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Pérez-Cano L, Boccuto L, Sirci F, Hidalgo JM, Valentini S, Bosio M, Liogier D’Ardhuy X, Skinner C, Cascio L, Srikanth S, Jones K, Buchanan CB, Skinner SA, Gomez-Mancilla B, Hyvelin JM, Guney E, Durham L. Characterization of a Clinically and Biologically Defined Subgroup of Patients with Autism Spectrum Disorder and Identification of a Tailored Combination Treatment. Biomedicines 2024; 12:991. [PMID: 38790952 PMCID: PMC11117897 DOI: 10.3390/biomedicines12050991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 04/23/2024] [Accepted: 04/27/2024] [Indexed: 05/26/2024] Open
Abstract
Autism spectrum disorder (ASD) is a heterogeneous group of neurodevelopmental disorders (NDDs) with a high unmet medical need. The diagnosis of ASD is currently based on behavior criteria, which overlooks the diversity of genetic, neurophysiological, and clinical manifestations. Failure to acknowledge such heterogeneity has hindered the development of efficient drug treatments for ASD and other NDDs. DEPI® (Databased Endophenotyping Patient Identification) is a systems biology, multi-omics, and machine learning-driven platform enabling the identification of subgroups of patients with NDDs and the development of patient-tailored treatments. In this study, we provide evidence for the validation of a first clinically and biologically defined subgroup of patients with ASD identified by DEPI, ASD Phenotype 1 (ASD-Phen1). Among 313 screened patients with idiopathic ASD, the prevalence of ASD-Phen1 was observed to be ~24% in 84 patients who qualified to be enrolled in the study. Metabolic and transcriptomic alterations differentiating patients with ASD-Phen1 were consistent with an over-activation of NF-κB and NRF2 transcription factors, as predicted by DEPI. Finally, the suitability of STP1 combination treatment to revert such observed molecular alterations in patients with ASD-Phen1 was determined. Overall, our results support the development of precision medicine-based treatments for patients diagnosed with ASD.
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Affiliation(s)
- Laura Pérez-Cano
- Discovery and Data Science (DDS) Unit, STALICLA SL, Moll de Barcelona, s/n, Edif Este, 08039 Barcelona, Spain; (F.S.); (J.M.H.); (S.V.); (M.B.); (E.G.)
| | - Luigi Boccuto
- JC Self Research Institute, Greenwood Genetic Center, Greenwood, SC 29649, USA; (L.B.); (C.S.); (L.C.); (S.S.); (K.J.); (C.B.B.); (S.A.S.)
- Healthcare Genetics and Genomics, School of Nursing, Clemson University, Clemson, SC 29634, USA
| | - Francesco Sirci
- Discovery and Data Science (DDS) Unit, STALICLA SL, Moll de Barcelona, s/n, Edif Este, 08039 Barcelona, Spain; (F.S.); (J.M.H.); (S.V.); (M.B.); (E.G.)
| | - Jose Manuel Hidalgo
- Discovery and Data Science (DDS) Unit, STALICLA SL, Moll de Barcelona, s/n, Edif Este, 08039 Barcelona, Spain; (F.S.); (J.M.H.); (S.V.); (M.B.); (E.G.)
| | - Samuel Valentini
- Discovery and Data Science (DDS) Unit, STALICLA SL, Moll de Barcelona, s/n, Edif Este, 08039 Barcelona, Spain; (F.S.); (J.M.H.); (S.V.); (M.B.); (E.G.)
| | - Mattia Bosio
- Discovery and Data Science (DDS) Unit, STALICLA SL, Moll de Barcelona, s/n, Edif Este, 08039 Barcelona, Spain; (F.S.); (J.M.H.); (S.V.); (M.B.); (E.G.)
| | - Xavier Liogier D’Ardhuy
- Drug Development Unit (DDU), STALICLA SA, Avenue de Sécheron 15, 1202 Geneva, Switzerland; (X.L.D.); (B.G.-M.); (J.-M.H.)
| | - Cindy Skinner
- JC Self Research Institute, Greenwood Genetic Center, Greenwood, SC 29649, USA; (L.B.); (C.S.); (L.C.); (S.S.); (K.J.); (C.B.B.); (S.A.S.)
| | - Lauren Cascio
- JC Self Research Institute, Greenwood Genetic Center, Greenwood, SC 29649, USA; (L.B.); (C.S.); (L.C.); (S.S.); (K.J.); (C.B.B.); (S.A.S.)
- Research and Education in Disease Diagnosis and Interventions (REDDI) Lab, Center for Innovative Medical Devices and Sensors (CIMeDS), Clemson University, Clemson, SC 29634, USA
| | - Sujata Srikanth
- JC Self Research Institute, Greenwood Genetic Center, Greenwood, SC 29649, USA; (L.B.); (C.S.); (L.C.); (S.S.); (K.J.); (C.B.B.); (S.A.S.)
- Research and Education in Disease Diagnosis and Interventions (REDDI) Lab, Center for Innovative Medical Devices and Sensors (CIMeDS), Clemson University, Clemson, SC 29634, USA
| | - Kelly Jones
- JC Self Research Institute, Greenwood Genetic Center, Greenwood, SC 29649, USA; (L.B.); (C.S.); (L.C.); (S.S.); (K.J.); (C.B.B.); (S.A.S.)
- Research and Education in Disease Diagnosis and Interventions (REDDI) Lab, Center for Innovative Medical Devices and Sensors (CIMeDS), Clemson University, Clemson, SC 29634, USA
| | - Caroline B. Buchanan
- JC Self Research Institute, Greenwood Genetic Center, Greenwood, SC 29649, USA; (L.B.); (C.S.); (L.C.); (S.S.); (K.J.); (C.B.B.); (S.A.S.)
| | - Steven A. Skinner
- JC Self Research Institute, Greenwood Genetic Center, Greenwood, SC 29649, USA; (L.B.); (C.S.); (L.C.); (S.S.); (K.J.); (C.B.B.); (S.A.S.)
| | - Baltazar Gomez-Mancilla
- Drug Development Unit (DDU), STALICLA SA, Avenue de Sécheron 15, 1202 Geneva, Switzerland; (X.L.D.); (B.G.-M.); (J.-M.H.)
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC H3A 0G4, Canada
| | - Jean-Marc Hyvelin
- Drug Development Unit (DDU), STALICLA SA, Avenue de Sécheron 15, 1202 Geneva, Switzerland; (X.L.D.); (B.G.-M.); (J.-M.H.)
| | - Emre Guney
- Discovery and Data Science (DDS) Unit, STALICLA SL, Moll de Barcelona, s/n, Edif Este, 08039 Barcelona, Spain; (F.S.); (J.M.H.); (S.V.); (M.B.); (E.G.)
| | - Lynn Durham
- Discovery and Data Science (DDS) Unit, STALICLA SL, Moll de Barcelona, s/n, Edif Este, 08039 Barcelona, Spain; (F.S.); (J.M.H.); (S.V.); (M.B.); (E.G.)
- Drug Development Unit (DDU), STALICLA SA, Avenue de Sécheron 15, 1202 Geneva, Switzerland; (X.L.D.); (B.G.-M.); (J.-M.H.)
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Niemeyer L, Mechler K, Dittmann RW, Banaschewski T, Buitelaar J, Durston S, Häge A. Memantine as treatment for compulsivity in child and adolescent psychiatry: Descriptive findings from an incompleted randomized, double-blind, placebo-controlled trial. Contemp Clin Trials Commun 2022; 29:100982. [PMID: 36092975 PMCID: PMC9450066 DOI: 10.1016/j.conctc.2022.100982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 07/29/2022] [Accepted: 08/09/2022] [Indexed: 11/28/2022] Open
Abstract
Background Autism spectrum disorder (ASD) and obsessive-compulsive disorder (OCD) are mental disorders with a considerable overlap in terms of their defining symptoms. The glutamatergic agent memantine appears to be a promising candidate for the treatment of ASD and OCD in children and adolescents. The aim of this study was to investigate the clinical efficacy and tolerability/safety of memantine in this population. Methods This randomized, double-blind, placebo-controlled multicenter add-on trial comprised patients aged 6 to 17; 9 years with a confirmed diagnosis of ASD and/or OCD. Participants were randomized to either memantine or placebo for 10 consecutive weeks, including an up-titration phase. Results A total of 7 patients were included in the study. N = 4 (57.1%) participants were treated with verum (memantine) and n = 3 (42.9%) received placebo. Patients receiving memantine showed a more pronounced reduction in their CY-BOCS score, as well as greater CGI-Improvement, compared to patients receiving placebo. No serious adverse events (SAEs) were reported. Conclusions Our findings, although based on a very small number of patients and therefore insufficient to draw clear conclusions, appear to be in line with the hypothesis that memantine is an effective, tolerable and safe agent for children and adolescents. Trial registration EudraCT Number: 2014-003080-38, Registered 14 July 2014, https://www.clinicaltrialsregister.eu/ctr-search/search?query=2014-003080-38.
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Affiliation(s)
- Larissa Niemeyer
- Pediatric Psychopharmacology, Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Konstantin Mechler
- Pediatric Psychopharmacology, Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Ralf W. Dittmann
- Pediatric Psychopharmacology, Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Tobias Banaschewski
- Pediatric Psychopharmacology, Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Jan Buitelaar
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
| | - Sarah Durston
- Department of Psychiatry, University Medical Center Utrecht Brain Center, Utrecht, the Netherlands
| | - Alexander Häge
- Pediatric Psychopharmacology, Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
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Kim BU, Kim HW, Park EJ, Kim JH, Boon-Yasidhi V, Tarugsa J, Reyes A, Manalo SG, Joung YS. Long-Term Improvement and Safety of Aripiprazole for Irritability and Adaptive Function in Asian Children and Adolescents with Autistic Disorder: A 52-Week, Multinational, Multicenter, Open-Label Study. J Child Adolesc Psychopharmacol 2022; 32:390-399. [PMID: 36112116 DOI: 10.1089/cap.2022.0004] [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: 11/13/2022]
Abstract
Objective: Evaluate the long-term improvement and safety of aripiprazole in treating irritability in Asian children and adolescents (6-17 years) with autistic disorder. Methods: A 52-week, open-label, flexibly dosed (2-15 mg/day) study on the improvement and safety of aripiprazole in patients with autistic disorder who had completed an antecedent 12-week open-label study. The evaluation of efficacy was conducted using the Aberrant Behavior Checklist (ABC), Clinical Global Impression (CGI) scale, Child Yale-Brown Obsessive-Compulsive Scale (CY-BOCS), Vineland Adaptive Behavior Scale (VABS), and the Parenting Stress Index-Short Form (PSI-SF). Safety and tolerability measurements included adverse events, vital signs, electrocardiography, laboratory tests, body weight, and extrapyramidal symptoms (EPSs). Results: During the 52-week treatment, all effectiveness variables, including ABC, CGI, CY-BOCS, VABS, and PSI-SF scores, showed improvement. Regarding safety, the proportion of patients who experienced any treatment-emergent adverse events (TEAEs) was 58.62% (34/58 subjects, 75 cases). The most common TEAE was nasopharyngitis reported in 20.69% (15/58 subjects, 15 cases) and the other TEAE with an incidence of ≥10% was weight increases in 18.97% (11/58 subjects, 11 cases). Of them, 27.59% (16/58 subjects, 28 cases) experienced adverse drug reactions (ADRs). The most common ADR was weight increase reported in 15.52% (9/58 subjects, nine cases). The incidence of serious adverse events (SAEs) was 5.17% (3/58 subjects, three cases), which were epiphysiolysis, seizure, and a suicide attempt, but these were not ADRs. There were no clinically significant changes found in the evaluation of EPSs. Conclusions: Aripiprazole showed improvement for behavioral problems and adaptive functioning and was well tolerated in patients with autistic disorder until nearly a year after drug use. The Clinical Trial Registration number: NCT02069977.
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Affiliation(s)
- Byoung-Uk Kim
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Severance Hospital, Seoul, Korea
| | - Hyo-Won Kim
- Department of Psychiatry, University of Ulsan College of Medicine, Asan Medical Center Children's Hospital, Seoul, Korea
| | - Eun Jin Park
- Department of Psychiatry, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Ji-Hoon Kim
- Department of Psychiatry, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Vitharon Boon-Yasidhi
- Division of Child and Adolescent Psychiatry, Department of Pediatrics, Mahidol University Faculty of Medicine Siriraj Hospital, Bangkok, Thailand
| | - Jariya Tarugsa
- Division of Child and Adolescent Psychiatry, Department of Pediatrics, Mahidol University Faculty of Medicine Siriraj Hospital, Bangkok, Thailand
| | - Alexis Reyes
- Section of Pediatrics, Child Neuroscience Center, Philippine Children's Medical Center, Quezon City, Philippines
| | - Stella G Manalo
- Department of Pediatrics, The Medical City, Pasig City, Philippines.,Department of Pediatrics, College of Medicine, University of Philippines, Manila, Philippines
| | - Yoo-Sook Joung
- Department of Psychiatry, Sungkyunkwan University School of Medicine, Samsung Medical Center, Gangnam-gu, Seoul, Korea
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Crutel V, Lambert E, Penelaud PF, Albarrán Severo C, Fuentes J, Rosier A, Hervás A, Marret S, Oliveira G, Parellada M, Kyaga S, Gouttefangeas S, Bertrand M, Ravel D, Falissard B. Bumetanide Oral Liquid Formulation for the Treatment of Children and Adolescents with Autism Spectrum Disorder: Design of Two Phase III Studies (SIGN Trials). J Autism Dev Disord 2021; 51:2959-2972. [PMID: 33151500 PMCID: PMC8254707 DOI: 10.1007/s10803-020-04709-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
There are currently no approved pharmacological treatments to improve social reciprocity and limit repetitive and rigid behaviors in autism spectrum disorder (ASD). We describe the design of two Phase III studies evaluating the efficacy/safety of bumetanide oral liquid formulation in ASD. These are international, multicenter, randomized, double-blind, placebo-controlled studies in children and adolescents with ASD aged 7 to 17 years (n = 200; study 1), or younger children with ASD aged 2 to 6 years (n = 200; study 2). The primary endpoint of each is change in Childhood Autism Rating Scale 2 total raw score after 6 months. These studies could contribute to the first pharmacological treatment to improve social reciprocity and limit repetitive and rigid behaviors in children and adolescents with ASD.
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Affiliation(s)
- Véronique Crutel
- Neuro Immuno-Inflammation Therapeutic Area, Institut de Recherches Internationales Servier, Suresnes, France
| | - Estelle Lambert
- Neuro Immuno-Inflammation Therapeutic Area, Institut de Recherches Internationales Servier, Suresnes, France
| | - Pierre-François Penelaud
- Neuro Immuno-Inflammation Therapeutic Area, Institut de Recherches Internationales Servier, Suresnes, France
| | - Cristina Albarrán Severo
- Neuro Immuno-Inflammation Therapeutic Area, Institut de Recherches Internationales Servier, Suresnes, France
| | - Joaquin Fuentes
- Child & Adolescent Psychiatry Service, Policlínica Gipuzkoa & GAUTENA Autism Society, San Sebastián, Spain
| | - Antoine Rosier
- Department of Neonatal Pediatrics, CHU de Rouen and CHU Le Rouvray, Sotteville les Rouen, France
| | - Amaia Hervás
- Child and Adolescent Mental Health Service, Hospital Universitari Mútua de Terrassa, and Global Institute of Neurodevelopment Integrated Care (IGAIN), Barcelona, Spain
| | - Stéphane Marret
- Department of Neonatal Pediatrics, Intensive Care, and Neuropediatrics, Rouen University Hospital, Rouen, France
- INSERM U 1245 team 4 Neovasc, School of Medicine, Normandy University, Rouen, France
| | - Guiomar Oliveira
- Neurodevelopmental and Autism Unit from Child Developmental Center and Centro de Investigação e Formação Clínica, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Faculty of Medicine, University Clinic of Pediatrics, University of Coimbra, Coimbra, Portugal
| | - Mara Parellada
- Servicio de Psiquiatría del Niño y del Adolescente Hospital General Universitario Gregorio Marañón, CIBERSAM, IiSGM, Ibiza 43, Madrid, Spain
| | - Simon Kyaga
- Global Medical and Patient Affairs, Servier, 35 rue de Verdun, 92284, Suresnes cedex, Suresnes, France.
| | - Sylvie Gouttefangeas
- Neuro Immuno-Inflammation Therapeutic Area, Institut de Recherches Internationales Servier, Suresnes, France
| | - Marianne Bertrand
- Neuro Immuno-Inflammation Therapeutic Area, Institut de Recherches Internationales Servier, Suresnes, France
| | | | - Bruno Falissard
- University Paris-Sud, Univ. Paris-Descartes, AP-HP, INSERM U1178, Paris, France
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Muris P, Ollendick TH. Selective Mutism and Its Relations to Social Anxiety Disorder and Autism Spectrum Disorder. Clin Child Fam Psychol Rev 2021; 24:294-325. [PMID: 33462750 PMCID: PMC8131304 DOI: 10.1007/s10567-020-00342-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2020] [Indexed: 12/24/2022]
Abstract
In current classification systems, selective mutism (SM) is included in the broad anxiety disorders category. Indeed, there is abundant evidence showing that anxiety, and social anxiety in particular, is a prominent feature of SM. In this article, we point out that autism spectrum problems in addition to anxiety problems are sometimes also implicated in SM. To build our case, we summarize evidence showing that SM, social anxiety disorder (SAD), and autism spectrum disorder (ASD) are allied clinical conditions and share communalities in the realm of social difficulties. Following this, we address the role of a prototypical class of ASD symptoms, restricted and repetitive behaviors and interests (RRBIs), which are hypothesized to play a special role in the preservation and exacerbation of social difficulties. We then substantiate our point that SM is sometimes more than an anxiety disorder by addressing its special link with ASD in more detail. Finally, we close by noting that the possible involvement of ASD in SM has a number of consequences for clinical practice with regard to its classification, assessment, and treatment of children with SM and highlight a number of directions for future research.
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Affiliation(s)
- Peter Muris
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
- Stellenbosch University, Stellenbosch, South Africa.
| | - Thomas H Ollendick
- Virginia Polytechnic Institute and State University, Blacksburg, USA
- Roehampton University, London, England
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Kim HW, Park EJ, Kim JH, Boon-Yasidhi V, Tarugsa J, Reyes A, Manalo S, Joung YS. Aripiprazole for Irritability in Asian Children and Adolescents with Autistic Disorder: A 12-Week, Multinational, Multicenter, Prospective Open-Label Study. J Child Adolesc Psychopharmacol 2019; 28:402-408. [PMID: 29688754 DOI: 10.1089/cap.2017.0152] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES We investigated the effectiveness and tolerability of aripiprazole in the treatment of irritability in Asian children and adolescents (6-17 years) with autistic disorder in a 12-week, multinational, multicenter, open-label study. METHODS Sixty-seven subjects (10.0 ± 3.1 years old, 52 boys) were enrolled and treated with flexibly dosed aripiprazole for 12 weeks (mean dose, 5.1 ± 2.5 mg; range 2-15 mg). RESULTS Aripiprazole significantly reduced the mean caregiver-rated scores for the Irritability, Lethargy/Social Withdrawal, Stereotypy, Hyperactivity, and Inappropriate Speech subscales of the Aberrant Behavior Checklist from baseline to week 12 (p < 0.001 for all subscales). Clinician-rated Clinical Global Impression Severity of Illness scale score also improved from baseline through week 12 (p < 0.001). The most common adverse event was weight gain and no serious adverse event related to aripiprazole treatment was noted. CONCLUSION Our results suggest that aripiprazole is effective and generally tolerable in the treatment of irritability in Asian children and adolescents with autistic disorder. Further studies with larger sample sizes and longer treatment durations are required.
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Affiliation(s)
- Hyo-Won Kim
- 1 Department of Psychiatry, University of Ulsan College of Medicine , Asan Medical Center, Seoul, South Korea
| | - Eun-Jin Park
- 2 Department of Psychiatry, Inje University , Ilsan Paik Hospital, Goyang, South Korea
| | - Ji-Hoon Kim
- 3 Department of Psychiatry, Pusan National University Yangsan Hospital , Pusan, South Korea
| | - Vitharon Boon-Yasidhi
- 4 Division of Child and Adolescent Psychiatry, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University , Bangkok, Thailand
| | - Jariya Tarugsa
- 4 Division of Child and Adolescent Psychiatry, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University , Bangkok, Thailand
| | - Alexis Reyes
- 5 Section of Pediatrics, Child Neuroscience Center, Philippine Children's Medical Center , Quezon City, Philippines
| | - Stella Manalo
- 6 Department of Pediatrics, College of Medicine, University of the Philippines , Manila, Philippines .,7 Department of Pediatrics, The Medical City, Pasig City, Philippines
| | - Yoo-Sook Joung
- 8 Department of Psychiatry, Sungkyunkwan University School of Medicine , Samsung Medical Center, Seoul, South Korea
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7
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The Need for a Developmentally Based Measure of Social Communication Skills. J Am Acad Child Adolesc Psychiatry 2019; 58:555-560. [PMID: 31130206 PMCID: PMC6599636 DOI: 10.1016/j.jaac.2018.12.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 12/04/2018] [Accepted: 02/15/2019] [Indexed: 12/14/2022]
Abstract
The ability to demonstrate and quantify changes in social communication skills has been hindered by a lack of existing measures with appropriate standardization and psychometric properties. Such a measure would be helpful for research in many populations but would be particularly crucial for detecting incremental changes in youth with neurodevelopmental disorders who might gain skills but still lag substantially behind same-age peers. Although study designs and statistical methods are under development to try to account for slow and/or nonlinear, but potentially meaningful, improvements,1 there is a dearth of measures designed to capture growth and loss of social communication skills. This opinion piece outlines the argument for such a measure and the primary issues to consider in its development.
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8
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Wagner RE, Zhang Y, Gray T, Abbacchi A, Cormier D, Todorov A, Constantino JN. Autism-Related Variation in Reciprocal Social Behavior: A Longitudinal Study. Child Dev 2018; 90:441-451. [PMID: 30346626 PMCID: PMC6446804 DOI: 10.1111/cdev.13170] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Deficits in reciprocal social behavior are a characterizing feature of autism spectrum disorder (ASD). Autism‐related variation in reciprocal social behavior (AVR) in the general population is continuously distributed and highly heritable—a function of additive genetic influences that overlap substantially with those which engender clinical autistic syndromes. This is the first long‐term prospective study of the stability of AVR from childhood through early adulthood, conducted via serial ratings using the Social Responsiveness Scale, in a cohort‐sequential study involving children with ASD, other psychiatric conditions, and their siblings (N = 602, ages = 2.5–29). AVR exhibits marked stability throughout childhood in individuals with and without ASD.
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Affiliation(s)
| | - Yi Zhang
- Washington University in Saint Louis School of Medicine
| | - Teddi Gray
- Washington University in Saint Louis School of Medicine
| | - Anna Abbacchi
- Washington University in Saint Louis School of Medicine
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Frye RE. Social Skills Deficits in Autism Spectrum Disorder: Potential Biological Origins and Progress in Developing Therapeutic Agents. CNS Drugs 2018; 32:713-734. [PMID: 30105528 PMCID: PMC6105175 DOI: 10.1007/s40263-018-0556-y] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Autism spectrum disorder is defined by two core symptoms: a deficit in social communication and the presence of repetitive behaviors and/or restricted interests. Currently, there is no US Food and Drug Administration-approved drug for these core symptoms. This article reviews the biological origins of the social function deficit associated with autism spectrum disorder and the drug therapies with the potential to treat this deficit. A review of the history of autism demonstrates that a deficit in social interaction has been the defining feature of the concept of autism from its conception. Abnormalities identified in early social skill development and an overview of the pathophysiology abnormalities associated with autism spectrum disorder are discussed as are the abnormalities in brain circuits associated with the social function deficit. Previous and ongoing clinical trials examining agents that have the potential to improve social deficits associated with autism spectrum disorder are discussed in detail. This discussion reveals that agents such as oxytocin and propranolol are particularly promising and undergoing active investigation, while other agents such as vasopressin agonists and antagonists are being activity investigated but have limited published evidence at this time. In addition, agents such as bumetanide and manipulation of the enteric microbiome using microbiota transfer therapy appear to have promising effects on core autism spectrum disorder symptoms including social function. Other pertinent issues associated with developing treatments in autism spectrum disorder, such as disease heterogeneity, high placebo response rates, trial design, and the most appropriate way of assessing effects on social skills (outcome measures), are also discussed.
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Affiliation(s)
- Richard E Frye
- Division of Neurodevelopmental Disorders, Department of Neurology, Barrow Neurological Institute, Phoenix Children's Hospital, 1919 E Thomas St, Phoenix, AZ, 85016, USA.
- Department of Child Health, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, 85004, USA.
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Emerson RW, Adams C, Nishino T, Hazlett HC, Wolff JJ, Zwaigenbaum L, Constantino JN, Shen MD, Swanson MR, Elison JT, Kandala S, Estes AM, Botteron KN, Collins L, Dager SR, Evans AC, Gerig G, Gu H, McKinstry RC, Paterson S, Schultz RT, Styner M, Schlaggar BL, Pruett JR, Piven J. Functional neuroimaging of high-risk 6-month-old infants predicts a diagnosis of autism at 24 months of age. Sci Transl Med 2018; 9:9/393/eaag2882. [PMID: 28592562 DOI: 10.1126/scitranslmed.aag2882] [Citation(s) in RCA: 201] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 11/15/2016] [Accepted: 02/24/2017] [Indexed: 12/30/2022]
Abstract
Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by social deficits and repetitive behaviors that typically emerge by 24 months of age. To develop effective early interventions that can potentially ameliorate the defining deficits of ASD and improve long-term outcomes, early detection is essential. Using prospective neuroimaging of 59 6-month-old infants with a high familial risk for ASD, we show that functional connectivity magnetic resonance imaging correctly identified which individual children would receive a research clinical best-estimate diagnosis of ASD at 24 months of age. Functional brain connections were defined in 6-month-old infants that correlated with 24-month scores on measures of social behavior, language, motor development, and repetitive behavior, which are all features common to the diagnosis of ASD. A fully cross-validated machine learning algorithm applied at age 6 months had a positive predictive value of 100% [95% confidence interval (CI), 62.9 to 100], correctly predicting 9 of 11 infants who received a diagnosis of ASD at 24 months (sensitivity, 81.8%; 95% CI, 47.8 to 96.8). All 48 6-month-old infants who were not diagnosed with ASD were correctly classified [specificity, 100% (95% CI, 90.8 to 100); negative predictive value, 96.0% (95% CI, 85.1 to 99.3)]. These findings have clinical implications for early risk assessment and the feasibility of developing early preventative interventions for ASD.
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Affiliation(s)
- Robert W Emerson
- Carolina Institute for Developmental Disabilities, University of North Carolina at Chapel Hill, Chapel Hill, NC 27510, USA.
| | - Chloe Adams
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Tomoyuki Nishino
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Heather Cody Hazlett
- Carolina Institute for Developmental Disabilities, University of North Carolina at Chapel Hill, Chapel Hill, NC 27510, USA.,Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA
| | - Jason J Wolff
- Department of Educational Psychology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Lonnie Zwaigenbaum
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - John N Constantino
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Mark D Shen
- Carolina Institute for Developmental Disabilities, University of North Carolina at Chapel Hill, Chapel Hill, NC 27510, USA
| | - Meghan R Swanson
- Carolina Institute for Developmental Disabilities, University of North Carolina at Chapel Hill, Chapel Hill, NC 27510, USA
| | - Jed T Elison
- Institute of Child Development, University of Minnesota, Minneapolis, MN 55455, USA
| | - Sridhar Kandala
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Annette M Estes
- Department of Speech and Hearing Sciences, University of Washington, Seattle, WA 98105, USA
| | - Kelly N Botteron
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA.,Mallinckrodt Institute of Radiology, Washington University, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Louis Collins
- Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Stephen R Dager
- Center on Human Development and Disability, University of Washington, Seattle, WA 98105, USA.,Department of Radiology, University of Washington, Seattle, WA 98105, USA
| | - Alan C Evans
- Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Guido Gerig
- Tandon School of Engineering, New York University, Brooklyn, NY 11201, USA
| | - Hongbin Gu
- Carolina Institute for Developmental Disabilities, University of North Carolina at Chapel Hill, Chapel Hill, NC 27510, USA
| | - Robert C McKinstry
- Mallinckrodt Institute of Radiology, Washington University, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Sarah Paterson
- Center for Autism Research, Department of Pediatrics, Children's Hospital of Philadelphia, and University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Robert T Schultz
- Center for Autism Research, Department of Pediatrics, Children's Hospital of Philadelphia, and University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Martin Styner
- Carolina Institute for Developmental Disabilities, University of North Carolina at Chapel Hill, Chapel Hill, NC 27510, USA
| | | | - Bradley L Schlaggar
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA.,Mallinckrodt Institute of Radiology, Washington University, Washington University School of Medicine, St. Louis, MO 63110, USA.,Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - John R Pruett
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Joseph Piven
- Carolina Institute for Developmental Disabilities, University of North Carolina at Chapel Hill, Chapel Hill, NC 27510, USA.,Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA
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11
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Marrus N, Kennon-McGill S, Harris B, Zhang Y, Glowinski AL, Constantino JN. Use of a Video Scoring Anchor for Rapid Serial Assessment of Social Communication in Toddlers. J Vis Exp 2018. [PMID: 29608153 PMCID: PMC5931764 DOI: 10.3791/57041] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Reciprocal social behavior (RSB), an early-emerging capacity to engage in social contingency—which is foundational for both social learning and social competency—is hypothesized to be disrupted in autism spectrum disorder (ASD). The ability to quantify the full range of RSB during the toddler period, when core symptoms of ASD often arise, is pivotal for evaluating early risk for ASD, characterizing social development, and tracking response to early interventions. However, important parameters of variation in RSB—especially prior to the development of verbal language—can be nuanced and difficult to characterize using questionnaire-based methods. To address this challenge, we developed a system for measuring quantitative variation in RSB in toddlers (ages 18 - 30 months) that incorporated not only standard questionnaire data from caregivers but also a novel set of video-referenced items, through which a respondent compares the behavior of a subject to that observed in a short video of a young child manifesting a highly competent level of social communication. Testing of this measure in a general population sample of twins confirmed that both the video-referenced items and the RSB Total Score (video-referenced items plus non-video-referenced items) displayed unimodal, continuous distributions, strong internal consistency, marked preservation of individual differences, and extremely high heritability. In addition, video-referenced items were particularly sensitive to quantifying incremental changes in social communication, a major element of RSB, over the course of early childhood development. Scores on the vrRSB clearly differentiated children with and without ASD and these data comprise an initial validation of this promising method for quantifying early RSB—cross-sectionally, over time, and as a function of early intervention.
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Affiliation(s)
- Natasha Marrus
- Department of Psychiatry, Washington University School of Medicine
| | | | - Brooke Harris
- Veteran's Administration Palo Alto Health Care System
| | - Yi Zhang
- Department of Psychiatry, Washington University School of Medicine
| | - Anne L Glowinski
- Department of Psychiatry, Washington University School of Medicine
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12
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Chan W, Smith LE, Hong J, Greenberg JS, Mailick MR. Validating the social responsiveness scale for adults with autism. Autism Res 2017. [PMID: 28639377 DOI: 10.1002/aur.1813] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
The Social Responsiveness Scale [SRS; Constantino & Gruber, 2005] is a widely-used measure of autism symptoms, but its application for the study of adults with autism spectrum disorders has not been fully evaluated. Using a factor structure consistent with The Diagnostic and Statistical Manual of Mental Disorders (5th ed., DSM-V) criteria for autism spectrum disorder [Frazier et al., 2014], the primary purpose of the current study was to establish the validity of the SRS with a sample of adults with autism spectrum disorder (N = 237). Correlational analyses indicated that SRS factors were highly associated with autism symptoms and behavioral measures, indicating concurrent and predictive validity. Multiple regression results demonstrated that SRS factors were differentially related to measures specific to social or behavioral domains, indicating convergent and discriminant validity. Implications for future research are discussed. Autism Res 2017, 10: 1663-1671. © 2017 International Society for Autism Research, Wiley Periodicals, Inc.
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Affiliation(s)
- Wai Chan
- Waisman Center, University of Wisconsin-Madison, Madison, Wisconsin, 53705
| | - Leann E Smith
- Waisman Center, University of Wisconsin-Madison, Madison, Wisconsin, 53705
| | - Jinkuk Hong
- Waisman Center, University of Wisconsin-Madison, Madison, Wisconsin, 53705
| | - Jan S Greenberg
- Waisman Center, University of Wisconsin-Madison, Madison, Wisconsin, 53705
| | - Marsha R Mailick
- Waisman Center, University of Wisconsin-Madison, Madison, Wisconsin, 53705
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13
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Rafaniello C, Pozzi M, Pisano S, Ferrajolo C, Bertella S, Sportiello L, Carnovale C, Sullo MG, Cattaneo D, Gentili M, Rizzo R, Pascotto A, Mani E, Villa L, Riccio MP, Sperandeo S, Bernardini R, Bravaccio C, Clementi E, Molteni M, Rossi F, Radice S, Capuano A. Second generation antipsychotics in 'real-life' paediatric patients. Adverse drug reactions and clinical outcomes of drug switch. Expert Opin Drug Saf 2017; 15:1-8. [PMID: 27875914 DOI: 10.1080/14740338.2016.1229301] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Gap in knowledge on benefit/risk ratio of second generation antipsychotics (SGA) in the paediatric population represents a challenge for the scientific community. This study aims to analyse all suspected adverse drug reactions (ADRs) to SGA observed during the study period; compare the safety profiles of risperidone and aripiprazole; evaluate the effect of switching from risperidone to aripiprazole or to a first generation antipsychotic (FGA). METHODS Prospective analysis of spontaneously reported ADRs concerning 184 paediatric outpatients between 2012 and 2014.; clinical outcomes of drug switch were evaluated. RESULTS Out of the 184 patients, 130 experienced at least one ADR; ADRs were usually not serious and more frequently associated with aripiprazole. Switching to aripiprazole was associated with better results than switching to FGAs in the Clinical Global Impression scale- Efficacy (CGI-E) scores (p = 0.018), Disturbed behaviour checklist-parents (DBC-P) self-absorption subscale (p = 0.010); only a trend for difference between changing to aripiprazole vs FGAs in the DBC-P total score (p = 0.054) and social relating subscale (p = 0.053) was observed. CONCLUSIONS SGAs safety data were consistent with the ones already known; however, there is still a need to improve the knowledge in pharmacovigilance field among clinicians. Switching to aripiprazole may be a valid alternative to risperidone.
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Affiliation(s)
- Concetta Rafaniello
- a Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Department of Experimental Medicine, Section of Pharmacology L. Donatelli, School of Medicine and Surgery , Second University of Naples , Naples , Italy
| | - Marco Pozzi
- b Scientific Institute IRCCS Eugenio Medea , Bosisio Parini, Lecco , Italy
| | - Simone Pisano
- c Department of Mental and Physical Health and Preventive Medicine, Child and Adolescent Psychiatry Division , Second University of Naples , Naples , Italy
| | - Carmen Ferrajolo
- a Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Department of Experimental Medicine, Section of Pharmacology L. Donatelli, School of Medicine and Surgery , Second University of Naples , Naples , Italy
| | - Silvana Bertella
- b Scientific Institute IRCCS Eugenio Medea , Bosisio Parini, Lecco , Italy
| | - Liberata Sportiello
- a Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Department of Experimental Medicine, Section of Pharmacology L. Donatelli, School of Medicine and Surgery , Second University of Naples , Naples , Italy
| | - Carla Carnovale
- d Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco , L. Sacco University Hospital, Università di Milano , Milan , Italy
| | - Maria Giuseppa Sullo
- a Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Department of Experimental Medicine, Section of Pharmacology L. Donatelli, School of Medicine and Surgery , Second University of Naples , Naples , Italy
| | - Dario Cattaneo
- d Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco , L. Sacco University Hospital, Università di Milano , Milan , Italy
| | - Marta Gentili
- d Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco , L. Sacco University Hospital, Università di Milano , Milan , Italy
| | - Renata Rizzo
- e Child and Adolescent Neuropsychiatry, Department of Medical and Paediatric Sciences, School of Medicine , University of Catania , Catania , Italy
| | - Antonio Pascotto
- c Department of Mental and Physical Health and Preventive Medicine, Child and Adolescent Psychiatry Division , Second University of Naples , Naples , Italy
| | - Elisa Mani
- b Scientific Institute IRCCS Eugenio Medea , Bosisio Parini, Lecco , Italy
| | - Laura Villa
- b Scientific Institute IRCCS Eugenio Medea , Bosisio Parini, Lecco , Italy
| | - Maria Pia Riccio
- c Department of Mental and Physical Health and Preventive Medicine, Child and Adolescent Psychiatry Division , Second University of Naples , Naples , Italy
| | - Serena Sperandeo
- c Department of Mental and Physical Health and Preventive Medicine, Child and Adolescent Psychiatry Division , Second University of Naples , Naples , Italy
| | - Renato Bernardini
- f Department of Clinical and Molecular Biomedicine, Section of Pharmacology and Biochemistry, School of Medicine , University of Catania , Catania , Italy
| | - Carmela Bravaccio
- g Department of Translational Medical Sciences , University Federico II of Naples , Naples , Italy
| | - Emilio Clementi
- b Scientific Institute IRCCS Eugenio Medea , Bosisio Parini, Lecco , Italy.,d Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco , L. Sacco University Hospital, Università di Milano , Milan , Italy
| | - Massimo Molteni
- b Scientific Institute IRCCS Eugenio Medea , Bosisio Parini, Lecco , Italy
| | - Francesco Rossi
- a Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Department of Experimental Medicine, Section of Pharmacology L. Donatelli, School of Medicine and Surgery , Second University of Naples , Naples , Italy
| | - Sonia Radice
- d Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco , L. Sacco University Hospital, Università di Milano , Milan , Italy
| | - Annalisa Capuano
- a Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Department of Experimental Medicine, Section of Pharmacology L. Donatelli, School of Medicine and Surgery , Second University of Naples , Naples , Italy
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14
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Effects of bumetanide on neurobehavioral function in children and adolescents with autism spectrum disorders. Transl Psychiatry 2017; 7:e1056. [PMID: 28291262 PMCID: PMC5416661 DOI: 10.1038/tp.2017.10] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Revised: 12/17/2016] [Accepted: 01/09/2017] [Indexed: 12/17/2022] Open
Abstract
In animal models of autism spectrum disorder (ASD), the NKCC1 chloride-importer inhibitor bumetanide restores physiological (Cl-)i levels, enhances GABAergic inhibition and attenuates electrical and behavioral symptoms of ASD. In an earlier phase 2 trial; bumetanide reduced the severity of ASD in children and adolescents (3-11 years old). Here we report the results of a multicenter phase 2B study primarily to assess dose/response and safety effects of bumetanide. Efficacy outcome measures included the Childhood Autism Rating Scale (CARS), the Social Responsive Scale (SRS) and the Clinical Global Impressions (CGI) Improvement scale (CGI-I). Eighty-eight patients with ASD spanning across the entire pediatric population (2-18 years old) were subdivided in four age groups and randomized to receive bumetanide (0.5, 1.0 or 2.0 mg twice daily) or placebo for 3 months. The mean CARS value was significantly improved in the completers group (P: 0.015). Also, 23 treated children had more than a six-point improvement in the CARS compared with only one placebo-treated individual. Bumetanide significantly improved CGI (P: 0.0043) and the SRS score by more than 10 points (P: 0.02). The most frequent adverse events were hypokalemia, increased urine elimination, loss of appetite, dehydration and asthenia. Hypokalemia occurred mainly at the beginning of the treatment at 1.0 and 2.0 mg twice-daily doses and improved gradually with oral potassium supplements. The frequency and incidence of adverse event were directly correlated with the dose of bumetanide. Therefore, bumetanide improves the core symptoms of ASD and presents a favorable benefit/risk ratio particularly at 1.0 mg twice daily.
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15
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Haker H, Schneebeli M, Stephan KE. Can Bayesian Theories of Autism Spectrum Disorder Help Improve Clinical Practice? Front Psychiatry 2016; 7:107. [PMID: 27378955 PMCID: PMC4911361 DOI: 10.3389/fpsyt.2016.00107] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 06/03/2016] [Indexed: 11/13/2022] Open
Abstract
Diagnosis and individualized treatment of autism spectrum disorder (ASD) represent major problems for contemporary psychiatry. Tackling these problems requires guidance by a pathophysiological theory. In this paper, we consider recent theories that re-conceptualize ASD from a "Bayesian brain" perspective, which posit that the core abnormality of ASD resides in perceptual aberrations due to a disbalance in the precision of prediction errors (sensory noise) relative to the precision of predictions (prior beliefs). This results in percepts that are dominated by sensory inputs and less guided by top-down regularization and shifts the perceptual focus to detailed aspects of the environment with difficulties in extracting meaning. While these Bayesian theories have inspired ongoing empirical studies, their clinical implications have not yet been carved out. Here, we consider how this Bayesian perspective on disease mechanisms in ASD might contribute to improving clinical care for affected individuals. Specifically, we describe a computational strategy, based on generative (e.g., hierarchical Bayesian) models of behavioral and functional neuroimaging data, for establishing diagnostic tests. These tests could provide estimates of specific cognitive processes underlying ASD and delineate pathophysiological mechanisms with concrete treatment targets. Written with a clinical audience in mind, this article outlines how the development of computational diagnostics applicable to behavioral and functional neuroimaging data in routine clinical practice could not only fundamentally alter our concept of ASD but eventually also transform the clinical management of this disorder.
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Affiliation(s)
- Helene Haker
- Translational Neuromodeling Unit (TNU), Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Maya Schneebeli
- Translational Neuromodeling Unit (TNU), Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Klaas Enno Stephan
- Translational Neuromodeling Unit (TNU), Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland
- Wellcome Trust Centre for Neuroimaging, University College London, London, UK
- Max Planck Institute for Metabolism Research, Cologne, Germany
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16
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Diagnosis of autism spectrum disorder: reconciling the syndrome, its diverse origins, and variation in expression. Lancet Neurol 2016; 15:279-91. [DOI: 10.1016/s1474-4422(15)00151-9] [Citation(s) in RCA: 188] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 05/11/2015] [Accepted: 06/28/2015] [Indexed: 01/08/2023]
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17
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Minshawi NF, Wink LK, Shaffer R, Plawecki MH, Posey DJ, Liu H, Hurwitz S, McDougle CJ, Swiezy NB, Erickson CA. A randomized, placebo-controlled trial of D-cycloserine for the enhancement of social skills training in autism spectrum disorders. Mol Autism 2016; 7:2. [PMID: 26770664 PMCID: PMC4712595 DOI: 10.1186/s13229-015-0062-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 12/14/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Researchers have demonstrated that d-cycloserine (DCS) can enhance the effects of behavioral interventions in adults with anxiety and enhances prosocial behavior in animal models of autism spectrum disorders (ASD). This study extended upon this background by combining DCS with behavioral social skills therapy in youth with ASD to assess its impact on the core social deficits of ASD. We hypothesized that DCS used in combination with social skills training would enhance the acquisition of social skills in children with ASD. METHODS A 10-week, double-blind, placebo-controlled trial of DCS (50 mg) given 30 min prior to weekly group social skills training was conducted at two sites. Children with ASD were randomized to receive 10 weeks (10 doses) of DCS or placebo in a 1:1 ratio. RESULTS No statistically significant difference attributable to drug treatment was observed in the change scores for the primary outcome measure, the Social Responsiveness Scale (SRS), total score (p = 0.45), or on secondary outcome measures. CONCLUSIONS The results of this trial demonstrated no drug-related short-term improvement on the primary outcome measure, or any of the secondary outcome measures. However, an overall significant improvement in SRS total raw score was observed from baseline to end of treatment for the entire group of children with ASD. This suggests a need to further study the efficacy of the social skills training protocol. Limitations to the current study and areas for future research are discussed. TRIAL REGISTRATION ClinicalTrials.govNCT01086475.
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Affiliation(s)
- Noha F. Minshawi
- />Christian Sarkine Autism Treatment Center, Riley Hospital for Children at Indiana University Health, Indiana University School of Medicine Department of Psychiatry, Indianapolis, IN USA
| | - Logan K. Wink
- />Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue MLC 4002, Cincinnati, OH 45229 USA
| | - Rebecca Shaffer
- />Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue MLC 4002, Cincinnati, OH 45229 USA
| | - Martin H. Plawecki
- />Christian Sarkine Autism Treatment Center, Riley Hospital for Children at Indiana University Health, Indiana University School of Medicine Department of Psychiatry, Indianapolis, IN USA
| | | | - Hai Liu
- />Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN USA
| | - Sarah Hurwitz
- />Indiana University School of Education, Bloomington, IN USA
| | - Christopher J. McDougle
- />Lurie Center for Autism, Departments of Psychiatry and Pediatrics, Massachusetts General Hospital and MassGeneral Hospital for Children, Harvard Medical School, Boston, MA USA
| | - Naomi B. Swiezy
- />Christian Sarkine Autism Treatment Center, Riley Hospital for Children at Indiana University Health, Indiana University School of Medicine Department of Psychiatry, Indianapolis, IN USA
| | - Craig A. Erickson
- />Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue MLC 4002, Cincinnati, OH 45229 USA
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18
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Aman M, Rettiganti M, Nagaraja HN, Hollway JA, McCracken J, McDougle CJ, Tierney E, Scahill L, Arnold LE, Hellings J, Posey DJ, Swiezy NB, Ghuman J, Grados M, Shah B, Vitiello B. Tolerability, Safety, and Benefits of Risperidone in Children and Adolescents with Autism: 21-Month Follow-up After 8-Week Placebo-Controlled Trial. J Child Adolesc Psychopharmacol 2015; 25:482-93. [PMID: 26262903 PMCID: PMC4545698 DOI: 10.1089/cap.2015.0005] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Risperidone has demonstrated efficacy for acute (8 week) and intermediate length (6 month) management of severe irritability and aggression in children and adolescents with autism. Less is known about the long-term effects of risperidone exposure in this population. We examined the tolerability, safety, and therapeutic benefit of risperidone exposure over a 1-2 year follow-up period. METHODS In a naturalistic study, 84 children and adolescents 5-17 years of age (from an original sample of 101) were assessed an average of 21.4 months after initial entry into a placebo-controlled 8 week trial of risperidone for children and adolescents with autism and severe irritability. They were assessed at baseline and at follow-up on safety and tolerability measures (blood, urinalysis, electrocardiogram [ECG], medical history, vital signs, neurological symptoms, other adverse events), developmental measures (adaptive behavior, intelligence quotient [IQ]), and standardized rating instruments. Treatment over the follow-up period, after completion of protocol participation, was uncontrolled. Statistical analyses assessed outcome over time with or without prolonged risperidone therapy. RESULTS Two-thirds of the 84 subjects continued to receive risperidone (mean 2.47 mg/day, S.D. 1.29 mg). At follow-up, risperidone was associated with more enuresis, more excessive appetite, and more weight gain, but not more adverse neurological effects. No clinically significant events were noted on blood counts, chemistries, urinalysis, ECG, or interim medical history. Regardless of drug condition at follow-up, there was considerable improvement in maladaptive behavior compared with baseline, including core symptoms associated with autism. Height and weight gains were elevated with risperidone. Social skills on Vineland Adaptive Behavior Scale (VABS) improved with risperidone. Parent-rated Aberrant Behavior Checklist (ABC) Irritability subscale scores were reduced in those taking risperidone at follow-up. Several other measures of maladaptive behavior (some related to socialization) also showed improved functioning in association with risperidone on the ABC or on the Modified Real Life Rating Scale. CONCLUSIONS Increased appetite, weight gain, and enuresis are risks associated with long-term risperidone. Our data suggest that these risks were balanced by longer-term behavioral and social benefits for many children over 1.8 years of ongoing treatment.
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Affiliation(s)
- Michael Aman
- Nisonger Center, Ohio State University, Columbus, Ohio
| | - Mallikarjuna Rettiganti
- Biostatistics Program, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Haikady N. Nagaraja
- Biostatistics, College of Public Health, Ohio State University, Columbus, Ohio
| | | | - James McCracken
- Department of Psychiatry and Behavioral Sciences, David Geffen School of Medicine UCLA - Semel Institute, University of California, Los Angeles, California
| | | | | | | | | | | | - David J. Posey
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana
| | - Naomi B. Swiezy
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana
| | | | | | - Bhavik Shah
- Department of Psychiatry and Behavioral Sciences, David Geffen School of Medicine UCLA - Semel Institute, University of California, Los Angeles, California
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