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Wieting J, Baumann MV, Deest-Gaubatz S, Bleich S, Eberlein CK, Frieling H, Deest M. Structured neurological soft signs examination reveals motor coordination deficits in adults diagnosed with high-functioning autism. Sci Rep 2024; 14:16123. [PMID: 38997308 PMCID: PMC11245607 DOI: 10.1038/s41598-024-66723-5] [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: 12/02/2022] [Accepted: 07/03/2024] [Indexed: 07/14/2024] Open
Abstract
Neurological soft signs (NSS), discrete deficits in motor coordination and sensory integration, have shown promise as markers in autism diagnosis. While motor impairments, partly associated with core behavioral features, are frequently found in children with autism, there is limited evidence in adults. In this study, NSS were assessed in adults undergoing initial diagnosis of high-functioning autism (HFA), a subgroup difficult to diagnose due to social adaptation and psychiatric comorbidity. Adults with HFA (n = 34) and 1:1 sex-, age-, and intelligence-matched neurotypical controls were administered a structured NSS examination including motor, sensory, and visuospatial tasks. We showed that adults with HFA have significantly increased motor coordination deficits compared with controls. Using hierarchical cluster analysis within the HFA group, we also identified a subgroup that was particularly highly affected by NSS. This subgroup differed from the less affected by intelligence level, but not severity of autism behavioral features nor global psychological distress. It remains questionable whether motor impairment represents a genuinely autistic trait or is more a consequence of factors such as intelligence. Nevertheless, we conclude that examining NSS in terms of motor coordination may help diagnose adults with HFA and identify HFA individuals who might benefit from motor skills interventions.
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Affiliation(s)
- Jelte Wieting
- Hannover Medical School, Department of Psychiatry, Social Psychiatry and Psychotherapy, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Madita Vanessa Baumann
- Hannover Medical School, Department of Psychiatry, Social Psychiatry and Psychotherapy, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Stephanie Deest-Gaubatz
- Hannover Medical School, Department of Psychiatry, Social Psychiatry and Psychotherapy, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Stefan Bleich
- Hannover Medical School, Department of Psychiatry, Social Psychiatry and Psychotherapy, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Christian Karl Eberlein
- Hannover Medical School, Department of Psychiatry, Social Psychiatry and Psychotherapy, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Helge Frieling
- Hannover Medical School, Department of Psychiatry, Social Psychiatry and Psychotherapy, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Maximilian Deest
- Oberberg Fachklinik Weserbergland, Brede 29, 32699, Extertal-Laßbruch, Germany
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Zebrack JE, Gao J, Verhey B, Tian L, Stave C, Farhadian B, Ma M, Silverman M, Xie Y, Tran P, Thienemann M, Wilson JL, Frankovich J. Prevalence of Neurological Soft Signs at Presentation in Pediatric Acute-Onset Neuropsychiatric Syndrome. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.04.26.24306193. [PMID: 38746142 PMCID: PMC11092680 DOI: 10.1101/2024.04.26.24306193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Importance Studies of brain imaging and movements during REM sleep indicate basal ganglia involvement in pediatric acute-onset neuropsychiatric syndrome (PANS). Characterizing neurological findings commonly present in patients with PANS could improve diagnostic accuracy. Objective To determine the prevalence of neurological soft signs which may reflect basal ganglia dysfunction (NSS-BG) in youth presenting with PANS and whether clinical characteristics of PANS correlate with NSS-BG. Design, Setting, and Participants: 135 new patients who were evaluated at the Stanford Children's Immune Behavioral Health Clinic between November 1, 2014 and March 1, 2020 and met strict PANS criteria were retrospectively reviewed for study inclusion. 16 patients were excluded because they had no neurological exam within the first three visits and within three months of clinical presentation. Main Outcomes and Measures The following NSS-BG were recorded from medical record review: 1) glabellar tap reflex, 2) tongue movements, 3) milkmaid's grip, 4) choreiform movements, 5) spooning, and 6) overflow movements. We included data from prospectively collected symptoms and impairment scales. Results The study included 119 patients: mean age at PANS onset was 8.2 years, mean age at initial presentation was 10.4 years, 55.5% were male, and 73.9% were non-Hispanic White. At least one NSS-BG was observed in 95/119 patients (79.8%). Patients had 2.1 NSS-BG on average. Patients with 4 or more NSS-BG had higher scores of global impairment (p=0.052) and more symptoms (p=0.008) than patients with 0 NSS-BG. There was no significant difference in age at visit or reported caregiver burden. On Poisson and linear regression, the number of NSS-BG was associated with global impairment (2.857, 95% CI: 0.092-5.622, p=0.045) and the number of symptoms (1.049, 95% CI: 1.018-1.082, p=0.002), but not age or duration of PANS at presentation. Conclusions and Relevance We found a high prevalence of NSS-BG in patients with PANS and an association between NSS-BG and disease severity that is not attributable to younger age. PANS may have a unique NSS-BG profile, suggesting that targeted neurological exams may support PANS diagnosis.
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Affiliation(s)
- Jane E. Zebrack
- Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
- Stanford PANS/Immune Behavioral Health Clinic and PANS Research Program at Lucile Packard Children's Hospital, Stanford, CA, USA
| | - Jaynelle Gao
- Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
- Stanford PANS/Immune Behavioral Health Clinic and PANS Research Program at Lucile Packard Children's Hospital, Stanford, CA, USA
| | - Britta Verhey
- Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
- Stanford PANS/Immune Behavioral Health Clinic and PANS Research Program at Lucile Packard Children's Hospital, Stanford, CA, USA
| | - Lu Tian
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA, USA
| | - Christopher Stave
- Lane Medical Library, Stanford University School of Medicine, Stanford, CA, USA
| | - Bahare Farhadian
- Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
- Stanford PANS/Immune Behavioral Health Clinic and PANS Research Program at Lucile Packard Children's Hospital, Stanford, CA, USA
| | - Meiqian Ma
- Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
- Stanford PANS/Immune Behavioral Health Clinic and PANS Research Program at Lucile Packard Children's Hospital, Stanford, CA, USA
| | - Melissa Silverman
- Stanford PANS/Immune Behavioral Health Clinic and PANS Research Program at Lucile Packard Children's Hospital, Stanford, CA, USA
- Division of Child and Adolescent Psychiatry and Child Development, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Yuhuan Xie
- Stanford PANS/Immune Behavioral Health Clinic and PANS Research Program at Lucile Packard Children's Hospital, Stanford, CA, USA
- Division of Child and Adolescent Psychiatry and Child Development, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Paula Tran
- Stanford PANS/Immune Behavioral Health Clinic and PANS Research Program at Lucile Packard Children's Hospital, Stanford, CA, USA
- Division of Child and Adolescent Psychiatry and Child Development, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Margo Thienemann
- Stanford PANS/Immune Behavioral Health Clinic and PANS Research Program at Lucile Packard Children's Hospital, Stanford, CA, USA
- Division of Child and Adolescent Psychiatry and Child Development, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Jenny L. Wilson
- Division of Pediatric Neurology, Department of Pediatrics, Oregon Health & Science University, Portland, OR, USA
| | - Jennifer Frankovich
- Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
- Stanford PANS/Immune Behavioral Health Clinic and PANS Research Program at Lucile Packard Children's Hospital, Stanford, CA, USA
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Ceruti C, Mingozzi A, Scionti N, Marzocchi GM. Comparing Executive Functions in Children and Adolescents with Autism and ADHD-A Systematic Review and Meta-Analysis. CHILDREN (BASEL, SWITZERLAND) 2024; 11:473. [PMID: 38671689 PMCID: PMC11049008 DOI: 10.3390/children11040473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 04/09/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024]
Abstract
Two neurodevelopmental conditions, autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD), have been associated with executive function (EF) impairments but the specificity of their impairments is still controversial. The present meta-analysis aimed to identify the differences in EF profiles of ASD, ADHD, and ASD+ADHD in relation to a control group of individuals with typical development (TD) and to understand whether the EF performance could change depending upon the type of measure used to assess EF (performance tests vs. questionnaires). Results from 36 eligible studies revealed that ADHD and ASD showed more difficulties than the TD group in tests and, particularly, in questionnaires. No significant differences in the EF profile emerged between ASD and ADHD when assessed through neuropsychological tests (d = 0.02), while significant differences emerged when assessed through questionnaires, with ADHD having higher ratings than ASD (d = -0.34). EF questionnaires and neuropsychological tests may catch two different constructs of EF, with the former being more predictive of everyday life EF impairments. The comparison between the double diagnosis group (ADHD+ASD) and the clinical groups pointed out that the former has a more similar EF profile to the ADHD-alone one and that it shows more difficulties than ASD-alone.
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Affiliation(s)
| | | | | | - Gian Marco Marzocchi
- Department of Psychology, University of Milan-Bicocca, 20126 Milan, Italy; (C.C.); (A.M.)
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Wodka EL, Parish-Morris J, Annett RD, Carpenter L, Dillon E, Michaelson J, Kim SH, Landa R, Kanne S. Co-occurring attention-deficit/hyperactivity disorder and anxiety disorders differentially affect males and females with autism. Clin Neuropsychol 2022; 36:1069-1093. [PMID: 34315336 PMCID: PMC9181886 DOI: 10.1080/13854046.2021.1942554] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To examine overlap and divergence of symptomatology in Autism Spectrum Disorder (ASD) with and without co-occurring Attention/Deficit Hyperactivity Disorder (ADHD) and/or Anxiety Disorder by age and sex. METHOD Participants included 25,078 individuals registered in the SPARK cohort, age 6-18 years. SPARK participation includes online consent and registration, as well as parent-reported ASD, ADHD, and Anxiety Disorder diagnoses, developmental, medical, and intervention history, and standardized rating scales. Individuals with ASD, ASD + ADHD, ASD + Anxiety, or ASD + ADHD + Anxiety were compared on measures assessing social communication, restricted and repetitive behaviors (RRBs), and motor functioning, and differences between male and female profiles were examined. RESULTS Significant differences in symptom presentation between females/males, school-age/adolescent individuals, and by co-occurring conditions (ASD/ADHD/Anxiety) are apparent, and the impact of co-occurring conditions differed by age and sex. Most notably, school-age femaleswith ASD without co-occurring conditions present with significantly fewer concerns about social communication skills and have better motor skills, but have more prominent RRBs as compared to same-aged males with ASD alone; co-occurring conditions were associated with increased social communication problems and motor concerns, most consistently for school-age females. CONCLUSIONS School-age females with ASD are at highest risk for underestimation of autism-related symptoms, including underestimation of symptoms beyond core ASD features (motor skills). Further, across ages, particular consideration should be given when probing for social communication symptoms, RRBs, and motor skills in females with ASD alone, as well as with co-occurring ADHD and/or Anxiety. For females with co-occurring symptoms and conditions, use of symptom-specific measures in lieu of omnibus measures should be considered.
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Affiliation(s)
- Ericka L. Wodka
- Department of psychiatry and Behavioral sciences, Johns hopkins university school of Medicine, Baltimore, Maryland, USA
- Center for autism and related Disorders, Kennedy Krieger institute, Baltimore, Maryland, USA
| | - Julia Parish-Morris
- Children’s hospital of philadelphia, Center for autism research, philadelphia, pennsylvania, USA
- Department of psychiatry, university of pennsylvania perelman school of Medicine, philadelphia, pennsylvania, USA
| | - Robert D. Annett
- Department of pediatrics, university of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Laura Carpenter
- Developmental-Behavioral pediatrics, Medical university of south Carolina, Charleston, south Carolina, USA
| | - Emily Dillon
- Department of psychiatry and Behavioral sciences, rush university Medical Center, Chicago, illinois, USA
| | - Jacob Michaelson
- Department of psychiatry, university of iowa, iowa City, iowa, USA
| | - So Hyun Kim
- Department of psychiatry, Weill Cornell Medicine, new york City, new york, USA
| | - Rebecca Landa
- Department of psychiatry and Behavioral sciences, Johns hopkins university school of Medicine, Baltimore, Maryland, USA
- Center for autism and related Disorders, Kennedy Krieger institute, Baltimore, Maryland, USA
| | | | - Stephen Kanne
- Department of psychiatry, Weill Cornell Medicine, new york City, new york, USA
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Pitzianti M, Fagioli S, Pontis M, Pasini A. Attention Deficits Influence the Development of Motor Abnormalities in High Functioning Autism. Child Psychiatry Hum Dev 2021; 52:1131-1142. [PMID: 33145671 PMCID: PMC8528792 DOI: 10.1007/s10578-020-01088-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/18/2020] [Indexed: 11/27/2022]
Abstract
Early attentional dysfunction is one of the most consistent findings in autism spectrum disorder (ASD), including the high functioning autism (HFA). There are no studies that assess how the atypical attentional processes affect the motor functioning in HFA. In this study, we evaluated attentional and motor functioning in a sample of 15 drug-naive patients with HFA and 15 healthy children (HC), and possible link between attentional dysfunction and motor impairment in HFA. Compared to HC, HFA group was seriously impaired in a considerable number of attentional processes and showed a greater number of motor abnormalities. Significant correlations between attention deficits and motor abnormalities were observed in HFA group. These preliminary findings suggest that deficit of attentional processes can be implied in motor abnormalities in HFA.
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Affiliation(s)
- Mariabernarda Pitzianti
- Unit of Child Neurology and Psychiatry, Department of Systems Medicine, "Tor Vergata" University, Via Montpellier 1, 00133, Rome, Italy
- Child Neuropsychiatry, USL Umbria-2, Viale VIII Marzo, 05100, Terni, Italy
| | - Sabrina Fagioli
- Department of Education, University of "Roma Tre", Via del Castro Pretorio 20, 00185, Rome, Italy.
- Neuroimaging Laboratory, IRCCS Santa Lucia Foundation, Via Ardeatina 306, 00179, Rome, Italy.
| | - Marco Pontis
- Comprehensive Rehabilitation Center Ctr Asl 8, Cagliari, Italy
| | - Augusto Pasini
- Unit of Child Neurology and Psychiatry, Department of Systems Medicine, "Tor Vergata" University, Via Montpellier 1, 00133, Rome, Italy
- Child Neuropsychiatry, USL Umbria-2, Viale VIII Marzo, 05100, Terni, Italy
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6
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Tonizzi I, Giofrè D, Usai MC. Inhibitory Control in Autism Spectrum Disorders: Meta-analyses on Indirect and Direct Measures. J Autism Dev Disord 2021; 52:4949-4965. [PMID: 34816341 DOI: 10.1007/s10803-021-05353-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2021] [Indexed: 11/25/2022]
Abstract
This manuscript aimed to advance our understanding of inhibitory control (IC) in autism spectrum disorders (ASD), adopting a meta-analytic multilevel approach. The first meta-analysis, on 164 studies adopting direct measures, indicated a significant small-to-medium (g = 0.484) deficit in the group with ASD (n = 5140) compared with controls (n = 6075). Similar effect sizes between response inhibition and interference control were found, but they were differentially affected by intellectual functioning and age. The second meta-analysis, on 24 studies using indirect measures, revealed a large deficit (g = 1.334) in the group with ASD (n = 985) compared with controls (n = 1300). Presentation format, intellectual functioning, and age were significant moderators. The effect of comorbidity with ADHD was not statistically significant. Implications are discussed for IC research and practice in autism.
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Affiliation(s)
- Irene Tonizzi
- Department of Educational Sciences, University of Genoa, Corso Podestà 2, 16128, Genoa, Italy
| | - David Giofrè
- Department of Educational Sciences, University of Genoa, Corso Podestà 2, 16128, Genoa, Italy
| | - Maria Carmen Usai
- Department of Educational Sciences, University of Genoa, Corso Podestà 2, 16128, Genoa, Italy.
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Pitzianti MB, Spiridigliozzi S, Bartolucci E, Esposito S, Pasini A. New Insights on the Effects of Methylphenidate in Attention Deficit Hyperactivity Disorder. Front Psychiatry 2020; 11:531092. [PMID: 33132928 PMCID: PMC7561436 DOI: 10.3389/fpsyt.2020.531092] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 09/02/2020] [Indexed: 12/17/2022] Open
Abstract
This narrative review describes an overview of the multiple effects of methylphenidate (MPH) in attention-deficit/hyperactivity disorder (ADHD) and its potential neurobiological targets. It addressed the following aspects: 1) MPH effects on attention and executive functions in ADHD; 2) the relation between MPH efficacy and dopamine transporter gene (DAT) polymorphism; and 3) the role of MPH as an epigenetic modulator in ADHD. Literature analysis showed that MPH, the most commonly used psychostimulant in the therapy of ADHD, acts on multiple components of the disorder. Marked improvements in attentional and executive dysfunction have been observed in children with ADHD during treatment with MPH, as well as reductions in neurological soft signs. MPH efficacy may be influenced by polymorphisms in the DAT, and better responses to treatment were associated with the 10/10 genotype. Innovative lines of research have suggested that ADHD etiopathogenesis and its neuropsychological phenotypes also depend on the expression levels of human endogenous retrovirus (HERV). In particular, several studies have revealed that ADHD is associated with HERV-H over-expression and that MPH administration results in decreased expression levels of this retroviral family and a reduction in the main symptoms of the disorder. In conclusion, there is a confirmed role for MPH as an elective drug in the therapy of ADHD alone or in association with behavioral therapy. Its effectiveness can vary based on DAT polymorphisms and can act as a modulator of HERV-H gene expression, pointing to targets for a precision medicine approach.
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Affiliation(s)
- Maria Bernarda Pitzianti
- Division of Child Neuropsychiatry, Department of Neuroscience, University of Rome Tor Vergata, Rome, Italy.,Department of Child Neuropsychiatry, USL Umbria 2, Terni, Italy
| | - Simonetta Spiridigliozzi
- Division of Child Neuropsychiatry, Department of Neuroscience, University of Rome Tor Vergata, Rome, Italy
| | | | - Susanna Esposito
- Paediatric Clinic, Pietro Barilla Children's Hospital, Department of Medicine and Surgery, Università of Parma, Parma, Italy
| | - Augusto Pasini
- Division of Child Neuropsychiatry, Department of Neuroscience, University of Rome Tor Vergata, Rome, Italy.,Department of Child Neuropsychiatry, USL Umbria 2, Terni, Italy
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Qigong in the treatment of children with autism spectrum disorder: A systematic review. JOURNAL OF INTEGRATIVE MEDICINE-JIM 2019; 17:250-260. [DOI: 10.1016/j.joim.2019.04.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 01/07/2019] [Indexed: 12/22/2022]
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Ramos AA, Hamdan AC, Machado L. A meta-analysis on verbal working memory in children and adolescents with ADHD. Clin Neuropsychol 2019; 34:873-898. [PMID: 31007130 DOI: 10.1080/13854046.2019.1604998] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Objective: Previous meta-analyses have demonstrated verbal working memory (WM) dysfunction in children and adolescents with attention deficit/hyperactivity disorder (ADHD); however, the findings are inconsistent. The main objective of this meta-analysis was to investigate the performance of children and adolescents with ADHD in the Digit Span Backwards (DSB) subtest from the Wechsler Intelligence Scale for Children or Wechsler Adult Intelligence Scale. We also sought to provide an updated meta-analysis on WM in children and adolescents with ADHD.Method: PubMed, PsyINFO, Scopus, and Web of Science were searched to locate studies published between 1990 and 2016 that report DSB scores both of children and adolescents with ADHD and matched controls. Potential moderator variables were also analyzed.Results: Forty-nine studies comparing children and adolescents with ADHD (n = 4956) against healthy controls (n = 3249) generated a medium-sized effect (Hedges' g) of 0.56 (95% CI [0.49, 0.64]), indicating poorer verbal WM performance in those with ADHD. A subgroup meta-analysis of studies with participants aged 8-16 years only demonstrated low heterogeneity (I2 = 17.06, cf. 55.50 for the main analysis). Moreover, the meta-regression showed a negative association (β = -.05, p = .02) between DSB performance differences and increasing age, indicating that for every one year increase in age the effect size decreased by .05.Conclusion: These results, which emanated from the largest meta-analysis concerning verbal WM in ADHD reported to date, reinforce WM as a key domain of cognitive dysfunction in ADHD, and point to age as the main variable influencing DSB performance difficulties.
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Affiliation(s)
- Ari Alex Ramos
- Department of Psychology, Federal University of Paraná, Curitiba, Brazil.,Department of Psychology, University of Otago, Dunedin, New Zealand
| | | | - Liana Machado
- Department of Psychology, University of Otago, Dunedin, New Zealand
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10
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Burke SL, Wagner E, Marolda H, Quintana JE, Maddux M. Gap analysis of service needs for adults with neurodevelopmental disorders. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2019; 23:97-116. [PMID: 28847208 DOI: 10.1177/1744629517726209] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In Florida, the Agency for Persons with Disabilities provides waivers for adults with the following types of disabilities: intellectual disability, autism spectrum disorder, cerebral palsy, spina bifida, Down syndrome, and Prader-Willi syndrome. This review examined the peer-reviewed literature to indicate and assess the common needs for individuals with intellectual and developmental disabilities. Current models of service delivery, the efficacy of these services, and remaining gaps in the need fulfillment of individuals within the six diagnostic categorizations of interest were examined. Severity level within each diagnostic category was plotted on a matrix according to whether the needs of individuals were minimal, moderate, severe, or universal. The study found that sexual health education, socialization, and adult-focused medical care are universal needs among the six conditions. The study indicates that health-care professionals must work toward addressing the many unmet needs in comprehensive life span care services for adult individuals with neurodevelopmental disorders.
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11
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Scientific Evidence for the Evaluation of Neurological Soft Signs as Atypical Neurodevelopment Markers in Childhood Neuropsychiatric Disorders. J Psychiatr Pract 2018; 24:230-238. [PMID: 30427806 DOI: 10.1097/pra.0000000000000312] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Motor dysfunction is commonly present in children with neurodevelopmental disorders. Developmental changes in voluntary control of motor skills include improvements in speed and motor coordination as well as reduced frequency of neurological soft signs (NSS) that are commonly observed in typically developing younger children. NSS are motor and sensory conditions that cannot be linked to specific cerebral lesions. The persistence of NSS into later childhood and adolescence is linked with an increased risk of psychiatric disorders. This finding gives support to the neurodevelopmental model of NSS in which minor neurological impairments may be viewed as potential signs of deviant brain development and might represent trait markers of vulnerability for neurodevelopmental disorders. Given that NSS are easily detectable, it is important that clinicians increase their knowledge of the clinical presentation and research implications of the relationship between NSS and childhood neurodevelopmental disorders. To the best of our knowledge, this is the first review article to give an updated overview of the current knowledge of NSS in the most common neuropsychiatric disorders of childhood/adolescence, such as attention-deficit/hyperactivity disorder, autism spectrum disorder, obsessive-compulsive disorder, bipolar disorder, and first episode of psychosis. The article also presents key points for future research studies on this topic.
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12
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Meguid NA, Nashaat NH, Hashem HS, Khalil MM. Frequency of risk factors and coexisting abnormalities in a population of Egyptian children with autism spectrum disorder. Asian J Psychiatr 2018; 32:54-58. [PMID: 29216607 DOI: 10.1016/j.ajp.2017.11.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 11/29/2017] [Accepted: 11/29/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Many risk factors interact together during the critical period of development and govern the future phenotype of autism spectrum disorder (ASD). Furthermore, co-occurring abnormalities among individuals with ASD vary a lot so as their abilities. AIM OF WORK To investigate possible risk factors and to determine the prevalence of coexisting abnormalities in a sample of Egyptian ASD children and their influence on the severity and their communication performance. METHODS The diagnosis and severity of ASD for participants (N=80) was performed by DSM-5, ADIR and CARS. They were investigated regarding the possible risk factors and coexisting abnormalities. A detailed history taking, clinical examination, the Arabic preschool language scale, cognitive abilities assessment and other additional instrumental measures such as EEG were used. RESULTS Caesarian section and neonatal jaundice were the most common risk factors. The severity of ASD was positively related to maternal and paternal ages. Developmental language disorder, intellectual disability, attention deficit hyperactivity disorder, sleep disorder and EEG changes were more frequently detected among studied cases. The CARS scores were significantly higher in ADHD and EEG changes groups. The most severely affected CARS items in the groups with these disorders were determined. CONCLUSION High parental ages has an impact on the severity of ASD. ADHD, sleep disorder, and EEG changes seem to have an impact on certain elements of the adaptive behavior especially the communicative performance of ASD individuals. We recommend to seriously investigate co-morbid abnormalities and consider them during the process of management of ASD for proper intervention plans.
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Affiliation(s)
- Nagwa Abdel Meguid
- Research on Children with Special Needs Department, Medical research division, National Research Centre, Cairo, Egypt; CONEM Egypt Child Brain Research Group, National Research Centre, Cairo, Egypt
| | - Neveen Hassan Nashaat
- Research on Children with Special Needs Department, Medical research division, National Research Centre, Cairo, Egypt.
| | - Heba S Hashem
- Research on Children with Special Needs Department, Medical research division, National Research Centre, Cairo, Egypt
| | - Mai M Khalil
- Research on Children with Special Needs Department, Medical research division, National Research Centre, Cairo, Egypt
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Neurological soft signs, but not theory of mind and emotion recognition deficit distinguished children with ADHD from healthy control. Psychiatry Res 2017. [PMID: 28628794 DOI: 10.1016/j.psychres.2017.06.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Attention Deficit Hyperactivity Disorder (ADHD) is associated with social cognition impairment, executive dysfunction and motor abnormalities, consisting in the persistence of neurological soft signs (NSS). Theory of mind (ToM) and emotion recognition (ER) deficit of children with ADHD have been interpreted as a consequence of their executive dysfunction, particularly inhibitory control deficit. To our knowledge, there are not studies that evaluate the possible correlation between the ToM and ER deficit and NSS in the population with ADHD, while this association has been studied in other psychiatric disorders, such as schizophrenia. Therefore, the aim of this study was to evaluate ToM and ER and NSS in a sample of 23 drug-naïve children with ADHD and a sample of 20 healthy children and the possible correlation between social cognition dysfunction and NSS in ADHD. Our findings suggest that ToM and ER dysfunction is not a constant feature in the population with ADHD, while NSS confirmed as a markers of atypical neurodevelopment and predictors of the severity of functional impairment in children with ADHD.
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Cawthorpe D. Comprehensive Description of Comorbidity for Autism Spectrum Disorder in a General Population. Perm J 2017; 21:16-088. [PMID: 28241914 DOI: 10.7812/tpp/16-088] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
CONTEXT Few published studies of autism spectrum disorder (ASD) and comorbidity are population based. OBJECTIVE To describe the comorbidity of ASD and disorders listed in the main classes of the International Classification of Diseases, Ninth Revision (ICD-9) in a general population. DESIGN Direct physician billing data for the city of Calgary, Alberta, Canada, for the treatment of any presenting concern in the Calgary Health Zone (n = 763,449) from 1994 to 2009 were extracted. Diagnosed ICD-9 disorders (independent variable) were grouped into 17 categories using ICD-9 diagnosis codes. ASD (dependent variable) was classified under ICD-9 Code 299. Individuals with and without independent disorder classes were counted by the presence or absence of any ASD. Odds ratios (ORs) and 95% confidence intervals of the association were calculated. MAIN OUTCOME MEASURES ORs of ASD comorbidities. RESULTS Annual rates of ASD increased 3.9-fold for males and 1.4-fold for females. Diagnosed disorders ranked by OR in the independent ICD-9 categories indicated that males with ASD had overall higher ORs (> 1.0) in 11 main ICD-9 classes, and females with ASD had higher ORs (> 1.0) in 12 main ICD-9 classes. Males with ASD had lower ORs in 4 main ICD-9 disease classes; females with ASD had lower ORs related only to the main class "complications of pregnancy and childbirth." Five main ICD-9 classes were not significant for males or females. CONCLUSIONS Patients with ASD have significant comorbidity of physical disorders. This finding may inform other areas of research and assessment in clinical management.
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Affiliation(s)
- David Cawthorpe
- Adjunct Professor in the Departments of Psychiatry and Community Health Services at the University of Calgary in Alberta, Canada.
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