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Eccles JA, Quadt L, Garfinkel SN, Critchley HD. A model linking emotional dysregulation in neurodivergent people to the proprioceptive impact of joint hypermobility. Philos Trans R Soc Lond B Biol Sci 2024; 379:20230247. [PMID: 39005028 DOI: 10.1098/rstb.2023.0247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 05/04/2024] [Indexed: 07/16/2024] Open
Abstract
Emotional feelings are putatively ascribed to central representation of bodily states in the context of expectation and uncertainty in both internal state and external world. Neurodivergent people are more likely to experience co-occurring mental health challenges, although mechanistic insights underpinning this association are scarce. We therefore undertook a study to test whether imprecise processing of proprioceptive error signals may underlie the connection between neurodivergence and emotional dysregulation. In a cohort of people with complex chronic conditions, including chronic pain/fatigue, and complex trauma, and in a comparison group, we assessed presence of neurodivergence, variant connective tissue manifested through joint hypermobility, and emotional dysregulation. We present a data-informed conceptual model showing that variant connective tissue determines whether proprioceptive surprise is linked with emotional dysregulation in neurodivergent individuals. We suggest that future research in this area may have important clinical implications for the interaction of mental and physical wellbeing in neurodivergent people. This article is part of the theme issue 'Sensing and feeling: an integrative approach to sensory processing and emotional experience'.
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Affiliation(s)
- Jessica A Eccles
- Department of Clinical Neuroscience, Brighton and Sussex Medical School, Falmer BN1 9RY, UK
- Sussex Neurodevelopmental Service, Sussex Partnership NHS Foundation Trust, West Sussex, BN2 3EW, UK
| | - Lisa Quadt
- Department of Clinical Neuroscience, Brighton and Sussex Medical School, Falmer BN1 9RY, UK
- Sussex Neurodevelopmental Service, Sussex Partnership NHS Foundation Trust, West Sussex, BN2 3EW, UK
| | - Sarah N Garfinkel
- Department of Clinical Neuroscience, Brighton and Sussex Medical School, Falmer BN1 9RY, UK
- Institute of Cognitive Neuroscience, University College London, London WC1N 3AZ, UK
| | - Hugo D Critchley
- Department of Clinical Neuroscience, Brighton and Sussex Medical School, Falmer BN1 9RY, UK
- Sussex Neurodevelopmental Service, Sussex Partnership NHS Foundation Trust, West Sussex, BN2 3EW, UK
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Pivodic A, Hansson M, Löfqvist C, Sävman K, Elfvin A, Jacobson L, Dinkler L, Hallberg B, Ley D, Morsing E, Lundgren P, Gyllén J, Pfeiffer-Mosesson C, Hellström A. Challenges of parenting children born before 24 weeks of gestation. Acta Paediatr 2024. [PMID: 38984707 DOI: 10.1111/apa.17350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 06/24/2024] [Accepted: 06/28/2024] [Indexed: 07/11/2024]
Abstract
AIM To assess experience of care, well-being of parents and children's development in a cohort of extremely premature infants born <24 weeks of gestation in Sweden from 2007 to 2018. METHODS A survey based on multiple questionnaires answered by 124/349 (35.5%) parents. RESULTS The median age of parents and children was 43 and 9 years, respectively; 74.2% were mothers. Parents expressed high healthcare satisfaction. Following discharge from neonatal care, the satisfaction with the infant's treatment, support from personnel and being respected as a parent significantly declined but remained high. The criteria for suspected developmental deviation according to the screening test early symptomatic syndromes eliciting neurodevelopmental clinical examinations-questionnaire was fulfilled by 84.3%, 55.6% had suspected avoidant restrictive food intake disorder and 47.9% had visual perception problems. Parents experienced severe fatigue (48.6%) despite strong social support and family self-efficacy. Economic support was provided to 30.6%, and 37.9% of children were enrolled in habilitation services. CONCLUSION This study highlighted the substantial challenges faced by parents of infants born before 24 weeks of gestation, including decreased satisfaction post-discharge, fatigue and concerns about children's well-being. The findings underscore the need for comprehensive family-centred support and long-term multi-professional follow-up centres.
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Affiliation(s)
- Aldina Pivodic
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Ophthalmology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Malin Hansson
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Research and Development Primary Healthcare, Gothenburg, Sweden
| | - Chatarina Löfqvist
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Karin Sävman
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Neonatology, The Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Anders Elfvin
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Neonatology, The Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Lena Jacobson
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Lisa Dinkler
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Boubou Hallberg
- Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - David Ley
- Department of Pediatrics, Institute of Clinical Sciences, Skåne University Hospital Lund, Lund, Sweden
| | - Eva Morsing
- Department of Pediatrics, Clinical Sciences, Lund University, Lund, Sweden
| | - Pia Lundgren
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Ophthalmology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Jenny Gyllén
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Carola Pfeiffer-Mosesson
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ann Hellström
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Ophthalmology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
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3
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Gillberg C, Larsson Y, Billstedt E. Extreme or pathological demand avoidance: prioritising research to understand the prevalence and cause. THE LANCET. CHILD & ADOLESCENT HEALTH 2024; 8:471-473. [PMID: 38574748 DOI: 10.1016/s2352-4642(24)00057-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 02/28/2024] [Indexed: 04/06/2024]
Affiliation(s)
- Christopher Gillberg
- Gillberg Neuropsychiatry Centre, University of Gothenburg, Gothenburg 411 19, Sweden; Kochi Gillberg Neuropsychiatry Centre, University Medical School, Kochi, Japan; School of Health and Wellbeing, University of Glasgow, Glasgow, UK.
| | - Ylva Larsson
- Child Neuropsychiatry Clinic, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Eva Billstedt
- Gillberg Neuropsychiatry Centre, University of Gothenburg, Gothenburg 411 19, Sweden
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Johnson MH, Fearon P, Pickles A, Jones EJH. Editorial Perspective: The paradox of precision health in early development - building large samples to yield individual-level measures. J Child Psychol Psychiatry 2024; 65:991-994. [PMID: 38433119 DOI: 10.1111/jcpp.13974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/18/2024] [Indexed: 03/05/2024]
Abstract
Precision health refers to the use of individualised biomarkers or predictive models to provide more tailored information about an individual's likely prognosis. For child psychiatry and psychology, we argue that this approach requires a focus on neurocognitive measures collected in early life and at large scale. However, the large sample sizes necessary to uncover individual-level predictors are currently rare in studies of neurodevelopmental conditions in early childhood. We recommend two strategies going forward: first, including neurocognitive measures in new national cohort studies, and second, synergising measures and data across currently funded longitudinal studies.
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Affiliation(s)
- Mark H Johnson
- Department of Psychology, University of Cambridge, Cambridge, UK
- Centre for Brain and Cognitive Development, Birkbeck, University of London, London, UK
| | - Pasco Fearon
- Department of Psychology, University of Cambridge, Cambridge, UK
| | - Andrew Pickles
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Emily J H Jones
- Centre for Brain and Cognitive Development, Birkbeck, University of London, London, UK
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He C, Zhou H, Chen L, Liu Z. NEAT1 Promotes Valproic Acid-Induced Autism Spectrum Disorder by Recruiting YY1 to Regulate UBE3A Transcription. Mol Neurobiol 2024:10.1007/s12035-024-04309-y. [PMID: 38922486 DOI: 10.1007/s12035-024-04309-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 06/13/2024] [Indexed: 06/27/2024]
Abstract
Evidence suggests that long non-coding RNAs (lncRNAs) play a significant role in autism. Herein, we explored the functional role and possible molecular mechanisms of NEAT1 in valproic acid (VPA)-induced autism spectrum disorder (ASD). A VPA-induced ASD rat model was constructed, and a series of behavioral tests were performed to examine motor coordination and learning-memory abilities. qRT-PCR and western blot assays were used to evaluate target gene expression levels. Loss-and-gain-of-function assays were conducted to explore the functional role of NEAT1 in ASD development. Furthermore, a combination of mechanistic experiments and bioinformatic tools was used to assess the relationship and regulatory role of the NEAT1-YY1-UBE3A axis in ASD cellular processes. Results showed that VPA exposure induced autism-like developmental delays and behavioral abnormalities in the VPA-induced ASD rat model. We found that NEAT1 was elevated in rat hippocampal tissues after VPA exposure. NEAT1 promoted VPA-induced autism-like behaviors and mitigated apoptosis, oxidative stress, and inflammation in VPA-induced ASD rats. Notably, NEAT1 knockdown improved autism-related behaviors and ameliorated hippocampal neuronal damage. Mechanistically, it was observed that NEAT1 recruited the transcription factor YY1 to regulate UBE3A expression. Additionally, in vitro experiments further confirmed that NEAT1 knockdown mitigated hippocampal neuronal damage, oxidative stress, and inflammation through the YY1/UBE3A axis. In conclusion, our study demonstrates that NEAT1 is highly expressed in ASD, and its inhibition prominently suppresses hippocampal neuronal injury and oxidative stress through the YY1/UBE3A axis, thereby alleviating ASD development. This provides a new direction for ASD-targeted therapy.
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Affiliation(s)
- Chuping He
- Department of Children's Health, Chenzhou First People's Hospital, No. 6, Feihong Road, Suxian District, Chenzhou, 423000, Hunan, China
| | - Huimei Zhou
- Department of Children's Health, Chenzhou First People's Hospital, No. 6, Feihong Road, Suxian District, Chenzhou, 423000, Hunan, China.
| | - Lei Chen
- Department of Children's Health, Chenzhou First People's Hospital, No. 6, Feihong Road, Suxian District, Chenzhou, 423000, Hunan, China
| | - Zeying Liu
- Department of Children's Health, Chenzhou First People's Hospital, No. 6, Feihong Road, Suxian District, Chenzhou, 423000, Hunan, China
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Agebjörn J, Gillberg C, Eberhard J, Billstedt E, Nyrenius J. Association Between Autism and PTSD Among Adult Psychiatric Outpatients. J Autism Dev Disord 2024:10.1007/s10803-024-06439-7. [PMID: 38916696 DOI: 10.1007/s10803-024-06439-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2024] [Indexed: 06/26/2024]
Abstract
PURPOSE Autism Spectrum Disorder (ASD) occurs in 1-1.5% of the general population and possibly in up to 20% of psychiatric outpatients. Post Traumatic Stress Disorder (PTSD) occurs at some point in life in 4% of the general population and in 14-20% of psychiatric outpatients. Knowledge about how PTSD manifests in people with ASD is important in order for it to be correctly diagnosed and intervened for. METHODS This study investigated the relationship between PTSD and autism among adult psychiatric outpatients (N = 90) of whom 63 had ASD or subthreshold ASD based on DSM-5 criteria. The study group was subjected to in-depth psychiatric assessments using validated instruments. Diagnosis of PTSD was made based on the Mini International Neuropsychiatric Interview (MINI). RESULTS There was a trend towards PTSD being more common among participants with ASD compared to participants without ASD, although significant differences could not be shown in this small sample. 21% of the ASD group had current PTSD, compared to 4% of the study group without ASD. There were no differences between the groups regarding exposure to trauma. There was a trend towards a relationship between number of autism symptoms and hyperarousal symptoms in PTSD. Conversely, the PTSD symptom of irritability/outbursts of anger, was significantly associated with number of autism symptoms. CONCLUSIONS A subgroup of psychiatric outpatients with ASD also suffer from PTSD. Hyperarousal symptoms are possibly more prevalent in the presentation of PTSD in individuals/patients with ASD compared to those without ASD.
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Affiliation(s)
- Johan Agebjörn
- Adult Psychiatric Clinic Arlöv, Region Skåne, Arlöv, Sweden.
| | - Christopher Gillberg
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jonas Eberhard
- Adult Psychiatry Helsingborg, Region Skåne, Sweden; and Department of Clinical Sciences Lund/Clinical Sciences Helsingborg,, Lund University, Lund, Sweden
| | - Eva Billstedt
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Johan Nyrenius
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Adult Psychiatry Helsingborg, Region Skåne, Sweden; and Department of Clinical Sciences Lund/Clinical Sciences Helsingborg,, Lund University, Lund, Sweden
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Hegemann L, Corfield EC, Askelund AD, Allegrini AG, Askeland RB, Ronald A, Ask H, St Pourcain B, Andreassen OA, Hannigan LJ, Havdahl A. Genetic and phenotypic heterogeneity in early neurodevelopmental traits in the Norwegian Mother, Father and Child Cohort Study. Mol Autism 2024; 15:25. [PMID: 38849897 PMCID: PMC11161964 DOI: 10.1186/s13229-024-00599-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 04/18/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Autism and different neurodevelopmental conditions frequently co-occur, as do their symptoms at sub-diagnostic threshold levels. Overlapping traits and shared genetic liability are potential explanations. METHODS In the population-based Norwegian Mother, Father, and Child Cohort study (MoBa), we leverage item-level data to explore the phenotypic factor structure and genetic architecture underlying neurodevelopmental traits at age 3 years (N = 41,708-58,630) using maternal reports on 76 items assessing children's motor and language development, social functioning, communication, attention, activity regulation, and flexibility of behaviors and interests. RESULTS We identified 11 latent factors at the phenotypic level. These factors showed associations with diagnoses of autism and other neurodevelopmental conditions. Most shared genetic liabilities with autism, ADHD, and/or schizophrenia. Item-level GWAS revealed trait-specific genetic correlations with autism (items rg range = - 0.27-0.78), ADHD (items rg range = - 0.40-1), and schizophrenia (items rg range = - 0.24-0.34). We find little evidence of common genetic liability across all neurodevelopmental traits but more so for several genetic factors across more specific areas of neurodevelopment, particularly social and communication traits. Some of these factors, such as one capturing prosocial behavior, overlap with factors found in the phenotypic analyses. Other areas, such as motor development, seemed to have more heterogenous etiology, with specific traits showing a less consistent pattern of genetic correlations with each other. CONCLUSIONS These exploratory findings emphasize the etiological complexity of neurodevelopmental traits at this early age. In particular, diverse associations with neurodevelopmental conditions and genetic heterogeneity could inform follow-up work to identify shared and differentiating factors in the early manifestations of neurodevelopmental traits and their relation to autism and other neurodevelopmental conditions. This in turn could have implications for clinical screening tools and programs.
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Affiliation(s)
- Laura Hegemann
- PsychGen Centre for Genetic Epidemiology and Mental Health, Norwegian Institute of Public Health, Oslo, Norway.
- Nic Waals Institute, Lovisenberg Diaconal Hospital, Oslo, Norway.
- Department of Psychology, University of Oslo, Oslo, Norway.
| | - Elizabeth C Corfield
- PsychGen Centre for Genetic Epidemiology and Mental Health, Norwegian Institute of Public Health, Oslo, Norway
- Nic Waals Institute, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Adrian Dahl Askelund
- PsychGen Centre for Genetic Epidemiology and Mental Health, Norwegian Institute of Public Health, Oslo, Norway
- Nic Waals Institute, Lovisenberg Diaconal Hospital, Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Andrea G Allegrini
- Division of Psychology & Language Sciences, Department of Clinical, Educational & Health Psychology, Faculty of Brain Sciences, University College London, London, UK
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Ragna Bugge Askeland
- PsychGen Centre for Genetic Epidemiology and Mental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Angelica Ronald
- School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Helga Ask
- PsychGen Centre for Genetic Epidemiology and Mental Health, Norwegian Institute of Public Health, Oslo, Norway
- PROMENTA Research Centre,Department of Psychology, University of Oslo, Oslo, Norway
| | - Beate St Pourcain
- Language and Genetics Department, Max Planck Institute for Psycholinguistics, Nijmegen, The Netherlands
- MRC Integrative Epidemiology Unit (IEU), University of Bristol, Bristol, UK
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Ole A Andreassen
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Laurie J Hannigan
- PsychGen Centre for Genetic Epidemiology and Mental Health, Norwegian Institute of Public Health, Oslo, Norway
- Nic Waals Institute, Lovisenberg Diaconal Hospital, Oslo, Norway
- MRC Integrative Epidemiology Unit (IEU), University of Bristol, Bristol, UK
| | - Alexandra Havdahl
- PsychGen Centre for Genetic Epidemiology and Mental Health, Norwegian Institute of Public Health, Oslo, Norway
- Nic Waals Institute, Lovisenberg Diaconal Hospital, Oslo, Norway
- PROMENTA Research Centre,Department of Psychology, University of Oslo, Oslo, Norway
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Parks KMA, Cardy JO, Joanisse MF. Language and reading in attention-deficit/hyperactivity disorder and comorbid attention-deficit/hyperactivity disorder + developmental language disorder. JCPP ADVANCES 2024; 4:e12218. [PMID: 38827980 PMCID: PMC11143959 DOI: 10.1002/jcv2.12218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 11/20/2023] [Indexed: 06/05/2024] Open
Abstract
Background The current study sought to examine whether psycholinguistic assessments could discriminate children and adolescents with developmental language disorder (DLD) from those with attention-deficit/hyperactivity disorder (ADHD; combined or inattentive subtype) and comorbid DLD + ADHD. Methods The Clinical Evaluation of Language Fundamentals-Screening Test (CELFST; Wiig et al., 2013), the Comprehensive Test of Phonological Processing (nonword repetition subtest; Wagner et al., 2013), and the Test of Word Reading Efficiency (sight word and phonemic decoding subtests; Torgesen et al., 2012) were examined in 441 children and adolescents between 6 and 16 years of age. Results The presence of a language disorder (with or without ADHD) predicted poor performance across tasks. Children and adolescents with ADHD (combined vs. inattentive) only significantly differed in sight word reading, in favor of those with combined type. Measures of reading efficiency could distinguish between the two types of ADHD, but not between other groups. Interestingly, scores on the standard language screener were no worse for children with ADHD + DLD than children with DLD only. Conclusions The combination of comorbid ADHD + DLD did not appear to be associated with lower language abilities, sight word reading, or phonemic decoding relative to DLD alone. Reading efficiency was effective in discriminating between ADHD subtypes. These findings offer valuable insights into differential diagnosis and the identification of comorbidity.
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Affiliation(s)
- Kaitlyn M. A. Parks
- Department of PsychologyWestern UniversityLondonOntarioCanada
- Brain and Mind InstituteWestern UniversityLondonOntarioCanada
| | - Janis Oram Cardy
- Brain and Mind InstituteWestern UniversityLondonOntarioCanada
- School of Communication Sciences and DisordersWestern UniversityLondonOntarioCanada
| | - Marc F. Joanisse
- Department of PsychologyWestern UniversityLondonOntarioCanada
- Brain and Mind InstituteWestern UniversityLondonOntarioCanada
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Johnson M, Johnels JÅ, Östlund S, Jakobsson K, Högstedt J, Larsson PJ, Gillberg C, Billstedt E. Long-term medication for ADHD (LMA) trial: 2-year prospective observational study in children and adolescents. Core symptoms, daily functioning, and comorbidity outcomes. Eur Arch Psychiatry Clin Neurosci 2024; 274:879-890. [PMID: 38280948 PMCID: PMC11127865 DOI: 10.1007/s00406-023-01744-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 12/11/2023] [Indexed: 01/29/2024]
Abstract
More knowledge is needed about long-term ADHD medication and symptom, daily functioning, comorbidity, and tolerability outcomes. This "Long-term Medication for ADHD (LMA) trial" was a prospective observational 2-year trial in children and adolescents aged 6-18 years (extension of 1-year trial). Participants met criteria for DSM-5 ADHD (inattentive or combined), with complex comorbidities; autism spectrum disorder (31%), autistic traits (24%), oppositional symptoms (59%), anxiety (32%), dyslexia/language disorder (16%), borderline intellectual functioning (17%). Medication was individually tailored and followed-up at clinical visits (1, 2, 3, 6, 12, 18, 24 months). Primary outcome: Clinical Global Impression-Severity and Improvement scales (CGI-S, CGI-I). Secondary outcomes: Investigator-rated ADHD-Rating Scale, Weiss Functional Impairment Rating Scale-Parent report (WFIRS-P; Family, School Learning and Behavior, Life Skills, Self-Concept, Social Activities, and Risky Activities domains), comorbidity symptoms and adverse events (AEs). One hundred twenty-eight participants were enrolled (1-year trial only n = 27, LMA trial n = 101). Of these 29 (23%) discontinued, mainly due to AEs (n = 7), moving (n = 7), or no longer needing medication (n = 6). Main AEs were poor appetite, low mood, anxiety, irritability, fatigue. Improvements from baseline to 2 years were large in CGI-S (effect size (ES) 2.28), ADHD-RS (ES 2.06), and moderate to large in WFIRS-P (ES total 0.73, learning 0.4, family 0.67). Overall, the trial showed robust and sustained improvements in ADHD symptom severity and daily functioning over a period of 2 years of ADHD medication in children and adolescents with ADHD and complex comorbidities. Most AEs were mild. Comorbidity symptoms were improved after 1 year, particularly oppositional symptoms, depression, and anxiety.
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Affiliation(s)
- M Johnson
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - J Åsberg Johnels
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - S Östlund
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - K Jakobsson
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - J Högstedt
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - P Javid Larsson
- Habilitation and Health, Region Västra Götaland, Gothenburg, Sweden
| | - C Gillberg
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - E Billstedt
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Yasumitsu-Lovell K, Thompson L, Fernell E, Eitoku M, Suganuma N, Gillberg C. Validity of the ESSENCE-Q neurodevelopmental screening tool in Japan. Dev Med Child Neurol 2024. [PMID: 38760958 DOI: 10.1111/dmcn.15956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 04/05/2024] [Accepted: 04/10/2024] [Indexed: 05/20/2024]
Abstract
AIM To assess the validity of the Early Symptomatic Syndromes Eliciting Neurodevelopmental Clinical Examinations-Questionnaire (ESSENCE-Q), a simple screening tool for neurodevelopmental problems, in Japan. METHOD Parents/caregivers completed the 11-item ESSENCE-Q for 77 612 children aged 2 years 6 months included in a national birth cohort study. Information about neurodevelopmental disorders (NDDs: autism spectrum disorder; intellectual disability and/or developmental language disorder; motor delay/motor disorder) was collected at age 3 years. Each ESSENCE-Q item was scored on a binary (0,1) scale, with a total score range of 0 to 11. Total scores and individual items were compared across children with and without NDDs. RESULTS NDDs were recorded in 854 children (1.1%). With a total ESSENCE-Q score cut-off of ≥3, receiver operating characteristic curve analysis showed an area under the curve of 0.91, with sensitivity 84.9%, specificity 84.8%, positive predictive value 5.9%, and negative predictive value 99.8%. The proportion of parental concerns at 2 years 6 months differed significantly by NDD status for communication (89.5% vs 14.2%) and general development (80.2% vs 7.4%). ESSENCE-Q total scores were moderately negatively correlated (-0.36, p < 0.001) with Japanese Ages and Stages Questionnaire scores. INTERPRETATION The parent/caregiver-completed ESSENCE-Q is useful as a tool for screening out children with neurotypical development at this early age. Further research into longer-term predictive validity will be possible as more NDD diagnoses are given as the children grow up.
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Affiliation(s)
- Kahoko Yasumitsu-Lovell
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Kochi Gillberg Neuropsychiatry Centre, Kochi, Japan
- Department of Environmental Medicine, Kochi Medical School, Kochi University, Kochi, Japan
| | - Lucy Thompson
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Elisabeth Fernell
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Masamitsu Eitoku
- Department of Environmental Medicine, Kochi Medical School, Kochi University, Kochi, Japan
| | - Narufumi Suganuma
- Department of Environmental Medicine, Kochi Medical School, Kochi University, Kochi, Japan
| | - Christopher Gillberg
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Kochi Gillberg Neuropsychiatry Centre, Kochi, Japan
- Department of Environmental Medicine, Kochi Medical School, Kochi University, Kochi, Japan
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
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11
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Hoza B, Shoulberg EK. Transdiagnostic considerations are critical to understanding childhood neurodevelopmental disorders. Front Hum Neurosci 2024; 18:1385873. [PMID: 38774129 PMCID: PMC11106478 DOI: 10.3389/fnhum.2024.1385873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 04/19/2024] [Indexed: 05/24/2024] Open
Abstract
Growing dissatisfaction with the current categorical diagnostic systems has led to a movement toward transdiagnostic dimensional approaches to assessment of childhood mental health disorders. We argue that a transdiagnostic approach is especially important and appropriate when screening for neurodevelopmental disorders during early childhood. In the early childhood years, symptoms often appear in the form of developmental delays that could portend a variety of different disorders. Early intervention at this point is critical, even though a final endpoint disorder is not yet apparent. Intervening early has the potential to grow the area of weakness, possibly correcting or at least ameliorating these delays. Early intervention requires a multidisciplinary approach integrating efforts across settings and providers that monitor the development of young children. We argue here that young children's language ability is central to the development of social cognition, and a prerequisite for adequate social functioning. Social deficits are defining features of a subset of neurodevelopmental disorders such as autism spectrum disorder and social (pragmatic) communication disorder. Critically, impairment in social functioning is common in additional neurodevelopmental disorders such as attention-deficit/hyperactivity disorder (ADHD), learning disorders, and even motor disorders. For this reason, we argue that, at the earliest sign of a possible neurodevelopmental disorder, children should be screened for language deficits prior to initiating a focused assessment for a specific type of neurodevelopmental disorder such as ADHD. Any detected language deficits should be considered in the design and implementation of the assessment, as well as the ultimate intervention plan.
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Affiliation(s)
- Betsy Hoza
- Department of Psychological Science, University of Vermont, Burlington, VT, United States
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12
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Dellenmark-Blom M, Järvholm K, Sjögren L, Levinsson A, Dahlgren J. Family screening for neurodevelopmental problems and its associations with child cognitive function enable tailored treatment for childhood obesity. Acta Paediatr 2024. [PMID: 38710886 DOI: 10.1111/apa.17263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 04/19/2024] [Accepted: 04/23/2024] [Indexed: 05/08/2024]
Abstract
AIM To identify neurodevelopmental disorders in children with obesity, and investigate associations to cognitive functions as well as parents' self-reported neurodevelopmental problems. METHODS Eighty children were included at two outpatient obesity clinics in Sweden 2018-2019. Of these, 50 children without previously diagnosed neurodevelopmental disorders were screened, and so were their parents. Children who screened positive for neurodevelopmental problems were referred to a specialised psychiatry unit for further diagnosis. Test results of cognitive functioning were compared with the norm and between study groups by neurodevelopmental diagnoses. RESULTS Of the screened families, 17/50 children were diagnosed by the psychiatric unit with attention deficit-hyperactivity disorder (ADHD) and 15/82 parents screened positive for neurodevelopmental problems. Having a mother who screened positive for neurodevelopmental problems was associated with child ADHD (p < 0.05). The children's full-scale intelligence quotient (92.86 ± 12.01, p < 0.001) and working memory index (90.62 ± 12.17, p < 0.001) were lower than the norm. Working memory index was lower in children with ADHD compared to without ADHD: 84.76 ± 9.58 versus 94.09 ± 12.29 (p ≤ 0.01). Executive constraints were associated with verbal deviances. CONCLUSION Increased awareness is needed about the overlap between neurodevelopmental problems and obesity in obesity clinics.
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Affiliation(s)
- Maria Dellenmark-Blom
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kajsa Järvholm
- Department of Psychology, Lund University, Lund, Sweden
- Childhood Obesity Unit, Skåne University Hospital, Malmö, Sweden
- Region Västra Götaland, Regional Obesity Center, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lovisa Sjögren
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Regional Obesity Center, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Pediatrics, Halland Hospital Halmstad, Halmstad, Sweden
| | - Anna Levinsson
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Research Centre of the University of Montreal University Hospital, Montreal, Canada
| | - Jovanna Dahlgren
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Regional Obesity Center, Sahlgrenska University Hospital, Gothenburg, Sweden
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Kochhar P, Arora I, Bellato A, Ropar D, Hollis C, Groom M(MJ. A comparison of visual attention to pictures in the Autism Diagnostic Observation Schedule in children and adolescents with ADHD and/or autism. Front Psychiatry 2024; 15:1378593. [PMID: 38742132 PMCID: PMC11089217 DOI: 10.3389/fpsyt.2024.1378593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 04/08/2024] [Indexed: 05/16/2024] Open
Abstract
Background Attention-Deficit/Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD) are neurodevelopmental conditions which frequently co-occur. The Autism Diagnostic Observation Schedule (ADOS) is commonly used to aid with diagnostic assessment of ASD but was not originally designed for use in those with comorbid ADHD. Visual attention to social stimuli has been often studied in ASD using eye-tracking, to obtain quantitative indices of how attention is deployed to different parts of a social image/scene. As the ADOS includes tasks that rely on attending to and processing images of social scenes, these measures of visual attention could provide useful additional objective measurement alongside ADOS scores to enhance the characterisation of autistic symptoms in those with ADHD. Methods Children with ASD, comorbid ASD and ADHD, ADHD and Neurotypical (NT) controls were recruited (n=84). Visual attention was measured using eye-tracking during free viewing of social scenes selected from the ADOS. The full ADOS was then administered. Stimulant medication was temporarily withdrawn during this assessment. Research diagnoses were based on the Development and Wellbeing Assessment (DAWBA), ADOS, Social Communication Questionnaire (SCQ, a measure of ASD severity) and Conners' Rating Scales (CRS-3, a measure of ADHD severity) following clinical consensus. Results Using factorial ANOVAs to model ADHD, Autism and their interaction, we found that fixation duration to faces was reduced in those with ASD (ASD and ASD+ADHD) compared to those without ASD (ADHD and NT). Reduced visual attention to faces in the whole sample was associated with Autism symptom severity (SCQ subscale scores) but not ADHD symptom severity (CRS-3 scores). Discussion Our findings provide preliminary evidence in support of implementing visual attention measurement during assessment of ASD in the context of comorbidity with ADHD. For example, if a child with ADHD was found to reduce attention to faces in ADOS pictures this may suggest additive difficulties on the autism spectrum. Replication across a larger sample would be informative. This work has future potential in the clinic to help with complex cases, including those with co-occurring ADHD and ASD.
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Affiliation(s)
- Puja Kochhar
- Neurodevelopmental Specialist Service, Nottinghamshire Healthcare National Health Service (NHS) Foundation Trust, Nottingham, United Kingdom
- Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Iti Arora
- Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
- Division of Psychology and Language Sciences, Faculty of Brain Sciences, University College London, London, United Kingdom
| | - Alessio Bellato
- Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
- School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, United Kingdom
| | - Danielle Ropar
- School of Psychology, University of Nottingham, Nottingham, United Kingdom
| | - Chris Hollis
- Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
- National Institute for Health and Care Research (NIHR) MindTech Medtech Co-operative, Institute of Mental Health, UK NIHR, Nottingham, United Kingdom
- Nottingham Biomedical Research Centre, Institute of Mental Health, Nottingham, United Kingdom
| | - Madeleine (Maddie) J. Groom
- Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
- National Institute for Health and Care Research (NIHR) MindTech Medtech Co-operative, Institute of Mental Health, UK NIHR, Nottingham, United Kingdom
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14
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Cavonius-Rintahaka D, Roos M, Aho AL. The effectiveness of a dialogical family guidance intervention regarding child treatment response in families with a child with neurodevelopmental disorders. BMC Psychol 2024; 12:189. [PMID: 38580992 PMCID: PMC10998394 DOI: 10.1186/s40359-024-01706-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 04/03/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Children with neurodevelopmental disorders (NDD) can have emotional and behavioral symptoms affecting not only the child, but the whole family. Since family members have a strong impact on each other, studies highlight the need to offer effective family interventions to strengthen the wellbeing of the family. The aim of the current study is to clarify whether there is a difference between parents` opinions regarding their child`s emotional and behavioral condition immediately after Dialogical Family Guidance (DFG) has ended and after a three and six month follow-up. METHOD Fifty families with a child with NDD were randomized into two groups. Group 1 received DFG with an immediate starting point, and Group 2 received DFG after a three-month waiting period. Parent experiences of treatment response regarding their children`s emotional and behavioral symptoms were estimated before and after DFG using the parent version of the Strengths and Difficulties Questionnaire (SDQ-p) at baseline, and after three and six months. Additionally, comparisons between boys and girls, and the age of the child were analyzed. RESULTS The total difficulties score between Group 1 and Group 2 showed no difference immediately after DFG, or after three months. Regarding subdomains boys had more peer problems than girls, and at baseline, children between 3 and 6 years appeared to have more conduct problems than children between 7 and 13 years. Subdomain prosocial behavior increased statistically significantly during the study period in Group 1. Other SDQ-p subdomains remained constant in both groups between baseline and three and six month follow-up. CONCLUSIONS The result does not show any differences between parents` opinions regarding their child immediately after or three months after DFG regarding SDQ-p total difficulties scores in either group. The difference between younger and older children regarding conduct problems at baseline, and the difference between boys and girls regarding peer problems is worth paying attention to in the clinical setting. Because of the small sample, it is not possible to draw relevant conclusions regarding the intervention`s effect regarding the child`s mental health dimensions, gender, or age. Nevertheless, Dialogical family Guidance represents one intervention that can be used. TRIAL REGISTRATION ClinicalTrials.gov NCT04892992 (retrospectively registered May 18th 2021).
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Affiliation(s)
- Diana Cavonius-Rintahaka
- Faculty of Social Science, Nursing Science, University of Tampere, Tampere, Finland.
- Neuropsychiatric Unit, Helsinki University Hospital (HUH), Child psychiatry, Helsinki, Finland.
| | - Mervi Roos
- Faculty of Social Science, Nursing Science, University of Tampere, Tampere, Finland
| | - Anna Liisa Aho
- Faculty of Social Science, Nursing Science, University of Tampere, Tampere, Finland
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15
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Epihova G, Astle DE. What is developmental about developmental prosopagnosia? Cortex 2024; 173:333-338. [PMID: 38460488 DOI: 10.1016/j.cortex.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 12/21/2023] [Accepted: 02/19/2024] [Indexed: 03/11/2024]
Abstract
Developmental prosopagnosia (DP) is characterised by difficulties recognising face identities and is associated with diverse co-occurring object recognition difficulties. The high co-occurrence rate and heterogeneity of associated difficulties in DP is an intrinsic feature of developmental conditions, where co-occurrence of difficulties is the rule, rather than the exception. However, despite its name, cognitive and neural theories of DP rarely consider the developmental context in which these difficulties occur. This leaves a large gap in our understanding of how DP emerges in light of the developmental trajectory of face recognition. Here, we argue that progress in the field requires re-considering the developmental origins of differences in face recognition abilities, rather than studying the end-state alone. In practice, considering development in DP necessitates a re-evaluation of current approaches in recruitment, design, and analyses.
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Affiliation(s)
- Gabriela Epihova
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK.
| | - Duncan E Astle
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK; Department of Psychiatry, University of Cambridge, Cambridge, UK
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16
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Gustafsson BM, Sund Levander M. The assessment of preschool children with ESSENCE symptoms: concordance between parents, preschool teachers and child psychologists. BMC Pediatr 2024; 24:191. [PMID: 38493112 PMCID: PMC10943794 DOI: 10.1186/s12887-024-04693-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 03/04/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND It is important to detect children with Early Symptomatic Syndromes Eliciting Neurodevelopmental Clinical Examinations (ESSENCE) in order to implement early intervention and support for the child and family. Standardized instruments for assessment in different contexts of behaviour problems, engagement and psychosocial health obtain an objective picture of the preschool child's mental health. AIM To explore and compare parents', preschool teachers' and child health care psychologists' assessment of behaviour, everyday function, engagement, social interaction and psychosocial health in children with ESSENCE symptoms. METHOD Parents of 152 children (114 boys and 38 girls, 4.5 ± 1 years) with ESSENCE symptoms, 155 preschool teachers and 8 child psychologists participated. Parents and preschool teachers assessed externalizing and internalizing behavioural problems using the Strengths and Difficulties Questionnaire (SDQ), including the SDQ supplement for assessing the impact of behavioral problems on daily function. Preschool teachers also assessed engagement and social interaction using the Children's Engagement Questionnaire (CEQ), and the child psychologists assessed psychosocial health with the Child Psychosocial Health Assessment (LillaLAPS) and template in conversations with parents of children with neurodevelopmental problems. RESULTS Parents', preschool teachers' and child psychologists' assessment of the child's ESSENCE symptoms overall agreed. Both parents and preschool teachers see a strength in the child's social abilities. Differences in mean values show that parents assess more conduct, emotional symptoms and problems in daily life and more social skills, compared to the preschool teachers rating more peer problems. CONCLUSION It is important to consider different contexts to identify the child's need for support in everyday life. Expanded use of validated screening instruments in clinical practice would promote detection of children not already identified as exhibiting neurodevelopmental problems.
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Affiliation(s)
- B M Gustafsson
- Linköping University, Department of Child and Adolescent Psychiatry, Department of Biomedical and Clinical Sciences, Linköping, Sweden.
- Psychiatric Clinic, Högland Hospital Eksjö, Department of Psychiatry and Rehabilitation, Region Jönköping County, Jönköping, Sweden.
| | - M Sund Levander
- Psychiatric Clinic, Högland Hospital Eksjö, Department of Psychiatry and Rehabilitation, Region Jönköping County, Jönköping, Sweden
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Landgren V, Svensson L, Törnhage CJ, Theodosious M, Gillberg C, Johnson M, Knez R, Landgren M. Neurodevelopmental problems, general health and academic achievements in a school-based cohort of 11-year-old Swedish children. Acta Paediatr 2024; 113:506-516. [PMID: 37823347 DOI: 10.1111/apa.16989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 07/10/2023] [Accepted: 09/26/2023] [Indexed: 10/13/2023]
Abstract
AIM Assessing rates of neurodevelopmental problems (NDPs) in 11-year-old children and possible association with other health complaints and school performance. METHODS In-school study of 11-year-old children as an add-on assessment to the 4th grade regular health check-up, comprising a structured physical neurodevelopmental examination, neuropsychological assessment, behavioural ratings, maternal interview, review of medical records and academic achievements. RESULTS Out of 348 children recruited from eight schools, 223 (64%) participated. Any physical condition was found in 102/222 (46%), most commonly atopy (18%). One in five had a BMI z-score >2 standard deviations over the reference mean. One or more NDP was found in 86/221 (40%) children. The number of failed national tests correlated positively with NDP severity rated with the clinical global impression severity instrument (Spearman's r = 0.41, p < 0.001). The majority of participants with failed national tests, also had co-occurring health complaints (≥2 of: stomach or extremity ache, headache, difficulties sleeping, internalising symptoms or obesity) and NDPs. CONCLUSION Health complaints, physical conditions and NDPs are very common in 11-year-old children and warrant adequately staffed, thoroughly equipped school healthcare services.
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Affiliation(s)
- Valdemar Landgren
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Psychiatry, Skaraborg Hospital, Skövde, Sweden
| | - Leif Svensson
- Department of Pediatrics, Skaraborg Hospital, Skövde, Sweden
| | - Carl-Johan Törnhage
- Department of Pediatrics, Skaraborg Hospital, Skövde, Sweden
- Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Michail Theodosious
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- School Health Services, Gothenburg, Sweden
| | - Christopher Gillberg
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mats Johnson
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Rajna Knez
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Pediatrics, Skaraborg Hospital, Skövde, Sweden
| | - Magnus Landgren
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Li Q, Li W, Hu K, Wang Y, Li Y, Xu J. A de novo variant in RERE causes autistic behavior by disrupting related genes and signaling pathway. Clin Genet 2024; 105:273-282. [PMID: 38018232 DOI: 10.1111/cge.14461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 11/10/2023] [Accepted: 11/15/2023] [Indexed: 11/30/2023]
Abstract
Autism spectrum disorder (ASD) is a highly variable neurodevelopmental disorder that typically manifests childhood, characterized by a triad of symptoms: impaired social interaction, communication difficulties, and restricted interests with repetitive behaviors. De novo variants in related genes can cause ASD. We present the case of a 6-year-old Chinese boy with autistic behavior, including language communication impairments, intellectual disabilities, stunted development, and irritability in social interactions. Using Sanger sequencing, we confirmed a pathogenic in the RERE gene (NM_012102.4) (c.3732delC, p.Tyr1245Thrfs*12; EX21; Het). Subsequently, we generated an RERE point mutation cell line (ReMut) using CRISPR/Cas9 Targeted Genome Editing. Immunofluorescence was conducted to determine the location of the mutant RERE. RNA-sequencing and mass spectrometry analyses were performed to elucidate the ASD-related genes and signaling pathways disrupted by this variant in RERE. We identified 3790 differentially expressed genes and 684 differentially expressed proteins. The SHH signaling pathway was found to be downregulated, and the Hippo pathway was upregulated in ReMut. Genes implicated in autism, such as CNTNAP2, STX1A, FARP2, and GPC1, were significantly downregulated. Simultaneously, we noted alterations in HDAC1 and HDAC2, which are members of the WHHERE complex, suggesting their role in the pathogenesis of this patient. In conclusion, we report a de novo variant in RERE associated with autistic behavior. The finding that ASD is associated with RERE variants underscore the role of genetic factors in ASD and provides insights regarding the mechanisms underlying RERE variants in disease onset.
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Affiliation(s)
- Qian Li
- The First Affiliated Hospital of Zhengzhou University & Institute of Reproductive Health, Henan Academy of Innovations in Medical Science, Zhengzhou, Henan, China
- NHC Key Laboratory of Birth Defects Prevention, Zhengzhou, Henan, China
- Jining No. 1 People's Hospital, Jining, Shandong, China
| | - Wenbo Li
- The First Affiliated Hospital of Zhengzhou University & Institute of Reproductive Health, Henan Academy of Innovations in Medical Science, Zhengzhou, Henan, China
- NHC Key Laboratory of Birth Defects Prevention, Zhengzhou, Henan, China
| | - Kaiyue Hu
- The First Affiliated Hospital of Zhengzhou University & Institute of Reproductive Health, Henan Academy of Innovations in Medical Science, Zhengzhou, Henan, China
- NHC Key Laboratory of Birth Defects Prevention, Zhengzhou, Henan, China
| | - Yaqian Wang
- The First Affiliated Hospital of Zhengzhou University & Institute of Reproductive Health, Henan Academy of Innovations in Medical Science, Zhengzhou, Henan, China
- NHC Key Laboratory of Birth Defects Prevention, Zhengzhou, Henan, China
| | - Yang Li
- The First Affiliated Hospital of Zhengzhou University & Institute of Reproductive Health, Henan Academy of Innovations in Medical Science, Zhengzhou, Henan, China
- NHC Key Laboratory of Birth Defects Prevention, Zhengzhou, Henan, China
| | - Jiawei Xu
- The First Affiliated Hospital of Zhengzhou University & Institute of Reproductive Health, Henan Academy of Innovations in Medical Science, Zhengzhou, Henan, China
- NHC Key Laboratory of Birth Defects Prevention, Zhengzhou, Henan, China
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Harada Y, Ohyama J, Sano M, Ishii N, Maida K, Wada M, Wada M. Temporal characteristics of facial ensemble in individuals with autism spectrum disorder: examination from arousal and attentional allocation. Front Psychiatry 2024; 15:1328708. [PMID: 38439795 PMCID: PMC10910007 DOI: 10.3389/fpsyt.2024.1328708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 02/02/2024] [Indexed: 03/06/2024] Open
Abstract
Introduction Individuals with Autism Spectrum Disorder (ASD) show atypical recognition of facial emotions, which has been suggested to stem from arousal and attention allocation. Recent studies have focused on the ability to perceive an average expression from multiple spatially different expressions. This study investigated the effect of autistic traits on temporal ensemble, that is, the perception of the average expression from multiple changing expressions. Methods We conducted a simplified temporal-ensemble task and analyzed behavioral responses, pupil size, and viewing times for eyes of a face. Participants with and without diagnosis of ASD viewed serial presentations of facial expressions that randomly switched between emotional and neutral. The temporal ratio of the emotional expressions was manipulated. The participants estimated the intensity of the facial emotions for the overall presentation. Results We obtained three major results: (a) many participants with ASD were less susceptible to the ratio of anger expression for temporal ensembles, (b) they produced significantly greater pupil size for angry expressions (within-participants comparison) and smaller pupil size for sad expressions (between-groups comparison), and (c) pupil size and viewing time to eyes were not correlated with the temporal ensemble. Discussion These results suggest atypical temporal integration of anger expression and arousal characteristics in individuals with ASD; however, the atypical integration is not fully explained by arousal or attentional allocation.
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Affiliation(s)
- Yuki Harada
- Developmental Disorders Section, Department of Rehabilitation for Brain Functions, Research Institute of National Rehabilitation Center for Persons with Disabilities, Tokorozawa, Saitama, Japan
- Faculty of Humanities, Kyoto University of Advanced Science, Kyoto, Japan
| | - Junji Ohyama
- Human Augmentation Research Center, National Institute of Advanced Industrial Science and Technology, Kashiwa, Chiba, Japan
| | - Misako Sano
- Developmental Disorders Section, Department of Rehabilitation for Brain Functions, Research Institute of National Rehabilitation Center for Persons with Disabilities, Tokorozawa, Saitama, Japan
- Graduate School of Medicine, Nagoya University, Nagoya, Aichi, Japan
| | - Naomi Ishii
- Developmental Disorders Section, Department of Rehabilitation for Brain Functions, Research Institute of National Rehabilitation Center for Persons with Disabilities, Tokorozawa, Saitama, Japan
| | - Keiko Maida
- Developmental Disorders Section, Department of Rehabilitation for Brain Functions, Research Institute of National Rehabilitation Center for Persons with Disabilities, Tokorozawa, Saitama, Japan
| | - Megumi Wada
- Developmental Disorders Section, Department of Rehabilitation for Brain Functions, Research Institute of National Rehabilitation Center for Persons with Disabilities, Tokorozawa, Saitama, Japan
- Graduate School of Contemporary Psychology, Rikkyo University, Niiza, Saitama, Japan
| | - Makoto Wada
- Developmental Disorders Section, Department of Rehabilitation for Brain Functions, Research Institute of National Rehabilitation Center for Persons with Disabilities, Tokorozawa, Saitama, Japan
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Kitazoe N, Mimoto S, Fukunaga I, Hamaguchi M, Hatakenaka Y, Gillberg C. The ESSENCE-Q: Can specialist supervision improve scoring agreement across specialist and public health nurses/nursery teachers? Acta Paediatr 2024; 113:267-275. [PMID: 37846436 DOI: 10.1111/apa.17001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 09/28/2023] [Accepted: 10/04/2023] [Indexed: 10/18/2023]
Abstract
AIM This study aimed to explore whether the supervision of community public health nurses (PHNs) and nursery school teachers (NSTs) by a specialist, familiar with Early Symptomatic Syndromes Eliciting Neurodevelopmental Clinical Examinations (ESSENCE), improved the agreement of ESSENCE-Questionnaire (ESSENCE-Q) scoring, across raters. METHODS A PHN, two NSTs, and a speech-language pathologist (SLP), familiar with ESSENCE, independently assessed 32 children. The ESSENCE-Q results were divided into the first (child 1-18) and second groups (the 19th child and the following children). Changes in score discrepancies were analysed for ESSENCE-Q cutoff scores and total ESSENCE-Q scores across raters. The SLP scores were used as a reference to evaluate sensitivity and specificity. RESULTS The total ESSENCE-Q scores of the PHN and NSTs showed higher concordance in the second group (p < 0.05). Comparisons of the differences between the PHN/NSTs and SLP in total ESSENCE-Q scores showed a significantly smaller difference in the NSTs' scores in the second group (p < 0.05). CONCLUSION The findings suggest that specialist supervision may lead to a better agreement between PHN and NSTs regarding ESSENCE-Q scores.
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Affiliation(s)
- Noriko Kitazoe
- Kochi Gillberg Neuropsychiatry Centre, Kochi Treatment and Welfare Center, Kochi, Japan
| | - Sae Mimoto
- Kochi Gillberg Neuropsychiatry Centre, Kochi Treatment and Welfare Center, Kochi, Japan
| | - Ichiro Fukunaga
- Kochi Gillberg Neuropsychiatry Centre, Kochi Treatment and Welfare Center, Kochi, Japan
- Chuo-Nishi Public Health and Welfare Office, Kochi Prefectural Government, Kochi, Japan
| | - Masako Hamaguchi
- Kochi Gillberg Neuropsychiatry Centre, Kochi Treatment and Welfare Center, Kochi, Japan
- The child development support programs COLORFUL PIECE, Kochi, Japan
| | - Yuhei Hatakenaka
- Kochi Gillberg Neuropsychiatry Centre, Kochi Treatment and Welfare Center, Kochi, Japan
- Faculty of Humanities and Social Sciences, University of the Ryukyus, Okinawa, Japan
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Christopher Gillberg
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Cederlund M. Education and supervision have potential to make nursery school teachers and primary health nurses to valuable resources in the identification of children with neurodevelopmental disabilities. Acta Paediatr 2024; 113:168-169. [PMID: 37997692 DOI: 10.1111/apa.17044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 11/13/2023] [Indexed: 11/25/2023]
Affiliation(s)
- Mats Cederlund
- Sahlgrenska Academy, Neurology and Physiology, Gothenburg University, Gothenburg, Sweden
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Thorsson M, Galazka MA, Johnson M, Åsberg Johnels J, Hadjikhani N. Visuomotor tracking strategies in children: associations with neurodevelopmental symptoms. Exp Brain Res 2024; 242:337-353. [PMID: 38078961 DOI: 10.1007/s00221-023-06752-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 11/19/2023] [Indexed: 01/25/2024]
Abstract
Children with neurodevelopmental disorders (NDDs) often display motor problems that may impact their daily lives. Studying specific motor characteristics related to spatiotemporal control may inform us about the mechanisms underlying their challenges. Fifty-eight children with varying neurodevelopmental symptoms load (median age: 5.6 years, range: 2.7-12.5 years) performed an interactive tablet-based tracking task. By investigating digit touch errors relative to the target's movement direction, we found that a load of neurodevelopmental symptoms was associated with reduced performance in the tracking of abrupt alternating directions (zigzag) and overshooting the target. In contrast, reduced performance in children without neurodevelopmental symptoms was associated with lagging behind the target. Neurodevelopmental symptom load was also associated with reduced flexibility in correcting for lateral deviations in smooth tracking (spiral). Our findings suggest that neurodevelopmental symptoms are associated with difficulties in motor regulation related to inhibitory control and reduced flexibility, impacting motor control in NDDs.
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Affiliation(s)
- Max Thorsson
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Martyna A Galazka
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Division of Cognition and Communication, Department of Applied Information Technology, University of Gothenburg, Gothenburg, Sweden
| | - Mats Johnson
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jakob Åsberg Johnels
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Section of Speech and Language Pathology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Nouchine Hadjikhani
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Athinoula A. Martinos Center for Biomedical Imaging, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
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Lang J, Wylie G, Haig C, Gillberg C, Minnis H. Towards system redesign: An exploratory analysis of neurodivergent traits in a childhood population referred for autism assessment. PLoS One 2024; 19:e0296077. [PMID: 38198484 PMCID: PMC10781046 DOI: 10.1371/journal.pone.0296077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 12/05/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Children's health services in many countries are moving from single condition diagnostic silo assessments to considering neurodevelopment in a more holistic sense. There has been increasing recognition of the importance of clinical overlap and co-occurrence of different neurotypes when assessing neurodivergent children. Using a cross-sectional service evaluation design, we investigated the overlap of neurodivergences in a cohort of children referred for autism assessment, focusing on motor, learning, and attention/activity level domains. We aimed to determine what proportion of children in a cohort referred for an autism assessment showed traits of additional neurodivergences, and what proportion were further investigated. METHODS We evaluated anonymised medical records of children aged between two and 17 years referred for autism assessment. We used validated questionnaires to assess for neurodivergent traits. A weighted scoring system was developed to determine traits in each neurodevelopmental domain and a score above the median was considered to indicate a neurodivergent trait. Evidence of further investigations were recorded. We then examined the relationships between autism traits and traits of additional neurodivergence. RESULTS 114 participants were included for evaluation. 62.3% (n = 71) had completed questionnaires for analysis. Of these, 71.8% (n = 51) scored greater than the median for at least one additional neurotype, indicating the presence of other neurodivergent traits, and 88.7% (n = 64) attracted a diagnosis of autism. Only 26.3% of children with evidence of additional neurotypes were further investigated beyond their autism assessment. CONCLUSIONS Our results demonstrate the extensive overlap between additional neurodivergent traits in a population of children referred with suspected autism and show that only a small proportion were further investigated. The use of standardised questionnaires to uncover additional neurodivergences may have utility in improving the holistic nature of neurodevelopmental assessments.
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Affiliation(s)
- Jason Lang
- School of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Georgia Wylie
- School of Medicine, University of Glasgow, Glasgow, Scotland
| | - Caroline Haig
- School of Health and Wellbeing, Robertson Centre for Biostatistics, Glasgow, Scotland
| | | | - Helen Minnis
- School of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
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24
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Landgren V, Hedman E, Lindblad I, Gillberg C, Fernell E. Adult psychiatric and psychosocial outcomes of children with mild intellectual disability: a register follow-up of a population-based cohort. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2024; 68:34-44. [PMID: 37699865 DOI: 10.1111/jir.13087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 08/04/2023] [Accepted: 08/24/2023] [Indexed: 09/14/2023]
Abstract
BACKGROUND Very few longitudinal psychiatric and psychosocial outcome studies of children with mild intellectual disability (MID) have been performed. METHODS The study group was population based and consisted of 82 individuals, born in 1979-1985 and diagnosed in childhood at ages between 3 and 15 years with MID. In the present study, register data regarding school attendance, employment, economic situation, psychiatric diagnoses and criminal sentences were retrieved for the years 1997-2018, when the individuals were up to 39 years old. RESULTS At follow-up, data were obtained for 78 of the 82 individuals (47 male and 31 female). Mean age at follow-up was 36 years. Of the 78 individuals, 57 (73%) had exclusively received education for pupils with MID, but 21 (27%) had graduated from regular education of some sort (at least 9 years). Forty-four (56%) had never been employed, and 34 (44%) had been registered as employed for at least a shorter period. Forty-seven (60%) had received a sick pension at some point in adulthood. Of the 78 individuals, 44 (56%) had any psychiatric disorder recorded and about half of these (n = 21) had had inpatient treatment. A total of 31 of the 44 individuals in psychiatric care (70%) had ID noted as one of their diagnoses. Of the 78 individuals, 48 (62%) had support from the Act concerning Support and Service for Persons with Certain Functional Impairments (Swedish LSS law) as adults. Twenty-one individuals (27%) had had a criminal conviction, of whom five male individuals had been incarcerated. CONCLUSIONS Individuals with MID constitute a heterogeneous group with regard to severity of functional impairment, co-occurring psychiatric disorders and need of support from society. Primary health care, psychiatry and habilitation services need to work together in order to meet the multiple needs of this group.
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Affiliation(s)
- V Landgren
- Department of Psychiatry, Skaraborg Hospital, Skövde, Sweden
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgren's Academy, Gothenburg University, Gothenburg, Sweden
| | - E Hedman
- Department of Psychiatry, Skaraborg Hospital, Skövde, Sweden
| | - I Lindblad
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgren's Academy, Gothenburg University, Gothenburg, Sweden
| | - C Gillberg
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgren's Academy, Gothenburg University, Gothenburg, Sweden
| | - E Fernell
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgren's Academy, Gothenburg University, Gothenburg, Sweden
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25
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Charman T, Pasco G, Hendry A, Bazelmans T, Narvekar N, Goodwin A, Halkola H, Agyapong M, Holman R, Ali JB, Ersoy M, Johnson MH, Pickles A, Jones EJH. Three year outcomes in infants with a family history of autism and/or attention deficit hyperactivity disorder. JCPP ADVANCES 2023; 3:e12189. [PMID: 38054052 PMCID: PMC10694531 DOI: 10.1002/jcv2.12189] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 06/26/2023] [Indexed: 12/07/2023] Open
Abstract
Background Most research on early outcomes in infants with a family history (FH) of autism has focussed on categorically defined autism, although some have language and developmental delays. Less is known about outcomes in infants with a FH of attention deficit hyperactivity disorder (ADHD). Methods Infants with and without a FH of autism and/or ADHD, due to a first-degree relative with either or both conditions, were recruited at 5 or 10 months. Three year outcomes were characterised using latent profile analysis (LPA) across measures of cognitive ability, adaptive functioning and autism, ADHD and anxiety traits (n = 131). We additionally ran an LPA using only autism and ADHD measures, and the broader LPA in an independent cohort (n = 139) and in both cohorts combined (n = 270). Results A Low Developmental Level + High Behavioural Concerns class had elevated autism, ADHD and anxiety scores, low cognitive and adaptive function, and included all but one child with autism. A Low Developmental Level + Typical Behaviour class had average cognitive ability and typical behaviour but low adaptive function. A Typical Developmental Level + Some Behavioural Concerns class had average cognitive and adaptive function but slightly elevated behaviour scores. A High Developmental Level + Typical Behaviour class had above average cognitive ability and typical behaviour. All four LPAs identified classes characterised by combinations of either, or both, Low Development Level and elevated behaviour scores, as well as a typically developing class. No classes had elevated autism or ADHD traits in isolation. Conclusions Some infants with a FH of autism or ADHD have atypical developmental and behavioural outcomes, but do not show strong autism or ADHD traits in isolation. The field needs to recalibrate aims and methods to embrace the broader transdiagnostic pattern of outcomes seen in these infants.
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Affiliation(s)
- Tony Charman
- Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
| | - Greg Pasco
- Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
| | - Alexandra Hendry
- Department of Experimental PsychologyUniversity of OxfordOxfordUK
| | - Tessel Bazelmans
- Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
| | - Nisha Narvekar
- Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
| | - Amy Goodwin
- Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
| | - Hanna Halkola
- Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
| | - Mary Agyapong
- Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
| | - Rebecca Holman
- Centre for Brain and Cognitive DevelopmentBirkbeckUniversity of LondonLondonUK
| | - Jannath Begum Ali
- Centre for Brain and Cognitive DevelopmentBirkbeckUniversity of LondonLondonUK
| | - Mutluhan Ersoy
- Department of PsychologyKastamonu UniversityKastamonuTurkey
| | - Mark H. Johnson
- Centre for Brain and Cognitive DevelopmentBirkbeckUniversity of LondonLondonUK
- Department of PsychologyUniversity of CambridgeCambridgeUK
| | - Andrew Pickles
- Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
| | - Emily J. H. Jones
- Centre for Brain and Cognitive DevelopmentBirkbeckUniversity of LondonLondonUK
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26
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Blanco B, Lloyd-Fox S, Begum-Ali J, Pirazzoli L, Goodwin A, Mason L, Pasco G, Charman T, Jones EJH, Johnson MH. Cortical responses to social stimuli in infants at elevated likelihood of ASD and/or ADHD: A prospective cross-condition fNIRS study. Cortex 2023; 169:18-34. [PMID: 37847979 DOI: 10.1016/j.cortex.2023.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 07/06/2023] [Accepted: 07/12/2023] [Indexed: 10/19/2023]
Abstract
Autism spectrum disorders (ASD) and attention-deficit hyperactivity disorder (ADHD) are highly prevalent neurodevelopmental conditions that often co-occur and present both common and distinct neurodevelopmental profiles. Studying the developmental pathways leading to the emergence of ASD and/or ADHD symptomatology is crucial in understanding neurodiversity and discovering the mechanisms that underpin it. This study used functional near-infrared spectroscopy (fNIRS) to investigate differences in cortical specialization to social stimuli between 4- to 6-month-old infants at typical and elevated likelihood of ASD and/or ADHD. Results showed that infants at both elevated likelihood of ASD and ADHD had reduced selectivity to vocal sounds in left middle and superior temporal gyrus. Furthermore, infants at elevated likelihood of ASD showed attenuated responses to visual social stimuli in several cortical regions compared to infants at typical likelihood. Individual brain responses to visual social stimuli were associated with later autism traits, but not ADHD traits. These outcomes support our previous observations showing atypical social brain responses in infants at elevated likelihood of ASD and align with later atypical brain responses to social stimuli observed in children and adults with ASD. These findings highlight the importance of characterizing antecedent biomarkers of atypicalities in processing socially relevant information that might contribute to both phenotypic overlap and divergence across ASD and ADHD conditions and their association with the later emergence of behavioural symptoms.
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Affiliation(s)
- Borja Blanco
- Department of Psychology, University of Cambridge, UK.
| | | | - Jannath Begum-Ali
- Centre for Brain & Cognitive Development, Birkbeck, University of London, UK
| | - Laura Pirazzoli
- Laboratories of Cognitive Neuroscience, Division of Developmental Medicine, Department of Medicine, Boston Children's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Amy Goodwin
- Institute of Psychiatry, Psychology & Neuroscience, Kings College London, UK
| | - Luke Mason
- Centre for Brain & Cognitive Development, Birkbeck, University of London, UK; Institute of Psychiatry, Psychology & Neuroscience, Kings College London, UK
| | - Greg Pasco
- Institute of Psychiatry, Psychology & Neuroscience, Kings College London, UK
| | - Tony Charman
- Institute of Psychiatry, Psychology & Neuroscience, Kings College London, UK
| | - Emily J H Jones
- Centre for Brain & Cognitive Development, Birkbeck, University of London, UK
| | - Mark H Johnson
- Department of Psychology, University of Cambridge, UK; Centre for Brain & Cognitive Development, Birkbeck, University of London, UK
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Rogač Ž, Stevanović D, Bečanović S, Dimitrijević A, Andrić I, Božić L, Nikolić DM. Onset of Inattention and Hyperactivity in Children and Adolescents With Epilepsy 6 months After the Diagnosis. J Atten Disord 2023; 27:1662-1669. [PMID: 37465953 DOI: 10.1177/10870547231187150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
OBJECTIVE Complete or major symptoms of ADHD are often present in epilepsy. This study evaluated inattention and hyperactivity symptoms over the first 6 months in newly diagnosed pediatric epilepsy without comorbid ADHD. METHOD Children and adolescents with newly diagnosed epilepsy were followed for 6 months after starting antiseizure medications. The Nisonger Child Behavior Rating Form (NCBRF), Adverse Event Profile (AEP), and the Revised Wechsler Intelligence Scale for Children were used. RESULTS There was a marked increase in attention difficulties while a moderate increase in hyperactivity levels. AEP scores, changes in non-verbal aspects of intelligence, levels of hyperactivity at the follow-up, and attention at baseline were significant predictors for inattention. In contrast, only levels of hyperactivity at the baseline and inattention at the follow-up were significant predictors for hyperactivity. CONCLUSION Significant inattention and hyperactivity levels originated 6 months after the diagnosis of epilepsy and starting antiseizure medication.
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Affiliation(s)
- Željka Rogač
- Clinical Centre of Montenegro, Podgorica, Montenegro
| | - Dejan Stevanović
- Clinic for Neurology and Psychiatry for Children and Youth, Belgrade, Serbia
| | | | | | | | | | - Dimitrije M Nikolić
- University Children's Hospital, Belgrade, Serbia
- University of Belgrade, Serbia
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Serenius F, Kaul YF, Källén K, Hafström M, Ådén U, Stjernqvist K, Farooqi A. Neurobehavioral symptoms in children born extremely preterm: A Swedish National Study. Acta Paediatr 2023; 112:2387-2399. [PMID: 37551108 DOI: 10.1111/apa.16942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 08/03/2023] [Accepted: 08/07/2023] [Indexed: 08/09/2023]
Abstract
AIM To determine the prevalence of neurobehavioral symptoms at 6.5 years in children born extremely preterm (EPT, <27 weeks' gestation). METHODS Population-based cohort study of infants born EPT in Sweden from 2004 to 2007. Of 486 survivors 375 were assessed and compared with 369 matched term-born controls. EPT children free from neurosensory and intellectual disabilities (neurodevelopmental disabilities [NDD]-free, n = 236) were compared separately. Standardised questionnaires were used to assess parental ratings of hyperactivity and attention, emotional, peer-relation, conduct and social problems; and deficits in perception, language and memory. RESULTS EPT children had more reported problems in all assessed neurobehavioral domains than controls, with more than three times greater odds for most outcomes. Except for conduct problems, increased problems were identified also in NDD-free children. The odds of having neurobehavioral problems in ≥3 co-occurring domains were five (whole EPT group) and three (NDD-free group) times higher than in controls. CONCLUSION EPT children with or without NDD have more neurobehavioral problems in multiple domains than term peers. Ongoing assessments of behaviour until school age or beyond should recognise early symptoms of attention, everyday social problems, perceptual, emotional or language difficulties.
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Affiliation(s)
- Fredrik Serenius
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Department of Neonatology, Child and Adolescent Medicine, Umeå University Hospital, Umeå, Sweden
| | | | - Karin Källén
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Lund, University of Lund, Lund, Sweden
| | - Maria Hafström
- Department of Paediatrics, Institute of Clinical Science, University of Gothenburg, Gothenburg, Sweden
- Angered Hospital, Gothenburg, Sweden
| | - Ulrika Ådén
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Karin Stjernqvist
- Department of Clinical Sciences, Pediatric Section, Lund University, Lund, Sweden
- Department of Neonatal Care and Pediatric Surgery, Skåne University Hospital, Lund, Sweden
| | - Aijaz Farooqi
- Department of Neonatology, Child and Adolescent Medicine, Umeå University Hospital, Umeå, Sweden
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Agnafors S, Kjellström AN, Björk MP, Rusner M, Torgerson J. Health care utilization in children and adolescents with psychiatric disorders. Acta Psychiatr Scand 2023; 148:327-337. [PMID: 37415523 DOI: 10.1111/acps.13590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 06/05/2023] [Accepted: 06/11/2023] [Indexed: 07/08/2023]
Abstract
OBJECTIVE Mental illness is increasing among young people and likewise the request for health care services. At the same time, somatic comorbidity is common in children and adolescents with psychiatric disorders. There is a lack of studies on health care use in children and adolescents, and the hypothesis was that children and adolescents with psychiatric disorders use more primary-, and specialized somatic health care compared to children without psychiatric disorders. METHODS In this retrospective population-based register study, all individuals aged 3-17 years living in Västra Götaland region in Sweden in 2017 were included (n = 298,877). Linear and Poisson regression were used to compare health care use during 2016-2018 between children with and without psychiatric diagnoses, controlling for age and gender. The results were reported as unstandardised beta coefficient (ß) and adjusted prevalence ratio (aPR) respectively. RESULTS Having a psychiatric diagnosis was associated with more primary care visits (ß 2.35, 95% CI 2.30-2.40). This applied to most diagnoses investigated. Girls had more primary care visits than boys. Likewise, individuals with psychiatric diagnoses had more specialized somatic outpatient care (ß 1.70, 95% CI 1.67-1.73), both planned and unplanned (ß 1.23, 95% CI 1.21-1.25; ß 0.18, 95% CI 0.17-0.19). Somatic inpatient care was more common in those having a psychiatric diagnosis (aPR 1.65, 95% CI 1.58-1.72), with the diagnoses of psychosis and substance use exerting the greatest risk. CONCLUSIONS Psychiatric diagnoses were associated with increased primary-, somatic outpatient- as well as somatic inpatient care. Increased awareness of comorbidity and easy access to relevant health care could be beneficial for patients and caregivers. The results call for a review of current health care systems with distinct division between medical disciplines and levels of health care.
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Affiliation(s)
- Sara Agnafors
- Division of Children's and Women's health, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Research, Södra Älvsborgs Hospital, Borås, Sweden
| | - Anna Norman Kjellström
- Department of Data Management and Analysis, Head Office, Region Västra Götaland, Skövde, Sweden
| | - Marcus Praetorius Björk
- Research and Development Primary Health Care, Region Västra Götaland, Gothenburg, Sweden
- General Practice/Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Marie Rusner
- Department of Research, Södra Älvsborgs Hospital, Borås, Sweden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jarl Torgerson
- Department of Psychosis, Sahlgrenska University Hospital, Gothenburg, Sweden
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Liang X, Qiu H, Li SX. Objectively measured sleep continuity in children and adolescents with ADHD: A systematic review and meta-analysis. Psychiatry Res 2023; 328:115447. [PMID: 37657199 DOI: 10.1016/j.psychres.2023.115447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 08/25/2023] [Accepted: 08/27/2023] [Indexed: 09/03/2023]
Abstract
Sleep disturbances are often linked to attention-deficit/hyperactivity disorder (ADHD). Consistent findings document that children and adolescents with ADHD report more sleep problems than their typically developing (TD) peers across subjective sleep domains. However, few differences between these groups were observed in objectively measured sleep parameters, such as polysomnography (PSG) and actigraphy. This study synthesized empirical studies to identify objectively measured sleep continuity differences between children and adolescents with ADHD and TD. We included observational research and baseline data from intervention studies between 5- to 18-year-old individuals with ADHD and their TD peers at five databases from inception and September 2022. This systematic review and meta-analysis of 45 articles, including 1622 children and adolescents with ADHD and 2013 TD, found that compared with TD, children and adolescents with ADHD have higher sleep latency and moderately decreased sleep efficiency measured by actigraphy. Polysomnography-measured differences between ADHD and TD were not significant. Medication status and comorbid psychiatric status significantly moderated the group differences in sleep efficiency between ADHD and TD. Also, the group differences in sleep latency between ADHD and TD were moderated by actigraphy recorded nights. These findings highlight the importance of reducing disparities in sleep parameters among children and adolescents with and without ADHD.
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Affiliation(s)
- Xiao Liang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China.
| | - Hui Qiu
- Department of Educational Administration and Policy, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Shirley Xin Li
- Department of Psychology, University of Hong Kong, Hong Kong SAR, China; State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong SAR, China
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31
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Pranjić M, Rahman N, Kamenetskiy A, Mulligan K, Pihl S, Arnett AB. A systematic review of behavioral and neurobiological profiles associated with coexisting attention-deficit/hyperactivity disorder and developmental coordination disorder. Neurosci Biobehav Rev 2023; 153:105389. [PMID: 37704094 DOI: 10.1016/j.neubiorev.2023.105389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 08/31/2023] [Accepted: 09/10/2023] [Indexed: 09/15/2023]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) and developmental coordination disorder (DCD) co-occur in approximately 50% of cases. This study aimed to characterize the behavioral, cognitive, and neurobiological profiles of co-occurring ADHD and DCD diagnoses by mapping, synthesizing, and providing a critical appraisal of the existing literature. A systematic search was conducted across four databases (MEDLINE, PsycINFO, Embase, and Scopus) to identify studies comparing a coexisting ADHD+DCD diagnosis to ADHD and DCD alone. From 2353 screened articles, 15 behavioral and 10 neuroimaging studies were included. Collectively, these studies suggest that the comorbid ADHD+DCD presentation constitutes a more severe phenotype characterized by neurocognitive differences associated with both conditions. Despite sharing some common neural features, our findings support the separate etiology hypothesis indicating that neural network alterations in individuals with ADHD+DCD represent a unique neural pattern rather than a sum of ADHD and DCD characteristics. Considering the heterogeneity inherent to both ADHD and DCD, future studies should involve rigorous and comprehensive assessment procedures to delineate how different subtypes of each diagnosis relate to distinct performance characteristics.
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Affiliation(s)
- Marija Pranjić
- Division of Developmental Medicine, Boston Children's Hospital, Boston, MA, USA.
| | - Navin Rahman
- Division of Developmental Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Adelia Kamenetskiy
- Division of Developmental Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Kaitlin Mulligan
- Division of Developmental Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Stephen Pihl
- Division of Developmental Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Anne B Arnett
- Division of Developmental Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA
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32
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Liang X, Qiu H, Tsai CL, Li C, Sit CHP. MVPA and Motor Proficiency between Children with ADHD and Typical Development: Associations with Sleep Quality. Med Sci Sports Exerc 2023; 55:1886-1893. [PMID: 37227227 DOI: 10.1249/mss.0000000000003223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
PURPOSE This study examined the associations of motor proficiency with moderate-to-vigorous physical activity (MVPA) and sleep quality in children with attention-deficit/hyperactivity disorder (ADHD) and children with typical development (TD). METHODS This cross-sectional study included 88 medical-naive children with ADHD age 6-12 yr (mean (SD) age, 8.43 (1.38) yr; 81.8% boys) and 40 age-matched children with TD (mean (SD) age, 8.46 (1.44) yr; 60% boys). MVPA was recorded by a wGT3X-BT accelerometer for 7 consecutive days. Motor proficiency was assessed using the Test of Gross Motor Development-Third Edition. Sleep quality was assessed using a self-report questionnaire. RESULTS Children with ADHD spent significantly less time in MVPA daily, displayed less proficiency in locomotor and ball skills, and reported poorer sleep quality (e.g., longer sleep latency, less sleep duration, and lower sleep efficiency) than children with TD. MVPA guideline attainment and sleep duration significantly predicted locomotor skills development; in turn, locomotor skills predicted MVPA guideline attainment. MVPA and ball skills increased by age in children with ADHD. CONCLUSIONS Our results highlight the importance of promoting MVPA, motor proficiency, and sleep duration in children with ADHD and TD since childhood.
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Affiliation(s)
| | - Hui Qiu
- Department of Educational Administration and Policy, The Chinese University of Hong Kong, Hong Kong, CHINA
| | - Chia-Liang Tsai
- Institute of Physical Education, Health & Leisure Studies, National Cheng Kung University, Tainan, TAIWAN
| | | | - Cindy H P Sit
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Hong Kong, CHINA
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33
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Galazka MA, Wallin L, Thorsson M, Gillberg C, Billstedt E, Hadjikhani N, Åsberg Johnels J. Self-reported eye contact sensitivity and face processing in chromosome 22q11.2 deletion syndrome. J Clin Exp Neuropsychol 2023; 45:570-578. [PMID: 37732542 DOI: 10.1080/13803395.2023.2259043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 09/04/2023] [Indexed: 09/22/2023]
Abstract
INTRODUCTION 22q11.2 deletion syndrome (22qDS) has been associated with varying levels of social impairments, and with atypical visual scanning of faces. The present study explored whether self-reported sensitivity to eye contact might be related to these phenomena. METHOD Individuals with confirmed 22qDS were interviewed about their experience and possible discomfort with eye contact. In cases where individuals expresesed discomfort, they were subsequently asked about coping mechanisms used to deal with this discomfort. In addition to self-reported eye contact discomfort, gaze to emotional faces was examined using eye tracking. RESULTS In the subgroup of individuals who reported discomfort during eye contact, eye tracking results revealed a lower amount of gaze in the eyes of neutral faces, as well as the absence of the typical left visual field (LVF) bias, indicative of alterations in hemispheric lateralization. This subgroup also scored lower on a measure of everyday functioning. CONCLUSIONS Our results show that, by simply asking individuals with this social and communicative disorder about eye gaze discomfort, we may better understand the specific challenges that they experience. Moreover, information gained from such first-person reports together with eye-tracking measures further informs about the integrity of their face processing system, as well as about the nature and degree of impairment in this population.
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Affiliation(s)
- Martyna A Galazka
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Division of Cognition and Communication, Department of Applied Information Technology, University of Gothenburg, Gothenburg, Sweden
| | - Lena Wallin
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Cognition and Old Age Psychiatric Clinic, Sahlgrenska University Hospital, Psychiatry, Gothenburg, Sweden
| | - Max Thorsson
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Christopher Gillberg
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Child Neuropsychiatric Clinic, Queen Silvia Children's Hospital, Västra Götalandsregionen, Gothenburg, Sweden
| | - Eva Billstedt
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Child Neuropsychiatric Clinic, Queen Silvia Children's Hospital, Västra Götalandsregionen, Gothenburg, Sweden
| | - Nouchine Hadjikhani
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jakob Åsberg Johnels
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Child Neuropsychiatric Clinic, Queen Silvia Children's Hospital, Västra Götalandsregionen, Gothenburg, Sweden
- Section of Speech and Language Pathology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Barone H, Elgen IB, Bliksrud YT, Vangsøy Hansen E, Skavhellen RR, Furevik MI, Haavik J. Case report: ADHD and prognosis in tyrosinemia type 1. Front Psychiatry 2023; 14:1213590. [PMID: 37533886 PMCID: PMC10392124 DOI: 10.3389/fpsyt.2023.1213590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 06/26/2023] [Indexed: 08/04/2023] Open
Abstract
Neurometabolic disorders such as tyrosinemia type 1 (TYRSN1) may interfere with brain metabolism and show symptoms of attention-deficit hyperactivity disorder (ADHD) in patients treated with the enzyme inhibitor nitisinone [2-(2-nitro-4-trifluoromethylbenzoyl)-1,3-cyclohexanedione, NTBC]. It has been reported that ADHD treatment improves treatment compliance, which is imperative for the long-term prognosis of patients with TYRSN1. In this study, we report the case of a male patient who was diagnosed with TYRSN1 at 3 months of age and was subsequently treated with NTBC, restricted protein intake, and amino acids supplementation. At 7 years of age, he was referred for neuropsychiatric assessment, diagnosed with ADHD, and treated with methylphenidate. The effects of the treatment were monitored via parental interviews, questionnaires covering ADHD symptoms, and a continuous performance test. A reduction in ADHD symptoms, particularly inattentiveness, was observed across all measures. The early identification of ADHD and the treatment of neurometabolic disorders, such as TYRSN1, may be important from a lifetime perspective as this may improve the prognosis of the medical condition as well.
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Affiliation(s)
- Helene Barone
- Regional Resource Center for Autism, ADHD and Tourette Syndrome, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Irene Bircow Elgen
- Department of Child and Adolescent Psychiatry, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | | | | | - Rita Rigmor Skavhellen
- Department of Child and Adolescent Psychiatry, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Magne Ivar Furevik
- Department of Child and Adolescent Psychiatry, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Jan Haavik
- Bergen Center of Brain Plasticity, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Biomedicine, University of Bergen, Bergen, Norway
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Lundqvist S, Knez R, Nagy K, Nasic S, Kerekes N, Kantzer A. Prevalence of chronic pain in children and adolescents with psychiatric conditions. PAEDIATRIC & NEONATAL PAIN 2023; 5:50-56. [PMID: 37283952 PMCID: PMC10240401 DOI: 10.1002/pne2.12100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 01/17/2023] [Accepted: 02/09/2023] [Indexed: 06/08/2023]
Abstract
The prevalence of pain in children and adolescents with psychiatric conditions is rarely investigated. The aims of the current study were to (a) describe the prevalence of headaches and abdominal pain in children and adolescents with psychiatric conditions, (b) compare the prevalence of pain in children and adolescents with psychiatric conditions with that in the general population, and (c) investigate the associations between pain experience and different types of psychiatric diagnoses. Families with a child aged 6-15 years who had been referred to a child and adolescent psychiatry (CAP) clinic completed the Chronic Pain in Psychiatric Conditions questionnaire. Information about the child/adolescent's psychiatric diagnosis(es) was extracted from the CAP clinic's medical records. The children and adolescents included in the study were divided into diagnostic groups and compared. Their data were also compared with data of control subjects collected during a previous study of the general population. Abdominal pain was more common among girls with a psychiatric diagnosis (85%) than in the matched control population (62%, p = 0.031). Children and adolescents with neurodevelopmental diagnoses had a higher prevalence of abdominal pain than children and adolescents with other psychiatric diagnoses. Pain conditions in children and adolescents with a psychiatric diagnosis are common and must be addressed.
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Affiliation(s)
- Sara Lundqvist
- Institute for Neuroscience and PhysiologyGothenburg UniversityGothenburgSweden
- Child and Adolescent Psychiatric ClinicSahlgrenska University HospitalGothenburgSweden
| | - Rajna Knez
- Institute for Neuroscience and PhysiologyGothenburg UniversityGothenburgSweden
- Department of PaediatricsSkaraborg's HospitalSkövdeSweden
| | - Karin Nagy
- Child and Adolescent Psychiatric ClinicSahlgrenska University HospitalGothenburgSweden
| | | | - Nóra Kerekes
- Department of Health SciencesUniversity WestTrollhättanSweden
| | - Anne‐Katrin Kantzer
- Department of Child and Adolescent PsychiatryNU Hospital GroupTrollhättanSweden
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Parekh SA, Wren-Jarvis J, Lazerwitz M, Rowe MA, Powers R, Bourla I, Cai LT, Chu R, Trimarchi K, Garcia R, Marco EJ, Mukherjee P. Hemispheric lateralization of white matter microstructure in children and its potential role in sensory processing dysfunction. Front Neurosci 2023; 17:1088052. [PMID: 37139524 PMCID: PMC10149818 DOI: 10.3389/fnins.2023.1088052] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 03/28/2023] [Indexed: 05/05/2023] Open
Abstract
Diffusion tensor imaging (DTI) studies have demonstrated white matter microstructural differences between the left and right hemispheres of the brain. However, the basis of these hemispheric asymmetries is not yet understood in terms of the biophysical properties of white matter microstructure, especially in children. There are reports of altered hemispheric white matter lateralization in ASD; however, this has not been studied in other related neurodevelopmental disorders such as sensory processing disorder (SPD). Firstly, we postulate that biophysical compartment modeling of diffusion MRI (dMRI), such as Neurite Orientation Dispersion and Density Imaging (NODDI), can elucidate the hemispheric microstructural asymmetries observed from DTI in children with neurodevelopmental concerns. Secondly, we hypothesize that sensory over-responsivity (SOR), a common type of SPD, will show altered hemispheric lateralization relative to children without SOR. Eighty-seven children (29 females, 58 males), ages 8-12 years, presenting at a community-based neurodevelopmental clinic were enrolled, 48 with SOR and 39 without. Participants were evaluated using the Sensory Processing 3 Dimensions (SP3D). Whole brain 3 T multi-shell multiband dMRI (b = 0, 1,000, 2,500 s/mm2) was performed. Tract Based Spatial Statistics were used to extract DTI and NODDI metrics from 20 bilateral tracts of the Johns Hopkins University White-Matter Tractography Atlas and the lateralization Index (LI) was calculated for each left-right tract pair. With DTI metrics, 12 of 20 tracts were left lateralized for fractional anisotropy and 17/20 tracts were right lateralized for axial diffusivity. These hemispheric asymmetries could be explained by NODDI metrics, including neurite density index (18/20 tracts left lateralized), orientation dispersion index (15/20 tracts left lateralized) and free water fraction (16/20 tracts lateralized). Children with SOR served as a test case of the utility of studying LI in neurodevelopmental disorders. Our data demonstrated increased lateralization in several tracts for both DTI and NODDI metrics in children with SOR, which were distinct for males versus females, when compared to children without SOR. Biophysical properties from NODDI can explain the hemispheric lateralization of white matter microstructure in children. As a patient-specific ratio, the lateralization index can eliminate scanner-related and inter-individual sources of variability and thus potentially serve as a clinically useful imaging biomarker for neurodevelopmental disorders.
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Affiliation(s)
- Shalin A. Parekh
- Department of Radiology and Biomedical Imaging, University of California–San Francisco, San Francisco, CA, United States
| | - Jamie Wren-Jarvis
- Department of Radiology and Biomedical Imaging, University of California–San Francisco, San Francisco, CA, United States
| | - Maia Lazerwitz
- Department of Radiology and Biomedical Imaging, University of California–San Francisco, San Francisco, CA, United States
- Cortica Healthcare, San Rafael, CA, United States
| | - Mikaela A. Rowe
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, United States
| | - Rachel Powers
- Department of Radiology and Biomedical Imaging, University of California–San Francisco, San Francisco, CA, United States
- Cortica Healthcare, San Rafael, CA, United States
| | - Ioanna Bourla
- Department of Radiology and Biomedical Imaging, University of California–San Francisco, San Francisco, CA, United States
| | - Lanya T. Cai
- Department of Radiology and Biomedical Imaging, University of California–San Francisco, San Francisco, CA, United States
| | - Robyn Chu
- Cortica Healthcare, San Rafael, CA, United States
| | | | | | | | - Pratik Mukherjee
- Department of Radiology and Biomedical Imaging, University of California–San Francisco, San Francisco, CA, United States
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Thorsson M, Galazka MA, Hajjari P, Fernell E, Delafield-Butt J, Gillberg C, Johnson M, Åsberg Johnels J, Hadjikhani N. A novel tablet-based motor coordination test performs on par with the Beery VMI subtest and offers superior temporal metrics: findings from children with pediatric acute-onset neuropsychiatric syndrome. Exp Brain Res 2023; 241:1421-1436. [PMID: 37052647 PMCID: PMC10130113 DOI: 10.1007/s00221-023-06612-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 03/28/2023] [Indexed: 04/14/2023]
Abstract
Neuropsychiatric and neurodevelopmental disorders are often associated with coordination problems. Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) constitutes a specific example of acute and complex symptomatology that includes difficulties with motor control. The present proof-of-concept study aimed at testing a new, bespoke tablet-based motor coordination test named SpaceSwipe, providing fine-grained measures that could be used to follow-up on symptoms evolution in PANS. This test enables computationally precise and objective metrics of motor coordination, taking into account both directional and spatial features continuously. We used SpaceSwipe to assess motor coordination in a group of children with PANS (n = 12, assessed on in total of 40 occasions) and compared it against the motor coordination subtest from the Beery-Buktenica Developmental Test of Visual-Motor Integration (Beery VMI) 6th edition, traditionally used to follow-up symptomatology. Using a bivariate linear regression, we found that 33 s of the directional offset from tracking a moving target in SpaceSwipe could predict the Beery VMI motor coordination (VMI MC) raw scores (mean absolute error: 1.75 points). Positive correlations between the predicted scores and the VMI MC scores were found for initial testing (radj = 0.87) and for repeated testing (radj = 0.79). With its short administration time and its close prediction to Beery VMI scores, this proof-of-concept study demonstrates the potential for SpaceSwipe as a patient-friendly tool for precise, objective assessment of motor coordination in children with neurodevelopmental or neuropsychiatric disorders.
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Affiliation(s)
- Max Thorsson
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg, Sweden.
- , Gothenburg, Sweden.
| | - Martyna A Galazka
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg, Sweden
| | - Parisa Hajjari
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg, Sweden
| | - Elisabeth Fernell
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg, Sweden
| | | | - Christopher Gillberg
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg, Sweden
| | - Mats Johnson
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg, Sweden
| | - Jakob Åsberg Johnels
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg, Sweden
- Section of Speech and Language Pathology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg, Sweden
| | - Nouchine Hadjikhani
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg, Sweden
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, USA
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Gidziela A, Ahmadzadeh YI, Michelini G, Allegrini AG, Agnew-Blais J, Lau LY, Duret M, Procopio F, Daly E, Ronald A, Rimfeld K, Malanchini M. A meta-analysis of genetic effects associated with neurodevelopmental disorders and co-occurring conditions. Nat Hum Behav 2023; 7:642-656. [PMID: 36806400 PMCID: PMC10129867 DOI: 10.1038/s41562-023-01530-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 01/16/2023] [Indexed: 02/22/2023]
Abstract
A systematic understanding of the aetiology of neurodevelopmental disorders (NDDs) and their co-occurrence with other conditions during childhood and adolescence remains incomplete. In the current meta-analysis, we synthesized the literature on (1) the contribution of genetic and environmental factors to NDDs, (2) the genetic and environmental overlap between different NDDs, and (3) the co-occurrence between NDDs and disruptive, impulse control and conduct disorders (DICCs). Searches were conducted across three platforms: Web of Science, Ovid Medline and Ovid Embase. Studies were included only if 75% or more of the sample consisted of children and/or adolescents and the studies had measured the aetiology of NDDs and DICCs using single-generation family designs or genomic methods. Studies that had selected participants on the basis of unrelated diagnoses or injuries were excluded. We performed multilevel, random-effects meta-analyses on 296 independent studies, including over four million (partly overlapping) individuals. We further explored developmental trajectories and the moderating roles of gender, measurement, geography and ancestry. We found all NDDs to be substantially heritable (family-based heritability, 0.66 (s.e. = 0.03); SNP heritability, 0.19 (s.e. = 0.03)). Meta-analytic genetic correlations between NDDs were moderate (grand family-based genetic correlation, 0.36 (s.e. = 0.12); grand SNP-based genetic correlation, 0.39 (s.e. = 0.19)) but differed substantially between pairs of disorders. The genetic overlap between NDDs and DICCs was strong (grand family-based genetic correlation, 0.62 (s.e. = 0.20)). While our work provides evidence to inform and potentially guide clinical and educational diagnostic procedures and practice, it also highlights the imbalance in the research effort that has characterized developmental genetics research.
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Affiliation(s)
- Agnieszka Gidziela
- School of Biological and Behavioural Sciences, Queen Mary University of London, London, UK.
- Social, Genetic and Developmental Psychiatry Centre, King's College London, London, UK.
| | - Yasmin I Ahmadzadeh
- Social, Genetic and Developmental Psychiatry Centre, King's College London, London, UK
| | - Giorgia Michelini
- School of Biological and Behavioural Sciences, Queen Mary University of London, London, UK
- UCLA Semel Institute for Neuroscience, Division of Child and Adolescent Psychiatry, University of California, Los Angeles, Los Angeles, CA, USA
| | - Andrea G Allegrini
- Social, Genetic and Developmental Psychiatry Centre, King's College London, London, UK
- Division of Psychology and Language Sciences, University College London, London, UK
| | - Jessica Agnew-Blais
- School of Biological and Behavioural Sciences, Queen Mary University of London, London, UK
| | - Lok Yan Lau
- Social, Genetic and Developmental Psychiatry Centre, King's College London, London, UK
| | - Megan Duret
- Social, Genetic and Developmental Psychiatry Centre, King's College London, London, UK
| | - Francesca Procopio
- Social, Genetic and Developmental Psychiatry Centre, King's College London, London, UK
| | - Emily Daly
- Social, Genetic and Developmental Psychiatry Centre, King's College London, London, UK
| | - Angelica Ronald
- Department of Psychological Sciences, Birkbeck University of London, London, UK
| | - Kaili Rimfeld
- Social, Genetic and Developmental Psychiatry Centre, King's College London, London, UK
- Department of Psychology, Royal Holloway University of London, Egham, UK
| | - Margherita Malanchini
- School of Biological and Behavioural Sciences, Queen Mary University of London, London, UK.
- Social, Genetic and Developmental Psychiatry Centre, King's College London, London, UK.
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Schön M, Pablo L, Julián N, Mattina T, Gunnarsson C, Hadzsiev K, Verpelli C, Bourgeron T, Sarah J, van Ravenswaaij-Arts CMA, Hennekam RC. Definition and clinical variability of SHANK3-related Phelan-McDermid syndrome. Eur J Med Genet 2023; 66:104754. [PMID: 37003575 DOI: 10.1016/j.ejmg.2023.104754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 03/14/2023] [Accepted: 03/26/2023] [Indexed: 04/03/2023]
Abstract
Phelan-McDermid syndrome (PMS) is an infrequently described syndrome that presents with a disturbed development, neurological and psychiatric characteristics, and sometimes other comorbidities. As part of the development of European medical guidelines we studied the definition, phenotype, genotype-phenotype characteristics, and natural history of the syndrome. The number of confirmed diagnoses of PMS in different European countries was also assessed and it could be concluded that PMS is underdiagnosed. The incidence of PMS in European countries is estimated to be at least 1 in 30,000. Next generation sequencing, including analysis of copy number variations, as first tier in diagnostics of individuals with intellectual disability will likely yield a larger number of individuals with PMS than presently known. A definition of PMS by its phenotype is at the present not possible, and therefore PMS-SHANK3 related is defined by the presence of SHANK3 haploinsufficiency, either by a deletion involving region 22q13.2-33 or a pathogenic/likely pathogenic variant in SHANK3. In summarizing the phenotype, we subdivided it into that of individuals with a 22q13 deletion and that of those with a pathogenic/likely pathogenic SHANK3 variant. The phenotype of individuals with PMS is variable, depending in part on the deletion size or, whether only a variant of SHANK3 is present. The core phenotype in the domains development, neurology, and senses are similar in those with deletions and SHANK3 variants, but individuals with a SHANK3 variant more often are reported to have behavioural disorders and less often urogenital malformations and lymphedema. The behavioural disorders may, however, be a less outstanding feature in individuals with deletions accompanied by more severe intellectual disability. Data available on the natural history are limited. Results of clinical trials using insulin-like growth factor I (IGF-1), intranasal insulin, and oxytocin are available, other trials are in progress. The present guidelines for PMS aim at offering tools to caregivers and families to provide optimal care to individuals with PMS.
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Affiliation(s)
- Michael Schön
- Institute for Anatomy and Cell Biology, Ulm University, Germany.
| | - Lapunzina Pablo
- Instituto de Genética Médica y Molecular (INGEMM)-IdiPAZ, Hospital Universitario La Paz, CIBERER, Centro de Investigación Biomédica en Red de Enfermedades Raras, ISCIII; ITHACA-European Reference Network, Hospital La Paz, Madrid, Spain
| | - Nevado Julián
- Instituto de Genética Médica y Molecular (INGEMM)-IdiPAZ, Hospital Universitario La Paz, CIBERER, Centro de Investigación Biomédica en Red de Enfermedades Raras, ISCIII; ITHACA-European Reference Network, Hospital La Paz, Madrid, Spain
| | - Teresa Mattina
- Department of Biomedical and Biotechnological Sciences, Medical Genetics, University of Catania, Catania, Italy
| | - Cecilia Gunnarsson
- Department of Clinical Genetics and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Centre for Rare Diseases in South East Region of Sweden, Linköping University, Linköping, Sweden
| | - Kinga Hadzsiev
- Department of Medical Genetics, Medical School, University of Pécs, Pécs, Hungary
| | | | - Thomas Bourgeron
- Génétique Humaine et Fonctions Cognitives, Institut Pasteur, UMR3571 CNRS, Université de Paris Cité, IUF, 75015, Paris, France
| | - Jesse Sarah
- Department of Neurology, Ulm University, Germany
| | | | - Raoul C Hennekam
- Department of Pediatrics, Amsterdam University Medical Center, Amsterdam, the Netherlands
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Kopp S, Asztély KS, Landberg S, Waern M, Bergman S, Gillberg C. Girls With Social and/or Attention Deficit Re-Examined in Young Adulthood: Prospective Study of Diagnostic Stability, Daily Life Functioning and Social Situation. J Atten Disord 2023; 27:830-846. [PMID: 36915033 DOI: 10.1177/10870547231158751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
OBJECTIVE Investigate diagnostic stability, daily life functioning and social situation in women diagnosed with ADHD and/or ASD in childhood. METHODS Prospective 17 to 20-year follow-up study of 100 girls of whom 92 diagnosed in childhood with main DSM-IV ADHD or ASD, and 60 comparison girls. Ninety and 54 of these women were examined (M = 27, 4 years old) with semi-structured interviews and questionnaires, close relatives were interviewed. RESULTS At follow-up, 89% of women with ADHD or ASD in childhood still met the criteria for either of these diagnoses. Very few women were "in remission." In 34% the main diagnosis shifted from ADHD to ASD. Women with ADHD and ASD had significantly more disability and unfavorable social situation than comparison women. CONCLUSION Women with ADHD and/or ASD in childhood had impairing problems 17 to 20 years later. Early ADHD changed to ASD in adulthood in some cases. Nearly all with ASD met criteria for ADHD as adults.
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Affiliation(s)
- Svenny Kopp
- University of Gothenburg Institute of Neuroscience and Physiology, Göteborg, Sweden
| | | | - Sara Landberg
- University of Gothenburg Institute of Neuroscience and Physiology, Göteborg, Sweden
| | - Margda Waern
- University of Gothenburg Institute of Neuroscience and Physiology, Göteborg, Sweden
| | - Stefan Bergman
- University of Gothenburg Institute of Medicine, Göteborg, VG Region, Sweden
| | - Christopher Gillberg
- University of Gothenburg Institute of Neuroscience and Physiology, Göteborg, Sweden
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Boman C, Bernhardsson S. Exploring needs, barriers, and facilitators for promoting physical activity for children with intellectual developmental disorders: A qualitative focus group study. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2023; 27:5-23. [PMID: 35128986 PMCID: PMC9940129 DOI: 10.1177/17446295211064368] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Many children with intellectual developmental disorders are insufficiently physically active and do not reach recommendations for physical activity. Pediatric healthcare providers play a key role in addressing these children's needs, including promoting interventions for physical activity. AIM To explore pediatric healthcare providers' perceived needs, barriers, and facilitators for promoting physical activity for children with intellectual developmental disorders. METHODS Semi-structured focus groups, analyzed using qualitative content analysis. Sixteen healthcare providers participated. RESULTS Main findings are the importance of parental support and engagement, need for structure, and stakeholder collaboration to bridge the gap between pediatric organizations and external stakeholders. CONCLUSION The study highlights the need for developing and implementing strategies to promote physical activity for children with intellectual developmental disorders in pediatric health care, and for producing guidelines regarding physical activity interventions for this vulnerable group.
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Affiliation(s)
- Charlotte Boman
- Centre for physical activity, Region Västra Götaland, Gothenburg, Sweden
- Department of Health and Rehabilitation, Unit of Physiotherapy, Sahlgrenska Academy, Institute of Neuroscience and Physiology, 3570University of Gothenburg, Gothenburg, Sweden
| | - Susanne Bernhardsson
- Department of Health and Rehabilitation, Unit of Physiotherapy, Sahlgrenska Academy, Institute of Neuroscience and Physiology, 3570University of Gothenburg, Gothenburg, Sweden
- Research, Education, Development and Innovation, Primary Health Care, Region Västra Götaland, Gothenburg, Sweden
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Olivier P, Gressens P, Barthelemy C. Neurodevelopmental disorders: research and interventions beyond classifications. J Neural Transm (Vienna) 2023; 130:181-184. [PMID: 36757475 DOI: 10.1007/s00702-023-02596-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 01/27/2023] [Indexed: 02/10/2023]
Affiliation(s)
- Paul Olivier
- Autism and NDD Scientific Interest Group (GIS Autisme et TND), Paris, France.
| | - Pierre Gressens
- Autism and NDD Scientific Interest Group (GIS Autisme et TND), Paris, France
- Université Paris Cité, NeuroDiderot, Inserm, Paris, France
| | - Catherine Barthelemy
- Autism and NDD Scientific Interest Group (GIS Autisme et TND), Paris, France
- Faculty of Medicine, University of Tours, Tours, France
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Davidson C, Turner F, Gillberg C, Campbell SL, Boyd S, Minnis H. Using the live assessment to discriminate between Autism Spectrum Disorder and Disinhibited Social Engagement Disorder. RESEARCH IN DEVELOPMENTAL DISABILITIES 2023; 134:104415. [PMID: 36634523 DOI: 10.1016/j.ridd.2022.104415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/21/2022] [Accepted: 12/29/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Children with Autism Spectrum Disorder (ASD) and children with Disinhibited Social Engagement Disorder (DSED) may present with similar social problems, despite differing aetiologies, resulting in diagnostic conundrums. METHODS Thirty children: 10 with ASD, no maltreatment history, 10 with DSED and 10 typically developing children were assessed via 'gold standard' ASD assessments, including the Autism Diagnostic Observational Schedule (ADOS) and a unique unstructured observation known as the Live assessment. Live utilises a triadic interaction (2 assessors and child), playful teasing and social 'stress' scenarios to increase the social challenge. RESULTS The ADOS supported discrimination of DSED from ASD to a degree. Where additional neurodevelopmental problems created ambiguity, the Live assessment was more supportive than the ADOS for unpicking the underlying nature of the social problems. CONCLUSION Live supported differentiation between ASD, DSED and other neurodevelopmental problems. The greater social challenge presented by Live exacerbated core problems of ASD and, in DSED, core social skills stood out.
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Affiliation(s)
- Claire Davidson
- University of Glasgow, Academic CAMHS, West Glasgow Ambulatory Care Hospital, Glasgow G3 8SJ, United Kingdom.
| | - Fiona Turner
- University of Glasgow, Academic CAMHS, West Glasgow Ambulatory Care Hospital, Glasgow G3 8SJ, United Kingdom.
| | - Christopher Gillberg
- University of Glasgow, Academic CAMHS, West Glasgow Ambulatory Care Hospital, Glasgow G3 8SJ, United Kingdom; Gillberg Neuropsychiatry Service, University of Gothenburg, Gothenburg, Sweden.
| | - Sharon L Campbell
- NHS Greater Glasgow and Clyde, SCA, West Glasgow Ambulatory Care Hospital, Glasgow G3 8SJ, United Kingdom.
| | - Sheila Boyd
- NHS Greater Glasgow and Clyde, SCA, West Glasgow Ambulatory Care Hospital, Glasgow G3 8SJ, United Kingdom.
| | - Helen Minnis
- University of Glasgow, Academic CAMHS, West Glasgow Ambulatory Care Hospital, Glasgow G3 8SJ, United Kingdom.
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Øie MG, Storaas TAV, Egeland J. Neuropsychological and Symptom Predictors of Diagnostic Persistence in ADHD: A 25-Year Follow-up Study. J Atten Disord 2023; 27:612-622. [PMID: 36802957 DOI: 10.1177/10870547231154903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
BACKGROUND This study extends long-term predictive research on ADHD by including both neuropsychological and symptom measures at baseline in adolescence as predictors of diagnostic persistence 25 years later. METHODS Nineteen males with ADHD and 26 healthy controls (HC; M/F = 13/13), were assessed in adolescence and 25 years later. Measurements at baseline included a comprehensive test battery measuring eight neuropsychological domains, an IQ estimate, the Child Behavior Checklist (CBCL), and the Global Assessment Scale of Symptoms. Differences between ADHD Retainers, Remitters, and HC were calculated with ANOVAs, and potential predictions of differences in the ADHD group by linear regression analyses. RESULTS Eleven (58%) participants retained their ADHD diagnoses at follow-up. Motor Coordination and Visual perception at baseline predicted diagnosis at follow-up. CBCL Attention problems at baseline in the ADHD group predicted variance in diagnostic status. CONCLUSION Lower-order neuropsychological functions related to motor function and perception are important long-time predictors of persistence of ADHD.
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Affiliation(s)
- Merete Glenne Øie
- University of Oslo, Norway.,Innlandet Hospital Trust, Brumunddal, Norway
| | | | - Jens Egeland
- University of Oslo, Norway.,Vestfold Hospital Trust, Tønsberg, Norway
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Overbeck G, Kragstrup J, Gørtz M, Rasmussen IS, Graungaard AH, Siersma V, de Voss S, Ertmann RK, Shahrzad S, Appel CL, Wilson P. Family wellbeing in general practice: a study protocol for a cluster-randomised trial of the web-based resilience programme on early child development. Trials 2023; 24:7. [PMID: 36597136 PMCID: PMC9810520 DOI: 10.1186/s13063-022-07045-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 12/20/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Social, emotional and behavioural problems in early childhood are associated with increased risk for a wide range of poor outcomes associated with substantial cost and impact on society as a whole. Some of these problems are rooted in the early mother-infant relationship and might be prevented. In Denmark, primary health care has a central role in preventive care during pregnancy and the first years of the child's life and general practice provides opportunities to promote a healthy mother-infant relationship in early parenthood. OBJECTIVE In the context of standardised antenatal and child development assessments focused on psychosocial wellbeing, we examine the impact of a complex intervention designed to improve maternal mentalisation skills, involving training of general practice clinicians and signposting towards a web-based resource. Joint main outcomes are child socio-emotional and language development at age 30 months measured by parentally reported questionnaires (Communicative Development Inventory and Strengths and Difficulties Questionnaire). METHODS The study is a cluster-randomised controlled trial based in general practices in the Capital Region and the Zealand Region of Denmark. Seventy practices were included. Practices were randomised by a computer algorithm in a ratio of 1:1 to intervention or control groups. Each practice was asked to recruit up to 30 women consecutively at their first scheduled antenatal assessment. Clinicians in both groups received one day of training in preventive antenatal and child development consultations with added focus on parental psychosocial well-being, social support, and parent-child interaction. These preventive consultations delivered in both trial arms require enhanced data recording about psychosocial factors. In intervention clinics, clinicians were asked to signpost a web page at three scheduled antenatal consultations and at four scheduled consultations when the child is 5 weeks, 5 months, 1 and 2 years. DISCUSSION We hypothesise that the intervention will increase mothers' ability to be sensitive to their child's mental state to an extent that improves the child's language and mental state at 30 months of age measured by parent-reported questionnaires. TRIAL REGISTRATION ClinicalTrials.gov NCT04129359. Registered on Oct 16 2019.
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Affiliation(s)
- Gritt Overbeck
- grid.5254.60000 0001 0674 042XUniversity of Copenhagen, Department of Public Health, Centre for General Practice, University of Copenhagen, Copenhagen, Denmark
| | - Jakob Kragstrup
- grid.5254.60000 0001 0674 042XUniversity of Copenhagen, Department of Public Health, Centre for General Practice, University of Copenhagen, Copenhagen, Denmark
| | - Mette Gørtz
- grid.5254.60000 0001 0674 042XDepartment of Economics and Center for Economic Behavior and Inequality (CEBI), University of Copenhagen, Copenhagen, Denmark
| | - Ida Scheel Rasmussen
- grid.5254.60000 0001 0674 042XUniversity of Copenhagen, Department of Public Health, Centre for General Practice, University of Copenhagen, Copenhagen, Denmark
| | - Anette Hauskov Graungaard
- grid.5254.60000 0001 0674 042XUniversity of Copenhagen, Department of Public Health, Centre for General Practice, University of Copenhagen, Copenhagen, Denmark
| | - Volkert Siersma
- grid.5254.60000 0001 0674 042XUniversity of Copenhagen, Department of Public Health, Centre for General Practice, University of Copenhagen, Copenhagen, Denmark
| | - Sarah de Voss
- grid.5254.60000 0001 0674 042XUniversity of Copenhagen, Department of Public Health, Centre for General Practice, University of Copenhagen, Copenhagen, Denmark
| | - Ruth Kirk Ertmann
- grid.5254.60000 0001 0674 042XUniversity of Copenhagen, Department of Public Health, Centre for General Practice, University of Copenhagen, Copenhagen, Denmark
| | - Sinead Shahrzad
- grid.5254.60000 0001 0674 042XUniversity of Copenhagen, Department of Public Health, Centre for General Practice, University of Copenhagen, Copenhagen, Denmark
| | - Clara Lundmark Appel
- grid.5254.60000 0001 0674 042XUniversity of Copenhagen, Department of Public Health, Centre for General Practice, University of Copenhagen, Copenhagen, Denmark
| | - Philip Wilson
- grid.5254.60000 0001 0674 042XUniversity of Copenhagen, Department of Public Health, Centre for General Practice, University of Copenhagen, Copenhagen, Denmark ,grid.7107.10000 0004 1936 7291Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland
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Johnson M, Gillberg C, Vinsa I, Fransson G, Samuelsson L, Jakobsson K, Östlund S, Fernell E, Gillberg C. A randomized controlled trial of a new intervention in early symptomatic syndromes eliciting neurodevelopmental clinical examinations: PR-ESSENCE. Eur Child Adolesc Psychiatry 2023; 32:63-74. [PMID: 34218336 PMCID: PMC9908639 DOI: 10.1007/s00787-021-01837-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 06/25/2021] [Indexed: 10/20/2022]
Abstract
The need for effective intervention programs for youth with neurodevelopmental problems (ESSENCE) and challenging behaviour is great. This study examines Problem Resolution in ESSENCE (PR-ESSENCE), a newly developed model in which children and parents develop mutual problem resolution strategies. Ten-week randomized controlled trial of PR-ESSENCE for children and adolescents aged 5-18 years, compared to treatment as usual. Outcomes were assessed at baseline and randomized period endpoint. Primary outcome was the Clinical Global Impression-Improvement scale (CGI-I) rated by blinded assessors. Secondary outcomes were rated by parents-SNAP-IV, Eyberg Child Behavior Inventory (ECBI), Relationship Problems Questionnaire, Family Burden of Illness Module, and children-Beck Youth Inventories (BYI). ClinicalTrials.gov identifier: NCT03780413. The study enrolled 108 participants (active n = 72; controls n = 36, randomized 2:1), of whom 95 completed the randomized period. No clinically significant group differences were found in baseline characteristics. More than half had autism and 80% had ADD or ADHD. Large treatment effects were seen on CGI-I (ITT analysis, Effect Size 1.48). Treatment responders, much/very much improved on CGI-I, were 51.4% in active group and 5.6% of controls. Effect sizes were medium to large in parent ratings on SNAP-IV (ODD and ADHD symptoms), ECBI (behaviour problems), and in BYI child self-ratings of disruptive behaviour. PR-ESSENCE treatment improved global symptoms and functioning (CGI-I), behaviour problems, ADHD and ODD symptoms, and disruptive behaviour. Treatment effects were at least equivalent to those in previous studies of well-established Parent Management Training and Collaborative Problem Solving programs.
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Affiliation(s)
- Mats Johnson
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Kungsgatan 12A, 411 19, Gothenburg, Sweden.
| | - Carina Gillberg
- grid.8761.80000 0000 9919 9582Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Kungsgatan 12A, 411 19 Gothenburg, Sweden
| | - Ingrid Vinsa
- grid.8761.80000 0000 9919 9582Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Kungsgatan 12A, 411 19 Gothenburg, Sweden
| | - Gunnar Fransson
- grid.8761.80000 0000 9919 9582Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Kungsgatan 12A, 411 19 Gothenburg, Sweden
| | - Lena Samuelsson
- grid.8761.80000 0000 9919 9582Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Kungsgatan 12A, 411 19 Gothenburg, Sweden
| | - Klara Jakobsson
- grid.8761.80000 0000 9919 9582Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Kungsgatan 12A, 411 19 Gothenburg, Sweden
| | - Sven Östlund
- grid.8761.80000 0000 9919 9582Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Kungsgatan 12A, 411 19 Gothenburg, Sweden
| | - Elisabeth Fernell
- grid.8761.80000 0000 9919 9582Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Kungsgatan 12A, 411 19 Gothenburg, Sweden
| | - Christopher Gillberg
- grid.8761.80000 0000 9919 9582Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Kungsgatan 12A, 411 19 Gothenburg, Sweden
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Loth E. Does the current state of biomarker discovery in autism reflect the limits of reductionism in precision medicine? Suggestions for an integrative approach that considers dynamic mechanisms between brain, body, and the social environment. Front Psychiatry 2023; 14:1085445. [PMID: 36911126 PMCID: PMC9992810 DOI: 10.3389/fpsyt.2023.1085445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 01/23/2023] [Indexed: 02/24/2023] Open
Abstract
Over the past decade, precision medicine has become one of the most influential approaches in biomedical research to improve early detection, diagnosis, and prognosis of clinical conditions and develop mechanism-based therapies tailored to individual characteristics using biomarkers. This perspective article first reviews the origins and concept of precision medicine approaches to autism and summarises recent findings from the first "generation" of biomarker studies. Multi-disciplinary research initiatives created substantially larger, comprehensively characterised cohorts, shifted the focus from group-comparisons to individual variability and subgroups, increased methodological rigour and advanced analytic innovations. However, although several candidate markers with probabilistic value have been identified, separate efforts to divide autism by molecular, brain structural/functional or cognitive markers have not identified a validated diagnostic subgroup. Conversely, studies of specific monogenic subgroups revealed substantial variability in biology and behaviour. The second part discusses both conceptual and methodological factors in these findings. It is argued that the predominant reductionist approach, which seeks to parse complex issues into simpler, more tractable units, let us to neglect the interactions between brain and body, and divorce individuals from their social environment. The third part draws on insights from systems biology, developmental psychology and neurodiversity approaches to outline an integrative approach that considers the dynamic interaction between biological (brain, body) and social mechanisms (stress, stigma) to understanding the origins of autistic features in particular conditions and contexts. This requires 1) closer collaboration with autistic people to increase face validity of concepts and methodologies; (2) development of measures/technologies that enable repeat assessment of social and biological factors in different (naturalistic) conditions and contexts, (3) new analytic methods to study (simulate) these interactions (including emergent properties), and (4) cross-condition designs to understand which mechanisms are transdiagnostic or specific for particular autistic sub-populations. Tailored support may entail both creating more favourable conditions in the social environment and interventions for some autistic people to increase well-being.
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Affiliation(s)
- Eva Loth
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
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Pre-/perinatal reduced optimality and neurodevelopment at 1 month and 3 years of age: Results from the Japan Environment and Children's Study (JECS). PLoS One 2023; 18:e0280249. [PMID: 36630408 PMCID: PMC9833583 DOI: 10.1371/journal.pone.0280249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 12/17/2022] [Indexed: 01/12/2023] Open
Abstract
Neurodevelopmental disorders (NDDs) in children are associated with a complex combination of genetic and/or environmental factors. Pre-/perinatal events are major known environmental suboptimal factors, and their individual and combined contributions vary. This study investigated the association between pre-/perinatal reduced optimality and child development observed by parents at 1 month, as well as NDDs at 3 years of age (i.e., motor delay, intellectual disability, developmental language disorder, and autism spectrum disorder), in the context of the Japan Environment and Children's Study. The study also assessed whether child development at 1 month predicted NDDs at 3 years of age. Associations between 25 pre-/perinatal factors and (a) developmental concerns at 1 month of age and (b) NDDs at 3 years were analyzed (n = 71,682). Binomial regression models were used to investigate risk ratios of the developmental outcome at each time point for total pre-/perinatal reduced optimality scale scores, as well as for individual pre-/perinatal factors of the reduced optimality scale. Finally, we assessed the ability of parental observations of offspring development at 1 month to predict NDDs at 3 years. Total reduced optimality scores were positively associated with 1-month developmental concerns and 3-year NDDs, with higher scores (i.e., a reduction in optimality) associated with an increased risk of both NDDs and earlier parental concerns. Neonatal transportation, epidural analgesia, advanced maternal age, cesarean section delivery, Apgar score ≤8, and hyperbilirubinemia were identified as individual risk factors for 3-year NDDs, overlapping with 14 risk factors for 1-month developmental concerns except Apgar score ≤8. Among six developmental items assessed at 1 month of age, concerns about gross motor function and difficulty holding/trouble calming down had the strongest associations with later-diagnosed motor delay and autism spectrum disorder, respectively. Five perinatal factors and advanced maternal age were associated with NDD at 3 years of age, as were early parental developmental concerns regarding their offspring's overall development, indicating the importance of careful follow-up of offspring born with pre-/perinatal reduced optimality. The results also implicated early parental concerns, as early as 1 month, may also be a useful indicator of later NDD status.
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Fernell E, Gillberg C. Autism under the umbrella of ESSENCE. Front Psychiatry 2023; 14:1002228. [PMID: 36756219 PMCID: PMC9901504 DOI: 10.3389/fpsyt.2023.1002228] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 01/09/2023] [Indexed: 01/24/2023] Open
Abstract
This brief article gives a short overview of "comorbidity" in autism. The most common co-occurring disorders will be presented and discussed within the context of ESSENCE (Early Symptomatic Syndromes Eliciting Neurodevelopmental Clinical Examinations), a concept that provides a holistic perspective for neurodevelopmental disorders. The ESSENCE concept also considers the heterogeneous and changing clinical panorama of developmental disorders over time, and also the multifactorial etiologies, including so called behavioral phenotype syndromes. Aspects on behavioral interventions in autism are presented-interventions that need to be adapted and take into account all non-autism associated ESSENCE, including intellectual disability and Attention-Deficit/Hyperactivity Disorder (ADHD). The article also focuses on current research on pharmacological intervention based on the hypothesis of imbalance in excitatory/inhibitory transmitter systems in autism and some other ESSENCE.
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Affiliation(s)
- Elisabeth Fernell
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Christopher Gillberg
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
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Zakirova-Engstrand R, Roll-Pettersson L, Andersson K, Larsson H, Allodi Westling M, Hirvikoski T. Group Psychoeducational Intervention for Grandparents of Young Children with ASD: An Open Feasibility Study. J Autism Dev Disord 2023; 53:808-824. [PMID: 34247300 PMCID: PMC8272608 DOI: 10.1007/s10803-021-05189-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2021] [Indexed: 11/28/2022]
Abstract
This initial open feasibility trial reports on feasibility and preliminary effectiveness of the manualized, group-based psychoeducational intervention for grandparents of preschool-aged children with ASD provided by the outpatient habilitation services in Stockholm, Sweden. One hundred and twenty non-custodial grandparents participated in a 6-h intervention program. The study demonstrated good feasibility: 114 (95%) grandparents completed both pre- and post-intervention measures and evaluations and reported high intervention acceptability. The results also indicated that grandparents increased their knowledge about ASD from pre-intervention to post-intervention, gained skills about strategies of supporting their grandchildren and adult children, and appreciated the opportunity to meet and share experiences with other grandparents. Follow-up with a randomized controlled trial design is needed to firmly establish efficacy of this intervention.
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Affiliation(s)
| | | | | | - Helena Larsson
- Habilitation & Health, Stockholm County Council, Stockholm, Sweden
| | | | - Tatja Hirvikoski
- Habilitation & Health, Stockholm County Council, Stockholm, Sweden ,Department of Women’s and Children’s Health, Center for Neurodevelopmental Disorders at Karolinska Institutet (KIND), Pediatric Neuropsychiatry Unit, Karolinska Institutet, Stockholm, Sweden ,Center for Psychiatry Research, Region Stockholm, Stockholm, Sweden
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