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Havdahl A, Farmer C, Surén P, Øyen AS, Magnus P, Susser E, Lipkin WI, Reichborn-Kjennerud T, Stoltenberg C, Bishop S, Thurm A. Attainment and loss of early social-communication skills across neurodevelopmental conditions in the Norwegian Mother, Father and Child Cohort Study. J Child Psychol Psychiatry 2024; 65:610-619. [PMID: 36973172 PMCID: PMC10522798 DOI: 10.1111/jcpp.13792] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/15/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Delays and loss of early-emerging social-communication skills are often discussed as unique to autism. However, most studies of regression have relied on retrospective recall and clinical samples. Here, we examine attainment and loss of social-communication skills in the population-based Norwegian Mother, Father and Child Cohort Study (MoBa). METHODS Mothers rated their child's attainment of 10 early-emerging social-communication skills at ages 18 and 36 months (N = 40,613, 50.9% male). Prospectively reported loss was defined as skill presence at 18 months but absence at 36 months. At 36 months, mothers also recalled whether the child had lost social-communication skills. The Norwegian Patient Registry was used to capture diagnoses of Autism Spectrum Disorder (autism) and other neurodevelopmental disabilities (NDDs). RESULTS Delay in at least one skill was observed in 14% of the sample and loss in 5.4%. Recalled loss of social-communication skills was rare (0.86%) and showed low convergence with prospectively reported loss. Delay and especially loss were associated with elevated odds of an autism diagnosis (n = 383) versus no autism diagnosis (n = 40,230; ≥3 skills delayed: OR = 7.09[4.15,12.11]; ≥3 skills lost: OR = 30.66[17.30,54.33]). They were also associated with an increased likelihood of autism compared to some other NDDs. Delay (relative risk [RR] = 4.16[2.08, 8.33]) and loss (RR = 10.00[3.70, 25.00]) associated with increased likelihood of autism versus ADHD, and loss (RR = 4.35[1.28,14.29]), but not delay (RR = 2.00[0.78,5.26]), associated with increased likelihood of autism compared to language disability. Conversely, delay conferred decreased likelihood of autism versus intellectual disability (RR = 0.11[0.06,0.21]), and loss was not reliably associated with likelihood of autism versus intellectual disability (RR = 1.89[0.44,8.33]). CONCLUSIONS This population-based study suggests that loss of early social communication skills is more common than studies using retrospective reports have indicated and is observed across several NDD diagnoses (not just autism). Nevertheless, most children with NDD diagnoses showed no reported delay or loss in these prospectively measured skills.
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Affiliation(s)
- Alexandra Havdahl
- Norwegian Institute of Public Health, Oslo, Norway
- Nic Waals Institute, Lovisenberg Diaconal Hospital, Oslo, Norway
- PROMENTA Research Centre, Department of Psychology, University of Oslo, Oslo, Norway
| | - Cristan Farmer
- Neurodevelopmental and Behavioral Phenotyping Service, National Institute of Mental Health, Bethesda, MD
| | - Pål Surén
- Norwegian Institute of Public Health, Oslo, Norway
| | - Anne-Siri Øyen
- Nic Waals Institute, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Per Magnus
- Norwegian Institute of Public Health, Oslo, Norway
| | - Ezra Susser
- New York State Psychiatric Institute, Columbia University Medical Center, New York, NY
- Department of Epidemiology, Mailman School of Public Health, New York, NY
| | - W. Ian Lipkin
- Center for Infection and Immunity, Mailman School of Public Health and Departments of Neurology and Pathology, Vagelos College of Physicians and Surgeons of Columbia University, New York, NY
| | | | - Camilla Stoltenberg
- Norwegian Institute of Public Health, Oslo, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Somer Bishop
- UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA
| | - Audrey Thurm
- Neurodevelopmental and Behavioral Phenotyping Service, National Institute of Mental Health, Bethesda, MD
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Han L, Guan L, Zhang Z, Li W, Li J, Bao C, Ye M, Tang M, Ke X. Risk factors and clinical characteristics of autism spectrum disorder with regression in China. Autism Res 2023; 16:1836-1846. [PMID: 37578311 DOI: 10.1002/aur.3008] [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: 06/01/2023] [Accepted: 07/26/2023] [Indexed: 08/15/2023]
Abstract
Autism spectrum disorder with regression (ASD-R) is characterized by the loss of previously acquired skills during the initial year of life. This study aimed to investigate the clinical characteristics, patterns of regression, and potential risk factors associated with ASD-R in the Chinese Han population. A case-control study was conducted between September 2020 and March 2022. A total of 186 children were enrolled, including 58 children with ASD-R, 70 with ASD without regression (ASD-NR), and 58 typically developing children. Demographic information, clinical characteristics, and potential risk factors related to ASD-R were assessed using a combination of questionnaires, interviews, and physician assessments. The results revealed that children with ASD-R exhibited more severe impairments in social communication and stereotyped behaviors compared with those with ASD-NR. Language regression, constituting 40% of cases within the ASD-R group, was found to be the most common type of regression. Furthermore, our analysis revealed that fever (OR = 4.01, 95% CI: 1.26-12.76) and diarrhea (OR = 6.32, 95% CI: 1.38-29.03) were identified as significant risk factors for ASD-R. These findings contribute to our understanding of the heterogeneity of ASD and highlight the importance of considering immune responses and gastrointestinal factors in the etiology of ASD-R.
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Affiliation(s)
- Lu Han
- Child Mental Health Research Center, the Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Luyang Guan
- Child Mental Health Research Center, the Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Ziyi Zhang
- Child Mental Health Research Center, the Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Wenqing Li
- Child Mental Health Research Center, the Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Jinhui Li
- Nanjing Brain Hospital, Medical School of Nanjing University, Nanjing, China
| | - Chenxi Bao
- Child Mental Health Research Center, the Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Mei Ye
- Nanjing Jiangning District Maternal and Child Health and Family Planning Service Center, Nanjing Jiangning District Maternal and Child Health Care Institute, Nanjing, China
| | - Min Tang
- Nanjing Jiangning District Maternal and Child Health and Family Planning Service Center, Nanjing Jiangning District Maternal and Child Health Care Institute, Nanjing, China
| | - Xiaoyan Ke
- Child Mental Health Research Center, the Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
- Nanjing Brain Hospital, Medical School of Nanjing University, Nanjing, China
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Yoshida T, Matsumura K, Hatakeyama T, Inadera H. Association between Cesarean section and neurodevelopmental disorders in a Japanese birth cohort: the Japan Environment and Children's Study. BMC Pediatr 2023; 23:306. [PMID: 37331958 DOI: 10.1186/s12887-023-04128-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 06/12/2023] [Indexed: 06/20/2023] Open
Abstract
BACKGROUND The long-term effects of a Cesarean section (CS) birth on child neurodevelopment are of increasing interest. In this study, we examined the associations between mode of delivery and presence of neurodevelopmental disorders in toddlers. Moreover, given that the prevalence of several neurodevelopmental disorders such as autism spectrum disorder (ASD) is known to differ by sex, we also investigated these associations separately in male and female toddlers. METHODS We investigated 65,701 mother-toddler pairs from the Japan Environment and Children's Study, a nationally representative children's cohort study. To investigate the associations between mode of delivery (CS or vaginal delivery) and neurodevelopmental disorders (motor delay, intellectual disability, and ASD) in 3-year-old toddlers as a whole and stratified by sex, we used logistic regression models to calculate adjusted odds ratios (aORs) with 95% confidence intervals (CIs). RESULTS The morbidity of ASD at age 3 years was higher for children delivered by CS than those delivered vaginally (aOR 1.38, 95% CI 1.04-1.83). However, no such difference was evident in the case of motor delay or intellectual disability (aOR 1.33, 95% CI 0.94-1.89; aOR 1.18, 95% CI 0.94-1.49, respectively). In the analysis by sex, CS was not associated with increased risk of any of the neurodevelopmental disorders in males, but it was associated with increased risks of motor delay (aOR 1.88, 95% CI 1.02-3.47) and ASD (aOR 1.82, 95% CI 1.04-3.16) in females. CONCLUSIONS This study provides evidence of significant associations between mode of delivery and neurodevelopmental disorders in early childhood. Females may be more sensitive to the effects of CS than males.
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Affiliation(s)
- Taketoshi Yoshida
- Division of Neonatology, Maternal and Perinatal Center, Toyama University Hospital, 2630 Sugitani, Toyama City, 930-0194, Japan.
| | - Kenta Matsumura
- Department of Public Health, Faculty of Medicine, University of Toyama, Toyama, Japan
- Toyama Regional Center for JECS, University of Toyama, Toyama, Japan
| | | | - Hidekuni Inadera
- Department of Public Health, Faculty of Medicine, University of Toyama, Toyama, Japan
- Toyama Regional Center for JECS, University of Toyama, Toyama, Japan
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4
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Xiong M, Li F, Liu Z, Xie X, Shen H, Li W, Wei L, He R. Efficacy of Melatonin for Insomnia in Children with Autism Spectrum Disorder: A Meta-analysis. Neuropediatrics 2023; 54:167-173. [PMID: 36827993 PMCID: PMC10166641 DOI: 10.1055/s-0043-1761437] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
AIM This study aimed to evaluate the effectiveness of melatonin in treating insomnia in children with autism spectrum disorder (ASD). METHODS Comprehensive searches were conducted in the PubMed, EMBASE, and Web of Science databases from their inception to April 20, 2022. Data were extracted and assessed for quality by two researchers. Statistical analysis was performed using the Stata 15.0 software. RESULTS Four studies including 238 patients were included. The results showed that compared with the control group, melatonin could shorten the sleep-onset latency (standardized mean difference [SMD] = - 1.34, 95% CI: -2.19 to -0.48), reduce the number of awakenings (SMD = -2.35, 95% CI: -4.62 to -0.08), and prolong the total sleep time (SMD = 1.42, 95% CI: 0.5-2.33) in children with ASD. CONCLUSION Melatonin has a certain effect on relieving sleep disturbances in children with ASD, which can shorten sleep latency, reduce the number of awakenings, and prolong total sleep time. Larger studies are required to verify this hypothesis.
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Affiliation(s)
- Mei Xiong
- Department of Nursing, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Department of Pediatric Surgery, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Fang Li
- Department of Cardiology, People's Hospital of Jianyang City, Jianyang, China
| | - Zhaohua Liu
- Department of Nursing, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Department of Cardiothoracic Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Xin Xie
- Department of Nursing, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Department of Nephrology, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Sichuan Clinical Research Center for Nephropathy, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Hongli Shen
- Department of Nursing, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Department of Pediatric Surgery, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Weiteng Li
- Department of Nursing, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Department of Pediatric Surgery, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Liping Wei
- Department of Nursing, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Department of Pediatric Surgery, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Rongfang He
- Department of Nursing, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Department of Psychiatry, The Affiliated Hospital of Southwest Medical University, Luzhou, China
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Hu C, Yang F, Yang T, Chen J, Dai Y, Jia F, Wu L, Hao Y, Li L, Zhang J, Ke X, Yi M, Hong Q, Chen J, Fang S, Wang Y, Wang Q, Jin C, Li T, Chen L. A Multi-Center Study on the Relationship Between Developmental Regression and Disease Severity in Children With Autism Spectrum Disorders. Front Psychiatry 2022; 13:796554. [PMID: 35356716 PMCID: PMC8959377 DOI: 10.3389/fpsyt.2022.796554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 02/04/2022] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION This study aimed to investigate the prevalence of developmental regression in children with Autism Spectrum Disorder (ASD) and to explore its relationship with disease severity. METHODS We finally included 1,027 ASD children aged 2-5 years from 13 cities in China: 138 with regressive ASD and 889 with non-regressive ASD. The Social Responsiveness Scale (SRS), Autism Behavior Checklist (ABC), Child Autism Rating Scale (CARS), and Children Neuropsychological and Behavioral Scale-Revision 2016 (CNBS-R2016) were used to evaluate the core symptoms and developmental status of children in the two groups. RESULTS Among the 1,027 ASD children eventually included, 138 (13.44%) cases showed regressive behavior and the average regression occurring age was 24.00 (18.00-27.00) months. Among the regressive children, 105 cases (76.09%) had language regression, 79 cases (57.25%) had social regression, and 4 cases (2.90%) had motor regression. The total scores of ABC and the sub-score of sensory and stereotypic behavior (β = 5.122, 95% CI: 0.818, 9.426, P < 0.05; β = 1.104, 95% CI: 0.120, 2.089, P < 0.05; β = 1.388, 95% CI: 0.038, 2.737, P < 0.05), the SRS total scores and the sub-score of autistic mannerisms (β = 4.991, 95% CI: 0.494, 9.487, P < 0.05; β = 1.297, 95% CI: 0.140, 2.453, P < 0.05) of children in the regressive group were all higher than the non-regressive group. The total developmental quotient (DQ) of CNBS-R2016 and the DQ of gross motor, fine motor, adaptive behavior, language (β = -5.827, 95% CI: -11.529, -0.125, P < 0.05) and personal society in the regressive group were lower than the non-regressive group and the proportion of children with intelligent developmental impairment was higher the non-regressive group. CONCLUSION Regressive autism is mainly manifested as language and social regression. Children with regressive ASD have more severe core symptoms, lower neurodevelopmental level DQ, and more serious disease degree than children with non-regressive ASD, which requires further etiological examinations and more clinical attention.
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Affiliation(s)
- Chaoqun Hu
- Growth, Development and Mental Health Center of Children and Adolescents, Chongqing Key Laboratory of Childhood Nutrition and Health, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Fan Yang
- Growth, Development and Mental Health Center of Children and Adolescents, Chongqing Key Laboratory of Childhood Nutrition and Health, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Ting Yang
- Growth, Development and Mental Health Center of Children and Adolescents, Chongqing Key Laboratory of Childhood Nutrition and Health, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Jie Chen
- Growth, Development and Mental Health Center of Children and Adolescents, Chongqing Key Laboratory of Childhood Nutrition and Health, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Ying Dai
- Growth, Development and Mental Health Center of Children and Adolescents, Chongqing Key Laboratory of Childhood Nutrition and Health, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Feiyong Jia
- Department of Developmental and Behavioral Pediatric, The First Hospital of Jilin University, Changchun, China
| | - Lijie Wu
- Department of Children's and Adolescent Health, Public Health College of Harbin Medical University, Harbin, China
| | - Yan Hao
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ling Li
- Department of Children Rehabilitation, Hainan Women and Children's Medical Center, Haikou, China
| | - Jie Zhang
- Xi'an Children's Hospital, Xi'an, China
| | - Xiaoyan Ke
- Child Mental Health Research Center of Nanjing Brain Hospital, Nanjing, China
| | - Mingji Yi
- Department of Child Health Care, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Qi Hong
- Maternal and Child Health Hospital of Baoan, Shenzhen, China
| | - Jinjin Chen
- Department of Child Healthcare, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Shuanfeng Fang
- Children's Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Yichao Wang
- NHC Key Laboratory of Birth Defect for Research and Prevention, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, China
| | - Qi Wang
- Deyang Maternity & Child Healthcare Hospital, Deyang, China
| | - Chunhua Jin
- Department of Children Health Care, Capital Institute of Pediatrics, Beijing, China
| | - Tingyu Li
- Growth, Development and Mental Health Center of Children and Adolescents, Chongqing Key Laboratory of Childhood Nutrition and Health, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Li Chen
- Growth, Development and Mental Health Center of Children and Adolescents, Chongqing Key Laboratory of Childhood Nutrition and Health, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
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Gagnon D, Zeribi A, Douard É, Courchesne V, Rodríguez-Herreros B, Huguet G, Jacquemont S, Loum MA, Mottron L. Bayonet-shaped language development in autism with regression: a retrospective study. Mol Autism 2021; 12:35. [PMID: 33985558 PMCID: PMC8117564 DOI: 10.1186/s13229-021-00444-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 05/03/2021] [Indexed: 11/10/2022] Open
Abstract
Background Language delay is one of the major referral criteria for an autism evaluation. Once an autism spectrum diagnosis is established, the language prognosis is among the main parental concerns. Early language regression (ELR) is observed by 10–50% of parents but its relevance to late language level and socio-communicative ability is uncertain. This study aimed to establish the predictive value of ELR on the progression of language development and socio-communicative outcomes to guide clinicians in addressing parents’ concerns at the time of diagnosis. Methods We used socio-communicative, language, and cognitive data of 2,047 autism spectrum participants from the Simons Simplex Collection, aged 4–18 years (mean = 9 years; SD = 3.6). Cox proportional hazard and logistic regression models were used to evaluate the effect of ELR on language milestones and the probability of using complex and flexible language, as defined by the choice of ADOS module at enrollment. Linear models were then used to evaluate the relationship of ELR and non-verbal IQ with socio-communicative and language levels. Results ELR is associated with earlier language milestones but delayed attainment of fluent, complex, and flexible language. However, this language outcome can be expected for almost all autistic children without intellectual disability at 18 years of age. It is mostly influenced by non-verbal IQ, not ELR. The language and socio-communicative level of participants with flexible language, as measured by the Vineland and ADOS socio-communicative subscales, was not affected by ELR. Limitations This study is based on a relatively coarse measure of ultimate language level and relies on retrospective reporting of early language milestones and ELR. It does not prospectively document the age at which language catches up, the relationship between ELR and other behavioral areas of regression, nor the effects of intervention. Conclusions For autistic individuals with ELR and a normal level of non-verbal intelligence, language development follows a “bayonet shape” trajectory: early first words followed by regression, a plateau with limited progress, and then language catch up. Supplementary Information The online version contains supplementary material available at 10.1186/s13229-021-00444-8.
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Affiliation(s)
- David Gagnon
- Research Center of the CIUSSS-NIM, Hôpital Rivière-Des-Prairies, 7070, Boul. Perras, Montreal, QC, H2E 1A4, Canada.,Department of psychiatry, University of Montreal, 2900 Boul. Édouard-Montpetit, Montreal, QC, H3T 1J4, Canada
| | - Abderrahim Zeribi
- University of Montreal, 2900, Boul. Édouard-Montpetit, Montreal, QC, H3T 1J4, Canada.,University of Sherbrooke, 2500, Boul. de L'Université, Sherbrooke, QC, J1K 2R1, Canada.,Sainte-Justine Research Center, 3175, Chemin de La Côte-Sainte-Catherine, Montreal, QC, H3T 1C5, Canada
| | - Élise Douard
- University of Montreal, 2900, Boul. Édouard-Montpetit, Montreal, QC, H3T 1J4, Canada.,Sainte-Justine Research Center, 3175, Chemin de La Côte-Sainte-Catherine, Montreal, QC, H3T 1C5, Canada
| | - Valérie Courchesne
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, 3801 University Street, Montreal, QC, H3A 2B4, Canada
| | - Borja Rodríguez-Herreros
- Centre Cantonal Autisme, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Avenue de Beaumont 23, 1011, Lausanne, Switzerland
| | - Guillaume Huguet
- University of Montreal, 2900, Boul. Édouard-Montpetit, Montreal, QC, H3T 1J4, Canada.,Sainte-Justine Research Center, 3175, Chemin de La Côte-Sainte-Catherine, Montreal, QC, H3T 1C5, Canada
| | - Sébastien Jacquemont
- University of Montreal, 2900, Boul. Édouard-Montpetit, Montreal, QC, H3T 1J4, Canada.,Sainte-Justine Research Center, 3175, Chemin de La Côte-Sainte-Catherine, Montreal, QC, H3T 1C5, Canada
| | - Mor Absa Loum
- University of Montreal, 2900, Boul. Édouard-Montpetit, Montreal, QC, H3T 1J4, Canada.,Sainte-Justine Research Center, 3175, Chemin de La Côte-Sainte-Catherine, Montreal, QC, H3T 1C5, Canada
| | - Laurent Mottron
- Research Center of the CIUSSS-NIM, Hôpital Rivière-Des-Prairies, 7070, Boul. Perras, Montreal, QC, H2E 1A4, Canada. .,Department of psychiatry, University of Montreal, 2900 Boul. Édouard-Montpetit, Montreal, QC, H3T 1J4, Canada.
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Martin-Borreguero P, Gómez-Fernández AR, De La Torre-Aguilar MJ, Gil-Campos M, Flores-Rojas K, Perez-Navero JL. Children With Autism Spectrum Disorder and Neurodevelopmental Regression Present a Severe Pattern After a Follow-Up at 24 Months. Front Psychiatry 2021; 12:644324. [PMID: 33841211 PMCID: PMC8032949 DOI: 10.3389/fpsyt.2021.644324] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 02/16/2021] [Indexed: 12/21/2022] Open
Abstract
This study examined the presence of neurodevelopmental regression and its effects on the clinical manifestations and the severity of autism spectrum disorder (ASD) in a group of children with autism compared with those without neurodevelopmental regression at the time of initial classification and subsequently. Methods and Subjects: ASD patients were classified into two subgroups, neurodevelopmental regressive (AMR) and non-regressive (ANMR), using a questionnaire based on the Autism Diagnostic Interview-Revised test. The severity of ASD and neurodevelopment were assessed with the Childhood Autism Rating Scale Test-2, Strengths and Difficulties Questionnaire, and Pervasive Developmental Disorders Behavior Inventory Parent Ratings (PDDBI) and with the Battelle Developmental Inventory tests at the beginning of the study and after 24 months of follow-up. Fifty-two patients aged 2-6 years with ASD were included. Nineteen were classified with AMR, and 33 were classified with ANMR. Results: The AMR subgroup presented greater severity of autistic symptoms and higher autism scores. Additionally, they showed lower overall neurodevelopment. The AMR subgroup at 24 months had poorer scores on the Battelle Developmental Inventory test in the following areas: Total personal/social (p < 0.03), Total Motor (p < 0.04), Expressive (p < 0.01), and Battelle Total (p < 0.04). On the PDDBI test, the AMR subgroup had scores indicating significantly more severe ASD symptoms in the variables: ritual score (p < 0.038), social approach behaviors (p < 0.048), expressive language (p < 0.002), and autism score (p < 0.003). Conclusions: ASD patients exhibited a set of different neurological phenotypes. The AMR and ANMR subgroups presented different clinical manifestations and prognoses in terms of the severity of autistic symptoms and neurodevelopment.
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Affiliation(s)
- Pilar Martin-Borreguero
- Unit of Psychology and Paediatric Psychiatry, Reina Sofia University Hospital, Cordoba, Spain
| | - Antonio Rafael Gómez-Fernández
- Department of Paediatrics, Infanta Margarita Hospital, Cabra, Córdoba, Spain.,Department of Paediatrics, Reina Sofia University Hospital, Córdoba University, Maimonides Biomedical Research Institute of Córdoba (IMIBIC), Córdoba, Spain
| | - Maria Jose De La Torre-Aguilar
- Department of Paediatrics, Reina Sofia University Hospital, Córdoba University, Maimonides Biomedical Research Institute of Córdoba (IMIBIC), Córdoba, Spain
| | - Mercedes Gil-Campos
- Department of Paediatrics, Reina Sofia University Hospital, Córdoba University, Maimonides Biomedical Research Institute of Córdoba (IMIBIC), Córdoba, Spain.,Centre for Biomedical Research on Rare Diseases (CIBERER), ISCIII, Madrid, Spain
| | - Katherine Flores-Rojas
- Centre for Biomedical Research on Rare Diseases (CIBERER), ISCIII, Madrid, Spain.,Paediatric Research Unit, Reina Sofia University Hospital, Maimonides Biomedical Research Institute of Córdoba (IMIBIC), CIBERObn, Córdoba, Spain
| | - Juan Luis Perez-Navero
- Department of Paediatrics, Reina Sofia University Hospital, Córdoba University, Maimonides Biomedical Research Institute of Córdoba (IMIBIC), Córdoba, Spain.,Centre for Biomedical Research on Rare Diseases (CIBERER), ISCIII, Madrid, Spain
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8
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Boterberg S, Van Coster R, Roeyers H. Characteristics, Early Development and Outcome of Parent-Reported Regression in Autism Spectrum Disorder. J Autism Dev Disord 2020; 49:4603-4625. [PMID: 31463633 DOI: 10.1007/s10803-019-04183-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
This study explored regression patterns in 100 children with ASD (3-11 years) using several approaches to enhance the validity of retrospective parent report. Both early development and outcome were examined in regression groups defined by 36 months age cut-off and two underlying empirical patterns based on type and onset age. Results over regression groups were generally consistent. During early development, children with regression showed a similar amount of social atypicalities and stereotyped behaviour as compared to children without regression. However, parents indicated less communication skills which could be a valuable predictor of regression. Development after regression was characterised by early language delay and more restricted and repetitive behaviour. The findings provide insight into the diagnosis and prognosis of regression in ASD.
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Affiliation(s)
- Sofie Boterberg
- Department of Experimental Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Henri Dunantlaan 2, 9000, Ghent, Belgium.
| | - Rudy Van Coster
- Department of Paediatric Neurology and Metabolism, Faculty of Medicine and Health Sciences, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium
| | - Herbert Roeyers
- Department of Paediatric Neurology and Metabolism, Faculty of Medicine and Health Sciences, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium
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González-Cortés T, Gutiérrez-Contreras E, Espino-Silva PK, Haro-Santa Cruz J, Álvarez-Cruz D, Rosales-González CC, Sida-Godoy C, Nava-Hernández MP, López-Márquez FC, Ruiz-Flores P. Clinical Profile of Autism Spectrum Disorder in a Pediatric Population from Northern Mexico. J Autism Dev Disord 2019; 49:4409-4420. [PMID: 31385173 DOI: 10.1007/s10803-019-04154-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Autism spectrum disorder (ASD) is a neurodevelopmental condition classified based on needs of support, in order to address impairments in the areas of social communication and restricted and repetitive behavior. The aim of this work is to describe the main clinical features of the ASD severity levels in a group of Mexican pediatric patients. The results show firstly that this condition was more frequent in males than females. Secondly, an inverse relationship was found between the intellectual coefficient and the level of severity of the disorder. Thirdly, deficits in social reciprocity and communication were more evident in Level 3, than in Levels 1 and 2, while the difference was less evident in restricted and repetitive patterns of behavior.
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Affiliation(s)
- Tania González-Cortés
- Centro de Investigación y Atención del Autismo, Sistema Nacional para el Desarrollo Integral de la Familia (DIF) del Estado de Coahuila, Orquídeas 100 Torreón Residencial, 27000, Torreón, Coahuila, Mexico.
| | - Elizabeth Gutiérrez-Contreras
- Centro de Investigación y Atención del Autismo, Sistema Nacional para el Desarrollo Integral de la Familia (DIF) del Estado de Coahuila, Orquídeas 100 Torreón Residencial, 27000, Torreón, Coahuila, Mexico
| | - Perla Karina Espino-Silva
- Facultad de Medicina Unidad Torreón, Centro de Investigación Biomédica, Universidad Autónoma de Coahuila, Gregorio A. García 198 Centro, 27000, Torreón, Coahuila, Mexico
| | - Jorge Haro-Santa Cruz
- Facultad de Medicina Unidad Torreón, Centro de Investigación Biomédica, Universidad Autónoma de Coahuila, Gregorio A. García 198 Centro, 27000, Torreón, Coahuila, Mexico
| | - Diana Álvarez-Cruz
- Centro de Investigación y Atención del Autismo, Sistema Nacional para el Desarrollo Integral de la Familia (DIF) del Estado de Coahuila, Orquídeas 100 Torreón Residencial, 27000, Torreón, Coahuila, Mexico
| | - Claudia Cecilia Rosales-González
- Centro de Investigación y Atención del Autismo, Sistema Nacional para el Desarrollo Integral de la Familia (DIF) del Estado de Coahuila, Orquídeas 100 Torreón Residencial, 27000, Torreón, Coahuila, Mexico
| | - Cristina Sida-Godoy
- Facultad de Medicina Unidad Torreón, Centro de Investigación Biomédica, Universidad Autónoma de Coahuila, Gregorio A. García 198 Centro, 27000, Torreón, Coahuila, Mexico
| | - Martha Patricia Nava-Hernández
- Facultad de Medicina Unidad Torreón, Centro de Investigación Biomédica, Universidad Autónoma de Coahuila, Gregorio A. García 198 Centro, 27000, Torreón, Coahuila, Mexico
| | - Francisco Carlos López-Márquez
- Facultad de Medicina Unidad Torreón, Centro de Investigación Biomédica, Universidad Autónoma de Coahuila, Gregorio A. García 198 Centro, 27000, Torreón, Coahuila, Mexico
| | - Pablo Ruiz-Flores
- Centro de Investigación y Atención del Autismo, Sistema Nacional para el Desarrollo Integral de la Familia (DIF) del Estado de Coahuila, Orquídeas 100 Torreón Residencial, 27000, Torreón, Coahuila, Mexico.,Facultad de Medicina Unidad Torreón, Centro de Investigación Biomédica, Universidad Autónoma de Coahuila, Gregorio A. García 198 Centro, 27000, Torreón, Coahuila, Mexico
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Prevalence of Co-occurring Medical and Behavioral Conditions/Symptoms Among 4- and 8-Year-Old Children with Autism Spectrum Disorder in Selected Areas of the United States in 2010. J Autism Dev Disord 2019. [PMID: 29524016 DOI: 10.1007/s10803-018-3521-1] [Citation(s) in RCA: 103] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
We compared the prevalence of various medical and behavioral co-occurring conditions/symptoms between 4- and 8-year-olds with autism spectrum disorder (ASD) from five sites in the Autism and Developmental Disabilities Monitoring Network during the 2010 survey year, accounting for sociodemographic differences. Over 95% of children had at least one co-occurring condition/symptom. Overall, the prevalence was higher in 8- than 4-year-olds for 67% of co-occurring conditions/symptoms examined. Further, our data suggested that co-occurring conditions/symptoms increased or decreased the age at which children were first evaluated for ASD. Similarly, among the 8-year-olds, the prevalence of most co-occurring conditions/symptoms was higher in children with a previous ASD diagnosis documented in their records. These findings are informative for understanding and screening co-occurring conditions/symptoms in ASD.
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11
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Boterberg S, Charman T, Marschik PB, Bölte S, Roeyers H. Regression in autism spectrum disorder: A critical overview of retrospective findings and recommendations for future research. Neurosci Biobehav Rev 2019; 102:24-55. [PMID: 30917924 DOI: 10.1016/j.neubiorev.2019.03.013] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 03/15/2019] [Accepted: 03/18/2019] [Indexed: 11/16/2022]
Abstract
Historically, two onset patterns in autism spectrum disorder (ASD) were described: early onset of symptoms and regression in which one-third appear to show a loss of previously established skills in the second year of life. Since this phenomenon could represent a distinct ASD subtype and provide more insight into the etiology, diagnosis, and prognosis, many studies have compared these two groups. The present review discusses definitions, etiology, and methods used in research with a retrospective design and provides an overview of the results on early development and outcomes. However, retrospective research has not provided clear answers on regression as a distinct subtype of ASD and the historic division between early onset and regression does not seem to fit the empirical findings. Based on inconsistent results, future research on onset patterns in ASD needs to be more systematic on the definitions and methods used. Several recommendations to enhance the reliability of future retrospective results are discussed. The combination of a categorical and dimensional approach provides a new interesting framework.
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Affiliation(s)
- Sofie Boterberg
- Department of Experimental Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium.
| | - Tony Charman
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; South London and Maudsley NHS Foundation Trust, London, UK
| | - Peter B Marschik
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Goettingen, Goettingen, Germany; iDN - Interdisciplinary Developmental Neuroscience, Division of Phoniatrics, Medical University of Graz, Graz, Austria
| | - Sven Bölte
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research; Department of Women's and Children's Health, Karolinska Institutet & Child and Adolescent Psychiatry, Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden; Curtin Autism Research Group, School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Western Australia, Australia
| | - Herbert Roeyers
- Department of Experimental Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
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12
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Soke GN, Rosenberg SA, Rosenberg CR, Vasa RA, Lee LC, DiGuiseppi C. Self-injurious behaviors in children with autism spectrum disorder enrolled in the Study to Explore Early Development. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2018; 22:625-635. [PMID: 28635306 PMCID: PMC5912993 DOI: 10.1177/1362361316689330] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We assessed potential factors associated with "current" or "ever" self-injurious behaviors, reported in the Autism Diagnostic Interview-Revised, among children with autism spectrum disorder (n = 692) from the Study to Explore Early Development. Data on factors examined were obtained from questionnaires, standardized clinical instruments, and birth certificates. We employed a log-binomial regression to assess these associations. Although most associations were quite similar for currently and ever exhibiting self-injurious behaviors, a few differences were noted. We documented previously unreported associations of current self-injurious behaviors with maternal age and cesarean delivery, and ever self-injurious behaviors with maternal age, child sex, gestational age, and maternal race. We also confirmed previously reported associations with adaptive skills, somatic conditions (sleep, gastrointestinal, and sensory abnormalities), and other behavioral problems. These findings are informative for clinical practice and future research.
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Affiliation(s)
- Gnakub Norbert Soke
- University of Colorado Denver, USA
- Centers for Disease Control and Prevention, USA
| | | | | | | | - Li-Ching Lee
- Johns Hopkins Bloomberg School of Public Health, USA
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Factors Associated with Self-Injurious Behaviors in Children with Autism Spectrum Disorder: Findings from Two Large National Samples. J Autism Dev Disord 2017; 47:285-296. [PMID: 27830427 DOI: 10.1007/s10803-016-2951-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
In this study, we explored potential associations among self-injurious behaviors (SIB) and a diverse group of protective and risk factors in children with autism spectrum disorder from two databases: Autism and Developmental Disabilities Monitoring (ADDM) Network and the Autism Speaks-Autism Treatment Network (AS-ATN). The presence of SIB was determined from children's records in ADDM and a parent questionnaire in AS-ATN. We used multiple imputation to account for missing data and a non-linear mixed model with site as a random effect to test for associations. Despite differences between the two databases, similar associations were found; SIB were associated with developmental, behavioral, and somatic factors. Implications of these findings are discussed in relation to possible etiology, future longitudinal studies, and clinical practice.
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Phenotypic Characteristics of Autism Spectrum Disorder in a Diverse Sample of Somali and Other Children. J Autism Dev Disord 2017; 47:3150-3165. [DOI: 10.1007/s10803-017-3232-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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15
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Abstract
Autism spectrum disorders (ASDs) are neurodevelopmental disorders whose core features of impaired social communication and atypical repetitive behaviors and/or restrictions in range of interests emerge in toddlerhood and carry significant implications at successive stages of development. The ability to reliably identify most cases of the condition far earlier than the average age of diagnosis presents a novel opportunity for early intervention, but the availability of such an intervention is disparate across US communities, and its impact is imperfectly understood. New research may transform the clinical approach to these conditions in early childhood.
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Affiliation(s)
- John N Constantino
- Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8504, St Louis, MO 63110, USA.
| | - Natasha Marrus
- Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8504, St Louis, MO 63110, USA
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Backes B, Zanon RB, Bosa CA. Características Sintomatológicas de Crianças com Autismo e Regressão da Linguagem Oral. PSICOLOGIA: TEORIA E PESQUISA 2017. [DOI: 10.1590/0102.3772e3343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO O presente estudo investigou as características da regressão da linguagem oral e da sintomatologia em crianças pré-escolares com Transtorno do Espectro Autista, relacionando-o com os pressupostos da perspectiva sociopragmática. Foi utilizado um banco de dados com 150 crianças norte-americanas, sendo as informações referentes à regressão da linguagem oral e à sintomatologia obtidas por meio da Autism Diagnostic Interview - Revised. Trinta crianças preencheram os critérios para participação neste estudo. Destas, seis apresentaram regressão das habilidades de linguagem oral, com uma média de idade de 25 meses para o início da perda. Em relação à sintomatologia, alguns comportamentos destacaram-se por apresentarem maior comprometimento, como o direcionamento da atenção, a conversação recíproca e o uso repetitivo de objetos.
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Reported History of Developmental Regression and Restricted, Repetitive Behaviors in Children with Autism Spectrum Disorders. J Dev Behav Pediatr 2016; 37:451-6. [PMID: 27366956 DOI: 10.1097/dbp.0000000000000316] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Previous research on developmental regression in youth with autism spectrum disorders (ASD) has often been limited by the definition, assessment, and methodology used to evaluate and describe regression. This study sought to overcome these limitations by examining the prevalence, timing, and correlates of documented cases of developmental regression in a large, epidemiological sample of youth with ASD. METHOD Utilizing a population-based surveillance methodology, this study includes 862 youth with ASD identified through abstraction and clinician record review. RESULTS Approximately 21% of the sample had developmental regression documented in their medical or educational records with the mean age of regression being 24.2 ± 14.3 months. Youth with ASD and a history of regression were more likely to have comorbid intellectual disability, a prior community diagnosis of ASD, and be eligible for educational services as a student with autism. Youth with a documented history of regression also had higher rates of restricted, repetitive behaviors, such as stereotyped speech, nonfunctional routines/rituals, and sensory interests. CONCLUSION Results suggest that youth with a history of regression are not only more likely to have comorbid intellectual disability but are also are more likely to have been previously diagnosed with ASD in the community, suggesting that development regression may play an important role in identifying children who are at the risk for ASD and need evaluation. Higher rates of restricted, repetitive behaviors in youth with a documented history of regression may also provide important insights into the relationship between ASD and developmental regression.
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18
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Goin-Kochel RP, Mire SS, Dempsey AG. Emergence of autism spectrum disorder in children from simplex families: relations to parental perceptions of etiology. J Autism Dev Disord 2015; 45:1451-63. [PMID: 25398603 DOI: 10.1007/s10803-014-2310-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Current research describes a four-category scheme of Autism Spectrum Disorder (ASD) onset: early, regressive, plateau, delay + regression. To replicate prevalence of different onset types, ASD onset (per the Autism Diagnostic Interview--Revised) was examined in a large North American sample; for a subset, parents' causal beliefs were ascertained via the Revised Illness Perception Questionnaire to examine potential associations with ASD-onset types. Onset rates were similar across samples, with a slightly higher proportion of children in the subsample categorized with regression. Top-rated causes of ASD were genetics, brain structure, will of God, toxins in vaccines, and environmental pollution. Parents reporting regression more often believed that toxins in vaccines caused ASD. Influences on treatment selection and broader public-health ramifications are discussed.
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Rates and predictors of adherence to psychotropic medications in children with autism spectrum disorders. J Autism Dev Disord 2015; 44:2931-48. [PMID: 24929833 DOI: 10.1007/s10803-014-2156-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Medication adherence in children is poor, particularly among those with chronic or mental health disorders. However, adherence has not been fully assessed in autism spectrum disorders (ASDs). The validated proportion of days covered method was used to quantify adherence to psychotropic medication in Medicaid-eligible children who met diagnostic criteria for ASD between 2000 and 2008 (N = 628). Among children prescribed attention deficit hyperactivity disorder (ADHD) medications, antidepressants, or antipsychotics, 44, 40 and 52 % were adherent respectively. Aggressive behaviors and abnormalities in eating, drinking, and/or sleeping, co-occurring ADHD, and the Medication Regimen Complexity Index were the most significant predictors of adherence rather than demographics or core deficits of ASD. Identifying barriers to adherence in ASD may ultimately lead to improved treatment outcomes.
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20
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Logan SL, Carpenter L, Leslie RS, Garrett-Mayer E, Hunt KJ, Charles J, Nicholas JS. Aberrant Behaviors and Co-occurring Conditions as Predictors of Psychotropic Polypharmacy among Children with Autism Spectrum Disorders. J Child Adolesc Psychopharmacol 2015; 25:323-36. [PMID: 25919445 PMCID: PMC4442569 DOI: 10.1089/cap.2013.0119] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES The purpose of this study was to identify rates and predictors of psychotropic medication polypharmacy among Medicaid-eligible children in South Carolina with autism spectrum disorder (ASD) from 2000 to 2008. METHODS Population-based surveillance data were linked with state Medicaid records to obtain a detailed demographic, behavioral, educational, clinical, and diagnostic data set for all Medicaid-eligible 8-year-old children (n=629) who were identified and diagnosed with ASD using standardized criteria. Polypharmacy was defined as having interclass psychotropic medication claims overlapping for ≥30 consecutive days at any time during the 2-year study period. Multivariable logistic regression was used to model predictors of any polypharmacy, and for the three most common combinations. RESULTS Overall, 60% (n=377) used any psychotropic medication, and 41% (n=153) of those had interclass polypharmacy. Common combinations were attention-deficit/hyperactivity disorder (ADHD) medications with an antidepressant (A/AD), antipsychotic (A/AP) or a mood stabilizer (A/MS). Black children had lower odds of any polypharmacy, as did those eligible for Medicaid because of income or being foster care versus those eligible because of disability. There were no significant associations between polypharmacy and social deficits in ASD for any combination, although children with communication deficits diagnostic of ASD had lower odds of any polypharmacy and A/AP polypharmacy. Children with argumentative, aggressive, hyperactive/impulsive, or self-injurious aberrant behaviors had higher odds of polypharmacy, as did children with diagnosed co-occurring ADHD, anxiety or mood disorders, or conduct/oppositional defiant disorder (ODD) in Medicaid records. CONCLUSIONS Future research is warranted to investigate how child-level factors impact combination psychotropic medication prescribing practices and outcomes in ASD.
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Affiliation(s)
- Sarah L Logan
- 1 Department of Healthcare Leadership and Management, Medical University of South Carolina , Charleston, South Carolina
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21
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Rubenstein E, Wiggins LD, Lee LC. A Review of the Differences in Developmental, Psychiatric, and Medical Endophenotypes Between Males and Females with Autism Spectrum Disorder. JOURNAL OF DEVELOPMENTAL AND PHYSICAL DISABILITIES 2015; 27:119-139. [PMID: 26146472 PMCID: PMC4490156 DOI: 10.1007/s10882-014-9397-x] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Autism spectrum disorder (ASD) is over four times more prevalent in males compared to females. Increased understanding of sex differences in ASD endophenotypes could add insight into possible etiologies and the assessment and management of the disorder. Consequently, the purpose of this review is to describe current literature regarding sex differences in the developmental, psychiatric, and medical endophenotypes of ASD in order to illustrate current knowledge and areas in need of further research. Our review found that repetitive behaviors and restricted interests are more common in males than females with ASD. Intellectual disability is more common in females than males with ASD. Attention to detail may be more common in males than females with ASD and epilepsy may be more common in females than males with ASD, although limited research in these areas prevent definitive conclusions from being drawn. There does not appear to be a sex difference in other developmental, psychiatric, and medical symptoms associated with ASD, or the research was contradictory or too sparse to establish a sex difference. Our review is unique in that it offers detailed discussion of sex differences in three major endophenotypes of ASD. Further research is needed to better understand why sex differences exist in certain ASD traits and to evaluate whether phenotypic sex differences are related to different pathways of development, assessment, and treatment of the disorder.
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Affiliation(s)
- Eric Rubenstein
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room E6032, Baltimore, MD 21205, USA
| | - Lisa D. Wiggins
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 1600 Clifton Rd. MS E-86, Atlanta 30333 GA, USA
| | - Li-Ching Lee
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room E6032, Baltimore, MD 21205, USA
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Zanon RB, Backes B, Bosa CA. Identificação dos primeiros sintomas do autismo pelos pais. PSICOLOGIA: TEORIA E PESQUISA 2014. [DOI: 10.1590/s0102-37722014000100004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Dificuldades no desenvolvimento social são os indicadores mais prováveis de um futuro diagnóstico de autismo, entretanto o atraso da fala parece ser o motivo que mais mobiliza os pais na busca por assistência. Neste estudo foram investigados os primeiros sintomas percebidos pelos pais de crianças com autismo e a idade da criança na ocasião. Participaram 32 pré-escolares e o instrumento utilizado foi a Autism Diagnostic Interview-Revised. Comprometimentos no desenvolvimento da linguagem foram os sintomas mais frequentemente observados, porém os da socialização foram os mais precocemente identificados. No geral, a idade média em que os primeiros sintomas foram percebidos foi 15,2 meses. Os resultados corroboram achados de outros estudos, ressaltando a importância dos comprometimentos sociais para a identificação precoce do autismo.
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Backes B, Zanon RB, Bosa CA. The relation between language regression and social communicative development of children with autism spectrum disorder. Codas 2014; 25:268-73. [PMID: 24408339 DOI: 10.1590/s2317-17822013000300013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2012] [Accepted: 02/18/2013] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To investigate the relationship between language regression and the subsequent social-communicative development of preschool children with Autism Spectrum Disorder (ASD). METHODS Thirty children with ASD participated in the study and were divided into two groups: with (n=6) and without (n=24) language regression. Language regression was assessed by the Autism Diagnostic Interview-Revised and the social-communicative development was measured by the Autism Diagnostic Observation Schedule. RESULTS Of the 30 children who met the criteria for participation in this study, six (20%) had regression of oral language skills, with a mean age of onset of 25 months. There were no statistical significant differences in the social-communicative development between the groups with and without language regression. CONCLUSION The findings of this research do not seem to confirm the relationship between the occurrence of language regression and the subsequent impairment on social-communicative development of children with ASD.
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Barger BD, Campbell JM, McDonough JD. Prevalence and onset of regression within autism spectrum disorders: a meta-analytic review. J Autism Dev Disord 2013; 43:817-28. [PMID: 22855372 DOI: 10.1007/s10803-012-1621-x] [Citation(s) in RCA: 113] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Rates and onset of regression were meta-analyzed from 85 articles representing 29,035 participants with autism spectrum disorders (ASD). Overall prevalence rate for regression was 32.1, 95 % CI [29.5, 34.8] occurring at mean of 1.78 years, 95 % CI [1.67, 1.89]. Regression prevalence rates differed according to four types of regression: language regression, 24.9 %; language/social regression, 38.1 %; mixed regression, 32.5 %; and unspecified regression, 39.1 %. Regression prevalence also differed according to sampling method: population-based prevalence was 21.8 %, clinic-based prevalence was 33.6 %, and parent survey-based prevalence was 40.8 %. Risk of regression was equal for males and females, but higher for individuals diagnosed with autism versus another ASD. Later age of regression onset was predicted by older age of child.
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Affiliation(s)
- Brian D Barger
- Department of Educational Psychology and Instructional Technology, University of Georgia, Athens, GA, USA
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25
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Early Signs of Autism in Toddlers: A Follow-Up Study in the Danish National Birth Cohort. J Autism Dev Disord 2013; 43:2366-75. [DOI: 10.1007/s10803-013-1785-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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26
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Regression in children with autism spectrum disorders. Indian J Pediatr 2012; 79:1333-7. [PMID: 22350733 DOI: 10.1007/s12098-012-0683-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Accepted: 01/11/2012] [Indexed: 01/20/2023]
Abstract
OBJECTIVES To understand the characteristics of autistic regression and to compare the clinical and developmental profile of children with autism spectrum disorders (ASD) in whom parents report developmental regression with age matched ASD children in whom no regression is reported. METHODS Participants were 35 (Mean age = 3.57 y, SD = 1.09) children with ASD in whom parents reported developmental regression before age 3 y and a group of age and IQ matched 35 ASD children in whom parents did not report regression. All children were recruited from the outpatient Child Psychology Clinic of the Department of Pediatrics of a tertiary care teaching hospital in North India. Multi-disciplinary evaluations including neurological, diagnostic, cognitive, and behavioral assessments were done. Parents were asked in detail about the age at onset of regression, type of regression, milestones lost, and event, if any, related to the regression. In addition, the Childhood Autism Rating Scale (CARS) was administered to assess symptom severity. RESULTS The mean age at regression was 22.43 mo (SD = 6.57) and large majority (66.7%) of the parents reported regression between 12 and 24 mo. Most (75%) of the parents of the regression-autistic group reported regression in the language domain, particularly in the expressive language sector, usually between 18 and 24 mo of age. Regression of language was not an isolated phenomenon and regression in other domains was also reported including social skills (75%), cognition (31.25%). In majority of the cases (75%) the regression reported was slow and subtle. There were no significant differences in the motor, social, self help, and communication functioning between the two groups as measured by the DP II.There were also no significant differences between the two groups on the total CARS score and total number of DSM IV symptoms endorsed. However, the regressed children had significantly (t = 2.36, P = .021) more social deficits as per the DSM IV as compared to the non-regressed children with autism. CONCLUSIONS Autism with regression is not characterized by a distinctive developmental or symptom profile. Developmental regression may, however, be an early and reliable marker in a significant number of children with autism.
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Zhang Y, Xu Q, Liu J, Li SC, Xu X. Risk factors for autistic regression: results of an ambispective cohort study. J Child Neurol 2012; 27:975-81. [PMID: 22290858 DOI: 10.1177/0883073811430163] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
A subgroup of children diagnosed with autism experience developmental regression featured by a loss of previously acquired abilities. The pathogeny of autistic regression is unknown, although many risk factors likely exist. To better characterize autistic regression and investigate the association between autistic regression and potential influencing factors in Chinese autistic children, we conducted an ambispective study with a cohort of 170 autistic subjects. Analyses by multiple logistic regression showed significant correlations between autistic regression and febrile seizures (OR = 3.53, 95% CI = 1.17-10.65, P = .025), as well as with a family history of neuropsychiatric disorders (OR = 3.62, 95% CI = 1.35-9.71, P = .011). This study suggests that febrile seizures and family history of neuropsychiatric disorders are correlated with autistic regression.
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Affiliation(s)
- Ying Zhang
- Department of Child Health Care, Children's Hospital of Fudan University, Shanghai, China
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Shumway S, Thurm A, Swedo SE, Deprey L, Barnett LA, Amaral DG, Rogers SJ, Ozonoff S. Brief report: symptom onset patterns and functional outcomes in young children with autism spectrum disorders. J Autism Dev Disord 2012; 41:1727-32. [PMID: 21360021 DOI: 10.1007/s10803-011-1203-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
This study examined the relationship between onset status and current functioning using a recently proposed onset classification system in 272 young children with autism spectrum disorder (ASD). Participants were classified into one of the following groups, based on parent report using the Autism Diagnostic Interview--Revised: Early Onset (symptoms by 12 months, no loss), Delay + Regression (symptoms by 12 months plus loss), Plateau (no early symptoms or loss), and Regression (no early symptoms, followed by loss). Findings indicate that current functioning does not differ according to onset pattern, calling into question the use of onset categorizations for prognostic purposes in children with ASD.
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Affiliation(s)
- Stacy Shumway
- Pediatrics and Developmental Neuroscience Branch, National Institute of Mental Health, Bethesda, MD 20892-1255, USA.
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Retention of autism spectrum diagnoses by community professionals: findings from the autism and developmental disabilities monitoring network, 2000 and 2006. J Dev Behav Pediatr 2012; 33:387-95. [PMID: 22580734 PMCID: PMC4486212 DOI: 10.1097/dbp.0b013e3182560b2f] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Past research is inconsistent in the stability of autism spectrum disorder (ASD) diagnoses. The authors therefore sought to examine the proportion of children identified from a population-based surveillance system that had a change in classification from ASD to non-ASD and factors associated with such changes. METHODS Children with a documented age of first ASD diagnosis noted in surveillance records by a community professional (n = 1392) were identified from the Autism and Developmental Disabilities Monitoring Network. Children were considered to have a change in classification if an ASD was excluded after the age of first recorded ASD diagnosis. Child and surveillance factors were entered into a multivariable regression model to determine factors associated with diagnostic change. RESULTS Only 4% of our sample had a change in classification from ASD to non-ASD noted in evaluation records. Factors associated with change in classification from ASD to non-ASD were timing of first ASD diagnosis at 30 months or younger, onset other than developmental regression, presence of specific developmental delays, and participation in a special needs classroom other than autism at 8 years of age. CONCLUSIONS Our results found that children with ASDs are likely to retain an ASD diagnosis, which underscores the need for continued services. Children diagnosed at 30 months or younger are more likely to experience a change in classification from ASD to non-ASD than children diagnosed at 31 months or older, suggesting earlier identification of ASD symptoms may be associated with response to intervention efforts or increased likelihood for overdiagnosis.
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Abstract
A comprehensive literature search was performed to collate evidence of mitochondrial dysfunction in autism spectrum disorders (ASDs) with two primary objectives. First, features of mitochondrial dysfunction in the general population of children with ASD were identified. Second, characteristics of mitochondrial dysfunction in children with ASD and concomitant mitochondrial disease (MD) were compared with published literature of two general populations: ASD children without MD, and non-ASD children with MD. The prevalence of MD in the general population of ASD was 5.0% (95% confidence interval 3.2, 6.9%), much higher than found in the general population (≈ 0.01%). The prevalence of abnormal biomarker values of mitochondrial dysfunction was high in ASD, much higher than the prevalence of MD. Variances and mean values of many mitochondrial biomarkers (lactate, pyruvate, carnitine and ubiquinone) were significantly different between ASD and controls. Some markers correlated with ASD severity. Neuroimaging, in vitro and post-mortem brain studies were consistent with an elevated prevalence of mitochondrial dysfunction in ASD. Taken together, these findings suggest children with ASD have a spectrum of mitochondrial dysfunction of differing severity. Eighteen publications representing a total of 112 children with ASD and MD (ASD/MD) were identified. The prevalence of developmental regression (52%), seizures (41%), motor delay (51%), gastrointestinal abnormalities (74%), female gender (39%), and elevated lactate (78%) and pyruvate (45%) was significantly higher in ASD/MD compared with the general ASD population. The prevalence of many of these abnormalities was similar to the general population of children with MD, suggesting that ASD/MD represents a distinct subgroup of children with MD. Most ASD/MD cases (79%) were not associated with genetic abnormalities, raising the possibility of secondary mitochondrial dysfunction. Treatment studies for ASD/MD were limited, although improvements were noted in some studies with carnitine, co-enzyme Q10 and B-vitamins. Many studies suffered from limitations, including small sample sizes, referral or publication biases, and variability in protocols for selecting children for MD workup, collecting mitochondrial biomarkers and defining MD. Overall, this evidence supports the notion that mitochondrial dysfunction is associated with ASD. Additional studies are needed to further define the role of mitochondrial dysfunction in ASD.
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Abstract
The last decade has seen an increase of interest in autism spectrum disorders (ASD). With the prevalence now approaching 1%, children with ASD are usually first evaluated by clinicians working in primary care, such as pediatricians and family practitioners. Although classic autism is easy to recognize, differentiating autism from other spectrum disorders and comorbid conditions is not always simple.
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Affiliation(s)
- Ahsan Nazeer
- Child and Adolescent Psychiatry, Michigan State University, Kalamazoo Center for Medical Studies, 1722 Shaffer Road, Suite # 3, Kalamazoo, MI 49048, USA.
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Ekinci O, Arman AR, Melek I, Bez Y, Berkem M. The phenomenology of autistic regression: subtypes and associated factors. Eur Child Adolesc Psychiatry 2012; 21:23-9. [PMID: 22080249 DOI: 10.1007/s00787-011-0228-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2011] [Accepted: 11/03/2011] [Indexed: 12/27/2022]
Abstract
This study aimed to investigate the association of autistic regression (AR) and subtypes of AR with medical, developmental and psychiatric factors. Fifty-seven children with autistic spectrum disorders (ASD) were included in the study. Two types of AR are defined as regression after a normal social/language development (type 1) and regression as the worsening of previously reported autistic features (type 2). The frequency of history of AR was 56.1%. Male gender and sleep problems were found to be associated with a positive history of AR. The frequency of gastrointestinal complaints/diseases was higher in children with regression type 2 when compared to the children with regression type 1. Future studies with larger sample size and prospective design will contribute to clarifying the phenomenology and the associated factors of AR.
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Onset patterns in autism: correspondence between home video and parent report. J Am Acad Child Adolesc Psychiatry 2011; 50:796-806.e1. [PMID: 21784299 PMCID: PMC3668453 DOI: 10.1016/j.jaac.2011.03.012] [Citation(s) in RCA: 96] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Revised: 03/17/2011] [Accepted: 03/22/2011] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The onset of autism is usually conceptualized as occurring in one of two patterns, early onset or regressive. This study examined the number and shape of trajectories of symptom onset evident in coded home movies of children with autism and examined their correspondence with parent report of onset. METHOD Four social-communicative behaviors were coded from the home video of children with autism (n = 52) or typical development (n = 23). All home videos from 6 through 24 months of age were coded (3199 segments). Latent class modeling was used to characterize trajectories and determine the optimal number needed to describe the coded home video. These trajectories were then compared with parent reports of onset patterns, as defined by the Autism Diagnostic Interview-Revised. RESULTS A three-trajectory model best fit the data from the participants with autism. One trajectory displayed low levels of social-communication across time. A second trajectory displayed high levels of social-communication early in life, followed by a significant decrease over time. A third trajectory displayed initial levels of behavior that were similar to the typically developing group but little progress in social-communication with age. There was poor correspondence between home video-based trajectories and parent report of onset. CONCLUSIONS More than two onset categories may be needed to describe the ways in which symptoms emerge in children with autism. There is low agreement between parent report and home video, suggesting that methods for improving parent report of early development must be developed.
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Pfaff DW, Rapin I, Goldman S. Male predominance in autism: neuroendocrine influences on arousal and social anxiety. Autism Res 2011; 4:163-76. [PMID: 21465671 DOI: 10.1002/aur.191] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2010] [Accepted: 02/22/2011] [Indexed: 01/13/2023]
Abstract
We offer a neurobiologic theory based on animal work that helps account for the conspicuous male predominance in autism spectrum disorders (ASD). In young male animals, testosterone (TST) binds to androgen receptors (AR) in brainstem neurons responsible for enhancing brain arousal. As a consequence, arousal-related neurotransmitters bombard the amygdala hypersensitized by TST acting though AR. Arousal-related inputs are known to prime amygdaloid mechanisms for fear and anxiety, with resultant social avoidance. We hypothesize that similar mechanisms contribute to autism's male predominance and to its defining impaired social skills. The theory rests on two key interacting factors: the molecular effects of TST in genetically vulnerable boys in combination with environmental stresses they experienced in utero, neonatally, or during the first years. We postulate that higher TST levels and, therefore, higher amounts of arousal-related inputs to the amygdala sensitize these genetically vulnerable male infants to very early stresses. In sharp contrast to boys, girls not only do not have high levels of TST-facilitated arousal-causing inputs to the amygdala but they also enjoy the protection afforded by estrogenic hormones, oxytocin, and the oxytocin receptor. This theory suggests that novel technologies applied to the molecular endocrinology of TST's actions through AR will offer new avenues of enquiry into ASD. Since the high male preponderance in autism is important yet understudied, we offer our theory, which is based on detailed neurobehavioral research with animals, to stimulate basic and clinical research in animals and humans and hopefully help develop novel more effective medical treatments for autism.
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Giannotti F, Cortesi F, Cerquiglini A, Vagnoni C, Valente D. Sleep in children with autism with and without autistic regression. J Sleep Res 2010; 20:338-47. [PMID: 21518065 DOI: 10.1111/j.1365-2869.2010.00882.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The purpose of the present investigation was to characterize and compare traditional sleep architecture and non-rapid eye movement (NREM) sleep microstructure in a well-defined cohort of children with regressive and non-regressive autism, and in typically developing children (TD). We hypothesized that children with regressive autism would demonstrate a greater degree of sleep disruption either at a macrostructural or microstructural level and a more problematic sleep as reported by parents. Twenty-two children with non-regressive autism, 18 with regressive autism without comorbid pathologies and 12 with TD, aged 5-10years, underwent standard overnight multi-channel polysomnographic evaluation. Parents completed a structured questionnaire (Childrens' Sleep Habits Questionnaire-CSHQ). The initial hypothesis, that regressed children have more disrupted sleep, was supported by our findings that they scored significantly higher on CSHQ, particularly on bedtime resistance, sleep onset delay, sleep duration and night wakings CSHQ subdomains than non-regressed peers, and both scored more than typically developing controls. Regressive subjects had significantly less efficient sleep, less total sleep time, prolonged sleep latency, prolonged REM latency and more time awake after sleep onset than non-regressive children and the TD group. Regressive children showed lower cyclic alternating pattern (CAP) rates and A1 index in light sleep than non-regressive and TD children. Our findings suggest that, even though no particular differences in sleep architecture were found between the two groups of children with autism, those who experienced regression showed more sleep disorders and a disruption of sleep either from a macro- or from a microstructural viewpoint.
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Affiliation(s)
- Flavia Giannotti
- Center of Pediatric Sleep Disorders, Department of Developmental Neurology and Psychiatry, University of Rome La Sapienza, Italy.
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Autism spectrum disorder and co-occurring developmental, psychiatric, and medical conditions among children in multiple populations of the United States. J Dev Behav Pediatr 2010; 31:267-75. [PMID: 20431403 DOI: 10.1097/dbp.0b013e3181d5d03b] [Citation(s) in RCA: 278] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Autism spectrum disorders (ASDs) often co-occur with other developmental, psychiatric, neurologic, or medical diagnoses. OBJECTIVE This study examined co-occurring non-ASD diagnoses and symptoms in a population-based cohort of 8 year olds identified with ASD. METHOD Data on 2,568 children meeting surveillance case definition for ASD were collected by a multi-site surveillance program. Information was systematically abstracted and reviewed from existing health and education source records and systematically entered into a summary record in a secure database. RESULTS Eighty-one percent of study children were male; 63% white, 23% black, 14% Hispanic, Asian, or not stated. When age of ASD classification was available, 20% were classified before age 3 years, 36% between ages 3 and 5 years, and 44% after age 5 years. The co-occurrence of > or = 1 non-ASD developmental diagnoses was 83%, > or = 1 psychiatric diagnoses was 10%, > or = 1 neurologic diagnoses was 16%, and at least one possibly causative genetic or neurologic diagnosis was 4%. Children with a previous ASD classification and co-occurring psychiatric or neurologic conditions were more likely to be diagnosed or classified at a later age. Each category of co-occurring non-ASD diagnosis was significantly increased in children whose records did not include an ASD diagnosis or educational classification but who met surveillance criteria for ASD. CONCLUSIONS These data highlight the need for clinicians to keep in mind the high prevalence of associated diagnoses with an ASD diagnosis, and the possibility that in younger children other symptoms or disorders may be masking or obscuring core symptoms of ASD, which would lead to a diagnosis.
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Current World Literature. Curr Opin Neurol 2010; 23:194-201. [DOI: 10.1097/wco.0b013e328338cade] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Yochum CL, Bhattacharya P, Patti L, Mirochnitchenko O, Wagner GC. Animal model of autism using GSTM1 knockout mice and early post-natal sodium valproate treatment. Behav Brain Res 2010; 210:202-10. [PMID: 20178820 DOI: 10.1016/j.bbr.2010.02.032] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2009] [Revised: 02/15/2010] [Accepted: 02/16/2010] [Indexed: 11/16/2022]
Abstract
Autism is a heterogeneous, behaviorally defined developmental disorder with unknown etiology but thought to be the result of environmental insult acting upon the developing brain of a genetically susceptible individual. Approximately 30% of individuals with autism have normal development up to the age of about 30 months after which they experience behavioral regression and lose previously acquired motor, cognitive and social skills. Early post-natal toxicant administration to mice has been used to model autistic regression. To test the hypothesis that genetically altered mice might be more sensitive to toxicant exposure early in life, mice with a deletion of glutathione-S-transferaseM1 (GSTM1; a gene associated with increased risk of autism that codes for an enzyme involved in the management of toxicant-induced oxidative stress) and wild-type controls were exposed to valproic acid (VPA; a toxicant known to cause autism-like behavioral deficits that, in part, are mediated through oxidative stress) on post-natal day 14. VPA treatment caused significant increases in apoptosis in granule cells of the hippocampus and cerebellum. There was a genotype by treatment by sex interaction with wild-type females exhibiting significantly fewer apoptotic cells in these regions compared to all other groups. VPA treatment also resulted in long-lasting deficits in social behaviors and significant alterations in brain chemistry. VPA-treated GSTM1 knockout animals performed significantly fewer crawl-under behaviors compared to saline-treated knockout animals as well as wild-type controls receiving either treatment. Collectively, these studies indicate that VPA-treatment causes cerebellar and hippocampal apoptosis and that having the wild-type GSTM1 genotype may confer protection against VPA-induced neuronal death in female mice.
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Affiliation(s)
- Carrie L Yochum
- Environmental & Occupational Health Sciences Institute, UMDNJ/RWJMS, Piscataway, NJ 08854, USA
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