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Thompson EL, Gillespie-Smith K, Mair APA, Obsuth I. Exploring Emotional Dysregulation and Avoidance with Caregivers as the Mechanisms Linking Social Communication Understanding and Aggressive Behaviours. J Autism Dev Disord 2024:10.1007/s10803-024-06276-8. [PMID: 38714626 DOI: 10.1007/s10803-024-06276-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2024] [Indexed: 05/10/2024]
Abstract
Many autistic adolescents and young adults present with aggressive behaviours, which can be challenging for caregivers. The present study aimed to explore the underlying mechanisms between social communication understanding and aggressive behaviours in autistic and non-autistic adolescents, specifically the role of emotional dysregulation and its impact on avoidance with caregivers. Caregivers of autistic (n = 275) and non-autistic adolescents (n = 123) completed standardised caregiver-report questionnaires measuring social communication understanding, emotional dysregulation, avoidance between the adolescent and caregiver and aggressive behaviours. A serial mediation analysis indicated that levels of social communication understanding were indirectly associated with aggressive behaviours. This occurred through increased emotional dysregulation, which may have led to increased avoidance between the autistic and non-autistic adolescents and their caregivers. These findings support a sequential process by which adolescents with low social communication understanding are more likely to behave aggressively through being emotionally dysregulated and the impact of this on the increased avoidance within the caregiver-adolescent dyad. This process was found within autistic and non-autistic adolescents, suggesting a mechanism across individuals with aggression. These findings indicate that interventions based on improving emotion regulation ability and responses between adolescents and their caregivers may aid in reducing aggressive behaviours in adolescents and young adults with lower social communication understanding.
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Affiliation(s)
- Emma Louise Thompson
- School of Health and Social Science, University of Edinburgh, Edinburgh, EH8 9AG, UK.
- Department of Psychological Service & Research, NHS Dumfries & Galloway, Dumfries, DG1 4AP, UK.
| | - Karri Gillespie-Smith
- School of Health and Social Science, University of Edinburgh, Edinburgh, EH8 9AG, UK
| | - Ally Pax Arcari Mair
- School of Health and Social Science, University of Edinburgh, Edinburgh, EH8 9AG, UK
| | - Ingrid Obsuth
- School of Health and Social Science, University of Edinburgh, Edinburgh, EH8 9AG, UK
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2
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Bahri J, Abbes ZS, Ben Yahia H, Halayem S, Jelili S, Hajri M, Amado I, Medalia A, Bouden A. Toward an integrative socio-cognitive approach in autism spectrum disorder: NEAR method adaptation-study protocol. Front Psychiatry 2023; 14:940066. [PMID: 37293399 PMCID: PMC10244578 DOI: 10.3389/fpsyt.2023.940066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 05/02/2023] [Indexed: 06/10/2023] Open
Abstract
BackgroundThe cognitive impairments exhibited by people with ASD, threaten the development of social skills that are essential for establishing and maintaining harmonious social relationships. Cognitive remediation and social skills training are now considered as crucial therapeutic approaches in the management of these disorders. Several programs have already been validated and have shown improvements in social skills or cognitive performance. However, the effects of these training methods seem to be difficult to generalize to other everyday life. The aim of our study is to alleviate cognitive and social deficiencies by using a socio-cognitive framework to adapt the Neuropsychological Educational Approach to Remediation (NEAR) method for adolescents with ASD.Methods/designAdolescents meeting the DSM-5 criteria for ASD, older than 13 years, and following a regular school curriculum will be recruited from clinical population at the Child and Adolescent Psychiatry in Razi University Hospital-Manouba- Tunisia. Our study is an open and non-randomized controlled trial including 30 patients: NEAR group / control group. The NEAR method combines computerized cognitive exercises and bridging groups inspired from cognitive behavioral therapy. NEAR group will be divided into three groups of five patients each. The duration of the sessions will vary according to the capacities of the participants and the exchanges between them (about 60–120 min). In our study, bridging groups will be amended by adding other tasks including planning role plays and scenarios of problematic social situations in autism, taking into account cultural particularities in order to promote social skills. Computerized exercises will be enriched by adding other tasks aiming to improve the recognition and expression of facial emotions by using digital videos and photographs expressing the six basic emotions. The duration of the program will be about 6 months. All selected patients will have an assessment of cognitive function: social cognition, neurocognition and pragmatic skills, social skills, self-esteem and global functioning at baseline, 1 week after the end of the NEAR program and 6 months later.ConclusionThis adaptive program is a promising socio-cognitive intervention that create new perspectives for adolescents with autism spectrum disorder.
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Affiliation(s)
- Jihene Bahri
- Department of Child and Adolescent Psychiatry, Razi Hospital, Manouba, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Zeineb S. Abbes
- Department of Child and Adolescent Psychiatry, Razi Hospital, Manouba, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Houda Ben Yahia
- Department of Child and Adolescent Psychiatry, Razi Hospital, Manouba, Tunisia
| | - Soumeyya Halayem
- Department of Child and Adolescent Psychiatry, Razi Hospital, Manouba, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Selima Jelili
- Department of Child and Adolescent Psychiatry, Razi Hospital, Manouba, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Melek Hajri
- Department of Child and Adolescent Psychiatry, Razi Hospital, Manouba, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Isabelle Amado
- CH Sainte-Anne, C3RP & Services de Psychiatrie d'adultes HU & 75G17, Paris, France
| | - Alice Medalia
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
| | - Asma Bouden
- Department of Child and Adolescent Psychiatry, Razi Hospital, Manouba, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
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3
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Gidziela A, Ahmadzadeh YI, Michelini G, Allegrini AG, Agnew-Blais J, Lau LY, Duret M, Procopio F, Daly E, Ronald A, Rimfeld K, Malanchini M. A meta-analysis of genetic effects associated with neurodevelopmental disorders and co-occurring conditions. Nat Hum Behav 2023; 7:642-656. [PMID: 36806400 PMCID: PMC10129867 DOI: 10.1038/s41562-023-01530-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 01/16/2023] [Indexed: 02/22/2023]
Abstract
A systematic understanding of the aetiology of neurodevelopmental disorders (NDDs) and their co-occurrence with other conditions during childhood and adolescence remains incomplete. In the current meta-analysis, we synthesized the literature on (1) the contribution of genetic and environmental factors to NDDs, (2) the genetic and environmental overlap between different NDDs, and (3) the co-occurrence between NDDs and disruptive, impulse control and conduct disorders (DICCs). Searches were conducted across three platforms: Web of Science, Ovid Medline and Ovid Embase. Studies were included only if 75% or more of the sample consisted of children and/or adolescents and the studies had measured the aetiology of NDDs and DICCs using single-generation family designs or genomic methods. Studies that had selected participants on the basis of unrelated diagnoses or injuries were excluded. We performed multilevel, random-effects meta-analyses on 296 independent studies, including over four million (partly overlapping) individuals. We further explored developmental trajectories and the moderating roles of gender, measurement, geography and ancestry. We found all NDDs to be substantially heritable (family-based heritability, 0.66 (s.e. = 0.03); SNP heritability, 0.19 (s.e. = 0.03)). Meta-analytic genetic correlations between NDDs were moderate (grand family-based genetic correlation, 0.36 (s.e. = 0.12); grand SNP-based genetic correlation, 0.39 (s.e. = 0.19)) but differed substantially between pairs of disorders. The genetic overlap between NDDs and DICCs was strong (grand family-based genetic correlation, 0.62 (s.e. = 0.20)). While our work provides evidence to inform and potentially guide clinical and educational diagnostic procedures and practice, it also highlights the imbalance in the research effort that has characterized developmental genetics research.
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Affiliation(s)
- Agnieszka Gidziela
- School of Biological and Behavioural Sciences, Queen Mary University of London, London, UK. .,Social, Genetic and Developmental Psychiatry Centre, King's College London, London, UK.
| | - Yasmin I Ahmadzadeh
- Social, Genetic and Developmental Psychiatry Centre, King's College London, London, UK
| | - Giorgia Michelini
- School of Biological and Behavioural Sciences, Queen Mary University of London, London, UK.,UCLA Semel Institute for Neuroscience, Division of Child and Adolescent Psychiatry, University of California, Los Angeles, Los Angeles, CA, USA
| | - Andrea G Allegrini
- Social, Genetic and Developmental Psychiatry Centre, King's College London, London, UK.,Division of Psychology and Language Sciences, University College London, London, UK
| | - Jessica Agnew-Blais
- School of Biological and Behavioural Sciences, Queen Mary University of London, London, UK
| | - Lok Yan Lau
- Social, Genetic and Developmental Psychiatry Centre, King's College London, London, UK
| | - Megan Duret
- Social, Genetic and Developmental Psychiatry Centre, King's College London, London, UK
| | - Francesca Procopio
- Social, Genetic and Developmental Psychiatry Centre, King's College London, London, UK
| | - Emily Daly
- Social, Genetic and Developmental Psychiatry Centre, King's College London, London, UK
| | - Angelica Ronald
- Department of Psychological Sciences, Birkbeck University of London, London, UK
| | - Kaili Rimfeld
- Social, Genetic and Developmental Psychiatry Centre, King's College London, London, UK.,Department of Psychology, Royal Holloway University of London, Egham, UK
| | - Margherita Malanchini
- School of Biological and Behavioural Sciences, Queen Mary University of London, London, UK. .,Social, Genetic and Developmental Psychiatry Centre, King's College London, London, UK.
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4
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Hu W, Sun M. COVID-19 Stressors and Aggression among Chinese College Students: The Mediation Role of Coping Strategies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3171. [PMID: 36833866 PMCID: PMC9968146 DOI: 10.3390/ijerph20043171] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/04/2023] [Accepted: 02/04/2023] [Indexed: 06/18/2023]
Abstract
Although college students experienced excessive stressors (COVID-19 disease and negative COVID-19 news) during the COVID-19 pandemic, few studies have been aimed at coping strategies used by college students to deal with stress caused by the pandemic. Coping strategies are efforts to deal with anxiety in the face of a perceived threat or stress. Aggression is harmful social interaction with the intention of inflicting damage or harm upon another individual. In the present study, we aimed to examine the direct effect of stressors resulting from the pandemic on college students' aggression, as well as the indirect effect via their coping strategies. Through a cross-sectional survey of 601 Chinese college students (M-age = 20.28), we tested the proposed framework. We first found that information stressors of COVID-19 ranked highest among the four stressors of the pandemic. Results also indicated that college students' stressors of COVID-19 were directly and positively associated with their aggressive behavior. For the indirect effect, college students would adopt both adaptive coping strategies (self-help strategy) and maladaptive coping strategies (avoidance strategy and self-punishment strategy) with the stressors of COVID-19. Furthermore, adaptive coping strategy (approach strategy) was negatively related to their aggression, whereas maladaptive coping strategy (avoidance strategy and self-punishment strategy) was positively related to their aggressive behavior. The present research extends the general strain theory in the COVID-19 context. Practical implications are also discussed.
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Affiliation(s)
- Wencai Hu
- College of Humanities and Communication, Zhejiang University of Finance and Economics, Hangzhou 310018, China
| | - Mengru Sun
- College of Media and International Culture, Zhejiang University, Hangzhou 310058, China
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5
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Tordjman S. Aggressive behavior: A language to be understood. Encephale 2022; 48 Suppl 1:S4-S13. [DOI: 10.1016/j.encep.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 08/09/2022] [Indexed: 11/30/2022]
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6
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Bogdanova OV, Bogdanov VB, Pizano A, Bouvard M, Cazalets JR, Mellen N, Amestoy A. The Current View on the Paradox of Pain in Autism Spectrum Disorders. Front Psychiatry 2022; 13:910824. [PMID: 35935443 PMCID: PMC9352888 DOI: 10.3389/fpsyt.2022.910824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 06/17/2022] [Indexed: 01/18/2023] Open
Abstract
Autism spectrum disorder (ASD) is a neurodevelopmental disorder, which affects 1 in 44 children and may cause severe disabilities. Besides socio-communicational difficulties and repetitive behaviors, ASD also presents as atypical sensorimotor function and pain reactivity. While chronic pain is a frequent co-morbidity in autism, pain management in this population is often insufficient because of difficulties in pain evaluation, worsening their prognosis and perhaps driving higher mortality rates. Previous observations have tended to oversimplify the experience of pain in autism as being insensitive to painful stimuli. Various findings in the past 15 years have challenged and complicated this dogma. However, a relatively small number of studies investigates the physiological correlates of pain reactivity in ASD. We explore the possibility that atypical pain perception in people with ASD is mediated by alterations in pain perception, transmission, expression and modulation, and through interactions between these processes. These complex interactions may account for the great variability and sometimes contradictory findings from the studies. A growing body of evidence is challenging the idea of alterations in pain processing in ASD due to a single factor, and calls for an integrative view. We propose a model of the pain cycle that includes the interplay between the molecular and neurophysiological pathways of pain processing and it conscious appraisal that may interfere with pain reactivity and coping in autism. The role of social factors in pain-induced response is also discussed. Pain assessment in clinical care is mostly based on subjective rather than objective measures. This review clarifies the strong need for a consistent methodology, and describes innovative tools to cope with the heterogeneity of pain expression in ASD, enabling individualized assessment. Multiple measures, including self-reporting, informant reporting, clinician-assessed, and purely physiological metrics may provide more consistent results. An integrative view on the regulation of the pain cycle offers a more robust framework to characterize the experience of pain in autism.
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Affiliation(s)
- Olena V. Bogdanova
- CNRS, Aquitaine Institute for Cognitive and Integrative Neuroscience, INCIA, UMR 5287, Université de Bordeaux, Bordeaux, France
| | - Volodymyr B. Bogdanov
- Laboratoire EA 4136 – Handicap Activité Cognition Santé HACS, Collège Science de la Sante, Institut Universitaire des Sciences de la Réadaptation, Université de Bordeaux, Bordeaux, France
| | - Adrien Pizano
- CNRS, Aquitaine Institute for Cognitive and Integrative Neuroscience, INCIA, UMR 5287, Université de Bordeaux, Bordeaux, France
- Centre Hospitalier Charles-Perrens, Pôle Universitaire de Psychiatrie de l’Enfant et de l’Adolescent, Bordeaux, France
| | - Manuel Bouvard
- CNRS, Aquitaine Institute for Cognitive and Integrative Neuroscience, INCIA, UMR 5287, Université de Bordeaux, Bordeaux, France
- Centre Hospitalier Charles-Perrens, Pôle Universitaire de Psychiatrie de l’Enfant et de l’Adolescent, Bordeaux, France
| | - Jean-Rene Cazalets
- CNRS, Aquitaine Institute for Cognitive and Integrative Neuroscience, INCIA, UMR 5287, Université de Bordeaux, Bordeaux, France
| | - Nicholas Mellen
- Department of Neurology, University of Louisville, Louisville, KY, United States
| | - Anouck Amestoy
- CNRS, Aquitaine Institute for Cognitive and Integrative Neuroscience, INCIA, UMR 5287, Université de Bordeaux, Bordeaux, France
- Centre Hospitalier Charles-Perrens, Pôle Universitaire de Psychiatrie de l’Enfant et de l’Adolescent, Bordeaux, France
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7
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Joseph JJ, Mela M, Pei J. Aggressive behaviour and violence in children and adolescents with FASD: A synthesizing review. Clin Psychol Rev 2022; 94:102155. [DOI: 10.1016/j.cpr.2022.102155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 02/09/2022] [Accepted: 03/23/2022] [Indexed: 11/03/2022]
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8
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Yan H, Siegel L, Breitbart S, Gorodetsky C, Fasano A, Rahim A, Loh A, Kulkarni AV, Ibrahim GM. An open-label prospective pilot trial of nucleus accumbens deep brain stimulation for children with autism spectrum disorder and severe, refractory self-injurious behavior: study protocol. Pilot Feasibility Stud 2022; 8:24. [PMID: 35109924 PMCID: PMC8808966 DOI: 10.1186/s40814-022-00988-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 01/20/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Children and youth with autism spectrum disorder (ASD) may manifest self-injurious behaviors (SIB) that may become severe and refractory with limited pharmacologic or behavioral treatment options. Here, we present the protocol of a prospective, mixed-methods study to assess the safety and efficacy of deep brain stimulation (DBS) of the nucleus accumbens (NAcc) for children and youth with ASD and severe, refractory SIB. METHODS This is a prospective, single-center, single-cohort, open-label, non-randomized pilot trial of 6 patients. Participants will be recruited through specialized behavioral clinics with persistent severe and refractory SIB following standard and intensive interventions. Following NAcc-DBS, participants will be enrolled in the study for 12 months. The primary objectives of the study are safety and feasibility, assessed by rate of recruitment and identification of factors impacting adherence to follow-up and study protocol. Potential treatment efficacy will be assessed by changes in the Children's Yale-Brown Obsessive-Compulsive Scale in ASD (CYBOCS-ASD), the Behavior Problems Index (BPI), the Inventory of Statements about Self-Injury (ISAS) and the Repetitive Behavior Scale-Revised (RBS-R) questionnaires. Additional clinical outcomes will be assessed, including measures of participant and caregiver quality of life, actigraph measurements, and positron emission tomography (PET) changes following DBS. DISCUSSION This study will be the first to evaluate the effect of DBS of the NAcc on a pediatric population in a controlled, prospective trial. Secondary outcomes will improve the understanding of behavioral, neuro-imaging, and electrophysiologic changes in children with ASD and SIB treated with DBS. This trial will provide an estimated effect size of NAcc-DBS for severe refractory SIB in children with ASD in preparation for future comparative trials. TRIAL REGISTRATION Registration on ClinicalTrials.gov was completed on 12 June 2019 with the Identifier: NCT03982888 .
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Affiliation(s)
- Han Yan
- Division of Neurosurgery, The Hospital for Sick Children, 555 University Avenue, Room 1503, Toronto, ON, M5G 1X8, Canada.,Institute of Health of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Lauren Siegel
- Neurosciences and Mental Health Program, The Hospital for Sick Children, 555 University Avenue, Room 1503, Toronto, ON, M5G 1X8, Canada
| | - Sara Breitbart
- Division of Neurosurgery, The Hospital for Sick Children, 555 University Avenue, Room 1503, Toronto, ON, M5G 1X8, Canada.,Neurosciences and Mental Health Program, The Hospital for Sick Children, 555 University Avenue, Room 1503, Toronto, ON, M5G 1X8, Canada
| | | | - Alfonso Fasano
- Division of Neurology, The Hospital for Sick Children, Toronto, Canada.,Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada. Division of Neurology, University of Toronto, Toronto, Ontario, Canada.,Krembil Brain Institute, Toronto, Ontario, Canada.,CenteR for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, ON, Canada
| | - Aliya Rahim
- Neurosciences and Mental Health Program, The Hospital for Sick Children, 555 University Avenue, Room 1503, Toronto, ON, M5G 1X8, Canada.,Surrey Place, Toronto, Ontario, Canada
| | - Alvin Loh
- Surrey Place, Toronto, Ontario, Canada.,Division of Developmental Paediatrics, Department of Paediatrics, University of Toronto, Toronto, Canada
| | - Abhaya V Kulkarni
- Division of Neurosurgery, The Hospital for Sick Children, 555 University Avenue, Room 1503, Toronto, ON, M5G 1X8, Canada.,Institute of Health of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - George M Ibrahim
- Division of Neurosurgery, The Hospital for Sick Children, 555 University Avenue, Room 1503, Toronto, ON, M5G 1X8, Canada. .,Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Canada. .,Institute of Biomedical Engineering, University of Toronto, Toronto, Canada. .,Institute of Medical Science, University of Toronto, Toronto, Canada.
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9
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Behavioral and Emotional Disorders in Children and Their Anesthetic Implications. CHILDREN-BASEL 2020; 7:children7120253. [PMID: 33255535 PMCID: PMC7759846 DOI: 10.3390/children7120253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/20/2020] [Accepted: 11/21/2020] [Indexed: 12/29/2022]
Abstract
While most children have anxiety and fears in the hospital environment, especially prior to having surgery, there are several common behavioral and emotional disorders in children that can pose a challenge in the perioperative setting. These include anxiety, depression, oppositional defiant disorder, conduct disorder, attention deficit hyperactivity disorder, obsessive compulsive disorder, post-traumatic stress disorder, and autism spectrum disorder. The aim of this review article is to provide a brief overview of each disorder, explore the impact on anesthesia and perioperative care, and highlight some management techniques that can be used to facilitate a smooth perioperative course.
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10
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Korbut S, Hedley D, Chetcuti L, Sahin E, Nuske HJ. Temperament predicts challenging behavior in children with autism spectrum disorder at age 5. RESEARCH IN AUTISM SPECTRUM DISORDERS 2020; 71:101492. [PMID: 35633756 PMCID: PMC9137884 DOI: 10.1016/j.rasd.2019.101492] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Challenging behaviors during early childhood have a significant impact on cognitive and social development. The present study aimed to identify the developmental predictors of these behaviors in preschool aged children with Autism Spectrum Disorder (ASD) at 2-year follow-up. We examined temperament, which has been identified as key to emotion regulation in typical development, as well as developmental level and ASD symptom severity, as potential predictors of parent-reported challenging behavior. METHOD Forty-three parents of preschool aged children with ASD from a previous study were invited to participate. Data from 26 children with ASD aged 4-6 years (M = 5, SD = .60) were available for follow-up analyses. Developmental level, ASD symptom severity, and temperamental difficulty at baseline were considered as potential predictors of frequency and severity of challenging behavior at follow-up. RESULTS Baseline negative affectivity was uniquely predictive of frequency of challenging behavior at follow-up. Although no individual variable was identified as a unique predictor of variance, the combined effects of temperament were predictive of the severity of challenging behavior at follow-up, contributing to 46 % of variance in scores. CONCLUSIONS These findings highlight the potential impact of emotion-regulation related aspects of temperament on later emerging challenging behavior in young children with ASD, suggesting opportunities for early intervention. Results also identified a role for developmental level in the severity of challenging behavior, but suggest that the effect may be metered by temperament.
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Affiliation(s)
- Siobhan Korbut
- Olga Tennison Autism Research Centre, La Trobe University, VIC, Australia
| | - Darren Hedley
- Olga Tennison Autism Research Centre, La Trobe University, VIC, Australia
| | - Lacey Chetcuti
- Olga Tennison Autism Research Centre, La Trobe University, VIC, Australia
| | - Ensu Sahin
- Olga Tennison Autism Research Centre, La Trobe University, VIC, Australia
| | - Heather J. Nuske
- Penn Center for Mental Health, University of Pennsylvania, PA, USA
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11
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Goodwin MS, Mazefsky CA, Ioannidis S, Erdogmus D, Siegel M. Predicting aggression to others in youth with autism using a wearable biosensor. Autism Res 2019; 12:1286-1296. [PMID: 31225952 DOI: 10.1002/aur.2151] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 05/03/2019] [Accepted: 05/14/2019] [Indexed: 12/28/2022]
Abstract
Unpredictable and potentially dangerous aggressive behavior by youth with Autism Spectrum Disorder (ASD) can isolate them from foundational educational, social, and familial activities, thereby markedly exacerbating morbidity and costs associated with ASD. This study investigates whether preceding physiological and motion data measured by a wrist-worn biosensor can predict aggression to others by youth with ASD. We recorded peripheral physiological (cardiovascular and electrodermal activity) and motion (accelerometry) signals from a biosensor worn by 20 youth with ASD (ages 6-17 years, 75% male, 85% minimally verbal) during 69 independent naturalistic observation sessions with concurrent behavioral coding in a specialized inpatient psychiatry unit. We developed prediction models based on ridge-regularized logistic regression. Our results suggest that aggression to others can be predicted 1 min before it occurs using 3 min of prior biosensor data with an average area under the curve of 0.71 for a global model and 0.84 for person-dependent models. The biosensor was well tolerated, we obtained useable data in all cases, and no users withdrew from the study. Relatively high predictive accuracy was achieved using antecedent physiological and motion data. Larger trials are needed to further establish an ideal ratio of measurement density to predictive accuracy and reliability. These findings lay the groundwork for the future development of precursor behavior analysis and just-in-time adaptive intervention systems to prevent or mitigate the emergence, occurrence, and impact of aggression in ASD. Autism Res 2019, 12: 1286-1296. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Unpredictable aggression can create a barrier to accessing community, therapeutic, medical, and educational services. The present study evaluated whether data from a wearable biosensor can be used to predict aggression to others by youth with autism spectrum disorder (ASD). Results demonstrate that aggression to others can be predicted 1 min before it occurs with high accuracy, laying the groundwork for the future development of preemptive behavioral interventions and just-in-time adaptive intervention systems to prevent or mitigate the emergence, occurrence, and impact of aggression to others in ASD.
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Affiliation(s)
- Matthew S Goodwin
- Department of Health Sciences, Northeastern University, Boston, Massachusetts
| | - Carla A Mazefsky
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Stratis Ioannidis
- Department of Electrical and Computer Engineering, Northeastern University, Boston, Massachusetts
| | - Deniz Erdogmus
- Department of Electrical and Computer Engineering, Northeastern University, Boston, Massachusetts
| | - Matthew Siegel
- Maine Medical Center Research Institute, Portland, Maine
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12
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Keefer A, White SW, Vasa RA, Reaven J. Psychosocial interventions for internalizing disorders in youth and adults with ASD. Int Rev Psychiatry 2018. [PMID: 29537895 DOI: 10.1080/09540261.2018.1432575] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Internalizing disorders are common in individuals with ASD. Psychosocial interventions targeting these disorders in the ASD population have burgeoned in the last decade. Cognitive-behavioural therapy, modified for ASD, is the most frequently investigated model, although other interventions, including behaviour therapy, third-wave interventions, models targeting transdiagnostic constructs, and alternative interventions and treatment delivery methods are now emerging. This review provides a summary of the efficacy of these interventions in treating internalizing disorders in youth and adults with ASD. The barriers to accessing these treatments, which are experienced by many individuals with ASD and their families, as well as future research directions, are also discussed.
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Affiliation(s)
- Amy Keefer
- a Center for Autism and Related Disorders , Kennedy Krieger Institute , Baltimore , MD , USA.,b Department of Psychiatry and Behavioral Sciences , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Susan W White
- c Department of Psychology , Virginia Tech , Blacksburg , VA , USA
| | - Roma A Vasa
- a Center for Autism and Related Disorders , Kennedy Krieger Institute , Baltimore , MD , USA.,b Department of Psychiatry and Behavioral Sciences , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Judy Reaven
- d Department of Psychiatry , University of Colorado Anschutz Medical Campus , Aurora , CO , USA
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Hashikawa Y, Hashikawa K, Falkner AL, Lin D. Ventromedial Hypothalamus and the Generation of Aggression. Front Syst Neurosci 2017; 11:94. [PMID: 29375329 PMCID: PMC5770748 DOI: 10.3389/fnsys.2017.00094] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 11/28/2017] [Indexed: 12/28/2022] Open
Abstract
Aggression is a costly behavior, sometimes with severe consequences including death. Yet aggression is prevalent across animal species ranging from insects to humans, demonstrating its essential role in the survival of individuals and groups. The question of how the brain decides when to generate this costly behavior has intrigued neuroscientists for over a century and has led to the identification of relevant neural substrates. Various lesion and electric stimulation experiments have revealed that the hypothalamus, an ancient structure situated deep in the brain, is essential for expressing aggressive behaviors. More recently, studies using precise circuit manipulation tools have identified a small subnucleus in the medial hypothalamus, the ventrolateral part of the ventromedial hypothalamus (VMHvl), as a key structure for driving both aggression and aggression-seeking behaviors. Here, we provide an updated summary of the evidence that supports a role of the VMHvl in aggressive behaviors. We will consider our recent findings detailing the physiological response properties of populations of VMHvl cells during aggressive behaviors and provide new understanding regarding the role of the VMHvl embedded within the larger whole-brain circuit for social sensation and action.
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Affiliation(s)
- Yoshiko Hashikawa
- Neuroscience Institute, New York University School of Medicine, New York University, New York, NY, United States
| | - Koichi Hashikawa
- Neuroscience Institute, New York University School of Medicine, New York University, New York, NY, United States
| | - Annegret L Falkner
- Neuroscience Institute, New York University School of Medicine, New York University, New York, NY, United States
| | - Dayu Lin
- Neuroscience Institute, New York University School of Medicine, New York University, New York, NY, United States.,Department of Psychiatry, New York University School of Medicine, New York University, New York, NY, United States.,Center for Neural Science, New York University, New York, NY, United States
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Yang YH, Kim HJ, Lee WH. Clinical Characteristics of Aggressive Behavior Problems in Children with Autism Spectrum Disorder: Preliminary Study. Soa Chongsonyon Chongsin Uihak 2017. [DOI: 10.5765/jkacap.2017.28.4.228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Young-Hui Yang
- Department of Child and Adolescent Psychiatry, National Center for Mental Health, Seoul, Korea
- Center for Behavior Development, National Center for Mental Health, Seoul, Korea
| | - Hyen-Jung Kim
- Center for Behavior Development, National Center for Mental Health, Seoul, Korea
| | - Won-Hye Lee
- Department of Clinical Psychology, National Center for Mental Health, Seoul, Korea
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Yamamuro K, Tsujii N, Ota T, Kishimoto T, Iida J. Pharmacotherapy for the treatment of aggression in pediatric and adolescent patients with autism spectrum disorder comorbid with attention-deficit hyperactivity disorder: A questionnaire survey of 571 psychiatrists. Psychiatry Clin Neurosci 2017; 71:554-561. [PMID: 28317224 DOI: 10.1111/pcn.12523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 03/07/2017] [Accepted: 03/14/2017] [Indexed: 01/03/2023]
Abstract
AIM Both attention-deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) are frequently accompanied by serious aggression that requires psychiatric treatment. However, little is known about the experiences psychiatrists have had using pharmacotherapy to treat aggression in patients who have both ASD and ADHD (ASD/ADHD). The purpose of this study was to examine the experiences of Japanese child and adolescent psychiatrists in prescribing medication for aggression in patients with ASD/ADHD. METHODS A prospective questionnaire was mailed to 2001 psychiatrists affiliated with the Japanese Society for Child and Adolescent Psychiatry. Multivariate logistic regression analysis was used to identify factors predicting the outcome of pharmacotherapeutic treatment of aggression in pediatric and adolescent patients with ASD/ADHD. RESULTS Of 2001 psychiatrists, 571 (28.5%) completed the full questionnaire (final sample). Of these, 488 (85.4%) prescribed psychotropic medication in treating pediatric and adolescent patients with ASD/ADHD, 299 (61.3%) of them doing so to treat aggression. Prescribers' duration of practice (odds ratio, 1.055; P = 0.038) and patient symptoms of residual impulsivity (odds ratio, 2.479; P = 0.039) increased the odds of prescribing psychotropic medications to treat aggression in these patients. The respondents reported a similar effect for patients with ADHD/ASD compared with those with ADHD only in treating aggression. CONCLUSION Japanese psychiatrists tended to prescribe psychotropic medication for aggression in pediatric and adolescent patients with ASD/ADHD. Future studies examining aggression in pediatric and adolescent patients with ASD/ADHD should aim to accumulate evidence for the use of psychotropic medications, which could help clinicians make better decisions.
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Affiliation(s)
- Kazuhiko Yamamuro
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan
| | - Noa Tsujii
- Department of Neuropsychiatry, Kindai University Faculty of Medicine, Osaka, Japan
| | - Toyosaku Ota
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan
| | - Toshifumi Kishimoto
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan
| | - Junzo Iida
- Faculty of Nursing, Nara Medical University School of Medicine, Kashihara, Japan
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Billstedt E, Anckarsäter H, Wallinius M, Hofvander B. Neurodevelopmental disorders in young violent offenders: Overlap and background characteristics. Psychiatry Res 2017; 252:234-241. [PMID: 28285251 DOI: 10.1016/j.psychres.2017.03.004] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 02/10/2017] [Accepted: 03/03/2017] [Indexed: 12/14/2022]
Abstract
Neurodevelopmental disorders (Attention-Deficit/Hyperactivity Disorder (ADHD), Autism Spectrum Disorder (ASD), tic disorder, intellectual disability (ID)), in prison populations have received increased attention but the focus has generally been on one single condition leaving out the global picture. This study assessed the prevalence and overlap of neurodevelopmental disorders (NDD) in a consecutive cohort (n=270) of young adult male offenders (age 18-25 years), sentenced for "hands-on" violent offences and serving prison time in Swedish prisons. Seventy-one percent of all who met inclusion criteria participated. Comprehensive clinical assessments were carried out including history of early antisocial behavior and maladjustment, self-report questionnaires and an intelligence test. Sixty-three percent of the study group met DSM-IV criteria for childhood ADHD, 43% for ADHD in adulthood, 10% met criteria for an ASD, 6% for Tourette syndrome, and 1% for ID. Twenty-two percent had borderline intellectual functioning. A substantial rate of overlap between the NDDs was found. The combined NDD group had an earlier onset of antisocial behavior, had more aggressive behavior and lower school achievements than the non-NDD group. The results highlight the need for prison and probation services to be attentive of and screen for neurodevelopmental disorders in young violent offenders.
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Affiliation(s)
- Eva Billstedt
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
| | - Henrik Anckarsäter
- Centre for Ethics, Law and Mental Health, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Märta Wallinius
- Forensic Psychiatry, Department of Clinical Sciences, Lund University, Lund, Sweden; Regional Forensic Psychiatric Clinic, Växjö, Sweden
| | - Björn Hofvander
- Lund University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry, Lund, Sweden; Division of Forensic Psychiatry, Region Skåne, Sweden
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Cappe É, Poirier N, Boujut É, Nader-Grosbois N, Dionne C, Boulard A. [Autism spectrum disorder and evaluation of perceived stress parents and professionals: Study of the psychometric properties of a French adaptation of the Appraisal of Life Event Scale (ALES-vf)]. Encephale 2016; 43:321-325. [PMID: 27623118 DOI: 10.1016/j.encep.2016.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 12/07/2015] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Autism and related disorders are grouped into the category of « Autism Spectrum Disorder » (ASD) in the DSM-5. This appellation reflects the idea of a dimensional representation of autism that combines symptoms and characteristics that vary in severity and intensity. Despite common characteristics, there are varying degrees in intensity and in the onset of symptoms, ranging from a disability that can be very heavy with a total lack of communication and major disorders associated with the existence of a relative autonomy associated, sometimes, with extraordinary intellectual abilities. Parents are faced with several difficult situations, such as sleep disturbances, agitation, shouting, hetero violence, self-harm, learning difficulties, stereotyping, lack of social and emotional reciprocity, inappropriate behavior, etc. They can feel helpless and may experience stress related to these developmental and behavioral difficulties. The heterogeneity of symptoms, the presence of behavioral problems, the lack of reciprocity and autonomy also represent a challenge for practitioners in institutions and teachers at school. The objective of this research is to present the validation of a French translation of the Appraisal of Life Events Scale (ALES-vf) from Ferguson, Matthex and Cox, specifically adapted to the context of ASD. ALES was originally developed to operationalize the three dimensions of perceived stress (threat, loss and challenge) described by Lazarus and Folkman. METHODOLOGY ALES-vf was initially translated into French and adapted to the situation of parents of children with ASD. It was subsequently administered to 343 parents, 150 paramedical professionals involved with people with ASD, and 155 teachers from an ordinary school environment and from specialized schools, welcoming in their classroom at least one child with ASD. RESULTS An exploratory factor analysis performed on data from 170 parents highlighted two exploratory models with four and three factors, slightly different from the original three-factor model of Ferguson and his collaborators. Confirmatory analyzes were conducted on data from 173 other parents to test two exploratory models and the original model of Ferguson. It has also been tested on data from 305 professionals (paramedical professionals and teachers) and on the whole sample (parents and professionals). The results suggest a better match of the original three-factor model. In addition, Cronbach's alpha coefficients and inter-item correlations showed a good internal consistency for these three factors. Finally, variance analysis and regressions were performed to test the effect of the nationality of the parents, the child's level of autonomy, the child's level of communication, and on the perceived stress by experienced professionals. CONCLUSION ALES-vf, after our adaptation has good psychometric properties for use not only with parents but also with professionals (teachers, educators, psychologists) working with children with ASD. Our analyses showed that the nationality of the parents does not significantly influence the subscales « threat » and « challenge » of ALES-vf, which makes it usable in other Francophone countries. Specificities in the subscales were identified based on group membership (parents and professionals). For example parents get higher average scores on subscales « loss » and « threat » and a lower average score on the subscale « challenge », compared to professionals. Finally, regarding the specifics found among professionals, the results show that the years of experience have an effect on perceived stress. Specifically, teachers and educators who have more experience perceive their work with children with ASD as a challenge. This is consistent with the results of studies showing that teachers who have had experience with children with ASD had less difficulty in their interventions.
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Affiliation(s)
- É Cappe
- Laboratoire de psychopathologie et processus de santé (LPPS - EA4057), institut de psychologie, université Paris Descartes, Sorbonne Paris Cité, Bureau 4087, 71, avenue Edouard-Vaillant, 92100 Boulogne-Billancourt, France.
| | - N Poirier
- Département de psychologie, université du Québec à Montréal, C.P. 8888 succursale Centre-ville, Montréal, Québec, H3C 3P8 Canada
| | - É Boujut
- Laboratoire de psychopathologie et processus de santé (LPPS - EA4057), institut de psychologie, université Paris Descartes, Sorbonne Paris Cité, Bureau 4087, 71, avenue Edouard-Vaillant, 92100 Boulogne-Billancourt, France
| | - N Nader-Grosbois
- Institut de recherche en sciences psychologiques, université catholique de Louvain, place de l'Université 1, 1348 Louvain, Belgique
| | - C Dionne
- Département de psychoéducation, université du Québec à Trois-Rivières, 3351, boulevard des Forges, Trois-Rivières, QC, G9A 5H7 Canada
| | - A Boulard
- Service de psychologie clinique de l'enfant et de l'adolescent, département de psychologie et cliniques des systèmes humains, université de Liège, place du 20-Août-7, 4000 Liège, Belgique
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18
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De Giacomo A, Craig F, Terenzio V, Coppola A, Campa MG, Passeri G. Aggressive Behaviors and Verbal Communication Skills in Autism Spectrum Disorders. Glob Pediatr Health 2016; 3:2333794X16644360. [PMID: 27336016 PMCID: PMC4905127 DOI: 10.1177/2333794x16644360] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 02/23/2016] [Accepted: 03/08/2016] [Indexed: 12/28/2022] Open
Abstract
Aggressive behavior is a common problem among children with autism spectrum disorder (ASD) and could negatively affect family functioning and school and social competence. The aim of the present study was to investigate the relationship between aggressive behavior, such as self-aggression and other-aggression, with verbal communication ability and IQ level in children with ASD. The sample examined in this study included 88 children with a diagnosis of ASD. For the purposes of our study, much attention was focused on individual items of the Autism Diagnostic Observation Schedule and the Autism Diagnostic Interview–Revised that were useful to evaluate the aggressive behavior. We have not found any association between aggressive behavior (other-aggression and self-aggression) and the absence of language or low IQ in children with ASD. Thus, the degree of severity of autism is probably the most important risk factor for this behavior.
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Abstract
INTRODUCTION For the past two decades, researchers have been using various approaches to investigate the relationship, if any, between autism spectrum disorder (ASD) and violence. The need to clarify that relationship was reinforced by the tragic mass shooting at Sandy Hook Elementary School in Newtown, Connecticut, in December 2012 by an individual diagnosed with Asperger's syndrome. The purpose of this article is (1) to provide an updated review of the literature on the association between ASD and violence, and (2) to examine implications for treating, and for preventing violence by, individuals with ASD. METHOD A review of all published literature regarding ASD and violence from 1943 to 2014 was conducted using electronic and paper searches. RESULTS Although some case reports have suggested an increased violence risk in individuals with ASD compared to the general population, prevalence studies have provided no conclusive evidence to support this suggestion. Among individuals with ASD, however, generative (e.g., comorbid psychopathology, social-cognition deficits, emotion-regulation problems) and associational (e.g., younger age, Asperger's syndrome diagnosis, repetitive behavior) risk factors have been identified or proposed for violent behavior. CONCLUSIONS While no conclusive evidence indicates that individuals with ASD are more violent than those without ASD, specific generative and associational risk factors may increase violence risk among individuals with ASD. Further research would help to clarify or confirm these findings, suggest potential directions for evaluation, treatment, and prevention, and potentially provide compelling empirical support for forensic testimony regarding defendants with ASD charged with violent crimes.
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Affiliation(s)
- David S Im
- From the University of Michigan Medical School and Center for Forensic Psychiatry, Saline, MI
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20
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Roubertoux PL, Carlier M, Tordjman S. Deficit in Social Relationships and Reduced Field of Interest in Mice. ORGANISM MODELS OF AUTISM SPECTRUM DISORDERS 2015. [DOI: 10.1007/978-1-4939-2250-5_14] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Cappe E, Rougé MC, Boujut E. Burnout des professionnels de l’éducation spécialisée intervenant auprès d’individus ayant un trouble du spectre de l’autisme: rôle des antécédents psychosociaux et des processus transactionnels. PSYCHOLOGIE DU TRAVAIL ET DES ORGANISATIONS 2015. [DOI: 10.1016/s1420-2530(16)30013-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Matson JL, Cervantes PE. Assessing aggression in persons with autism spectrum disorders: an overview. RESEARCH IN DEVELOPMENTAL DISABILITIES 2014; 35:3269-3275. [PMID: 25178710 DOI: 10.1016/j.ridd.2014.08.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 08/04/2014] [Indexed: 06/03/2023]
Abstract
Aggression is a commonly co-occurring problem with autism spectrum disorders (ASD). Comorbid aggression can be every bit as debilitating as core symptoms of ASD itself. As a result, careful identification of aggression, the context in which it occurs, and factors that maintain the behavior all have important implications for treatment. As a result, researchers have begun to develop methods and measures to assess aggression among persons with ASD. The purpose of this paper was to review measures that have been used to assess aggression among persons with ASD. We located 25 different assessment methods for both children and adults. The current status and future directions of this area of research are discussed.
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23
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Hill AP, Zuckerman KE, Hagen AD, Kriz DJ, Duvall SW, van Santen J, Nigg J, Fair D, Fombonne E. Aggressive Behavior Problems in Children with Autism Spectrum Disorders: Prevalence and Correlates in a Large Clinical Sample. RESEARCH IN AUTISM SPECTRUM DISORDERS 2014; 8:1121-1133. [PMID: 25221619 PMCID: PMC4160737 DOI: 10.1016/j.rasd.2014.05.006] [Citation(s) in RCA: 124] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Aggressive behavior problems (ABP) are frequent yet poorly understood in children with Autism Spectrum Disorders (ASD) and are likely to co-vary significantly with comorbid problems. We examined the prevalence and sociodemographic correlates of ABP in a clinical sample of children with ASD (N = 400; 2-16.9 years). We also investigated whether children with ABP experience more intensive medical interventions, greater impairments in behavioral functioning, and more severe comorbid problems than children with ASD who do not have ABP. One in four children with ASD had Child Behavior Checklist scores on the Aggressive Behavior scale in the clinical range (T-scores ≥ 70). Sociodemographic factors (age, gender, parent education, race, ethnicity) were unrelated to ABP status. The presence of ABP was significantly associated with increased use of psychotropic drugs and melatonin, lower cognitive functioning, lower ASD severity, and greater comorbid sleep, internalizing, and attention problems. In multivariate models, sleep, internalizing, and attention problems were most strongly associated with ABP. These comorbid problems may hold promise as targets for treatment to decrease aggressive behavior and proactively identify high-risk profiles for prevention.
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Affiliation(s)
- Alison Presmanes Hill
- Center for Spoken Language Understanding, Department of Pediatrics, Oregon Health & Science University, 840 SW Gaines Street, Portland, OR 97239
- Institute on Development and Disability, Oregon Health & Science University, 707 SW Gaines Street, Portland, OR 97239
| | - Katharine E. Zuckerman
- Division of General Pediatrics and Child & Adolescent Health Measurement Initiative, Department of Pediatrics, 707 SW Gaines Street, Oregon Health & Science University, Portland, OR 97239
| | - Arlene D. Hagen
- Institute on Development and Disability, Oregon Health & Science University, 707 SW Gaines Street, Portland, OR 97239
- Department of Psychiatry, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239
| | - Daniel J. Kriz
- Institute on Development and Disability, Oregon Health & Science University, 707 SW Gaines Street, Portland, OR 97239
| | - Susanne W. Duvall
- Institute on Development and Disability, Oregon Health & Science University, 707 SW Gaines Street, Portland, OR 97239
| | - Jan van Santen
- Center for Spoken Language Understanding, Department of Pediatrics, Oregon Health & Science University, 840 SW Gaines Street, Portland, OR 97239
- Institute on Development and Disability, Oregon Health & Science University, 707 SW Gaines Street, Portland, OR 97239
| | - Joel Nigg
- Department of Psychiatry, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239
| | - Damien Fair
- Department of Psychiatry, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239
- Department of Behavioral Neuroscience, Oregon Health & Science University, 3181 SW Sam Jackson Park Road L470, Portland, OR 97239
| | - Eric Fombonne
- Institute on Development and Disability, Oregon Health & Science University, 707 SW Gaines Street, Portland, OR 97239
- Department of Behavioral Neuroscience, Oregon Health & Science University, 3181 SW Sam Jackson Park Road L470, Portland, OR 97239
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Adler BA, Wink LK, Early M, Shaffer R, Minshawi N, McDougle CJ, Erickson CA. Drug-refractory aggression, self-injurious behavior, and severe tantrums in autism spectrum disorders: a chart review study. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2014; 19:102-6. [PMID: 24571823 DOI: 10.1177/1362361314524641] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aggression, self-injurious behavior, and severe tantrums are impairing symptoms frequently experienced by individuals with autism spectrum disorders. Despite US Food and Drug Administration approval of two atypical antipsychotics targeting these symptoms in youth with autistic disorder, they remain frequently drug refractory. We define drug-refractory aggression, self-injurious behavior, and severe tantrums in people with autism spectrum disorders as behavioral symptoms requiring medication adjustment despite previous trials of risperidone and aripiprazole or previous trials of three psychotropic drugs targeting the symptom cluster, one of which was risperidone or aripiprazole. We reviewed the medical records of individuals of all ages referred to our clinic for autism spectrum disorder diagnostic evaluation, as well as pharmacotherapy follow-up notes for all people meeting autism spectrum disorder criteria, for drug-refractory symptoms. Among 250 consecutively referred individuals, 135 met autism spectrum disorder and enrollment criteria, and 53 of these individuals met drug-refractory symptom criteria. Factors associated with drug-refractory symptoms included age 12 years or older (p < 0.0001), diagnosis of autistic disorder (p = 0.0139), and presence of intellectual disability (p = 0.0273). This pilot report underscores the significance of drug-refractory aggression, self-injurious behavior, and severe tantrums; suggests the need for future study clarifying factors related to symptom development; and identifies the need for focused treatment study of this impairing symptom domain.
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Affiliation(s)
| | - Logan K Wink
- Cincinnati Children's Hospital Medical Center, USA
| | - Maureen Early
- Riley Children's Hospital, USA Indiana University School of Medicine, USA
| | - Rebecca Shaffer
- Riley Children's Hospital, USA Indiana University School of Medicine, USA
| | - Noha Minshawi
- Riley Children's Hospital, USA Indiana University School of Medicine, USA
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Farmer C, Butter E, Mazurek MO, Cowan C, Lainhart J, Cook EH, DeWitt MB, Aman M. Aggression in children with autism spectrum disorders and a clinic-referred comparison group. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2014; 19:281-91. [PMID: 24497627 DOI: 10.1177/1362361313518995] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
A gap exists in the literature regarding aggression in autism spectrum disorders and how this behavior compares to other groups. In this multisite study, the Children's Scale for Hostility and Aggression: Reactive/Proactive and the Aggression subscale of the Child Behavior Checklist were rated for 414 children with autism spectrum disorder (autistic disorder, 69%; pervasive developmental disorder not otherwise specified, 24%; Asperger's disorder, 7%) and 243 clinic-referred children without autism spectrum disorder, aged 1-21 years (mean age about 7 years). Participants were not selected for aggressive behavior. Relative to the comparison group, children with autism spectrum disorder were reported to have less aggression and were more likely to be rated as reactive rather than proactive. Among all subjects, sex was not associated with aggression; higher IQ/adaptive behavior and older age were associated with more sophisticated types of aggression, while lower scores on IQ, adaptive behavior, and communication measures were associated with more physical aggression. The interaction between demographic variables and diagnosis was significant only for age: younger but not older children with autism spectrum disorder showed less aggression than clinic-referred controls.
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Affiliation(s)
- Cristan Farmer
- The Ohio State University, USA; National Institute of Mental Health, USA
| | - Eric Butter
- The Ohio State University, USA; Nationwide Children's Hospital, USA
| | | | | | - Janet Lainhart
- University of Utah, USA; University of Wisconsin-Madison, USA
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Smith RS, Sharp J. Fascination and isolation: a grounded theory exploration of unusual sensory experiences in adults with Asperger syndrome. J Autism Dev Disord 2013; 43:891-910. [PMID: 22923038 DOI: 10.1007/s10803-012-1633-6] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Unusual sensory experiences are commonly seen in people with Asperger syndrome (AS). They correlate with functional impairments and cause distress. The current study investigates how these experiences have affected nine adults with AS's lives, as well as the coping strategies utilised. Semi-structured interviews were conducted using Instant Messaging software. Data were analysed using Grounded Theory. A number of inter-related categories and focused codes were identified. The categories included heightened senses, sensory stress, the stress avalanche, moderating factors, coping strategies, other people, self-acceptance, fascination, and isolation. A model was constructed as to how these categories and codes interact. How these findings link with previous research into autism spectrum disorders is discussed. Implications for services and future research are also made.
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Affiliation(s)
- Richard S Smith
- Sheffield Health and Social Care NHS Foundation Trust, St Georges Community Hospital, Winter Street, Sheffield, South Yorkshire, S3 7ND, UK.
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Carter EJ, Williams DL, Minshew NJ, Lehman JF. Is he being bad? Social and language brain networks during social judgment in children with autism. PLoS One 2012; 7:e47241. [PMID: 23082151 PMCID: PMC3474836 DOI: 10.1371/journal.pone.0047241] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Accepted: 09/11/2012] [Indexed: 11/19/2022] Open
Abstract
Individuals with autism often violate social rules and have lower accuracy in identifying and explaining inappropriate social behavior. Twelve children with autism (AD) and thirteen children with typical development (TD) participated in this fMRI study of the neurofunctional basis of social judgment. Participants indicated in which of two pictures a boy was being bad (Social condition) or which of two pictures was outdoors (Physical condition). In the within-group Social-Physical comparison, TD children used components of mentalizing and language networks [bilateral inferior frontal gyrus (IFG), bilateral medial prefrontal cortex (mPFC), and bilateral posterior superior temporal sulcus (pSTS)], whereas AD children used a network that was primarily right IFG and bilateral pSTS, suggesting reduced use of social and language networks during this social judgment task. A direct group comparison on the Social-Physical contrast showed that the TD group had greater mPFC, bilateral IFG, and left superior temporal pole activity than the AD group. No regions were more active in the AD group than in the group with TD in this comparison. Both groups successfully performed the task, which required minimal language. The groups also performed similarly on eyetracking measures, indicating that the activation results probably reflect the use of a more basic strategy by the autism group rather than performance disparities. Even though language was unnecessary, the children with TD recruited language areas during the social task, suggesting automatic encoding of their knowledge into language; however, this was not the case for the children with autism. These findings support behavioral research indicating that, whereas children with autism may recognize socially inappropriate behavior, they have difficulty using spoken language to explain why it is inappropriate. The fMRI results indicate that AD children may not automatically use language to encode their social understanding, making expression and generalization of this knowledge more difficult.
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Affiliation(s)
- Elizabeth J Carter
- Robotics Institute, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA.
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Lacaria M, Spencer C, Gu W, Paylor R, Lupski JR. Enriched rearing improves behavioral responses of an animal model for CNV-based autistic-like traits. Hum Mol Genet 2012; 21:3083-96. [PMID: 22492990 DOI: 10.1093/hmg/dds124] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Potocki-Lupski syndrome (PTLS; MIM #610883), characterized by neurobehavioral abnormalities, intellectual disability and congenital anomalies, is caused by a 3.7-Mb duplication in 17p11.2. Neurobehavioral studies determined that ∼70-90% of PTLS subjects tested positive for autism or autism spectrum disorder (ASD). We previously chromosomally engineered a mouse model for PTLS (Dp(11)17/+) with a duplication of a 2-Mb genomic interval syntenic to the PTLS region and identified consistent behavioral abnormalities in this mouse model. We now report extensive phenotyping with behavioral assays established to evaluate core and associated autistic-like traits, including tests for social abnormalities, ultrasonic vocalizations, perseverative and stereotypic behaviors, anxiety, learning and memory deficits and motor defects. Alterations were identified in both core and associated ASD-like traits. Rearing this animal model in an enriched environment mitigated some, and even rescued selected, neurobehavioral abnormalities, suggesting a role for gene-environment interactions in the determination of copy number variation-mediated autism severity.
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Affiliation(s)
- Melanie Lacaria
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA
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