Autism spectrum disorder: screening, diagnosis, and medical evaluation

Constitutive activation of ERK1/2 signaling protects against myocardial ischemia via inhibition of mitochondrial fragmentation in the aging heart

Background

Studies have shown that the ability of the myocardium to tolerate ischemia becomes significantly compromised with age. During ischemia, several endogenous protective signals are activated to protect the heart from injury, among which extracellular-signal regulated kinase (ERK) 1/2 signaling has been established as playing a pivotal role. However, in aging hearts, the activation of ERK1/2 is compromised. Mitogen-activated protein kinase/ERK kinase (MEK) is a major regulator of ERK1/2 signaling. In the present study, we investigated whether transduction of CaMEK, a constitutively activated MEK, using adeno-associated virus serotype 9 (AAV9) could protect the aging heart against ischemia.

Methods

Myocardial ischemia models were established in aging mice and senescent cardiomyocytes, and AAV9-mediated delivery of CaMEK was applied. Echocardiography, fluorescent staining, transmission electron microscopy, flow cytometry, and immunoblotting were used to explore the effects of CaMEK and their underlying mechanism.

Results

AAV9-CaMEK activated ERK1/2 signaling and exerted cardioprotective effects against ischemia in aging hearts. Specifically, CaMEK transduction decreased dynamin-related protein-1 (Drp1) expression and phosphorylation at serine 616, resulting in improved mitochondrial morphology and function in aging ischemic hearts. Furthermore, CaMEK transduction exerted similar protective effects in senescent cardiomyocytes under hypoxia. Meanwhile, with the inhibition of ERK1/2 signaling in senescent cardiomyocytes under hypoxia, the opposite effects were observed, including an increase in mitochondrial fragmentation and aggravation of mitochondrial dysfunction and cell apoptosis.

Conclusions

Our results suggested that AAV9-CaMEK alleviated ischemia-induced myocardium injury in the aging heart, at least in part, through inhibition of mitochondrial fragmentation. Therefore, AAV9-CaMEK is a potential intervention for prevention of ischemia-induced injury of the aging myocardium.

Identifying the Cognitive Correlates of Reciprocity in Children with Autism Spectrum Disorder

This study examined the cognitive correlates of reciprocity in children with autism spectrum disorder (ASD). A total of 59 children with ASD were assessed with the Interactive Drawing Task, Theory of Mind Task Battery, Children's Card Change Sort Task, and Children's Gambling Task respectively for their reciprocity, theory of mind, cool executive function (EF), and hot EF. The correlational findings revealed that cool EF (r = .482 and - .501, p < .01) and hot EF (r = .396, p < .05) were significantly correlated with children's total reciprocity. The regression models also showed that cool and hot EF abilities were significant predictors. Conclusively, cool and hot EF abilities are the correlates of reciprocity rather than of ToM in children with ASD.

Psychometric Properties of Spanish Adaptation of the PDD-MRS Scale in Adults with Intellectual Developmental Disorders: The EVTEA-DI Scale

Strategies for the early detection of autism spectrum disorders (ASD) in people with intellectual developmental disorder (IDD) are urgently needed, but few specific tools have been developed. The present study examines the psychometric properties of the EVTEA-DI, a Spanish adaptation of the PDD-MRS, in a large randomized sample of 979 adults with IDD. Factorial solution analysis suggested a three-factor solution (stereotyped behavior, communication, and social behavior). The EVTEA-DI showed good reliability and convergent validity when compared to the Childhood Autism Rating Scale. Discriminative validity analysis resulted in an acceptable global sensitivity of 70% and a high specificity of 90%. The EVTEA-DI proved to be a valid screening tool in ASD assessment of the adult Spanish population with IDD.

Autism Spectrum Disorder Screening Instruments for Very Young Children: A Systematic Review

Research on ASD in infancy has provided a rationale for developing screening instruments for children from the first year of life to age of 18 months. A comprehensive literature search identified candidate screening tools. Using methodological probe questions adapted from the Quality Assessment of Diagnostic Accuracy Studies (QUADAS), two Level 1 and three Level 2 screening instruments were reviewed in detail. Research evidence conclusions were that instrument development was in beginning phases, is not yet strong, and requires further development. Clinical recommendations were to continue vigilant developmental and autism surveillance from the first year on but to use the screening instruments per se only for high-risk children rather than for population screening, with considerations regarding feasibility for individual settings, informing caregivers about strengths and weaknesses of the tool, and monitoring new research.

Use of a Picture Exchange Communication System for preventive procedures in individuals with autism spectrum disorder: pilot study

The aim of the present study was to evaluate the use of the Picture Exchange Communication System (PECS) in individuals with autism spectrum disorder (ASD) in order to facilitate patient-professional communication during preventive procedures. In this study, 26 patients with ASD, between 5 and 19 years of age (10±3.3 y), were divided into two groups: G1 (n = 13) with no previous experience of dental treatment, and G2 (n = 13), with such previous experience. The initial approach followed the principles of the Son-Rise Program®. The seven PECSs presented the routine of the dental office: "room," "ground," "chair," "dentist," "mouth," "low," and "triple." Each PEC was used up to three times in order to acquire the skill proposed. It was verified that G2 required a greater number of times to achieve the acceptance of PECS "ground," "dentist," "mouth," and "triple" (p < .05). We concluded that PECS facilitated patient-professional communication during preventive procedures, including for ASD patients with previous dental experience.

The PI3K signaling pathway as a pharmacological target in Autism related disorders and Schizophrenia

This review is focused in PI3K’s involvement in two widespread mental disorders: Autism and Schizophrenia. A large body of evidence points to synaptic dysfunction as a cause of these diseases, either during the initial phases of brain synaptic circuit’s development or later modulating synaptic function and plasticity. Autism related disorders and Schizophrenia are complex genetic conditions in which the identification of gene markers has proved difficult, although the existence of single-gene mutations with a high prevalence in both diseases offers insight into the role of the PI3K signaling pathway. In the brain, components of the PI3K pathway regulate synaptic formation and plasticity; thus, disruption of this pathway leads to synapse dysfunction and pathological behaviors. Here, we recapitulate recent evidences that demonstrate the imbalance of several PI3K elements as leading causes of Autism and Schizophrenia, together with the plausible new pharmacological paths targeting this signaling pathway.

The assessment of autism spectrum disorders in adults

Purpose

– The purpose of this paper is to explore and highlight the main elements of an autism spectrum disorder assessment in adults. It features significant challenges for the clinical teams responsible to undertake the assessment. This paper aims to explain the importance of the wider needs assessment in accordance to the Autism Act and Autism Strategy.

Design/methodology/approach

– The paper describes the main symptom domains for an ASD diagnosis, according to the two basic diagnostic manuals. It provides compendious summary of the available diagnostic tools and the significant comorbidities people with ASD present with including other neurodevelopmental disorders, mental or physical health problems, challenging behaviour and risk issues.

Findings

– The paper proposes that all National Health System professionals should be able to recognise possible signs of ASD and accordingly refer individuals for a comprehensive assessment to secondary services. It highlights the importance of a wider needs assessment as part of a broader approach to addressing the needs of those with suspected ASD.

Practical implications

– The paper aims to improve the gaps which remain in the referral and diagnostic process of people affected by ASD.

Social implications

– Through a comprehensive assessment the paper aims to improve the educational, social and personal functioning of people with ASD as well as the quality of life of their parents and carers.

Originality/value

– The paper assembles a wide range of relevant considerations in regards to potential ASD in one place, and can be used to inform a comprehensive understanding of the assessment/diagnosis process.

Non-traumatic Dental Condition-Related Emergency Department Visits and Associated Costs for Children and Adults with Autism Spectrum Disorders

We analyzed 2010 US National Emergency Department Sample data and ran regression models to test the hypotheses that individuals with ASD are more likely to have non-traumatic dental condition (NTDC)-related emergency department (ED) visits and to incur greater costs for these visits than those without ASD. There were nearly 2.3 million NTDC-related ED visits in 2010. Less than 1.0% (children) and 2.1% (adults) of all ED visits were for NTDC. There was no significant difference in NTDC-related ED visits or costs for children by ASD status. Adults with ASD had significantly lower odds of NTDC-related ED visits (OR 0.39; 95% CI 0.29, 0.52; p < 0.001) but incurred significantly greater mean costs for NTDC-related ED visits (p < 0.006) than did adults without ASD.

Behavioural aspects of patients with Autism Spectrum Disorders (ASD) that affect their dental management

Dental treatment in patients with Autism Spectrum Disorders (ASD) can be complicated due to the presence of behavioral alterations. In this group, there are no specific behavioral profiles that allow dentist to anticipate the attitude that a patient will show during a visit. Thus, behavioral attitudes have been described that vary from total permissiveness and collaboration during even bloody procedures, to the absolute impossibility in conducting a simple oral examination. There is no effective behavioral management technique for all ASD patients. Prior information, such as the type of ASD or the presence of certain concurrent pathologies can help predict the patient’s likely behavior. Therefore, gathering all the information in a preliminary interview with the parents/guardians of the patient is recommended. Knowing these factors will allow individualized behavioral management strategies to be designed and facilitates the planning of dental treatment.

Key words:Dentistry, autism, ASD, behavior management.

Levantamento de protocolos e métodos diagnósticos do transtorno autista aplicáveis na clínica fonoaudiológica: uma revisão de literatura

A Fonoaudiologia, no âmbito das ciências da saúde que estudam a comunicação humana, assume grande importância tanto no diagnóstico quanto no tratamento daquelas pessoas com autismo. Entretanto, ainda são poucos os fonoaudiólogos que publicam regularmente sobre o tema, o que demonstra ser uma área que necessita de mais estudos. O transtorno autista caracteriza-se por um prejuízo no desenvolvimento da interação social, da comunicação e do comportamento. Seu diagnóstico deve ser criterioso e considerar os três campos acima. É comum o fonoaudiólogo ser o primeiro profissional procurado pelos pais de crianças autistas; portanto, ele deve saber identificar esses casos. O objetivo da pesquisa foi levantar métodos e protocolos de avaliação e diagnóstico do transtorno autista, disponíveis na literatura nacional, cujas aplicações possam ser da prática clínica fonoaudiológica. A partir de várias referências, encontraram-se dez protocolos: sete traduzidos e validados da língua estrangeira para o português brasileiro e três desenvolvidos no próprio Brasil. Não foram encontradas publicações nacionais que utilizassem quatro dos dez instrumentos apresentados para fins de triagem ou diagnóstico de casos suspeitos ou com risco para autismo. Evidencia-se, também, a pouca participação do fonoaudiólogo nesse processo. Além disso, nenhum desses instrumentos foi considerado preciso para diagnosticar esse transtorno. É importante salientar que é necessária uma reflexão crítica à realidade do que ocorre, ainda, no processo de diagnóstico do autismo.

Translation and validation of Autism Diagnostic Interview-Revised (ADI-R) for autism diagnosis in Brazil

OBJECTIVE: To translate into Brazilian Portuguese the Autism Diagnostic Interview-Revised (ADI-R), an extremely useful diagnostic tool in autism. METHODS: A case-control study was done to validate the ADI-R. After being translated, the interview was applied in a sample of 20 patients with autism and 20 patients with intellectual disability without autism, in order to obtain the initial psychometric properties. RESULTS: The internal consistency was high, with a of Crombach of 0.967. The validity of criterion had sensitivity and specificity of 100%, having as a gold standard the DSM-IV diagnostic criteria. The interview had high discriminant validity, with higher scores in the group of patients with autism, as well as high interobserver consistency, with median kappa of 0.824. CONCLUSION: The final version of ADI-R had satisfactory psychometric characteristics, indicating good preliminary validation properties. The instrument needs to be applied in bigger samples in other areas of the country.

The validity of the Baby and Infant Screen for Children with aUtIsm Traits: Part 1 (BISCUIT: Part 1)

A top priority in the field of autism spectrum disorders (ASD) is the development of precise early diagnostic tools that can be completed with minimal time and training. We report on the convergent and divergent validity of the Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT), specifically the BISCUIT-Part 1. Previous research with this scale has determined its reliability and sensitivity/specificity. In this study, a sample of 1,007 toddlers 17-37 months of age were assessed individually. The BISCUIT-Part 1 demonstrated good convergent validity with the Modified CHecklist for Autism in Toddlers (M-CHAT) and the Personal Social domain from the Battelle Developmental Inventory, Second Edition (BDI-2). Additionally, divergent validity was demonstrated by its small correlation with the Adaptive and Motor domains from the BDI-2.

Fractality and a wavelet-chaos-neural network methodology for EEG-based diagnosis of autistic spectrum disorder

A method is presented for investigation of EEG of children with autistic spectrum disorder using complexity and chaos theory with the goal of discovering a nonlinear feature space. Fractal Dimension is proposed for investigation of complexity and dynamical changes in autistic spectrum disorder in brain. Two methods are investigated for computation of fractal dimension: Higuchi's Fractal Dimension and Katz's Fractal Dimension. A wavelet-chaos-neural network methodology is presented for automated EEG-based diagnosis of autistic spectrum disorder. The model is tested on a database of eyes-closed EEG data obtained from two groups: nine autistic spectrum disorder children, 6 to 13 years old, and eight non-autistic spectrum disorder children, 7 to 13 years old. Using a radial basis function classifier, an accuracy of 90% was achieved based on the most significant features discovered via analysis of variation statistical test, which are three Katz's Fractal Dimensions in delta (of loci Fp2 and C3) and gamma (of locus T6) EEG sub-bands with P < 0.001.

Childhood autism and auditory system abnormalities

Hearing disorders are common among children with autism, ranging from peripheral and sensorineural hearing deficit or loss to auditory hypersensitivity with bizarre reactions to sounds. The auditory abnormalities and consequent sensory deprivation exacerbate the communication deficit of autism, and early auditory assessment holds an important place in the planning of intervention and the overall prognosis of patients. Physiologic, pathologic, imaging, and neurochemical studies have revealed an array of aberrations in the perception and processing of the audiologic stimuli, including (among others) maturational defects, atypical lateralization, and serotonin dysfunction.

Multiple rare variants in the etiology of autism spectrum disorders

Recent studies in autism spectrum disorders (ASDs) support an important role for multiple rare variants in these conditions. This is a clinically important finding, as, with the demonstration that a significant proportion of ASDs are the result of rare, etiological genetic variants, it becomes possible to make use of genetic testing to supplement behavioral analyses for an earlier diagnosis. As it appears that earlier interventions in ASDs will produce better outcomes, the development of genetic testing to augment behaviorally based evaluations in ASDs holds promise for improved treatment. Furthermore, these rare variants involve synaptic and neuronal genes that implicate specific paihvi/ays, cells, and subcellular compartments in ASDs, which in turn will suggest novel therapeutic approaches in ASDs, Of particular recent interest are the synaptic cell adhesion and associated molecules, including neurexin 1, neuroligin 3 and 4, and SHANK3, which implicate glutamatergic synapse abnormalities in ASDs, In the current review we will overview the evidence for a genetic etiology for ASDs, and summarize recent genetic findings in these disorders.

Enhanced perceptual processing of speech in autism

Theories of autism have proposed that a bias towards low-level perceptual information, or a featural/surface-biased information-processing style, may compromise higher-level language processing in such individuals. Two experiments, utilizing linguistic stimuli with competing low-level/perceptual and high-level/semantic information, tested processing biases in children with autism and matched controls. Whereas children with autism exhibited superior perceptual processing of speech relative to controls, and showed no evidence of either a perceptual or semantic processing bias, controls showed a tendency to process speech semantically. The data provide partial support to the perceptual theories of autism. It is additionally proposed that the pattern of results may reflect different patterns of attentional focusing towards single or multiple stimulus cues in speech between children with autism and controls.

Autism spectrum disorders: concurrent clinical disorders

Individuals with autism spectrum disorder are heterogeneous in clinical presentation, concurrent disorders, and developmental outcomes. This study characterized the clinical co-occurrences and potential subgroups in 160 children with autism spectrum disorders who presented to The Autism Center between 1999 and 2003. Medical and psychiatric co-occurrences included sleep disorders, epilepsy, food intolerance, gastrointestinal dysfunction, mood disorder, and aggressive and self-injurious behaviors. Sleep disorders were associated with gastrointestinal dysfunction (P < .05) and mood disorders (P < .01). Food intolerance was associated with gastrointestinal dysfunction (P = .001). Subjects with mood disorder tended to develop aggressive or self-injurious behaviors (P < .05). Developmental regression was not associated with increased co-occurrence of medical or psychiatric disorders. Medical co-occurrence did not present as a risk factor for psychiatric co-occurrence, and vice versa. These results showed a high prevalence of multiple medical and psychiatric co-occurrences. There may be common pathophysiologic mechanisms resulting in clinical subgroups of autism spectrum disorders. Recognition of the co-occurrence of concurrent disorders may provide insight into the therapeutic strategy.

The neuropathology, medical management and dental implications of autism

BACKGROUND

A paucity of information exists in the dental literature about autism and its dental implications.

TYPES OF STUDIES REVIEWED

The authors conducted a MEDLINE search for the period 2000 through 2006, using the term "autism," with the aim of defining the condition's clinical manifestations, dental and medical treatment and dental implications.

RESULTS

Autism is a severe developmental brain disorder that appears in infancy, persists throughout life, and is characterized by impaired social interaction, abnormalities in communication (both verbal and nonverbal) and restricted interests. Often accompanying the disorder are behavioral disturbances - such as self-mutilation, aggression, psychiatric symptoms and seizures - that necessitate the administration of multiple medications to help the affected person participate effectively in the educational and rehabilitative process.

CLINICAL IMPLICATIONS

Dentists caring for people with autism must be familiar with the manifestations of the disease and its associated features so that they can garner the maximum level of patient cooperation. They also must be familiar with the medications used to treat the associated features of the disorder because many of them cause untoward orofacial and systemic reactions and may precipitate adverse interactions with dental therapeutic agents.

Developmental Neurobiology and Clinical Disorders: Lost in Translation?

Advances in defining mechanisms of cortical development have been paralleled in recent years by an intense interest in translating these findings into greater insight of both childhood- and adult-onset cognitive and mental health disorders of developmental etiology. Successful integration of basic and clinical findings have been applied to monogenic disorders. The greater challenge lies in studying cortical development in the context of gene x environment interactions, which underlie the pathogenesis of the most common neurodevelopmental disorders. This can occur through an improved delineation of pathophysiological characteristics unique to specific complex disorders and the application of this information to the refinement of the most relevant model systems.