1
|
Chan MMY, Choi CXT, Tsoi TCW, Zhong J, Han YMY. Clinical and neuropsychological correlates of theta-band functional excitation-inhibition ratio in autism: An EEG study. Clin Neurophysiol 2024; 163:56-67. [PMID: 38703700 DOI: 10.1016/j.clinph.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 01/29/2024] [Accepted: 04/05/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVE How abnormal brain signaling impacts cognition in autism spectrum disorder (ASD) remained elusive. This study aimed to investigate the local and global brain signaling in ASD indicated by theta-band functional excitation-inhibition (fE/I) ratio and explored psychophysiological relationships between fE/I, cognitive deficits, and ASD symptomatology. METHODS A total of 83 ASD and typically developing (TD) individuals participated in this study. Participants' interference control and set-shifting abilities were assessed. Resting-state electroencephalography (EEG) was used for estimating theta-band fE/I ratio. RESULTS ASD individuals (n = 31 without visual EEG abnormality; n = 22 with visual EEG abnormality) generally performed slower in a cognitive task tapping interference control and set-maintenance abilities, but only ASD individuals with visually abnormal EEG performed significantly slower than their TD counterparts (Bonferroni-corrected ps < .001). Heightened theta-band fE/I ratios at the whole-head level, left and right hemispheres were observed in the ASD subgroup without visual EEG abnormality only (Bonferroni-corrected ps < .001), which remained highly significant when only data from medication-naïve participants were analyzed. In addition, higher left hemispheric fE/I ratios in ASD individuals without visual EEG abnormality were significantly correlated with faster interference control task performance, in turn faster reaction time was significantly associated with less severe restricted, repetitive behavior (Bonferroni-corrected ps ≤ .0017). CONCLUSIONS Differential theta-band fE/I within the ASD population. Heightened theta-band fE/I in ASD without visual EEG abnormality may be associated with more efficient filtering of distractors and a less severe ASD symptom manifestation. SIGNIFICANCE Brain signaling, indicated by theta-band fE/I, was different in ASD subgroups. Only ASD with visually-normal EEG showed heightened theta-band fE/I, which was associated with faster processing of visual distractors during a cognitive task. More efficient distractor filtering was associated with less restricted, repetitive behaviors.
Collapse
Affiliation(s)
- Melody M Y Chan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region; Queensland Brain Institute, The University of Queensland, St Lucia QLD 4072, Australia
| | - Coco X T Choi
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region
| | - Tom C W Tsoi
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region
| | - Junpei Zhong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region
| | - Yvonne M Y Han
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region; University Research Facility in Behavioral and Systems Neuroscience (UBSN), The Hong Kong Polytechnic University, Hong Kong Special Administrative Region.
| |
Collapse
|
2
|
Huang Z, Wang F, Xue L, Zhu H, Zou X. Relationships between Sensory Processing and Executive Functions in Children with Combined ASD and ADHD Compared to Typically Developing and Single Disorder Groups. Brain Sci 2024; 14:566. [PMID: 38928566 PMCID: PMC11201769 DOI: 10.3390/brainsci14060566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 05/17/2024] [Accepted: 05/29/2024] [Indexed: 06/28/2024] Open
Abstract
The prevalence of autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) is increasing, with a tendency for co-occurrence. Some studies indicate a connection between atypical sensory processing and executive function. This study aims to explore the distinctive etiology of executive function deficits in children with ASD+ADHD by investigating the relationship between sensory processing and executive function, comparing children with ASD, ASD+ADHD, ADHD, and typically developing children (TD). METHOD Sensory Profile 2 (SP-2) and Behavior Rating Inventory of Executive Function 2 (BRIEF-2) were measured in 120 school-aged children. The results of the above scales were compared across these four groups, and correlation and regression analyses between BRIEF2 and SP2 were conducted. RESULTS Our research revealed varying levels of atypical sensory processing and executive function anomalies across the three neurodevelopmental disorder groups compared to the TD group. The ASD+ADHD group showed particularly significant differences. The heightened emotional problems observed in ASD+ADHD children may be associated with more prominent atypical sensory processing. Variance analysis of inhibitory function revealed differences between ASD+ADHD and ADHD children, suggesting distinct etiological mechanisms for attention issues between ASD+ADHD and ADHD. CONCLUSIONS ASD+ADHD represents a phenotype distinct from both ASD and ADHD. Special consideration should be given to interventions for children with ASD+ADHD. The results of this study may offer a new perspective on understanding the occurrence of ASD+ADHD and potential individualized intervention methods.
Collapse
Affiliation(s)
| | | | | | | | - Xiaobing Zou
- Child Developmental-Behavioral Center, The Third Affiliated Hospital of Sun Yat-sen University, No. 600, Tianhe Rd., Guangzhou 510630, China
| |
Collapse
|
3
|
De la Cerna-Luna R, Fernandez-Guzman D, Baquerizo-Sedano M, Cabala-Olazabal S, Taype-Rondan A. Characteristics of children with autism spectrum disorder in pediatric rehabilitation at a referral hospital in Peru. Rev Peru Med Exp Salud Publica 2024; 41:19-27. [PMID: 38808840 PMCID: PMC11149770 DOI: 10.17843/rpmesp.2024.411.13285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 03/06/2024] [Indexed: 05/30/2024] Open
Abstract
OBJECTIVE. Motivation for the study. Despite the prevalence of ASD, research in the field of Physical Medicine and Rehabilitation is scarce in Peru. Main findings. Of 120 children with a previous diagnosis of ASD, only 9.8% received inclusive education. The median age at diagnosis was 3.83 years. We also found that 78.4% had no disability certificate and 77.5% had incomplete psychological evaluation. The median time since the last physical, occupational, and speech therapy sessions was 3 months, 8 months, and 3.5 months, respectively. Implications. These findings highlight the need to enhance early diagnosis, inclusive education, and evaluation and subsequent certification of disability, as well as to establish more timely interventions. Autism spectrum disorder (ASD) is characterized by developmental disorders, difficulties in social interaction and communication, and restrictive and repetitive patterns of behavior. Despite its high prevalence, few studies have been conducted in rehabilitation settings. This study aimed to describe the characteristics of children with ASD from the Pediatric Rehabilitation Service of the Rebagliati Hospital (SRP-HNERM). MATERIALS AND METHODS. Cross-sectional descriptive study. We reviewed the medical records of children under 14 years of age previously diagnosed with ASD from the SRP-HNERM during 2022. RESULTS. A total of 120 children with ASD were evaluated. The median age was 5 years. Most received regular education, but it was inclusive only for 9.8%. The mean age at diagnosis was 3.83 years. We found that 78.4% had no disability certificate and 77.5% of the participants had incomplete psychological evaluation. The median time since the last physical, occupational and speech therapy sessions was 3, 8 and 3.5 months respectively. CONCLUSION. The mean age at diagnosis of ASD was older than three years, and more than 75% of the patients had neither a disability certificate nor a complete psychological evaluation. The median time since the last rehabilitation therapy sessions was three months or more. Our findings highlight the need to improve early diagnosis, inclusive education and evaluation and subsequent certification of disability, as well as to establish timely interventions.
Collapse
Affiliation(s)
- Roger De la Cerna-Luna
- Pediatric Rehabilitation Service, Edgardo Rebagliati Martins National Hospital, EsSalud, Lima, Peru.Pediatric Rehabilitation ServiceEdgardo Rebagliati Martins National HospitalEsSaludLimaPeru
| | - Daniel Fernandez-Guzman
- Human Medicine, Universidad Científica del Sur, Lima, Peru.Universidad Científica del PerúHuman MedicineUniversidad Científica del SurLimaPeru
| | - Marilia Baquerizo-Sedano
- Faculty of Health Sciences, University of Burgos, Burgos, Spain.University of BurgosFaculty of Health SciencesUniversity of BurgosBurgosSpain
| | - Stephanie Cabala-Olazabal
- Department of Research, Teaching and Integral Rehabilitation in Learning, National Institute of Rehabilitation, Ministry of Health, Lima, Peru.Department of Research, Teaching and Integral Rehabilitation in LearningNational Institute of RehabilitationMinistry of HealthLimaPeru
| | - Alvaro Taype-Rondan
- Research Unit for the Generation and Synthesis of Health Evidence, Vice Rectorate for Research, San Ignacio de Loyola University, Lima, Peru.San Ignacio de Loyola UniversityResearch Unit for the Generation and Synthesis of Health EvidenceVice Rectorate for ResearchSan Ignacio de Loyola UniversityLimaPeru
| |
Collapse
|
4
|
Bove M, Palmieri MA, Santoro M, Agosti LP, Gaetani S, Romano A, Dimonte S, Costantino G, Sikora V, Tucci P, Schiavone S, Morgese MG, Trabace L. Amygdalar neurotransmission alterations in the BTBR mice model of idiopathic autism. Transl Psychiatry 2024; 14:193. [PMID: 38632257 PMCID: PMC11024334 DOI: 10.1038/s41398-024-02905-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 04/02/2024] [Accepted: 04/08/2024] [Indexed: 04/19/2024] Open
Abstract
Autism Spectrum Disorders (ASD) are principally diagnosed by three core behavioural symptoms, such as stereotyped repertoire, communication impairments and social dysfunctions. This complex pathology has been linked to abnormalities of corticostriatal and limbic circuits. Despite experimental efforts in elucidating the molecular mechanisms behind these abnormalities, a clear etiopathogenic hypothesis is still lacking. To this aim, preclinical studies can be really helpful to longitudinally study behavioural alterations resembling human symptoms and to investigate the underlying neurobiological correlates. In this regard, the BTBR T+ Itpr3tf/J (BTBR) mice are an inbred mouse strain that exhibits a pattern of behaviours well resembling human ASD-like behavioural features. In this study, the BTBR mice model was used to investigate neurochemical and biomolecular alterations, regarding Nerve Growth Factor (NGF) and Brain-Derived Neurotrophic Factor (BDNF), together with GABAergic, glutamatergic, cholinergic, dopaminergic and noradrenergic neurotransmissions and their metabolites in four different brain areas, i.e. prefrontal cortex, hippocampus, amygdala and hypothalamus. In our results, BTBR strain reported decreased noradrenaline, acetylcholine and GABA levels in prefrontal cortex, while hippocampal measurements showed reduced NGF and BDNF expression levels, together with GABA levels. Concerning hypothalamus, no differences were retrieved. As regarding amygdala, we found reduced dopamine levels, accompanied by increased dopamine metabolites in BTBR mice, together with decreased acetylcholine, NGF and GABA levels and enhanced glutamate content. Taken together, our data showed that the BTBR ASD model, beyond its face validity, is a useful tool to untangle neurotransmission alterations that could be underpinned to the heterogeneous ASD-like behaviours, highlighting the crucial role played by amygdala.
Collapse
Affiliation(s)
- Maria Bove
- Department of Clinical and Experimental Medicine, University of Foggia, Via Napoli 20, 71122, Foggia, Italy
| | - Maria Adelaide Palmieri
- Department of Clinical and Experimental Medicine, University of Foggia, Via Napoli 20, 71122, Foggia, Italy
| | - Martina Santoro
- Department of Physiology and Pharmacology "V. Erspamer", Sapienza University of Rome, 00185, Rome, Italy
| | - Lisa Pia Agosti
- Department of Clinical and Experimental Medicine, University of Foggia, Via Napoli 20, 71122, Foggia, Italy
| | - Silvana Gaetani
- Department of Physiology and Pharmacology "V. Erspamer", Sapienza University of Rome, 00185, Rome, Italy
| | - Adele Romano
- Department of Physiology and Pharmacology "V. Erspamer", Sapienza University of Rome, 00185, Rome, Italy
| | - Stefania Dimonte
- Department of Clinical and Experimental Medicine, University of Foggia, Via Napoli 20, 71122, Foggia, Italy
| | - Giuseppe Costantino
- Department of Clinical and Experimental Medicine, University of Foggia, Via Napoli 20, 71122, Foggia, Italy
| | - Vladyslav Sikora
- Department of Clinical and Experimental Medicine, University of Foggia, Via Napoli 20, 71122, Foggia, Italy
- Department of Pathology, Sumy State University, 40007, Sumy, Ukraine
| | - Paolo Tucci
- Department of Clinical and Experimental Medicine, University of Foggia, Via Napoli 20, 71122, Foggia, Italy
| | - Stefania Schiavone
- Department of Clinical and Experimental Medicine, University of Foggia, Via Napoli 20, 71122, Foggia, Italy
| | - Maria Grazia Morgese
- Department of Clinical and Experimental Medicine, University of Foggia, Via Napoli 20, 71122, Foggia, Italy
| | - Luigia Trabace
- Department of Clinical and Experimental Medicine, University of Foggia, Via Napoli 20, 71122, Foggia, Italy.
| |
Collapse
|
5
|
Aishworiya R, Valica T, Hagerman R, Restrepo B. An Update on Psychopharmacological Treatment of Autism Spectrum Disorder. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2024; 22:198-211. [PMID: 38680976 PMCID: PMC11046717 DOI: 10.1176/appi.focus.24022006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
While behavioral interventions remain the mainstay of treatment of autism spectrum disorder (ASD), several potential targeted treatments addressing the underlying neurophysiology of ASD have emerged in the last few years. These are promising for the potential to, in future, become part of the mainstay treatment in addressing the core symptoms of ASD. Although it is likely that the development of future targeted treatments will be influenced by the underlying heterogeneity in etiology, associated genetic mechanisms influencing ASD are likely to be the first targets of treatments and even gene therapy in the future for ASD. In this article, we provide a review of current psychopharmacological treatment in ASD including those used to address common comorbidities of the condition and upcoming new targeted approaches in autism management. Medications including metformin, arbaclofen, cannabidiol, oxytocin, bumetanide, lovastatin, trofinetide, and dietary supplements including sulforophane and N-acetylcysteine are discussed. Commonly used medications to address the comorbidities associated with ASD including atypical antipsychotics, serotoninergic agents, alpha-2 agonists, and stimulant medications are also reviewed. Targeted treatments in Fragile X syndrome (FXS), the most common genetic disorder leading to ASD, provide a model for new treatments that may be helpful for other forms of ASD. Appeared originally in Neurotherapeutics 2022; 19:248-262.
Collapse
Affiliation(s)
- Ramkumar Aishworiya
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California Davis, 2825 50th Street, Sacramento, CA 95817, USA (Aishworiya, Valica, Hagerman, Restrepo); Khoo Teck Puat-National University Children's Medical Institute, National University Health System, 5 Lower Kent Ridge Road, Singapore 119074, Singapore; Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Singapore 119228, Singapore (Aishworiya); Association for Children With Autism, Chisinau, Moldova (Valica); Department of Pediatrics, University of California Davis School of Medicine, 4610 X St, Sacramento, CA 95817, USA (Hagerman, Restrepo)
| | - Tatiana Valica
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California Davis, 2825 50th Street, Sacramento, CA 95817, USA (Aishworiya, Valica, Hagerman, Restrepo); Khoo Teck Puat-National University Children's Medical Institute, National University Health System, 5 Lower Kent Ridge Road, Singapore 119074, Singapore; Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Singapore 119228, Singapore (Aishworiya); Association for Children With Autism, Chisinau, Moldova (Valica); Department of Pediatrics, University of California Davis School of Medicine, 4610 X St, Sacramento, CA 95817, USA (Hagerman, Restrepo)
| | - Randi Hagerman
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California Davis, 2825 50th Street, Sacramento, CA 95817, USA (Aishworiya, Valica, Hagerman, Restrepo); Khoo Teck Puat-National University Children's Medical Institute, National University Health System, 5 Lower Kent Ridge Road, Singapore 119074, Singapore; Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Singapore 119228, Singapore (Aishworiya); Association for Children With Autism, Chisinau, Moldova (Valica); Department of Pediatrics, University of California Davis School of Medicine, 4610 X St, Sacramento, CA 95817, USA (Hagerman, Restrepo)
| | - Bibiana Restrepo
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California Davis, 2825 50th Street, Sacramento, CA 95817, USA (Aishworiya, Valica, Hagerman, Restrepo); Khoo Teck Puat-National University Children's Medical Institute, National University Health System, 5 Lower Kent Ridge Road, Singapore 119074, Singapore; Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Singapore 119228, Singapore (Aishworiya); Association for Children With Autism, Chisinau, Moldova (Valica); Department of Pediatrics, University of California Davis School of Medicine, 4610 X St, Sacramento, CA 95817, USA (Hagerman, Restrepo)
| |
Collapse
|
6
|
Zhang Y, Yin L, You C, Liu C, Dong P, Xu X, Zhang K. Efficacy and Safety of Methylphenidate and Atomoxetine in Medication-Naive Children with Attention-Deficit Hyperactivity Disorder in a Real-World Setting. Drugs R D 2024; 24:29-39. [PMID: 37982991 PMCID: PMC11035522 DOI: 10.1007/s40268-023-00445-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2023] [Indexed: 11/21/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Methylphenidate (MPH) and atomoxetine (ATX) are the most common medications used to treat attention-deficit hyperactivity disorder (ADHD) in China; however, despite this, there is still a paucity of studies comparing their efficacy and safety, particularly for different characteristics. To address the lack of research, a real-world prospective cohort study was conducted to examine these properties of MPH and ATX, and to analyze correlations associated with age, sex, and different ADHD presentation. METHODS Children with ADHD meeting the eligibility criteria were recruited from January 2016 to July 2021. Study participants were treated with either MPH or ATX prescribed in the real-world setting, and were followed up for 26 weeks. Clinical efficacy response and adverse events (AEs) were recorded and measured. Subgroup analysis was performed to examine the efficacy response and AEs associated with age, sex, and different ADHD presentation. RESULTS A total of 1050 children were recruited and 29 children were lost to follow-up. Of the 1021 children remaining, 533 were treated with MPH and 488 were treated with ATX. No significant differences were found in intelligence quotient, age, sex, or ADHD presentation between the MPH- and ATX-treated groups (p > 0.05). The response rates were 84.6% in the MPH-treated group and 63.3% in the ATX-treated group. Subgroup analysis of response rate demonstrated that the treatment effect of MPH over ATX was consistent across subgroups except in the girls (odds ratio [OR] 2.09, 95% confidence interval [CI] 0.97-4.7) and the hyperactive/impulsive presentation group (OR 2.88, 95% CI 0.77-12.76). A total of 47.8% of children experienced AEs during MPH treatment, significantly lower than the rate of 56.8% during ATX treatment (p < 0.05). The incidence of AEs in the MPH-treated group was higher in young children (<8 years: 56.8%; 8-10 years: 47.2%) and lower in children over 10 years of age (29.0%). CONCLUSIONS Overall, MPH was more effective and better tolerated than ATX. The incidence of AEs in children treated with MPH varied with age, and was higher in young children and lower in children over 10 years of age.
Collapse
Affiliation(s)
- Ying Zhang
- Department of Child Healthcare, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Li Yin
- Department of Pediatrics, Taixing People's Hospital, Taizhou, China
| | - Cun You
- Department of Pediatrics, Fudan University Minhang Hospital, Shanghai, China
| | - Chunxue Liu
- Department of Child Healthcare, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Ping Dong
- Department of Child Healthcare, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Xiu Xu
- Department of Child Healthcare, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China.
| | - Kaifeng Zhang
- Department of Child Healthcare, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China.
| |
Collapse
|
7
|
Carnovale C, Battini V, Santoro C, Riccio MP, Carucci S, Nobile M, Formisano P, Bravaccio C, Zuddas A, Clementi E, Pozzi M, Pisano S. Umbrella Review: Association Between Antipsychotic Drugs and Metabolic Syndrome Hallmarks in Children and Adolescents. J Am Acad Child Adolesc Psychiatry 2024; 63:313-335. [PMID: 37391174 DOI: 10.1016/j.jaac.2023.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 04/04/2023] [Accepted: 06/14/2023] [Indexed: 07/02/2023]
Abstract
OBJECTIVE To summarize the available evidence on metabolic parameters indicating metabolic adverse effects and risk of metabolic syndrome in children and adolescents treated with antipsychotics, following a pre-specified protocol (PROSPERO ID 252336). METHOD We searched PubMed, Embase and PsycINFO until May 14, 2021, to identify systematic reviews (SR), meta-analyses (MA) and network meta-analyses (NMA) examining symptoms associated to metabolic syndrome in patients <18 years of age who required treatment with oral antipsychotic drugs. Evidence from quantitative analyses for all outcomes related to anthropometric, glyco-metabolic, and blood pressure parameters (measured from baseline to intervention-end and/or follow-up, in subjects exposed to antipsychotics and placebo) was reported on the basis of their metrics (median difference [medianD], mean difference [MD], standardized mean difference [SMD], odds ratio [OR], risk ratio ([RR]). A qualitative synthesis was also made. A formal quality assessment of the included studies was carried out by using the AMSTAR 2. We also provided a hierarchical stratification of the evidence from meta-analyses based on the class of evidence. RESULTS A total of 23 articles (13 MA, 4 NMA and 6 SR) were included for review. As compared with placebo, an increase in triglyceride levels was associated with olanzapine (medianD [95% CI]: 37 [12.27, 61.74] mg/dL; MD [95% CI]: 38.57 [21.44, 55.77] mg/dL) and quetiapine (medianD [95% CI]: 21.58 [95% CI]: 4.27, 38.31 mg/dL; MD [95% CI]: 34.87 [20.08, 49.67] mg/dL; SMD [95% CI]: 0.37 [0.06, 0.068]), whereas decreased triglyceride levels were found for lurasidone. Increased total cholesterol level was associated with asenapine (medianD [95% CI]: 9.1 [1.73, 16.44] mg/dL), quetiapine (medianD [95% CI]: 15.60 [7.30, 24.05] mg/dL; olanzapine (MD [95% CI] from 3.67 [1.43, 5.92] mg/dL to 20.47 [13.97, 26.94] mg/dL]; and lurasidone (medianD [95% CI]: 8.94 [1.27, 16.90] mg/dL). Change in glucose levels did not differ among antipsychotics or placebo. Lurasidone, molindone, and ziprasidone were the best tolerated in terms of weight gain. According to the AMSTAR 2 scoring system, 13 (56.5%) reviews were rated as very low quality. According to classes of evidence, most MA were level 4, especially because of their limited total sample size. CONCLUSION By collating meta-analyses assessing biochemical markers of metabolic syndrome in antipsychotic-treated children, we conclude that olanzapine should not be the antipsychotic of choice in patients at risk for hypertriglyceridemia or hypercholesterolemia. Aripiprazole and lurasidone appear to be better tolerated in terms of metabolic adverse events. Insufficient meta-analytic data are available to provide a precise risk estimate of metabolic syndrome, and, overall, the quality of evidence is low. STUDY REGISTRATION INFORMATION Association between the use of antipsychotic drugs and alterations of the parameters defining the Metabolic Syndrome (MetS) in children and adolescents: an umbrella review; https://www.crd.york.ac.uk/prospero/; CRD42021252336.
Collapse
Affiliation(s)
- Carla Carnovale
- "Luigi Sacco" University Hospital, Università degli Studi di Milano, Milan, Italy
| | - Vera Battini
- "Luigi Sacco" University Hospital, Università degli Studi di Milano, Milan, Italy
| | - Claudia Santoro
- Università degli Studi della Campania "Luigi Vanvitelli", Italy
| | | | - Sara Carucci
- University of Cagliari, Cagliari, Italy, and "A.Cao" Pediatric Hospital, Cagliari, Italy
| | - Maria Nobile
- Scientific Institute IRCCS Eugenio Medea, Bosisio Parini (LC), Italy
| | | | | | - Alessandro Zuddas
- University of Cagliari, Cagliari, Italy, and "A.Cao" Pediatric Hospital, Cagliari, Italy
| | - Emilio Clementi
- "Luigi Sacco" University Hospital, Università degli Studi di Milano, Milan, Italy; Scientific Institute IRCCS Eugenio Medea, Bosisio Parini (LC), Italy
| | - Marco Pozzi
- Scientific Institute IRCCS Eugenio Medea, Bosisio Parini (LC), Italy.
| | | |
Collapse
|
8
|
Zhuang H, Liang Z, Ma G, Qureshi A, Ran X, Feng C, Liu X, Yan X, Shen L. Autism spectrum disorder: pathogenesis, biomarker, and intervention therapy. MedComm (Beijing) 2024; 5:e497. [PMID: 38434761 PMCID: PMC10908366 DOI: 10.1002/mco2.497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 01/27/2024] [Accepted: 01/30/2024] [Indexed: 03/05/2024] Open
Abstract
Autism spectrum disorder (ASD) has become a common neurodevelopmental disorder. The heterogeneity of ASD poses great challenges for its research and clinical translation. On the basis of reviewing the heterogeneity of ASD, this review systematically summarized the current status and progress of pathogenesis, diagnostic markers, and interventions for ASD. We provided an overview of the ASD molecular mechanisms identified by multi-omics studies and convergent mechanism in different genetic backgrounds. The comorbidities, mechanisms associated with important physiological and metabolic abnormalities (i.e., inflammation, immunity, oxidative stress, and mitochondrial dysfunction), and gut microbial disorder in ASD were reviewed. The non-targeted omics and targeting studies of diagnostic markers for ASD were also reviewed. Moreover, we summarized the progress and methods of behavioral and educational interventions, intervention methods related to technological devices, and research on medical interventions and potential drug targets. This review highlighted the application of high-throughput omics methods in ASD research and emphasized the importance of seeking homogeneity from heterogeneity and exploring the convergence of disease mechanisms, biomarkers, and intervention approaches, and proposes that taking into account individuality and commonality may be the key to achieve accurate diagnosis and treatment of ASD.
Collapse
Affiliation(s)
- Hongbin Zhuang
- College of Life Science and OceanographyShenzhen UniversityShenzhenP. R. China
| | - Zhiyuan Liang
- College of Life Science and OceanographyShenzhen UniversityShenzhenP. R. China
| | - Guanwei Ma
- College of Life Science and OceanographyShenzhen UniversityShenzhenP. R. China
| | - Ayesha Qureshi
- College of Life Science and OceanographyShenzhen UniversityShenzhenP. R. China
| | - Xiaoqian Ran
- College of Life Science and OceanographyShenzhen UniversityShenzhenP. R. China
| | - Chengyun Feng
- Maternal and Child Health Hospital of BaoanShenzhenP. R. China
| | - Xukun Liu
- College of Life Science and OceanographyShenzhen UniversityShenzhenP. R. China
| | - Xi Yan
- College of Life Science and OceanographyShenzhen UniversityShenzhenP. R. China
| | - Liming Shen
- College of Life Science and OceanographyShenzhen UniversityShenzhenP. R. China
- Shenzhen‐Hong Kong Institute of Brain Science‐Shenzhen Fundamental Research InstitutionsShenzhenP. R. China
| |
Collapse
|
9
|
Aran A, Cayam Rand D. Cannabinoid treatment for the symptoms of autism spectrum disorder. Expert Opin Emerg Drugs 2024; 29:65-79. [PMID: 38226593 DOI: 10.1080/14728214.2024.2306290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/12/2024] [Indexed: 01/17/2024]
Abstract
INTRODUCTION Autism spectrum disorder (ASD) is a neurodevelopmental disorder affecting approximately 3% of school-age children. The core symptoms are deficits in social communication and restricted and repetitive patterns of behavior. Associated problems in cognition, language, behavior, sleep and mood are prevalent. Currently, no established pharmacological treatment exists for core ASD symptoms. Risperidone and aripiprazole are used to manage associated irritability, but their effectiveness is limited and adverse events are common. AREAS COVERED This mini-review summarizes existing scientific literature and ongoing clinical trials concerning cannabinoid treatment for ASD. Uncontrolled case series have documented improvements in both core ASD symptoms and related behavioral challenges in children treated with cannabis extracts rich in cannabidiol (CBD). Placebo-controlled studies involving CBD-rich cannabis extracts and/or pure CBD in children with ASD have demonstrated mixed efficacy results. A similar outcome was observed in a placebo-controlled study of pure CBD addressing social avoidance in Fragile X syndrome. Importantly, these studies have shown relatively high safety and tolerability. EXPERT OPINION While current clinical data suggest the potential of CBD and CBD-rich cannabis extract in managing core and behavioral deficits in ASD, it is prudent to await the results of ongoing placebo-controlled trials before considering CBD treatment for ASD.
Collapse
Affiliation(s)
- Adi Aran
- Neuropediatric Unit, Shaare Zedek Medical Center, Jerusalem, Israel
- Israel School of Medicine, Hebrew university of Jerusalem, Jerusalem, Israel
| | - Dalit Cayam Rand
- Neuropediatric Unit, Shaare Zedek Medical Center, Jerusalem, Israel
- Israel School of Medicine, Hebrew university of Jerusalem, Jerusalem, Israel
| |
Collapse
|
10
|
Chaulagain A, Lyhmann I, Halmøy A, Widding-Havneraas T, Nyttingnes O, Bjelland I, Mykletun A. A systematic meta-review of systematic reviews on attention deficit hyperactivity disorder. Eur Psychiatry 2023; 66:e90. [PMID: 37974470 PMCID: PMC10755583 DOI: 10.1192/j.eurpsy.2023.2451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 05/29/2023] [Accepted: 08/31/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND There are now hundreds of systematic reviews on attention deficit hyperactivity disorder (ADHD) of variable quality. To help navigate this literature, we have reviewed systematic reviews on any topic on ADHD. METHODS We searched MEDLINE, PubMed, PsycINFO, Cochrane Library, and Web of Science and performed quality assessment according to the Joanna Briggs Institute Manual for Evidence Synthesis. A total of 231 systematic reviews and meta-analyses met the eligibility criteria. RESULTS The prevalence of ADHD was 7.2% for children and adolescents and 2.5% for adults, though with major uncertainty due to methodological variation in the existing literature. There is evidence for both biological and social risk factors for ADHD, but this evidence is mostly correlational rather than causal due to confounding and reverse causality. There is strong evidence for the efficacy of pharmacological treatment on symptom reduction in the short-term, particularly for stimulants. However, there is limited evidence for the efficacy of pharmacotherapy in mitigating adverse life trajectories such as educational attainment, employment, substance abuse, injuries, suicides, crime, and comorbid mental and somatic conditions. Pharmacotherapy is linked with side effects like disturbed sleep, reduced appetite, and increased blood pressure, but less is known about potential adverse effects after long-term use. Evidence of the efficacy of nonpharmacological treatments is mixed. CONCLUSIONS Despite hundreds of systematic reviews on ADHD, key questions are still unanswered. Evidence gaps remain as to a more accurate prevalence of ADHD, whether documented risk factors are causal, the efficacy of nonpharmacological treatments on any outcomes, and pharmacotherapy in mitigating the adverse outcomes associated with ADHD.
Collapse
Affiliation(s)
- Ashmita Chaulagain
- Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Ingvild Lyhmann
- Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Anne Halmøy
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Tarjei Widding-Havneraas
- Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Olav Nyttingnes
- Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Ingvar Bjelland
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Arnstein Mykletun
- Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
- Department of Community Medicine, UiT – The Arctic University of Norway, Tromsø, Norway
- Centre for Work and Mental Health, Nordland Hospital, Bodø, Norway
| |
Collapse
|
11
|
Chan MMY, Choi CXT, Tsoi TCW, Shea CKS, Yiu KWK, Han YMY. Effects of multisession cathodal transcranial direct current stimulation with cognitive training on sociocognitive functioning and brain dynamics in autism: A double-blind, sham-controlled, randomized EEG study. Brain Stimul 2023; 16:1604-1616. [PMID: 37918630 DOI: 10.1016/j.brs.2023.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 10/15/2023] [Accepted: 10/23/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Few treatment options are available for targeting core symptoms of autism spectrum disorder (ASD). The development of treatments that target common neural circuit dysfunctions caused by known genetic defects, namely, disruption of the excitation/inhibition (E/I) balance, is promising. Transcranial direct current stimulation (tDCS) is capable of modulating the E/I balance in healthy individuals, yet its clinical and neurobiological effects in ASD remain elusive. OBJECTIVE This double-blind, randomized, sham-controlled trial investigated the effects of multisession cathodal prefrontal tDCS coupled with online cognitive remediation on social functioning, information processing efficiency and the E/I balance in ASD patients aged 14-21 years. METHODS Sixty individuals were randomly assigned to receive either active or sham tDCS (10 sessions in total, 20 min/session, stimulation intensity: 1.5 mA, cathode: F3, anode: Fp2, size of electrodes: 25 cm2) combined with 20 min of online cognitive remediation. Social functioning, information processing efficiency during cognitive tasks, and theta- and gamma-band E/I balance were measured one day before and after the treatment. RESULTS Compared to sham tDCS, active cathodal tDCS was effective in enhancing overall social functioning [F(1, 58) = 6.79, p = .012, ηp2 = 0.105, 90% CI: (0.013, 0.234)] and information processing efficiency during cognitive tasks [F(1, 58) = 10.07, p = .002, ηp2 = 0.148, 90% CI: (0.034, 0.284)] in these individuals. Electroencephalography data showed that this cathodal tDCS protocol was effective in reducing the theta-band E/I ratio of the cortical midline structures [F(1, 58) = 4.65, p = .035, ηp2 = 0.074, 90% CI: (0.010, 0.150)] and that this reduction significantly predicted information processing efficiency enhancement (b = -2.546, 95% BCa CI: [-4.979, -0.113], p = .041). CONCLUSION Our results support the use of multisession cathodal tDCS over the left dorsolateral prefrontal cortex combined with online cognitive remediation for reducing the elevated theta-band E/I ratio in sociocognitive information processing circuits in ASD patients, resulting in more adaptive regulation of global brain dynamics that is associated with enhanced information processing efficiency after the intervention.
Collapse
Affiliation(s)
- Melody M Y Chan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region; Queensland Brain Institute, The University of Queensland, St Lucia, QLD, 4072, Australia
| | - Coco X T Choi
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region
| | - Tom C W Tsoi
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region
| | - Caroline K S Shea
- Alice Ho Miu Ling Nethersole Hospital, Hospital Authority, Hong Kong Special Administrative Region; Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Klaire W K Yiu
- Alice Ho Miu Ling Nethersole Hospital, Hospital Authority, Hong Kong Special Administrative Region
| | - Yvonne M Y Han
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region; University Research Facility in Behavioral and Systems Neuroscience (UBSN), The Hong Kong Polytechnic University, Hong Kong Special Administrative Region.
| |
Collapse
|
12
|
Han YM, Chan MM, Shea CK, Mo FY, Yiu KW, Chung RC, Cheung MC, Chan AS. Effects of prefrontal transcranial direct current stimulation on social functioning in autism spectrum disorder: A randomized clinical trial. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:2465-2482. [PMID: 37151094 DOI: 10.1177/13623613231169547] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
LAY ABSTRACT Currently available pharmacological and behavioral interventions for adolescents and young adults with autism spectrum disorder (ASD) yield only modest effect in alleviating their core behavioral and cognitive symptoms, and some of these treatment options are associated with undesirable side effects. Hence, developing effective treatment protocols is urgently needed. Given emerging evidence shows that the abnormal connections of the frontal brain regions contribute to the manifestations of ASD behavioral and cognitive impairments, noninvasive treatment modalities that are capable in modulating brain connections, such as transcranial direct current stimulation (tDCS), have been postulated to be potentially promising for alleviating core symptoms in ASD. However, whether tDCS can reduce behavioral symptoms and enhance cognitive performance in ASD remains unclear. This randomized controlled trial involving 105 adolescents and young adults with ASD showed that multiple sessions of a tDCS protocol, which was paired up with computerized cognitive training, was effective in improving social functioning in adolescents and young adults with ASD. No prolonged and serious side effects were observed. With more future studies conducted in different clinical settings that recruit participants from a wider age range, this tDCS protocol may be potentially beneficial to a broad spectrum of individuals with autism.
Collapse
Affiliation(s)
| | - Melody My Chan
- The Hong Kong Polytechnic University, Hong Kong
- The University of Queensland, Australia
| | - Caroline Ks Shea
- Hospital Authority, Hong Kong
- The Chinese University of Hong Kong, Hong Kong
| | - Flora Ym Mo
- Hospital Authority, Hong Kong
- The Chinese University of Hong Kong, Hong Kong
| | | | | | | | | |
Collapse
|
13
|
Lai MC. Mental health challenges faced by autistic people. Nat Hum Behav 2023; 7:1620-1637. [PMID: 37864080 DOI: 10.1038/s41562-023-01718-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 09/07/2023] [Indexed: 10/22/2023]
Abstract
Mental health challenges impede the well-being of autistic people. This Review outlines contributing neurodevelopmental and physical health conditions, rates and developmental trajectories of mental health challenges experienced by autistic people, as well as unique clinical presentations. A framework is proposed to consider four contributing themes to aid personalized formulation: social-contextual determinants, adverse life experiences, autistic cognitive features, and shared genetic and early environmental predispositions. Current evidence-based and clinical-knowledge-informed intervention guidance and ongoing development of support are highlighted for specific mental health areas. Tailored mental health support for autistic people should be neurodivergence-informed, which is fundamentally humanistic and compatible with the prevailing bio-psycho-social frameworks. The personalized formulation should be holistic, considering physical health and transdiagnostic neurodevelopmental factors, intellectual and communication abilities, and contextual-experiential determinants and their interplay with autistic cognition and biology, alongside resilience. Supporting family well-being is integral. Mutual empathic understanding is fundamental to creating societies in which people across neurotypes are all empowered to thrive.
Collapse
Affiliation(s)
- Meng-Chuan Lai
- Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health and Azrieli Adult Neurodevelopmental Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
- Department of Psychology, Faculty of Arts and Science, University of Toronto, Toronto, Ontario, Canada.
- Department of Psychiatry, Hospital for Sick Children, Toronto, Ontario, Canada.
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK.
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.
| |
Collapse
|
14
|
Hellings J. Pharmacotherapy in autism spectrum disorders, including promising older drugs warranting trials. World J Psychiatry 2023; 13:262-277. [PMID: 37383284 PMCID: PMC10294139 DOI: 10.5498/wjp.v13.i6.262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 03/06/2023] [Accepted: 04/18/2023] [Indexed: 06/19/2023] Open
Abstract
Available pharmacotherapies for autism spectrum disorders (ASD) are reviewed based on clinical and research experience, highlighting some older drugs with emerging evidence. Several medications show efficacy in ASD, though controlled studies in ASD are largely lacking. Only risperidone and aripiprazole have Federal Drug Administration approval in the United States. Methylphenidate (MPH) studies showed lower efficacy and tolerability for attention deficit hyperactivity disorder (ADHD) than in the typically developing (TD) population; atomoxetine demonstrated lower efficacy but comparable tolerability to TD outcomes. Guanfacine improved hyperactivity in ASD comparably to TD. Dex-troamphetamine promises greater efficacy than MPH in ASD. ADHD medications reduce impulsive aggression in youth, and may also be key for this in adults. Controlled trials of the selective serotonin reuptake inhibitors citalopram and fluoxetine demonstrated poor tolerability and lack of efficacy for repetitive behaviors. Trials of antiseizure medications in ASD remain inconclusive, however clinical trials may be warranted in severely disabled individuals showing bizarre behaviors. No identified drugs treat ASD core symptoms; oxytocin lacked efficacy. Amitriptyline and loxapine however, show promise. Loxapine at 5-10 mg daily resembled an atypical antipsychotic in positron emission tomography studies, but may be weight-sparing. Amitriptyline at approximately 1 mg/ kg/day used cautiously, shows efficacy for sleep, anxiety, impulsivity and ADHD, repetitive behaviors, and enuresis. Both drugs have promising neurotrophic properties.
Collapse
Affiliation(s)
- Jessica Hellings
- Department of Psychiatry, University of Missouri-Kansas City, Lee's Summit, MO 64063, United States
| |
Collapse
|
15
|
Lee J, Lee SI. Unrecognized comorbid autism spectrum disorder in children initially diagnosed with only attention deficit hyperactivity disorder. Asian J Psychiatr 2023; 85:103629. [PMID: 37243986 DOI: 10.1016/j.ajp.2023.103629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/07/2023] [Accepted: 05/13/2023] [Indexed: 05/29/2023]
Abstract
The present study examined the prevalence of autism spectrum disorder (ASD) in intellectually capable children with attention deficit hyperactivity disorder (ADHD). Retrospective chart review on 103 children (mean age= 7.83 ± 1.72 years female=15.53%), without intellectual disability, who were diagnosed with only ADHD were done. Among the 103 children 27 children (26.21%) were later co-diagnosed with ASD. The results of the present study provide helpful insights in accurate recognition of co-occurring ASD in intellectually capable children diagnosed with ADHD. The potential for the coexistence of ASD should always be given careful consideration when examining children with ADHD.
Collapse
Affiliation(s)
- Jeewon Lee
- Department of Psychiatry, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea.
| | - Soyoung Irene Lee
- Department of Psychiatry, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| |
Collapse
|
16
|
Seok JW, Soltis-Vaughan B, Lew BJ, Ahmad A, Blair RJR, Hwang S. Psychopharmacological treatment of disruptive behavior in youths: systematic review and network meta-analysis. Sci Rep 2023; 13:6921. [PMID: 37117632 PMCID: PMC10147946 DOI: 10.1038/s41598-023-33979-2] [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: 10/12/2022] [Accepted: 04/21/2023] [Indexed: 04/30/2023] Open
Abstract
To conduct a systematic review of the comparative efficacy of various psychotropic medications for the treatment of disruptive behavior (DBs) in youths. To this aim, we systematically reviewed randomized clinical trials (RCTs) of various psychotropic medications targeting symptoms of DBs and applied network meta-analysis to investigate their relative efficacy. Fifty-five RCTs meeting the inclusion criteria were selected. To predict and interpret relative treatment efficacy, we compared the efficacy of various psychotropic medications prescribed for DB symptoms based on their mechanism of action. Network meta-analysis revealed that for reducing DBs, second-generation antipsychotics, stimulants, and non-stimulant ADHD medications were more efficacious than placebo, and second-generation antipsychotics were the most efficacious. The dopaminergic modulation of top-down inhibitory process by these medications is discussed in this review. This study offers information on the relative efficacy of various psychotropic medications for the treatment of DB, and insight into a potential neurobiological underpinning for those symptoms. It also illustrates the potential utility of these neurobiological mechanisms as a target for future treatment studies.
Collapse
Affiliation(s)
- Ji-Woo Seok
- Department of Psychiatry, University of Nebraska Medical Center, 985578 Nebraska Medical Center, Omaha, NE, 68198-5578, USA
- Digital Health Research Division, Korea Institute of Oriental Medicine, Daejeon, South Korea
| | - Brigette Soltis-Vaughan
- Department of Psychiatry, University of Nebraska Medical Center, 985578 Nebraska Medical Center, Omaha, NE, 68198-5578, USA
| | - Brandon J Lew
- Department of Psychiatry, University of Nebraska Medical Center, 985578 Nebraska Medical Center, Omaha, NE, 68198-5578, USA
| | - Aatiya Ahmad
- Department of Psychiatry, University of Nebraska Medical Center, 985578 Nebraska Medical Center, Omaha, NE, 68198-5578, USA
| | - R J R Blair
- Child and Adolescent Mental Health Centre, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark
| | - Soonjo Hwang
- Department of Psychiatry, University of Nebraska Medical Center, 985578 Nebraska Medical Center, Omaha, NE, 68198-5578, USA.
| |
Collapse
|
17
|
Brewster PR, Mohammad Ishraq Bari S, Walker GM, Werfel TA. Current and Future Directions of Drug Delivery for the Treatment of Mental Illnesses. Adv Drug Deliv Rev 2023; 197:114824. [PMID: 37068660 DOI: 10.1016/j.addr.2023.114824] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/22/2023] [Accepted: 04/11/2023] [Indexed: 04/19/2023]
Abstract
Mental illnesses including anxiety disorders, autism spectrum disorder, post-traumatic stress disorder, schizophrenia, depression, and others exact an immense toll on the healthcare system and society at large. Depression alone impacts 21 million adults and costs over $200 billion annually in the United States. However, pharmaceutical strategies to treat mental illnesses are lagging behind drug development in many other disease areas. Because many of the shortcomings of therapeutics for mental illness relate to delivery problems, drug delivery technologies have the potential to radically improve the effectiveness of therapeutics for these diseases. This review describes the current pharmacotherapeutic approaches to treating mental illnesses as well as drug delivery approaches that have improved existing therapies. Approaches to improve drug bioavailability, provide controlled release of therapeutics, and enable drug targeting to the central nervous system (CNS) will be highlighted. Moreover, next-generation delivery approaches such as environmentally-controlled release and interval/sequential drug release will be addressed. Based on the evolving landscape of the treatment of mental illnesses, the nascent field of drug delivery in mental health has tremendous potential for growth in terms of both economic and patient impact.
Collapse
Affiliation(s)
- Parker R Brewster
- Department of Biomedical Engineering, University of Mississippi, University, MS 38677, USA; Department of Chemical Engineering, University of Mississippi, University, MS 38677, USA
| | | | - Glenn M Walker
- Department of Biomedical Engineering, University of Mississippi, University, MS 38677, USA
| | - Thomas A Werfel
- Department of Biomedical Engineering, University of Mississippi, University, MS 38677, USA; Department of Chemical Engineering, University of Mississippi, University, MS 38677, USA; Department of BioMolecular Sciences, University of Mississippi, University, MS 38677, USA; Cancer Center and Research Institute, University of Mississippi Medical Center, Jackson, MS 39216, USA
| |
Collapse
|
18
|
Trembath D, Varcin K, Waddington H, Sulek R, Bent C, Ashburner J, Eapen V, Goodall E, Hudry K, Roberts J, Silove N, Whitehouse A. Non-pharmacological interventions for autistic children: An umbrella review. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:275-295. [PMID: 36081343 DOI: 10.1177/13623613221119368] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
LAY ABSTRACT What is already known about the topic?The delivery of evidence-based interventions is an important part of the clinical pathway for many autistic children and their families. However, parents, practitioners, and policymakers face challenges making evidence informed decisions, due to the wide variety of interventions available and the large, and often inconsistent, body of evidence regarding their effectiveness.What this paper adds?This is a comprehensive umbrella review, also known as a 'review of reviews', which examined the range of interventions available, the evidence for their effectiveness, and whether effects were influenced by factors relating to individual children (e.g. chronological age, core autism characteristics, and related skills) or the ways interventions were delivered (by whom and in what setting, format, mode, and amount). There was evidence for positive therapeutic effects for some, but not all, interventions. No single intervention had a positive effect for all child and family outcomes of interest. The influence of child and delivery characteristics on effects was unclear.Implications for practice, research, and policyThe findings provide parents, practitioners, and policymakers with a synthesis of the research evidence to inform decision-making and highlight the importance of individualised approaches in the absence of clear and consistent evidence. The findings also highlight the need to improve consistency and completeness in reporting of research studies, so that the same questions may be answered more comprehensively in the future.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Andrew Whitehouse
- Telethon Kids Institute and The University of Western Australia, Australia
| |
Collapse
|
19
|
Cortese S, Besag FM, Clark B, Hollis C, Kilgariff J, Moreno C, Nicholls D, Wilkinson P, Woodbury-Smith M, Sharma A. Common practical questions - and answers - at the British Association for Psychopharmacology child and adolescent psychopharmacology course. J Psychopharmacol 2023; 37:119-134. [PMID: 36476096 PMCID: PMC9912307 DOI: 10.1177/02698811221140005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The British Association for Psychopharmacology course on child and adolescent psychopharmacology has been run for more than 20 years and is currently a very popular course, attracting around 140 delegates/year from across the United Kingdom and abroad. As Faculty of recent sessions of the course, we have selected the most common questions we have been asked in recent years and provided evidence-based and/or expert-informed answers. We have included 27 questions and answers related to attention-deficit/hyperactivity disorder, anxiety and depressive disorders, autism spectrum disorder, bipolar disorder, eating disorders, epilepsy (in differential diagnosis or comorbid with mental health conditions), obsessive-compulsive disorder, personality disorders, psychotic spectrum disorders, and tics/Tourette syndrome in children and young people. We hope that this article will be helpful for prescribers in their daily clinical practice and we look forward to further, high-level evidence informing the answers to these and other questions in child and adolescent psychopharmacology.
Collapse
Affiliation(s)
- Samuele Cortese
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK.,Solent NHS Trust, Southampton, UK.,Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York City, NY, USA.,Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Frank Mc Besag
- UCL School of Pharmacy, London, UK.,East London Foundation NHS Trust, Bedfordshire, UK.,Institute of Psychiatry, Psychology and Neuroscience, KCL, London, UK
| | - Bruce Clark
- National Specialist Clinic for Young People with OCD, BDD and Related Disorders, South London and Maudsley NHS Foundation Trust, London, UK
| | - Chris Hollis
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Child and Adolescent Psychiatry, Nottinghamshire Healthcare NHS Foundation Trust, Queen's Medical Centre, Nottingham, UK.,National Institute of Mental Health (NIHR) MindTech Medtech Co-operative, Institute of Mental Health, Nottingham, UK.,NIHR Nottingham Biomedical Research Centre, Mental Health & Technology Theme, Institute of Mental Health, Nottingham, UK
| | - Joseph Kilgariff
- Department of Child and Adolescent Psychiatry, Nottinghamshire Healthcare NHS Foundation Trust, Queen's Medical Centre, Nottingham, UK
| | - Carmen Moreno
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, ISCIII, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Dasha Nicholls
- Division of Psychiatry, Imperial College London, London, UK.,NIHR ARC Northwest, London, UK
| | - Paul Wilkinson
- School of Clinical Medicine, University of Cambridge, Cambridge, Cambridgeshire, UK.,Cambridgeshire and Peterborough NHS Foundation Trust, Cambridgeshire, UK
| | | | - Aditya Sharma
- Academic Psychiatry, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.,Specialist Adolescent Mood Disorders Service (SAMS), Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| |
Collapse
|
20
|
Cortese S. Evidence-based prescribing of medications for ADHD: where are we in 2023? Expert Opin Pharmacother 2023; 24:425-434. [PMID: 36639953 DOI: 10.1080/14656566.2023.2169604] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
INTRODUCTION A large number of randomized controlled trials (RCTs) and observational studies on the pharmacotherapy of ADHD are available. AREAS COVERED Based on a search in PubMed and PsycInfo (up to 15 September 2022), this review addresses to which extent this body of research is currently able to inform routine prescribing practice, in terms of the choice of medication, titration strategy, augmentation treatments, and use of alternative, non-approved treatments. EXPERT OPINION A growing body of evidence is informing prescribers on some, but certainly not all, aspects related to the pharmacological treatment of ADHD in the daily clinical practice, with important weaknesses/gaps that need to be addressed. First, evidence synthesis of RCTs is not able to inform decision-making at the individual patient level. Second, the maximum safe and effective doses, possibly beyond those currently recommended, are not well understood. Third, evidence from RCTs on augmenting strategies is still limited. Fourth, no novel agents with the same or higher effect size of stimulants, in terms of efficacy, but with better tolerability and lower abuse potential, have been found. Implementation of precision psychiatry approaches and stratification of patients in future RCTs will be key to, respectively, individualize the treatment strategies and test etiopathophysiology-based agents.
Collapse
Affiliation(s)
- Samuele Cortese
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK.,Solent NHS Trust, Southampton, UK.,Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York, New York, USA.,Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
| |
Collapse
|
21
|
Webb SJ, Naples AJ, Levin AR, Hellemann G, Borland H, Benton J, Carlos C, McAllister T, Santhosh M, Seow H, Atyabi A, Bernier R, Chawarska K, Dawson G, Dziura J, Faja S, Jeste S, Murias M, Nelson CA, Sabatos-DeVito M, Senturk D, Shic F, Sugar CA, McPartland JC. The Autism Biomarkers Consortium for Clinical Trials: Initial Evaluation of a Battery of Candidate EEG Biomarkers. Am J Psychiatry 2023; 180:41-49. [PMID: 36000217 PMCID: PMC10027395 DOI: 10.1176/appi.ajp.21050485] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Numerous candidate EEG biomarkers have been put forward for use in clinical research on autism spectrum disorder (ASD), but biomarker development has been hindered by limited attention to the psychometric properties of derived variables, inconsistent results across small studies, and variable methodology. The authors evaluated the basic psychometric properties of a battery of EEG assays for their potential suitability as biomarkers in clinical trials. METHODS This was a large, multisite, naturalistic study in 6- to 11-year-old children who either had an ASD diagnosis (N=280) or were typically developing (N=119). The authors evaluated an EEG battery composed of well-studied assays of resting-state activity, face perception (faces task), biological motion perception, and visual evoked potentials (VEPs). Biomarker psychometrics were evaluated in terms of acquisition rates, construct performance, and 6-week stability. Preliminary evaluation of use was explored through group discrimination and phenotypic correlations. RESULTS Three assays (resting state, faces task, and VEP) show promise in terms of acquisition rates and construct performance. Six-week stability values in the ASD group were moderate (intraclass correlations ≥0.66) for the faces task latency of the P1 and N170, the VEP amplitude of N1 and P1, and resting alpha power. Group discrimination and phenotype correlations were primarily observed for the faces task P1 and N170. CONCLUSIONS In the context of a large-scale, rigorous evaluation of candidate EEG biomarkers for use in ASD clinical trials, neural response to faces emerged as a promising biomarker for continued evaluation. Resting-state activity and VEP yielded mixed results. The study's biological motion perception assay failed to display construct performance. The results provide information about EEG biomarker performance that is relevant for the next stage of biomarker development efforts focused on context of use.
Collapse
Affiliation(s)
- Sara Jane Webb
- Center for Child Health, Behavior, and Development and Seattle Children's Research Institute, Seattle (Webb, Borland, Benton, Santhosh, Shic); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Webb, Bernier); Yale Child Study Center (Naples, Carlos, McAllister, Chawarska, McPartland), Yale Center for Clinical Investigation (Seow), and Department of Emergency Medicine (Dziura), Yale University, New Haven, Conn.; Department of Neurology, Boston Children's Hospital, Boston (Levin); Department of Neurology, Harvard Medical School, Boston (Levin); Department of Psychiatry and Biobehavioral Sciences (Hellemann, Jeste, Senturk, Sugar) and Department of Biostatistics (Senturk, Sugar), University of California Los Angeles, Los Angeles; Department of Computer Science, University of Colorado, Colorado Springs (Atyabi); Duke Center for Autism and Brain Development (Dawson, Sabatos-DeVito) and Department of Psychiatry and Behavioral Sciences (Dawson), Duke University, Durham, N.C.; Department of Pediatrics, Harvard University, Boston (Faja, Nelson); Division of Developmental Medicine, Boston Children's Hospital, Boston (Faja, Nelson); Department of Medical Social Sciences, Northwestern University, Chicago (Murias); Graduate School of Education, Harvard University, Boston (Nelson); Department of Pediatrics, University of Washington, Seattle (Shic)
| | - Adam J Naples
- Center for Child Health, Behavior, and Development and Seattle Children's Research Institute, Seattle (Webb, Borland, Benton, Santhosh, Shic); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Webb, Bernier); Yale Child Study Center (Naples, Carlos, McAllister, Chawarska, McPartland), Yale Center for Clinical Investigation (Seow), and Department of Emergency Medicine (Dziura), Yale University, New Haven, Conn.; Department of Neurology, Boston Children's Hospital, Boston (Levin); Department of Neurology, Harvard Medical School, Boston (Levin); Department of Psychiatry and Biobehavioral Sciences (Hellemann, Jeste, Senturk, Sugar) and Department of Biostatistics (Senturk, Sugar), University of California Los Angeles, Los Angeles; Department of Computer Science, University of Colorado, Colorado Springs (Atyabi); Duke Center for Autism and Brain Development (Dawson, Sabatos-DeVito) and Department of Psychiatry and Behavioral Sciences (Dawson), Duke University, Durham, N.C.; Department of Pediatrics, Harvard University, Boston (Faja, Nelson); Division of Developmental Medicine, Boston Children's Hospital, Boston (Faja, Nelson); Department of Medical Social Sciences, Northwestern University, Chicago (Murias); Graduate School of Education, Harvard University, Boston (Nelson); Department of Pediatrics, University of Washington, Seattle (Shic)
| | - April R Levin
- Center for Child Health, Behavior, and Development and Seattle Children's Research Institute, Seattle (Webb, Borland, Benton, Santhosh, Shic); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Webb, Bernier); Yale Child Study Center (Naples, Carlos, McAllister, Chawarska, McPartland), Yale Center for Clinical Investigation (Seow), and Department of Emergency Medicine (Dziura), Yale University, New Haven, Conn.; Department of Neurology, Boston Children's Hospital, Boston (Levin); Department of Neurology, Harvard Medical School, Boston (Levin); Department of Psychiatry and Biobehavioral Sciences (Hellemann, Jeste, Senturk, Sugar) and Department of Biostatistics (Senturk, Sugar), University of California Los Angeles, Los Angeles; Department of Computer Science, University of Colorado, Colorado Springs (Atyabi); Duke Center for Autism and Brain Development (Dawson, Sabatos-DeVito) and Department of Psychiatry and Behavioral Sciences (Dawson), Duke University, Durham, N.C.; Department of Pediatrics, Harvard University, Boston (Faja, Nelson); Division of Developmental Medicine, Boston Children's Hospital, Boston (Faja, Nelson); Department of Medical Social Sciences, Northwestern University, Chicago (Murias); Graduate School of Education, Harvard University, Boston (Nelson); Department of Pediatrics, University of Washington, Seattle (Shic)
| | - Gerhard Hellemann
- Center for Child Health, Behavior, and Development and Seattle Children's Research Institute, Seattle (Webb, Borland, Benton, Santhosh, Shic); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Webb, Bernier); Yale Child Study Center (Naples, Carlos, McAllister, Chawarska, McPartland), Yale Center for Clinical Investigation (Seow), and Department of Emergency Medicine (Dziura), Yale University, New Haven, Conn.; Department of Neurology, Boston Children's Hospital, Boston (Levin); Department of Neurology, Harvard Medical School, Boston (Levin); Department of Psychiatry and Biobehavioral Sciences (Hellemann, Jeste, Senturk, Sugar) and Department of Biostatistics (Senturk, Sugar), University of California Los Angeles, Los Angeles; Department of Computer Science, University of Colorado, Colorado Springs (Atyabi); Duke Center for Autism and Brain Development (Dawson, Sabatos-DeVito) and Department of Psychiatry and Behavioral Sciences (Dawson), Duke University, Durham, N.C.; Department of Pediatrics, Harvard University, Boston (Faja, Nelson); Division of Developmental Medicine, Boston Children's Hospital, Boston (Faja, Nelson); Department of Medical Social Sciences, Northwestern University, Chicago (Murias); Graduate School of Education, Harvard University, Boston (Nelson); Department of Pediatrics, University of Washington, Seattle (Shic)
| | - Heather Borland
- Center for Child Health, Behavior, and Development and Seattle Children's Research Institute, Seattle (Webb, Borland, Benton, Santhosh, Shic); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Webb, Bernier); Yale Child Study Center (Naples, Carlos, McAllister, Chawarska, McPartland), Yale Center for Clinical Investigation (Seow), and Department of Emergency Medicine (Dziura), Yale University, New Haven, Conn.; Department of Neurology, Boston Children's Hospital, Boston (Levin); Department of Neurology, Harvard Medical School, Boston (Levin); Department of Psychiatry and Biobehavioral Sciences (Hellemann, Jeste, Senturk, Sugar) and Department of Biostatistics (Senturk, Sugar), University of California Los Angeles, Los Angeles; Department of Computer Science, University of Colorado, Colorado Springs (Atyabi); Duke Center for Autism and Brain Development (Dawson, Sabatos-DeVito) and Department of Psychiatry and Behavioral Sciences (Dawson), Duke University, Durham, N.C.; Department of Pediatrics, Harvard University, Boston (Faja, Nelson); Division of Developmental Medicine, Boston Children's Hospital, Boston (Faja, Nelson); Department of Medical Social Sciences, Northwestern University, Chicago (Murias); Graduate School of Education, Harvard University, Boston (Nelson); Department of Pediatrics, University of Washington, Seattle (Shic)
| | - Jessica Benton
- Center for Child Health, Behavior, and Development and Seattle Children's Research Institute, Seattle (Webb, Borland, Benton, Santhosh, Shic); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Webb, Bernier); Yale Child Study Center (Naples, Carlos, McAllister, Chawarska, McPartland), Yale Center for Clinical Investigation (Seow), and Department of Emergency Medicine (Dziura), Yale University, New Haven, Conn.; Department of Neurology, Boston Children's Hospital, Boston (Levin); Department of Neurology, Harvard Medical School, Boston (Levin); Department of Psychiatry and Biobehavioral Sciences (Hellemann, Jeste, Senturk, Sugar) and Department of Biostatistics (Senturk, Sugar), University of California Los Angeles, Los Angeles; Department of Computer Science, University of Colorado, Colorado Springs (Atyabi); Duke Center for Autism and Brain Development (Dawson, Sabatos-DeVito) and Department of Psychiatry and Behavioral Sciences (Dawson), Duke University, Durham, N.C.; Department of Pediatrics, Harvard University, Boston (Faja, Nelson); Division of Developmental Medicine, Boston Children's Hospital, Boston (Faja, Nelson); Department of Medical Social Sciences, Northwestern University, Chicago (Murias); Graduate School of Education, Harvard University, Boston (Nelson); Department of Pediatrics, University of Washington, Seattle (Shic)
| | - Carter Carlos
- Center for Child Health, Behavior, and Development and Seattle Children's Research Institute, Seattle (Webb, Borland, Benton, Santhosh, Shic); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Webb, Bernier); Yale Child Study Center (Naples, Carlos, McAllister, Chawarska, McPartland), Yale Center for Clinical Investigation (Seow), and Department of Emergency Medicine (Dziura), Yale University, New Haven, Conn.; Department of Neurology, Boston Children's Hospital, Boston (Levin); Department of Neurology, Harvard Medical School, Boston (Levin); Department of Psychiatry and Biobehavioral Sciences (Hellemann, Jeste, Senturk, Sugar) and Department of Biostatistics (Senturk, Sugar), University of California Los Angeles, Los Angeles; Department of Computer Science, University of Colorado, Colorado Springs (Atyabi); Duke Center for Autism and Brain Development (Dawson, Sabatos-DeVito) and Department of Psychiatry and Behavioral Sciences (Dawson), Duke University, Durham, N.C.; Department of Pediatrics, Harvard University, Boston (Faja, Nelson); Division of Developmental Medicine, Boston Children's Hospital, Boston (Faja, Nelson); Department of Medical Social Sciences, Northwestern University, Chicago (Murias); Graduate School of Education, Harvard University, Boston (Nelson); Department of Pediatrics, University of Washington, Seattle (Shic)
| | - Takumi McAllister
- Center for Child Health, Behavior, and Development and Seattle Children's Research Institute, Seattle (Webb, Borland, Benton, Santhosh, Shic); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Webb, Bernier); Yale Child Study Center (Naples, Carlos, McAllister, Chawarska, McPartland), Yale Center for Clinical Investigation (Seow), and Department of Emergency Medicine (Dziura), Yale University, New Haven, Conn.; Department of Neurology, Boston Children's Hospital, Boston (Levin); Department of Neurology, Harvard Medical School, Boston (Levin); Department of Psychiatry and Biobehavioral Sciences (Hellemann, Jeste, Senturk, Sugar) and Department of Biostatistics (Senturk, Sugar), University of California Los Angeles, Los Angeles; Department of Computer Science, University of Colorado, Colorado Springs (Atyabi); Duke Center for Autism and Brain Development (Dawson, Sabatos-DeVito) and Department of Psychiatry and Behavioral Sciences (Dawson), Duke University, Durham, N.C.; Department of Pediatrics, Harvard University, Boston (Faja, Nelson); Division of Developmental Medicine, Boston Children's Hospital, Boston (Faja, Nelson); Department of Medical Social Sciences, Northwestern University, Chicago (Murias); Graduate School of Education, Harvard University, Boston (Nelson); Department of Pediatrics, University of Washington, Seattle (Shic)
| | - Megha Santhosh
- Center for Child Health, Behavior, and Development and Seattle Children's Research Institute, Seattle (Webb, Borland, Benton, Santhosh, Shic); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Webb, Bernier); Yale Child Study Center (Naples, Carlos, McAllister, Chawarska, McPartland), Yale Center for Clinical Investigation (Seow), and Department of Emergency Medicine (Dziura), Yale University, New Haven, Conn.; Department of Neurology, Boston Children's Hospital, Boston (Levin); Department of Neurology, Harvard Medical School, Boston (Levin); Department of Psychiatry and Biobehavioral Sciences (Hellemann, Jeste, Senturk, Sugar) and Department of Biostatistics (Senturk, Sugar), University of California Los Angeles, Los Angeles; Department of Computer Science, University of Colorado, Colorado Springs (Atyabi); Duke Center for Autism and Brain Development (Dawson, Sabatos-DeVito) and Department of Psychiatry and Behavioral Sciences (Dawson), Duke University, Durham, N.C.; Department of Pediatrics, Harvard University, Boston (Faja, Nelson); Division of Developmental Medicine, Boston Children's Hospital, Boston (Faja, Nelson); Department of Medical Social Sciences, Northwestern University, Chicago (Murias); Graduate School of Education, Harvard University, Boston (Nelson); Department of Pediatrics, University of Washington, Seattle (Shic)
| | - Helen Seow
- Center for Child Health, Behavior, and Development and Seattle Children's Research Institute, Seattle (Webb, Borland, Benton, Santhosh, Shic); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Webb, Bernier); Yale Child Study Center (Naples, Carlos, McAllister, Chawarska, McPartland), Yale Center for Clinical Investigation (Seow), and Department of Emergency Medicine (Dziura), Yale University, New Haven, Conn.; Department of Neurology, Boston Children's Hospital, Boston (Levin); Department of Neurology, Harvard Medical School, Boston (Levin); Department of Psychiatry and Biobehavioral Sciences (Hellemann, Jeste, Senturk, Sugar) and Department of Biostatistics (Senturk, Sugar), University of California Los Angeles, Los Angeles; Department of Computer Science, University of Colorado, Colorado Springs (Atyabi); Duke Center for Autism and Brain Development (Dawson, Sabatos-DeVito) and Department of Psychiatry and Behavioral Sciences (Dawson), Duke University, Durham, N.C.; Department of Pediatrics, Harvard University, Boston (Faja, Nelson); Division of Developmental Medicine, Boston Children's Hospital, Boston (Faja, Nelson); Department of Medical Social Sciences, Northwestern University, Chicago (Murias); Graduate School of Education, Harvard University, Boston (Nelson); Department of Pediatrics, University of Washington, Seattle (Shic)
| | - Adham Atyabi
- Center for Child Health, Behavior, and Development and Seattle Children's Research Institute, Seattle (Webb, Borland, Benton, Santhosh, Shic); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Webb, Bernier); Yale Child Study Center (Naples, Carlos, McAllister, Chawarska, McPartland), Yale Center for Clinical Investigation (Seow), and Department of Emergency Medicine (Dziura), Yale University, New Haven, Conn.; Department of Neurology, Boston Children's Hospital, Boston (Levin); Department of Neurology, Harvard Medical School, Boston (Levin); Department of Psychiatry and Biobehavioral Sciences (Hellemann, Jeste, Senturk, Sugar) and Department of Biostatistics (Senturk, Sugar), University of California Los Angeles, Los Angeles; Department of Computer Science, University of Colorado, Colorado Springs (Atyabi); Duke Center for Autism and Brain Development (Dawson, Sabatos-DeVito) and Department of Psychiatry and Behavioral Sciences (Dawson), Duke University, Durham, N.C.; Department of Pediatrics, Harvard University, Boston (Faja, Nelson); Division of Developmental Medicine, Boston Children's Hospital, Boston (Faja, Nelson); Department of Medical Social Sciences, Northwestern University, Chicago (Murias); Graduate School of Education, Harvard University, Boston (Nelson); Department of Pediatrics, University of Washington, Seattle (Shic)
| | - Raphael Bernier
- Center for Child Health, Behavior, and Development and Seattle Children's Research Institute, Seattle (Webb, Borland, Benton, Santhosh, Shic); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Webb, Bernier); Yale Child Study Center (Naples, Carlos, McAllister, Chawarska, McPartland), Yale Center for Clinical Investigation (Seow), and Department of Emergency Medicine (Dziura), Yale University, New Haven, Conn.; Department of Neurology, Boston Children's Hospital, Boston (Levin); Department of Neurology, Harvard Medical School, Boston (Levin); Department of Psychiatry and Biobehavioral Sciences (Hellemann, Jeste, Senturk, Sugar) and Department of Biostatistics (Senturk, Sugar), University of California Los Angeles, Los Angeles; Department of Computer Science, University of Colorado, Colorado Springs (Atyabi); Duke Center for Autism and Brain Development (Dawson, Sabatos-DeVito) and Department of Psychiatry and Behavioral Sciences (Dawson), Duke University, Durham, N.C.; Department of Pediatrics, Harvard University, Boston (Faja, Nelson); Division of Developmental Medicine, Boston Children's Hospital, Boston (Faja, Nelson); Department of Medical Social Sciences, Northwestern University, Chicago (Murias); Graduate School of Education, Harvard University, Boston (Nelson); Department of Pediatrics, University of Washington, Seattle (Shic)
| | - Katarzyna Chawarska
- Center for Child Health, Behavior, and Development and Seattle Children's Research Institute, Seattle (Webb, Borland, Benton, Santhosh, Shic); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Webb, Bernier); Yale Child Study Center (Naples, Carlos, McAllister, Chawarska, McPartland), Yale Center for Clinical Investigation (Seow), and Department of Emergency Medicine (Dziura), Yale University, New Haven, Conn.; Department of Neurology, Boston Children's Hospital, Boston (Levin); Department of Neurology, Harvard Medical School, Boston (Levin); Department of Psychiatry and Biobehavioral Sciences (Hellemann, Jeste, Senturk, Sugar) and Department of Biostatistics (Senturk, Sugar), University of California Los Angeles, Los Angeles; Department of Computer Science, University of Colorado, Colorado Springs (Atyabi); Duke Center for Autism and Brain Development (Dawson, Sabatos-DeVito) and Department of Psychiatry and Behavioral Sciences (Dawson), Duke University, Durham, N.C.; Department of Pediatrics, Harvard University, Boston (Faja, Nelson); Division of Developmental Medicine, Boston Children's Hospital, Boston (Faja, Nelson); Department of Medical Social Sciences, Northwestern University, Chicago (Murias); Graduate School of Education, Harvard University, Boston (Nelson); Department of Pediatrics, University of Washington, Seattle (Shic)
| | - Geraldine Dawson
- Center for Child Health, Behavior, and Development and Seattle Children's Research Institute, Seattle (Webb, Borland, Benton, Santhosh, Shic); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Webb, Bernier); Yale Child Study Center (Naples, Carlos, McAllister, Chawarska, McPartland), Yale Center for Clinical Investigation (Seow), and Department of Emergency Medicine (Dziura), Yale University, New Haven, Conn.; Department of Neurology, Boston Children's Hospital, Boston (Levin); Department of Neurology, Harvard Medical School, Boston (Levin); Department of Psychiatry and Biobehavioral Sciences (Hellemann, Jeste, Senturk, Sugar) and Department of Biostatistics (Senturk, Sugar), University of California Los Angeles, Los Angeles; Department of Computer Science, University of Colorado, Colorado Springs (Atyabi); Duke Center for Autism and Brain Development (Dawson, Sabatos-DeVito) and Department of Psychiatry and Behavioral Sciences (Dawson), Duke University, Durham, N.C.; Department of Pediatrics, Harvard University, Boston (Faja, Nelson); Division of Developmental Medicine, Boston Children's Hospital, Boston (Faja, Nelson); Department of Medical Social Sciences, Northwestern University, Chicago (Murias); Graduate School of Education, Harvard University, Boston (Nelson); Department of Pediatrics, University of Washington, Seattle (Shic)
| | - James Dziura
- Center for Child Health, Behavior, and Development and Seattle Children's Research Institute, Seattle (Webb, Borland, Benton, Santhosh, Shic); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Webb, Bernier); Yale Child Study Center (Naples, Carlos, McAllister, Chawarska, McPartland), Yale Center for Clinical Investigation (Seow), and Department of Emergency Medicine (Dziura), Yale University, New Haven, Conn.; Department of Neurology, Boston Children's Hospital, Boston (Levin); Department of Neurology, Harvard Medical School, Boston (Levin); Department of Psychiatry and Biobehavioral Sciences (Hellemann, Jeste, Senturk, Sugar) and Department of Biostatistics (Senturk, Sugar), University of California Los Angeles, Los Angeles; Department of Computer Science, University of Colorado, Colorado Springs (Atyabi); Duke Center for Autism and Brain Development (Dawson, Sabatos-DeVito) and Department of Psychiatry and Behavioral Sciences (Dawson), Duke University, Durham, N.C.; Department of Pediatrics, Harvard University, Boston (Faja, Nelson); Division of Developmental Medicine, Boston Children's Hospital, Boston (Faja, Nelson); Department of Medical Social Sciences, Northwestern University, Chicago (Murias); Graduate School of Education, Harvard University, Boston (Nelson); Department of Pediatrics, University of Washington, Seattle (Shic)
| | - Susan Faja
- Center for Child Health, Behavior, and Development and Seattle Children's Research Institute, Seattle (Webb, Borland, Benton, Santhosh, Shic); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Webb, Bernier); Yale Child Study Center (Naples, Carlos, McAllister, Chawarska, McPartland), Yale Center for Clinical Investigation (Seow), and Department of Emergency Medicine (Dziura), Yale University, New Haven, Conn.; Department of Neurology, Boston Children's Hospital, Boston (Levin); Department of Neurology, Harvard Medical School, Boston (Levin); Department of Psychiatry and Biobehavioral Sciences (Hellemann, Jeste, Senturk, Sugar) and Department of Biostatistics (Senturk, Sugar), University of California Los Angeles, Los Angeles; Department of Computer Science, University of Colorado, Colorado Springs (Atyabi); Duke Center for Autism and Brain Development (Dawson, Sabatos-DeVito) and Department of Psychiatry and Behavioral Sciences (Dawson), Duke University, Durham, N.C.; Department of Pediatrics, Harvard University, Boston (Faja, Nelson); Division of Developmental Medicine, Boston Children's Hospital, Boston (Faja, Nelson); Department of Medical Social Sciences, Northwestern University, Chicago (Murias); Graduate School of Education, Harvard University, Boston (Nelson); Department of Pediatrics, University of Washington, Seattle (Shic)
| | - Shafali Jeste
- Center for Child Health, Behavior, and Development and Seattle Children's Research Institute, Seattle (Webb, Borland, Benton, Santhosh, Shic); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Webb, Bernier); Yale Child Study Center (Naples, Carlos, McAllister, Chawarska, McPartland), Yale Center for Clinical Investigation (Seow), and Department of Emergency Medicine (Dziura), Yale University, New Haven, Conn.; Department of Neurology, Boston Children's Hospital, Boston (Levin); Department of Neurology, Harvard Medical School, Boston (Levin); Department of Psychiatry and Biobehavioral Sciences (Hellemann, Jeste, Senturk, Sugar) and Department of Biostatistics (Senturk, Sugar), University of California Los Angeles, Los Angeles; Department of Computer Science, University of Colorado, Colorado Springs (Atyabi); Duke Center for Autism and Brain Development (Dawson, Sabatos-DeVito) and Department of Psychiatry and Behavioral Sciences (Dawson), Duke University, Durham, N.C.; Department of Pediatrics, Harvard University, Boston (Faja, Nelson); Division of Developmental Medicine, Boston Children's Hospital, Boston (Faja, Nelson); Department of Medical Social Sciences, Northwestern University, Chicago (Murias); Graduate School of Education, Harvard University, Boston (Nelson); Department of Pediatrics, University of Washington, Seattle (Shic)
| | - Michael Murias
- Center for Child Health, Behavior, and Development and Seattle Children's Research Institute, Seattle (Webb, Borland, Benton, Santhosh, Shic); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Webb, Bernier); Yale Child Study Center (Naples, Carlos, McAllister, Chawarska, McPartland), Yale Center for Clinical Investigation (Seow), and Department of Emergency Medicine (Dziura), Yale University, New Haven, Conn.; Department of Neurology, Boston Children's Hospital, Boston (Levin); Department of Neurology, Harvard Medical School, Boston (Levin); Department of Psychiatry and Biobehavioral Sciences (Hellemann, Jeste, Senturk, Sugar) and Department of Biostatistics (Senturk, Sugar), University of California Los Angeles, Los Angeles; Department of Computer Science, University of Colorado, Colorado Springs (Atyabi); Duke Center for Autism and Brain Development (Dawson, Sabatos-DeVito) and Department of Psychiatry and Behavioral Sciences (Dawson), Duke University, Durham, N.C.; Department of Pediatrics, Harvard University, Boston (Faja, Nelson); Division of Developmental Medicine, Boston Children's Hospital, Boston (Faja, Nelson); Department of Medical Social Sciences, Northwestern University, Chicago (Murias); Graduate School of Education, Harvard University, Boston (Nelson); Department of Pediatrics, University of Washington, Seattle (Shic)
| | - Charles A Nelson
- Center for Child Health, Behavior, and Development and Seattle Children's Research Institute, Seattle (Webb, Borland, Benton, Santhosh, Shic); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Webb, Bernier); Yale Child Study Center (Naples, Carlos, McAllister, Chawarska, McPartland), Yale Center for Clinical Investigation (Seow), and Department of Emergency Medicine (Dziura), Yale University, New Haven, Conn.; Department of Neurology, Boston Children's Hospital, Boston (Levin); Department of Neurology, Harvard Medical School, Boston (Levin); Department of Psychiatry and Biobehavioral Sciences (Hellemann, Jeste, Senturk, Sugar) and Department of Biostatistics (Senturk, Sugar), University of California Los Angeles, Los Angeles; Department of Computer Science, University of Colorado, Colorado Springs (Atyabi); Duke Center for Autism and Brain Development (Dawson, Sabatos-DeVito) and Department of Psychiatry and Behavioral Sciences (Dawson), Duke University, Durham, N.C.; Department of Pediatrics, Harvard University, Boston (Faja, Nelson); Division of Developmental Medicine, Boston Children's Hospital, Boston (Faja, Nelson); Department of Medical Social Sciences, Northwestern University, Chicago (Murias); Graduate School of Education, Harvard University, Boston (Nelson); Department of Pediatrics, University of Washington, Seattle (Shic)
| | - Maura Sabatos-DeVito
- Center for Child Health, Behavior, and Development and Seattle Children's Research Institute, Seattle (Webb, Borland, Benton, Santhosh, Shic); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Webb, Bernier); Yale Child Study Center (Naples, Carlos, McAllister, Chawarska, McPartland), Yale Center for Clinical Investigation (Seow), and Department of Emergency Medicine (Dziura), Yale University, New Haven, Conn.; Department of Neurology, Boston Children's Hospital, Boston (Levin); Department of Neurology, Harvard Medical School, Boston (Levin); Department of Psychiatry and Biobehavioral Sciences (Hellemann, Jeste, Senturk, Sugar) and Department of Biostatistics (Senturk, Sugar), University of California Los Angeles, Los Angeles; Department of Computer Science, University of Colorado, Colorado Springs (Atyabi); Duke Center for Autism and Brain Development (Dawson, Sabatos-DeVito) and Department of Psychiatry and Behavioral Sciences (Dawson), Duke University, Durham, N.C.; Department of Pediatrics, Harvard University, Boston (Faja, Nelson); Division of Developmental Medicine, Boston Children's Hospital, Boston (Faja, Nelson); Department of Medical Social Sciences, Northwestern University, Chicago (Murias); Graduate School of Education, Harvard University, Boston (Nelson); Department of Pediatrics, University of Washington, Seattle (Shic)
| | - Damla Senturk
- Center for Child Health, Behavior, and Development and Seattle Children's Research Institute, Seattle (Webb, Borland, Benton, Santhosh, Shic); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Webb, Bernier); Yale Child Study Center (Naples, Carlos, McAllister, Chawarska, McPartland), Yale Center for Clinical Investigation (Seow), and Department of Emergency Medicine (Dziura), Yale University, New Haven, Conn.; Department of Neurology, Boston Children's Hospital, Boston (Levin); Department of Neurology, Harvard Medical School, Boston (Levin); Department of Psychiatry and Biobehavioral Sciences (Hellemann, Jeste, Senturk, Sugar) and Department of Biostatistics (Senturk, Sugar), University of California Los Angeles, Los Angeles; Department of Computer Science, University of Colorado, Colorado Springs (Atyabi); Duke Center for Autism and Brain Development (Dawson, Sabatos-DeVito) and Department of Psychiatry and Behavioral Sciences (Dawson), Duke University, Durham, N.C.; Department of Pediatrics, Harvard University, Boston (Faja, Nelson); Division of Developmental Medicine, Boston Children's Hospital, Boston (Faja, Nelson); Department of Medical Social Sciences, Northwestern University, Chicago (Murias); Graduate School of Education, Harvard University, Boston (Nelson); Department of Pediatrics, University of Washington, Seattle (Shic)
| | - Frederick Shic
- Center for Child Health, Behavior, and Development and Seattle Children's Research Institute, Seattle (Webb, Borland, Benton, Santhosh, Shic); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Webb, Bernier); Yale Child Study Center (Naples, Carlos, McAllister, Chawarska, McPartland), Yale Center for Clinical Investigation (Seow), and Department of Emergency Medicine (Dziura), Yale University, New Haven, Conn.; Department of Neurology, Boston Children's Hospital, Boston (Levin); Department of Neurology, Harvard Medical School, Boston (Levin); Department of Psychiatry and Biobehavioral Sciences (Hellemann, Jeste, Senturk, Sugar) and Department of Biostatistics (Senturk, Sugar), University of California Los Angeles, Los Angeles; Department of Computer Science, University of Colorado, Colorado Springs (Atyabi); Duke Center for Autism and Brain Development (Dawson, Sabatos-DeVito) and Department of Psychiatry and Behavioral Sciences (Dawson), Duke University, Durham, N.C.; Department of Pediatrics, Harvard University, Boston (Faja, Nelson); Division of Developmental Medicine, Boston Children's Hospital, Boston (Faja, Nelson); Department of Medical Social Sciences, Northwestern University, Chicago (Murias); Graduate School of Education, Harvard University, Boston (Nelson); Department of Pediatrics, University of Washington, Seattle (Shic)
| | - Catherine A Sugar
- Center for Child Health, Behavior, and Development and Seattle Children's Research Institute, Seattle (Webb, Borland, Benton, Santhosh, Shic); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Webb, Bernier); Yale Child Study Center (Naples, Carlos, McAllister, Chawarska, McPartland), Yale Center for Clinical Investigation (Seow), and Department of Emergency Medicine (Dziura), Yale University, New Haven, Conn.; Department of Neurology, Boston Children's Hospital, Boston (Levin); Department of Neurology, Harvard Medical School, Boston (Levin); Department of Psychiatry and Biobehavioral Sciences (Hellemann, Jeste, Senturk, Sugar) and Department of Biostatistics (Senturk, Sugar), University of California Los Angeles, Los Angeles; Department of Computer Science, University of Colorado, Colorado Springs (Atyabi); Duke Center for Autism and Brain Development (Dawson, Sabatos-DeVito) and Department of Psychiatry and Behavioral Sciences (Dawson), Duke University, Durham, N.C.; Department of Pediatrics, Harvard University, Boston (Faja, Nelson); Division of Developmental Medicine, Boston Children's Hospital, Boston (Faja, Nelson); Department of Medical Social Sciences, Northwestern University, Chicago (Murias); Graduate School of Education, Harvard University, Boston (Nelson); Department of Pediatrics, University of Washington, Seattle (Shic)
| | - James C McPartland
- Center for Child Health, Behavior, and Development and Seattle Children's Research Institute, Seattle (Webb, Borland, Benton, Santhosh, Shic); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Webb, Bernier); Yale Child Study Center (Naples, Carlos, McAllister, Chawarska, McPartland), Yale Center for Clinical Investigation (Seow), and Department of Emergency Medicine (Dziura), Yale University, New Haven, Conn.; Department of Neurology, Boston Children's Hospital, Boston (Levin); Department of Neurology, Harvard Medical School, Boston (Levin); Department of Psychiatry and Biobehavioral Sciences (Hellemann, Jeste, Senturk, Sugar) and Department of Biostatistics (Senturk, Sugar), University of California Los Angeles, Los Angeles; Department of Computer Science, University of Colorado, Colorado Springs (Atyabi); Duke Center for Autism and Brain Development (Dawson, Sabatos-DeVito) and Department of Psychiatry and Behavioral Sciences (Dawson), Duke University, Durham, N.C.; Department of Pediatrics, Harvard University, Boston (Faja, Nelson); Division of Developmental Medicine, Boston Children's Hospital, Boston (Faja, Nelson); Department of Medical Social Sciences, Northwestern University, Chicago (Murias); Graduate School of Education, Harvard University, Boston (Nelson); Department of Pediatrics, University of Washington, Seattle (Shic)
| |
Collapse
|
22
|
Hatch B, Kadlaskar G, Miller M. Diagnosis and treatment children and adolescents with autism and ADHD. PSYCHOLOGY IN THE SCHOOLS 2022; 60:295-311. [PMID: 37065905 PMCID: PMC10092654 DOI: 10.1002/pits.22808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/11/2022] [Accepted: 09/11/2022] [Indexed: 11/12/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) and autism are neurodevelopmental disorders that emerge in childhood. There is increasing recognition that ADHD and autism frequently co-occur. Yet, questions remain among clinicians regarding the best ways to evaluate and treat co-occurring autism and ADHD. This review outlines issues relevant to providing evidence-based practice to individuals and families who may be experiencing difficulties associated with co-occurring autism and ADHD. After describing the complexities of the co-occurrence of autism and ADHD, we present practical considerations for best practice assessment and treatment of co-occurring autism and ADHD. Regarding assessment, this includes considerations for interviewing parents/caregivers and youth, using validated parent and teacher rating scales, conducting cognitive assessments, and conducting behavior observations. Regarding treatment, consideration is given to behavioral management, school-based interventions, social skills development, and the use of medications. Throughout, we note the quality of evidence that supports a particular component of assessment or treatment, highlighting when evidence is most relevant to those with co-occurring autism and ADHD across stages of development. In light of the current evidence for assessment and treatment of co-occurring autism and ADHD, we conclude by outlining practical implications for clinical and educational practice.
Collapse
Affiliation(s)
- Burt Hatch
- School of Psychology Victoria University of Wellington Wellington New Zealand
| | - Girija Kadlaskar
- Department of Psychiatry & Behavioral Sciences and MIND Institute University of California Davis California USA
| | - Meghan Miller
- Department of Psychiatry & Behavioral Sciences and MIND Institute University of California Davis California USA
| |
Collapse
|
23
|
Chandler S, Carter Leno V, White P, Yorke I, Hollocks MJ, Baird G, Pickles A, Simonoff E, Charman T. Pathways to adaptive functioning in autism from early childhood to adolescence. Autism Res 2022; 15:1883-1893. [PMID: 35899846 PMCID: PMC9796413 DOI: 10.1002/aur.2785] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 07/15/2022] [Indexed: 01/07/2023]
Abstract
Adaptive functioning is lower in many autistic individuals to a greater extent than would be expected based on IQ. However, the clinical features associated with these difficulties are less well understood. This study examines longitudinal and contemporaneous associations of adaptive functioning in autistic youth across a wide ability range. Parent-reported autism symptoms, co-occurring emotional, behavioral and attention deficit hyperactivity disorder (ADHD) symptoms, and IQ were assessed in early childhood (M age 7 years; T1) and 6 years later in adolescence (M age 13 years; T2) in 179 autistic youth. Adaptive functioning was assessed at T2. Structural equation modeling estimated pathways to adaptive functioning from autism, and psychiatric symptoms at T1 and T2, testing whether associations were driven by continuity of behaviors from T1 to T2 or their contemporaneous effect at T2, or both, controlling for T1 IQ. Lower adaptive functioning at T2 was associated with higher T1 and T2 ADHD symptoms (β = -0.14, and β = -0.21) but not behavioral nor emotional symptoms at either timepoint. Lower adaptive functioning at T2 was also associated with lower T1 IQ (β = 0.43) and higher social communication symptoms (β = -0.37) at T2 but not T1, but the relationship with ADHD symptoms remained. Paths were not moderated by sex or IQ. Increased symptoms of ADHD, both in early childhood and contemporaneously, were associated with reduced adaptive functioning in adolescence. Co-occurring ADHD may be a modifiable risk factor for adaptive function impairments and should be routinely assessed and when present evidence-based treatments initiated which may benefit adaptive functioning outcomes. LAY SUMMARY: Adaptive functioning is lower in many autistic individuals to a greater extent than would be expected based on IQ. However, the clinical features associated with these difficulties are less well understood. In a community sample higher attention deficit/hyperactivity disorder (ADHD) symptoms, but not emotional or behavioral symptoms, in both early childhood and contemporaneously were associated with lower adaptive functioning in autistic adolescents. Co-occurring ADHD may be a modifiable risk factor for adaptive function difficulties in autism.
Collapse
Affiliation(s)
- Susie Chandler
- Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
| | | | - Philippa White
- Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
| | - Isabel Yorke
- Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
| | - Matthew J. Hollocks
- Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK,South London and Maudsley NHS Foundation Trust (SLaM)LondonUK
| | | | - Andrew Pickles
- Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK,Maudsley Biomedical Research Centre for Mental HealthLondonUK
| | - Emily Simonoff
- Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK,South London and Maudsley NHS Foundation Trust (SLaM)LondonUK,Maudsley Biomedical Research Centre for Mental HealthLondonUK
| | - Tony Charman
- Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK,South London and Maudsley NHS Foundation Trust (SLaM)LondonUK
| |
Collapse
|
24
|
Rosello R, Martinez-Raga J, Tomas JM, Mira A, Cortese S. Cognitive and behavioral profiles in children with autism spectrum disorder with and without Attention-Deficit/hyperactivity disorder. Child Adolesc Ment Health 2022; 28:269-276. [PMID: 35441444 DOI: 10.1111/camh.12562] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 02/03/2022] [Accepted: 02/23/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Understanding the developmental trajectories of children with autism spectrum disorder (ASD) with and without comorbid ADHD is relevant to tailor care plans. This prospective study assessed, for the first time, cognitive, emotional, behavioral, and learning outcomes in adolescence of children with ASD-ADHD and in those with ASD+ADHD in childhood. Possible predictors of severity of ASD core symptoms in adolescence were also evaluated. METHODS Forty-five adolescents without intellectual disability, 26 diagnosed in childhood with ASD-ADHD and 19 with ASD+ADHD, were evaluated at baseline (mean age: 8.6 ± 1.3) and at 5-year follow-up (mean age: 12.9 ± 0.9). Parents and teachers completed questionnaires on executive functions, theory of mind (ToM), emotional/behavioral difficulties (EBD), and learning style at both time points.. RESULTS Overall different developmental trajectories for the two groups were found. In general, deficits in metacognition processes, ToM skills, EBD, and learning abilities were more pronounced in the ASD+ group. Over time, the ASD+ADHD group, but not the ASD-ADHD, tended to improve in EBD and metacognition but their level of development continued to be lower compared with ASD+ADHD. EBD in childhood were significant predictors of autism core symptoms of adolescents. CONCLUSIONS Our findings highlight the importance of an early identification of comorbid ADHD symptoms in ASD to offer treatment strategies based on specific developmental trajectories.
Collapse
Affiliation(s)
- Rocio Rosello
- Division of Psychiatry, Hospital Universitario Dr Peset, Valencia, Spain.,Doctor Peset Hospital of Valencia, Valencia, Spain
| | - Jose Martinez-Raga
- Doctor Peset Hospital of Valencia, Valencia, Spain.,Division of Psychiatry, University of Valencia, Valencia, Spain
| | - Jose Manuel Tomas
- Division of Methodology and Behavioural Science, University of Valencia, Valencia, Spain
| | - Alvaro Mira
- Division of Developmental and Educational Psychology, University of Valencia, Valencia, Spain
| | - Samuele Cortese
- Solent NHS Trust, Southampton, UK.,Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York, NY, USA.,Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK.,Centre for Innovation in Mental Health (CIMH), University of Southampton, Southampton, UK
| |
Collapse
|
25
|
Siafis S, Çıray O, Wu H, Schneider-Thoma J, Bighelli I, Krause M, Rodolico A, Ceraso A, Deste G, Huhn M, Fraguas D, San José Cáceres A, Mavridis D, Charman T, Murphy DG, Parellada M, Arango C, Leucht S. Pharmacological and dietary-supplement treatments for autism spectrum disorder: a systematic review and network meta-analysis. Mol Autism 2022; 13:10. [PMID: 35246237 PMCID: PMC8896153 DOI: 10.1186/s13229-022-00488-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 02/02/2022] [Indexed: 12/22/2022] Open
Abstract
Background There is still no approved medication for the core symptoms of autism spectrum disorder (ASD). This network meta-analysis investigated pharmacological and dietary-supplement treatments for ASD. Methods We searched for randomized-controlled-trials (RCTs) with a minimum duration of seven days in ClinicalTrials.gov, EMBASE, MEDLINE, PsycINFO, WHO-ICTRP (from inception up to July 8, 2018), CENTRAL and PubMed (up to November 3, 2021). The co-primary outcomes were core symptoms (social-communication difficulties-SCD, repetitive behaviors-RB, overall core symptoms-OCS) measured by validated scales and standardized-mean-differences (SMDs). Associated symptoms, e.g., irritability/aggression and attention-deficit/hyperactivity disorder (ADHD) symptoms, dropouts and important side-effects, were investigated as secondary outcomes. Studies in children/adolescents and adults were analyzed separately in random-effects pairwise and network meta-analyses. Results We analyzed data for 41 drugs and 17 dietary-supplements, from 125 RCTs (n = 7450 participants) in children/adolescents and 18 RCTs (n = 1104) in adults. The following medications could improve at least one core symptom domain in comparison with placebo: aripiprazole (k = 6 studies in analysis, SCD: SMD = 0.27 95% CI [0.09, 0.44], RB: 0.48 [0.26, 0.70]), atomoxetine (k = 3, RB:0.49 [0.18, 0.80]), bumetanide (k = 4, RB: 0.35 [0.09, 0.62], OCS: 0.61 [0.31, 0.91]), and risperidone (k = 4, SCM: 0.31 [0.06, 0.55], RB: 0.60 [0.29, 0.90]; k = 3, OCS: 1.18 [0.75, 1.61]) in children/adolescents; fluoxetine (k = 1, RB: 1.20 [0.45, 1.96]), fluvoxamine (k = 1, RB: 1.04 [0.27, 1.81]), oxytocin (k = 6, RB:0.41 [0.16, 0.66]) and risperidone (k = 1, RB: 0.97 [0.21,1.74]) in adults. There were some indications of improvement by carnosine, haloperidol, folinic acid, guanfacine, omega-3-fatty-acids, probiotics, sulforaphane, tideglusib and valproate, yet imprecise and not robust. Confidence in these estimates was very low or low, except moderate for oxytocin. Medications differed substantially in improving associated symptoms, and in their side-effect profiles. Limitations Most of the studies were inadequately powered (sample sizes of 20–80 participants), with short duration (8–13 weeks), and about a third focused on associated symptoms. Networks were mainly star-shaped, and there were indications of reporting bias. There was no optimal rating scale measuring change in core symptoms. Conclusions Some medications could improve core symptoms, although this could be likely secondary to the improvement of associated symptoms. Evidence on their efficacy and safety is preliminary; therefore, routine prescription of medications for the core symptoms cannot be recommended. Trial registration PROSPERO-ID CRD42019125317. Supplementary Information The online version contains supplementary material available at 10.1186/s13229-022-00488-4.
Collapse
Affiliation(s)
- Spyridon Siafis
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany.
| | - Oğulcan Çıray
- Department of Child and Adolescent Psychiatry, Mardin State Hospital, Artuklu, Mardin, Turkey
| | - Hui Wu
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany
| | - Johannes Schneider-Thoma
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany
| | - Irene Bighelli
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany
| | - Marc Krause
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Alessandro Rodolico
- Department of Experimental and Clinical Medicine, Psychiatric Clinic University Hospital 'Gaspare Rodolico', University of Catania, Catania, Italy
| | - Anna Ceraso
- Department of Psychiatry, Spedali Civili Hospital, Brescia, Italy
| | - Giacomo Deste
- Department of Psychiatry, Spedali Civili Hospital, Brescia, Italy
| | - Maximilian Huhn
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany.,Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Social Foundation Bamberg, Teaching Hospital of the University of Erlangen, Bamberg, Germany
| | - David Fraguas
- Institute of Psychiatry and Mental Health, Hospital Clínico San Carlos, IdISSC CIBERSAM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Antonia San José Cáceres
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,Centro Investigación Biomédica en Red Salud Mental (CIBERSAM), Madrid, Spain
| | - Dimitris Mavridis
- Department of Primary Education, University of Ioannina, Ioannina, Greece.,Faculté de Médecine, Université Paris Descartes, Paris, France
| | - Tony Charman
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Declan G Murphy
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Mara Parellada
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,School of Medicine, Universidad Complutense, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,Centro Investigación Biomédica en Red Salud Mental (CIBERSAM), Madrid, Spain
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,School of Medicine, Universidad Complutense, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,Centro Investigación Biomédica en Red Salud Mental (CIBERSAM), Madrid, Spain
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany
| |
Collapse
|
26
|
Abstract
PURPOSE OF REVIEW There are currently no approved medications for the core symptoms of autism spectrum disorder (ASD), and only limited data on the management of co-occurring mental health and behavioural symptoms. The purpose of this review is to synthesize recent trials on novel treatments in ASD, with a focus on research trends in the past 2 years. RECENT FINDINGS No new pharmacologic agents received regulatory approval for use in ASD. Several large randomized controlled trials (RCTs) had negative or ambiguous results (e.g. fluoxetine, oxytocin). A cross-over RCT of an oral cannabinoid suggested possible benefits for disruptive behaviours. Two large-scale multicentre trials of bumetanide were terminated early for lack of efficacy. Multicenter trials using repetitive transcranial magnetic stimulation are underway. Recent meta-analyses indicate that specific behavioural and psychological interventions can support social communication and treat anxiety. Numerous novel treatment targets informed by biological mechanisms are under investigation. SUMMARY Recent data support the use of behavioural and psychological interventions for social communication and anxiety in ASD; data are more limited regarding pharmacotherapy for core and associated symptoms. Next steps include replication of early findings, trials of new molecular targets, and the identification of novel biomarkers, including genetic predictors, of treatment response.
Collapse
Affiliation(s)
- Danielle Baribeau
- University of Toronto
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Jacob Vorstman
- University of Toronto
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Evdokia Anagnostou
- University of Toronto
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| |
Collapse
|
27
|
Lord C, Charman T, Havdahl A, Carbone P, Anagnostou E, Boyd B, Carr T, de Vries PJ, Dissanayake C, Divan G, Freitag CM, Gotelli MM, Kasari C, Knapp M, Mundy P, Plank A, Scahill L, Servili C, Shattuck P, Simonoff E, Singer AT, Slonims V, Wang PP, Ysrraelit MC, Jellett R, Pickles A, Cusack J, Howlin P, Szatmari P, Holbrook A, Toolan C, McCauley JB. The Lancet Commission on the future of care and clinical research in autism. Lancet 2022; 399:271-334. [PMID: 34883054 DOI: 10.1016/s0140-6736(21)01541-5] [Citation(s) in RCA: 258] [Impact Index Per Article: 129.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 06/22/2021] [Accepted: 06/24/2021] [Indexed: 12/13/2022]
Affiliation(s)
| | - Tony Charman
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Alexandra Havdahl
- Nic Waals Institute, Lovisenberg Diaconal Hospital, Oslo, Norway; Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway; Department of Psychology, University of Oslo, Oslo, Norway
| | - Paul Carbone
- Department of Pediatrics at University of Utah, Salt Lake City, UT, USA
| | - Evdokia Anagnostou
- Holland Bloorview Kids Rehabilitation Hospital, Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | | | - Themba Carr
- Rady Children's Hospital San Diego, Encinitas, CA, USA
| | - Petrus J de Vries
- Division of Child & Adolescent Psychiatry, University of Cape Town, Cape Town, South Africa
| | - Cheryl Dissanayake
- Olga Tennison Autism Research Centre, La Trobe University, Melbourne, VIC, Australia
| | | | | | | | | | | | - Peter Mundy
- University of California, Davis, Davis, CA, USA
| | | | | | - Chiara Servili
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | | | - Emily Simonoff
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | | | - Vicky Slonims
- Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Paul P Wang
- Simons Foundation Autism Research Initiative, Simons Foundation, New York, NY, USA; Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | | | - Rachel Jellett
- Olga Tennison Autism Research Centre, La Trobe University, Melbourne, VIC, Australia
| | - Andrew Pickles
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | | | - Patricia Howlin
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Peter Szatmari
- Holland Bloorview Kids Rehabilitation Hospital, Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | | | | | | |
Collapse
|
28
|
Masi G, Pfanner C, Liboni F, Lenzi F, Villafranca A, D’Acunto G, Fantozzi P, Falcone F, Simonelli V, Muratori P, Levantini V, Favole I, Amianto F, Davico C, Vitiello B. Acute Tolerability of Methylphenidate in Treatment-Naïve Children with ADHD: An Analysis of Naturalistically Collected Data from Clinical Practice. Paediatr Drugs 2022; 24:147-154. [PMID: 35137333 PMCID: PMC8940796 DOI: 10.1007/s40272-022-00492-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/10/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The acute tolerability of methylphenidate (MPH) in children with attention-deficit/hyperactivity disorder (ADHD) has been studied mainly in research samples. Taking advantage of the mandatory test-dose procedure required for starting MPH in Italy, this study aimed to assess the incidence of intolerable adverse events after initial exposure to MPH in routine clinical practice. METHODS The medical records of 480 consecutively treated, previously drug-naïve children and adolescents with ADHD (90% male, mean age 10.6 ± 3.0 years) were retrospectively analyzed. All children received an initial single dose of MPH immediate release (5 or 10 mg) followed by a 4-hour direct medical observation. Heart rate and blood pressure were measured at dosing and 1, 2, and 3 hours afterwards. If the first dose was well tolerated, the child continued treatment with MPH 5-20 mg daily, and was reassessed a week later. RESULTS Eleven patients (2.3%, 95% CI 1.1-4.1) interrupted treatment within a week of initiation because of the following adverse events: irritability (n = 3), tics worsening (n = 3), reduced appetite (n = 1), enuresis (n = 1), hallucinations (n = 1), hyperfocus (n = 1), and 'rebound' behavioral worsening (n = 1). The most common adverse events were reduced appetite (20%), irritability (14.2%), headache (10.6%), sleep problems (9.4%), stomachache (9.4%), and tics (5%). Intellectual disability increased the risk of any adverse event in general and of irritability in particular. No cardiovascular symptom was clinically reported. However, routine assessments of vital signs during the first 3 hours after the first dose of MPH showed that 9% of the children had a 20% increase in heart rate, 8.8% had a 20% increase in diastolic blood pressure and 4.5% had a 20% increase in systolic blood pressure. Of these, 25.2% still had an elevated heart rate 1 week later. CONCLUSIONS Among stimulant-naïve children in clinical practice, the incidence of acute MPH intolerance can be estimated to be between 1.2 and 4.1%. An asymptomatic elevation in cardiovascular parameters can be observed in about 1 out of 10 children and warrants monitoring during ongoing treatment.
Collapse
Affiliation(s)
- Gabriele Masi
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Pisa, Italy
| | - Chiara Pfanner
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Pisa, Italy
| | - Francesca Liboni
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Pisa, Italy
| | - Francesca Lenzi
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Pisa, Italy
| | - Arianna Villafranca
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Pisa, Italy
| | - Giulia D’Acunto
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Pisa, Italy
| | - Pamela Fantozzi
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Pisa, Italy
| | - Francesca Falcone
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Valerio Simonelli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Pietro Muratori
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Pisa, Italy
| | - Valentina Levantini
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Pisa, Italy
| | - Irene Favole
- Section of Child and Adolescent Neuropsychiatry, Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy
| | | | - Chiara Davico
- Section of Child and Adolescent Neuropsychiatry, Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy
| | - Benedetto Vitiello
- Section of Child and Adolescent Neuropsychiatry, Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy.
| |
Collapse
|
29
|
Maniram J, Karrim SBS, Oosthuizen F, Wiafe E. Pharmacological Management of Core Symptoms and Comorbidities of Autism Spectrum Disorder in Children and Adolescents: A Systematic Review. Neuropsychiatr Dis Treat 2022; 18:1629-1644. [PMID: 35968512 PMCID: PMC9371468 DOI: 10.2147/ndt.s371013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 07/21/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The pharmacological management of Autism Spectrum Disorder (ASD) in children remains a challenge due to limited effective management options and the absence of approved drugs to manage the core symptoms. This review aims to describe and highlight effective pharmacological management options employed in managing the core symptoms and comorbidities of ASD from eligible studies over the past decade. METHODS A search of databases; PubMed, Scopus, Science Direct, and PsychInfo for pharmacotherapeutic options for ASD was conducted in this systematic review. Duplicate studies were removed by utilizing the EndNote citation manager. The studies were subsequently screened independently by two authors. Eligible studies from 01 January 2012 to 01 January 2022 were included based on established eligibility criteria. A narrative synthesis was used for data analysis. RESULTS The systematic review provides a comprehensive list of effective management options for ASD comorbidities and core symptoms from 33 included studies. The management options for ASD comorbidities; insomnia, hyperactivity, irritability and aggression, gastrointestinal disturbances, and subclinical epileptiform discharges, were reviewed. Risperidone, aripiprazole, methylphenidate, guanfacine, levetiracetam, and atomoxetine are examples of effective pharmacological drugs against ASD comorbidities. Additionally, this review identified various drugs that improve the core symptoms of ASD and include but are not limited to, bumetanide, buspirone, intranasal oxytocin, intranasal vasopressin, and prednisolone. CONCLUSION This review has successfully summarized the pharmacological advancements made in the past decade to manage ASD. Although there is still no pharmacological cure for ASD core symptoms or additional drugs that have obtained regulatory approval for use in ASD, the availability of promising pharmacological agents are under evaluation and study.
Collapse
Affiliation(s)
- Jennal Maniram
- School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Saira B S Karrim
- School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Frasia Oosthuizen
- School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Ebenezer Wiafe
- School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.,Clinical Pharmacy Services Unit, Directorate of Pharmacy, Ho Teaching Hospital, Ho, Ghana
| |
Collapse
|
30
|
Aishworiya R, Valica T, Hagerman R, Restrepo B. An Update on Psychopharmacological Treatment of Autism Spectrum Disorder. Neurotherapeutics 2022; 19:248-262. [PMID: 35029811 PMCID: PMC9130393 DOI: 10.1007/s13311-022-01183-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2022] [Indexed: 01/05/2023] Open
Abstract
While behavioral interventions remain the mainstay of treatment of autism spectrum disorder (ASD), several potential targeted treatments addressing the underlying neurophysiology of ASD have emerged in the last few years. These are promising for the potential to, in future, become part of the mainstay treatment in addressing the core symptoms of ASD. Although it is likely that the development of future targeted treatments will be influenced by the underlying heterogeneity in etiology, associated genetic mechanisms influencing ASD are likely to be the first targets of treatments and even gene therapy in the future for ASD. In this article, we provide a review of current psychopharmacological treatment in ASD including those used to address common comorbidities of the condition and upcoming new targeted approaches in autism management. Medications including metformin, arbaclofen, cannabidiol, oxytocin, bumetanide, lovastatin, trofinetide, and dietary supplements including sulforophane and N-acetylcysteine are discussed. Commonly used medications to address the comorbidities associated with ASD including atypical antipsychotics, serotoninergic agents, alpha-2 agonists, and stimulant medications are also reviewed. Targeted treatments in Fragile X syndrome (FXS), the most common genetic disorder leading to ASD, provide a model for new treatments that may be helpful for other forms of ASD.
Collapse
Affiliation(s)
- Ramkumar Aishworiya
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California Davis, 2825 50th Street, Sacramento, CA, 95817, USA
- Khoo Teck Puat-National University Children's Medical Institute, National University Health System, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
- Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Tatiana Valica
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California Davis, 2825 50th Street, Sacramento, CA, 95817, USA
- Association for Children With Autism, Chisinau, Moldova
| | - Randi Hagerman
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California Davis, 2825 50th Street, Sacramento, CA, 95817, USA.
- Department of Pediatrics, University of California Davis School of Medicine, 4610 X St, Sacramento, CA, 95817, USA.
| | - Bibiana Restrepo
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California Davis, 2825 50th Street, Sacramento, CA, 95817, USA
- Department of Pediatrics, University of California Davis School of Medicine, 4610 X St, Sacramento, CA, 95817, USA
| |
Collapse
|
31
|
Rosello R, Martinez-Raga J, Mira A, Pastor JC, Solmi M, Cortese S. Cognitive, social, and behavioral manifestations of the co-occurrence of autism spectrum disorder and attention-deficit/hyperactivity disorder: A systematic review. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 26:743-760. [PMID: 34961363 DOI: 10.1177/13623613211065545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
LAY ABSTRACT This work aimed to review recent research on the characteristics of individuals who have both autism spectrum disorder and attention-deficit/hyperactivity disorder due to their high co-occurrence. Thirty-four studies were analyzed and main findings summarized in two content domains focusing on areas that could enhance our understanding of the cognitive and behavioral characteristics of individuals with autism spectrum disorder + attention-deficit/hyperactivity disorder (ASD+). Most of the results suggested that ASD+ is a co-occurring condition associated with more severe impairments in cognitive functioning, adaptive behavior, and increased likelihood to present more emotional/behavioral problems. These results will be helpful to provide improved care plans for individuals with both attention-deficit/hyperactivity disorder and autism spectrum disorder.
Collapse
|
32
|
Farhat LC, Bloch MH. Commentary: Identifying individualized predictions of response in ADHD pharmacotherapy - a commentary on Rodrigues et al. (2020). J Child Psychol Psychiatry 2021; 62:701-703. [PMID: 33368287 DOI: 10.1111/jcpp.13374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 11/30/2020] [Indexed: 11/30/2022]
Abstract
In this issue, Rodrigues et al. (2020) present a systematic review with meta-analyses that reports the efficacy of five treatments for children with attention-deficit hyperactivity disorder symptoms in the context of autism spectrum disorder - (a) methylphenidate; (b) atomoxetine; (c) guanfacine; (d) aripiprazole; and (e) risperidone. In this commentary, we highlight the contrast between the scarce evidence base of treatment for ADHD in the context of autism and other subpopulations, such as tic disorders and intellectual disability, and the extensive evidence base of treatment for ADHD in general. The commentary weighs about the conundrum clinicians face of whether to rely on the limited evidence base of treatment for ADHD in subpopulation, or to derive conclusions from the larger body of evidence of treatment for ADHD in general. The commentary also discusses potential avenues for future research to address this clinical problem.
Collapse
Affiliation(s)
- Luis C Farhat
- Departament of Psychiatry, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Michael H Bloch
- Yale Child Study Center, Yale University School of Medicine, New Haven, CT, USA.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| |
Collapse
|
33
|
Fu D, Wu DD, Guo HL, Hu YH, Xia Y, Ji X, Fang WR, Li YM, Xu J, Chen F, Liu QQ. The Mechanism, Clinical Efficacy, Safety, and Dosage Regimen of Atomoxetine for ADHD Therapy in Children: A Narrative Review. Front Psychiatry 2021; 12:780921. [PMID: 35222104 PMCID: PMC8863678 DOI: 10.3389/fpsyt.2021.780921] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 12/28/2021] [Indexed: 12/12/2022] Open
Abstract
Atomoxetine, a selective norepinephrine (NE) reuptake inhibitor, was approved for attention deficit/hyperactivity disorder (ADHD) treatment in children, adolescents and adults. We searched the database PubMed/MEDLINE (2000 to October 1, 2021). Only publications in English were considered. Atomoxetine inhibits the presynaptic norepinephrine transporter (NET), preventing the reuptake of NE throughout the brain along with inhibiting the reuptake of dopamine in specific brain regions such as the prefrontal cortex (PFC). The novel mechanism of atomoxetine also includes several new brain imaging studies and animal model studies. It is mainly metabolized by the highly polymorphic drug metabolizing enzyme cytochrome P450 2D6 (CYP2D6). Atomoxetine is effective and generally well tolerated. ADHD is often accompanied by multiple comorbidities. A series of studies have been published suggesting that atomoxetine is effective in the treatment of ADHD symptoms for children with various types of comorbidity. In some cases, it is possible that atomoxetine may have a positive influence on the symptoms of comorbidities. Atomoxetine can be administered either as a single daily dose or split into two evenly divided doses, and has a negligible risk of abuse or misuse. The latest guideline updated that clinical dose selection of atomoxetine was recommended based on both CYP2D6 genotype and the peak concentration. To have a more comprehensive understanding of atomoxetine, this review sets the focus on the mechanism, clinical efficacy and dosage regimen in detail, and also touches on those studies regarding adverse reactions of atomoxetine.
Collapse
Affiliation(s)
- Di Fu
- Department of Pharmacy, Pharmaceutical Sciences Research Center, Children's Hospital of Nanjing Medical University, Nanjing, China.,School of Basic Medical Sciences and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Dan-Dan Wu
- Department of Children Health Care, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Hong-Li Guo
- Department of Pharmacy, Pharmaceutical Sciences Research Center, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Ya-Hui Hu
- Department of Pharmacy, Pharmaceutical Sciences Research Center, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Ying Xia
- Department of Pharmacy, Pharmaceutical Sciences Research Center, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Xing Ji
- Department of Pharmacy, Pharmaceutical Sciences Research Center, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Wei-Rong Fang
- School of Basic Medical Sciences and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Yun-Man Li
- School of Basic Medical Sciences and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Jing Xu
- Department of Pharmacy, Pharmaceutical Sciences Research Center, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Feng Chen
- Department of Pharmacy, Pharmaceutical Sciences Research Center, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Qian-Qi Liu
- Department of Children Health Care, Children's Hospital of Nanjing Medical University, Nanjing, China
| |
Collapse
|