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Engelstad AM, Joffe-Nelson L, Hurewitz SR, Pawlowski KG, Baumer NT. The JASPER (Joint Attention, Symbolic Play, Engagement and Regulation) Intervention in Down Syndrome: A pilot study. RESEARCH IN DEVELOPMENTAL DISABILITIES 2024; 152:104796. [PMID: 39047661 DOI: 10.1016/j.ridd.2024.104796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 06/21/2024] [Accepted: 06/21/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Children with Down syndrome (DS) often need support building language, socialization, and regulation, yet few receive behavioral intervention for this. The Joint Attention, Symbolic Play, Engagement and Regulation (JASPER) intervention holds promise as a clinician-caregiver-mediated approach. AIMS The aims of this pilot study were to (1) describe the behavioral phenotype of children with DS (2) quantify change in child engagement following JASPER receipt, (3) measure caregiver adoption of JASPER strategies, and (4) generate hypotheses and directions for future research. METHODS AND PROCEDURES Sixteen toddlers with DS and their caregivers enrolled in the study. Dyads were randomly assigned to one of two conditions: immediate intervention or waitlist control. During the COVID-19 pandemic, intervention was delivered remotely. OUTCOMES AND RESULTS Caregivers learned to implement JASPER strategies and pilot data suggest improvements in joint engagement and regulation during play. Case series data show individual heterogeneity of intervention response. Remote intervention delivery may be associated with greater participant retention. CONCLUSIONS AND IMPLICATIONS JASPER may be a viable treatment option to improve joint engagement and emotion regulation in young children with DS. Parents appear receptive to learning and implementing JASPER strategies at home. Remote JASPER delivery may improve participation in research or treatment programs.
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Affiliation(s)
- Anne-Michelle Engelstad
- Division of Developmental Medicine, Boston Children's Hospital, Boston, MA, USA; Harvard Graduate School of Education, Cambridge, MA, USA.
| | - Linnea Joffe-Nelson
- Division of Developmental Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Sophie R Hurewitz
- Division of Developmental Medicine, Boston Children's Hospital, Boston, MA, USA
| | | | - Nicole T Baumer
- Division of Developmental Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Neurology, Boston Children's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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Fucà E, Costanzo F, Vicari S. Characterising repetitive behaviours in children and adolescents with Down syndrome. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2024. [PMID: 39105267 DOI: 10.1111/jir.13179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 07/09/2024] [Accepted: 07/19/2024] [Indexed: 08/07/2024]
Abstract
BACKGROUND Individuals with intellectual disability, including people with Down syndrome (DS), often exhibit restricted and repetitive behaviours (RRBs). However, RRBs have not been deeply characterised in children and adolescents with DS. METHOD The study encompassed a cohort of 151 participants aged 4 to 18 years with DS. RRBs were assessed utilising the Repetitive Behaviour Scale-Revised. Additionally, data pertaining to cognitive and adaptive functioning, linguistic abilities, sleep patterns and emotional/behavioural issues were gathered. RESULTS Self-injurious behaviours were reported less frequently whereas parents most commonly endorsed items related to behaviours associated with the need for sameness and ritualistic behaviours. We observed very few gender differences, whereas some age-related differences emerged, with adolescents exhibiting higher scores in items related with higher-level RRBs. The analysis of the association between RRBs and clinical features revealed that RRBs were associated with parent-reported sleep difficulties, as well as with internalising and externalising problems. We also observed a negative correlation with IQ whereas associations with adaptive skills emerged mainly for lower-level RRBs, such as motor stereotypies. Finally, RRBs were negatively associated with linguistic abilities, both expressive and receptive. CONCLUSIONS RRBs in children and adolescents with DS are of significant clinical interest due to their associations with various clinical dimensions. Therefore, psychological and neuropsychiatric assessment should include an accurate evaluation of RRBs for young people with DS.
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Affiliation(s)
- E Fucà
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - F Costanzo
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - S Vicari
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
- Department of Life Science and Public Health, Catholic University of the Sacred Heart, Rome, Italy
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Mingins JE, Tarver J, Pearson E, Edwards G, Bird M, Crawford H, Oliver C, Shelley L, Waite J. Development and psychometric properties of the Clinical Anxiety Scale for People with Intellectual Disabilities (ClASP-ID). J Neurodev Disord 2024; 16:43. [PMID: 39068415 PMCID: PMC11283710 DOI: 10.1186/s11689-024-09554-9] [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: 01/03/2024] [Accepted: 06/25/2024] [Indexed: 07/30/2024] Open
Abstract
BACKGROUND There is a critical need for the development of dependable and valid anxiety assessment tools suitable for people with moderate to severe intellectual disabilities, particularly those who speak few or no words. Distinguishing anxiety from distress caused by physical discomfort (pain) or characteristics associated with autism, prevalent in this population, necessitates specialised assessment tools. This study (a) developed a parent-report anxiety questionnaire tailored for individuals with severe to moderate intellectual disabilities, potentially with a co-diagnosis of autism, and (b) evaluated the psychometric attributes of this novel measure. METHODS A comprehensive approach involving literature reviews, inspection of existing tools, and interviews with clinicians and parents guided the creation of the Clinical Anxiety Scale for People with Intellectual Disabilities. The tool was completed by parents or caregivers (N = 311) reporting on individuals aged 4 or older with intellectual disabilities. RESULTS Exploratory factor analysis indicated a four-factor structure encompassing anxiety, pain, low energy/withdrawal, and consolability. The anxiety factor explained the most variance in scores (26.3%). The anxiety, pain, low energy/withdrawal subscales demonstrated robust internal consistency (α = 0.81-0.92), and convergent, divergent, and discriminant validity. Robustness of these subscales was further evidenced by test-retest reliability (ICC = 0.79-0.88) and inter-rater reliability (ICC = 0.64-0.71). Subgroup analyses consistently demonstrated strong psychometric properties among individuals diagnosed with non-syndromic autism (N = 98), children (N = 135), adults (N = 175), and across diverse communication abilities within the sample. Moreover, individuals diagnosed with both autism and anxiety exhibited significantly higher scores on the anxiety subscale compared to those without an anxiety diagnosis, while showing no difference in autism characteristic scores. CONCLUSIONS The findings indicate that the Clinical Anxiety Scale for People with Intellectual Disabilities is a promising measure for use across diverse diagnostic groups, varying communication abilities, and with people with moderate to severe intellectual disabilities.
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Affiliation(s)
- Jessica Eliza Mingins
- School of Psychology, College of Health and Life Sciences, Aston University, Birmingham, B4 7 ET, United Kingdom.
| | - Joanne Tarver
- School of Psychology, College of Health and Life Sciences, Aston University, Birmingham, B4 7 ET, United Kingdom
| | - Effie Pearson
- School of Psychology, College of Health and Life Sciences, Aston University, Birmingham, B4 7 ET, United Kingdom
| | - Georgina Edwards
- School of Health and Care, Coventry University, Priory St, Coventry, CV1 5FB, England
| | - Megan Bird
- School of Psychology, College of Health and Life Sciences, Aston University, Birmingham, B4 7 ET, United Kingdom
| | - Hayley Crawford
- Mental Health and Wellbeing Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, England
| | - Chris Oliver
- School of Psychology, University of Birmingham, Edgbaston, B15 2TT, England
| | - Lauren Shelley
- School of Psychology, College of Health and Life Sciences, Aston University, Birmingham, B4 7 ET, United Kingdom
| | - Jane Waite
- School of Psychology, College of Health and Life Sciences, Aston University, Birmingham, B4 7 ET, United Kingdom
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Spinazzi NA, Velasco AB, Wodecki DJ, Patel L. Autism Spectrum Disorder in Down Syndrome: Experiences from Caregivers. J Autism Dev Disord 2024; 54:1171-1180. [PMID: 36624226 PMCID: PMC10907487 DOI: 10.1007/s10803-022-05758-x] [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] [Accepted: 09/12/2022] [Indexed: 01/11/2023]
Abstract
This study aimed to learn about the experiences of families of individuals with a dual diagnosis of Down syndrome (DS) and autism spectrum disorder (ASD) (DS-ASD), and to document the journey from early concerns to diagnosis and intervention. Caregivers completed an online survey describing their journey raising a child with DS-ASD. Survey responses were analyzed qualitatively and coded into categories to highlight common themes. Stereotypy, severe communication impairments, and behavioral difficulties prompted caregivers to pursue further evaluation. There was a mean 4.65-year gap between first noticing symptoms and receiving an ASD diagnosis. Several therapeutic interventions were identified as beneficial, including behavioral and communication support. Caregivers expressed frustration and described high levels of stress and social isolation. The diagnosis of ASD in children with DS is often delayed, and caregivers' initial concerns are frequently dismissed. Raising a child with DS-ASD can lead to social isolation and elevated caregiver stress. More research is needed to tailor diagnostic algorithms and therapeutic interventions to the unique needs of this patient population. Caregivers yearn for improved understanding of DS-ASD, more targeted therapies and educational programs, and more overall support.
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Affiliation(s)
- Noemi Alice Spinazzi
- Division of Primary Care, Department of Pediatrics, UCSF Benioff Children's Hospital Oakland, 5220 Claremont Ave, Oakland, CA, USA.
| | - Alyssa Bianca Velasco
- Graduate Medical Education, Department of Pediatrics, UCSF Benioff Children's Hospital Oakland, Oakland, CA, USA
- Lucille Packard Children's Hospital Stanford, Palo Alto, USA
| | | | - Lina Patel
- Division of Child and Adolescent Mental Health, Department of Psychiatry, Children's Hospital Colorado and University of Colorado, Aurora, CO, USA
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Escudero SC, Sepúlveda EM. Pragmatic competence in people with dual diagnosis: down syndrome and autism spectrum disorder. BMC Psychol 2024; 12:74. [PMID: 38360760 PMCID: PMC10870447 DOI: 10.1186/s40359-023-01508-5] [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: 09/01/2023] [Accepted: 12/23/2023] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Pragmatics is an area that can be affected in a wide variety of disorders. In this sense, Syndromic Autism is defined as a disorder in which a causal link is established between an associated syndrome and Autism Spectrum Disorder (ASD). Likewise, Down Syndrome (DS) is one of the main genetically based syndromes in which ASD is described as one of its possible manifestations. In this direction, people with DS are described as social beings whereas in ASD there seems to be a specific alteration of this domain. METHODS In this study, pragmatic performance was analysed in a sample of 72 participants, where comparisons were made between the scores obtained by children with ASD (n = 24), with DS (n = 24) and with DS + ASD (n = 24). RESULTS The Social Communication Questionnaire (SCQ), the Block Objective and Criterial Language Battery (BLOC-SR) and the Neuropsychology subtest (NEPSY-II) aimed at Theory of Mind (ToM) identified significant differences between the groups. However, two-to-two comparisons reported no significant differences between DS and DS + ASD. CONCLUSIONS Although several studies report differences between the three proposed groups, our data seem to suggest that ASD symptomatology in DS is associated with Intellectual Developmental Disorder (IDD). However, the lack of solid scientific evidence regarding comorbid diagnosis makes further research along these lines indispensable. TRIAL REGISTRATION This study was approved by the Ethics Committee for Social Research at UCLM with reference CEIS-704,511-L8M4.
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Affiliation(s)
- Sara Cortés Escudero
- Department of Psychology, Faculty of Health Sciences, University of Castilla-La-Mancha, Avda Real Fábrica de la Seda s/n, 45600, Talavera de la Reina, Spain
| | - Esther Moraleda Sepúlveda
- Department of Psychology, Faculty of Pychology, University Complutense. Campus de Somosaguas, 28223, Pozuelo de Alarcón. Madrid, Spain.
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Del Hoyo Soriano L, Sterling A, Edgin J, Hamilton DR, Berry-Kravis E, Dimachkie Nunnally A, Thurman AJ, Abbeduto L. Associations Among Sex, Cognitive Ability, and Autism Symptoms in Individuals with Down Syndrome. J Autism Dev Disord 2024; 54:301-311. [PMID: 36315322 PMCID: PMC10184887 DOI: 10.1007/s10803-022-05779-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2022] [Indexed: 11/07/2022]
Abstract
This study explores sex-differences in (a) rates and profiles of autism symptoms as well as in (b) the contribution of intellectual quotient (IQ) to autism symptom presentation in Down syndrome (DS). Participants were 40 males and 38 females with DS, aged 6 to 23 years. Autism symptoms were rated through the Autism Diagnostic Observation Schedule-Second Edition (ADOS-2). Results show no sex differences in the ADOS-2 Calibrated Severity Scores (CSS). However, only females with DS who are classified as DS-Only have higher scores on verbal IQ than those classified as DS + autism. Furthermore, associations between IQ and all CSSs are found for females, but not for males. Findings suggest that verbal cognition may play differential roles for females and males with DS.
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Affiliation(s)
- Laura Del Hoyo Soriano
- MIND Institute, University of California Davis, 2825 50th Street, Sacramento, CA, USA.
- Department of Psychiatry and Behavioral Sciences, University of California, Davis Health, Sacramento, CA, USA.
| | - Audra Sterling
- Waisman Center, Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, WI, USA
| | - Jamie Edgin
- Department of Psychology, University of Arizona, Tucson, AZ, USA
| | - Debra R Hamilton
- Department of Human Genetics, School of Medicine, Emory University, Atlanta, GA, USA
| | - Elizabeth Berry-Kravis
- Departments of Pediatrics, Neurological Sciences and Biochemistry, Rush University Medical Center, Chicago, USA
| | | | - Angela John Thurman
- MIND Institute, University of California Davis, 2825 50th Street, Sacramento, CA, USA
- Department of Psychiatry and Behavioral Sciences, University of California, Davis Health, Sacramento, CA, USA
| | - Leonard Abbeduto
- MIND Institute, University of California Davis, 2825 50th Street, Sacramento, CA, USA
- Department of Psychiatry and Behavioral Sciences, University of California, Davis Health, Sacramento, CA, USA
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Baumer NT, Capone G. Psychopharmacological treatments in Down syndrome and autism spectrum disorder: State of the research and practical considerations. AMERICAN JOURNAL OF MEDICAL GENETICS. PART C, SEMINARS IN MEDICAL GENETICS 2023; 193:e32069. [PMID: 37870763 DOI: 10.1002/ajmg.c.32069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/20/2023] [Accepted: 09/30/2023] [Indexed: 10/24/2023]
Abstract
Individuals with Down syndrome (DS) or Autism Spectrum Disorder (ASD), and especially those with both DS and co-occurring ASD (DS + ASD) commonly display behavioral and psychiatric symptoms that can impact quality of life and places increased burden on caregivers. While the mainstay of treatment in DS and ASD is focused on educational and behavioral therapies, pharmacological treatments can be used to reduce symptom burden. There is a paucity of evidence and limited clinical trials in DS and DS + ASD. Some scientific evidence is available, primarily in open label studies and case series that can guide treatment choices. Additionally, clinical decisions are often extrapolated from evidence and experience from those with ASD, or intellectual disability in those without DS. This article reviews current research in pharmacological treatment in DS, ASD, and DS + ASD, reviews co-occurring neurodevelopmental and mental health diagnoses in individuals with DS + ASD across the lifespan, and describes practical approaches to psychopharmacological management.
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Affiliation(s)
- Nicole T Baumer
- Division of Developmental Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - George Capone
- Department of Pediatrics, Johns Hopkins Medicine, Baltimore, Maryland, USA
- Kennedy Krieger Institute, Baltimore, Maryland, USA
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Spinazzi NA, Santoro JD, Pawlowski K, Anzueto G, Howe YJ, Patel LR, Baumer NT. Co-occurring conditions in children with Down syndrome and autism: a retrospective study. J Neurodev Disord 2023; 15:9. [PMID: 36864370 PMCID: PMC9979529 DOI: 10.1186/s11689-023-09478-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 02/23/2023] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND Down syndrome (DS) is one of the most common genetic causes of intellectual disability, and it is associated with an increased incidence of numerous co-occurring conditions. Autism spectrum disorder (ASD) is common in persons with DS, with rates reported as high as 39%. However, little is known regarding co-occurring conditions in children with both DS and ASD. METHODS A single-center retrospective review of prospective longitudinally collected clinical data was performed. Any patient with a confirmed diagnosis of DS evaluated at a large, specialized Down Syndrome Program in a tertiary pediatric medical center between March 2018 and March 2022 was included. A standardized survey which included demographic and clinical questions was administered during each clinical evaluation. RESULTS In total, 562 individuals with DS were included. The median age was 10 years (IQR: 6.18-13.92). Of this group, 72 (13%) had a co-occurring diagnosis of ASD (DS+ASD). Individuals with DS+ASD were more likely to be male (OR 2.23, CI 1.29-3.84) and had higher odds of a current or prior diagnosis of constipation (OR 2.19, CI 1.31-3.65), gastroesophageal reflux (OR 1.91, CI 1.14-3.21), behavioral feeding difficulties (OR 2.71, CI 1.02-7.19), infantile spasms (OR 6.03, CI 1.79-20.34) and scoliosis (OR 2.73, CI 1.16-6.40). There were lower odds of congenital heart disease in the DS+ASD group (OR 0.56, CI 0.34-0.93). There was no observed difference in prematurity or Neonatal Intensive Care Unit complications between groups. Individuals with DS+ASD had similar odds of having a history of congenital heart defect requiring surgery to those with DS only. Furthermore, there was no difference in rates of autoimmune thyroiditis or celiac disease. There was also no difference in rates of diagnosed co-occurring neurodevelopmental or mental health conditions in this cohort, including anxiety disorders and attention-deficit/hyperactivity disorder. CONCLUSIONS This study identifies a variety of medical conditions which are more frequent in children with DS+ASD than DS alone, providing important information for the clinical management of these patients. Future research should investigate the role of some of these medical conditions in the development of ASD phenotypes, and whether there may be distinct genetic and metabolic contributions towards these conditions.
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Affiliation(s)
- Noemi A Spinazzi
- UCSF Benioff Children's Hospital Oakland, Oakland, CA, 94609, USA.
| | - Jonathan D Santoro
- Division of Neuroimmunology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, 90027, USA.,Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90033, USA
| | - Katherine Pawlowski
- Division of Developmental Medicine, Boston Children's Hospital, Boston, MA, 02115, USA
| | - Gabriel Anzueto
- Division of Developmental and Behavioral Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, 60611, USA.,Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Yamini J Howe
- Massachusetts General Hospital Lurie Center for Autism, Lexington, MA, 02421, USA.,Harvard Medical School, Boston, MA, 02115, USA
| | - Lina R Patel
- Department of Psychiatry, Children's Hospital Colorado, Aurora, CO, 80045, USA
| | - Nicole T Baumer
- Division of Developmental Medicine, Boston Children's Hospital, Boston, MA, 02115, USA.,Harvard Medical School, Boston, MA, 02115, USA.,Department of Neurology, Boston Children's Hospital, Boston, MA, 02115, USA
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Tevis C, Matson JL, Callahan M. Developmental Functioning of Toddlers At-Risk for Autism With and Without Down Syndrome. Dev Neurorehabil 2023; 26:1-9. [PMID: 36380608 DOI: 10.1080/17518423.2022.2147596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Due to the difficulties in differentiating between impairments associated with intellectual disability and ASD symptomology, DS often leads to delayed or misdiagnoses of ASD. METHOD An ANOVA was run to investigate the effects of ASD risk and DS on overall developmental functioning across three groups: ASD+, DS-, and DS+ (n = 138). A MANOVA was run to investigate the differences of group on five developmental subdomains. RESULTS The results revealed significant group differences in the overall developmental functioning and each developmental subdomain. Children in the DS+ group demonstrated significantly lower overall developmental functioning, as well as lower adaptive, cognitive, motor, and communication skills compared to their peers; however, children in the DS- group demonstrated significantly better social skills compared to their peers in the ASD+ group. DISCUSSION These findings support the need for early screening and identification of ASD among those with DS.
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Toilet Training in Children and Adolescents with Down Syndrome. J Dev Behav Pediatr 2022; 43:e381-e389. [PMID: 35026787 DOI: 10.1097/dbp.0000000000001058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 11/15/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Although the challenges of toilet training for children and adolescents with Down syndrome (DS) are well-known, details such as specific associations with comorbidities and related exacerbating factors are lacking. This study aims to characterize the nature of toilet training in a cohort of children and adolescents with DS and evaluate characteristics and comorbid conditions that may contribute to or prolong toilet training success in those with DS. METHOD This was a retrospective, cross-sectional study investigating toilet training in children and adolescents with DS. A survey was completed by 137 patients' parents or guardians as part of their care experience in the clinic. RESULTS Although toilet training on average began at age 3.40 years (SD = 1.47), children and adolescents with DS typically began telling caregivers they needed to use the toilet at 4.80 years (SD = 2.11), no longer used diapers during the day at 5.03 years (SD = 1.98) and night at 5.88 years (SD = 2.48), and were described by their caregivers as being fully toilet trained at 6.60 years (n = 28; SD = 2.43; range = 3.00-14.00 years). There was a linear trend in the age groups between 2 to 4 years (n = 37), 5 to 7 years (n = 42), 8 to 12 years (n = 39), and 13 to 17 years (n = 19) and the proportion of children and adolescents fully toilet trained (2 to 4 years = 0.040, 5 to 7 years = 0.211, 8 to 12 years = 0.278, and 13 to 17 years = 0.529). Typical readiness signs that children and adolescents with DS display and those most predictive of toileting success are reported. Placing the child on a schedule was the most successful (45.2%) training method identified by parents, with 55.8% of the families trying this approach. Children and adolescents aged 8 to 12 years with behavioral challenges were more likely (75.0%) to have daytime accidents compared with those without (25.9%), p = 0.006. CONCLUSION Children and adolescents with DS in this sample started toilet training at 3.4 years and completed toilet training at 6.6 years. Even after completing toilet training, many children and adolescents continue to require support from their caregivers with some aspects of toilet training. Skill loss associated with various life events, behavioral challenges, medical diagnoses, and inconsistencies in toileting expectations across settings are factors caregivers believe contribute to delayed toilet training. Caregivers found that a consistent toileting schedule, using reinforcers, and providing prompting to use the toilet were the most successful methods.
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Fleming V, Hom CL, Clare ICH, Hurd-Thomas SL, Krinsky-McHale S, Handen B, Hartley SL. Cognitive outcome measures for tracking Alzheimer's disease in Down syndrome. INTERNATIONAL REVIEW OF RESEARCH IN DEVELOPMENTAL DISABILITIES 2022; 62:227-263. [PMID: 37396708 PMCID: PMC10312212 DOI: 10.1016/bs.irrdd.2022.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Down syndrome (DS) is now viewed as a genetic type of Alzheimer's disease (AD), given the near-universal presence of AD pathology in middle adulthood and the elevated risk for developing clinical AD in DS. As the field of DS prepares for AD clinical intervention trials, there is a strong need to identify cognitive measures that are specific and sensitive to the transition from being cognitively stable to the prodromal (e.g., Mild Cognitive Impairment-Down syndrome) and clinical AD (e.g., Dementia) stages of the disease in DS. It is also important to determine cognitive measures that map onto biomarkers of early AD pathology during the transition from the preclinical to the prodromal stage of the disease, as this transition period is likely to be targeted and tracked in AD clinical trials. The present chapter discusses the current state of research on cognitive measures that could be used to screen/select study participants and as potential outcome measures in future AD clinical trials with adults with DS. In this chapter, we also identify key challenges that need to be overcome and questions that need to be addressed by the DS field as it prepares for AD clinical trials in the coming years.
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Affiliation(s)
- Victoria Fleming
- Waisman Center, University of Wisconsin-Madison, Madison, WI, United States
- School of Human Ecology, University of Wisconsin-Madison, Madison, WI, United States
| | - Christy L Hom
- Department of Psychiatry and Human Behavior, University of California, Irvine School of Medicine, Orange, CA, United States
| | - Isabel C H Clare
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | | | - Sharon Krinsky-McHale
- New York State Institute for Basic Research in Developmental Disabilities, Staten Island, NY, United States
| | - Benjamin Handen
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
| | - Sigan L Hartley
- Waisman Center, University of Wisconsin-Madison, Madison, WI, United States
- School of Human Ecology, University of Wisconsin-Madison, Madison, WI, United States
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Janicki MP, Hendrix JA, McCallion P. Examining older adults with neuroatypical conditions for MCI/dementia: Barriers and recommendations of the Neuroatypical Conditions Expert Consultative Panel. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2022; 14:e12335. [PMID: 35845263 PMCID: PMC9270662 DOI: 10.1002/dad2.12335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/16/2022] [Indexed: 01/04/2023]
Abstract
The Neuroatypical Conditions Expert Consultative Panel composed of numerous clinical and academic experts was convened to examine barriers to the examination of cognitive impairment in adults with a variety of neuroatypical conditions. Neuroatypical conditions affect normative intellectual development and function (such as intellectual disability and intellectual disability with conjoint psychiatric conditions), thought, moods, and cognition (such as severe mental illness), communication functions (such as the autism spectrum and hearing/vision impairments), and brain and motor function (such as cerebral palsy and acquired or traumatic brain injury). The panel concluded that current federal guidance for the assessment of cognitive impairment for mild cognitive impairment (MCI) or dementia does not sufficiently include information as to how to assess such adults. In addition, it concluded that adults with these conditions (1) challenge clinicians when attempting to discern current behavior and function from that which was pre-existing; (2) often have inherent comprehension and oral communication difficulties, motor task performance impediments, and difficulty with visuals; and (3) pose difficulties when assessed with standardized dementia measures and can benefit from the use of specialized instruments. The panel recommended that federal guidance be broadened to include adaptations of assessment practices to accommodate neuroatypical conditions; that educational packs be developed for clinicians about such conditions and on detecting and diagnosing MCI or dementia; and that research be expanded to produce more evidence-based information on both assessing adults with neuroatypical conditions for later-life adult cognitive diseases/disorders and planning post-diagnostic care.
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Affiliation(s)
- Matthew P. Janicki
- Department of Disability and Human DevelopmentUniversity of IllinoisChicagoIllinoisUSA
| | | | - Philip McCallion
- College of Public HealthTemple UniversityPhiladelphiaPennsylvaniaUSA
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Jin M, Xu R, Wang L, Alam MM, Ma Z, Zhu S, Martini AC, Jadali A, Bernabucci M, Xie P, Kwan KY, Pang ZP, Head E, Liu Y, Hart RP, Jiang P. Type-I-interferon signaling drives microglial dysfunction and senescence in human iPSC models of Down syndrome and Alzheimer's disease. Cell Stem Cell 2022; 29:1135-1153.e8. [PMID: 35803230 DOI: 10.1016/j.stem.2022.06.007] [Citation(s) in RCA: 50] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 04/27/2022] [Accepted: 06/09/2022] [Indexed: 12/17/2022]
Abstract
Microglia are critical in brain development and Alzheimer's disease (AD) etiology. Down syndrome (DS) is the most common genetic developmental disorder and risk factor for AD. Surprisingly, little information is available on the impact of trisomy of human chromosome 21 (Hsa21) on microglial functions during DS brain development and in AD in DS. Using induced pluripotent stem cell (iPSC)-based organoid and chimeric mouse models, we report that DS microglia exhibit an enhanced synaptic pruning function, which alters neuronal synaptic functions. In response to human brain tissue-derived pathological tau, DS microglia undergo cellular senescence and exhibit elevated type-I-interferon signaling. Mechanistically, knockdown of Hsa21-encoded type I interferon receptors, IFNARs, rescues the DS microglial phenotypes both during brain development and in response to pathological tau. Our findings provide in vivo evidence that human microglia respond to pathological tau by exhibiting dystrophic phenotypes. Targeting IFNARs may improve DS microglial functions and prevent senescence.
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Affiliation(s)
- Mengmeng Jin
- Department of Cell Biology and Neuroscience, Rutgers University, Piscataway, NJ 08854, USA
| | - Ranjie Xu
- Department of Cell Biology and Neuroscience, Rutgers University, Piscataway, NJ 08854, USA
| | - Le Wang
- Department of Neuroscience and Cell Biology and Child Health Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA
| | - Mahabub Maraj Alam
- Department of Cell Biology and Neuroscience, Rutgers University, Piscataway, NJ 08854, USA
| | - Ziyuan Ma
- Department of Cell Biology and Neuroscience, Rutgers University, Piscataway, NJ 08854, USA
| | - Sining Zhu
- Department of Cell Biology and Neuroscience, Rutgers University, Piscataway, NJ 08854, USA
| | - Alessandra C Martini
- Department of Pathology and Laboratory Medicine, University of California, Irvine, CA 92697, USA
| | - Azadeh Jadali
- Department of Cell Biology and Neuroscience, Rutgers University, Piscataway, NJ 08854, USA
| | - Matteo Bernabucci
- Department of Neuroscience and Cell Biology and Child Health Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA
| | - Ping Xie
- Department of Cell Biology and Neuroscience, Rutgers University, Piscataway, NJ 08854, USA
| | - Kelvin Y Kwan
- Department of Cell Biology and Neuroscience, Rutgers University, Piscataway, NJ 08854, USA
| | - Zhiping P Pang
- Department of Neuroscience and Cell Biology and Child Health Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA
| | - Elizabeth Head
- Department of Pathology and Laboratory Medicine, University of California, Irvine, CA 92697, USA
| | - Ying Liu
- Department of Neurosurgery and Center for Stem Cell and Regenerative Medicine, University of Texas Health Science Center at Houston, Houston, TX 77030, USA; Department of Environmental Health Sciences, Robert Stempel College of Public Health and Social Work, Center for Translational Science, Florida International University, Miami, FL 34987, USA
| | - Ronald P Hart
- Department of Cell Biology and Neuroscience, Rutgers University, Piscataway, NJ 08854, USA
| | - Peng Jiang
- Department of Cell Biology and Neuroscience, Rutgers University, Piscataway, NJ 08854, USA.
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14
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Diniz NLF, Parlato-Oliveira E, Pimenta PGA, de Araújo LA, Valadares ER. Autism and Down syndrome: early identification and diagnosis. ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:620-630. [PMID: 35946706 PMCID: PMC9387185 DOI: 10.1590/0004-282x-anp-2021-0156] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 08/25/2021] [Accepted: 09/06/2021] [Indexed: 06/15/2023]
Abstract
The diagnosis of autism spectrum disorder (ASD) in Down syndrome (DS) is underestimated because it is necessary to understand which aspects of the behavioral phenotype are related to DS and which are related to ASD. Objective: To conduct a systematic review of the literature on early identification and diagnosis of ASD in patients with DS. Data source: The VHL, MEDLINE, Cochrane, CINAHL, Scopus, Web of Science and Embase databases were searched and data were evaluated using PRISMA. Data synthesis: Out of 1,729 articles evaluated, 15 were selected. Although well studied, identification of ASD in DS can be difficult because of the need to understand which aspects of the behavioral phenotype are related to Down syndrome and which to autism. In this review, the prevalence of ASD was found to range from 12% to 41%. Early identification of autism risk in individuals with Down syndrome is still poorly studied, even though there are screening instruments for infants. Several instruments for diagnosing autism in individuals with Down syndrome were found, but a developmental approach is fundamental for making a clear diagnosis. Conclusions: Screening procedures are important for detecting early signs of autism risk in the first year of life. Careful evaluation methods are needed to establish the diagnosis, which include choosing appropriate tools for evaluation of development and cognition, and analysis of qualitative aspects of social interaction, among others. It has been indicated in the literature that early detection and timely accurate diagnosis, in association with an intervention, may benefit development, quality of life and social inclusion.
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Affiliation(s)
- Natália Lisce Fioravante Diniz
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Programa Saúde da Criança e do Adolescente, Belo Horizonte MG, Brasil
| | - Erika Parlato-Oliveira
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Programa Saúde da Criança e do Adolescente, Belo Horizonte MG, Brasil
- CRPMS, UFR Études Psychanalytiques, Université Paris Diderot, Paris, France
- CRPMS, Université de Paris, Paris, France
| | | | - Liubiana Arantes de Araújo
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Programa Saúde da Criança e do Adolescente, Belo Horizonte MG, Brasil
| | - Eugênia Ribeiro Valadares
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Programa Saúde da Criança e do Adolescente, Belo Horizonte MG, Brasil
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15
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Boterberg S, Zanatta A, Moerman F, Schaubroeck S, Siew J, De Schryver M, Roeyers H. The impact of COVID-19 measures on parent-reported restricted and repetitive behaviours in pre-school children with autism. Heliyon 2022; 8:e09727. [PMID: 35720765 PMCID: PMC9188681 DOI: 10.1016/j.heliyon.2022.e09727] [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] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/22/2022] [Accepted: 06/09/2022] [Indexed: 11/18/2022] Open
Abstract
Background COVID-19 restrictive measures have had a considerable impact on daily life routines, which may be especially challenging for families of children with autism. In pre-schoolers with autism, it is likely that the disruption of routines mainly impacts the presence of restrictive and repetitive behaviours (RRBs). Furthermore, influence of comorbid conditions, secondary behavioural difficulties and home environment characteristics on RRBs was explored. Method A cross-sectional online survey design was used to collect parent-report data on 254 children with autism (2.5–6 years) during lockdown in the early months of the pandemic. RRBs were assessed using the Repetitive Behaviour Scale-Revised (RBS-R). Results Parents reported a significant increase in stereotypic, self-injurious, compulsive and ritualistic behaviour, and restricted interests after implementation of COVID-19 restrictions. The presence of a co-occurring condition, such as language impairments or intellectual disability, was associated with more self-injurious and stereotypic behaviour. However, there was no effect of home environment on RRBs. Further, most children showed increases in internalising and/or externalising behaviour. Increased inattentive behaviour was associated with more ritualistic and stereotypic behaviour, and restricted interests. Decreases in hyperactivity were related to more restricted interests. Importantly, in a subset of children, parents reported less behavioural difficulties during the lockdown. Conclusions Findings highlight the importance of flexible implementation and continuity of care for pre-schoolers with autism and support for parents. Further follow-up of children with autism and RRBs, and co-occurring behavioural difficulties is needed and could enhance our understanding of the long-term effects associated with sudden restrictive measures to daily routines.
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Affiliation(s)
- Sofie Boterberg
- Research in Developmental Disorders Lab, Department of Experimental Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Henri Dunantlaan 2, 9000, Ghent, Belgium
- Corresponding author.
| | - Arianna Zanatta
- Research in Developmental Disorders Lab, Department of Experimental Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Henri Dunantlaan 2, 9000, Ghent, Belgium
| | - Floor Moerman
- Research in Developmental Disorders Lab, Department of Experimental Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Henri Dunantlaan 2, 9000, Ghent, Belgium
| | - Sarah Schaubroeck
- Research in Developmental Disorders Lab, Department of Experimental Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Henri Dunantlaan 2, 9000, Ghent, Belgium
| | - Jasmine Siew
- Research in Developmental Disorders Lab, Department of Experimental Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Henri Dunantlaan 2, 9000, Ghent, Belgium
| | - Maarten De Schryver
- Research Support Office, Faculty of Psychology and Educational Sciences, Ghent University, Henri Dunantlaan 2, 9000, Ghent, Belgium
| | - Herbert Roeyers
- Research in Developmental Disorders Lab, Department of Experimental Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Henri Dunantlaan 2, 9000, Ghent, Belgium
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16
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Bull MJ, Trotter T, Santoro SL, Christensen C, Grout RW, Burke LW, Berry SA, Geleske TA, Holm I, Hopkin RJ, Introne WJ, Lyons MJ, Monteil DC, Scheuerle A, Stoler JM, Vergano SA, Chen E, Hamid R, Downs SM, Grout RW, Cunniff C, Parisi MA, Ralston SJ, Scott JA, Shapira SK, Spire P. Health Supervision for Children and Adolescents With Down Syndrome. Pediatrics 2022; 149:e2022057010. [PMID: 35490285 DOI: 10.1542/peds.2022-057010] [Citation(s) in RCA: 79] [Impact Index Per Article: 39.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- Marilyn J Bull
- Department of Pediatrics, Division of Developmental Medicine, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, Indiana
| | - Tracy Trotter
- Department of Pediatrics, Division of Developmental Medicine, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, Indiana
| | | | - Celanie Christensen
- Department of Pediatrics, Division of Medical Genetics and Metabolism, Massachusetts General Hospital, Boston, Massachusetts
| | - Randall W Grout
- Division of Children's Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
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17
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Fidler DJ, Prince MA, Van Deusen K, Esbensen AJ, Thurman AJ, Abbeduto L, Patel L, Mervis C, Schworer EK, Lee NR, Edgin JO, Hepburn S, Davis S, Daunhauer LA. Latent profiles of autism symptoms in children and adolescents with Down syndrome. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2022; 66:265-281. [PMID: 34984734 PMCID: PMC9009451 DOI: 10.1111/jir.12910] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 11/12/2021] [Accepted: 11/14/2021] [Indexed: 05/29/2023]
Abstract
BACKGROUND Down syndrome (DS) is associated with elevated rates of autism spectrum disorder (ASD) and autism symptomatology. To better characterise heterogeneity in ASD symptomatology in DS, profiles of caregiver-reported ASD symptoms were modelled for children and adolescents with DS. METHODS Participants (n = 125) were recruited through several multi-site research studies on cognition and language in DS. Using the Social Responsiveness Scale-2 (SRS-2; Constantino and Gruber 2012), two latent profile analyses (LPA) were performed, one on the broad composite scores of social communication and interaction and restricted interests and repetitive behaviour, and a second on the four social dimensions of social communication, social motivation, social awareness, and social cognition. RESULTS A three-profile model was the best fit for both analyses, with each analysis yielding a low ASD symptom profile, an elevated or mixed ASD symptom profile and a high ASD symptom profile. Associations were observed between profile probability scores and IQ, the number of co-occurring biomedical conditions reported, sex, and SRS-2 form. CONCLUSIONS Characterising heterogeneity in ASD symptom profiles can inform more personalised supports in this population, and implications for potential therapeutic approaches for individuals with DS are discussed.
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Affiliation(s)
- D J Fidler
- Human Development and Family Studies, Colorado State University, Fort Collins, CO, USA
| | - M A Prince
- Human Development and Family Studies, Colorado State University, Fort Collins, CO, USA
- Department of Psychology, Colorado State University, Fort Collins, CO, USA
| | - K Van Deusen
- Human Development and Family Studies, Colorado State University, Fort Collins, CO, USA
| | - A J Esbensen
- Department of Pediatrics, Cincinnati Children's Hospital Medical Campus, Cincinnati, OH, USA
| | - A J Thurman
- Department of Psychiatry, MIND Institute, University of California - Davis Health, Sacramento, CA, USA
| | - L Abbeduto
- Department of Psychiatry, MIND Institute, University of California - Davis Health, Sacramento, CA, USA
| | - L Patel
- Department of Psychiatry, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
| | - C Mervis
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY, USA
| | - E K Schworer
- Department of Pediatrics, Cincinnati Children's Hospital Medical Campus, Cincinnati, OH, USA
| | - N R Lee
- Department of Psychology, Drexel University, Philadelphia, PA, USA
| | - J O Edgin
- Sonoran University Center for Excellence in Developmental Disabilities, University of Arizona, Tucson, AZ, USA
| | - S Hepburn
- Human Development and Family Studies, Colorado State University, Fort Collins, CO, USA
| | - S Davis
- Department of Psychology, Colorado State University, Fort Collins, CO, USA
| | - L A Daunhauer
- Human Development and Family Studies, Colorado State University, Fort Collins, CO, USA
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18
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Li D, Xu J, Yang MQ. Gene Regulation Analysis Reveals Perturbations of Autism Spectrum Disorder during Neural System Development. Genes (Basel) 2021; 12:genes12121901. [PMID: 34946850 PMCID: PMC8700980 DOI: 10.3390/genes12121901] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 11/24/2021] [Accepted: 11/24/2021] [Indexed: 01/21/2023] Open
Abstract
Autism spectrum disorder (ASD) is a neurodevelopmental disorder that impedes patients' cognition, social, speech and communication skills. ASD is highly heterogeneous with a variety of etiologies and clinical manifestations. The prevalence rate of ASD increased steadily in recent years. Presently, molecular mechanisms underlying ASD occurrence and development remain to be elucidated. Here, we integrated multi-layer genomics data to investigate the transcriptome and pathway dysregulations in ASD development. The RNA sequencing (RNA-seq) expression profiles of induced pluripotent stem cells (iPSCs), neural progenitor cells (NPCs) and neuron cells from ASD and normal samples were compared in our study. We found that substantially more genes were differentially expressed in the NPCs than the iPSCs. Consistently, gene set variation analysis revealed that the activity of the known ASD pathways in NPCs and neural cells were significantly different from the iPSCs, suggesting that ASD occurred at the early stage of neural system development. We further constructed comprehensive brain- and neural-specific regulatory networks by incorporating transcription factor (TF) and gene interactions with long 5 non-coding RNA(lncRNA) and protein interactions. We then overlaid the transcriptomes of different cell types on the regulatory networks to infer the regulatory cascades. The variations of the regulatory cascades between ASD and normal samples uncovered a set of novel disease-associated genes and gene interactions, particularly highlighting the functional roles of ELF3 and the interaction between STAT1 and lncRNA ELF3-AS 1 in the disease development. These new findings extend our understanding of ASD and offer putative new therapeutic targets for further studies.
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Affiliation(s)
- Dan Li
- Division of Bioinformatics and Biostatistics, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR 72079, USA;
| | - Joshua Xu
- Division of Bioinformatics and Biostatistics, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR 72079, USA;
- Correspondence: (J.X.); (M.Q.Y.)
| | - Mary Qu Yang
- MidSouth Bioinformatics Center, Joint Bioinformatics Graduate Program of University of Arkansas at Little Rock, University of Arkansas for Medical Sciences, Little Rock, AR 72204, USA
- Correspondence: (J.X.); (M.Q.Y.)
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19
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Dimachkie Nunnally A, Nguyen V, Anglo C, Sterling A, Edgin J, Sherman S, Berry-Kravis E, del Hoyo Soriano L, Abbeduto L, Thurman AJ. Symptoms of Autism Spectrum Disorder in Individuals with Down Syndrome. Brain Sci 2021; 11:1278. [PMID: 34679343 PMCID: PMC8533848 DOI: 10.3390/brainsci11101278] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/20/2021] [Accepted: 09/23/2021] [Indexed: 11/16/2022] Open
Abstract
There is a growing body of evidence to suggest that individuals with Down syndrome (DS) are diagnosed with autism spectrum disorders (ASD) at a higher rate than individuals in the general population. Nonetheless, little is known regarding the unique presentation of ASD symptoms in DS. The current study aims to explore the prevalence and profiles of ASD symptoms in a sample of individuals with DS (n = 83), aged between 6 and 23 years. Analysis of this sample (MAge = 15.13) revealed that approximately 37% of the sample met the classification cut-off for ASD using the Autism Diagnostic Observation Schedule 2 (ADOS-2) Calibrated Severity Score (CSS), an indicator of the participants' severity of ASD-related symptoms. Item-level analyses revealed that multiple items on Module 2 and Module 3 of the ADOS-2, mostly in the Social Affect (SA) subdomain, differentiated the children with DS who did not meet ASD classification (DS-only) from those who did (DS + ASD). Lastly, comparisons of individuals with DS-only and those with DS + ASD differed significantly on the syntactic complexity of their expressive language. These findings shed light on the unique presentation of ASD symptoms in a sample of individuals with DS and suggest that expressive language abilities may play a pivotal role in the presentation of ASD symptoms in DS.
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Affiliation(s)
- Amanda Dimachkie Nunnally
- MIND Institute, University of California Davis Health, 2825 50th Street, Sacramento, CA 95816, USA; (V.N.); (C.A.); (L.d.H.S.); (L.A.); (A.J.T.)
| | - Vivian Nguyen
- MIND Institute, University of California Davis Health, 2825 50th Street, Sacramento, CA 95816, USA; (V.N.); (C.A.); (L.d.H.S.); (L.A.); (A.J.T.)
| | - Claudine Anglo
- MIND Institute, University of California Davis Health, 2825 50th Street, Sacramento, CA 95816, USA; (V.N.); (C.A.); (L.d.H.S.); (L.A.); (A.J.T.)
| | - Audra Sterling
- Waisman Center and Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, WI 53706, USA;
| | - Jamie Edgin
- Department of Psychology, University of Arizona, Tucson, AZ 85721, USA;
| | - Stephanie Sherman
- Department of Human Genetics, School of Medicine, Emory University, Atlanta, GA 30322, USA;
| | - Elizabeth Berry-Kravis
- Departments of Pediatrics, Neurological Sciences and Biochemistry, Rush University Medical Center, Chicago, IL 60612, USA;
| | - Laura del Hoyo Soriano
- MIND Institute, University of California Davis Health, 2825 50th Street, Sacramento, CA 95816, USA; (V.N.); (C.A.); (L.d.H.S.); (L.A.); (A.J.T.)
| | - Leonard Abbeduto
- MIND Institute, University of California Davis Health, 2825 50th Street, Sacramento, CA 95816, USA; (V.N.); (C.A.); (L.d.H.S.); (L.A.); (A.J.T.)
- Department of Psychiatry and Behavioral Sciences, University of California, Davis Health, Sacramento, CA 95817, USA
| | - Angela John Thurman
- MIND Institute, University of California Davis Health, 2825 50th Street, Sacramento, CA 95816, USA; (V.N.); (C.A.); (L.d.H.S.); (L.A.); (A.J.T.)
- Department of Psychiatry and Behavioral Sciences, University of California, Davis Health, Sacramento, CA 95817, USA
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20
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Ustinova NV, Namazova-Baranova LS. Role of Pediatrician in Early Risk Evaluation, Diagnosis and Management of Children with Autism Spectrum Disorders. CURRENT PEDIATRICS 2021. [DOI: 10.15690/vsp.v20i2.2255] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The article discusses recent ideas about autism: classification approaches, incidence, etiology and pathogenesis, clinical manifestations and diagnosis, comorbid medical conditions, early detection approaches and medical care for children with autism spectrum disorders. The focus is on the information needed for pediatricians in their practice to provide effective medical care for children with neurodevelopmental disorders.
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Affiliation(s)
- Nataliya V. Ustinova
- Research Institute of Pediatrics and Children's Health in Central Clinical Hospital of the Russian Academy of Sciences; Scientific and Practical Center for Mental Health of Children and Adolescents n.a. G.E. Sukhareva
| | - Leyla S. Namazova-Baranova
- Research Institute of Pediatrics and Children's Health in Central Clinical Hospital of the Russian Academy of Sciences; Pirogov Russian National Research Medical University
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21
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Bradbury KR, Anderberg EI, Huang-Storms L, Vasile I, Greene RK, Duvall SW. Co-occurring Down Syndrome and Autism Spectrum Disorder: Cognitive, Adaptive, and Behavioral Characteristics. J Autism Dev Disord 2021; 52:1235-1246. [PMID: 33905067 DOI: 10.1007/s10803-021-05016-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2021] [Indexed: 11/29/2022]
Abstract
The current study explores functioning in individuals with co-occurring Autism Spectrum Disorder and Down Syndrome (ASD+DS; n = 23), individuals with ASD and cognitive impairment (ASD+ID; n = 99) and individuals with idiopathic ID (n = 38). ANCOVA results revealed that individuals with ASD+DS showed strengths in behavioral functioning compared to individuals with ID and more similar behavioral functioning to those with ASD+ID (η2 = 0.12), with the exception of disruptive behaviors. Cognitive functioning (ɸc = 0.41) and ASD symptomatology (η2 = 0.11) were more comparable for children with ASD+DS and ASD + ID than for individuals with ID. Individuals with ASD+DS had the lowest overall adaptive skills (η2 = 0.11). Findings highlight similarities between ASD+DS and ASD+ID groups, emphasizing the importance of ASD identification within the DS population to provide access to specific interventions.
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Affiliation(s)
- Kathryn R Bradbury
- Division of Pediatric Psychology, Department of Pediatrics, Institute on Development and Disability, Oregon Health & Science University and Doernbecher Children's Hospital, Portland, OR, USA. .,Children's Neuropsychological Services, Andover, MA, USA.
| | - Emily I Anderberg
- Division of Pediatric Psychology, Department of Pediatrics, Institute on Development and Disability, Oregon Health & Science University and Doernbecher Children's Hospital, Portland, OR, USA.,Lurie Center for Autism at Massachusetts General Hospital, Boston, MA, USA
| | - Lark Huang-Storms
- Oregon Center for Children and Youth with Special Health Needs (OCCYSHN), Oregon Health & Science University, Portland, OR, USA.,Center for Integrative Brain Research and Autism Center, Seattle Children's Hospital, Seattle, WA, USA
| | - Iulia Vasile
- Division of Pediatric Psychology, Department of Pediatrics, Institute on Development and Disability, Oregon Health & Science University and Doernbecher Children's Hospital, Portland, OR, USA
| | - Rachel K Greene
- Division of Pediatric Psychology, Department of Pediatrics, Institute on Development and Disability, Oregon Health & Science University and Doernbecher Children's Hospital, Portland, OR, USA
| | - Susanne W Duvall
- Division of Pediatric Psychology, Department of Pediatrics, Institute on Development and Disability, Oregon Health & Science University and Doernbecher Children's Hospital, Portland, OR, USA
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22
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Channell MM, Mattie LJ, Hamilton DR, Capone GT, Mahone EM, Sherman SL, Rosser TC, Reeves RH, Kalb LG. Capturing cognitive and behavioral variability among individuals with Down syndrome: a latent profile analysis. J Neurodev Disord 2021; 13:16. [PMID: 33874886 PMCID: PMC8056665 DOI: 10.1186/s11689-021-09365-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 04/03/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There is a high degree of inter- and intra-individual variability observed within the phenotype of Down syndrome. The Down Syndrome Cognition Project was formed to capture this variability by developing a large nationwide database of cognitive, behavioral, health, and genetic information on individuals with Down syndrome, ages 6-25 years. The current study used the Down Syndrome Cognition Project database to characterize cognitive and behavioral variability among individuals with Down syndrome. METHODS Latent profile analysis was used to identify classes across a sample of 314 participants based on their cognition (IQ and executive functioning), adaptive and maladaptive behavior, and autism spectrum disorder symptomatology. A multivariate multinomial regression model simultaneously examined demographic correlates of class. RESULTS Results supported a 3-class model. Each class demonstrated a unique profile across the subdomains of cognition and behavior. The "normative" class was the largest (n = 153, 48%) and displayed a relatively consistent profile of cognition and adaptive behavior, with low rates of maladaptive behavior and autism symptomatology. The "cognitive" class (n = 109, 35%) displayed low cognitive scores and adaptive behavior and more autism symptomatology, but with low rates of maladaptive behavior. The "behavioral" class, the smallest group (n = 52, 17%), demonstrated higher rates of maladaptive behavior and autism symptomatology, but with cognition levels similar to the "normative" class; their adaptive behavior scores fell in between the other two classes. Household income and sex were the only demographic variables to differ among classes. CONCLUSIONS These findings highlight the importance of subtyping the cognitive and behavioral phenotype among individuals with Down syndrome to identify more homogeneous classes for future intervention and etiologic studies. Results also demonstrate the feasibility of using latent profile analysis to distinguish subtypes in this population. Limitations and future directions are discussed.
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Affiliation(s)
- Marie Moore Channell
- University of Illinois at Urbana-Champaign, 901 S. Sixth St, Champaign, IL, 61820, USA.
| | - Laura J Mattie
- University of Illinois at Urbana-Champaign, 901 S. Sixth St, Champaign, IL, 61820, USA
| | | | - George T Capone
- Kennedy Krieger Institute, 801 N Broadway, Baltimore, MD, 21205, USA
| | - E Mark Mahone
- Kennedy Krieger Institute, 1750 E. Fairmount Ave, Baltimore, MD, 21231, USA
| | | | | | - Roger H Reeves
- Johns Hopkins School of Medicine, 725 N Washington St, Baltimore, MD, 21205, USA
| | - Luther G Kalb
- Kennedy Krieger Institute, Johns Hopkins School of Public Health, 3901 Greenspring Avenue, Baltimore, MD, 21211, USA
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Cook A, Quinn ED, Rowland C. Exploring Expressive Communication Skills in a Cross-Sectional Sample of Individuals With a Dual Diagnosis of Autism Spectrum Disorder and Down Syndrome. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2021; 126:97-113. [PMID: 33651892 PMCID: PMC8552670 DOI: 10.1352/1944-7558-126.2.97] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 03/30/2020] [Indexed: 06/12/2023]
Abstract
Individuals with a comorbid diagnosis of Down syndrome (DS) and autism spectrum disorder (ASD) have been found to exhibit greater deficits in expressive communication than individuals with DS only. We hypothesized that individuals with a comorbid diagnosis (n = 430) would have significantly lower Communication Matrix scores and specifically social communication scores than individuals with DS alone (n = 4,352). In a sample of 4,782 individuals with DS, scores for individuals with a comorbid diagnosis were on average 18.01 points and 7.26 points lower for total score and social score respectively as compared to individuals with DS. Comorbid diagnosis accounted for 10.5% of the variance in communication scores. Between-group differences in referential gestures and symbolic communication behaviors were also observed.
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Affiliation(s)
- Alexandria Cook
- Alexandria Cook, Emily D. Quinn, and Charity Rowland, Oregon Health and Science University, Institute on Development and Disability, Portland
| | - Emily D Quinn
- Alexandria Cook, Emily D. Quinn, and Charity Rowland, Oregon Health and Science University, Institute on Development and Disability, Portland
| | - Charity Rowland
- Alexandria Cook, Emily D. Quinn, and Charity Rowland, Oregon Health and Science University, Institute on Development and Disability, Portland
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24
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Versaci TM, Mattie LJ, Imming LJ. Down Syndrome and Autism Spectrum Disorder Dual Diagnosis: Important Considerations for Speech-Language Pathologists. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:34-46. [PMID: 33316160 DOI: 10.1044/2020_ajslp-20-00050] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose Individuals with Down syndrome (DS) often receive speech-language therapy services starting in infancy or toddlerhood. When providing speech-language therapy services for children with DS, speech-language pathologists (SLPs) need to consider the impact of other developmental and comorbid disorders that can affect language development, such as the presence of a dual diagnosis of DS and autism spectrum disorder (DS + ASD). The prevalence rate of ASD in DS is ~20%, which is higher than in the general population. Method This clinical focus article aims to provide SLPs with additional knowledge about DS + ASD to improve service delivery and support parents' ability to advocate for their child with confirmed or suspected DS + ASD. This is accomplished by summarizing the current evidence base on the presence of ASD in DS and discussing implications of a DS + ASD diagnosis for clinical practice with SLPs. Conclusions SLPs play a key role in supporting families of those with DS + ASD by advocating and educating. By understanding the unique profiles of strengths and weaknesses of individuals with DS + ASD, SLPs can provide appropriate service delivery (i.e., treatment and intervention approaches) and advocacy for their clients and their families.
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Affiliation(s)
- Theresa M Versaci
- Department of Speech & Hearing Science, University of Illinois at Urbana-Champaign, Champaign
| | - Laura J Mattie
- Department of Speech & Hearing Science, University of Illinois at Urbana-Champaign, Champaign
| | - Laura J Imming
- Department of Speech & Hearing Science, University of Illinois at Urbana-Champaign, Champaign
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25
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Sarovic D. A Unifying Theory for Autism: The Pathogenetic Triad as a Theoretical Framework. Front Psychiatry 2021; 12:767075. [PMID: 34867553 PMCID: PMC8637925 DOI: 10.3389/fpsyt.2021.767075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 10/27/2021] [Indexed: 12/27/2022] Open
Abstract
This paper presents a unifying theory for autism by applying the framework of a pathogenetic triad to the scientific literature. It proposes a deconstruction of autism into three contributing features (an autistic personality dimension, cognitive compensation, and neuropathological risk factors), and delineates how they interact to cause a maladaptive behavioral phenotype that may require a clinical diagnosis. The autistic personality represents a common core condition, which induces a set of behavioral issues when pronounced. These issues are compensated for by cognitive mechanisms, allowing the individual to remain adaptive and functional. Risk factors, both exogenous and endogenous ones, show pathophysiological convergence through their negative effects on neurodevelopment. This secondarily affects cognitive compensation, which disinhibits a maladaptive behavioral phenotype. The triad is operationalized and methods for quantification are presented. With respect to the breadth of findings in the literature that it can incorporate, it is the most comprehensive model yet for autism. Its main implications are that (1) it presents the broader autism phenotype as a non-pathological core personality domain, which is shared across the population and uncoupled from associated features such as low cognitive ability and immune dysfunction, (2) it proposes that common genetic variants underly the personality domain, and that rare variants act as risk factors through negative effects on neurodevelopment, (3) it outlines a common pathophysiological mechanism, through inhibition of neurodevelopment and cognitive dysfunction, by which a wide range of endogenous and exogenous risk factors lead to autism, and (4) it suggests that contributing risk factors, and findings of immune and autonomic dysfunction are clinically ascertained rather than part of the core autism construct.
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Affiliation(s)
- Darko Sarovic
- Gillberg Neuropsychiatry Centre, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden.,MedTech West, Gothenburg, Sweden
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26
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Abnormalities of synaptic mitochondria in autism spectrum disorder and related neurodevelopmental disorders. J Mol Med (Berl) 2020; 99:161-178. [PMID: 33340060 PMCID: PMC7819932 DOI: 10.1007/s00109-020-02018-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 11/27/2020] [Accepted: 12/02/2020] [Indexed: 12/18/2022]
Abstract
Autism spectrum disorder (ASD) is a neurodevelopmental condition primarily characterized by an impairment of social interaction combined with the occurrence of repetitive behaviors. ASD starts in childhood and prevails across the lifespan. The variability of its clinical presentation renders early diagnosis difficult. Mutations in synaptic genes and alterations of mitochondrial functions are considered important underlying pathogenic factors, but it is obvious that we are far from a comprehensive understanding of ASD pathophysiology. At the synapse, mitochondria perform diverse functions, which are clearly not limited to their classical role as energy providers. Here, we review the current knowledge about mitochondria at the synapse and summarize the mitochondrial disturbances found in mouse models of ASD and other ASD-related neurodevelopmental disorders, like DiGeorge syndrome, Rett syndrome, Tuberous sclerosis complex, and Down syndrome.
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27
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Santoro JD, Pagarkar D, Chu DT, Rosso M, Paulsen KC, Levitt P, Rafii MS. Neurologic complications of Down syndrome: a systematic review. J Neurol 2020; 268:4495-4509. [PMID: 32920658 DOI: 10.1007/s00415-020-10179-w] [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] [Received: 08/11/2020] [Revised: 08/17/2020] [Accepted: 08/19/2020] [Indexed: 12/18/2022]
Abstract
Down syndrome (DS) is one of the most well-recognized genetic disorders. Persons with DS are known to have a variety of co-morbid medical problems, affecting nearly all organ systems. Improved healthcare interventions and research have allowed for increased life span of persons with DS, although disorders of the neurologic system remain underexplored. The purpose of this systematic review is to provide clinically pertinent information on the neurological phenotypes of frequently occurring or clinically relevant conditions. A retrospective review of MEDLINE, Scopus, and Pubmed were used to identify sources among seventeen, clinically relevant, search categories. MeSH terms all contained the phrase "Down Syndrome" in conjunction with the topic of interest. 'Frequently-occurring' was defined as prevalent in more than 10% of persons with DS across their lifespan, whereas 'clinically-relevant' was defined as a disease condition where early diagnosis or intervention can augment the disease course. In total, 4896 sources were identified with 159 sources meeting criteria for inclusion. Seventeen clinical conditions were grouped under the following subjects: hypotonia, intellectual and learning disability, cervical instability, autism spectrum disorder, epilepsy, cerebrovascular disease, Alzheimer's disease and neuropsychiatric disease. The results of this review provide a blueprint for the clinical neurologist taking care of persons with DS across the age spectrum and indicate that there are many underrecognized and misdiagnosed co-occurring conditions in DS, highlighting the need for further research.
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Affiliation(s)
- Jonathan D Santoro
- Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA. .,Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| | - Dania Pagarkar
- Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA
| | - Duong T Chu
- Faculty of Medicine, Queen's University, Kingston, ON, Canada
| | - Mattia Rosso
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA
| | - Kelli C Paulsen
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, USA.,Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Pat Levitt
- Department of Pediatrics and Program in Developmental Neuroscience and Developmental Neurogenetics, The Saban Research Institute, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Michael S Rafii
- Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA.,Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Alzheimer's Therapeutic Research Institute (ATRI), Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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28
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Glennon JM, D'Souza H, Mason L, Karmiloff-Smith A, Thomas MSC. Visuo-attentional correlates of Autism Spectrum Disorder (ASD) in children with Down syndrome: A comparative study with children with idiopathic ASD. RESEARCH IN DEVELOPMENTAL DISABILITIES 2020; 104:103678. [PMID: 32505966 PMCID: PMC7429984 DOI: 10.1016/j.ridd.2020.103678] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 04/25/2020] [Accepted: 04/27/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Children with Down syndrome (DS) are at increased likelihood of Autism Spectrum Disorder (ASD) relative to the general population. To better understand the nature of this comorbidity, we examined the visuo-attentional processes associated with autistic trait expression in children with DS, focusing specifically on attentional disengagement and visual search performance. METHOD We collected eye-tracking data from children with DS (n = 15) and children with idiopathic ASD (iASD, n = 16) matched according to chronological age. Seven children with DS had a formal clinical diagnosis of ASD (DS+ASD). RESULTS In children with iASD, but not DS, higher autistic trait levels were associated with decreased temporal facilitation on a gap-overlap task, implying increased visuospatial orienting efficiency. In all cases, higher autistic trait levels were associated with improved visual search performance according to decreased target detection latency. On a visual search task, children with DS+ASD outperformed their peers with DS-ASD, mirroring the phenotypic advantage associated with iASD. We found no evidence of a relationship between attentional disengagement and visual search performance, providing preliminary evidence of a differentiation in terms of underlying visuo-attentional mechanism. CONCLUSION We illustrate the value of progressing beyond insensitive behavioural measures of phenotypic description to examine, in a more fine-grained way, the attentional features associated with ASD comorbidity in children with DS.
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Affiliation(s)
- Jennifer M Glennon
- Centre for Brain and Cognitive Development, Department of Psychological Sciences, Birkbeck College, University of London, United Kingdom.
| | - Hana D'Souza
- Centre for Brain and Cognitive Development, Department of Psychological Sciences, Birkbeck College, University of London, United Kingdom; Department of Psychology & Newnham College, University of Cambridge, United Kingdom
| | - Luke Mason
- Centre for Brain and Cognitive Development, Department of Psychological Sciences, Birkbeck College, University of London, United Kingdom
| | - Annette Karmiloff-Smith
- Centre for Brain and Cognitive Development, Department of Psychological Sciences, Birkbeck College, University of London, United Kingdom
| | - Michael S C Thomas
- Centre for Brain and Cognitive Development, Department of Psychological Sciences, Birkbeck College, University of London, United Kingdom
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Abstract
OBJECTIVE The prevalence of comorbid autism spectrum disorder (ASD) in children with Down syndrome (DS) is estimated to be around 16%. This study aims to fill gaps in the literature by describing developmental and behavioral phenotypes in this group relative to those with DS or ASD in isolation. METHODS Participants included 173 children (Mage = 73 months) with ASD, DS, or DS + ASD. Two 3 × 2 repeated-measures analyses of variance were completed with between-subject factors of the diagnostic group (DS, ASD, and DS + ASD) and within-subject factors of cognitive performance (verbal and nonverbal developmental quotient [DQ]) or ASD symptoms (social affect [SA] and restricted and repetitive behaviors [RRBs]). RESULTS Significant group-by-scale interactions were found, and pairwise comparisons revealed that for verbal DQ, DS + ASD < DS, ASD, whereas for nonverbal DQ, DS + ASD < DS < ASD. For SA, DS < DS + ASD < ASD, whereas for RRB, DS, DS + ASD < ASD. CONCLUSION Findings suggest greater cognitive impairment in DS + ASD on both verbal and nonverbal measures. Despite these significant cognitive challenges, ASD symptoms appeared less severe in DS + ASD relative to peers with ASD in isolation, although SA symptoms were elevated over DS-only. This unique DS + ASD presentation has important implications for early identification and intervention. Given previous research suggesting relative social strengths in DS and less severe ASD symptoms documented in this study, future research may benefit from investigating different aspects of SA (i.e., components related to reciprocal social interaction vs. social communication) in those with DS + ASD to more clearly delineate the social phenotype in this group and potentially inform intervention efforts.
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30
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Casanova MF, Casanova EL, Frye RE, Baeza-Velasco C, LaSalle JM, Hagerman RJ, Scherer SW, Natowicz MR. Editorial: Secondary vs. Idiopathic Autism. Front Psychiatry 2020; 11:297. [PMID: 32346372 PMCID: PMC7171716 DOI: 10.3389/fpsyt.2020.00297] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 03/25/2020] [Indexed: 01/04/2023] Open
Affiliation(s)
- Manuel F Casanova
- School of Medicine Greenville, University of South Carolina, Greenville, SC, United States
| | - Emily L Casanova
- School of Medicine Greenville, University of South Carolina, Greenville, SC, United States
| | | | | | | | - Randi Jensen Hagerman
- Department of Pediatrics, UC Davis School of Medicine, Sacramento, CA, United States
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31
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Channell MM. The Social Responsiveness Scale (SRS-2) in school-age children with Down syndrome at low risk for autism spectrum disorder. AUTISM & DEVELOPMENTAL LANGUAGE IMPAIRMENTS 2020; 5:2396941520962406. [PMID: 34179506 PMCID: PMC8232392 DOI: 10.1177/2396941520962406] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
BACKGROUND AND AIMS Little is known about how autism spectrum disorder (ASD) symptoms present in individuals with Down syndrome (DS). Some behaviors may be symptomatic of comorbid ASD or more broadly representative of the DS phenotype. A prior research study documented elevated ASD-like symptoms in adolescents and young adults with DS without comorbid ASD, using a common ASD risk screening tool-the Social Responsiveness Scale (SRS). The current study applied a similar approach to younger children with DS using the SRS-2. The primary aim was to document patterns of ASD-like symptoms in children with DS at low risk of comorbid ASD to distinguish the symptoms that may be present across DS in general. METHODS SRS-2 standard scores were analyzed in a sample of 40 children with DS, 6-11 years old, who were considered to be at low risk for ASD based on the Social Communication Questionnaire (SCQ) screener. Other developmental characteristics (i.e., age, nonverbal IQ, expressive language), social skills, and problem behaviors were also examined across the sample. RESULTS SRS-2 scores were significantly elevated in this sample compared to the normative population sample. A pattern of ASD-like symptomatology was observed across SRS-2 subdomains. These findings were similar to the findings of the prior study. However, nuanced differences were observed across the two samples that may represent developmental differences across different ages in this population. CONCLUSIONS Replicating and extending a prior study's findings, certain ASD-like behaviors may occur in individuals with DS who are at low risk for comorbid ASD. IMPLICATIONS Understanding the pattern of ASD-like behaviors that occur in children with DS who are at low risk for comorbid ASD will help clinicians in screening and identification efforts. In particular, it will lead to better specification of the behaviors or symptoms that are not characteristic of the DS phenotype and thus are red flags for comorbid ASD in this population.
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Affiliation(s)
- Marie Moore Channell
- Marie Moore Channell, Department of Speech
and Hearing Science, University of Illinois at Urbana-Champaign, 901 S. Sixth
Street, Champaign, IL 61820, USA.
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32
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Frye RE, Vassall S, Kaur G, Lewis C, Karim M, Rossignol D. Emerging biomarkers in autism spectrum disorder: a systematic review. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:792. [PMID: 32042808 DOI: 10.21037/atm.2019.11.53] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Autism spectrum disorder (ASD) affects approximately 2% of children in the United States (US) yet its etiology is unclear and effective treatments are lacking. Therapeutic interventions are most effective if started early in life, yet diagnosis often remains delayed, partly because the diagnosis of ASD is based on identifying abnormal behaviors that may not emerge until the disorder is well established. Biomarkers that identify children at risk during the pre-symptomatic period, assist with early diagnosis, confirm behavioral observations, stratify patients into subgroups, and predict therapeutic response would be a great advance. Here we underwent a systematic review of the literature on ASD to identify promising biomarkers and rated the biomarkers in regards to a Level of Evidence and Grade of Recommendation using the Oxford Centre for Evidence-Based Medicine scale. Biomarkers identified by our review included physiological biomarkers that identify neuroimmune and metabolic abnormalities, neurological biomarkers including abnormalities in brain structure, function and neurophysiology, subtle behavioral biomarkers including atypical development of visual attention, genetic biomarkers and gastrointestinal biomarkers. Biomarkers of ASD may be found prior to birth and after diagnosis and some may predict response to specific treatments. Many promising biomarkers have been developed for ASD. However, many biomarkers are preliminary and need to be validated and their role in the diagnosis and treatment of ASD needs to be defined. It is likely that biomarkers will need to be combined to be effective to identify ASD early and guide treatment.
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Affiliation(s)
- Richard E Frye
- Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, USA.,Deparment of Child Health, University of Arizona College of Medicine, Phoenix, AZ, USA
| | - Sarah Vassall
- Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Gurjot Kaur
- Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Christina Lewis
- Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Mohammand Karim
- Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, USA.,Deparment of Child Health, University of Arizona College of Medicine, Phoenix, AZ, USA
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Wester Oxelgren U, Åberg M, Myrelid Å, Annerén G, Westerlund J, Gustafsson J, Fernell E. Autism needs to be considered in children with Down Syndrome. Acta Paediatr 2019; 108:2019-2026. [PMID: 31090964 DOI: 10.1111/apa.14850] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 05/08/2019] [Accepted: 05/13/2019] [Indexed: 02/01/2023]
Abstract
AIM To analyse levels and profiles of autism symptoms in children with Down Syndrome (DS) with and without diagnosed autism spectrum disorder (ASD) and to specifically study the groups with severe Intellectual Disability (ID). METHODS From a population-based cohort of 60 children with DS (age 5-17 years) with 41 participating children, scores obtained from the Autism Diagnostic Observation Schedule (ADOS) Module-1 algorithm were compared between those with and without diagnosed ASD. Children with DS and ASD were also compared to a cohort of children with idiopathic ASD, presented in the ADOS manual. RESULTS Children with DS and ASD had significantly higher ADOS scores in all domains compared to those without ASD. When the groups with DS, with and without ASD, were restricted to those with severe ID, the difference remained. When the children with DS and ASD and the idiopathic autism group were compared, the ADOS profiles were similar. CONCLUSION A considerable proportion of children with DS has ASD, but there is also a group of children with DS and severe ID without autism. There is a need to increase awareness of the high prevalence of autism in children with DS to ensure that appropriate measures and care are provided.
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Affiliation(s)
| | - Marie Åberg
- Department of Health and Habilitation Kungsgärdet Center Uppsala Sweden
| | - Åsa Myrelid
- Department of Women’s and Children´s Health Uppsala University Uppsala Sweden
| | - Göran Annerén
- Department of Immunology, Genetics, and Pathology, Science for Life Laboratory Uppsala University Uppsala Sweden
| | - Joakim Westerlund
- Department of Psychology Stockholm University Stockholm Sweden
- Gillberg Neuropsychiatry Centre, Department of Neuroscience and Physiology Gothenburg University Gothenburg Sweden
| | - Jan Gustafsson
- Department of Women’s and Children´s Health Uppsala University Uppsala Sweden
| | - Elisabeth Fernell
- Gillberg Neuropsychiatry Centre, Department of Neuroscience and Physiology Gothenburg University Gothenburg Sweden
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Watkins A, Bissell S, Moss J, Oliver C, Clayton-Smith J, Haye L, Heald M, Welham A. Behavioural and psychological characteristics in Pitt-Hopkins syndrome: a comparison with Angelman and Cornelia de Lange syndromes. J Neurodev Disord 2019; 11:24. [PMID: 31586495 PMCID: PMC6778364 DOI: 10.1186/s11689-019-9282-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Accepted: 08/28/2019] [Indexed: 12/23/2022] Open
Abstract
Background Pitt-Hopkins syndrome (PTHS) is a genetic neurodevelopmental disorder associated with intellectual disability. Although the genetic mechanisms underlying the disorder have been identified, description of its behavioural phenotype is in its infancy. In this study, reported behavioural and psychological characteristics of individuals with PTHS were investigated in comparison with the reported behaviour of age-matched individuals with Angelman syndrome (AS) and Cornelia de Lange syndrome (CdLS). Methods Questionnaire data were collected from parents/caregivers of individuals with PTHS (n = 24), assessing behaviours associated with autism spectrum disorder (ASD), sociability, mood, repetitive behaviour, sensory processing, challenging behaviours and overactivity and impulsivity. For most measures, data were compared to data for people with AS (n = 24) and CdLS (n = 24) individually matched by adaptive ability, age and sex. Results Individuals with PTHS evidenced significantly higher levels of difficulties with social communication and reciprocal social interaction than individuals with AS, with 21 of 22 participants with PTHS meeting criteria indicative of ASD on a screening instrument. Individuals with PTHS were reported to be less sociable with familiar and unfamiliar people than individuals with AS, but more sociable with unfamiliar people than individuals with CdLS. Data also suggested areas of atypicality in sensory experiences. Challenging behaviours were reported frequently in PTHS, with self-injury (70.8%) occurring at significantly higher rates than in AS (41.7%) and aggression (54.2%) occurring at significantly higher rates than in CdLS (25%). Individuals with PTHS also evidenced lower reported mood than individuals with AS. Conclusions Behaviours which may be characteristic of PTHS include those associated with ASD, including deficits in social communication and reciprocal social interaction. High rates of aggression and self-injurious behaviour compared to other genetic syndrome groups are of potential clinical significance and warrant further investigation. An atypical sensory profile may also be evident in PTHS. The specific aetiology of and relationships between different behavioural and psychological atypicalities in PTHS, and effective clinical management of these, present potential topics for future research.
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Affiliation(s)
- Alice Watkins
- Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Birmingham, UK. .,Great Ormond Street Institute of Child Health, University College London, London, UK.
| | - Stacey Bissell
- Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Birmingham, UK
| | - Jo Moss
- Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Birmingham, UK.,Institute of Cognitive Neuroscience, University College London, London, UK
| | - Chris Oliver
- Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Birmingham, UK
| | - Jill Clayton-Smith
- Division of Evolution & Genomic Sciences, St Mary's Hospital, Manchester, UK
| | - Lorraine Haye
- Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Birmingham, UK
| | - Mary Heald
- Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Birmingham, UK
| | - Alice Welham
- Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Birmingham, UK.,Department of Psychology, University of Leicester, Leicester, UK
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Miles JH, Takahashi N, Muckerman J, Nowell KP, Ithman M. Catatonia in Down syndrome: systematic approach to diagnosis, treatment and outcome assessment based on a case series of seven patients. Neuropsychiatr Dis Treat 2019; 15:2723-2741. [PMID: 31571888 PMCID: PMC6759875 DOI: 10.2147/ndt.s210613] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 07/31/2019] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE The goal is to expand our knowledge of catatonia occurring in adolescents and young adults with Down syndrome (DS) by describing the first prospective, consecutive, well-characterized cohort of seven young people with DS diagnosed with catatonia and treated between 2013 and 2018, and to assess each patient's treatment responses. Longitudinal assessment of each patient's response to treatment is intended to provide clinicians and psychiatrists a firm foundation from which assess treatment efficacy. STUDY DESIGN Young adults with Down syndrome were consecutively enrolled in the study as they were diagnosed with catatonia. A comprehensive data set included medical, laboratory, developmental, demographic, family, social and genetic data, including query into disorders for which individuals with DS are at risk. Catatonia was diagnosed based on an unequivocal history of regression, positive Bush-Francis Catatonia Rating Scale and positive response to intravenous lorazepam. Patients' longitudinal progress was monitored using the Catatonia Impact Scale (CIS) developed for this purpose. RESULTS Seven consecutive DS patients, who presented with unequivocal regression were diagnosed with catatonia and treated for 2.7-6 years using standard-of-care therapies; primarily GABA agonist, lorazepam, electroconvulsive therapy (ECT) and glutamate antagonists (dextromethorphan/quinidine, memantine, minocycline). Responses to each treatment modality were assessed at clinic visits and through weekly electronic CIS reports. CONCLUSION Seven young adults with DS were diagnosed with catatonia; all responded to Lorazepam and/or ECT therapy with good to very good results. Though ECT most dramatically returned patients to baseline, symptoms often returned requiring additional ECT. Dextromethorphan/quinidine, not used until mid-2017, appeared to reduce the reoccurrence of symptoms following ECT. Though all seven patients improved significantly, each continues to require some form of treatment to maintain a good level of functioning. Findings of a significant number of autoimmune disorders and laboratory markers of immune activation in this population may guide new diagnostic and treatment opportunities.
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Affiliation(s)
- Judith H Miles
- Department of Child Health, University of Missouri Healthcare, Columbia, MO, USA
- Thompson Center for Autism and Neurodevelopmental Disorders, University of Missouri, Columbia, MO, USA
| | - Nicole Takahashi
- Thompson Center for Autism and Neurodevelopmental Disorders, University of Missouri, Columbia, MO, USA
| | - Julie Muckerman
- Thompson Center for Autism and Neurodevelopmental Disorders, University of Missouri, Columbia, MO, USA
| | - Kerri P Nowell
- Thompson Center for Autism and Neurodevelopmental Disorders, University of Missouri, Columbia, MO, USA
- Department of Health Psychology, University of Missouri Healthcare, Columbia, MO, USA
| | - Muaid Ithman
- Department of Psychiatry, University of Missouri Health Care, Columbia, MO, USA
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36
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Baburamani AA, Patkee PA, Arichi T, Rutherford MA. New approaches to studying early brain development in Down syndrome. Dev Med Child Neurol 2019; 61:867-879. [PMID: 31102269 PMCID: PMC6618001 DOI: 10.1111/dmcn.14260] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/28/2019] [Indexed: 12/19/2022]
Abstract
Down syndrome is the most common genetic developmental disorder in humans and is caused by partial or complete triplication of human chromosome 21 (trisomy 21). It is a complex condition which results in multiple lifelong health problems, including varying degrees of intellectual disability and delays in speech, memory, and learning. As both length and quality of life are improving for individuals with Down syndrome, attention is now being directed to understanding and potentially treating the associated cognitive difficulties and their underlying biological substrates. These have included imaging and postmortem studies which have identified decreased regional brain volumes and histological anomalies that accompany early onset dementia. In addition, advances in genome-wide analysis and Down syndrome mouse models are providing valuable insight into potential targets for intervention that could improve neurogenesis and long-term cognition. As little is known about early brain development in human Down syndrome, we review recent advances in magnetic resonance imaging that allow non-invasive visualization of brain macro- and microstructure, even in utero. It is hoped that together these advances may enable Down syndrome to become one of the first genetic disorders to be targeted by antenatal treatments designed to 'normalize' brain development. WHAT THIS PAPER ADDS: Magnetic resonance imaging can provide non-invasive characterization of early brain development in Down syndrome. Down syndrome mouse models enable study of underlying pathology and potential intervention strategies. Potential therapies could modify brain structure and improve early cognitive levels. Down syndrome may be the first genetic disorder to have targeted therapies which alter antenatal brain development.
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Affiliation(s)
- Ana A Baburamani
- Centre for the Developing BrainDepartment of Perinatal Imaging and HealthSchool of Biomedical Engineering & Imaging SciencesKing's College LondonKing's Health PartnersSt Thomas’ HospitalLondonUK
| | - Prachi A Patkee
- Centre for the Developing BrainDepartment of Perinatal Imaging and HealthSchool of Biomedical Engineering & Imaging SciencesKing's College LondonKing's Health PartnersSt Thomas’ HospitalLondonUK
| | - Tomoki Arichi
- Centre for the Developing BrainDepartment of Perinatal Imaging and HealthSchool of Biomedical Engineering & Imaging SciencesKing's College LondonKing's Health PartnersSt Thomas’ HospitalLondonUK,Department of BioengineeringImperial College LondonLondonUK,Children's NeurosciencesEvelina London Children's HospitalLondonUK
| | - Mary A Rutherford
- Centre for the Developing BrainDepartment of Perinatal Imaging and HealthSchool of Biomedical Engineering & Imaging SciencesKing's College LondonKing's Health PartnersSt Thomas’ HospitalLondonUK
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37
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Dekker AD, Sacco S, Carfi A, Benejam B, Vermeiren Y, Beugelsdijk G, Schippers M, Hassefras L, Eleveld J, Grefelman S, Fopma R, Bomer-Veenboer M, Boti M, Oosterling GDE, Scholten E, Tollenaere M, Checkley L, Strydom A, Van Goethem G, Onder G, Blesa R, Zu Eulenburg C, Coppus AMW, Rebillat AS, Fortea J, De Deyn PP. The Behavioral and Psychological Symptoms of Dementia in Down Syndrome (BPSD-DS) Scale: Comprehensive Assessment of Psychopathology in Down Syndrome. J Alzheimers Dis 2019; 63:797-819. [PMID: 29689719 PMCID: PMC5929348 DOI: 10.3233/jad-170920] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
People with Down syndrome (DS) are prone to develop Alzheimer’s disease (AD). Behavioral and psychological symptoms of dementia (BPSD) are core features, but have not been comprehensively evaluated in DS. In a European multidisciplinary study, the novel Behavioral and Psychological Symptoms of Dementia in Down Syndrome (BPSD-DS) scale was developed to identify frequency and severity of behavioral changes taking account of life-long characteristic behavior. 83 behavioral items in 12 clinically defined sections were evaluated. The central aim was to identify items that change in relation to the dementia status, and thus may differentiate between diagnostic groups. Structured interviews were conducted with informants of persons with DS without dementia (DS, n = 149), with questionable dementia (DS+Q, n = 65), and with diagnosed dementia (DS+AD, n = 67). First exploratory data suggest promising interrater, test-retest, and internal consistency reliability measures. Concerning item relevance, group comparisons revealed pronounced increases in frequency and severity in items of anxiety, sleep disturbances, agitation & stereotypical behavior, aggression, apathy, depressive symptoms, and eating/drinking behavior. The proportion of individuals presenting an increase was highest in DS+AD, intermediate in DS+Q, and lowest in DS. Interestingly, among DS+Q individuals, a substantial proportion already presented increased anxiety, sleep disturbances, apathy, and depressive symptoms, suggesting that these changes occur early in the course of AD. Future efforts should optimize the scale based on current results and clinical experiences, and further study applicability, reliability, and validity. Future application of the scale in daily care may aid caregivers to understand changes, and contribute to timely interventions and adaptation of caregiving.
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Affiliation(s)
- Alain D Dekker
- Department of Neurology and Alzheimer Research Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Laboratory of Neurochemistry and Behaviour, Institute Born-Bunge, University of Antwerp, Wilrijk, Belgium
| | | | - Angelo Carfi
- Department of Geriatrics, Policlinico Gemelli, Universitá Cattolica del Sacro Cuore, Rome, Italy
| | - Bessy Benejam
- Down Medical Center, Catalan Down Syndrome Foundation, Barcelona, Spain
| | - Yannick Vermeiren
- Department of Neurology and Alzheimer Research Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Laboratory of Neurochemistry and Behaviour, Institute Born-Bunge, University of Antwerp, Wilrijk, Belgium
| | - Gonny Beugelsdijk
- Ipse de Bruggen, Center for Intellectual Disabilities, Nieuwveen/Zwammerdam, The Netherlands
| | - Mieke Schippers
- Ipse de Bruggen, Center for Intellectual Disabilities, Nieuwveen/Zwammerdam, The Netherlands
| | - Lyanne Hassefras
- Ipse de Bruggen, Center for Intellectual Disabilities, Nieuwveen/Zwammerdam, The Netherlands
| | - José Eleveld
- Cosis, Center for Intellectual Disabilities, Groningen, The Netherlands
| | - Sharina Grefelman
- Cosis, Center for Intellectual Disabilities, Groningen, The Netherlands
| | - Roelie Fopma
- Talant, Center for Intellectual Disabilities, Heerenveen, The Netherlands
| | | | - Mariángeles Boti
- Down Medical Center, Catalan Down Syndrome Foundation, Barcelona, Spain
| | | | - Esther Scholten
- Elver, Center for Intellectual Disabilities, Nieuw-Wehl, The Netherlands
| | - Marleen Tollenaere
- Laboratory of Neurochemistry and Behaviour, Institute Born-Bunge, University of Antwerp, Wilrijk, Belgium.,Department of Neurology and Memory Clinic, Hospital Network Antwerp (ZNA) Middelheim and Hoge Beuken, Antwerp, Belgium
| | - Laura Checkley
- Division of Psychiatry, University College London, London, UK
| | - André Strydom
- Division of Psychiatry, University College London, London, UK
| | - Gert Van Goethem
- Het GielsBos, Center for Intellectual Disabilities, Gierle, Belgium.,Department of Neurology, University Hospital Antwerp, Antwerp, Belgium
| | - Graziano Onder
- Department of Geriatrics, Policlinico Gemelli, Universitá Cattolica del Sacro Cuore, Rome, Italy
| | - Rafael Blesa
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Christine Zu Eulenburg
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Antonia M W Coppus
- Dichterbij, Center for Intellectual Disabilities, Gennep, The Netherlands.,Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Juan Fortea
- Down Medical Center, Catalan Down Syndrome Foundation, Barcelona, Spain.,Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Peter P De Deyn
- Department of Neurology and Alzheimer Research Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Laboratory of Neurochemistry and Behaviour, Institute Born-Bunge, University of Antwerp, Wilrijk, Belgium.,Department of Neurology and Memory Clinic, Hospital Network Antwerp (ZNA) Middelheim and Hoge Beuken, Antwerp, Belgium
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38
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Godfrey M, Hepburn S, Fidler DJ, Tapera T, Zhang F, Rosenberg CR, Raitano Lee N. Autism spectrum disorder (ASD) symptom profiles of children with comorbid Down syndrome (DS) and ASD: A comparison with children with DS-only and ASD-only. RESEARCH IN DEVELOPMENTAL DISABILITIES 2019; 89:83-93. [PMID: 30959431 DOI: 10.1016/j.ridd.2019.03.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 02/19/2019] [Accepted: 03/01/2019] [Indexed: 05/23/2023]
Abstract
BACKGROUND Down syndrome (DS) is associated with increased rates of autism spectrum disorder (ASD), characterized by social-communicative impairments (SOC-COM) and repetitive behaviors and interests (RBI). However, little is known about the ASD symptom presentation in children with DS + ASD. AIMS The current study sought to describe parent-report of SOC-COM and RBI symptoms on the Autism Diagnostic Interview -Revised (ADI-R) in children with DS (n = 22), DS + ASD (n = 11), and ASD (n = 66). METHOD SOC-COM and RBI scores from the ADI-R were compared across the groups whose autism status was ascertained using the Autism Diagnostic Observation Schedule. RESULTS Differences in SOC-COM and RBI symptom severity was observed. The general pattern of findings was ASD > DS+ASD > DS. Dissimilar ASD symptom profiles were observed across groups. In ASD, SOC-COM scores were higher than RBI scores; in DS + ASD, similar SOC-COM and RBI scores were observed. Lastly, SOC-COM impairments were highly related to verbal cognition in youth with DS + ASD but not in those with DS or ASD. CONCLUSIONS AND IMPLICATIONS These findings suggest that children with DS + ASD have a distinct profile of ASD symptoms that differs from peers with either disorder in isolation. Thus, care should be taken in evaluating and designing treatments for this group.
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Affiliation(s)
- Mary Godfrey
- Department of Psychology, Drexel University, Philadelphia, PA, United States.
| | - Susan Hepburn
- Department of Human Developmental and Family Studies, Colorado State University, United States
| | - Deborah J Fidler
- Department of Human Developmental and Family Studies, Colorado State University, United States
| | - Tinashe Tapera
- Department of Psychology, Drexel University, Philadelphia, PA, United States
| | - Fengqing Zhang
- Department of Psychology, Drexel University, Philadelphia, PA, United States
| | | | - Nancy Raitano Lee
- Department of Psychology, Drexel University, Philadelphia, PA, United States
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39
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Characteristics Associated with Autism Spectrum Disorder Risk in Individuals with Down Syndrome. J Autism Dev Disord 2019; 49:3543-3556. [DOI: 10.1007/s10803-019-04074-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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40
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Mulder PA, Huisman S, Landlust AM, Moss J, Piening S, Hennekam RC, van Balkom IDC. Development, behaviour and autism in individuals with SMC1A variants. J Child Psychol Psychiatry 2019; 60:305-313. [PMID: 30295920 DOI: 10.1111/jcpp.12979] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/15/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Development and behaviour in Cornelia de Lange Syndrome (CdLS), including autism characteristics, have been described infrequently stratified to genetic cause and only a few studies have considered behavioural characteristics in relation to developmental level. Here, we describe the behavioural phenotype in individuals with CdLS with SMC1A variants. METHODS We performed an international, interdisciplinary study on 51 individuals with SMC1A variants. Results of questionnaire studies are compared to those in individuals with Down Syndrome and with Autism Spectrum Disorder. Results on cognition and self-injurious behaviour (SIB) are compared to those in individuals with CdLS caused by NIPBL variants. For Dutch participants with SMC1A variants we performed direct in-person assessments of cognition, autism, and added an interview and questionnaire on adaptive behaviour and sensory processing. RESULTS Individuals with SMC1A variants show a higher cognitive level and less SIB than individuals with NIPBL variants. Individuals with SMC1A variants without classic CdLS phenotype but with a Rett-like phenotype show more severe intellectual disability and more SIB compared to those with a CdLS phenotype. Autism is less present if outcomes in direct in-person assessments are evaluated taking developmental level into account compared to results based on a questionnaire. CONCLUSIONS Behaviour in individuals with CdLS should be evaluated taking genetic cause into account. Detailed interdisciplinary approaches are of clinical importance to inform tailored care and may eventually improve quality of life of patients and families.
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Affiliation(s)
- Paul A Mulder
- Autism Team Northern-Netherlands, Jonx Department of Youth Mental Health and Autism, Lentis Psychiatric Institute, Groningen, the Netherlands
| | - Sylvia Huisman
- Department of Pediatrics, University of Amsterdam, Amsterdam, the Netherlands.,Prinsenstichting Institute, Purmerend, the Netherlands
| | - Annemiek M Landlust
- Autism Team Northern-Netherlands, Jonx Department of Youth Mental Health and Autism, Lentis Psychiatric Institute, Groningen, the Netherlands
| | - Jo Moss
- Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Birmingham, UK.,Institute of Cognitive Neuroscience, University College London, London, UK
| | | | - Sigrid Piening
- Autism Team Northern-Netherlands, Jonx Department of Youth Mental Health and Autism, Lentis Psychiatric Institute, Groningen, the Netherlands
| | - Raoul C Hennekam
- Autism Team Northern-Netherlands, Jonx Department of Youth Mental Health and Autism, Lentis Psychiatric Institute, Groningen, the Netherlands.,Department of Pediatrics, University of Amsterdam, Amsterdam, the Netherlands
| | - Ingrid D C van Balkom
- Autism Team Northern-Netherlands, Jonx Department of Youth Mental Health and Autism, Lentis Psychiatric Institute, Groningen, the Netherlands
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41
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Salehi P, Herzig L, Capone G, Lu A, Oron AP, Kim SJ. Comparison of Aberrant Behavior Checklist profiles across Prader-Willi syndrome, Down syndrome, and autism spectrum disorder. Am J Med Genet A 2018; 176:2751-2759. [DOI: 10.1002/ajmg.a.40665] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 03/12/2018] [Accepted: 09/04/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Parisa Salehi
- Seattle Children's Hospital, Division of Endocrine; University of Washington; Seattle Washington
| | - Lisa Herzig
- Seattle Children's Hospital, Division of Developmental Medicine; University of Washington; Seattle Washington
| | - George Capone
- Kennedy Krieger Institute, Johns Hopkins University School of Medicine; Baltimore Maryland
| | - Amanda Lu
- Seattle Children's Hospital; University of Washington; Seattle Washington
| | - Assaf P. Oron
- Epidemiology Section; Institute for Disease Modeling; Bellevue Washington
| | - Soo-Jeong Kim
- Seattle Children's Hospital, Division of Psychiatry; University of Washington; Seattle Washington
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42
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Del Hoyo Soriano L, Thurman AJ, Abbeduto L. Specificity: A Phenotypic Comparison of Communication-Relevant Domains Between Youth With Down Syndrome and Fragile X Syndrome. Front Genet 2018; 9:424. [PMID: 30327664 PMCID: PMC6174242 DOI: 10.3389/fgene.2018.00424] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 09/10/2018] [Indexed: 01/25/2023] Open
Abstract
Despite the shared presence of an intellectual disability (ID), there is a growing literature documenting important phenotypic differences between Down syndrome (DS) and fragile X syndrome (FXS). These conclusions, however, are based on a synthesis across studies, each of which typically includes only measures of a limited number of constructs, and with differing participant characteristics. Firmer conclusions regarding specific phenotypes require a single comprehensive multi-domain assessment of participants with the syndrome groups being well matched on chronological age (CA) and cognitive functioning. The current study was designed to fill this gap by assessing several important cognitive and behavioral domains relevant to communication, such as: structural language skills, false belief understanding, as well as pragmatics and behavioral difficulties, in 30 adolescents of both sexes with DS and 39 males with FXS, matched on CA and nonverbal (NV) cognition. After statistically controlling for NV cognition, we did not find significant syndrome differences in expressive and receptive structural language or false belief understanding. In contrast, participants with DS displayed less stereotyped language and fewer behavioral difficulties compared to males with FXS. Within-syndrome associations among the targeted domains are described. Finally, females with DS were less impaired than males with DS in almost all structural language domains, whereas no significant sex-related differences were observed in NV cognition, false belief understanding, pragmatics, or behavior. Clinical and methodological implications of the findings are discussed.
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Affiliation(s)
- Laura Del Hoyo Soriano
- MIND Institute, University of California, Davis, Sacramento, CA, United States.,Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA, United States
| | - Angela John Thurman
- MIND Institute, University of California, Davis, Sacramento, CA, United States.,Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA, United States
| | - Leonard Abbeduto
- MIND Institute, University of California, Davis, Sacramento, CA, United States.,Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA, United States
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43
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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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44
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Soke GN, Rosenberg SA, Rosenberg CR, Vasa RA, Lee LC, DiGuiseppi C. Brief Report: Self-Injurious Behaviors in Preschool Children with Autism Spectrum Disorder Compared to Other Developmental Delays and Disorders. J Autism Dev Disord 2018; 48:2558-2566. [PMID: 29429009 PMCID: PMC5997504 DOI: 10.1007/s10803-018-3490-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
We compared the prevalence of self-injurious behaviors (SIB) in preschoolers aged 30-68 months with autism spectrum disorder (ASD) (n = 691) versus other developmental delays and disorders (DD) (n = 977) accounting for sociodemographic, cognitive, and medical factors. SIB prevalence was higher in ASD versus all DD [adjusted odds-ratio (aOR) 2.13 (95% confidence interval (95% CI) 1.53, 2.97)]. In subgroup analyses, SIB prevalence was higher in ASD versus DD without ASD symptoms [aOR 4.42 (95% CI 2.66, 7.33)], but was similar between ASD and DD with ASD symptoms [aOR 1.09 (95% CI 0.68, 1.77)]. We confirmed higher prevalence of SIB in ASD versus DD, independent of confounders. In children with DD, SIB prevalence increased with more ASD symptoms. These findings are informative to clinicians, researchers, and policymakers.
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Affiliation(s)
- G N Soke
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA.
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS E-86, Atlanta, GA, 30341, USA.
| | - S A Rosenberg
- Department of Psychiatry, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - C R Rosenberg
- Department of Psychiatry, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
- Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - R A Vasa
- School of Medicine, Kennedy Krieger Institute, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - L-C Lee
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - C DiGuiseppi
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
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The Effects of a Peer-Delivered Social Skills Intervention for Adults with Comorbid Down Syndrome and Autism Spectrum Disorder. J Autism Dev Disord 2017; 48:1869-1885. [DOI: 10.1007/s10803-017-3437-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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46
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Syndromic Autism: Progressing Beyond Current Levels of Description. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2017. [DOI: 10.1007/s40489-017-0116-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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47
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Oxelgren UW, Myrelid Å, Annerén G, Ekstam B, Göransson C, Holmbom A, Isaksson A, Åberg M, Gustafsson J, Fernell E. Prevalence of autism and attention-deficit-hyperactivity disorder in Down syndrome: a population-based study. Dev Med Child Neurol 2017; 59:276-283. [PMID: 27503703 DOI: 10.1111/dmcn.13217] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/17/2016] [Indexed: 01/20/2023]
Abstract
AIM To investigate the prevalence of autism spectrum disorder (ASD) and attention-deficit-hyperactivity disorder (ADHD) in a population-based group of children and adolescents with Down syndrome, and to relate the findings to level of intellectual disability and to medical conditions. METHOD From a population-based cohort of 60 children and adolescents with Down syndrome, 41 individuals (29 males, 12 females; mean age 11y, age range 5-17y) for whom parents gave consent for participation were clinically assessed with regard to ASD and ADHD. The main instruments used were the Autism Diagnostic Interview-Revised, Autism Diagnostic Observation Schedule, Swanson, Nolan, and Pelham-IV Rating Scale, and the Adaptive Behavior Assessment System-II. RESULTS High rates of ASD and ADHD were found: 17 (42%) and 14 (34%) of the 41 children met DSM criteria for ASD and ADHD respectively. INTERPRETATION Children with Down syndrome and coexisting neurodevelopmental/neuropsychiatric disorders in addition to intellectual disability and medical disorders constitute a severely disabled group. Based on the results, we suggest that screening is implemented for both ASD and ADHD, at the age of 3 to 5 years and early school years respectively, to make adequate interventions possible.
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Affiliation(s)
| | - Åsa Myrelid
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Göran Annerén
- Department of Immunology, Genetics, and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Bodil Ekstam
- Department of Health and Rehabilitation, Kungsgärdet Center, Uppsala, Sweden
| | - Cathrine Göransson
- Department of Health and Rehabilitation, Kungsgärdet Center, Uppsala, Sweden
| | - Agneta Holmbom
- Department of Health and Rehabilitation, Kungsgärdet Center, Uppsala, Sweden
| | - Anne Isaksson
- Department of Health and Rehabilitation, Kungsgärdet Center, Uppsala, Sweden
| | - Marie Åberg
- Department of Health and Rehabilitation, Kungsgärdet Center, Uppsala, Sweden
| | - Jan Gustafsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Elisabeth Fernell
- Gillberg Neuropsychiatry Centre, Department of Neuroscience and Physiology, Gothenburg University, Gothenburg, Sweden
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48
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Warner G, Howlin P, Salomone E, Moss J, Charman T. Profiles of children with Down syndrome who meet screening criteria for autism spectrum disorder (ASD): a comparison with children diagnosed with ASD attending specialist schools. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2017; 61:75-82. [PMID: 27868264 DOI: 10.1111/jir.12344] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 09/29/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Recent research suggests that around 16% to 18% of children with Down syndrome (DS) also meet diagnostic criteria for autism spectrum disorder (ASD). However, there are indications that profiles of autism symptoms in this group may vary from those typically described in children with ASD. METHOD Rates of autism symptoms and emotional and behavioural problems among children with DS who screened positive for ASD on the Social Communication Questionnaire (SCQ) (n = 183) were compared with a group of children with clinical diagnoses of ASD (n = 189) attending specialist schools in the UK. Groups were matched for age and approximate language level (use of phrase speech). RESULTS Profiles of autistic symptoms in the two groups were generally similar, but children with DS meeting ASD cut-off on the SCQ tended to show fewer problems in reciprocal social interaction than those in the ASD group. They also showed slightly lower rates of emotional and peer-related problems. The results mostly confirm findings from a previous study in which the original validation sample for the SCQ was used as a comparison group. CONCLUSION Findings suggest that children with DS who meet screening criteria for ASD show similar profiles of communication and repetitive behaviours to those typically described in autism. However, they tend to have relatively milder social difficulties. It is important that clinicians are aware of this difference if children with DS and ASD are to be correctly diagnosed and eligible for specialist intervention and education services.
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Affiliation(s)
- G Warner
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - P Howlin
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Faculty of Health Sciences, University of Sydney, BMRI, Sydney, New South Wales, Australia
| | - E Salomone
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Dipartimento di Psicologia, Università di Torino, Torino, Italy
| | - J Moss
- Cerebra Centre, University of Birmingham, Birmingham, UK
- Department of Psychology, Institute of Child Health, Behavioural and Brain Sciences Unit, London, UK
| | - T Charman
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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49
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Romhus S, Herder GA, Grindheim E, Schjølberg S, Howlin P. Changes in the frequency and characteristics of children diagnosed with autistic disorder in two Norwegian cohorts: 1992 and 2009. Scand J Child Adolesc Psychiatr Psychol 2017. [DOI: 10.21307/sjcapp-2017-001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Abstract
Background:
Is the increasing prevalence of autistic disorder (AD) a well-documented trend or merely a reflection of the wider recognition of AD among both the public at large and health care professionals? Data from relevant studies are frequently compromised by comparisons of different sites and different diagnostic methods.
Objectives:
To explore changes over time, we reviewed the following: 1) the frequency of AD diagnoses; 2) the characteristics of the diagnosed children; and 3) the ages of the children when initial concerns were addressed and AD diagnoses made.
Method:
We compared the case records of children between the ages of 1 and 17 years who were residing in Nordland County, Norway, and who were diagnosed with AD during two different data collection periods: 1992 (Cohort 1) and 2009 (Cohort 2).
Results:
In Cohort 1, 28 children were diagnosed with AD; 71 children in Cohort 2 received AD diagnoses. The increase was greatest among children with intelligence quotient (IQ) values of at least 70. The proportion of children with genetic syndromes was around 20% in both cohorts. Median age at AD diagnosis did not differ between the two cohorts (4.5 vs. 5.0 years, respectively). When the two cohorts were combined, children with IQ values of 70 or more without a genetic syndrome and those with IQ values of less than 50 with genetic syndromes were diagnosed at approximately the same age (5.5 and 5.3 years, respectively). Both groups were significantly older at diagnosis as compared with children with IQ values of less than 50 without genetic syndromes (3.5 years).
Conclusions:
The increase in the number of children diagnosed with AD is consistent with findings from international studies. Contrary to predictions, the age at diagnosis was not reduced over time. A higher proportion of children with IQ values in the average range in the latter cohort may have contributed to this. A delayed diagnosis of AD among children with genetic syndromes may indicate that early autism symptoms are attributed to the genetic condition. Clinical implications are discussed.
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Rachubinski AL, Hepburn S, Elias ER, Gardiner K, Shaikh TH. The co-occurrence of Down syndrome and autism spectrum disorder: is it because of additional genetic variations? Prenat Diagn 2016; 37:31-36. [DOI: 10.1002/pd.4957] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 10/23/2016] [Accepted: 10/26/2016] [Indexed: 12/12/2022]
Affiliation(s)
- Angela L. Rachubinski
- JFK Partners, Section of Developmental Pediatrics, Department of Pediatrics; University of Colorado Denver School of Medicine; Aurora CO USA
| | - Susan Hepburn
- Department of Human Development and Family Studies; Colorado State University; Fort Collins CO USA
| | - Ellen R. Elias
- Section of Genetics and Metabolism, Department of Pediatrics; University of Colorado Denver School of Medicine; Aurora CO USA
- Special Care Clinic; Children's Hospital Colorado; Aurora CO USA
| | - Katheleen Gardiner
- Section of Genetics and Metabolism, Department of Pediatrics; University of Colorado Denver School of Medicine; Aurora CO USA
- Linda Crnic Institute for Down Syndrome; University of Colorado Denver School of Medicine; Aurora CO USA
| | - Tamim H. Shaikh
- Section of Genetics and Metabolism, Department of Pediatrics; University of Colorado Denver School of Medicine; Aurora CO USA
- Linda Crnic Institute for Down Syndrome; University of Colorado Denver School of Medicine; Aurora CO USA
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