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Su T, Pei L. Acupuncture and oxytocinergic system: The promising treatment for autism. Transl Neurosci 2021; 12:96-102. [PMID: 33633868 PMCID: PMC7896431 DOI: 10.1515/tnsci-2021-0011] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 01/25/2021] [Accepted: 01/26/2021] [Indexed: 12/11/2022] Open
Abstract
Autism spectrum disorder (ASD) is a group of heterogeneous neurodevelopmental disorders characterized by impairments activities without efficient pharmacological therapies in social interaction, speech and stereotypic patterns. Clinical studies have shown the efficacy of acupuncture as an alternative therapy for autism. The effectiveness of acupuncture as an alternative treatment for autism has been demonstrated through clinical trials. However, the molecular mechanisms that underlie these effects remain unclear. Due to its profound pro-social, anxiolytic, stress management effects, and its potential use for the treatment of psychiatric disorders associated with altered socioemotional competence, oxytocin (OT) released from the hypothalamus has attracted considerable interest. In the past decade, a number of clinical and animal studies have shown that OT administration effectively reduces core symptoms of ASD, especially social behavior deficits. Recently, the endocannabinoid system has emerged as a promising target for the treatment of autism. OT was found to facilitate the endocannabinoid-mediated social reward processes in the nucleus accumbens of the mouse brain. Furthermore, serotonin and dopamine are involved in the reward response mediated by OT. In view of these findings, we conclude that acupuncture may produce therapeutic effects on autism by triggering the hypothalamic oxytocin system, which in turn activates the release of neurotransmitters such as endocannabinoids, dopamine and serotonin. This would be a valuable guide for further research on the mechanism of treatment of autism with acupuncture.
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Affiliation(s)
- Tangfeng Su
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China
| | - Lei Pei
- Department of Neurobiology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Department of Anesthesiology, Washington University in Saint Louis School of Medicine, Saint Louis, MO, 63110, USA
- The Institute for Brain Research (IBR), Collaborative Innovation Center for Brain Science, Huazhong University of Science and Technology, Wuhan, China
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Wu ZY, Huang SD, Zou JJ, Wang QX, Naveed M, Bao HN, Wang W, Fukunaga K, Han F. Autism spectrum disorder (ASD): Disturbance of the melatonin system and its implications. Biomed Pharmacother 2020; 130:110496. [DOI: 10.1016/j.biopha.2020.110496] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 06/25/2020] [Accepted: 07/02/2020] [Indexed: 12/15/2022] Open
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Cheng S, Guan F, Ma M, Zhang L, Cheng B, Qi X, Liang C, Li P, Kafle OP, Wen Y, Zhang F. An atlas of genetic correlations between psychiatric disorders and human blood plasma proteome. Eur Psychiatry 2020; 63:e17. [PMID: 32093803 PMCID: PMC7315878 DOI: 10.1192/j.eurpsy.2019.6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 10/10/2019] [Accepted: 10/12/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Psychiatric disorders are a group of complex psychological syndromes with high prevalence. Recent studies observed associations between altered plasma proteins and psychiatric disorders. This study aims to systematically explore the potential genetic relationships between five major psychiatric disorders and more than 3,000 plasma proteins. METHODS The genome-wide association study (GWAS) datasets of attention deficiency/hyperactive disorder (ADHD), autism spectrum disorder (ASD), bipolar disorder (BD), schizophrenia (SCZ) and major depressive disorder (MDD) were driven from the Psychiatric GWAS Consortium. The GWAS datasets of 3,283 human plasma proteins were derived from recently published study, including 3,301 study subjects. Linkage disequilibrium score (LDSC) regression analysis were conducted to evaluate the genetic correlations between psychiatric disorders and each of the 3,283 plasma proteins. RESULTS LDSC observed several genetic correlations between plasma proteins and psychiatric disorders, such as ADHD and lysosomal Pro-X carboxypeptidase (p value = 0.015), ASD and extracellular superoxide dismutase (Cu-Zn; p value = 0.023), BD and alpha-N-acetylgalactosaminide alpha-2,6-sialyltransferase 6 (p value = 0.007), MDD and trefoil factor 1 (p value = 0.011), and SCZ and insulin-like growth factor-binding protein 6 (p value = 0.011). Additionally, we detected four common plasma proteins showing correlation evidence with both BD and SCZ, such as tumor necrosis factor receptor superfamily member 1B (p value = 0.012 for BD, p value = 0.011 for SCZ). CONCLUSIONS This study provided an atlas of genetic correlations between psychiatric disorders and plasma proteome, providing novel clues for pathogenetic and biomarkers, therapeutic studies of psychiatric disorders.
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Affiliation(s)
- Shiqiang Cheng
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi’an Jiaotong University, Xi’an, China; Collaborative Innovation Center of Endemic Diseases and Health Promotion in Silk Road Region, Xi’an Jiaotong University, Xi’an 710061, China
| | - Fanglin Guan
- School of Medicine & Forensics, Health Science Center, Xi’an Jiaotong University, Xi’an, China
| | - Mei Ma
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi’an Jiaotong University, Xi’an, China; Collaborative Innovation Center of Endemic Diseases and Health Promotion in Silk Road Region, Xi’an Jiaotong University, Xi’an 710061, China
| | - Lu Zhang
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi’an Jiaotong University, Xi’an, China; Collaborative Innovation Center of Endemic Diseases and Health Promotion in Silk Road Region, Xi’an Jiaotong University, Xi’an 710061, China
| | - Bolun Cheng
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi’an Jiaotong University, Xi’an, China; Collaborative Innovation Center of Endemic Diseases and Health Promotion in Silk Road Region, Xi’an Jiaotong University, Xi’an 710061, China
| | - Xin Qi
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi’an Jiaotong University, Xi’an, China; Collaborative Innovation Center of Endemic Diseases and Health Promotion in Silk Road Region, Xi’an Jiaotong University, Xi’an 710061, China
| | - Chujun Liang
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi’an Jiaotong University, Xi’an, China; Collaborative Innovation Center of Endemic Diseases and Health Promotion in Silk Road Region, Xi’an Jiaotong University, Xi’an 710061, China
| | - Ping Li
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi’an Jiaotong University, Xi’an, China; Collaborative Innovation Center of Endemic Diseases and Health Promotion in Silk Road Region, Xi’an Jiaotong University, Xi’an 710061, China
| | - Om Prakash Kafle
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi’an Jiaotong University, Xi’an, China; Collaborative Innovation Center of Endemic Diseases and Health Promotion in Silk Road Region, Xi’an Jiaotong University, Xi’an 710061, China
| | - Yan Wen
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi’an Jiaotong University, Xi’an, China; Collaborative Innovation Center of Endemic Diseases and Health Promotion in Silk Road Region, Xi’an Jiaotong University, Xi’an 710061, China
| | - Feng Zhang
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi’an Jiaotong University, Xi’an, China; Collaborative Innovation Center of Endemic Diseases and Health Promotion in Silk Road Region, Xi’an Jiaotong University, Xi’an 710061, China
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4
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Olsen I, Hicks SD. Oral microbiota and autism spectrum disorder (ASD). J Oral Microbiol 2019; 12:1702806. [PMID: 31893019 PMCID: PMC6913665 DOI: 10.1080/20002297.2019.1702806] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 11/14/2019] [Accepted: 11/28/2019] [Indexed: 12/14/2022] Open
Abstract
Autism spectrum disorder (ASD) is associated with several oropharyngeal abnormalities, including dysbiosis in the oral microbiota. Since the oral cavity is the start of the gastrointestinal tract, this strengthens and extends the notion of a microbial gut-brain axis in ASD and even raises the question whether a microbial oral-brain axis exists. It is clear that oral bacteria can find their way to the brain through a number of pathways following routine dental procedures. A connection between the oral microbiota and a number of other brain disorders has been reported. As the evidence so far for an association between the oral microbiota and ASDs rests on a few reports only, further studies in this field are necessary. The current review discusses a possible relationship between oral bacteria and the biologic and symptomologic aspects of ASD, focusing on the clinical implications for diagnostic and therapeutic development.
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Affiliation(s)
- Ingar Olsen
- Department of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Steven D. Hicks
- Department of Pediatrics, Penn State College of Medicine, Hershey, PA, USA
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Hicks SD, Rajan AT, Wagner KE, Barns S, Carpenter RL, Middleton FA. Validation of a Salivary RNA Test for Childhood Autism Spectrum Disorder. Front Genet 2018; 9:534. [PMID: 30473705 PMCID: PMC6237842 DOI: 10.3389/fgene.2018.00534] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 10/22/2018] [Indexed: 11/25/2022] Open
Abstract
Background: The diagnosis of autism spectrum disorder (ASD) relies on behavioral assessment. Efforts to define biomarkers of ASD have not resulted in an objective, reliable test. Studies of RNA levels in ASD have demonstrated potential utility, but have been limited by a focus on single RNA types, small sample sizes, and lack of developmental delay controls. We hypothesized that a saliva-based poly-“omic” RNA panel could objectively distinguish children with ASD from their neurotypical peers and children with non-ASD developmental delay. Methods: This multi-center cross-sectional study included 456 children, ages 19–83 months. Children were either neurotypical (n = 134) or had a diagnosis of ASD (n = 238), or non-ASD developmental delay (n = 84). Comprehensive human and microbial RNA abundance was measured in the saliva of all participants using unbiased next generation sequencing. Prior to analysis, the sample was randomly divided into a training set (82% of subjects) and an independent validation test set (18% of subjects). The training set was used to develop an RNA-based algorithm that distinguished ASD and non-ASD children. The validation set was not used in model development (feature selection or training) but served only to validate empirical accuracy. Results: In the training set (n = 372; mean age 51 months; 75% male; 51% ASD), a set of 32 RNA features (controlled for demographic and medical characteristics), identified ASD status with a cross-validated area under the curve (AUC) of 0.87 (95% CI: 0.86–0.88). In the completely separate validation test set (n = 84; mean age 50 months; 85% male; 60% ASD), the algorithm maintained an AUC of 0.88 (82% sensitivity and 88% specificity). Notably, the RNA features were implicated in physiologic processes related to ASD (axon guidance, neurotrophic signaling). Conclusion: Salivary poly-omic RNA measurement represents a novel, non-invasive approach that can accurately identify children with ASD. This technology could improve the specificity of referrals for ASD evaluation or provide objective support for ASD diagnoses.
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Affiliation(s)
- Steven D Hicks
- Department of Pediatrics, Penn State College of Medicine, Hershey, PA, United States
| | | | - Kayla E Wagner
- Quadrant Biosciences, Inc., Syracuse, NY, United States.,Departments of Neuroscience and Physiology, State University of New York Upstate Medical University, Syracuse, NY, United States.,Departments of Psychiatry, Biochemistry and Molecular Biology, State University of New York Upstate Medical University, Syracuse, NY, United States.,Department of Pediatrics, State University of New York Upstate Medical University, Syracuse, NY, United States
| | - Sarah Barns
- Quadrant Biosciences, Inc., Syracuse, NY, United States.,Departments of Neuroscience and Physiology, State University of New York Upstate Medical University, Syracuse, NY, United States.,Departments of Psychiatry, Biochemistry and Molecular Biology, State University of New York Upstate Medical University, Syracuse, NY, United States.,Department of Pediatrics, State University of New York Upstate Medical University, Syracuse, NY, United States
| | | | - Frank A Middleton
- Departments of Neuroscience and Physiology, State University of New York Upstate Medical University, Syracuse, NY, United States.,Departments of Psychiatry, Biochemistry and Molecular Biology, State University of New York Upstate Medical University, Syracuse, NY, United States.,Department of Pediatrics, State University of New York Upstate Medical University, Syracuse, NY, United States
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Souza A, Carraro Detanico B, Fernandes Medeiros L, Oliveira CD, Leal Scarabelot V, Giotti Cioato S, Caumo W, Torres ILS. Acute stress disrupts temporal patterns of behavioral and biochemical parameters of rats. BIOL RHYTHM RES 2017. [DOI: 10.1080/09291016.2017.1386267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Andressa Souza
- Post-Graduate Program in Medicine: Medical Sciences – Medicine School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Pharmacology of Pain and Neuromodulation Laboratory: Pre-clinical Researchs, Department of Pharmacology, Universidade Federal do Rio Grande do Sul, ICBS, Porto Alegre, Brazil
- Animal Experimentation Unit and Graduate Research Group, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Post-Graduate Program in Health and Human Development, Universidade La Salle, Canoas, Brazil
| | - Bernardo Carraro Detanico
- Post-Graduate Program in Medicine: Medical Sciences – Medicine School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Pharmacology of Pain and Neuromodulation Laboratory: Pre-clinical Researchs, Department of Pharmacology, Universidade Federal do Rio Grande do Sul, ICBS, Porto Alegre, Brazil
- Animal Experimentation Unit and Graduate Research Group, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Post-Graduate Program in Health and Human Development, Universidade La Salle, Canoas, Brazil
| | - Liciane Fernandes Medeiros
- Pharmacology of Pain and Neuromodulation Laboratory: Pre-clinical Researchs, Department of Pharmacology, Universidade Federal do Rio Grande do Sul, ICBS, Porto Alegre, Brazil
- Animal Experimentation Unit and Graduate Research Group, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Post-Graduate Program in Health and Human Development, Universidade La Salle, Canoas, Brazil
| | - Carla de Oliveira
- Post-Graduate Program in Medicine: Medical Sciences – Medicine School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Pharmacology of Pain and Neuromodulation Laboratory: Pre-clinical Researchs, Department of Pharmacology, Universidade Federal do Rio Grande do Sul, ICBS, Porto Alegre, Brazil
- Animal Experimentation Unit and Graduate Research Group, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Post-Graduate Program in Health and Human Development, Universidade La Salle, Canoas, Brazil
| | - Vanessa Leal Scarabelot
- Pharmacology of Pain and Neuromodulation Laboratory: Pre-clinical Researchs, Department of Pharmacology, Universidade Federal do Rio Grande do Sul, ICBS, Porto Alegre, Brazil
- Animal Experimentation Unit and Graduate Research Group, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Post-Graduate Program in Health and Human Development, Universidade La Salle, Canoas, Brazil
| | - Stefania Giotti Cioato
- Post-Graduate Program in Medicine: Medical Sciences – Medicine School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Pharmacology of Pain and Neuromodulation Laboratory: Pre-clinical Researchs, Department of Pharmacology, Universidade Federal do Rio Grande do Sul, ICBS, Porto Alegre, Brazil
- Animal Experimentation Unit and Graduate Research Group, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Post-Graduate Program in Health and Human Development, Universidade La Salle, Canoas, Brazil
| | - Wolnei Caumo
- Post-Graduate Program in Medicine: Medical Sciences – Medicine School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Post-Graduate Program in Health and Human Development, Universidade La Salle, Canoas, Brazil
| | - Iraci LS Torres
- Post-Graduate Program in Medicine: Medical Sciences – Medicine School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Pharmacology of Pain and Neuromodulation Laboratory: Pre-clinical Researchs, Department of Pharmacology, Universidade Federal do Rio Grande do Sul, ICBS, Porto Alegre, Brazil
- Animal Experimentation Unit and Graduate Research Group, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Post-Graduate Program in Health and Human Development, Universidade La Salle, Canoas, Brazil
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7
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Checa-Ros A, Muñoz-Hoyos A, Molina-Carballo A, Muñoz-Gallego A, Narbona-Galdó S, Jerez-Calero A, Augustín-Morales MDC. Analysis of Different Melatonin Secretion Patterns in Children With Sleep Disorders: Melatonin Secretion Patterns in Children. J Child Neurol 2017; 32:1000-1008. [PMID: 28911277 DOI: 10.1177/0883073817726680] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The objective of this study was to analyze circadian patterns of urinary 6-sulphatoxymelatonin (aMT6s) excretion in children with primary sleep disorders in comparison with healthy controls. A total of 124 control children and 124 patients (aged 4-14 years) diagnosed with diverse primary sleep disorders were recruited. aMT6s concentrations were measured in diurnal and nocturnal urine, as well as in 24-hour urine. aMT6s levels were significantly higher and showed significantly more evident circadian variations in the control group ( P < .001). Four different melatonin (aMT) production and excretion patterns were distinguished in the group with sleep disorders: (1) standard aMT production pattern, (2) low aMT production pattern, (3) aMT production pattern with absence of circadian variation, and (4) aMT hyperproduction pattern. This study highlights the importance of analyzing specific alterations of aMT secretion in each sleep disorder and provides evidences to explain why not all children with sleep disturbances do respond to aMT treatment.
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Affiliation(s)
- Ana Checa-Ros
- 1 San Cecilio University Hospital, Department of Pediatrics, School of Medicine, University of Granada, Spain
| | - Antonio Muñoz-Hoyos
- 1 San Cecilio University Hospital, Department of Pediatrics, School of Medicine, University of Granada, Spain
| | - Antonio Molina-Carballo
- 1 San Cecilio University Hospital, Department of Pediatrics, School of Medicine, University of Granada, Spain
| | | | - Susana Narbona-Galdó
- 1 San Cecilio University Hospital, Department of Pediatrics, School of Medicine, University of Granada, Spain
| | - Antonio Jerez-Calero
- 1 San Cecilio University Hospital, Department of Pediatrics, School of Medicine, University of Granada, Spain
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Lydon S, Healy O, Reed P, Mulhern T, Hughes BM, Goodwin MS. A systematic review of physiological reactivity to stimuli in autism. Dev Neurorehabil 2016; 19:335-355. [PMID: 25356589 DOI: 10.3109/17518423.2014.971975] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The prevalence of abnormal behavioural responses to a variety of stimuli among individuals with autism has led researchers to examine whether physiological reactivity (PR) is typical in this population. This article reviewed studies assessing PR to sensory, social and emotional, and stressor stimuli in individuals with autism. METHODS Systematic searches of electronic databases identified 57 studies that met our inclusion criteria. Studies were analysed to determine: (a) participant characteristics; (b) physiological measures used; (c) PR to sensory, social and emotional or stressor stimuli; (d) the relation between PR and behavioural or psychological variables and (e) baseline physiological activity. A novel measure of methodological quality suitable for use with non-randomized, non-interventional, psychophysiological studies was also developed and applied. RESULTS Individuals with autism were found to respond differently than typically developing controls in 78.6%, 66.7% and 71.4% of sensory, social and emotional, and stressor stimulus classes, respectively. However, this extant literature is characterized by variable and inconsistent findings, which do not appear to be accounted for by varying methodological quality, making it difficult to determine what specific factors differentiate individuals with autism who present with atypical PR from those who do not. CONCLUSIONS Despite this uncertainty, individual differences in PR are clearly present in autism, suggesting additional research is needed to determine the variables relating to PR among those with ASD and to examine the possible existence of physiological subtype responders in the population.
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Affiliation(s)
- Sinéad Lydon
- a School of Psychology, Trinity College Dublin , Dublin , Ireland
| | - Olive Healy
- a School of Psychology, Trinity College Dublin , Dublin , Ireland
| | - Phil Reed
- b Department of Psychology , Swansea University , Swansea , UK
| | - Teresa Mulhern
- c School of Psychology, National University of Ireland , Galway , Ireland , and
| | - Brian M Hughes
- c School of Psychology, National University of Ireland , Galway , Ireland , and
| | - Matthew S Goodwin
- d Department of Health Sciences , Northeastern University , Boston , MA , USA
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Kerns CM, Newschaffer CJ, Berkowitz SJ. Traumatic Childhood Events and Autism Spectrum Disorder. J Autism Dev Disord 2016; 45:3475-86. [PMID: 25711547 DOI: 10.1007/s10803-015-2392-y] [Citation(s) in RCA: 127] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Traumatic childhood events are associated with a wide range of negative physical, psychological and adaptive outcomes over the life course and are one of the few identifiable causes of psychiatric illness. Children with autism spectrum disorder (ASD) may be at increased risk for both encountering traumatic events and developing traumatic sequelae; however, this topic has been understudied. This review considers the rationale for examining traumatic events and related symptomology in individuals with ASD and summarizes the limited research on this topic. A conceptual framework for understanding the interplay of ASD, trauma and traumatic sequelae is proposed and recommendations for future research presented.
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Affiliation(s)
- Connor Morrow Kerns
- A.J. Drexel Autism Institute, Drexel University, 3020 Market Street, Suite 560, Philadelphia, PA, 19104, USA.
| | - Craig J Newschaffer
- A.J. Drexel Autism Institute, Drexel University, 3020 Market Street, Suite 560, Philadelphia, PA, 19104, USA
| | - Steven J Berkowitz
- Department of Psychiatry, University of Pennsylvania, Pennsylvania, PA, USA
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Tonacci A, Billeci L, Tartarisco G, Ruta L, Muratori F, Pioggia G, Gangemi S. [Formula: see text]Olfaction in autism spectrum disorders: A systematic review. Child Neuropsychol 2015; 23:1-25. [PMID: 26340690 DOI: 10.1080/09297049.2015.1081678] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Olfactory function is a well-known early biomarker for neurodegeneration and neural functioning in the adult population, being supported by a number of brain structures that could be dysfunctioning in neurodegenerative processes. Evidence has suggested that atypical sensory and, particularly, olfactory processing is present in several neurodevelopmental conditions, including autism spectrum disorders (ASDs). In this paper, we present data obtained by a systematic literature review, conducted according to PRISMA guidelines, regarding the possible association between olfaction and ASDs, and analyze them critically in order to evaluate the occurrence of olfactory impairment in ASDs, as well as the possible usefulness of olfactory evaluation in such conditions. The results obtained in this analysis suggested a possible involvement of olfactory impairment in ASDs, underlining the importance of olfactory evaluation in the clinical assessment of ASDs. This assessment could be potentially included as a complementary evaluation in the diagnostic protocol of the condition. Methods for study selection and inclusion criteria were specified in advance and documented in PROSPERO protocol #CRD42014013939.
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Affiliation(s)
- Alessandro Tonacci
- a National Research Council of Italy - Institute of Clinical Physiology , IFC-CNR, Pisa Unit , Pisa , Italy
| | - Lucia Billeci
- a National Research Council of Italy - Institute of Clinical Physiology , IFC-CNR, Pisa Unit , Pisa , Italy
| | - Gennaro Tartarisco
- b National Research Council of Italy - Institute of Clinical Physiology , IFC-CNR, Messina Unit , Messina , Italy
| | - Liliana Ruta
- b National Research Council of Italy - Institute of Clinical Physiology , IFC-CNR, Messina Unit , Messina , Italy.,c Department of Developmental Neuroscience , Stella Maris Scientific Institute , Calambrone, Pisa , Italy
| | - Filippo Muratori
- c Department of Developmental Neuroscience , Stella Maris Scientific Institute , Calambrone, Pisa , Italy
| | - Giovanni Pioggia
- b National Research Council of Italy - Institute of Clinical Physiology , IFC-CNR, Messina Unit , Messina , Italy
| | - Sebastiano Gangemi
- d Department of Clinical and Experimental Medicine, School and Division of Allergy and Clinical Immunology , University Hospital "G. Martino" , Messina , Italy
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11
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Roy A, Roy M, Deb S, Unwin G, Roy A. Are opioid antagonists effective in attenuating the core symptoms of autism spectrum conditions in children: a systematic review. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2015; 59:293-306. [PMID: 24589346 DOI: 10.1111/jir.12122] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/13/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND ASC (autism spectrum conditions) may result from a failure of striatal beta endorphins to diminish with maturation. Many symptoms of ASC resemble behaviours induced in animals or humans by opiate administration, including decreased socialisation, diminished crying, repetitive stereotypies, insensitivity to pain and motor hyperactivity. Naltrexone, an opioid antagonist, has been used in the management of children with ASC and can produce a clinically significant reduction in the serious and life-threatening behaviour of self-injury for individuals who have not been responsive to any other type of treatment and is important for this reason. It was therefore appropriate to reconsider the available evidence and a systematic review was undertaken. METHODS Four electronic databases were searched for relevant journal articles. In addition, cross-referencing of pertinent reviews and a hand search for articles in major international intellectual disability (ID) journals between the years 2010 and 2012 was carried out to ensure that all relevant articles were identified. We also searched databases for unpublished clinical trials to overcome publication bias. Each database was searched up to present (February 2013) with no restrictions on the date of publication. The search terms consisted of broad expressions used to describe ID and autistic spectrum disorder as well as terms relating to opioid antagonists and specific drugs. All studies identified by the electronic database search and hand search were examined on the basis of title alone for relevance and duplication. The abstracts of the remaining papers were then scrutinised against the inclusion criteria. Where abstracts failed to provide adequate information, the full texts for these papers were obtained. All the full texts were then evaluated against the inclusion proforma. Two reviewers carried out all the stages of the process independently. The reviewers met to discuss their selections and where disagreements arose, these were settled by discussion with a member of the study group. Data from each study meeting the inclusion criteria were extracted on a pre-piloted data extraction form. The quality of each study was further assessed using the Jadad scale, a tool developed to assess the quality of randomised controlled trials. RESULTS 155 children participated in 10 studies; 27 received placebo. Of the 128 that received naltrexone 98 (77%) showed statistically significant improvement in symptoms of irritability and hyperactivity. Side effects were mild and the drug was generally well tolerated. CONCLUSIONS Naltrexone may improve hyperactivity and restlessness in children with autism but there was not sufficient evidence that it had an impact on core features of autism in majority of the participants. It is likely that a subgroup of children with autism and abnormal endorphin levels may respond to naltrexone and identifying the characteristics of these children must become a priority.
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Affiliation(s)
- A Roy
- Manchester Medical School, Manchester, UK
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12
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Levy SE, Hyman SL. Complementary and alternative medicine treatments for children with autism spectrum disorders. Child Adolesc Psychiatr Clin N Am 2015; 24:117-43. [PMID: 25455579 DOI: 10.1016/j.chc.2014.09.004] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
There are many treatments in current use for core and associated symptoms of autism spectrum disorders (ASD). This review discusses the complementary and alternative medical (CAM) treatments commonly added to conventional interventions for children with ASD, including natural products, mind and body practices, and other biomedical treatments. The article focuses on factors associated with use of CAM, the empirical evidence for the most frequently used treatments, and how clinicians work with families who choose CAM treatments. Some treatments have been ineffective, some have unacceptable potential side effects, and others require more study in depth.
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Affiliation(s)
- Susan E Levy
- Division of Developmental & Behavioral Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, 3550 Market Street, 3rd Floor, Philadelphia, PA 19104, USA.
| | - Susan L Hyman
- Neurodevelopmental and Behavioral Pediatrics, Golisano Children's Hospital, School of Medicine and Dentistry, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA
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Lee YJ, Oh SH, Park C, Hong M, Lee AR, Yoo HJ, Shin CY, Cheon KA, Bahn GH. Advanced pharmacotherapy evidenced by pathogenesis of autism spectrum disorder. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2014; 12:19-30. [PMID: 24851117 PMCID: PMC4022762 DOI: 10.9758/cpn.2014.12.1.19] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 03/17/2014] [Accepted: 03/20/2014] [Indexed: 01/08/2023]
Abstract
In clinical practice, pharmacological treatment is mostly focused on behavioral symptoms in everyday life. Nevertheless, persistent effort continues to develop medication for causal treatment. Recent changes in diagnostic criteria from Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision (DSM-IV-TR) to DSM-5 would affect not only diagnosing approaches, but also therapeutic approaches. Because previous pervasive developmental disorders have been integrated into a single entity, the autism spectrum disorder (ASD), we have to prepare for what medications are valuable for the ASD. In this article, we reviewed the following etiological treatment: acetylcholine and glutamate related medicine; amino acid medicine such as secretin, endogenous opioid, and oxytocin; complementary and alternative medicine such as chelating agents, vitamins, and omega-3; promising drugs related to the scope of pharmacogenetics currently under study.
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Affiliation(s)
- Yeon Jung Lee
- Department of Psychiatry, Kyung Hee University School of Medicine, Seoul, Korea
| | - Soo Hyun Oh
- Department of Life Sciences, Ewha Womans University, Seoul, Korea
| | - Chanmin Park
- Department of Psychiatry, Kyung Hee University School of Medicine, Seoul, Korea
| | - Minha Hong
- Department of Psychiatry, Dankook University Medical College, Chungnam, Korea
| | - Ah Rah Lee
- Kyung Hee University School of Medicine, Seoul, Korea
| | - Hee Jeong Yoo
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Chan Young Shin
- Department of Pharmacology, Konkuk University School of Medicine, Seoul, Korea
| | - Keun-Ah Cheon
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Korea
| | - Geon Ho Bahn
- Department of Psychiatry, Kyung Hee University School of Medicine, Seoul, Korea
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Tian Y, Yabuki Y, Moriguchi S, Fukunaga K, Mao PJ, Hong LJ, Lu YM, Wang R, Ahmed MM, Liao MH, Huang JY, Zhang RT, Zhou TY, Long S, Han F. Melatonin reverses the decreases in hippocampal protein serine/threonine kinases observed in an animal model of autism. J Pineal Res 2014; 56:1-11. [PMID: 23952810 DOI: 10.1111/jpi.12081] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 07/19/2013] [Indexed: 12/23/2022]
Abstract
Lower global cognitive function scores are a common symptom of autism spectrum disorders (ASDs). This study investigates the effects of melatonin on hippocampal serine/threonine kinase signaling in an experimental ASD model. We found that chronic melatonin (1.0 or 5.0 mg/kg/day, 28 days) treatment significantly rescued valproic acid (VPA, 600 mg/kg)-induced decreases in CaMKII (Thr286), NMDAR1 (Ser896), and PKA (Thr197) phosphorylation in the hippocampus without affecting total protein levels. Compared with control rats, the immunostaining of pyramidal neurons in the hippocampus revealed a decrease in immunolabeling intensity for phospho-CaMKII (Thr286) in the hippocampus of VPA-treated rats, which was ameliorated by chronic melatonin treatment. Consistent with the elevation of CaMKII/PKA/PKC phosphorylation observed in melatonin-treated rat, long-term potentiation (LTP) was enhanced after chronic melatonin (5.0 mg/kg) treatment, as reflected by extracellular field potential slopes that increased from 56 to 60 min (133.4 ± 3.9% of the baseline, P < 0.01 versus VPA-treated rats) following high-frequency stimulation (HFS) in hippocampal slices. Accordingly, melatonin treatment also significantly improved social behavioral deficits at postnatal day 50 in VPA-treated rats. Taken together, the increased phosphorylation of CaMKII/PKA/PKC signaling might contribute to the beneficial effects of melatonin on autism symptoms.
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Affiliation(s)
- Yun Tian
- Institute of Pharmacology, Toxicology and Biochemical Pharmaceutics, Zhejiang University, Hangzhou, China
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Kohls G, Chevallier C, Troiani V, Schultz RT. Social 'wanting' dysfunction in autism: neurobiological underpinnings and treatment implications. J Neurodev Disord 2012; 4:10. [PMID: 22958468 PMCID: PMC3436671 DOI: 10.1186/1866-1955-4-10] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Accepted: 05/17/2012] [Indexed: 12/27/2022] Open
Abstract
Most behavioral training regimens in autism spectrum disorders (ASD) rely on reward-based reinforcement strategies. Although proven to significantly increase both cognitive and social outcomes and successfully reduce aberrant behaviors, this approach fails to benefit a substantial number of affected individuals. Given the enormous amount of clinical and financial resources devoted to behavioral interventions, there is a surprisingly large gap in our knowledge of the basic reward mechanisms of learning in ASD. Understanding the mechanisms for reward responsiveness and reinforcement-based learning is urgently needed to better inform modifications that might improve current treatments. The fundamental goal of this review is to present a fine-grained literature analysis of reward function in ASD with reference to a validated neurobiological model of reward: the 'wanting'/'liking' framework. Despite some inconsistencies within the available literature, the evaluation across three converging sets of neurobiological data (neuroimaging, electrophysiological recordings, and neurochemical measures) reveals good evidence for disrupted reward-seeking tendencies in ASD, particularly in social contexts. This is most likely caused by dysfunction of the dopaminergic-oxytocinergic 'wanting' circuitry, including the ventral striatum, amygdala, and ventromedial prefrontal cortex. Such a conclusion is consistent with predictions derived from diagnostic criteria concerning the core social phenotype of ASD, which emphasize difficulties with spontaneous self-initiated seeking of social encounters (that is, social motivation). Existing studies suggest that social 'wanting' tendencies vary considerably between individuals with ASD, and that the degree of social motivation is both malleable and predictive of intervention response. Although the topic of reward responsiveness in ASD is very new, with much research still needed, the current data clearly point towards problems with incentive-based motivation and learning, with clear and important implications for treatment. Given the reliance of behavioral interventions on reinforcement-based learning principles, we believe that a systematic focus on the integrity of the reward system in ASD promises to yield many important clues, both to the underlying mechanisms causing ASD and to enhancing the efficacy of existing and new interventions.
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Affiliation(s)
- Gregor Kohls
- Center for Autism Research, The Children's Hospital of Philadelphia, 3535 Market Street, 8th floor, Suite 860, Philadelphia, PA, 19104, USA.
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Kumar A, Swanwick CC, Johnson N, Menashe I, Basu SN, Bales ME, Banerjee-Basu S. A brain region-specific predictive gene map for autism derived by profiling a reference gene set. PLoS One 2011; 6:e28431. [PMID: 22174805 PMCID: PMC3235126 DOI: 10.1371/journal.pone.0028431] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2011] [Accepted: 11/08/2011] [Indexed: 11/19/2022] Open
Abstract
Molecular underpinnings of complex psychiatric disorders such as autism spectrum disorders (ASD) remain largely unresolved. Increasingly, structural variations in discrete chromosomal loci are implicated in ASD, expanding the search space for its disease etiology. We exploited the high genetic heterogeneity of ASD to derive a predictive map of candidate genes by an integrated bioinformatics approach. Using a reference set of 84 Rare and Syndromic candidate ASD genes (AutRef84), we built a composite reference profile based on both functional and expression analyses. First, we created a functional profile of AutRef84 by performing Gene Ontology (GO) enrichment analysis which encompassed three main areas: 1) neurogenesis/projection, 2) cell adhesion, and 3) ion channel activity. Second, we constructed an expression profile of AutRef84 by conducting DAVID analysis which found enrichment in brain regions critical for sensory information processing (olfactory bulb, occipital lobe), executive function (prefrontal cortex), and hormone secretion (pituitary). Disease specificity of this dual AutRef84 profile was demonstrated by comparative analysis with control, diabetes, and non-specific gene sets. We then screened the human genome with the dual AutRef84 profile to derive a set of 460 potential ASD candidate genes. Importantly, the power of our predictive gene map was demonstrated by capturing 18 existing ASD-associated genes which were not part of the AutRef84 input dataset. The remaining 442 genes are entirely novel putative ASD risk genes. Together, we used a composite ASD reference profile to generate a predictive map of novel ASD candidate genes which should be prioritized for future research.
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Affiliation(s)
- Ajay Kumar
- MindSpec, McLean, Virginia, United States of America
| | | | | | - Idan Menashe
- MindSpec, McLean, Virginia, United States of America
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Leu RM, Beyderman L, Botzolakis EJ, Surdyka K, Wang L, Malow BA. Relation of melatonin to sleep architecture in children with autism. J Autism Dev Disord 2011; 41:427-33. [PMID: 20683768 DOI: 10.1007/s10803-010-1072-1] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Children with autism often suffer from sleep disturbances, and compared to age-matched controls, have decreased melatonin levels, as indicated by urine levels of the primary melatonin metabolite, 6-sulfatoxymelatonin (6-SM). We therefore investigated the relationship between 6-SM levels and sleep architecture in children with autism spectrum disorders (ASD). Twenty-three children, aged 4-10 years, completed two nights of polysomnography and one overnight urine collection for measurement of urinary 6-SM excretion rate. Parents completed the Children's Sleep Habits Questionnaire. We found that higher urinary 6-SM excretion rates were associated with increased N3 sleep, decreased N2 sleep, and decreased daytime sleepiness. The results warrant further examination to examine the effects of supplemental melatonin on sleep architecture and daytime sleepiness.
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Affiliation(s)
- Roberta M Leu
- Sleep Disorders Division, Department of Neurology, Vanderbilt University School of Medicine, Medical Center North, Nashville, TN 37232-2551, USA
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Doyen C, Mighiu D, Kaye K, Colineaux C, Beaumanoir C, Mouraeff Y, Rieu C, Paubel P, Contejean Y. Melatonin in children with autistic spectrum disorders: recent and practical data. Eur Child Adolesc Psychiatry 2011; 20:231-9. [PMID: 21359552 DOI: 10.1007/s00787-011-0162-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2010] [Accepted: 02/03/2011] [Indexed: 01/02/2023]
Abstract
Over the last 20 years, melatonin, a pineal hormone synthesized from serotonin, has been implicated in various studies on the autism spectrum disorder (ASD) and altered melatonin levels were detected in subgroups of subjects with ASD. Its effect on sleep disturbances got the attention of clinicians and several investigations were carried out to determine the usefulness and safety of melatonin administration in this disorder. Hypotheses were also raised regarding the possibility that the dysfunctional synthesis and secretion of melatonin detected in subgroups of subjects with ASD may increase the risk as well the severity of ASD. The purpose of this paper is to review our pharmacokinetic knowledge on melatonin and present results from recent studies on sleep disorders in autism, their treatment with melatonin and the impact of melatonin prescription in children with ASD evaluated in a Diagnostic Center for Autism Spectrum Disorder in Paris, France.
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Affiliation(s)
- C Doyen
- Department of Child and Adolescent Psychopathology, Sainte Anne Hospital, 14 rue Cabanis, Paris, France.
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Guénolé F, Godbout R, Nicolas A, Franco P, Claustrat B, Baleyte JM. Melatonin for disordered sleep in individuals with autism spectrum disorders: systematic review and discussion. Sleep Med Rev 2011; 15:379-87. [PMID: 21393033 DOI: 10.1016/j.smrv.2011.02.001] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2010] [Revised: 02/05/2011] [Accepted: 02/07/2011] [Indexed: 11/29/2022]
Abstract
Sleep disturbance is common in autism spectrum disorders (ASD) and melatonin is widely prescribed in such cases despite a lack of guidelines. The aim of this paper is to provide a systematic review of efficacy and safety of exogenous melatonin for treating disordered sleep in individuals with ASD. We performed a Pubmed(®) documentary search enlarged by a manual review of references, which finally supplied 12 citations (4 case reports, 3 retrospective studies, 2 open-label clinical trials, and 3 placebo-controlled trials). As a whole, we found that the literature supports the existence of a beneficial effect of melatonin on sleep in individuals with ASD, with only few and minor side effects. However, considering the small number of studies and their methodological limits, these conclusions cannot yet be regarded as evidence-based. Randomized controlled trials and long-term follow-up data are still lacking to better assess efficacy and safety of exogenous melatonin for disordered sleep in individuals with ASD.
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Affiliation(s)
- Fabian Guénolé
- CHU de Caen, Service de Psychiatrie de l'enfant et de l'adolescent, Avenue Clemenceau, Caen F-14000, France.
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Nandhu MS, Naijil G, Smijin S, Jayanarayanan S, Paulose CS. Opioid system functional regulation in neurological disease management. J Neurosci Res 2011; 88:3215-21. [PMID: 20734417 DOI: 10.1002/jnr.22463] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
There is increasing evidence to suggest a role for the opioid system in the control of pathophysiology of neurological disorders (Alzheimer's, Parkinson's, and Huntington's diseases, spinal cord injury, epilepsy, hypoxia, and autism). Resuscitation of the altered expression of the opioid system in various neurological disorders is of therapeutic importance. Such treatment may be beneficial in ameliorating the clinical symptoms of the disorder. This Mini-Review provides a brief update on opioid system regulation in neurological disorders and focuses on the opioids' pharmacological importance.
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Affiliation(s)
- M S Nandhu
- Molecular Neurobiology and Cell Biology Unit, Centre for Neuroscience, Department of Biotechnology, Cochin University of Science and Technology, Cochin, Kerala, India
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Handen BL, Taylor J, Tumuluru R. Psychopharmacological treatment of ADHD symptoms in children with autism spectrum disorder. Int J Adolesc Med Health 2011; 23:167-173. [PMID: 22191179 DOI: 10.1515/ijamh.2011.039] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
One of the most frequently reported behavioral concerns among children with autism spectrum disorder (ASD) is high rates of activity and inattention, symptoms that are often associated with attention deficit hyperactivity disorder (ADHD). Although there is a considerable body of research regarding the appropriate treatment of ADHD symptoms among typically developing children, the research among children with ASD is more limited. The evidence to date suggests that medication response rates among children with ASD are considerably lower than among typically developing children and that children with ASD tend to be at greater risk for experiencing side effects. The purpose of the present paper is to review the available research on the treatment of ADHD symptoms in children with ASD. This paper summarizes the data on a range of pharmacological options and provides specific recommendations for how best to clinically manage these symptoms.
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Affiliation(s)
- Benjamin L Handen
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA 15203, USA.
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Glickman G. Circadian rhythms and sleep in children with autism. Neurosci Biobehav Rev 2010; 34:755-68. [PMID: 19963005 DOI: 10.1016/j.neubiorev.2009.11.017] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2009] [Revised: 11/17/2009] [Accepted: 11/18/2009] [Indexed: 01/08/2023]
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Tordjman S, Anderson GM, Botbol M, Brailly-Tabard S, Perez-Diaz F, Graignic R, Carlier M, Schmit G, Rolland AC, Bonnot O, Trabado S, Roubertoux P, Bronsard G. Pain reactivity and plasma beta-endorphin in children and adolescents with autistic disorder. PLoS One 2009; 4:e5289. [PMID: 19707566 PMCID: PMC2728512 DOI: 10.1371/journal.pone.0005289] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2008] [Accepted: 02/10/2009] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Reports of reduced pain sensitivity in autism have prompted opioid theories of autism and have practical care ramifications. Our objective was to examine behavioral and physiological pain responses, plasma beta-endorphin levels and their relationship in a large group of individuals with autism. METHODOLOGY/PRINCIPAL FINDINGS The study was conducted on 73 children and adolescents with autism and 115 normal individuals matched for age, sex and pubertal stage. Behavioral pain reactivity of individuals with autism was assessed in three observational situations (parents at home, two caregivers at day-care, a nurse and child psychiatrist during blood drawing), and compared to controls during venepuncture. Plasma beta-endorphin concentrations were measured by radioimmunoassay. A high proportion of individuals with autism displayed absent or reduced behavioral pain reactivity at home (68.6%), at day-care (34.2%) and during venepuncture (55.6%). Despite their high rate of absent behavioral pain reactivity during venepuncture (41.3 vs. 8.7% of controls, P<0.0001), individuals with autism displayed a significantly increased heart rate in response to venepuncture (P<0.05). Moreover, this response (Delta heart rate) was significantly greater than for controls (mean+/-SEM; 6.4+/-2.5 vs. 1.3+/-0.8 beats/min, P<0.05). Plasma beta-endorphin levels were higher in the autistic group (P<0.001) and were positively associated with autism severity (P<0.001) and heart rate before or after venepuncture (P<0.05), but not with behavioral pain reactivity. CONCLUSIONS/SIGNIFICANCE The greater heart rate response to venepuncture and the elevated plasma beta-endorphin found in individuals with autism reflect enhanced physiological and biological stress responses that are dissociated from observable emotional and behavioral reactions. The results suggest strongly that prior reports of reduced pain sensitivity in autism are related to a different mode of pain expression rather than to an insensitivity or endogenous analgesia, and do not support opioid theories of autism. Clinical care practice and hypotheses regarding underlying mechanisms need to assume that children with autism are sensitive to pain.
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Affiliation(s)
- Sylvie Tordjman
- Laboratoire Psychologie de la Perception, Université Paris Descartes, UMR 8158 CNRS, Paris, France.
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Corbett BA, Schupp CW, Levine S, Mendoza S. Comparing cortisol, stress, and sensory sensitivity in children with autism. Autism Res 2009; 2:39-49. [PMID: 19358306 PMCID: PMC2698454 DOI: 10.1002/aur.64] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Previously we reported that children with autism show significant variability in cortisol. The current investigation was designed to extend these findings by exploring plausible relationships between cortisol and psychological measures of stress and sensory functioning. Salivary cortisol values for diurnal rhythms and response to stress in children with and without autism were compared to parent-report measures of child stress, the Stress Survey Schedule (SSS), sensory functioning, Short Sensory Profile (SSP), and Parenting Stress Index. In autism, a negative relationship between morning cortisol and the SSS revealed that higher observed symptoms of stress were related to lower cortisol. Lower cortisol is seen in conditions of chronic stress and in social situations characterized by unstable social relationships. Sensory sensitivity painted a more complicated picture, in that some aspects of SSP were associated with higher while others were associated with lower cortisol. We propose that increased sensory sensitivity may enhance the autistic child's susceptibility to the influence of zeitgeibers reflected in variable cortisol secretion. Evening cortisol was positively associated with SSS such that the higher the level of evening cortisol, the higher the child's parent-reported daily stress, especially to changes, such as in daily routine. Regarding the response to stress, the psychological and parent variables did not differentiate the groups; rather, discrete subgroups of cortisol responders and nonresponders were revealed in both the autism and neurotypical children. The results support a complex interplay between physiological and behavioral stress and sensory sensitivity in autism and plausible developmental factors influencing stress reactivity across the groups.
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Affiliation(s)
- Blythe A Corbett
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, California 95817, USA.
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Sandman CA, Touchette PE, Marion SD, Chicz-DeMet A. The role of proopiomelanocortin (POMC) in sequentially dependent self-injurious behavior. Dev Psychobiol 2008; 50:680-9. [PMID: 18688808 PMCID: PMC2577125 DOI: 10.1002/dev.20323] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Self-injuring behavior (SIB) is a life-threatening behavior exhibited by many species, including humans, and has no known cause and no agreed upon treatment. The role of the stress axis in the maintenance of this mysterious behavior was examined in subjects with life-long SIB. Over a 6-year period, 40 hr of direct observations of behavior and the environment were recorded on palmtop computers while 36 residential subjects (28 target and 8 control subjects) conducted their daily activities. Blood samples were collected in morning and evening for all subjects and within minutes after a self-injuring act in 28 target subjects who exhibited SIB to determine levels of ACTH and B-endorphin (BE). Self-injuring events in the patient group were significantly sequentially dependent (i.e., the only predictor of a self-injuring act was an antecedent self-injuring act). Higher morning levels of BE relative to ACTH predicted [r(df=27) = .57, p < .001] the sequentially dependent pattern of SIB. This effect was validated in a subgroup retested several months later [r(df=22) = .60, p < .001]. A subgroup of seven subjects exhibiting sequentially dependent patterns were administered an opiate blocker (naltrexone) in a double-blind, crossover design with an additional 14 hr/week of observation for 7 weeks. Naltrexone challenge interrupted the sequential pattern (improved behavior) in subjects with elevated BE immediately following SIB (r = .85, p < .01). The pattern of results supported the conclusion that the stress axis played a significant role in the maintenance of complex episodes of self-injury.
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Affiliation(s)
- Curt A Sandman
- Department of Psychiatry and Human Behavior, University of California, 2501 Harbor Blvd, Costa Mesa, Irvine, CA 92626, USA.
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Philippi A, Tores F, Carayol J, Rousseau F, Letexier M, Roschmann E, Lindenbaum P, Benajjou A, Fontaine K, Vazart C, Gesnouin P, Brooks P, Hager J. Association of autism with polymorphisms in the paired-like homeodomain transcription factor 1 (PITX1) on chromosome 5q31: a candidate gene analysis. BMC MEDICAL GENETICS 2007; 8:74. [PMID: 18053270 PMCID: PMC2222245 DOI: 10.1186/1471-2350-8-74] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2007] [Accepted: 12/06/2007] [Indexed: 12/22/2022]
Abstract
Background Autism is a complex, heterogeneous, behaviorally-defined disorder characterized by disruptions of the nervous system and of other systems such as the pituitary-hypothalamic axis. In a previous genome wide screen, we reported linkage of autism with a 1.2 Megabase interval on chromosome 5q31. For the current study, we hypothesized that 3 of the genes in this region could be involved in the development of autism: 1) paired-like homeodomain transcription factor 1 (PITX1), which is a key regulator of hormones within the pituitary-hypothalamic axis, 2) neurogenin 1, a transcription factor involved in neurogenesis, and 3) histone family member Y (H2AFY), which is involved in X-chromosome inactivation in females and could explain the 4:1 male:female gender distortion present in autism. Methods A total of 276 families from the Autism Genetic Resource Exchange (AGRE) repository composed of 1086 individuals including 530 affected children were included in the study. Single nucleotide polymorphisms tagging the three candidate genes were genotyped on the initial linkage sample of 116 families. A second step of analysis was performed using tightly linked SNPs covering the PITX1 gene. Association was evaluated using the FBAT software version 1.7.3 for single SNP analysis and the HBAT command from the same package for haplotype analysis respectively. Results Association between SNPs and autism was only detected for PITX1. Haplotype analysis within PITX1 showed evidence for overtransmission of the A-C haplotype of markers rs11959298 – rs6596189 (p = 0.0004). Individuals homozygous or heterozygous for the A-C haplotype risk allele were 2.54 and 1.59 fold more likely to be autistic than individuals who were not carrying the allele, respectively. Conclusion Strong and consistent association was observed between a 2 SNPs within PITX1 and autism. Our data suggest that PITX1, a key regulator of hormones within the pituitary-hypothalamic axis, may be implicated in the etiology of autism.
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Affiliation(s)
- Anne Philippi
- IntegraGen SA, 5 rue Henri Desbruères, Genopole Campus 1, Genavenir 8, 91000 Evry, France.
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Tordjman S, Drapier D, Bonnot O, Graignic R, Fortes S, Cohen D, Millet B, Laurent C, Roubertoux PL. Animal models relevant to schizophrenia and autism: validity and limitations. Behav Genet 2006; 37:61-78. [PMID: 17160702 DOI: 10.1007/s10519-006-9120-5] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2006] [Accepted: 10/12/2006] [Indexed: 10/23/2022]
Abstract
Development of animal models is a crucial issue in biological psychiatry. Animal models provide the opportunity to decipher the relationships between the nervous system and behavior and they are an obligatory step for drug tests. Mouse models or rat models to a lesser extent could help to test for the implication of a gene using gene targeting or transfecting technologies. One of the main problem for the development of animal models is to define a marker of the psychiatric disorder. Several markers have been suggested for schizophrenia and autism, but for the moment no markers or etiopathogenic mechanisms have been identified for these disorders. We examined here animal models related to schizophrenia and autism and discussed their validity and limitations after first defining these two disorders and considering their similarities and differences. Animal models reviewed in this article test mainly behavioral dimensions or biological mechanisms related to autistic disorder or schizophrenia rather than providing specific categorical models of autism or schizophrenia. Furthermore, most of these studies focus on a behavioral dimension associated with an underlying biological mechanism, which does not correspond to the complexity of mental disorders. It could be useful to develop animal models relevant to schizophrenia or autism to test a behavioral profile associated with a biological profile. A multi-trait approach seems necessary to better understand multidimensional disorders such as schizophrenia and autism and their biological and clinical heterogeneity. Finally, animal models can help us to clarify complex mechanisms and to study relationships between biological and behavioral variables and their interactions with environmental factors. The main interest of animal models is to generate new pertinent hypotheses relevant to humans opening the path to innovative research.
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Affiliation(s)
- Sylvie Tordjman
- Service Hospitalo-Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Université de Rennes 1 et Centre Hospitalier Guillaume Régnier, 154 rue de Châtillon, 35200, Rennes, France.
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Lam KSL, Aman MG, Arnold LE. Neurochemical correlates of autistic disorder: a review of the literature. RESEARCH IN DEVELOPMENTAL DISABILITIES 2006; 27:254-89. [PMID: 16002261 DOI: 10.1016/j.ridd.2005.03.003] [Citation(s) in RCA: 178] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2003] [Revised: 01/05/2005] [Accepted: 03/17/2005] [Indexed: 05/03/2023]
Abstract
Review of neurochemical investigations in autistic disorder revealed that a wide array of transmitter systems have been studied, including serotonin, dopamine, norepinephrine, acetylcholine, oxytocin, endogenous opioids, cortisol, glutamate, and gamma-aminobutyric acid (GABA). These studies have been complicated by the fact that autism is a very heterogeneous disorder which often presents with comorbid behavioral problems. In addition, many of these studies employed very small samples and inappropriate control groups, making it difficult to draw conclusions with confidence. Overall, serotonin appears to have the most empirical evidence for a role in autism, but this requires further investigation and replication. There is little support for the notion that a dysfunction of norepinephrine or the endogenous opioids are related to autism. The role of dopaminergic functioning has not been compelling thus far, though conflicting findings on central dopamine turnover require further study. Promising new areas of study may include possible dysfunction of the cholinergic system, oxytocin, and amino acid neurotransmitters. Implications for pharmacotherapy are briefly discussed for each neurotransmitter system with brief research examples. Review of this work emphasizes the need for future studies to control for subject variables, such as race, sex, pubertal status, and distress associated with blood draws, which can affect measures of neurochemical function. In addition, research in neurochemistry must continue to work in concert with other subspecialties to form a more comprehensive and theory-based approach to the neurobiological correlates of autistic disorder.
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Affiliation(s)
- Kristen S L Lam
- Neurodevelopmental Disorders Research Center, University of North Carolina at Chapel Hill, USA
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Johansson M, Råstam M, Billstedt E, Danielsson S, Strömland K, Miller M, Gillberg C. Autism spectrum disorders and underlying brain pathology in CHARGE association. Dev Med Child Neurol 2006; 48:40-50. [PMID: 16359593 DOI: 10.1017/s0012162206000090] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/12/2005] [Indexed: 11/07/2022]
Abstract
The rate of autism spectrum disorders (ASDs) and brain abnormalities was analyzed in 31 individuals (15 males, 16 females; age range 1mo to 31y, mean age 8y 11mo) with CHARGE association, as part of a multidisciplinary study. A meticulous neuropsychiatric examination was performed, including standardized autism diagnostic interviews. Judgement regarding ASDs was impossible in three infants and three patients who were deaf and blind. Five individuals met diagnostic criteria for autism, five for an autistic-like condition, and seven for autistic traits. Brain abnormalities were indicated in almost three-quarters of examined individuals, and midline abnormalities of the forebrain in one-third. Awareness of the coexistence of CHARGE and ASDs is important in habilitation care in CHARGE. Moreover, the results indicate that a subgroup of ASDs may be associated with errors in early embryonic brain development.
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Affiliation(s)
- Maria Johansson
- Department of Child and Adolescent Psychiatry, Göteborg University, Sweden.
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30
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Moles A, Kieffer BL, D'Amato FR. Deficit in attachment behavior in mice lacking the mu-opioid receptor gene. Science 2004; 304:1983-6. [PMID: 15218152 DOI: 10.1126/science.1095943] [Citation(s) in RCA: 340] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Endogenous opioid binding to micro receptors is hypothesized to mediate natural rewards and has been proposed to be the basis of infant attachment behavior. Here, we report that micro-opioid receptor knockout mouse pups emit fewer ultrasonic vocalizations when removed from their mothers but not when exposed to cold or male mice odors. Moreover these knockout pups do not show a preference toward their mothers' cues and do not show ultrasonic calls potentiation after brief maternal exposure. Results from this study may indicate a molecular mechanism for diseases characterized by deficits in attachment behavior, such as autism or reactive attachment disorder.
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Affiliation(s)
- Anna Moles
- Consiglio Nazionale delle Ricerche Institute of Neuroscience, Psychobiology and Psychopharmacology, Viale Marx 43, 00137 Roma, Italy
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31
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Abstract
In recent years, dolphin-assisted therapy has become very popular and an increasing number of facilities offer therapy programs with dolphins worldwide. To this date, there are no studies concerning the behavior of dolphins during these therapies. As a result of speculations that the echolocation of dolphins may play an important role for the success of the therapy and the high publicity of this in the media, people pay much more for dolphin-assisted than for other animal-assisted therapy programs. Based on publications in medicine, we will show that ultrasound emitted by dolphins could have an effect on biological tissue under some circumstances; such as sufficient intensity, repeated application over several days or weeks and a certain application duration per session. We recorded 83 sessions at the "Dolphins Plus", a fenced area with ocean water in the Florida Keys. Our observations demonstrate that only one out of five observed dolphins behave significantly differently towards patients compared to other humans and that the duration of the observed close contacts did not meet the requirements for common ultrasound therapies.
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Affiliation(s)
- Karsten Brensing
- Institute of Behavioral Research, Free University of Berlin, Verhaltensbiologie Haderslebener Strasse 9, D-12163 Berlin, Germany.
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32
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Birketvedt GS, Sundsfjord J, Florholmen JR. Hypothalamic-pituitary-adrenal axis in the night eating syndrome. Am J Physiol Endocrinol Metab 2002; 282:E366-9. [PMID: 11788368 DOI: 10.1152/ajpendo.00251.2001] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The typical neuroendocrine characteristics of the night eating syndrome have previously been described as changes in the circadian rhythm by an attenuation in the nocturnal rise of the plasma concentrations of melatonin and leptin and an increased circadian secretion of cortisol. The aim of this study was to test the hypothesis that night eaters have an overexpressed hypothalamic-pituitary-adrenal axis with an attenuated response to stress. Five female subjects with the night-eating syndrome and five sex-, age-, and weight-matched controls performed a 120-min corticotropin-releasing hormone (CRH) test (100 microg iv). Blood samples were drawn intravenously for measurements of the plasma concentrations of ACTH and cortisol. The results showed that, in night eaters compared with controls, the CRH-induced ACTH and cortisol response was significantly decreased to 47 and 71%, respectively. In conclusion, disturbances in the hypothalamic-pituitary-adrenal axis with an attenuated ACTH and cortisol response to CRH were found in subjects with night-eating syndrome.
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Vercellino F, Zanotto E, Ravera G, Veneselli E. Open-label risperidone treatment of 6 children and adolescents with autism. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2001; 46:559-60. [PMID: 11526814 DOI: 10.1177/070674370104600614] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Williams PG, Allard A, Sears L, Dalrymple N, Bloom AS. Brief report: case reports on naltrexone use in children with autism: controlled observations regarding benefits and practical issues of medication management. J Autism Dev Disord 2001; 31:103-8. [PMID: 11439748 DOI: 10.1023/a:1005674016014] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- P G Williams
- 571 S. Floyd Street, Peds-CEC, 100 Kosair Pediatric Center, University of Louisville, Louisville, Kentucky 40202, USA
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Symons FJ, Davis ML, Thompson T. Self-injurious behavior and sleep disturbance in adults with developmental disabilities. RESEARCH IN DEVELOPMENTAL DISABILITIES 2000; 21:115-123. [PMID: 10817418 DOI: 10.1016/s0891-4222(00)00028-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Sleep patterns of 30 individuals with self-injurious behavior and mental retardation were compared with those of 30 matched controls residing in the same residential facility that did not self-injure. Individuals were recorded as asleep or awake during 30 min intervals for eight hours per night. The results of a Wilcoxon signed-ranks test (p < .05) indicated that individuals with self-injury slept significantly less than individuals without self-injury. chi2 analyses (p < .01) indicated significantly greater variability in the number of intervals recorded as asleep among individuals with self-injury than their matched controls. These results are congruent with previous findings of sleep disturbance among persons with mental retardation and behavior problems. The possibility of neurochemical dysregulation in sleep disturbance among individuals with daytime self-injury is discussed.
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Affiliation(s)
- F J Symons
- Frank Porter Graham Child Development Center, University of North Carolina at Chapel Hill, 27599, USA.
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Cazzullo AG, Musetti MC, Musetti L, Bajo S, Sacerdote P, Panerai A. Beta-endorphin levels in peripheral blood mononuclear cells and long-term naltrexone treatment in autistic children. Eur Neuropsychopharmacol 1999; 9:361-6. [PMID: 10422898 DOI: 10.1016/s0924-977x(99)00010-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We assessed the clinical and biological effects of high-dose, long-term Naltrexone (NTX) treatment in 11 children (3-11 years), who had been diagnosed as autistic. The drug was given following an open design, for 12 weeks. Beta-Endorphin (beta-END) was assayed in peripheral blood mononuclear cells after 1 and 3 months of treatment, and 6 months after the completion of the course. Baseline beta-END levels were higher than in healthy age-matched controls. In seven patients treatment reduced beta-END, whose levels rose in four children. Autistic symptoms were considerably attenuated in all cases, with functional improvements involving several areas. There was a close correlation between the reduction in beta-END levels and the decrease of social withdrawal, and an evident--though weak--correlation between increases in beta-END and decreases in stereotypy and abnormal speech. Both effects persisted after treatment stopped.
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Affiliation(s)
- A G Cazzullo
- Institute of Child and Adolescent Neurologic and Psychiatric Sciences, University of Milan, Italy
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37
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Pedersen OS, Liu Y, Reichelt KL. Serotonin uptake stimulating peptide found in plasma of normal individuals and in some autistic urines. THE JOURNAL OF PEPTIDE RESEARCH : OFFICIAL JOURNAL OF THE AMERICAN PEPTIDE SOCIETY 1999; 53:641-6. [PMID: 10408338 DOI: 10.1034/j.1399-3011.1999.00058.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We have isolated a tripeptide from normal plasma and autistic urines which stimulates the uptake of serotonin (5-HT) into platelets. This peptide was purified by high-performance liquid chromatography (HPLC) and characterized by sequenation and mass-spectrometry. Synthetic peptide showed co-chromatography with the biological sample in the HPLC systems used. Close to 60% of the autistic children diagnosed using the Diagnostic Statistical Manual III-R had an increased HPLC peak eluting like this peptide in their urines compared with controls.
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Affiliation(s)
- O S Pedersen
- Research Institute, University of Oslo, Rikshospitalet, Norway
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38
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Abstract
OBJECTIVE To evaluate the effect of naltrexone on communication skills of young children with autism. METHOD Twenty-four children with autism, 3.0 to 8.3 years old (mean 5.1) who were living at home and attending appropriate school programs, participated in a randomized, double-blind, placebo-controlled, crossover trial. Naltrexone, 1.0 mg/kg, or placebo was administered daily for 2 weeks. Communication was evaluated from videotaped samples of seminaturalistic parent-child interaction. Child and parent language were assessed using similar measures. RESULTS In this heterogeneous sample, the median number of words the child produced on placebo was 9.5 (range 0-124). The median proportion of utterances with echolalia was 0.16. No differences were found between the naltrexone and placebo conditions in any of the measures of children or parents' communication. Significant correlations were found between the child's number of words and developmental quotient (Spearman rho = 0.58, p = .003) and between the child's and parent's number of words (rho = 0.55, p = .005). CONCLUSIONS Previous studies showed that naltrexone was associated with modest reduction in hyperactivity and restlessness in this group of children with autism. In this short-term study, the medication did not lead to improvement in communication, a core deficit of autism.
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Affiliation(s)
- H M Feldman
- Department of Pediatrics, University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh, PA 15213, USA
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Jansen LM, Gispen-de Wied CC, Jansen MA, van der Gaag RJ, Matthys W, van Engeland H. Pituitary-adrenal reactivity in a child psychiatric population: salivary cortisol response to stressors. Eur Neuropsychopharmacol 1999; 9:67-75. [PMID: 10082230 DOI: 10.1016/s0924-977x(98)00003-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The aim of this explorative study was to investigate whether physical and psychological challenges are effective in inducing a cortisol response in psychiatric and control children, and if so whether the cortisol response can discriminate between diagnostic groups and is related to psychiatric symptoms. Fifty-two patients, including children with dysthymia, oppositional defiant disorder/conduct disorder, pervasive developmental disorder, not otherwise specified (PDDNOS) and attention deficit hyperactivity disorder, were compared to 15 healthy control children. Symptomatology was scored using the Child Behaviour Checklist. The response to both psychological and physical challenges was assessed by measuring salivary cortisol and heart rate. Physical challenge, but not psychological challenge, resulted in an overall increase in heart rate and saliva cortisol. Dysthymic and PDDNOS patients showed a diminished cortisol response, in spite of a significant increase in heart rate. These groups scored highest on the symptom factor withdrawal. Withdrawal was negatively correlated with the cortisol response. Thus, physical exercise is effective in inducing a salivary cortisol response in children. Dysthymic and PDDNOS patients have a disturbed pituitary-adrenal function in relation to physical stress, that may be associated with withdrawal.
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Affiliation(s)
- L M Jansen
- Rudolf Magnus Institute of Neuroscience, Department of Child and Adolescent Psychiatry, Utrecht University, Academic Hospital, The Netherlands.
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40
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41
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42
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von Aster M, Zachmann M, Brandeis D, Wohlrab G, Richner M, Steinhausen HC. Psychiatric, neuropediatric, and neuropsychological symptoms in a case of hypomelanosis of Ito. Eur Child Adolesc Psychiatry 1997; 6:227-33. [PMID: 9443002 DOI: 10.1007/bf00539930] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
This case report presents a thirteen year-old boy who was diagnosed as having Hypomelanosis of Ito. The developmental history includes severe failure to thrive, and moderate atypical autism as well as diverse clinical and neuropsychological symptoms are present. The pattern of neuropsychological functioning, which can be partially related to the neurophysiological findings, is discussed within the context of existing neuropsychological theories about autistic disorders.
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Affiliation(s)
- M von Aster
- Department of Child and Adolescent Psychiatry, University of Zurich, Switzerland
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43
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Kolmen BK, Feldman HM, Handen BL, Janosky JE. Naltrexone in young autistic children: replication study and learning measures. J Am Acad Child Adolesc Psychiatry 1997; 36:1570-8. [PMID: 9394942 DOI: 10.1016/s0890-8567(09)66567-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE This study expanded upon previous work on naltrexone efficacy and safety in young autistic children and assessed performance on learning measures. METHOD Eleven children with autistic disorder, aged 3.0 to 8.3 years, were studied in home, school, and outpatient laboratory, bringing to 24 the combined study sample. Naltrexone, 1.0 mg/kg, was given daily in a randomized, double-blind, crossover design. Dependent measures were parent and teacher Clinical Global Impressions (CGI) and Naltrexone Side Effects Rating Scale (SE), Conners Parent Impulsivity/Hyperactivity Factor, Teacher Hyperactivity Factor, laboratory CGI, and analysis of videotaped behavior. Learning measures were the Early Intervention Developmental Profile-Language and paired-associate learning. RESULTS Comparisons between naltrexone and baseline, but not naltrexone and placebo, on parent and teacher ratings showed statistical significance. Three of 11 subjects improved in two or more settings. Side effects were mild. Administering naltrexone was a challenge. The combined study sample showed improvement on all parent measures and on Teacher CGI and SE-Restlessness compared with baseline and placebo. Eleven of the 24 children improved in two or more settings. Scores on learning measures did not change across conditions. CONCLUSIONS Naltrexone was associated with modest improvement of behavior in 11 of 24 children, but learning did not improve.
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Affiliation(s)
- B K Kolmen
- Children's Hospital of Pittsburgh, PA, USA
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44
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Affiliation(s)
- I Rapin
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, N.Y. 10461, USA
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45
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Abstract
Social play behavior is one of the earliest forms of non-mother-directed social behavior appearing in ontogeny in mammalian species. During the last century, there has been a lot of debate on the significance of social play behavior, but behavioral studies have indicated that social play behavior is a separate and relevant category of behavior. The present review provides a comprehensive survey of studies on the neurobiology of social play behavior. Evidence is presented that opioid and dopamine systems play a role in the reward aspect of social play behavior. The role of cholinergic, noradrenergic and opioid systems in attentional processes underlying the generation of social play behavior and the involvement of androgens in the sexual differentiation of social play behavior in rats is summarized. It is concluded that there is not only behavioral, but also neurobiological evidence to suggest that social play behavior represents a separate category of behavior, instead of a precursor for adult social, sexual or aggressive behavior.
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Affiliation(s)
- L J Vanderschuren
- Department of Medical Pharmacology, Rudolf Magnus Institute for Neurosciences, Faculty of Medicine, Utrecht University, The Netherlands.
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46
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Abstract
We describe a 9-year-old boy who presented with abnormal development in language and social interaction. He also showed evidence of stereotyped behaviour, thus fulfilling all the criteria for an ICD-10 diagnosis of autism. This was associated with multiple pituitary deficiency. No case of autism associated with hypopituitarism has hitherto been reported. The authors discuss the evidence for linking the two conditions as opposed to accepting them as coincidental. In some studies of autism, anatomical and imaging studies have provided evidence of pathology in the limbic lobe. This lobe plays an essential role in the modification and expression of emotional reactions. Together with other areas, the limbic system sends outputs from the hypothalamus and from there to the pituitary. Our case illustrates a possible link between emotional expression and hypopituitarism.
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Affiliation(s)
- K Gingell
- Elms Health Centre, Cradley, West Midlands, UK
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47
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Affiliation(s)
- M H Lewis
- University of Florida, Health Science Center, Gainsville 32610-0156, USA
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Nir I, Meir D, Zilber N, Knobler H, Hadjez J, Lerner Y. Brief report: circadian melatonin, thyroid-stimulating hormone, prolactin, and cortisol levels in serum of young adults with autism. J Autism Dev Disord 1995; 25:641-54. [PMID: 8720032 DOI: 10.1007/bf02178193] [Citation(s) in RCA: 142] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
An abnormal circadian pattern of melatonin was found in a group of young adults with an extreme autism syndrome. Although not out of phase, the serum melatonin levels differed from normal in amplitude and mesor. Marginal changes in diurnal rhythms of serum TSH and possibly prolactin were also recorded. Subjects with seizures tended to have an abnormal pattern of melatonin correlated with EEG changes. In others, a parallel was evidenced between thyroid function and impairment in verbal communication. There appears to be a tendency for various types of neuroendocrinological abnormalities in autistics, and melatonin, as well as possibly TSH and perhaps prolactin, could serve as biochemical variables of the biological parameters of the disease.
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Affiliation(s)
- I Nir
- Eitanim Psychiatric Hospital, Jerusalem, Israel
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Sukhov RR, Walker LC, Rance NE, Price DL, Young WS. Opioid precursor gene expression in the human hypothalamus. J Comp Neurol 1995; 353:604-22. [PMID: 7759618 PMCID: PMC9853479 DOI: 10.1002/cne.903530410] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Using in situ hybridization histochemistry, we studied the distribution of neurons that express preproopiomelanocortin (pre-POMC), preprodynorphin (pre-PDYN), and preproenkephalin (pre-PENK) gene transcripts within the human hypothalamus and surrounding structures. Of the three opioid systems, pre-POMC neurons have the most restricted distribution. Pre-POMC cells are most numerous in the infundibular nucleus and retrochiasmatic area of the mediobasal hypothalamus; a few labeled cells are present within the boundaries of the ventromedial nucleus and infundibular stalk. Pre-POMC message was not found in the limited samples of structures adjacent to the hypothalamus. In contrast to neurons that express pre-POMC, neurons expressing pre-PDYN and pre-PENK are more widely represented throughout the hypothalamus and extrahypothalamic structures. However, pre-PDYN and pre-PENK cells differ from one another in distribution. Pre-PDYN message is especially abundant in neurons of the tuberal and mammillary regions, with a distinct population of labeled cells in the premammillary nucleus and dorsal posterior hypothalamus. Pre-PDYN gene expression also is found in neurons of the dorsomedial nucleus, ventromedial nucleus, caudal magnocellular portion of the paraventricular nucleus, dorsolateral supraoptic nucleus, tuberomammillary nucleus, caudal lateral hypothalamus, and retrochiasmatic area. In structures immediately adjacent to the hypothalamus, pre-PDYN neurons were observed in the caudate nucleus, putamen, cortical nucleus of the amygdala, and bed nucleus of the stria terminalis. Pre-PENK neurons occur in varying numbers in all hypothalamic nuclei except the mammillary bodies. The chiasmatic region is particularly rich in pre-PENK neurons, with the highest packing density in the intermediate nucleus [the intermediate nucleus (Braak and Braak [1987] Anat. Embryol. 176:315-330) has also been termed the sexually dimorphic nucleus of the preoptic area (SDA-POA; Swaab and Fliers [1985] Science 228:1112-1115) or the interstitial nucleus of the anterior hypothalamus 1 (Allen et al. [1989] J. Neurosci. 9:497-506)], dorsal suprachiasmatic nucleus, medial preoptic area, and rostral lateral hypothalamic area. Pre-PENK neurons are numerous in the infundibular nucleus, ventromedial nucleus, dorsomedial nucleus, caudal parvicellular portion of the paraventricular nucleus, tuberomammillary nucleus, lateral hypothalamus, and retrochiasmatic area. Only a few lightly labeled cells were found in the periphery of the supraoptic nucleus and lateral tuberal nucleus. In areas adjacent to the hypothalamus, cells that contain pre-PENK message occur in the nucleus basalis of Meynert, central nucleus of amygdala, bed nucleus of the stria terminalis, caudate nucleus, and putamen.(ABSTRACT TRUNCATED AT 400 WORDS)
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Affiliation(s)
- R R Sukhov
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205-2196, USA
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50
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Gillberg C. Endogenous opioids and opiate antagonists in autism: brief review of empirical findings and implications for clinicians. Dev Med Child Neurol 1995; 37:239-45. [PMID: 7890130 DOI: 10.1111/j.1469-8749.1995.tb11998.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Endogenous opioid dysfunction hypotheses for the development of autism are reviewed, along with clinical empirical studies of opiate antagonists in autism and self-injurious behaviour. There is not yet sufficient evidence to suggest the use of opiate antagonists in the treatment of autism. Further research, particularly of natrexone in severe self-injury, is warranted.
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Affiliation(s)
- C Gillberg
- Department of Child and Adolescent Psychiatry, University of Göteborg, Annedals Clinics, Sweden
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