Autism spectrum disorders

Prevalence of autism spectrum disorder among children in Southeast Asia from 2002 to 2022: An updated systematic review and meta-analysis

Background and Aims

Autism spectrum disorder (ASD) is a neurodevelopmental condition that impacts the brain, characterized by challenges in social communication and interaction, often accompanied by repetitive behaviors or focused interests. This study sheds light on the prevalence of ASD within the Southeast Asian region.

Methods

The study protocol was registered in PROSPERO (Registration No: CRD42023413915). Appropriate search terms and Boolean operators were employed to explore electronic databases for relevant articles. Data thus extracted were prepared in Excel and analyzed in Comprehensive Meta-Analysis Software. The effect measure utilized in the study was represented by the proportion, and the choice between a fixed or random-effect model depended on the observed heterogeneity. Visual feedback was provided through the use of forest plots and funnel plots.

Results

A total of 14 studies were included in the qualitative and quantitative synthesis after screening the imported studies. The prevalence of ASD was six per 1000 population (proportion: 0.006; CI: 0.002-0.017; I 2: 99.263%). Among the ASD cases, 64.4% (proportion: 0.644; CI: 0.590-0.693; I 2: 9.937%) were males and 35.6% (proportion: 0.356; CI: 0.307-0.410; I 2: 9.937%) were females.

Conclusion

The prevalence of ASD in Southeast Asia was estimated to be six cases per 1000 individuals, with a higher prevalence among males. This study contributes to our understanding of ASD prevalence in the region, although it is essential to note certain limitations in estimating prevalence.

Changes in Anxiety following Taste Education Intervention: Fussy Eating Children with and without Neurodevelopmental Disorders

Despite the surge in studies on fussy eating in recent years, anxiety as an associated factor is generally not considered, even though children with fussy eating and those with neurodevelopmental disorders, including Autism Spectrum Disorder or Attention Deficit/Hyperactivity Disorder (ADHD) often have higher levels of anxiety than typically developing children. The current study investigated changes in anxiety scores during a Taste Education intervention, a seven-week school-based intervention for 71 children with fussy eating. Comparisons were made based on neurodevelopmental status (between children with (n = 30) and without (n = 41) neurodevelopmental disorders). Participants were paired based on age, sex, and neurodevelopmental disorder. The Multidimensional Anxiety Scale for Children (MASC) was administered at delayed intervention (for those waiting 7 weeks before starting the intervention), pre-intervention, post-intervention, and at six-month follow-up. Results did not indicate elevated anxiety based on mean MASC T-scores. MASC Total T-scores ranged from slightly elevated to average, decreasing significantly between pre-intervention and post-intervention, plateauing at six-month follow-up. Significant reductions between measurement points were seen for the physical symptoms, social anxiety, and separation anxiety subscales, but not for harm avoidance. Repeated measures analysis of variance with neurodevelopmental disorders as between-subjects factors did not reveal a significant interaction effect between neurodevelopmental disorders and changes in MASC Total score or subscales. The results indicated that our food-based intervention did not elevate MASC scores in fussy eating children, with or without neurodevelopmental disorders.

Body Composition in Fussy-Eating Children, with and without Neurodevelopmental Disorders, and Their Parents, Following a Taste Education Intervention

Fussy eaters may have an increased risk of becoming overweight or obese as adolescents, with fussy eating and weight status also correlating with neurodevelopmental disorders (NDs) such as autism spectrum disorder (ASD) and attention deficit/hyperactivity disorder (ADHD). Further, maternal and children's weight status relationships are well-established. In this study, we analyzed the body composition of parent-child dyads using bioelectrical impedance analysis (BIA). Fifty-one children aged 8-12 years, with an ND (n = 18) and without (n = 33), and their parents, participated in a 7-week food-based Taste Education intervention with 6-month follow-up. The paired t-test was used to compare differences in body composition based on children's ND status. In logistic regression analysis, odds of children being in the overweight/obese or overfat/obese categories increased by a factor of 9.1 and 10.6, respectively, when having NDs, adjusting for parents' BMI (body mass index) or fat percentage (FAT%). Children with NDs and their parents had significantly higher mean BMI-SDS (BMI standard deviation score) and FAT% at pre-intervention than children without NDs and their parents. Mean BMI-SDS and FAT% lowered significantly between time points for children with NDs and their parents but not for children without NDs or their parents. The findings underline the need for additional exploration into the relationships between children's and parents' body composition based on children's ND status.

Parent Perception of Child's Behavior during the Initial Dental Visit among Children with Autism Spectrum Disorder: A Cross Sectional Study

(1) Background: The purpose of this study was to evaluate parent perception of behavior and level of cooperation to determine the success of a dental appointment with a child with autism spectrum disorder (ASD). (2) Methods: pre-treatment form, task analysis (TAS), and Frankl scale scores were extracted from patient charts. Values were calculated for patient demographics and other health characteristics (N = 235). Regression models were constructed to examine the success level during the first dental appointment (measured by TAS and Frankl scores) by several factors. (3) Results: The model to test patient characteristics: age, gender, ethnicity, and verbal communication, Hispanic ethnicity significantly predicted the TAS score, F (4, 191) = 2.45, p = 0.03 [95% CI -17.18, -3.53], and age significantly predicted the Frankl score, F (4, 194) = 5.17, p = 0.00 [95% CI 0.04, 0.12]. There was a significant association between parent perception of behavior and Frankl scores, F (2, 202) = 7.68, p = 0.00 [ 95% CI -0.11, -0.02]. (4) Conclusion: The results indicate that ethnicity and age play a role in successful outcomes during the dental appointment. Additionally, parent perception of their child's behavior significantly predicted the Frankl score, thus coordinating with parents during the dental appointment can be a key factor in treatment planning for productive dental visits.

Children on the Autism Spectrum and the Use of Virtual Reality for Supporting Social Skills

Background: Autism spectrum disorders (ASDs) are characterized by differences in socio-pragmatic communication. These conditions are allocated within a “spectrum” of phenotypic variability. Virtual reality (VR) is a useful tool for healthcare intervention and particularly safely advancing social abilities in children with ASD. Methods: In our study two types of intervention for improving social skills were compared: (i) emotional training obtained by the use of virtual reality (Gr1), (ii) traditional emotional training performed individually with a therapist (Gr2). We aimed to identify the intervention with the shortest acquisition time for the proposed social tasks. Results: Our findings show that both types of intervention had the same acquisition time for the recognition of primary emotions. However, for the use of primary and secondary emotions, the group using VR showed shorter acquisition times. Conclusions: These findings together with previous preliminary datasuggest that VR can be a promising, dynamic and effective practice for the support of basic and complex social skills of these individuals.

Odds of fussy eating are greater among children with obesity and anxiety

BACKGROUND

Fussy eating has been associated with autism spectrum disorder (ASD), attention-deficit/hyperactive disorder (ADHD), anxiety, and depression. Despite these disorders being prevalent in obesity treatment, no studies have been published on the association of fussy eating in children with obesity and these disorders. Understanding fussy eating in children with obesity and comorbid disorders is important as acceptance of healthy foods tends to be low, especially in children with sensory sensitivities.

OBJECTIVES

Investigate the prevalence of fussy eating in a cross-sectional sample of children with obesity and ASD, ADHD, anxiety, and depression; and whether they were more likely to be fussy eaters, comparing those with and without these disorders.

METHODS

One hundred and four children referred to family-based obesity treatment in Iceland 2011-2016, mean age 12.0 (SD = 3.0), mean body mass index standard deviation score 3.5 (SD = 0.9). Binary logistic regression was used to estimate the relationship between fussy eating and disorders, adjusting for medication use.

RESULTS

A large minority (41.6%) were fussy eaters and 48.9% had at least one comorbid disorder. Over a third of children rejected bitter and sour tastes, and 1.9% and 7.9% rejected sweet and salty tastes, respectively. Compared with those without disorders, the odds of being a fussy eater were increased by a factor of 4.11 when having anxiety (95% confidence intervals) (1.02-16.58, p = 00.046), adjusting for medication use. The odds of being a fussy eater were not increased for other disorders; ASD, ADHD, or depression.

CONCLUSIONS

In children attending obesity treatment, fussy eating was common. Clinical care models in pediatric obesity treatment should address fussy eating, especially in children with anxiety.

A CNN Deep Local and Global ASD Classification Approach with Continuous Wavelet Transform Using Task-Based FMRI

Autism spectrum disorder (ASD) is a neurodegenerative disorder characterized by lingual and social disabilities. The autism diagnostic observation schedule is the current gold standard for ASD diagnosis. Developing objective computer aided technologies for ASD diagnosis with the utilization of brain imaging modalities and machine learning is one of main tracks in current studies to understand autism. Task-based fMRI demonstrates the functional activation in the brain by measuring blood oxygen level-dependent (BOLD) variations in response to certain tasks. It is believed to hold discriminant features for autism. A novel computer aided diagnosis (CAD) framework is proposed to classify 50 ASD and 50 typically developed toddlers with the adoption of CNN deep networks. The CAD system includes both local and global diagnosis in a response to speech task. Spatial dimensionality reduction with region of interest selection and clustering has been utilized. In addition, the proposed framework performs discriminant feature extraction with continuous wavelet transform. Local diagnosis on cingulate gyri, superior temporal gyrus, primary auditory cortex and angular gyrus achieves accuracies ranging between 71% and 80% with a four-fold cross validation technique. The fused global diagnosis achieves an accuracy of 86% with 82% sensitivity, 92% specificity. A brain map indicating ASD severity level for each brain area is created, which contributes to personalized diagnosis and treatment plans.

Taste education - A food-based intervention in a school setting, focusing on children with and without neurodevelopmental disorders and their families. A randomized controlled trial

Children with neurodevelopmental disorders (ND) such as Autism Spectrum Disorder (ASD) and Attention-Deficit/Hyperactive Disorder (ADHD) have high levels of fussy eating. However, no school-based food interventions exist for children with ASD and ADHD. To investigate the effect of Taste Education, 81 children with ND (n = 33), and without (n = 48), aged 8-12 years, and their parents, participated in a 7-week food intervention. Children were matched on age, ND, and sex, and randomized into Immediate-intervention and Delayed-intervention groups. Parents completed the Children's Eating Behaviour Questionnaire (CEBQ), and a food-variety questionnaire. After adjusting for baseline measures, repeated-measures analysis-of-variance with time-points, and condition as factors (Immediate intervention and Delayed intervention) were used to examine changes in CEBQ-scores, with a robust linear mixed-model fitted. Changes in percentage of accepted foods were tested using a logistic-regression model adjusting for baseline acceptance. Results showed superior results for Intervention compared to waiting, on Food fussiness, but not Enjoyment of food, with stable effects through six-months follow-up. There were non-significant differences between children with and without ND. Results also showed increased odds of accepting vegetables by a factor of 1.6 (95% Confidence Interval [CI]: 1.33-1.93, p < .001); nuts and seeds by a factor of 1.4 (95% CI: 1.27-1.6, p < .001), but no significant association for fruit (OR 1.12, 95% CI: 0.92-1.34, p = .244). Trends were similar for children regardless of ND-status. The Taste Education program, shows promise, as a simple, non-invasive way to decrease fussy eating and increase food variety in the long-term.

Genodermatoses with behavioural sequelae

Children with genodermatoses are at an increased risk of developing behavioural disorders which may impart lasting damage on the individual and their family members. As such, early recognition of childhood mental health disorders via meticulous history taking, thorough physical examination, and disorder-specific testing is of paramount importance for timely and effective intervention. If carried out properly, prompt psychiatric screening and intervention can effectively mitigate, prevent or even reverse, the psychiatric sequela in question. To that end, this review aims to inform the concerned physician of the manifestations and treatment strategies relevant to the psychological sequelae of genodermatoses.

A Pilot Randomised Control Trial of Digitally-Mediated Social Stories for Children on the Autism Spectrum

Social stories is a widely used intervention for children on the autism spectrum, particularly within an educational context. To date, systematic reviews and meta analyses of the research evaluating social stories has produced mixed results, often due to a lack of methodological rigour and variability in the development and delivery of the social stories. To address the gap in methodological rigour, a pilot Randomised Control Trial (RCT) was conducted, incorporating a social stories intervention group (n = 9 children on the autism spectrum) and an attentional control group who received a poem (n = 6 children on the autism spectrum) using a digital platform to address variability. Digitally-mediated social stories were found to be effective in producing beneficial changes in behaviour outcomes, which were sustained at a six-week follow up.

Association of Allelic Variants of the Reelin Gene with Autistic Spectrum Disorder: A Systematic Review and Meta-Analysis of Candidate Gene Association Studies

Autistic spectrum disorder (ASD) is a complex neurodevelopmental disability with a genetic basis, and several studies have suggested a potential role of the reelin gene (RELN) in ASD susceptibility. Accordingly, genetic association studies have explored this potential association, but the results have been controversial thus far. For this reason, we assessed the association of four genetic variants of RELN (the 5′UTR CGG triplet repeat and polymorphisms rs736707, rs362691, and rs2229864) with ASD by means of a systematic review and meta-analysis. We retrieved studies comparing the distribution of the above-mentioned genetic variants between ASD patients and healthy controls. A meta-analysis was conducted using a random effects model, and calculations of the odds ratios (ORs) and confidence intervals (CIs) were performed. A sensitivity analysis and tests to determine the heterogeneity of the results were also performed. Eleven previous studies fulfilled the inclusion criteria and analyzed the association of the above-mentioned genetic variants and ASD. We did not find any significant association between the allele or genotype frequencies of the analyzed polymorphisms and ASD, and large heterogeneity was found for the rs736707 polymorphism. Moreover, no significant differences were found between the 5′UTR triplet repeat and this disorder. In light of current evidence, no single genetic variant within this gene is clearly associated with the development of ASD, and ethnic differences may explain part of the observed heterogeneity. Larger studies among different ethnic groups are needed to establish the role of specific genetic variants within RELN in the etiology of this disorder.

Association of sensory sensitivities and toothbrushing cooperation in autism spectrum disorder

BACKGROUND

Sensory over-responsivity (SOR) is common in autistic spectrum disorder (ASD), and it leads to a more intense response to sensory stimuli.

AIM

To compare toothbrushing cooperation at home and in a dental office between SOR and sensory not over-responsivity (SNOR) children with ASD.

DESIGN

This cross-sectional observational study was conducted with 51 children with ASD aged 4-17 years. Caregivers assessed each subject's sensory response by completing a back-translation questionnaire listing eight sensitivities. Subjects who had three or more of the sensitivities were considered SOR subjects. Toothbrushing cooperation in the dental office was recorded on videos. Statistical analysis used the Spearman correlation coefficient, chi-square test, Fisher's exact test, and Mann-Whitney U test.

RESULTS

SNOR subjects (n = 10) had significantly higher scores in toothbrushing cooperation at home and in the dental office than did SOR subjects (n = 41) (P < .05). Oral sensitivity was significantly associated with toothbrushing cooperation at home, whereas oral, light, sound, and touch (face) sensitivities were significantly correlated with toothbrushing cooperation in the dental office (P < .05).

CONCLUSIONS

SOR subjects showed less toothbrushing cooperation than SNOR subjects both at home and in the dental office.

Prevalence of autism spectrum disorder in Asia: A systematic review and meta-analysis

There has been an increased prevalence of the diagnosis of Autism Spectrum Disorder (ASD) globally during the last decade. An updated and overall estimate of ASD prevalence in Asia would assist health professionals to develop relevant public health strategies. We performed a systematic review by searching English databases (Medline, Embase, Web of Science, and Cochran Library) from inception date to August 6, 2018. Subgroup, sensitivity, and meta-regression analyses were performed to address heterogeneity. Publication bias was evaluated using Egger's test. A total of 2,195,497 subjects in Asia from 12 eligible studies were included in this meta-analysis. The pooled estimate of ASD prevalence among the included subjects was 0.36% (95% CI: 0.16-0.79%). The pooled ASD prevalence in males (0.45%, 95% CI: 0.19-1.04%) was higher than that in females (0.18%, 95% CI: 0.079-0.49%). ASD prevalence in East Asia, South Asia, and West Asia was 0.51% (95% CI: 0.06-4.22%), 0.31% (95% CI: 0.14-0.65%), and 0.35% (95% CI: 0.07-1.80%) respectively. The prevalence of ASD is increasing in Asia. Universal and standardized diagnostic processes for ASD should be adopted for the prevention and control programs of ASD in future.

Epilepsy and Autism Spectrum Disorder: An Epidemiological Study in Shanghai, China

Autism spectrum disorder (ASD) is a neurodevelopmental disease that may involve various brain abnormalities. However, there are few large epidemiological studies on the relation between epilepsy and ASD in terms of different genders and ages. This study aimed to evaluate the relation between epilepsy and ASD based on 74,251 Chinese children aged 3-12 years who were recruited from kindergartens and primary schools in China. ASD was diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-V), and verification of epilepsy was based on medical records. The enrolled children diagnosed with ASD were examined by magnetic resonance imaging (MRI) and took genetic tests to rule out other neurological and congenital diseases. The raw odds ratio (OR) was 60.53 [95% confidence interval (CI) = 37.80-96.92, P < 0.01] for epilepsy and ASD, and the adjusted OR was 38.99 (95% CI = 20.70-73.41, P < 0.01) after controlling for the confounders. Moreover, the adjusted OR was significantly higher in girls (OR = 45.26, 95% CI = 16.42-124.76, P < 0.01) than in boys (OR = 32.64, 95% CI = 14.33-74.34, P < 0.01). Among children with younger age, the adjusted OR was the highest (OR = 75.12, 95% CI = 22.80-247.48.16, P < 0.01). These findings suggest that epilepsy might be closely linked to the development of ASD, especially for early-onset epilepsy and among girls.

Staff awareness training: improving knowledge and confidence of autism spectrum disorders and intellectual disabilities in a locked rehabilitation unit

Purpose

The purpose of this paper is to present a training package which was delivered to improve staff members’ knowledge and confidence of autism spectrum disorders (ASD) and intellectual disabilities (ID).

Design/methodology/approach

The training was facilitated in a locked rehabilitation unit for adult males, many of whom had diagnoses of ASD and/or ID. With all staff receiving an invite, 25 attended which was the majority of the staff team. This included staff from housekeeping, nursing and catering.

Findings

To evaluate the effectiveness of the training, a survey and short assessment was administered before and after training. This revealed an improvement in both perceived knowledge and confidence of ASD and ID, as well as actual knowledge. Follow-up interviews also revealed some evidence of sustained learning and practice changes.

Research limitations/implications

Based on these findings, it is recommended that further face-to-face training is delivered at this locked rehabilitation unit to further improve professional practice.

Originality/value

This paper provides value to other inpatient settings as it highlights to practitioners how face-to-face training can significantly improve staff members knowledge and confidence of developmental disorders.

Black South African caregivers’ understanding and responses to their children with autism spectrum disorder symptoms: a qualitative study

The purpose of this study was to investigate Black South African caregivers’ understanding and approaches to securing a cure for their children with autistic spectrum disorder symptoms. Qualitative data were collected focusing on exploring caregivers’ narratives. A purposive sampling technique was used to draw study participants who were of Black South African background and had a child with a diagnosis of an autistic spectrum disorder. Thematic analysis was used to analyse the data collected and to give analytical meaning to the narratives. The results yielded four dominant themes regarding the level of caregivers’ understanding of autistic spectrum disorder and the options they followed in searching for the cure of their children’s illness. The study drew attention to the feelings of frustration experienced by caregivers in their discovery that the use of both indigenous and Western approaches to autistic spectrum disorder symptoms yielded little benefits. Given these findings, a number of recommendations were made to improve policy and practice in the mental health treatment of children with autistic spectrum disorder symptoms among Black South African clients.

Parenting African American Children With Autism: The Influence of Respect and Faith in Mother, Father, Single-, and Two-Parent Care

PURPOSE

Parents are the most significant contributor to care of children with autism spectrum disorder (ASD), and as such research on African American parenting in ASD is conspicuously absent. Findings relevant to parenting are discussed from a study with urban African American families caring for children with ASD.

DESIGN

An ethnonursing study was conducted with 24 African American family members of children with ASD and 28 professionals. Data were analyzed and reported as themes.

FINDINGS

Two universal themes of were found of respect and faith in God and family that influenced parental care. Two diverse themes of mother's watchful care and father's protective care, along with differences in feelings of isolation and dependence on supports were found among single- and two-parent families. Discussion and Practice Implications: When health care professionals increase their knowledge and understanding of cultural practices in the parental care of children with ASD, they provide health care that is culturally congruent.

African American families on autism diagnosis and treatment: the influence of culture

Cultural factors such as health care access and autism spectrum disorder (ASD) symptom interpretations have been proposed as impacting delayed diagnosis and treatment for African American children with ASD. A qualitative study of urban African American families caring for their child with autism was conducted with 24 family members and 28 ASD professionals. Cultural caring meant families protected their child from harm including potential or actual distrustful encounters, and took action for their child and community to optimize their child's health and address the knowledge deficits of ASD within their community. Families and professionals believed cultural influences delayed families' receiving and seeking appropriate health care for the African American child with ASD affecting timely autism diagnosis and treatment.

Translating Research to Practice for Children With Autism Spectrum Disorder: Part I: Definition, Associated Behaviors, Prevalence, Diagnostic Process, and Interventions

INTRODUCTION

The number of children with autism spectrum disorder (ASD) is rising, along with the potential for challenging behaviors during health care encounters.

METHOD

We present an overview of the emerging science related to ASD diagnosis and interventions for children with ASD.

RESULTS

Emerging science on ASD reveals common associated challenging behaviors, increasing prevalence, emphasis on early diagnosis at 18 to 24 months of age, changes in the diagnostic process with criteria from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, and interventions with medication, education, and behavior management.

DISCUSSION

Family and health care provider preparation strategies facilitate care of children with ASD and their families. Early diagnosis at 18 to 24 months of age and evidence-based interventions contribute to best outcomes for children and families. Health care providers must be aware of the state of the science for diagnosis and best practices to provide family-centered care for this growing population.

Controlling false discoveries in high-dimensional situations: boosting with stability selection

BACKGROUND

Modern biotechnologies often result in high-dimensional data sets with many more variables than observations (n≪p). These data sets pose new challenges to statistical analysis: Variable selection becomes one of the most important tasks in this setting. Similar challenges arise if in modern data sets from observational studies, e.g., in ecology, where flexible, non-linear models are fitted to high-dimensional data. We assess the recently proposed flexible framework for variable selection called stability selection. By the use of resampling procedures, stability selection adds a finite sample error control to high-dimensional variable selection procedures such as Lasso or boosting. We consider the combination of boosting and stability selection and present results from a detailed simulation study that provide insights into the usefulness of this combination. The interpretation of the used error bounds is elaborated and insights for practical data analysis are given.

RESULTS

Stability selection with boosting was able to detect influential predictors in high-dimensional settings while controlling the given error bound in various simulation scenarios. The dependence on various parameters such as the sample size, the number of truly influential variables or tuning parameters of the algorithm was investigated. The results were applied to investigate phenotype measurements in patients with autism spectrum disorders using a log-linear interaction model which was fitted by boosting. Stability selection identified five differentially expressed amino acid pathways.

CONCLUSION

Stability selection is implemented in the freely available R package stabs (http://CRAN.R-project.org/package=stabs). It proved to work well in high-dimensional settings with more predictors than observations for both, linear and additive models. The original version of stability selection, which controls the per-family error rate, is quite conservative, though, this is much less the case for its improvement, complementary pairs stability selection. Nevertheless, care should be taken to appropriately specify the error bound.

Educational and therapeutic behavioral approaches to providing dental care for patients with Autism Spectrum Disorder

PURPOSE

Autism Spectrum Disorder (ASD) is a condition which most dentists will encounter in their practices. Contemporary educational and behavioral approaches may facilitate successful dental care.

METHODS

A literature review was conducted for relevant information on dental care for children with ASD.

RESULTS

Educational principles used for children with ASD can be applied in the dental setting. Examples include: parent involvement in identifying strengths, sensitivities, and goal setting; using stories or video modeling in advance of the appointment; dividing dental treatment into sequential components; and modification of the environment to minimize sensory triggers. Patients with ASD are more capable of tolerating procedures that they are familiar with, and therefore should be exposed to new environments and stimuli in small incremental steps.

CONCLUSIONS

By taking time to understand children with ASD as individuals and employing principles of learning, clinicians can provide high quality dental care for the majority of patients with ASD.

A study exploring knowledge, attitudes and behaviours towards autism among adults applying to a Family Health Center in Istanbul

OBJECTIVE:

The aim of this study was to assess knowledge, awareness, behavior and attitudes towards autism among applicants to a Family Health Center (FHC).

METHODS:

This descriptive study was performed at a Family Health Center (FHC) in Istanbul in August 2013. Data was obtained via face-to-face interviews with participants older than 18 years who were admitted to the FHC. The questionnaire consisted of questions on sociodemographic characteristics, applicants’ knowledge of autism and their approach to autism.

RESULTS:

160 applicants participated in our survey of which 38.8% had heard the word ‘autism’. Knowledge and awareness of autism, and attitudes and behaviours towards this disorder differed significantly with the educational level of the study participants (p<0.05) However, these parameters did not change with gender and income level of the participants (p>0.05).

CONCLUSION:

The most important outcome of our study is that awareness, or even having knowledge of the word autism is significant in breaking down stereotypes. Despite the low level of awareness of the disease, the majority of the participitants had a positive attitude towards autism.

Enhancement of Short-Term Memory by Methyl-6-(Phenylethynyl)-Pyridine in the BTBR T+tf/J Mouse Model of Autism Spectrum Disorder

BACKGROUND

Autism spectrum disorder (ASD) encompasses a range of disorders that are characterized by social and communication deficits and repetitive behaviors. This study evaluated the effect of methyl-6-(phenylethynyl)-pyridine (MPEP), an antagonist of the mGluR5 metabotropic glutamate receptor, on memory enhancement in the BTBR T+tf/J (BTBR) mouse strain, which has been recognized as a model of ASD.

METHODS

The pharmacological effects of MPEP on memory and motor coordination were assessed using the Morris water maze and rotarod tests in BTBR and C57BL/6J (B6) mice. Furthermore, we performed morphological analyses of cerebellar foliation in BTBR and B6 mice using hematoxylin and eosin staining.

RESULTS

MPEP-treated BTBR mice exhibited improved learning and memory in the Morris water maze test. MPEP administration also improved motor coordination in the rotarod test. However, no significant difference was observed regarding the numbers of Purkinje cells in the cerebella of BTBR versus normal B6 mice.

CONCLUSION

This study suggests that the mGluR5 antagonist MPEP has the potential to ameliorate learning and memory dysfunction and impaired motor coordination in BTBR mice. These results further suggest that the BTBR mouse model may be useful in pharmacological studies investigating drugs that could potentially alleviate cognitive dysfunction in ASD.

Association of genetic variants of GRIN2B with autism

Autism (MIM 209850) is a complex neurodevelopmental disorder characterized by social communication impairments and restricted repetitive behaviors. It has a high heritability, although much remains unclear. To evaluate genetic variants of GRIN2B in autism etiology, we performed a system association study of common and rare variants of GRIN2B and autism in cohorts from a Chinese population, involving a total sample of 1,945 subjects. Meta-analysis of a triad family cohort and a case-control cohort identified significant associations of multiple common variants and autism risk (Pmin = 1.73 × 10(-4)). Significantly, the haplotype involved with the top common variants also showed significant association (P = 1.78 × 10(-6)). Sanger sequencing of 275 probands from a triad cohort identified several variants in coding regions, including four common variants and seven rare variants. Two of the common coding variants were located in the autism-related linkage disequilibrium (LD) block, and both were significantly associated with autism (P < 9 × 10(-3)) using an independent control cohort. Burden analysis and case-only analysis of rare coding variants identified by Sanger sequencing did not find this association. Our study for the first time reveals that common variants and related haplotypes of GRIN2B are associated with autism risk.

Perinatal programming of neurodevelopment: epigenetic mechanisms and the prenatal shaping of the brain

The recent years have witnessed an exponential growth in the knowledge of epigenetic mechanisms, and piling evidence now links DNA methylation and histone modifications with a wide range of physiological processes from embryonic development to memory formation and behavior. Not surprisingly, deregulation of epigenetic modifications is associated with human diseases as well.An important feature of epigenetics is the ability of transducing environmental input into biological signaling, mainly by modulation of the transcriptome in response to a particular scenario. This characteristic generates developmental plasticity and allows the manifestation of a variety of phenotypes from the same genome.The early-life years represent a period of particular susceptibility to epigenetic alteration, as active changes in DNA methylation and histone marks are occurring as part of developmental programs and in response to environmental cues, which notably include psychosocial stimulation and maternal behavior. Memory formation and storage, response to stress in adult life, behavior, and manifestation of neurodegenerative conditions can all be imprinted in the organism by epigenetic modifications that contribute to shape the brain during prenatal or early postnatal life. Moreover, if these epigenetic alterations are preserved in the germ line, changes induced in one generation are likely inherited by future offspring. Programming by transgenerational inheritance thus represents a central mechanism by which environmental conditions may influence disease risk across multiple generations.As novel techniques emerge and as genome-wide profiling of disease-associated methylomes is achieved, epigenetic marks open a new source for biomarker discovery.

Environmental chemical exposures and autism spectrum disorders: a review of the epidemiological evidence

In the past decade, the number of epidemiological publications addressing environmental chemical exposures and autism has grown tremendously. These studies are important because it is now understood that environmental factors play a larger role in causing autism than previously thought and because they address modifiable risk factors that may open up avenues for the primary prevention of the disability associated with autism. In this review, we covered studies of autism and estimates of exposure to tobacco, air pollutants, volatile organic compounds and solvents, metals (from air, occupation, diet, dental amalgams, and thimerosal-containing vaccines), pesticides, and organic endocrine-disrupting compounds such as flame retardants, non-stick chemicals, phthalates, and bisphenol A. We included studies that had individual-level data on autism, exposure measures pertaining to pregnancy or the 1st year of life, valid comparison groups, control for confounders, and adequate sample sizes. Despite the inherent error in the measurement of many of these environmental exposures, which is likely to attenuate observed associations, some environmental exposures showed associations with autism, especially traffic-related air pollutants, some metals, and several pesticides, with suggestive trends for some volatile organic compounds (e.g., methylene chloride, trichloroethylene, and styrene) and phthalates. Whether any of these play a causal role requires further study. Given the limited scope of these publications, other environmental chemicals cannot be ruled out, but have not yet been adequately studied. Future research that addresses these and additional environmental chemicals, including their most common routes of exposures, with accurate exposure measurement pertaining to several developmental windows, is essential to guide efforts for the prevention of the neurodevelopmental damage that manifests in autism symptoms.

Use of restrictive interventions in a child and adolescent inpatient unit - predictors of use and effect on patient outcomes

OBJECTIVES

Restrictive interventions (seclusion, physical restraint, and use of acute/p.r.n. sedation) may have negative effects on patients. Identifying factors associated with use of restrictive interventions and examining their effect on admission outcomes is important for optimising inpatient psychiatric care.

METHODS

This study documented use of restrictive interventions within a child and adolescent psychiatric inpatient unit for 15 months. Two models examined predictors of use of restrictive interventions: (i) incident characteristics; and (ii) patient characteristics. The relationship between use of restrictive interventions and global clinical outcomes was also examined.

RESULTS

Of 134 patients admitted during the study period (61.9% female, mean age=13.8±2.9 years), 26.9% received at least one restrictive intervention. Incident factors associated with restrictive interventions were: physical aggression, early admission stage, and occurrence in private space. Patient factors that predicted use of restrictive interventions were developmental disorder and younger age. Use of restrictive interventions was not associated with increased length of stay or diminished improvement in global symptom ratings.

CONCLUSIONS

Further research is needed to identify best practice in children at high risk for receiving restrictive interventions.

Autism spectrum disorders: an update on oral health management

Dental professionals caring for patients with a diagnosis of autism spectrum disorder (ASD) will need to provide oral health care based on a family-centered approach that involves a comprehensive understanding of parental concerns and preferences, as well as the unique medical management, behaviors, and needs of the individual patient.

BACKGROUND

With the rising prevalence of autism spectrum disorders (ASD), oral health providers will find themselves increasingly likely to care for these patients in their daily practice. The purpose of this article is to provide a comprehensive update on the medical and oral health management of patients with autism spectrum disorders.

METHODS

The authors conducted a literature review by searching for relevant articles written in English in the PubMed database pertaining to the medical and oral health management of autism, including caries status, preventive, behavioral, trauma, and restorative considerations.

CONCLUSIONS

A detailed family centered approach based on parental preferences and concerns, the patient's challenging behaviors, and related comorbidities can serve to improve the treatment planning and oral health management of dental patients with ASD.

Increasing prevalence, changes in diagnostic criteria, and nutritional risk factors for autism spectrum disorders

The frequency of autism spectrum disorders (ASD) diagnoses has been increasing for decades, but researchers cannot agree on whether the trend is a result of increased awareness, improved detection, expanding definition, or an actual increase in incidence or a combination of these factors. Though both genetic and multiple environmental risk factors have been studied extensively, many potentially modifiable risk factors including nutritional and immune function related risk factors such as vitamin D, folic acid, and metabolic syndrome have not received sufficient attention. Several recent studies have put forward hypotheses to explain the mechanism of association between both folic acid and vitamin D and autism. A continuous rise in the prevalence of autism in the USA has coincided with a significant enhancement of maternal folate status with FDA mandated folic acid fortification of certain foods starting in 1998. There is also a growing body of research that suggests that vitamin D status either in utero or early in life may be a risk for autism. In this communication, controversies regarding increase in estimate of prevalence, implications of changes in definition, and possible association between some modifiable nutritional risk factors such as folic acid and vitamin D and ASD will be discussed.

Predictors of sustainable work participation of young adults with developmental disorders

For individuals with autism spectrum disorders (ASD) and attention deficit hyperactivity disorder (ADHD) work participation is a challenge, as shown by their low employment rates. The aim of this study was to investigate which factors predict work participation, finding work as well as maintaining employment, of young adults with ASD as well as ADD. We obtained data on 563 individuals with ASD and/or ADD, aged 15-27 years. The follow-up period ranged from 1.25 to 2.75 years. Being male (for ADD), living independently (for ASD), expecting to be able to work fulltime (for ASD and ADD), high perceived support from parents and perceived positive attitude of parents regarding work (for ASD and ADD) and perceived positive attitude of social environment (for ADD) predicted finding work by the young adult, while being male (for ADD) and higher age (for ASD and ADD) and positive attitude of social environment regarding work (for ASD) predicted maintaining employment. Both personal and social factors predict work outcome and should be taken into account when supporting individuals with DD in their transition to work.

Prevalence of autism spectrum disorders among children in China: a systematic review

BACKGROUND

There are no reliable estimates of the prevalences of autism and autism spectrum disorders (ASD) in China.

OBJECTIVE

Combine results across studies to estimate the prevalences of autism and ASD among Chinese children under the age of 18, and assess variations in the prevalences with respect to gender, ethnicity, and urban versus rural residence.

METHODS

Based on pre-defined inclusion and exclusion criteria, studies were identified by searching the following databases: Chinese National Knowledge Infrastructure, Chongqing VIP database for Chinese Technical Periodicals, WANFANG DATA, Chinese Biological Medical Literature Database, Pubmed, and Web of Science. Statistical analysis was conducted using R-2.15.2 software.

RESULTS

The 24 studies meeting inclusion criteria included 5 registry studies from Taiwan and Hong Kong (covering a total of 14570 369 children) and 19 community-based screening and diagnostic studies from mainland China (with a combined sample of 771 413 children). The annually reported prevalence of autism in the registry studies ranged from 1.8 to 424.6 per 10 000. A meta-analysis of 18 of the studies from mainland China (excluding a large nationwide study with the lowest prevalence of autism) with a range in rates from 2.8 to 30.4 per 10 000 generated an estimated pooled prevalence of autism of 12.8 per 10 000 (95%CI, 9.4 to 17.5). The pooled prevalence of ASD estimated from 5 of these studies (which had a range in rates from 7.3 to 75.3 per 10 000) was 24.5 per 10000 (95%CI, 10.4 to 57.4). The reported prevalence of autism varied substantially by gender, location of residence, date of publication, and source of the sample.

CONCLUSION

The huge difference between the rates for autism reported from registry systems in Hong Kong and Taiwan (a 200-fold difference) and the large differences in rates reported from community-based screening studies in mainland China (a 10- to 15-fold difference) highlight the urgent need for establishing standardized methods for estimating the prevalences of autism and ASD. Until these methodological improvements have been made, it will not be possible to develop evidence-based prevention and treatment strategies for the management of these uncommon but seriously disabling conditions.