assess whether the COVID-19 pandemic exacerbated autism-based disparities in hardship and program use. METHODS We examined five dimensions of economic hardship (poverty, food insecurity, medical hardship, medical costs, and foregone work) and four safety net programs (cash assistance, Supplemental Nutrition Assistance Program (SNAP), Special Supplemental Nutrition Program for Women, Infants and Children (WIC), and free or reduced-cost meals). First, we calculated adjusted prevalence and odds ratios to compare pre-COVID (2018-2019) and during COVID (2021) outcomes by autism status. Next, we calculated the adjusted odds of each outcome among autistic children compared to those of children with and without other special healthcare needs at both time points. RESULTS COVID-19 exacerbated autism-based disparities in food insecurity, SNAP, and public health insurance, but alleviated inequities in medical hardship, foregone work, and cash assistance. Autistic children did not experience declines in food insecurity or increases in SNAP like other children; medical hardship and foregone work decreased more for autistic children; and the magnitude of autism-based differences in public coverage significantly increased during the pandemic. CONCLUSION Federal relief efforts likely improved economic outcomes of children; however, these effects varied according to type of hardship and by disability group. Efforts to promote economic well-being among autistic populations should be tailored to the financial challenges most salient to low-income autistic children, like food insecurity.
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Affiliation(s)
- Kristy A Anderson
- Florida State University College of Social Work, 296 Champions Way, Tallahassee, FL, 32306, USA.
| | - Melissa Radey
- Florida State University College of Social Work, 296 Champions Way, Tallahassee, FL, 32306, USA
| | - Jessica E Rast
- A.J. Drexel Autism Institute, Drexel University, 3020 Market Street, Suite 560, Philadelphia, PA, 19104, USA
| | - Anne M Roux
- A.J. Drexel Autism Institute, Drexel University, 3020 Market Street, Suite 560, Philadelphia, PA, 19104, USA
| | - Lindsay Shea
- A.J. Drexel Autism Institute, Drexel University, 3020 Market Street, Suite 560, Philadelphia, PA, 19104, USA
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25
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Wang X, Ling Z, Luo T, Zhou Q, Zhao G, Li B, Xia K, Li J. Severity of Autism Spectrum Disorder Symptoms Associated with de novo Variants and Pregnancy-Induced Hypertension. J Autism Dev Disord 2024; 54:749-764. [PMID: 36445517 DOI: 10.1007/s10803-022-05824-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2022] [Indexed: 11/30/2022]
Abstract
Genetic factors, particularly, de novo variants (DNV), and an environment factor, exposure to pregnancy-induced hypertension (PIH), were reported to be associated with risk of autism spectrum disorder (ASD); however, how they jointly affect the severity of ASD symptom is unclear. We assessed the severity of core ASD symptoms affected by functional de novo variants or PIH. We selected phenotype data from Simon's Simplex Collection database, used genotypes from previous studies, and created linear regression models. We found that ASD patients carrying DNV with PIH exposure had increased adaptive and cognitive ability, decreased social problems, and enhanced repetitive behaviors; however, there was no difference in patients without DNV between those with or without PIH exposure. In addition, the DNV genes carried by patients exposed to PIH were enriched in ubiquitin-dependent proteolytic processes, highlighting how candidate genes in pathways and environments interact. The results indicate the joint contribution of DNV and PIH to ASD.
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Affiliation(s)
- Xiaomeng Wang
- Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, 41008, Hunan, China
- Centre for Medical Genetics, Hunan Key Laboratory of Medical Genetics, School of Life Sciences, Central South University, Changsha, 41008, Hunan, China
| | - Zhengbao Ling
- Centre for Medical Genetics, Hunan Key Laboratory of Medical Genetics, School of Life Sciences, Central South University, Changsha, 41008, Hunan, China
| | - Tengfei Luo
- Centre for Medical Genetics, Hunan Key Laboratory of Medical Genetics, School of Life Sciences, Central South University, Changsha, 41008, Hunan, China
| | - Qiao Zhou
- Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, 41008, Hunan, China
- Bioinformatics Center, National Clinical Research Centre for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Guihu Zhao
- Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, 41008, Hunan, China
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Bioinformatics Center, National Clinical Research Centre for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Bin Li
- Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, 41008, Hunan, China
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Bioinformatics Center, National Clinical Research Centre for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Kun Xia
- Centre for Medical Genetics, Hunan Key Laboratory of Medical Genetics, School of Life Sciences, Central South University, Changsha, 41008, Hunan, China.
- University of South China, Hengyang, Hunan, China.
| | - Jinchen Li
- Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, 41008, Hunan, China.
- Centre for Medical Genetics, Hunan Key Laboratory of Medical Genetics, School of Life Sciences, Central South University, Changsha, 41008, Hunan, China.
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China.
- Bioinformatics Center, National Clinical Research Centre for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China.
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26
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Zhao Y, Lu F, Wang X, Luo Y, Zhang R, He P, Zheng X. The economic burden of autism spectrum disorder with and without intellectual disability in China: A nationwide cost-of-illness study. Asian J Psychiatr 2024; 92:103877. [PMID: 38176313 DOI: 10.1016/j.ajp.2023.103877] [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: 08/29/2023] [Revised: 12/12/2023] [Accepted: 12/15/2023] [Indexed: 01/06/2024]
Abstract
OBJECTIVE The economic burden of autism spectrum disorder (ASD) on individuals, their families and society as a whole is poorly understood. Accurate figures are crucial for economic estimates and service planning. METHODS The total lifetime individual costs and annual societal costs of ASD in China were estimated with a prevalence-based, gross cost of illness approach and data from multiple sources. The direct medical costs in outpatient and inpatient settings from the electronic health records (EHRs) of hospitals, and direct nonmedical costs from a national survey were included. The indirect costs were from both the national survey and the estimation using human capital methods. Age-specific lifetime incremental societal costs were measured. Comorbidity-related and unrelated costs were analyzed separately. RESULTS The discounted lifetime cost for an individual with ASD in China was $2.65 million (at 2020 prices, $) for those without intellectual disability (ID) and $4.61 million (at 2020 prices, $) for those with ID. The total cost of ASD amounted to $41.8 billion in 2020. Productivity loss were major cost drivers for ASD individuals without ID. Direct nonmedical costs (rehabilitation or adult care costs etc.) were major drivers for ASD individuals with ID. In a lifetime course, the total annual costs for middle aged and elderly (>42 years) were highest, followed by transitional adults (18-29 years) and preschoolers, both for individuals with or without ID. The distribution of costs over the lifespan varied by the cost category. CONCLUSIONS ASD imposes a substantial economic burden on families and health care systems. Sectors and services coordination should be given policy considerations.
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Affiliation(s)
- Yanan Zhao
- School of Public Health, Peking University, Beijing, China; China Center for Health Development Studies, Peking University, Beijing, China
| | - Feng Lu
- Beijing Municipal Health Big Data and Policy Research Center, Beijing, China
| | - Xiangyu Wang
- China Center for Food and Drug International Exchange, Beijing, China
| | - Yanan Luo
- Department of Global Health, School of Public Health, Peking University, Beijing, China
| | - Rong Zhang
- Department of Neurobiology, School of Basic Medical Sciences, Peking University, Beijing, China; Neuroscience Research Institute, Peking University, Beijing, China; Key laboratory for Neuroscience, Ministry of Education/National Health and Family Planning Commission, Peking University, Beijing, China; Department of Integration of Chinese and Western Medicine, School of Basic Medical Sciences, Peking University, Beijing, China
| | - Ping He
- China Center for Health Development Studies, Peking University, Beijing, China.
| | - Xiaoying Zheng
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China.
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27
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Hamilton J, Finch T, Le Couteur A, Mackintosh J, Petrou A, Garland D, Parr JR. The lived experiences of relatives of autistic adults, and their perceptions of their relationships with autistic adults across multiple age-related transitions and demands: A qualitative interview study with reflexive thematic analysis. PLoS One 2024; 19:e0294232. [PMID: 38241348 PMCID: PMC10798545 DOI: 10.1371/journal.pone.0294232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 10/29/2023] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND There is a need to better understand autism across the life course, including the lives of both autistic people and supporting relatives. As part of a larger mixed methods cohort study involving autistic adults, carers and relatives this sub-study focused on the experiences of relatives alone to learn more about the lives of people from the wider personal networks. Our research questions were: 1. What are the experiences of family members who care for and/or support autistic adults, 2. How can the viewpoints of relatives add to what we know about transitions and challenges experienced by autistic adults, and 3. What strategies/support have been helpful for adults and relatives? METHODS Relatives of autistic adults were purposively sampled and recruited using the Relatives/Carers cohort from the Adult Autism Spectrum Cohort-UK. 18 participants aged 31-81years who were related to 16 autistic adults aged 18-57years were interviewed for 24-91minutes. Interview transcripts were examined using reflexive thematic analysis. MAIN FINDINGS Two overarching themes were developed, 'Family support goes a long way in caring for autistic adults' and 'When families turn to society for support' with subthemes. Relatives described benefits they had gained and their admiration for autistic adults. They reflected on how they gave support for independence in various contexts of dependence. They also identified the challenges that both autistic adults and families face navigating support systems (for example for healthcare and employment). An important novel outcome was the advocated value of role-models with lived experience who come from outside of the family. RECOMMENDATIONS The findings lead to recommendations for: (i) Strategies to reduce the barriers for support that are faced by autistic individuals and relatives during crisis points; (ii) recognition and support for what enables both relatives and autistic adults to function independently (e.g. funded activities, flexible employment); (iii) future planning conversations to include relatives who can enhance knowledge and help plan for future care or support needs for autistic adults and (iv) opportunities for role models (persons with lived experience, autistic adults and relatives) to inspire others and disseminate knowledge. CONCLUSIONS These findings add valuable insights into the experiences of relatives of autistic adults and challenge the reader to have greater appreciation of the many roles relatives can contribute across time and in a variety of contexts. These perspectives add important information for those working with and planning provision for autistic adults.
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Affiliation(s)
- Jahnese Hamilton
- Research and Development, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Tracy Finch
- Department of Nursing, Midwifery & Health, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Ann Le Couteur
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Joan Mackintosh
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Alex Petrou
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Deborah Garland
- Specialised Training Team, National Autistic Society, North East England, United Kingdom
| | - Jeremy R. Parr
- Research and Development, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
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28
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Al Awaji NN, Al-Taleb SM, Albagawi TO, Alshammari MT, Sharar FA, Mortada EM. Evaluating Parents' Concerns, Needs, and Levels of Satisfaction with the Services Provided for ASD Children in Saudi Arabia. J Multidiscip Healthc 2024; 17:123-146. [PMID: 38222477 PMCID: PMC10785689 DOI: 10.2147/jmdh.s447151] [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] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 12/20/2023] [Indexed: 01/16/2024] Open
Abstract
Background Supporting children with autism spectrum disorder (ASD) and their parents is vital in improving their children's abilities and their parents' ability to care for them. Thus, parents' perceptions of and levels of satisfaction with the services provided for their children must be assessed. Aim This study aimed to understand parents' perceptions of and satisfaction with the speech-language services (SLS) provided for ASD children in different health facilities in Saudi Arabia. Methods This cross-sectional study included 109 parents of ASD children. The survey included five sections dealing with (1) general information about the child; (2) assessment of the child's ASD characteristics (including their age when diagnosed, when they first noticed symptoms, and their speech, language, and communication abilities); (3) the reasons for enrollment in SLS sessions; (4) questions about SLS; and (5) parents' perceptions of SLS, satisfaction with the service, descriptions of their children's progress, and the respect and support they received. Results Parents' satisfaction levels were significantly higher when they had easy access to SLS, sufficient information and support, proper training in applying therapy exercises at home, and perceived respect and support from speech and language pathologists (SLPs). The reasons for discontinuing SLS included high session costs, the need for initial behavioral sessions, the lack of qualified SLPs, the end of the sessions, the lack of improvement, the nonavailability of specialized centers, and parents' dependence on home training only. They also sought opportunities for work and education, continuous and intensive SLS sessions, reduced costs, centers for adults with ASD, and accessible schools. Parents' main concerns were their children's poor speech and language skills, independence, and social acceptance. Conclusion and Implications The study highlighted the importance of understanding parents' experiences with SLS, identifying the factors that enhance SLS use by ASD children, and improving parents' satisfaction with such services.
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Affiliation(s)
- Nisreen Naser Al Awaji
- Department of Health Communication Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, Riyadh, 11671, Saudi Arabia
| | - Sumaih Mohammed Al-Taleb
- Department of Health Communication Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, Riyadh, 11671, Saudi Arabia
| | - Teef Olayan Albagawi
- Department of Health Communication Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, Riyadh, 11671, Saudi Arabia
| | - Maram Taleb Alshammari
- Department of Health Communication Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, Riyadh, 11671, Saudi Arabia
| | - Fay Abdullah Sharar
- Department of Health Communication Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, Riyadh, 11671, Saudi Arabia
| | - Eman M Mortada
- Health Sciences department, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, Riyadh, 11671, Saudi Arabia
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29
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Song J, Reilly M, Reichow B. Overview of Meta-Analyses on Naturalistic Developmental Behavioral Interventions for Children with Autism Spectrum Disorder. J Autism Dev Disord 2024:10.1007/s10803-023-06198-x. [PMID: 38170431 DOI: 10.1007/s10803-023-06198-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2023] [Indexed: 01/05/2024]
Abstract
We conducted an overview of reviews to determine the effects of naturalistic developmental behavioral interventions (NDBIs; Schreibman et al. (2015) J Autism Dev Disorders 45:2411-2428) on children with autism spectrum disorder under 8 years old. We conducted an electronic database search of Academic Search Premier, CINHAL, ERIC, Medline, and APA PsycINFO in October 2022 and August 2023 and utilized snowball methods to locate relevant reviews of NDBI. We included reviews meeting the following inclusion criteria: (1) review included a meta-analytic synthesis for at least one child outcome; (2) primary studies examined a NDBI; (3) primary studies included children with ASD with a mean pre-treatment age under eight years; (4) primary studies were conducted using a two-group comparison design; and (5) review was published in English. We extracted data on characteristics of the review, participant characteristics from the primary studies, intervention characteristics, and assessed the risk of bias of the included reviews. We conducted a narrative synthesis across outcomes reported in the included reviews. We included five reviews from six reports in this overview. Two reviews included studies that examined the Early Start Denver Model, two reviews included studies that examined the Pivotal Response Treatment, and one review included studies examining NDBIs collectively. We found positive effects of NDBIs on child's communication/language, cognition, and adaptive behavior. We found mixed effects for NDBIs on autism symptomatology and restricted and repetitive behaviors. Examination of moderator analyses reported in the included reviews suggested variables influencing the effects of NDBIs included proximity of outcome to intervention, boundedness of outcome to intervention, and study location. As shown in this overview, positive effects of NDBI for young children with ASD are supported by meta-analytic evidence. While the overall findings for NDBI across reviews are positive, the findings on specific outcomes and influential variables moderating the effects of NDBI are inconsistent. Additional evidence from randomized controlled trials and future meta-analyses are needed to strengthen our knowledge of the effects of NDBI for young children with ASD.Protocol Registration: PROSPERO CRD42022353045.
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Affiliation(s)
- Jinwei Song
- A. J. Pappanikou Center for Excellence in Developmental Disabilities, UConn Health, Farmington, CT, USA
- Neag School of Education, University of Connecticut, Storrs, CT, USA
| | - Molly Reilly
- A. J. Pappanikou Center for Excellence in Developmental Disabilities, UConn Health, Farmington, CT, USA
- Neag School of Education, University of Connecticut, Storrs, CT, USA
| | - Brian Reichow
- A. J. Pappanikou Center for Excellence in Developmental Disabilities, UConn Health, Farmington, CT, USA.
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30
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Wang L, Xie Z, Zhao D. Spring is not yet here: raising a child with ASD in rural southwest China. Disabil Rehabil 2024; 46:322-333. [PMID: 36573417 DOI: 10.1080/09638288.2022.2161642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 12/16/2022] [Indexed: 12/28/2022]
Abstract
PURPOSE This study aims to reveal the parenting experiences of parents of children with autism spectrum disorder (ASD) in rural southwest China under the framework of ecological systems theory. MATERIALS AND METHODS Semi-structured interviews were conducted with 21 parents of children with ASD from rural southwest China and the interview data were analyzed using the three coding steps of the grounded theory method, namely open, axial, and selective coding. RESULTS The results showed four themes: challenges from within the family; relationships between parents, the school, and the community; scarcity and low accessibility of available resources and services; the culture of discriminating against people with disabilities and the loss of eligibility for welfare. The mismatch between the needs of families of children with ASD and the resources available in social-environmental systems is the major issue faced by parents. CONCLUSIONS Raising a child with ASD in rural southwest China is affected by the interactions between the families and the internal structures in different environmental systems. The culture of discriminating against people with disabilities formed in the macrosystem could be the essential factor that affects the smoothness of the parenting process of children with ASD.
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Affiliation(s)
- Linlin Wang
- Department of Special Education, Yunnan Normal University, Kunming, People's Republic of China
| | - Zhengli Xie
- Faculty of Education, The University of Hong Kong, Hong Kong, Hong Kong
| | - Dehu Zhao
- Department of Special Education, Yunnan Normal University, Kunming, People's Republic of China
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Nord D, Hamre K, Andresen J. The Effects of Health Insurance Coverage on Workforce Engagement of Family Caregivers of Children With Intellectual Disability and Autism. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2024; 129:10-25. [PMID: 38147890 DOI: 10.1352/1944-7558-129.1.10] [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: 08/06/2021] [Accepted: 02/28/2023] [Indexed: 12/28/2023]
Abstract
For many families of children with intellectual disability and autism (ID/ASD), private health insurance and public programs, such as Medicaid and the Children's Health Insurance Program (CHIP), are critical sources of support. The purpose of this study was to examine the impact of health insurance coverage on workforce engagement of parents of children with ID/ASD. The study utilized 2014-2018 pooled National Health Interview Survey data to construct national estimates and test the effects of health insurance status on parent workforce outcomes. Primary findings indicate significantly higher odds of workforce absence (OR = 2.83, p < .0038) and unemployment (OR = 8.91, p < .0038) among parents with children with ID/ASD using public health insurance, compared to the reference group. Additionally, parents of children with ID/ASD who were uninsured were found to experience significantly higher unemployment (OR = 4.86, p < .0038) than the reference group. Findings have policy and research implications related to workforce engagement for parents, including issues impacting health insurance coverage, specifically related to Medicaid and CHIP.
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Affiliation(s)
- Derek Nord
- Derek Nord, Indiana University, Indiana Institute on Disability and Community
| | - Kristin Hamre
- Kristin Hamre, Indiana University, School of Social Work
| | - John Andresen
- John Andresen, Indiana University, Indiana Institute on Disability and Community
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de Jonge M, Boutjdir M, El-Korchi T, Torres H, Karpur A, Shih A, Elidrissi A. Urban and rural differences in needs, service use and satisfaction among caregivers of autistic children in Morocco. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:107-122. [PMID: 36800902 PMCID: PMC10771028 DOI: 10.1177/13623613221150086] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
LAY ABSTRACT It is very important to understand the needs of caregivers to be able to empower caregivers and to develop or improve services around the world. Therefore, research in different regions is needed to understand differences in caregivers needs between countries, but also between areas within countries. This study investigated differences in needs and service use between caregivers of autistic children in Morocco, living in urban and rural areas. A total of 131 Moroccan caregivers of autistic children took part in the study and responded to an interview survey. The results showed both similarities and differences between urban and rural living caregivers' challenges and needs. Autistic children from urban communities were much more likely to receive intervention and attend school than children from rural communities, even though age and verbal skills of the two groups of children were comparable. Caregivers expressed similar needs for improved care and education, but different challenges in caring. Limited autonomy skills in children were more challenging to rural caregivers, while limited social-communicational skills were more challenging to urban caregivers. These differences may inform healthcare policy-makers and program developers. Adaptive interventions are important to respond to regional needs, resources, and practices. In addition, the results showed the importance of addressing challenges as experienced by caregivers such as costs related to care, barriers in access to information, or stigma. Addressing these issues may help reduce both global and within-country differences in autism care.
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Affiliation(s)
| | - Mohamed Boutjdir
- VA New York Harbor Healthcare System, USA
- State University of New York Downstate Health Sciences University, USA
- NYU Grossman School of Medicine, USA
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Li Z, Liu S, Liu F, Dai N, Liang R, Lv S, Bao L. Gut microbiota and autism spectrum disorders: a bidirectional Mendelian randomization study. Front Cell Infect Microbiol 2023; 13:1267721. [PMID: 38156319 PMCID: PMC10753022 DOI: 10.3389/fcimb.2023.1267721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 11/22/2023] [Indexed: 12/30/2023] Open
Abstract
Background In recent years, observational studies have provided evidence supporting a potential association between autism spectrum disorder (ASD) and gut microbiota. However, the causal effect of gut microbiota on ASD remains unknown. Methods We identified the summary statistics of 206 gut microbiota from the MiBioGen study, and ASD data were obtained from the latest Psychiatric Genomics Consortium Genome-Wide Association Study (GWAS). We then performed Mendelian randomization (MR) to determine a causal relationship between the gut microbiota and ASD using the inverse variance weighted (IVW) method, simple mode, MR-Egger, weighted median, and weighted model. Furthermore, we used Cochran's Q test, MR-Egger intercept test, Mendelian Randomization Pleiotropy RESidual Sum and Outlier (MR-PRESSO), and leave-one-out analysis to identify heterogeneity and pleiotropy. Moreover, the Benjamin-Hochberg approach (FDR) was employed to assess the strength of the connection between exposure and outcome. We performed reverse MR analysis on the gut microbiota that were found to be causally associated with ASD in the forward MR analysis to examine the causal relationships. The enrichment analyses were used to analyze the biological function at last. Results Based on the results of IVW results, genetically predicted family Prevotellaceae and genus Turicibacter had a possible positive association with ASD (IVW OR=1.14, 95% CI: 1.00-1.29, P=3.7×10-2), four gut microbiota with a potential protective effect on ASD: genus Dorea (OR=0.81, 95% CI: 0.69-0.96, P=1.4×10-2), genus Ruminiclostridium5 (OR=0.81, 95% CI: 0.69-0.96, P=1.5×10-2), genus Ruminococcus1 (OR=0.83, 95% CI: 0.70-0.98, P=2.8×10-2), and genus Sutterella (OR=0.82, 95% CI: 0.68-0.99, P=3.6×10-2). After FDR multiple-testing correction we further observed that there were two gut microbiota still have significant relationship with ASD: family Prevotellaceae (IVW OR=1.24; 95% CI: 1.09-1.40, P=9.2×10-4) was strongly positively correlated with ASD and genus RuminococcaceaeUCG005 (IVW OR=0.78, 95% CI: 0.67-0.89, P=6.9×10-4) was strongly negatively correlated with ASD. The sensitivity analysis excluded the influence of heterogeneity and horizontal pleiotropy. Conclusion Our findings reveal a causal association between several gut microbiomes and ASD. These results deepen our comprehension of the role of gut microbiota in ASD's pathology, providing the foothold for novel ideas and theoretical frameworks to prevent and treat this patient population in the future.
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Affiliation(s)
- Zhi Li
- Department of Pediatrics, Hebei Medical University, Shijiazhuang, Hebei, China
- Department of Pediatrics, Bethune International Peace Hospital, Shijiazhuang, Hebei, China
| | - Shuai Liu
- Department of Cancer Epidemiology Division, University of Hawaii Cancer Center, Honolulu, HI, United States
| | - Fang Liu
- Department of Pediatrics, Hebei Medical University, Shijiazhuang, Hebei, China
- Department of Pediatrics, Bethune International Peace Hospital, Shijiazhuang, Hebei, China
| | - Nannan Dai
- Department of Clinical Laboratory, The ECO-City Hospital of Tianjin Fifth Central Hospital, Tianjin, China
| | - Rujia Liang
- Department of Pediatrics, Bethune International Peace Hospital, Shijiazhuang, Hebei, China
| | - Shaoguang Lv
- Department of Pediatrics, Bethune International Peace Hospital, Shijiazhuang, Hebei, China
| | - Lisha Bao
- Department of Pediatrics, Bethune International Peace Hospital, Shijiazhuang, Hebei, China
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Dou JF, Schmidt RJ, Volk HE, Nitta MM, Feinberg JI, Newschaffer CJ, Croen LA, Hertz-Picciotto I, Fallin MD, Bakulski KM. Exposure to heavy metals in utero and autism spectrum disorder at age 3: A meta-analysis of two longitudinal cohorts of siblings of children with autism. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.11.21.23298827. [PMID: 38045240 PMCID: PMC10690342 DOI: 10.1101/2023.11.21.23298827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Background Autism spectrum disorder (ASD) is a prevalent and heterogeneous neurodevelopmental disorder. Risk is attributed to genetic and prenatal environmental factors, though the environmental agents are incompletely characterized. Methods In Early Autism Risk Longitudinal Investigation (EARLI) and Markers of Autism Risk in Babies Learning Early Signs (MARBLES), two pregnancy cohorts of siblings of children with ASD, maternal urinary metals concentrations at two time points during pregnancy were measured using inductively coupled plasma mass spectrometry. At age three, clinicians assessed ASD with DSM-5 criteria. Using multivariable log binomial regression, we examined each metal for association with ASD status, adjusting for gestational age at urine sampling, child sex, maternal age, and maternal education, and meta-analyzed across the two cohorts. Results In EARLI (n=170) 17.6% of children were diagnosed with ASD, and an additional 43.5% were classified as having other non-neurotypical development (Non-TD). In MARBLES (n=156), 22.7% were diagnosed with ASD, while an additional 11.5% had Non-TD. In earlier pregnancy metals measures, having cadmium concentration over the level of detection was associated with 1.78 (1.19, 2.67) times higher risk of ASD, and 1.43 (1.06, 1.92) times higher risk of Non-TD. A doubling of early pregnancy cesium concentration was marginally associated with 1.81 (0.95, 3.42) times higher risk of ASD, and 1.58 (0.95, 2.63) times higher risk of Non-TD. Conclusion Exposure in utero to elevated levels of cadmium and cesium, as measured in maternal urine collected during pregnancy, was associated with increased risk of developing ASD.
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Affiliation(s)
- John F. Dou
- University of Michigan, Ann Arbor, Michigan, USA
| | | | | | | | | | | | - Lisa A. Croen
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
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Arenella M, Fanelli G, Kiemeney LA, McAlonan G, Murphy DG, Bralten J. Genetic relationship between the immune system and autism. Brain Behav Immun Health 2023; 34:100698. [PMID: 38020478 PMCID: PMC10663755 DOI: 10.1016/j.bbih.2023.100698] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Abstract
Autism spectrum disorder (ASD) is a common and complex neurodevelopmental condition. The pathophysiology of ASD is poorly defined; however, it includes a strong genetic component and there is increasing evidence to support a role of immune dysregulation. Nonetheless, it is unclear which immune phenotypes link to ASD through genetics. Hence, we investigated the genetic correlation between ASD and diverse classes of immune conditions and markers; and if these immune-related genetic factors link to specific autistic-like traits in the population. We estimated global and local genetic correlations between ASD (n = 55,420) and 11 immune phenotypes (n = 14,256-755,406) using genome-wide association study summary statistics. Subsequently, polygenic scores (PGS) for these immune phenotypes were calculated in a population-based sample (n = 2487) and associated to five autistic-like traits (i.e., attention to detail, childhood behaviour, imagination, rigidity, social skills), and a total autistic-like traits score. Sex-stratified PGS analyses were also performed. At the genome-wide level, ASD was positively correlated with allergic diseases (ALG), and negatively correlated with lymphocyte count, rheumatoid arthritis (RA), and systemic lupus erythematosus (SLE) (FDR-p = 0.01-0.02). At the local genetic level, ASD was correlated with RA, C-reactive protein, and granulocytes and lymphocyte counts (p = 5.8 × 10-6-0.002). In the general population sample, increased genetic liability for SLE, RA, ALG, and lymphocyte levels, captured by PGS, was associated with the total autistic score and with rigidity and childhood behaviour (FDR-p = 0.03). In conclusion, we demonstrated a genetic relationship between ASD and immunity that depends on the type of immune phenotype considered; some increase likelihood whereas others may potentially help build resilience. Also, this relationship may be restricted to specific genetic loci and link to specific autistic dimensions (e.g., rigidity).
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Affiliation(s)
- Martina Arenella
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, the Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands
| | - Giuseppe Fanelli
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, the Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Lambertus A. Kiemeney
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Grainne McAlonan
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Maudsley and South London NHS Foundation, London, United Kingdom
| | - Declan G. Murphy
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Maudsley and South London NHS Foundation, London, United Kingdom
| | - Janita Bralten
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, the Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands
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Harvey PC, Willis EPE, Brown DJ, Byrne AL, Baldwin APA, Heard D, Augutis W. Navigating the care of families with a child or children with autistic spectrum disorder. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2023; 27:912-926. [PMID: 35658565 DOI: 10.1177/17446295221106001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The aim of this project was to better understand nurse navigators work with children and families who are living with severe autism spectrum disorder to achieve improved health and wellbeing outcomes. Nurse navigators were introduced into the public health sector in Queensland in 2016, with 400 navigators currently working across 16 health services in diverse geographic and demographic settings. Narrative inquiry was used to explore one nurse navigator's journey working with children and families living with severe Autism. The challenges of rigid health systems to adapt to the requirements of children with special needs, particularly in relation to care in the emergency department and where interventional procedures are necessary were apparent. Nurse navigators can effectively co-ordinate the care of an extremely vulnerable patient cohort and provide essential advocacy in a health system that is rigid and lacking the flexibility to deal with individual needs.
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Affiliation(s)
| | | | - Dr Janie Brown
- Curtin University, Australia; St John of God Midland Public and Private Hospital, Western Australia; Central Queensland University, Australia
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Imbiriba T, Demirkaya A, Singh A, Erdogmus D, Goodwin MS. Wearable Biosensing to Predict Imminent Aggressive Behavior in Psychiatric Inpatient Youths With Autism. JAMA Netw Open 2023; 6:e2348898. [PMID: 38127348 PMCID: PMC10739066 DOI: 10.1001/jamanetworkopen.2023.48898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 10/24/2023] [Indexed: 12/23/2023] Open
Abstract
Importance Aggressive behavior is a prevalent and challenging issue in individuals with autism. Objective To investigate whether changes in peripheral physiology recorded by a wearable biosensor and machine learning can be used to predict imminent aggressive behavior before it occurs in inpatient youths with autism. Design, Setting, and Participants This noninterventional prognostic study used data collected from March 2019 to March 2020 from 4 primary care psychiatric inpatient hospitals. Enrolled participants were 86 psychiatric inpatients with confirmed diagnoses of autism exhibiting operationally defined self-injurious behavior, emotion dysregulation, or aggression toward others; 16 individuals were not included (18.6%) because they would not wear the biosensor (8 individuals) or were discharged before an observation could be made (8 individuals). Data were analyzed from March 2020 through October 2023. Main Outcomes and Measures Research staff performed live behavioral coding of aggressive behavior while inpatient study participants wore a commercially available biosensor that recorded peripheral physiological signals (cardiovascular activity, electrodermal activity, and motion). Logistic regression, support vector machines, neural networks, and domain adaptation were used to analyze time-series features extracted from biosensor data. Area under the receiver operating characteristic curve (AUROC) values were used to evaluate the performance of population- and person-dependent models. Results There were 70 study participants (mean [range; SD] age, 11.9 [5-19; 3.5] years; 62 males [88.6%]; 1 Asian [1.4%], 5 Black [7.1%], 1 Native Hawaiian or Other Pacific Islander [1.4%], and 63 White [90.0%]; 5 Hispanic [7.5%] and 62 non-Hispanic [92.5%] among 67 individuals with ethnicity data). Nearly half of the population (32 individuals [45.7%]) was minimally verbal, and 30 individuals (42.8%) had an intellectual disability. Participant length of inpatient hospital stay ranged from 8 to 201 days, and the mean (SD) length was 37.28 (33.95) days. A total of 429 naturalistic observational coding sessions were recorded, totaling 497 hours, wherein 6665 aggressive behaviors were documented, including self-injury (3983 behaviors [59.8%]), emotion dysregulation (2063 behaviors [31.0%]), and aggression toward others (619 behaviors [9.3%]). Logistic regression was the best-performing overall classifier across all experiments; for example, it predicted aggressive behavior 3 minutes before onset with a mean AUROC of 0.80 (95% CI, 0.79-0.81). Conclusions and Relevance This study replicated and extended previous findings suggesting that machine learning analyses of preceding changes in peripheral physiology may be used to predict imminent aggressive behaviors before they occur in inpatient youths with autism. Further research will explore clinical implications and the potential for personalized interventions.
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Affiliation(s)
- Tales Imbiriba
- College of Engineering, Northeastern University, Boston, Massachusetts
| | - Ahmet Demirkaya
- College of Engineering, Northeastern University, Boston, Massachusetts
| | - Ashutosh Singh
- College of Engineering, Northeastern University, Boston, Massachusetts
| | - Deniz Erdogmus
- College of Engineering, Northeastern University, Boston, Massachusetts
| | - Matthew S. Goodwin
- Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
- Khoury College of Computer Sciences, Northeastern University, Boston, Massachusetts
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Dhaliwal KK, Avedzi HM, Richard C, Zwaigenbaum L, Haqq AM. Brief Report: Plasma Leptin and Mealtime Feeding Behaviors Among Children with Autism Spectrum Disorder: A Pilot Study. J Autism Dev Disord 2023; 53:4929-4936. [PMID: 35583626 DOI: 10.1007/s10803-022-05581-4] [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] [Accepted: 04/19/2022] [Indexed: 10/18/2022]
Abstract
We examined the relationship between weight status, appetite regulating hormones, and mealtime behaviors among children, (5-12 years old), diagnosed with Autism Spectrum Disorder (ASD) in a cross-sectional study. All (N = 21) completed anthropometry measurements and (n = 18) provided blood samples for hormone analysis. Mealtime behavior, dietary, physical activity, puberty stage, and social impairment data were collected. Under fasting conditions, overweight/obese (OWOB) participants, (n = 6), had higher leptin concentrations (p < 0.02) and more feeding challenges (p < 0.05) than normal weight (n = 15). Higher leptin levels and disruptions in mealtime behaviors may exist among OWOB children in this study. Future longitudinal studies that examine appetite regulating hormones and mealtime behaviors may inform our understanding of the role of these markers in the development of obesity in ASD.
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Affiliation(s)
- Khushmol K Dhaliwal
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, 1C4 Walter C. Mackenzie Health Sciences Center, 8440-112 St NW, Edmonton, AB, T6G 2B7, Canada
| | - Hayford M Avedzi
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, 1C4 Walter C. Mackenzie Health Sciences Center, 8440-112 St NW, Edmonton, AB, T6G 2B7, Canada
| | - Caroline Richard
- Department of Agricultural, Food and Nutritional Science, Faculty of Agricultural, Life & Environmental Sciences, University of Alberta, Edmonton, Canada
| | - Lonnie Zwaigenbaum
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, 1C4 Walter C. Mackenzie Health Sciences Center, 8440-112 St NW, Edmonton, AB, T6G 2B7, Canada
| | - Andrea M Haqq
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, 1C4 Walter C. Mackenzie Health Sciences Center, 8440-112 St NW, Edmonton, AB, T6G 2B7, Canada.
- Department of Agricultural, Food and Nutritional Science, Faculty of Agricultural, Life & Environmental Sciences, University of Alberta, Edmonton, Canada.
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Hus Y. Frozen in Time, a Focused Review of Autism Prevalence in Canadian Indigenous Communities. Neuropsychiatr Dis Treat 2023; 19:2451-2468. [PMID: 38029046 PMCID: PMC10658944 DOI: 10.2147/ndt.s439450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 11/08/2023] [Indexed: 12/01/2023] Open
Abstract
The unprecedented global continuous rise in autism prevalence is often referred to as a Pandemic while its parallel cost increase to society portrays a Tsunami. Autism data originates mostly from industrialized High-Income geopolitical regions in Europe, North America, and Asian regions. Although efforts to determine autism data from regions in Low and Mid-economies are ongoing, prevalence information from geographically remote and economically vulnerable communities within the privileged regions is largely undetermined, as is the case of the Canadian Indigenous communities, the First Nations, Inuit, and Métis highlighted in this focused review. The underlying theoretical approach adopted here is Transcultural Psychiatry with its emphasis on Context including sociopolitical circumstances, considered the gateway to understanding health, illness, and recovery in groups and individuals. Accordingly, the review includes a concise relevant government system description and history of the relations with Indigenous peoples to provide context to present indigenous relations to Canadian government agencies. Scores in these communities face a myriad of survival challenges encompassing meagre health resources and services. Establishing autism prevalence data in these communities are exceedingly difficult due to multiple factors. While prominent among them are their strong ties to traditional approaches to health, illness, and autism conceptualization, the crucial obstacle is Crown and Provincial government authorities' and agencies' historically rooted colonial response to the needs of families with autistic members. It embodies a posture of infantilization, an attitude that is "frozen in time" in the approach, practice, accommodations, and services for these families. The review provides the preferred autism terminology, information sources, article flow, and Future Directions, all found in the Introduction's first paragraphs.
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Affiliation(s)
- Yvette Hus
- Department of Rehabilitation Sciences Theralab Research Director Prof. Kakia Petinou, Cyprus University of Technology, Limassol, Cyprus
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Katti H, Valiyamattam G, Taubert J, Nadig A. Editorial: Improving the quality of life of autistic people and their caregivers from diverse backgrounds: methods and approaches. Front Psychol 2023; 14:1242236. [PMID: 38022950 PMCID: PMC10680255 DOI: 10.3389/fpsyg.2023.1242236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Affiliation(s)
- Harish Katti
- National Institute of Mental Health, Bethesda, MD, United States
| | | | - Jessica Taubert
- The School of Psychology, The University of Queensland, St. Lucia, QLD, Australia
| | - Aparna Nadig
- School of Communication Sciences and Disorders, McGill University, Montreal, QC, Canada
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He S, Zhou F, Tian G, Cui Y, Yan Y. Effect of Anesthesia During Pregnancy, Delivery, and Childhood on Autism Spectrum Disorder: A Systematic Review and Meta-analysis. J Autism Dev Disord 2023:10.1007/s10803-023-06169-2. [PMID: 37934394 DOI: 10.1007/s10803-023-06169-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2023] [Indexed: 11/08/2023]
Abstract
To investigate the association between exposure to anesthesia during three periods of pregnancy, delivery, and childhood and autism spectrum disorder (ASD). PubMed, Scopus, Web of Science, Embase, Google Scholar, PsycArticles, and PsycINFO were searched from the date of database inception to 1 December 2022. Studies reported the association between exposure to anesthesia during pregnancy, delivery, and childhood and ASD were included. Extracted variables included hazard ratio (HR), relative risk or odds ratio, standard error, and 95% confidence interval (CI). Effect estimates were pooled using random-effects meta-analysis. In total, 16 studies including 8,156,608 individuals were included in the meta-analysis. Labor epidural anesthesia during delivery was associated with ASD in the general population (adjusted HR = 1.16, 95% CI, 1.06-1.28) but not in the sibling population (adjusted HR = 1.06, 95% CI, 0.98-1.15). Other anesthesia during delivery was not associated with ASD (general population: adjusted HR = 1.08, 95% CI, 0.99-1.17; sibling population: adjusted HR = 1.20, 95% CI, 0.81-1.79). Three studies suggested that exposure to anesthesia during pregnancy was associated with ASD in offspring (adjusted HR = 2.15, 95% CI, 1.32-3.48). There was no significant association between exposure to general anesthesia during childhood and ASD (adjusted HR = 1.02, 95% CI, 0.60-1.72). This meta-analysis did not confirm the association between exposure to anesthesia during labour and ASD. Previous observational studies used the neurotoxicity of anesthesia to biologically explain significant associations, but in fact different controls for confounding factors led to differences in associations. The evidence for pregnancy and childhood was limited given the small number of studies in these periods.
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Affiliation(s)
- Simin He
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, 410078, Hunan, China
| | - Feixiang Zhou
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, 410078, Hunan, China
| | - Gang Tian
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, 410078, Hunan, China
| | - Yiran Cui
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, 410078, Hunan, China
| | - Yan Yan
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, 410078, Hunan, China.
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Kazak A, Ramirez AP, Scialla MA, Alderfer MA, Sewell-Roberts C, Treadwell-Deering D. Adaptation and pilot implementation of the Psychosocial Assessment Tool for Autism Spectrum Disorders (PAT-ASD). J Autism Dev Disord 2023; 53:4308-4317. [PMID: 36001195 PMCID: PMC9399998 DOI: 10.1007/s10803-022-05713-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 08/04/2022] [Indexed: 11/29/2022]
Abstract
Recognizing the multifaceted and chronic demands on families of children with Autism Spectrum Disorder (ASD) and challenges in providing care matched to need, we adapted the Psychosocial Assessment Tool (PAT), a brief caregiver-report screener of family psychosocial risk, for this population. Study methods included literature review, focus groups with providers, and feedback from caregivers. The PAT-ASD is consistent with the original PAT, with new items reflecting core behavioral manifestations of ASD and parent and family challenges associated with chronicity. The PAT-ASD was implemented in a four-month pilot and was completed online by 59% of families. Although further testing of its validity is necessary, the PAT-ASD is a promising means of assessing family psychosocial risk for families of children with ASD.
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Affiliation(s)
- Anne Kazak
- Nemours Children's Health, Wilmington, DE, United States.
- Sidney Kimmel Medical School of Thomas Jefferson University, Philadelphia, PA, United States.
| | | | | | - Melissa A Alderfer
- Nemours Children's Health, Wilmington, DE, United States
- Sidney Kimmel Medical School of Thomas Jefferson University, Philadelphia, PA, United States
| | | | - Diane Treadwell-Deering
- Nemours Children's Health, Wilmington, DE, United States
- Sidney Kimmel Medical School of Thomas Jefferson University, Philadelphia, PA, United States
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de Oliveira C, Tanner B. Estimating Cumulative Health Care Costs of Childhood and Adolescence Autism Spectrum Disorder in Ontario, Canada: A Population-Based Incident Cohort Study. PHARMACOECONOMICS - OPEN 2023; 7:987-995. [PMID: 37755688 PMCID: PMC10721567 DOI: 10.1007/s41669-023-00441-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/07/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND Few studies have estimated cumulative health care costs post-diagnosis for individuals with autism spectrum disorder (ASD). OBJECTIVES Using an incidence-based approach, the objective of this analysis was to estimate cumulative costs of ASD to the Ontario health care system of children and adolescents. METHODS Using administrative health records from Ontario, Canada's most populous province, a retrospective, population-based, incident cohort study of children and adolescents aged 0-19 years old diagnosed with ASD was undertaken to estimate cumulative health care costs of ASD to the health care system from 2010 to 2019. Cumulative health care costs in 2021 Canadian dollars (CAD) from diagnosis to death or end of observation period were estimated using a consistent estimator based on the inverse probability weighting technique. Cumulative health care costs (and respective 95% confidence intervals [CI]) were estimated for 1, 5 and 10 years post-diagnosis by sex, age group and health service. RESULTS In 2010, there were 2867 diagnosed cases of ASD; in 2019, the number of incident cases had risen to 6072. The first year (i.e., 1-year) post-diagnosis cost of ASD was $4710.18 CAD (95% CI 4560.28-4860.08); just under a third of costs were for physician services. Total cumulative 5- and 10-year discounted costs were $16,025.95 CAD (15,371.64-16,680.26) and $32,635.76 CAD (28,906.94-36,364.58), respectively. Mean costs were higher for females and older age groups. CONCLUSIONS These results suggest that costs of ASD are high in the year of diagnosis and then increase at a steady rate thereafter. This information will help with future resource planning within the health care sector to ensure individuals with ASD are supported once their diagnosis is established.
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Affiliation(s)
- Claire de Oliveira
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
- ICES, Toronto, Canada.
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
| | - Bryan Tanner
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- ICES, Toronto, Canada
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Tsiplova K, Ungar WJ. Why it is so challenging to perform economic evaluations of interventions in autism and what to do about it. Autism Res 2023; 16:2061-2070. [PMID: 37606004 DOI: 10.1002/aur.3014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 07/29/2023] [Indexed: 08/23/2023]
Abstract
Economic evaluation is used to determine the optimal provision of services and programs under budget constraints and to inform public and private payer funding decisions. To maximize value-for-money in the design and delivery of programs and services for persons with autism spectrum disorder (ASD), it's essential to generate high-quality economic evidence to inform budget allocation. There is a paucity however, of economic evaluations of interventions for ASD. This is due in part to challenges in conducting economic evaluations in this population and the lack of guidance on suitable approaches. These challenges are related to the inherent heterogeneity of the autistic population; establishing short- and long-term effectiveness; measurement of costs and the availability of valid instruments for collecting economic data; the appropriateness of outcomes for use in economic evaluation; and achieving statistical power. This commentary addresses a lack of awareness and needed guidance on these issues by discussing the challenges and providing recommendations for how economic evaluations in ASD could be improved to generate high-quality evidence for program funding decision-making.
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Affiliation(s)
- Kate Tsiplova
- Program of Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Canada
| | - Wendy J Ungar
- Program of Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
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Lavi R, Stokes MA. Reliability and validity of the Autism Screen for Kids and Youth. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:1968-1982. [PMID: 36688323 DOI: 10.1177/13623613221149542] [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: 01/24/2023]
Abstract
LAY ABSTRACT It is important that autistic children be diagnosed as early as possible so their needs can be met and their families can gain important insights into their behavior and interact with them appropriately. However, very few autism screening instruments are appropriate for children who have outgrown early childhood. The Autism Screen for Kids and Youth (ASKY) presents parents of children aged 4-18 years with 30 items that relate to autistic behaviors as defined by the current clinical diagnostic criteria for autism spectrum disorder (DSM-5 ASD). We evaluated the Hebrew instrument's performance on 167 autistic and non-autistic children and adolescents. We found that the ASKY algorithm correctly identified 92% of the autistic individuals as "probable ASD" and correctly identified 72% of the non-autistic individuals as "probable non-ASD," with these classifications showing excellent stability over time. Using total questionnaire score instead of the algorithm improved the ASKY's ability to correctly identify autistic individuals as "probable ASD" and non-autistic individuals as "probable non-ASD" to 93% and 78%, respectively. Overall, the ASKY is a promising instrument for ASD screening of older children.
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Kim B, Oh IH, Cheong HK, Hwang JW. Prevalence and Medical Costs of Intellectual Disabilities and Pervasive Developmental Disorder in Korea: Based on National Health Insurance Service Claims Data from 2007 to 2019. Psychiatry Investig 2023; 20:972-983. [PMID: 37899221 PMCID: PMC10620333 DOI: 10.30773/pi.2023.0123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 07/27/2023] [Accepted: 08/08/2023] [Indexed: 10/31/2023] Open
Abstract
OBJECTIVE We aimed to investigate the annual prevalence of intellectual disabilities (ID) and autism spectrum disorder employing claims data registered in Korean National Health Insurance Service. We also estimated the annual average of medical costs incurred from these disorders using same datasets. METHODS In order to obtain the prevalence, we selected patients diagnosed with ID and pervasive and specific developmental disorders (PDD) from 2007 to 2019. The ensuing annual average of medical costs was also estimated from these patients. RESULTS The annual prevalence of ID and PDD (per 100,000) between 2007 and 2019 ranged from 56.7 to 78.6 and from 22.0 to 44.6 respectively. Regarding the annual average of total medical expenditure per a patient, the expenditure of the ID group was higher than that of PDD throughout the years, as shown that the ID expenditure ranged from 769.7 to 1,501.2 US dollars as opposed to the PDD expenditure in the range of 312.5 to 570.7 US dollars. The further comparison in relation to income levels elaborated that the medical aid beneficiary group constitutes the highest one and the difference of the expenditure across the remaining income groups was not prominent although the very low group generally ranked the highest over the years. CONCLUSION The prevalence of ID and PDD constantly increased and the same trend was displayed in ensuing health expenditures throughout the period. This implies that increasing needs exist across these patients with regards to therapeutic interventions, thereby contributing to prioritizing medical policies on national perspectives.
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Affiliation(s)
- Beomjun Kim
- Department of Psychiatry, Kangwon National University Hospital, Chuncheon, Republic of Korea
| | - In-Hwan Oh
- Department of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Hyeon-Kyoung Cheong
- Department of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Jun-Won Hwang
- Department of Psychiatry, Kangwon National University Hospital, Chuncheon, Republic of Korea
- Department of Psychiatry, Kangwon National University College of Medicine, Chuncheon, Republic of Korea
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Wang M, Xu D, Zhang L, Jiang H. Application of Multimodal MRI in the Early Diagnosis of Autism Spectrum Disorders: A Review. Diagnostics (Basel) 2023; 13:3027. [PMID: 37835770 PMCID: PMC10571992 DOI: 10.3390/diagnostics13193027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/13/2023] [Accepted: 09/20/2023] [Indexed: 10/15/2023] Open
Abstract
Autism spectrum disorder (ASD) is a neurodevelopmental disorder in children. Early diagnosis and intervention can remodel the neural structure of the brain and improve quality of life but may be inaccurate if based solely on clinical symptoms and assessment scales. Therefore, we aimed to analyze multimodal magnetic resonance imaging (MRI) data from the existing literature and review the abnormal changes in brain structural-functional networks, perfusion, neuronal metabolism, and the glymphatic system in children with ASD, which could help in early diagnosis and precise intervention. Structural MRI revealed morphological differences, abnormal developmental trajectories, and network connectivity changes in the brain at different ages. Functional MRI revealed disruption of functional networks, abnormal perfusion, and neurovascular decoupling associated with core ASD symptoms. Proton magnetic resonance spectroscopy revealed abnormal changes in the neuronal metabolites during different periods. Decreased diffusion tensor imaging signals along the perivascular space index reflected impaired glymphatic system function in children with ASD. Differences in age, subtype, degree of brain damage, and remodeling in children with ASD led to heterogeneity in research results. Multimodal MRI is expected to further assist in early and accurate clinical diagnosis of ASD through deep learning combined with genomics and artificial intelligence.
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Affiliation(s)
- Miaoyan Wang
- Department of Radiology, Affiliated Children’s Hospital of Jiangnan University, Wuxi 214000, China; (M.W.); (D.X.)
| | - Dandan Xu
- Department of Radiology, Affiliated Children’s Hospital of Jiangnan University, Wuxi 214000, China; (M.W.); (D.X.)
| | - Lili Zhang
- Department of Child Health Care, Affiliated Children’s Hospital of Jiangnan University, Wuxi 214000, China
| | - Haoxiang Jiang
- Department of Radiology, Affiliated Children’s Hospital of Jiangnan University, Wuxi 214000, China; (M.W.); (D.X.)
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Cherewick M, Daniel C, Shrestha CC, Giri P, Dukpa C, Cruz CM, Rai RP, Matergia M. Psychosocial interventions for autistic children and adolescents delivered by non-specialists in low- and middle-income countries: a scoping review. Front Psychol 2023; 14:1181976. [PMID: 37609501 PMCID: PMC10440606 DOI: 10.3389/fpsyg.2023.1181976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 07/24/2023] [Indexed: 08/24/2023] Open
Abstract
Background Most autistic individuals reside in low- and middle-income countries (LMIC) and have limited access to medical providers and specialists. Support for delivery of psychosocial interventions by non-specialists is growing to address this mental health care gap. This scoping review involved a systematic analysis of studies of non-specialist delivered psychosocial interventions for children and adolescents diagnosed with autism and living in low- and middle-income countries. Methods The primary objective of this review was to identify psychosocial interventions for autistic children and adolescents in LMIC delivered by non-specialists (parent, teacher, peer, community, multi-level) and to summarize resulting effects on targeted outcomes. The search strategy was completed in four databases with predetermined inclusion and exclusion criteria. The systematic search generated 3,601 articles. A total of 18 studies met inclusion/exclusion criteria. Data extraction was completed, and results summarized by; (1) participant sample; (2) intervention procedures; (3) implementation by non-specialists; (4) effect on evaluated outcomes; and (5) assessment of risk of bias. Studies examined a range of child and adolescent outcomes including assessment of communication skills, social skills, motor skills, functional and adaptive behaviors, emotional regulation, attention and engagement, sensory challenges, depression, anxiety, and quality of life. Several studies also evaluated intervention effects on family relationships, parent/caregiver stress and parent/caregiver mental health. Results Collectively, the 18 studies included a total of 952 ASC participants ranging in age from 2 to 16 years. Of the included studies, 8 studies were parent/caregiver-mediated, 1 study was peer-mediated, 2 studies were teacher-mediated, and 7 studies included multi-level non-specialist mediated components. Effects on evaluated outcomes are reported. Conclusion Non-specialist delivered interventions for autistic children and adolescents are effective for an array of outcomes and are particularly well suited for low- and middle-income countries. Implications for future research are discussed.
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Affiliation(s)
- Megan Cherewick
- Department of Community & Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Christina Daniel
- Department of Biostatistics & Informatics, Colorado School of Public Health, Aurora, CO, United States
| | | | - Priscilla Giri
- Darjeeling Ladenla Road Prerna, Darjeeling, West Bengal, India
| | - Choden Dukpa
- Darjeeling Ladenla Road Prerna, Darjeeling, West Bengal, India
| | - Christina M. Cruz
- Department of Psychiatry, School Psychology Program, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States
| | - Roshan P. Rai
- Darjeeling Ladenla Road Prerna, Darjeeling, West Bengal, India
| | - Michael Matergia
- Broadleaf Health & Education Alliance, Stroudsburg, PA, United States
- Center for Global Health, Colorado School of Public Health, Aurora, CO, United States
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Burnham Riosa P, Ensor R, Jichici B, Davy B. How my life is unique: Sibling perspectives of autism. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:1575-1587. [PMID: 36519754 DOI: 10.1177/13623613221142385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
LAY ABSTRACT The impact of autism on the family is an important area of study. Much of the existing literature has focused on the parent perspective, with less emphasis on the experiences of other family members, especially non-autistic siblings. This study aimed to explore the lived experiences of a sample of nine 8- to 17-year-old non-autistic siblings of children and youth on the autism spectrum. We interviewed non-autistic siblings and analysed the written transcripts. Our results revealed the following themes: (1) Role disparities, different expectations; (2) Connection and disconnection; and (3) Our family is (extra)ordinary. Our study findings highlight siblings' unique and collective perspectives regarding their brother or sister on the spectrum within the broader family unit. We discuss the implications of these results on siblings of autistic children and youth.
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Vörös D, Kiss O, Ollmann T, Mintál K, Péczely L, Zagoracz O, Kertes E, Kállai V, László BR, Berta B, Toth A, Lénárd L, László K. Intraamygdaloid Oxytocin Increases Time Spent on Social Interaction in Valproate-Induced Autism Animal Model. Biomedicines 2023; 11:1802. [PMID: 37509444 PMCID: PMC10376246 DOI: 10.3390/biomedicines11071802] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/16/2023] [Accepted: 06/17/2023] [Indexed: 07/30/2023] Open
Abstract
Autism spectrum disorder (ASD) is a pervasive neurodevelopmental disorder that affects about 1.5% of children worldwide. One of the core symptoms is impaired social interaction. Since proper treatment has not been found yet, an investigation of the exact pathophysiology of autism is essential. The valproate (VPA)-induced rat model can be an appropriate way to study autism. Oxytocin (OT) may amend some symptoms of ASD since it plays a key role in developing social relationships. In the present study, we investigated the effect of the intraamygdaloid OT on sham and intrauterine VPA-treated rats' social interaction using Crawley's social interaction test. Bilateral guide cannulae were implanted above the central nucleus of the amygdala (CeA), and intraamygdaloid microinjections were carried out before the test. Our results show that male Wistar rats prenatally exposed to VPA spent significantly less time on social interaction. Bilateral OT microinjection increased the time spent in the social zone; it also reached the level of sham-control animals. OT receptor antagonist blocked this effect of the OT but in itself did not significantly influence the behavior of the rats. Based on our results, we can establish that intraamygdaloid OT has significantly increased time spent on social interaction in the VPA-induced autism model, and its effect is receptor-specific.
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Affiliation(s)
- Dávid Vörös
- Medical School, Institute of Physiology, University of Pécs, Szigeti Str. 12, 7602 Pécs, Hungary
- Neuropeptides, Cognition, Animal Models of Neuropsychiatric Disorders Research Group, Medical School, Institute of Physiology, University of Pécs, 7602 Pécs, Hungary
| | - Orsolya Kiss
- Medical School, Institute of Physiology, University of Pécs, Szigeti Str. 12, 7602 Pécs, Hungary
- Neuropeptides, Cognition, Animal Models of Neuropsychiatric Disorders Research Group, Medical School, Institute of Physiology, University of Pécs, 7602 Pécs, Hungary
| | - Tamás Ollmann
- Medical School, Institute of Physiology, University of Pécs, Szigeti Str. 12, 7602 Pécs, Hungary
- Neuropeptides, Cognition, Animal Models of Neuropsychiatric Disorders Research Group, Medical School, Institute of Physiology, University of Pécs, 7602 Pécs, Hungary
- Neuroscience Center, University of Pécs, 7602 Pécs, Hungary
- Learning in Biological and Artificial Systems Research Group, Medical School, Institute of Physiology, University of Pécs, 7602 Pécs, Hungary
| | - Kitti Mintál
- Medical School, Institute of Physiology, University of Pécs, Szigeti Str. 12, 7602 Pécs, Hungary
- Neuropeptides, Cognition, Animal Models of Neuropsychiatric Disorders Research Group, Medical School, Institute of Physiology, University of Pécs, 7602 Pécs, Hungary
- Cellular Bioimpedance Research Group, Szentágothai Research Center, University of Pécs, 7602 Pécs, Hungary
| | - László Péczely
- Medical School, Institute of Physiology, University of Pécs, Szigeti Str. 12, 7602 Pécs, Hungary
- Neuroscience Center, University of Pécs, 7602 Pécs, Hungary
- Learning in Biological and Artificial Systems Research Group, Medical School, Institute of Physiology, University of Pécs, 7602 Pécs, Hungary
| | - Olga Zagoracz
- Medical School, Institute of Physiology, University of Pécs, Szigeti Str. 12, 7602 Pécs, Hungary
- Neuropeptides, Cognition, Animal Models of Neuropsychiatric Disorders Research Group, Medical School, Institute of Physiology, University of Pécs, 7602 Pécs, Hungary
- Neuroscience Center, University of Pécs, 7602 Pécs, Hungary
- Learning in Biological and Artificial Systems Research Group, Medical School, Institute of Physiology, University of Pécs, 7602 Pécs, Hungary
| | - Erika Kertes
- Medical School, Institute of Physiology, University of Pécs, Szigeti Str. 12, 7602 Pécs, Hungary
- Neuropeptides, Cognition, Animal Models of Neuropsychiatric Disorders Research Group, Medical School, Institute of Physiology, University of Pécs, 7602 Pécs, Hungary
- Neuroscience Center, University of Pécs, 7602 Pécs, Hungary
- Learning in Biological and Artificial Systems Research Group, Medical School, Institute of Physiology, University of Pécs, 7602 Pécs, Hungary
| | - Veronika Kállai
- Medical School, Institute of Physiology, University of Pécs, Szigeti Str. 12, 7602 Pécs, Hungary
- Neuropeptides, Cognition, Animal Models of Neuropsychiatric Disorders Research Group, Medical School, Institute of Physiology, University of Pécs, 7602 Pécs, Hungary
- Neuroscience Center, University of Pécs, 7602 Pécs, Hungary
- Learning in Biological and Artificial Systems Research Group, Medical School, Institute of Physiology, University of Pécs, 7602 Pécs, Hungary
| | - Bettina Réka László
- Medical School, Institute of Physiology, University of Pécs, Szigeti Str. 12, 7602 Pécs, Hungary
- Neuroscience Center, University of Pécs, 7602 Pécs, Hungary
| | - Beáta Berta
- Medical School, Institute of Physiology, University of Pécs, Szigeti Str. 12, 7602 Pécs, Hungary
- Neuropeptides, Cognition, Animal Models of Neuropsychiatric Disorders Research Group, Medical School, Institute of Physiology, University of Pécs, 7602 Pécs, Hungary
- Neuroscience Center, University of Pécs, 7602 Pécs, Hungary
- Learning in Biological and Artificial Systems Research Group, Medical School, Institute of Physiology, University of Pécs, 7602 Pécs, Hungary
| | - Attila Toth
- Medical School, Institute of Physiology, University of Pécs, Szigeti Str. 12, 7602 Pécs, Hungary
- Neuropeptides, Cognition, Animal Models of Neuropsychiatric Disorders Research Group, Medical School, Institute of Physiology, University of Pécs, 7602 Pécs, Hungary
- Neuroscience Center, University of Pécs, 7602 Pécs, Hungary
- Cellular Bioimpedance Research Group, Szentágothai Research Center, University of Pécs, 7602 Pécs, Hungary
| | - László Lénárd
- Medical School, Institute of Physiology, University of Pécs, Szigeti Str. 12, 7602 Pécs, Hungary
- Neuropeptides, Cognition, Animal Models of Neuropsychiatric Disorders Research Group, Medical School, Institute of Physiology, University of Pécs, 7602 Pécs, Hungary
- Neuroscience Center, University of Pécs, 7602 Pécs, Hungary
- Molecular Endocrinology and Neurophysiology Research Group, Szentágothai Center, University of Pécs, 7602 Pécs, Hungary
| | - Kristóf László
- Medical School, Institute of Physiology, University of Pécs, Szigeti Str. 12, 7602 Pécs, Hungary
- Neuropeptides, Cognition, Animal Models of Neuropsychiatric Disorders Research Group, Medical School, Institute of Physiology, University of Pécs, 7602 Pécs, Hungary
- Neuroscience Center, University of Pécs, 7602 Pécs, Hungary
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