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Berg J, Sideridis GD, DePillis R, Harstad E. Types and Predictors of Service use Among Young Children Recommended to Receive Intensive Services After Initial Autism Spectrum Disorder Diagnosis. J Autism Dev Disord 2024:10.1007/s10803-024-06454-8. [PMID: 38990372 DOI: 10.1007/s10803-024-06454-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2024] [Indexed: 07/12/2024]
Abstract
Intensive services are recommended for young children with autism spectrum disorder (ASD). Limited research on service receipt in states with mandated ASD-specific service coverage suggests that it remains low, and factors associated with intensity are unclear. Participants were 206 children from the Boston Outcomes of Autism in Toddlers study living in states with autism mandates, diagnosed with ASD through a multidisciplinary consultation at 12-36 months, and recommended to receive at least 20 h of services weekly. Outcome measures were caregiver-reported receipt of total and ASD-specific services within 18 months of ASD diagnosis. Separate negative binomial regression models were run for each outcome, with covariates of child adaptive and cognitive functioning, age, gender, household income, primary insurance, and maternal educational level. The sample was 83% male with a mean age of 24.5 months at ASD diagnosis. Mean Vineland adaptive behavior composite and Bayley cognitive standard scores were 73 and 81, respectively. 90% of children received ASD-specific services. The median intensities for total and ASD-specific services were 22 and 17 h weekly respectively, with 44% of the participants receiving at least 20 h of ASD-specific services weekly. Adjusted regression models found significant associations between lower adaptive scores and increased total and ASD-specific service receipt. Children in insurance-mandated states received a high intensity of intervention after clinical ASD diagnosis. Lower child adaptive functioning was associated with increased service receipt, while socioeconomic factors were not associated. Additional research in other regions and mandate-ineligible populations is needed.
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Affiliation(s)
- Julia Berg
- Division of Developmental Medicine, Boston Children's Hospital, Boston, MA, USA.
| | | | - Rafael DePillis
- Division of Developmental Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Elizabeth Harstad
- Division of Developmental Medicine, Boston Children's Hospital, Boston, MA, USA
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Mazurek MO, Nevill RE, Orlando K, Page K, Howard M, Davis BE. Integration of Family Navigation into ECHO Autism for Pediatric Primary Care in Underserved Communities. J Autism Dev Disord 2024:10.1007/s10803-024-06445-9. [PMID: 38954361 DOI: 10.1007/s10803-024-06445-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2024] [Indexed: 07/04/2024]
Abstract
Children with autism from underserved communities face complex system-, provider-, and family-level barriers to accessing timely diagnosis and early intervention. The current study evaluated the preliminary effects and feasibility of a new program (ECHO Autism LINKS) that integrated pediatric primary care provider (PCP) training with family navigation (FN) to bridge the gaps between screening, referral, and service access. Three cohorts of PCPs (n = 42) participated in the program, which consisted of 60-minute sessions delivered by Zoom twice per month for 12 months. Each session included didactics, case-based learning, and collaborative discussion with participants and an interdisciplinary team of experts. Family navigators were members of the expert team and provided FN services to families referred by PCP participants. Program attendance and engagement were strong, with 40 cases presented and 258 families referred for FN services, most of whom (83%) needed help accessing and connecting with services, and 13% required ongoing support due to complex needs. PCPs demonstrated significant improvements in self-efficacy in providing best-practice care for children with autism, reported high satisfaction, and observed improved knowledge and practice as a result of the program. The results of this initial pilot provide support for the feasibility, acceptability, and preliminary efficacy of the ECHO Autism LINKS program. The model holds promise in addressing complex barriers to healthcare access by providing both PCPs and families with the knowledge and support they need. Future research is needed to evaluate the efficacy and effectiveness of the program in improving child and family outcomes.
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Affiliation(s)
- Micah O Mazurek
- Department of Human Services, School of Education and Human Development, University of Virginia, 417 Emmet Street South, PO Box 400267, Charlottesville, VA, 22904, USA.
| | - Rose E Nevill
- Department of Human Services, School of Education and Human Development, University of Virginia, 417 Emmet Street South, PO Box 400267, Charlottesville, VA, 22904, USA
| | - Karen Orlando
- Department of Human Services, School of Education and Human Development, University of Virginia, 417 Emmet Street South, PO Box 400267, Charlottesville, VA, 22904, USA
| | - Keith Page
- Department of Human Services, School of Education and Human Development, University of Virginia, 417 Emmet Street South, PO Box 400267, Charlottesville, VA, 22904, USA
| | - Mya Howard
- Department of Human Services, School of Education and Human Development, University of Virginia, 417 Emmet Street South, PO Box 400267, Charlottesville, VA, 22904, USA
| | - Beth Ellen Davis
- Division of Neurodevelopmental and Behavioral Pediatrics, Department of Pediatrics, University of Virginia, Charlottesville, VA, USA
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Kaye AD, Allen KE, Smith Iii VS, Tong VT, Mire VE, Nguyen H, Lee Z, Kouri M, Jean Baptiste C, Mosieri CN, Kaye AM, Varrassi G, Shekoohi S. Emerging Treatments and Therapies for Autism Spectrum Disorder: A Narrative Review. Cureus 2024; 16:e63671. [PMID: 39092332 PMCID: PMC11293483 DOI: 10.7759/cureus.63671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Accepted: 07/01/2024] [Indexed: 08/04/2024] Open
Abstract
The prevalence of autism spectrum disorder (ASD) has increased over the last decade. In this regard, many emerging therapies have been described as ASD therapies. Although ASD does not have a cure, there are several management options available that can help reduce symptom severity. ASD is highly variable and, therefore, standard treatment protocols and studies are challenging to perform. Many of these therapies also address comorbidities for which patients with ASD have an increased risk. These concurrent diagnoses can include psychiatric and neurological disorders, including attention deficit and hyperactivity disorder, anxiety disorders, and epilepsy, as well as gastrointestinal symptoms such as chronic constipation and diarrhea. Both the extensive list of ASD-associated disorders and adverse effects from commonly prescribed medications for patients with ASD can impact presenting symptomatology. It is important to keep these potential interactions in mind when considering additional drug treatments or complementary therapies. This review addresses current literature involving novel pharmacological treatments such as oxytocin, bumetanide, acetylcholinesterase inhibitors, and memantine. It also discusses additional therapies such as diet intervention, acupuncture, music therapy, melatonin, and the use of technology to aid education. Notably, several of these therapies require more long-term research to determine efficacy in specific ASD groups within this patient population.
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Affiliation(s)
- Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Kaitlyn E Allen
- School of Medicine, Louisiana State University Health New Orleans School of Medicine, New Orleans, USA
| | - Van S Smith Iii
- School of Medicine, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Victoria T Tong
- School of Medicine, Louisiana State University Health New Orleans School of Medicine, New Orleans, USA
| | - Vivian E Mire
- School of Medicine, Louisiana State University Health New Orleans School of Medicine, New Orleans, USA
| | - Huy Nguyen
- School of Medicine, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Zachary Lee
- School of Medicine, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Maria Kouri
- Anesthesia, National and Kapodistrian University of Athens, Athens, GRC
| | - Carlo Jean Baptiste
- Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Chizoba N Mosieri
- Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Adam M Kaye
- Department of Pharmacy Practice, Thomas J. Long School of Pharmacy, University of the Pacific, Stockton, USA
| | | | - Sahar Shekoohi
- Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
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Uke P, Gaikwad S, Vagha K, Wandile S. Unraveling the Spectrum: A Comprehensive Review of Autism Spectrum Disorder in India. Cureus 2024; 16:e62753. [PMID: 39036210 PMCID: PMC11260197 DOI: 10.7759/cureus.62753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 06/20/2024] [Indexed: 07/23/2024] Open
Abstract
Autism spectrum disorder (ASD) is a complex neurodevelopmental condition characterized by deficits in social interaction, communication difficulties, and repetitive behaviors that profoundly impact the lives of affected individuals and their families. This article provides a comprehensive overview of ASD, focusing on screening, diagnosis, and intervention strategies. Early signs of ASD can manifest in infancy, but parents may not recognize them until their child falls behind in meeting social milestones. This delay in recognition is often due to a lack of awareness, societal stigma, and limited knowledge about developmental and behavioral disorders. Globally, ASD prevalence is increasing potentially due to broader diagnostic criteria, increased awareness, and improved screening practices. Screening for ASD is crucial for early identification and intervention. Various tools are available such as the Modified Checklist for Autism in Toddlers (M-CHATs), Trivandrum Autism Behavioral Checklist (TABC), and the Social Communication Questionnaire (SCQ). Diagnosing ASD involves using established criteria such as the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), and specific diagnostic tools like the Autism Diagnostic Observation Schedule (ADOS) and the Indian Scale for the Assessment of Autism (ISAA). Interventions for ASD should be multidisciplinary, involving professionals such as developmental pediatricians, psychologists, psychiatrists, special educators, occupational therapists, physiotherapists, speech therapists, and social workers. Applied behavior analysis (ABA), naturalistic developmental behavioral interventions (NDBIs), and parent-mediated treatment are among the evidence-based approaches. Additionally, speech-language therapy, motor therapy, and sensory integration therapy play vital roles in addressing the diverse needs of individuals with ASD. Medical interventions should be used alongside behavioral and environmental strategies. Early screening, accurate diagnosis, and tailored interventions are essential for improving the lives of individuals with ASD. A multidisciplinary approach and increased awareness are crucial in addressing the growing prevalence of ASD worldwide.
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Affiliation(s)
- Punam Uke
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Reseach, Wardha, IND
| | - Sarika Gaikwad
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Reseach, Wardha, IND
| | - Keta Vagha
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Reseach, Wardha, IND
| | - Shailesh Wandile
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Reseach, Wardha, IND
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Smith JV, McQuaid GA, Wallace GL, Neuhaus E, Lopez A, Ratto AB, Jack A, Khuu A, Webb SJ, Verbalis A, Pelphrey KA, Kenworthy L. Time is of the essence: Age at autism diagnosis, sex assigned at birth, and psychopathology. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024:13623613241249878. [PMID: 38725306 DOI: 10.1177/13623613241249878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
LAY ABSTRACT Previous research has shown that girls/women are diagnosed later than boys/men with autism. Individuals who are diagnosed later in life, especially girls/women, have greater anxious and depressive symptoms. Previous research has been limited due to narrow inclusionary criteria for enrollment in studies. The present study uses two samples-one clinic-based, large "real-world" sample and another research-based sample with strict criteria for autism diagnosis-to understand the relationships between diagnostic age, sex assigned at birth, and symptoms of anxiety/depression. In both samples, those who were diagnosed later had greater anxious/depressive symptoms, and anxiety was not predicted by sex. In the clinic-based but not research-based sample, those assigned female at birth were diagnosed later than those assigned male at birth. In the clinic-based sample only, individuals assigned female at birth and who were later diagnosed experienced greater symptoms of anxiety/depression compared to those assigned male who benefited from earlier diagnostic timing. Within the research-based sample, those assigned female at birth had greater depressive symptoms than those assigned male. These findings highlight the importance of timely identification of autism, especially for girls/women who are often diagnosed later. Community-based samples are needed to better understand real-world sex-based and diagnostic age-based disparities in mental health.
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Affiliation(s)
- Jessica V Smith
- Children's Research Institute, Children's National Hospital, USA
| | | | - Gregory L Wallace
- Department of Speech, Language, and Hearing Sciences, The George Washington University, USA
| | - Emily Neuhaus
- Center on Child Health, Behavior, and Development, Seattle Children's Research Institute, USA
| | - Andrea Lopez
- Children's Research Institute, Children's National Hospital, USA
| | - Allison B Ratto
- Children's Research Institute, Children's National Hospital, USA
| | - Allison Jack
- Department of Psychology, George Mason University, USA
| | - Alexis Khuu
- Children's Research Institute, Children's National Hospital, USA
| | - Sara J Webb
- Center on Child Health, Behavior, and Development, Seattle Children's Research Institute, USA
| | - Alyssa Verbalis
- Children's Research Institute, Children's National Hospital, USA
| | | | - Lauren Kenworthy
- Children's Research Institute, Children's National Hospital, USA
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Opoku MP, Mustafa A, Anwahi N, Shah H, Aldhaheri S, Almeqbaali A, Alkateri T, Belbase S. Exploring Collaborative Efforts Toward Promoting Better Eating Habits among Autistic Children in the United Arab Emirates. LINACRE QUARTERLY 2024; 91:193-213. [PMID: 38726315 PMCID: PMC11078127 DOI: 10.1177/00243639231156701] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
According to the principle of duty of care, adults in the lives of children with disabilities such as autistic children are expected to promote their development. The Nutbeam's health literacy model was adopted to explore the efforts of special education teachers and parents toward promoting better eating habits among autistic children in the United Arab Emirates (UAE). Twenty-one participants, comprising fifteen special education teachers and six parents with autistic children, were examined in this study. The results indicated that some special education teachers' and parents' limited understanding of unhealthy food might impact the development of autistic children. Furthermore, the findings also highlight the lack of collaboration and communication between teachers regarding the nutrition and healthy living of autistic children. The findings have practical consequences, such as urging UAE health policymakers to provide professional development for special education instructors and parents of autistic children.
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Affiliation(s)
- Maxwell Peprah Opoku
- Special Education Department, United Arab Emirates University, Al-Ain, Abu Zaby, United Arab Emirates
| | - Ashraf Mustafa
- Special Education Department, United Arab Emirates University, Al-Ain, Abu Zaby, United Arab Emirates
| | - Noora Anwahi
- Special Education Department, United Arab Emirates University, Al-Ain, Abu Zaby, United Arab Emirates
| | - Haseena Shah
- Special Education Department, United Arab Emirates University, Al-Ain, Abu Zaby, United Arab Emirates
| | - Salma Aldhaheri
- Special Education Department, United Arab Emirates University, Al-Ain, Abu Zaby, United Arab Emirates
| | - Aysha Almeqbaali
- Special Education Department, United Arab Emirates University, Al-Ain, Abu Zaby, United Arab Emirates
| | - Thara Alkateri
- Special Education Department, United Arab Emirates University, Al-Ain, Abu Zaby, United Arab Emirates
| | - Shashidhar Belbase
- Curriculum and Method of Instruction, United Arab Emirates University, Al-Ain, Abu Dhabi, United Arab Emirates
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KC S, Gupta RK, Kumar A, Khanal B, Lamichhane S, Buhusal A, Sah VP, Bartaula S, Raki IH, Jindal R. Acute intestinal obstruction secondary to ingested foreign body in an adult with autism spectrum disorder: A rare case report and review of literature. Clin Case Rep 2024; 12:e8759. [PMID: 38617069 PMCID: PMC11009455 DOI: 10.1002/ccr3.8759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 03/11/2024] [Accepted: 03/27/2024] [Indexed: 04/16/2024] Open
Abstract
Key Clinical Message Foreign body ingestion is common in pediatric age group however can be found in any age group with intellectual disability and neurodevelopmental delay. There is usually a delay in presentation and interventions following foreign body ingestion in patients with neurodevelopmental delay, leading to increased morbidity, mortality, and complications owing to inability of such patients giving relevant history. Most ingested foreign bodies naturally pass through the digestive tract without untoward effects. Only a few patients may require surgical interventions. Principle of management should be to reduce anxiety among patients and their visitors. Speedy recovery is enhanced so that they can return to their familiar environment soon. Abstract Foreign body ingestion is common in pediatric populations and may be found in any age group with intellectual disability and neurodevelopmental delay. As the patient cannot give a clear and relevant history, there is usually a delay in presentation and interventions following foreign body ingestion in patients with neurodevelopmental delay, leading to increased morbidity, mortality, and complications. Most foreign bodies pass through the digestive system without any complications, and very few require surgical intervention. The goal should be to reduce anxiety among patients and their visitors and to enhance speedy recovery so that they can return to their familiar environment soon. Here we report a case of Acute intestinal obstruction secondary to ingestion of the head portion of a doll which was managed with emergency laparotomy with enterotomy and removal of foreign body in a 16 years female with Autism Spectrum Disorder.
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Affiliation(s)
- Suraj KC
- Department of General SurgeryBPKIHSDharanNepal
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Smith JV, Menezes M, Brunt S, Pappagianopoulos J, Sadikova E, O Mazurek M. Understanding autism diagnosis in primary care: Rates of diagnosis from 2004 to 2019 and child age at diagnosis. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024:13623613241236112. [PMID: 38456360 DOI: 10.1177/13623613241236112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
LAY ABSTRACT The current demand for autism diagnostic services exceeds the ability of the workforce to assess and diagnose children in a timely manner. One solution may be to equip primary care providers (PCPs) with the tools and expertise needed to diagnose autism within their practice. PCPs are often trusted professionals who have many touchpoints with children during early development, in which they can identify early signs of autism. Recent initiatives have focused on bolstering PCPs' diagnostic capabilities; however, no studies have examined how the rates of autism diagnosis in primary care have changed over time. We aimed to evaluate whether autism diagnosis in primary care has changed over time and how diagnosis in primary care relates to a child's age at the time of diagnosis. We found that the likelihood of a child being diagnosed by a PCP decreased by about 2% with every passing year from 2004 to 2019 when accounting for demographic characteristics. In our sample, PCPs diagnosed children approximately 1 year earlier than non-PCPs (e.g., psychologists and psychiatrists). Further research is needed to understand why the proportion of children diagnosed by PCPs decreases over time. However, this decrease suggests more work is needed to get capacity-building initiatives into community primary care practice. Though we must continue to find effective ways to build community PCPs' ability to diagnose autism, the present findings support the crucial role PCPs can play in early autism diagnosis.
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Affiliation(s)
- Jessica V Smith
- Department of Human Services, School of Education and Human Development, University of Virginia, USA
| | - Michelle Menezes
- Department of Human Services, School of Education and Human Development, University of Virginia, USA
| | - Sophie Brunt
- Department of Human Services, School of Education and Human Development, University of Virginia, USA
| | - Jessica Pappagianopoulos
- Department of Human Services, School of Education and Human Development, University of Virginia, USA
| | - Eleonora Sadikova
- Department of Human Services, School of Education and Human Development, University of Virginia, USA
| | - Micah O Mazurek
- Department of Human Services, School of Education and Human Development, University of Virginia, USA
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Zhuang H, Liang Z, Ma G, Qureshi A, Ran X, Feng C, Liu X, Yan X, Shen L. Autism spectrum disorder: pathogenesis, biomarker, and intervention therapy. MedComm (Beijing) 2024; 5:e497. [PMID: 38434761 PMCID: PMC10908366 DOI: 10.1002/mco2.497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 01/27/2024] [Accepted: 01/30/2024] [Indexed: 03/05/2024] Open
Abstract
Autism spectrum disorder (ASD) has become a common neurodevelopmental disorder. The heterogeneity of ASD poses great challenges for its research and clinical translation. On the basis of reviewing the heterogeneity of ASD, this review systematically summarized the current status and progress of pathogenesis, diagnostic markers, and interventions for ASD. We provided an overview of the ASD molecular mechanisms identified by multi-omics studies and convergent mechanism in different genetic backgrounds. The comorbidities, mechanisms associated with important physiological and metabolic abnormalities (i.e., inflammation, immunity, oxidative stress, and mitochondrial dysfunction), and gut microbial disorder in ASD were reviewed. The non-targeted omics and targeting studies of diagnostic markers for ASD were also reviewed. Moreover, we summarized the progress and methods of behavioral and educational interventions, intervention methods related to technological devices, and research on medical interventions and potential drug targets. This review highlighted the application of high-throughput omics methods in ASD research and emphasized the importance of seeking homogeneity from heterogeneity and exploring the convergence of disease mechanisms, biomarkers, and intervention approaches, and proposes that taking into account individuality and commonality may be the key to achieve accurate diagnosis and treatment of ASD.
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Affiliation(s)
- Hongbin Zhuang
- College of Life Science and OceanographyShenzhen UniversityShenzhenP. R. China
| | - Zhiyuan Liang
- College of Life Science and OceanographyShenzhen UniversityShenzhenP. R. China
| | - Guanwei Ma
- College of Life Science and OceanographyShenzhen UniversityShenzhenP. R. China
| | - Ayesha Qureshi
- College of Life Science and OceanographyShenzhen UniversityShenzhenP. R. China
| | - Xiaoqian Ran
- College of Life Science and OceanographyShenzhen UniversityShenzhenP. R. China
| | - Chengyun Feng
- Maternal and Child Health Hospital of BaoanShenzhenP. R. China
| | - Xukun Liu
- College of Life Science and OceanographyShenzhen UniversityShenzhenP. R. China
| | - Xi Yan
- College of Life Science and OceanographyShenzhen UniversityShenzhenP. R. China
| | - Liming Shen
- College of Life Science and OceanographyShenzhen UniversityShenzhenP. R. China
- Shenzhen‐Hong Kong Institute of Brain Science‐Shenzhen Fundamental Research InstitutionsShenzhenP. R. China
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Shamabadi A, Karimi H, Arabzadeh Bahri R, Motavaselian M, Akhondzadeh S. Emerging drugs for the treatment of irritability associated with autism spectrum disorder. Expert Opin Emerg Drugs 2024; 29:45-56. [PMID: 38296815 DOI: 10.1080/14728214.2024.2313650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/30/2024] [Indexed: 02/02/2024]
Abstract
INTRODUCTION Autism spectrum disorder (ASD) is an early-onset disorder with a prevalence of 1% among children and reported disability-adjusted life years of 4.31 million. Irritability is a challenging behavior associated with ASD, for which medication development has lagged. More specifically, pharmacotherapy effectiveness may be limited against high adverse effects (considering side effect profiles and patient medication sensitivity); thus, the possible benefits of pharmacological interventions must be balanced against potential adverse events in each patient. AREAS COVERED After reviewing the neuropathophysiology of ASD-associated irritability, the benefits and tolerability of emerging medications in its treatment based on randomized controlled trials were detailed in light of mechanisms and targets of action. EXPERT OPINION Succeeding risperidone and aripiprazole, monotherapy with memantine may be beneficial. In addition, N-acetylcysteine, galantamine, sulforaphane, celecoxib, palmitoylethanolamide, pentoxifylline, simvastatin, minocycline, amantadine, pregnenolone, prednisolone, riluzole, propentofylline, pioglitazone, and topiramate, all adjunct to risperidone, and clonidine and methylphenidate outperformed placebo. These effects were through glutamatergic, γ-aminobutyric acidergic, inflammatory, oxidative, cholinergic, dopaminergic, and serotonergic systems. All medications were reported to be safe and tolerable. Considering sample size, follow-up, and effect size, further studies are necessary. Along with drug development, repositioning and combining existing drugs supported by the mechanism of action is recommended.
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Affiliation(s)
- Ahmad Shamabadi
- Psychiatric Research Center, Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hanie Karimi
- Psychiatric Research Center, Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Razman Arabzadeh Bahri
- Psychiatric Research Center, Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Shahin Akhondzadeh
- Psychiatric Research Center, Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Eroglu M, Efendi GY, Temelturk RD, Yaksi N. Living on with autism after a devastating earthquake: experiences of children and adolescents in Turkey. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2024; 70:766-776. [PMID: 38983491 PMCID: PMC11229709 DOI: 10.1080/20473869.2023.2301184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 12/23/2023] [Indexed: 07/11/2024]
Abstract
Introduction The current study aimed to investigate the psychological impact of the Turkey 2023 earthquakes on children with autism spectrum disorder (ASD) and their parents residing in Hatay, Sanlıurfa, and Ankara provinces, encompassing the periods both before and after the Turkey 2023 earthquakes. Method This cross-sectional, multicenter study included 103 children and adolescents with ASD aged between 6 and 18. Participants were evaluated based on their residence in Ankara, Hatay, and Sanlıurfa, three cities affected differently by the earthquake. Parent-report questionnaires were utilized to assess the children's autism symptoms and behavioural problems. The Childhood Autism Rating Scale was used to determine autism severity. The psychiatric problems of mothers were also assessed with self-report scales. Results Significantly increased levels of core autism symptoms, irritability, and hyperactivity were found in Hatay and Sanlıurfa participants after the earthquakes compared to before, while no differences were detected in children from the Ankara group. Scale score increases in the Hatay group, which had to take a more extended break from special education, were higher than in the Sanlıurfa group. Participants with late-diagnosed ASD exhibited a more significant increase in their scale scores after the earthquake. Depression, stress and hopelessness scores were the highest, and the life satisfaction levels were the lowest in mothers of the Hatay and Sanlıurfa groups. More pronounced increases were observed in aberrant behaviours among children of mothers with low educational levels following the earthquake. Discussion Our findings demonstrate that the exacerbation of core ASD symptoms and behavioural deterioration after the earthquakes are associated with disruptions in specialized education services, exposure to earthquake-related trauma, and the educational level of mothers.
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Affiliation(s)
- Mehtap Eroglu
- Department of Child and Adolescent Psychiatry, Hatay Training and Research Hospital, Hatay, Turkey
| | - Gokce Yagmur Efendi
- Department of Child and Adolescent Psychiatry, Sanlıurfa Mehmet Akif Inan Training and Research Hospital, Sanlıurfa, Turkey
| | - Rahime Duygu Temelturk
- Department of Child and Adolescent Psychiatry, Ankara University School of Medicine, Ankara, Turkey
| | - Nese Yaksi
- Department of Public Health, Amasya University School of Medicine, Amasya, Turkey
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Murphy AN, Moskowitz K, Fernandez F, Risser HJ. Perceived Parent Needs for Improving Parent Participation in School-Based Therapies for Children with Disabilities Using the Parent-Therapist Partnership Survey. J Autism Dev Disord 2024:10.1007/s10803-024-06282-w. [PMID: 38393438 DOI: 10.1007/s10803-024-06282-w] [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: 02/10/2024] [Indexed: 02/25/2024]
Abstract
Rehabilitative and habilitative therapies can help children with disabilities increase independence and overall wellbeing. However, children and their caregivers face many barriers to accessing these therapies and often rely on the school for therapy access. Given the limited resources available within the special education system, increasing parent involvement in special education therapies could improve service delivery. However, providers must first understand what parents need to participate in therapies before attempting to engage families. 217 parents completed an online survey consisting of the Parent-Therapist Partnership Survey and demographic questionnaires about theirfamiliesand their child[ren] with disabilities. The percentage of needs parents endorsed as important and thepercentageofimportantneedsendorsedasunmetwere calculated. Differences across demographic variables were assessed. Overall, parents reported an average of 75% of needs as important with significantly more needs endorsed as important regarding being an informed, engaged member of the child's care team (M = 83%) than needs related to support and guidance (M = 65%, p < 0.001). Furthermore, parentsreportedan average of 58% of important needs as unmet, with no significant differences in subscale averages. Significant associations were found for race/ethnicity, education, income, partner availability, number of children with disabilities in the household, transportation access, neighborhood opportunities, parent efficacy and social, emotional, and behavioral concerns. Parents reported a high percentage of needs as important, but a large percentage of these important needs were considered unmet. Significant disparities based on racial/ethnic identities and access to resources were found. In order to successfully engage parents in special education therapy activities, providers must work to understand and address parents' engagement needs, paying special attention to each family's unique circumstances to optimize engagement.
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Affiliation(s)
- Ashley N Murphy
- Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 710 N. Lake Shore Drive, Suite 1200, Chicago, IL, 60611, USA.
| | - Kathleen Moskowitz
- Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 710 N. Lake Shore Drive, Suite 1200, Chicago, IL, 60611, USA
| | - Francesca Fernandez
- Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 710 N. Lake Shore Drive, Suite 1200, Chicago, IL, 60611, USA
| | - Heather J Risser
- Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 710 N. Lake Shore Drive, Suite 1200, Chicago, IL, 60611, USA
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13
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Islam A, Ronco A, Becker SM, Blackburn J, Schittny JC, Kim K, Stein-Wexler R, Wexler AS. Can lung airway geometry be used to predict autism? A preliminary machine learning-based study. Anat Rec (Hoboken) 2024; 307:457-469. [PMID: 37771211 DOI: 10.1002/ar.25332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 09/13/2023] [Accepted: 09/18/2023] [Indexed: 09/30/2023]
Abstract
The goal of this study is to assess the feasibility of airway geometry as a biomarker for autism spectrum disorder (ASD). Chest computed tomography images of children with a documented diagnosis of ASD as well as healthy controls were identified retrospectively. Fifty-four scans were obtained for analysis, including 31 ASD cases and 23 controls. A feature selection and classification procedure using principal component analysis and support vector machine achieved a peak cross validation accuracy of nearly 89% using a feature set of eight airway branching angles. Sensitivity was 94%, but specificity was only 78%. The results suggest a measurable difference in airway branching angles between children with ASD and the control population.
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Affiliation(s)
- Asef Islam
- Department of Computer Science, Stanford University, Stanford, California, USA
| | - Anthony Ronco
- Department of Radiology, University of California, Davis, California, USA
| | - Stephen M Becker
- Department of Mechanical and Aerospace Engineering, University of California, Davis, California, USA
| | - Jeremiah Blackburn
- Department of Mechanical and Aerospace Engineering, University of California, Davis, California, USA
| | - Johannes C Schittny
- Institute of Anatomy, University of Bern, Bern, Switzerland
- Center for Health and the Environment, University of California, Davis, California, USA
| | - Kyoungmi Kim
- Department of Public Health Science, University of California, Davis, California, USA
| | | | - Anthony S Wexler
- Department of Mechanical and Aerospace Engineering, University of California, Davis, California, USA
- Department of Civil and Environmental Engineering, University of California, Davis, California, USA
- Department of Land, Air and Water Resources, University of California, Davis, California, USA
- Air Quality Research Center, University of California, Davis, California, USA
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14
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Rodnyy AY, Kondaurova EM, Tsybko AS, Popova NK, Kudlay DA, Naumenko VS. The brain serotonin system in autism. Rev Neurosci 2024; 35:1-20. [PMID: 37415576 DOI: 10.1515/revneuro-2023-0055] [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: 05/12/2023] [Accepted: 06/10/2023] [Indexed: 07/08/2023]
Abstract
Autism spectrum disorders (ASDs) are among the most common neurodevelopmental diseases. These disorders are characterized by lack of social interaction, by repetitive behavior, and often anxiety and learning disabilities. The brain serotonin (5-HT) system is known to be crucially implicated in a wide range of physiological functions and in the control of different kinds of normal and pathological behavior. A growing number of studies indicate the involvement of the brain 5-HT system in the mechanisms underlying both ASD development and ASD-related behavioral disorders. There are some review papers describing the role of separate key players of the 5-HT system in an ASD and/or autistic-like behavior. In this review, we summarize existing data on the participation of all members of the brain 5-HT system, namely, 5-HT transporter, tryptophan hydroxylase 2, MAOA, and 5-HT receptors, in autism in human and various animal models. Additionally, we describe the most recent studies involving modern techniques for in vivo regulation of gene expression that are aimed at identifying exact roles of 5-HT receptors, MAOA, and 5-HT transporter in the mechanisms underlying autistic-like behavior. Altogether, results of multiple research articles show that the brain 5-HT system intimately partakes in the control of some types of ASD-related behavior, and that specific changes in a function of a certain 5-HT receptor, transporter, and/or enzyme may normalize this aberrant behavior. These data give hope that some of clinically used 5-HT-related drugs have potential for ASD treatment.
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Affiliation(s)
- Alexander Ya Rodnyy
- Federal Research Center Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences, Akad. Lavrentyeva Ave. 10, Novosibirsk 630090, Russia
| | - Elena M Kondaurova
- Federal Research Center Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences, Akad. Lavrentyeva Ave. 10, Novosibirsk 630090, Russia
| | - Anton S Tsybko
- Federal Research Center Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences, Akad. Lavrentyeva Ave. 10, Novosibirsk 630090, Russia
| | - Nina K Popova
- Federal Research Center Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences, Akad. Lavrentyeva Ave. 10, Novosibirsk 630090, Russia
| | - Dmitry A Kudlay
- NRC Institute of Immunology FMBA of Russia, Kashirskoe Highway 24, Moscow 115522, Russia
- Sechenov's University, 8-2 Trubetskaya Str., Moscow 119991, Russia
| | - Vladimir S Naumenko
- Federal Research Center Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences, Akad. Lavrentyeva Ave. 10, Novosibirsk 630090, Russia
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15
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Gonçalves CL, Doifode T, Rezende VL, Costa MA, Rhoads JM, Soutullo CA. The many faces of microbiota-gut-brain axis in autism spectrum disorder. Life Sci 2024; 337:122357. [PMID: 38123016 DOI: 10.1016/j.lfs.2023.122357] [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: 09/20/2023] [Revised: 12/02/2023] [Accepted: 12/13/2023] [Indexed: 12/23/2023]
Abstract
The gut-brain axis is gaining more attention in neurodevelopmental disorders, especially autism spectrum disorder (ASD). Many factors can influence microbiota in early life, including host genetics and perinatal events (infections, mode of birth/delivery, medications, nutritional supply, and environmental stressors). The gut microbiome can influence blood-brain barrier (BBB) permeability, drug bioavailability, and social behaviors. Developing microbiota-based interventions such as probiotics, gastrointestinal (GI) microbiota transplantation, or metabolite supplementation may offer an exciting approach to treating ASD. This review highlights that RNA sequencing, metabolomics, and transcriptomics data are needed to understand how microbial modulators can influence ASD pathophysiology. Due to the substantial clinical heterogeneity of ASD, medical caretakers may be unlikely to develop a broad and effective general gut microbiota modulator. However, dietary modulation followed by administration of microbiota modulators is a promising option for treating ASD-related behavioral and gastrointestinal symptoms. Future work should focus on the accuracy of biomarker tests and developing specific psychobiotic agents tailored towards the gut microbiota seen in ASD patients, which may include developing individualized treatment options.
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Affiliation(s)
- Cinara L Gonçalves
- Graduate Program in Health Sciences, University of Southern Santa Catarina (UNESC), Criciúma, SC, Brazil.
| | - Tejaswini Doifode
- Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health (UTHealth), Houston, TX, USA
| | - Victoria L Rezende
- Graduate Program in Health Sciences, University of Southern Santa Catarina (UNESC), Criciúma, SC, Brazil
| | - Maiara A Costa
- Graduate Program in Health Sciences, University of Southern Santa Catarina (UNESC), Criciúma, SC, Brazil
| | - J Marc Rhoads
- Department of Pediatrics, Division of Pediatric Gastroenterology, McGovern Medical School, The University of Texas Health (UTHealth), Houston, TX, USA
| | - Cesar A Soutullo
- Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health (UTHealth), Houston, TX, USA
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16
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Beversdorf DQ, Ferguson B, Hunter S, Hirst K, Lolli B, Bellesheim KR, Barton AU, Muckerman J, Takahashi N, Selders K, Holem R, Sohl K, Dyke P, Stichter J, Mazurek M, Kanne S. Randomized controlled trial of propranolol on social communication and anxiety in children and young adults with autism spectrum disorder. Psychopharmacology (Berl) 2024; 241:19-32. [PMID: 38086927 DOI: 10.1007/s00213-023-06452-1] [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: 09/15/2022] [Accepted: 08/18/2023] [Indexed: 01/09/2024]
Abstract
RATIONALE Autism spectrum disorder (ASD) is characterized by impaired social communication and is also frequently characterized by co-occurring anxiety. Propranolol is widely utilized to treat performance and public speaking anxiety. Single-dose psychopharmacological challenge studies suggested benefits using propranolol for verbal tasks and social interaction. OBJECTIVE We conducted a double-blinded, placebo-controlled trial of the β-adrenergic antagonist propranolol in ASD for social interaction, anxiety, and language. METHODS Seventy-four participants with ASD, age 7-24 years, were enrolled and randomized to a 12-week course of propranolol or placebo, with blinded assessments at baseline, 6 weeks, and 12 weeks. The primary outcome was the General Social Outcome Measure-2 (GSOM-2) for social interaction, and secondary outcomes were the Clinician Global Clinical Impression-Improvement (CGI-I) ratings independently conducted for social interaction, anxiety, and language at 6 weeks and 12 weeks. RESULTS Sixty-nine participants completed the 12-week visit. No significant effect of drug was found for the GSOM-2 or the CGI-I for social interaction or language. CGI-I for anxiety showed greater improvement with propranolol at the 12-week time point (p = 0.045, odds ratio = 2.58 (95% CI = 1.02-6.52). Expected decreases in heart rate and blood pressure were observed with propranolol, and side effects were uncommon. CONCLUSIONS Propranolol did not impact social interaction measures or language, but there were indications of a beneficial effect for anxiety. This will need confirmation in a larger multicenter trial, monitoring markers or characteristics to identify those participants most likely to respond to propranolol for anxiety, and determine whether there is a subset of participants that are responsive for other previously reported outcomes.
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Affiliation(s)
- David Q Beversdorf
- Thompson Center for Autism & Neurodevelopmental Disorders, University of Missouri, One Hospital Drive, Columbia, MO, DC069.1065212, USA.
- Departments of Radiology, Neurology, and Psychological Sciences, University of Missouri, Columbia, USA.
- William and Nancy Thompson Endowed Chair in Radiology, University of Missouri, Columbia, USA.
| | - Bradley Ferguson
- Thompson Center for Autism & Neurodevelopmental Disorders, University of Missouri, One Hospital Drive, Columbia, MO, DC069.1065212, USA
- Department of Neurology, University of Missouri, Columbia, USA
| | - Samantha Hunter
- Thompson Center for Autism & Neurodevelopmental Disorders, University of Missouri, One Hospital Drive, Columbia, MO, DC069.1065212, USA
| | - Kathy Hirst
- Thompson Center for Autism & Neurodevelopmental Disorders, University of Missouri, One Hospital Drive, Columbia, MO, DC069.1065212, USA
| | - Bridget Lolli
- Thompson Center for Autism & Neurodevelopmental Disorders, University of Missouri, One Hospital Drive, Columbia, MO, DC069.1065212, USA
| | | | - Amy U Barton
- Northwest Missouri State University, Maryville, USA
| | - Julie Muckerman
- Thompson Center for Autism & Neurodevelopmental Disorders, University of Missouri, One Hospital Drive, Columbia, MO, DC069.1065212, USA
| | - Nicole Takahashi
- Thompson Center for Autism & Neurodevelopmental Disorders, University of Missouri, One Hospital Drive, Columbia, MO, DC069.1065212, USA
| | - Kimberly Selders
- Thompson Center for Autism & Neurodevelopmental Disorders, University of Missouri, One Hospital Drive, Columbia, MO, DC069.1065212, USA
| | - Ryan Holem
- Thompson Center for Autism & Neurodevelopmental Disorders, University of Missouri, One Hospital Drive, Columbia, MO, DC069.1065212, USA
- University of Missouri School of Medicine, Columbia, USA
| | - Kristin Sohl
- Deparment of Child Health, University of Missouri, Columbia, USA
| | - Peter Dyke
- Deparment of Child Health, University of Missouri, Columbia, USA
| | - Janine Stichter
- Department of Special Education, University of Missouri, Columbia, USA
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17
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Ciorba A, Fancello V, Sacchet B, Borin M, Malagutti N, Bianchini C, Stomeo F, Pelucchi S. Acute mastoiditis in cochlear implanted children: A single-centre experience. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2024; 75:17-22. [PMID: 37722656 DOI: 10.1016/j.otoeng.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 04/12/2023] [Indexed: 09/20/2023]
Abstract
BACKGROUND Acute mastoiditis (AM) is the most common complication of acute otitis media and primarily affects children under the age of two; current data on its prevalence in paediatric patients with cochlear implant (CI) are still scant. Proper management of AM in CI children is crucial in order to avoid the implications (financial and emotional) of an explant. Aim of this paper is to describe the cases of AM occurred among young patients with CI in follow up at our department, also in order to evaluate its prevalence, potential predisposing factors, clinical course and therapeutic strategies. PATIENTS AND METHODS Retrospective study. Medical records of all paediatric patients with CI, who had at least one year of follow-up, were searched aiming to identify those who developed AM, from January 1st 2002 to January 31st 2022. The following data were collected and analysed: demographic features, implant type and side, interval between CI surgery and AM, treatment, laboratory tests, clinical course, vaccination history, associated diseases. RESULTS AM was developed by six (1.3%) of the 439 children with CI (541 implanted ears). In total, 9 episodes (2.05 %) were recorded, as three patients reported two consecutive infections. Average time interval between CI surgery, to the first or only AM diagnosis, was 13.8 months (range 3-30 months). Furthermore, 3/6 of patients had a history of recurrent acute otitis media; 2/6 an autism spectrum disorder, associated to a combined immune deficiency in one case. All patients were hospitalized and promptly treated by intravenous antibiotic therapy; 4/6 also underwent a mastoidectomy. CI was not explanted in any cases of this series. CONCLUSIONS Over a 20-year period, AM rate in CI children was 1.3%, which is consistent with the current literature rates of 1-4.7%. All cases were successfully treated, preserving the integrity of the device. In our experience, the early parenteral antibiotic therapy and, when necessary, surgical treatment were adequate to eradicate the infection.
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Affiliation(s)
- Andrea Ciorba
- ENT & Audiology Unit, Department of Neurosciences, University Hospital of Ferrara, 44121 Ferrara, Italy
| | - Virginia Fancello
- ENT & Audiology Unit, Department of Neurosciences, University Hospital of Ferrara, 44121 Ferrara, Italy.
| | - Beatrice Sacchet
- ENT & Audiology Unit, Department of Neurosciences, University Hospital of Ferrara, 44121 Ferrara, Italy
| | - Michela Borin
- ENT & Audiology Unit, Department of Neurosciences, University Hospital of Ferrara, 44121 Ferrara, Italy
| | - Nicola Malagutti
- ENT & Audiology Unit, Department of Neurosciences, University Hospital of Ferrara, 44121 Ferrara, Italy
| | - Chiara Bianchini
- ENT & Audiology Unit, Department of Neurosciences, University Hospital of Ferrara, 44121 Ferrara, Italy
| | - Francesco Stomeo
- ENT & Audiology Unit, Department of Neurosciences, University Hospital of Ferrara, 44121 Ferrara, Italy
| | - Stefano Pelucchi
- ENT & Audiology Unit, Department of Neurosciences, University Hospital of Ferrara, 44121 Ferrara, Italy
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18
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Sommer M, Glaser B, Soldini E, Weber P, Ramelli GP. Age at initial diagnosis of autism spectrum disorders: a retrospective comparison of screening techniques between the southern and northwestern regions of Switzerland. Swiss Med Wkly 2023; 153:40131. [PMID: 38037847 DOI: 10.57187/smw.2023.40131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023] Open
Abstract
AIMS Early diagnosis of autism spectrum disorders (ASD) offers the possibility of early intervention and, in turn, gains in adaptive behaviour, language and cognition. The aim of the present study was to analyse whether age at diagnosis of autism spectrum disorders decreased in two regions of Switzerland from 2006 to 2016 following the implementation of different screening and referral techniques. In southern Switzerland, systematic paediatric screening using the Modified Checklist for Autism (M-CHAT) in toddlers was implemented in 2013, whereas in northwestern Switzerland, periodic trainings were used to increase paediatrician awareness of ASD. We investigated which method was associated with a younger average age at diagnosis. METHODS We conducted a retrospective, two-centre study searching clinical records of children and adolescents (aged 0-16 years) diagnosed with ASD in two neuropaediatric departments at Swiss hospitals between January 2006 and December 2016. All patients were diagnosed via a standardised evaluation based on two approved diagnostic tests: the Autism Diagnostic Observation Schedule-Second Edition (ADOS-2) and the Autism Diagnostic Interview-Revised (ADI-R). RESULTS In southern Switzerland, training and subsequent widespread use of the M-CHAT among paediatricians appeared to contribute to a significantly younger age at diagnosis. Age at diagnosis did not significantly decrease during the same period in northwestern Switzerland. CONCLUSION Our results point to the possibility of successfully reducing age at diagnosis in specific geographic areas through the implementation of screening questionnaires, such as the M-CHAT, at year 2 well-baby visits.
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Affiliation(s)
- Michael Sommer
- Department of Paediatric Neurology and Developmental Medicine, University of Basel, Children's Hospital, Basel, Switzerland
| | - Bronwyn Glaser
- Neuropediatrics Unit, Paediatric Institute of Southern Switzerland, EOC, Bellinzona, Switzerland
| | - Emiliano Soldini
- Competence Centre for Healthcare Practices and Policies, Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland
| | - Peter Weber
- Department of Paediatric Neurology and Developmental Medicine, University of Basel, Children's Hospital, Basel, Switzerland
| | - Gian Paolo Ramelli
- Neuropediatrics Unit, Paediatric Institute of Southern Switzerland, EOC, Bellinzona, Switzerland
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Goyal T, Kalra N, Tyagi R, Khatri A, Sabherwal P, Yangdol P. Evidence-based analysis of multi-pronged approaches for education and behavior management of autistic patients in a dental setting. SPECIAL CARE IN DENTISTRY 2023; 43:856-868. [PMID: 37080902 DOI: 10.1111/scd.12867] [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: 02/23/2022] [Revised: 01/09/2023] [Accepted: 04/10/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Autism spectrum disorder is a neurodevelopmental condition which has posed a challenge to carers, pediatricians and dentists through the years. Over the last four decades, the disorder has been better understood and management techniques have evolved. In the field of dentistry, the autistic child presents difficulty in management, even for the simplest dental procedures. A comprehensive understanding of other psychoeducational and behavioral approaches to manage autism is very important. This article aims to introduce various important key techniques such as Applied Behavior Analysis, TEACCH, Sensory Adapted Dental Environment, Picture Exchange Communication System, and Animal Assisted Therapy and analyze their application in dentistry. METHODS A search of literature was carried out in Clinicaltrials.gov, Medline and Scopus with the search terms "Applied Behavior Analysis," "TEACCH," "Sensory Adapted Dental Environment," "Picture Exchange Communication System," and "Animal Assisted Therapy" along with "autism OR autistic," "dental OR dentistry OR oral health." After the screening for inclusion and exclusion criteria, 10 eligible articles were included, in English, published within the last 10 years. RESULTS Limited research was available regarding these lesser-known behavioral approaches in dentistry. The few that were available showed encouraging results. The different techniques proved useful in increasing acceptance of dental treatment and reducing behavioral disturbances. The patients experienced reduced dental anxiety, lesser discomfort, improved communication, and knowledge. CONCLUSION Pediatric and special care dentists are likely to benefit by incorporating the recommended comprehensive behavior management techniques in their practice. There is evidence that these techniques will reduce behavioral disturbances in autistic children thereby making primary dental care possible without the need for sedation or general anesthesia.
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Affiliation(s)
- Tavisha Goyal
- Department of Pedodontics and Preventive Dentistry, University College of Medical Sciences, Guru Teg Bahadur Hospital, University of Delhi, Delhi, India
| | - Namita Kalra
- Department of Pedodontics and Preventive Dentistry, University College of Medical Sciences, Guru Teg Bahadur Hospital, University of Delhi, Delhi, India
| | - Rishi Tyagi
- Department of Pedodontics and Preventive Dentistry, University College of Medical Sciences, Guru Teg Bahadur Hospital, University of Delhi, Delhi, India
| | - Amit Khatri
- Department of Pedodontics and Preventive Dentistry, University College of Medical Sciences, Guru Teg Bahadur Hospital, University of Delhi, Delhi, India
| | - Puja Sabherwal
- Department of Pedodontics and Preventive Dentistry, University College of Medical Sciences, Guru Teg Bahadur Hospital, University of Delhi, Delhi, India
| | - Padma Yangdol
- Department of Pedodontics and Preventive Dentistry, University College of Medical Sciences, Guru Teg Bahadur Hospital, University of Delhi, Delhi, India
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20
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Yılmaz Z, Al-Taie A. A cross-sectional study of community pharmacists' self-reported disease knowledge and competence in the treatment of childhood autism spectrum disorder. Int J Clin Pharm 2023; 45:1088-1097. [PMID: 36547799 DOI: 10.1007/s11096-022-01530-4] [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: 08/02/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Autism spectrum disorder (ASD) is a neurodevelopmental disease that can cause significant social, communication, and behavioural challenges. Given the rising prevalence of autism and multiple medication use, healthcare professionals, including community pharmacists, are required to have sufficient ASD knowledge to affect positively the disease prognosis and related comorbidities. AIM To assess community pharmacists' knowledge of disease and pharmacotherapy of ASD, along with the provision of patient education and counselling provided by, community pharmacists in Turkey. METHOD This was a descriptive, cross-sectional study conducted among community pharmacists in Turkey using a structured, validated questionnaire to assess ASD knowledge, awareness, and the provision of patient education and counselling by community pharmacists. RESULTS 486 community pharmacists were included, with a mean age of 39.69 ± 13.10 years, and most (n = 151, 31.1%) in the age range between 20 and 29 years. 96.3% of community pharmacists never had training about ASD. 32.9% of the participants were aware of the medicines for ASD treatment, and 25.7% were aware of the drugs' side effects. The mean overall knowledge about childhood autism among health workers questionnaire (KCAHW) score was 11.83 ± 3.91, and there was a statistically significant KCAHW score difference between other pharmacists and those with ASD training (p = 0.006). CONCLUSION There is a lack of disease and pharmacotherapy knowledge about childhood ASD among Turkish community pharmacists, particularly about communication impairment, type, onset, and comorbidities, as well as poor knowledge about drug pharmacotherapy and patient counselling services. This potentially creates a barrier to the adequate provision of healthcare to autistic patients.
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Affiliation(s)
- Zekiye Yılmaz
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Acıbadem Mehmet Ali Aydınlar, Kayışdağı Cad. No: 32, Ataşehir, 34758, Istanbul, Turkey.
| | - Anmar Al-Taie
- Department of Clinical Pharmacy, Faculty of Pharmacy, Istinye University, Istanbul, Turkey
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21
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Hirst K, Zamzow RM, Stichter JP, Beversdorf DQ. A Pilot Feasibility Study Assessing the Combined Effects of Early Behavioral Intervention and Propranolol on Autism Spectrum Disorder (ASD). CHILDREN (BASEL, SWITZERLAND) 2023; 10:1639. [PMID: 37892301 PMCID: PMC10605265 DOI: 10.3390/children10101639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 09/20/2023] [Accepted: 09/27/2023] [Indexed: 10/29/2023]
Abstract
Autism spectrum disorder (ASD), a neurodevelopmental disorder typified by differences in social communication as well as restricted and repetitive behaviors, is often responsive to early behavioral intervention. However, there is limited information on whether such intervention can be augmented with pharmacological approaches. We conducted a double-blinded, placebo-controlled feasibility trial to examine the effects of the β-adrenergic antagonist propranolol combined with early intensive behavioral intervention (EIBI) for children with ASD. Nine participants with ASD, ages three to ten, undergoing EIBI were enrolled and randomized to a 12-week course of propranolol or placebo. Blinded assessments were conducted at baseline, 6 weeks, and 12 weeks. The primary outcome measures focusing on social interaction were the General Social Outcome Measure-2 (GSOM-2) and Social Responsiveness Scale-Second Edition (SRS-2). Five participants completed the 12-week visit. The sample size was insufficient to evaluate the treatment efficacy. However, side effects were infrequent, and participants were largely able to fully participate in the procedures. Conducting a larger clinical trial to investigate propranolol's effects on core ASD features within the context of behavioral therapy will be beneficial, as this will advance and individualize combined therapeutic approaches to ASD intervention. This initial study helps to understand feasibility constraints on performing such a study.
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Affiliation(s)
- Kathy Hirst
- Thompson Center for Autism and Neurodevelopment, University of Missouri, Columbia, MO 65211, USA; (K.H.); (J.P.S.)
| | - Rachel M. Zamzow
- Interdisciplinary Neuroscience Program, University of Missouri, Columbia, MO 65211, USA;
| | - Janine P. Stichter
- Thompson Center for Autism and Neurodevelopment, University of Missouri, Columbia, MO 65211, USA; (K.H.); (J.P.S.)
| | - David Q. Beversdorf
- Thompson Center for Autism and Neurodevelopment, University of Missouri, Columbia, MO 65211, USA; (K.H.); (J.P.S.)
- Interdisciplinary Neuroscience Program, University of Missouri, Columbia, MO 65211, USA;
- Departments of Radiology, Neurology, and Psychological Sciences, William and Nancy Thompson Endowed Chair in Radiology, University of Missouri, Columbia, MO 65211, USA
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22
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Black B, Hunter S, Cottrell H, Dar R, Takahashi N, Ferguson BJ, Valter Y, Porges E, Datta A, Beversdorf DQ. Remotely supervised at-home delivery of taVNS for autism spectrum disorder: feasibility and initial efficacy. Front Psychiatry 2023; 14:1238328. [PMID: 37840787 PMCID: PMC10568329 DOI: 10.3389/fpsyt.2023.1238328] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 09/14/2023] [Indexed: 10/17/2023] Open
Abstract
Background Transcutaneous auricular vagus nerve stimulation (taVNS) has potential clinical application for autism spectrum disorder (ASD). At-home sessions are necessary to allow delivery of repeated sessions, and remove burden on patients for daily visits, and reduce costs of clinic delivery. Our objective was to validate a protocol for remote supervised administration for home delivery of taVNS using specially designed equipment and platform. Methods An open-label design was followed involving administration by caretakers to 12 patients with ASD (ages:7-16). Daily 1-h sessions over 2 weeks were administered under remote supervision. The primary outcome was feasibility, which was assessed by completion rate, stimulation tolerability, and confirmation of programmed stimulation delivery. The secondary measures were initial efficacy assessed by Childhood Anxiety Sensitivity Index-Revised (CASI-R), Parent Rated Anxiety Scale for Youth with ASD (PRAS-ASD), and Clinician Global Impression (CGI) scales. Sleep measures were also tracked using Cleveland Adolescent Sleep Questionnaire (CASQ). Results Across 132 sessions, we obtained an 88.5% completion rate. A total of 22 expected adverse events were reported with headache being the most common followed by transient pain, itchiness, and stinging at the electrode site. One subject dropped out of the study unrelated to the stimulation or the study. Average scores of anxiety (CASI-R, PRAS-ASD, and CGI) and sleepiness (CASQ) were all improved at the 2 week time point. While not powered to determine efficacy, benefits were suggested in this open label pilot. Conclusion Remotely supervised, proxy-administered, at-home delivery of taVNS is feasible in patients with ASD. Initial efficacy supports pursuing larger scale trials.
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Affiliation(s)
- Benjamin Black
- Department of Pediatrics, Thompson Center for Autism and Neurodevelopment, University of Missouri, Columbia, MO, United States
| | - Samantha Hunter
- Department of Pediatrics, Thompson Center for Autism and Neurodevelopment, University of Missouri, Columbia, MO, United States
| | - Hannah Cottrell
- Department of Pediatrics, Thompson Center for Autism and Neurodevelopment, University of Missouri, Columbia, MO, United States
| | - Roee Dar
- School of Medicine, University of Missouri, Columbia, MO, United States
| | - Nicole Takahashi
- Department of Pediatrics, Thompson Center for Autism and Neurodevelopment, University of Missouri, Columbia, MO, United States
| | - Bradley J. Ferguson
- Department of Neurology, Thompson Center for Autism and Neurodevelopment, University of Missouri, Columbia, MO, United States
| | - Yishai Valter
- Research and Development, Soterix Medical, Woodbridge, NJ, United States
| | - Eric Porges
- Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, Gainesville, FL, United States
- Brain Rehabilitation Research Center, Malcom Randall VAMC, Gainesville, FL, United States
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States
| | - Abhishek Datta
- Research and Development, Soterix Medical, Woodbridge, NJ, United States
- Department of Biomedical Engineering, City College of New York, New York, NY, United States
| | - David Q. Beversdorf
- Department of Radiology, Neurology, and Psychological Sciences, and the Thompson Center for Autism and Neurodevelopment, University of Missouri-Columbia, Columbia, MO, United States
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Mendez MA, Oakley B, Canitano R, San José-Cáceres A, Tinelli M, Knapp M, Cusack J, Parellada M, Violland P, Derk Plas JR, Canal-Bedia R, Bejarano-Martin A, Murphy DG, Quoidbach V, Arango C. Autism care pathway in Europe. Eur Psychiatry 2023; 66:e81. [PMID: 37694810 PMCID: PMC10594203 DOI: 10.1192/j.eurpsy.2023.2435] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 04/24/2023] [Accepted: 05/01/2023] [Indexed: 09/12/2023] Open
Abstract
BACKGROUND Autism is a lifelong complex neurodevelopmental condition that affects brain development and behaviour with significant consequences for everyday life. Despite its personal, familial, and societal impact, Europe-wide harmonised guidelines are still lacking for early detection, diagnosis, and intervention, leading to an overall unsatisfactory autistic person and carer journey. METHODS The care pathway for autistic children and adolescents was analysed in Italy, Spain and the UK from the perspective of carers (using a survey aimed at caregivers of autistic children 0-18 years old), the autistic community, and professionals in order to identify major barriers (treatment gaps) preventing carers from receiving information, support, and timely screening/diagnosis and intervention. RESULTS Across all three countries, analysis of the current care pathway showed: long waits from the time carers raised their first concerns about a child's development and/or behaviour until screening and confirmed diagnosis; delayed or no access to intervention once a diagnosis was confirmed; limited information about autism and how to access early detection services; and deficient support for families throughout the journey. CONCLUSIONS These findings call for policy harmonisation in Europe to shorten long wait times for diagnosis and intervention and therefore, improve autistic people and their families' journey experience and quality of life.
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Affiliation(s)
- Maria A. Mendez
- Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- CIBERSAM (Mental Health Networking Biomedical Research Centre), Madrid, Spain
| | - Bethany Oakley
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- AIMS-2-TRIALS consortium
| | | | - Antonia San José-Cáceres
- Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- CIBERSAM (Mental Health Networking Biomedical Research Centre), Madrid, Spain
- AIMS-2-TRIALS consortium
| | - Michela Tinelli
- Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Martin Knapp
- Department of Health Policy, London School of Economics and Political Science, London, UK
| | | | - Mara Parellada
- Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- CIBERSAM (Mental Health Networking Biomedical Research Centre), Madrid, Spain
- AIMS-2-TRIALS consortium
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- School of Medicine, Universidad Complutense, Madrid, Spain
| | | | | | | | | | - Declan G.M. Murphy
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- AIMS-2-TRIALS consortium
| | | | - Celso Arango
- Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- CIBERSAM (Mental Health Networking Biomedical Research Centre), Madrid, Spain
- AIMS-2-TRIALS consortium
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- School of Medicine, Universidad Complutense, Madrid, Spain
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24
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Di Sarro R, Varrucciu N, Di Santantonio A, Natali F, Kaleci S, Bianco A, Cappai M, Lucchi F, Bertelli MO. Appropriateness of psychopharmacological therapies to psychiatric diagnoses in persons with autism spectrum disorder with or without intellectual disabilities: a cross-sectional analytic study. Expert Opin Drug Saf 2023; 22:1271-1281. [PMID: 36681385 DOI: 10.1080/14740338.2023.2172396] [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: 09/26/2022] [Revised: 12/06/2022] [Accepted: 12/09/2022] [Indexed: 01/23/2023]
Abstract
BACKGROUND Observational studies highlighted high rates of psychotropic medication in persons with autistic spectrum disorder (ASD) with or without intellectual disability, which seems to be associated with the management of problem behaviors more than co-occurrent psychiatric disorders. The purpose of the study is to investigate psychopharmacology use and diagnoses of co-occurrent psychiatric disorder (PD) in persons with ASD attending a public mental health service in Emilia Romagna, Italy. METHODS The present study is a multicenter, cross-sectional study. RESULTS 275 persons out of 486 (56.5%) resulted to receive at least one psychotropic drug, compared to 74 persons (15.2%) that were diagnosed with a PD. 63.6% were on poly-pharmacotherapy (2-10 compounds), with 37.8% receiving 3 or more medications. Antipsychotics were the most frequently prescribed class of psychotropic drugs (89%), followed by antiepileptics/mood stabilizers/lithium (42.1%) and anxiolytics (BDZ) (38.5%). Most common psychiatric disorders were psychotic disorders (29.7%), followed by anxiety disorders (17.5%), bipolar disorders (12.2%), and depressive disorders (9.4%). CONCLUSIONS Our findings support earlier research showing that many individuals with ASD receive pharmacotherapy without being diagnosed with a co-occurring psychiatric disorder, indicating that the main reasons for prescription and the type of compound frequently have little to no link with specific psychopathology.
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Affiliation(s)
- Rita Di Sarro
- Health and Disability Integrated Program, Public Local Health Bologna, Italy
| | - Niccolò Varrucciu
- Health and Disability Integrated Program, Public Local Health Bologna, Italy
| | - Anna Di Santantonio
- Health and Disability Integrated Program, Public Local Health Bologna, Italy
| | - Francesca Natali
- Health and Disability Integrated Program, Public Local Health Bologna, Italy
| | - Shaniko Kaleci
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Annamaria Bianco
- CREA (Research and Clinical Centre), San Sebastiano Foundation, Misericordia di Firenze, Florence, Italy
| | - Michela Cappai
- Emilia-Romagna Region, Mental Health and Pathological Addictions, Italy
| | - F Lucchi
- Department of Mental Health and Pathological Addictions, Public Local Health Bologna, Italy
| | - Marco O Bertelli
- CREA (Research and Clinical Centre), San Sebastiano Foundation, Misericordia di Firenze, Florence, Italy
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25
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Roberts MD, Christiansen A, O'Hagan B, Jansen E, Augustyn M. Developmentally-Trained Primary Care Clinicians: A Pipeline to Improved Access? J Dev Behav Pediatr 2023; 44:e350-e357. [PMID: 37205730 DOI: 10.1097/dbp.0000000000001178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 01/09/2023] [Indexed: 05/21/2023]
Abstract
OBJECTIVE The purpose of this study is to decrease wait time and improve access to developmental-behavioral pediatric (DBP) evaluation in children 4 years of age and younger as part of a quality improvement (QI) initiative in an urban safety-net hospital. METHODS A primary care pediatrician received DBP minifellowship training 6 hours per week for 1 year to become a developmentally-trained primary care clinician (DT-PCC). DT-PCCs then conducted developmental evaluations that consisted of using a Childhood Autism Rating Scale and Brief Observation of Symptoms of Autism to evaluate children 4 years and younger referred within the practice. Baseline standard practice involved a 3-visit model: DBP advanced practice clinician (DBP-APC) intake visit, neurodevelopmental evaluation by a developmental-behavioral pediatrician (DBP), and feedback by a developmental-behavioral pediatrician. Two QI cycles were completed to streamline the referral and evaluation process. RESULTS Seventy patients with a mean age of 29.5 months were seen. The average days to initial developmental assessment decreased from 135.3 days to 67.9 days with a streamlined referral to the DT-PCC. Of the 43 patients who required further evaluation by a DBP, the average days to developmental assessment reduced from 290.1 to 120.4 days. CONCLUSION Developmentally-trained primary care clinicians allowed for earlier access to developmental evaluations. Further research should explore how DT-PCCs can improve access to care and treatment for children with developmental delays.
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Affiliation(s)
- Mona Doss Roberts
- Boston University School of Medicine, Boston, MA
- Boston Medical Center, Boston, MA
- Department of Pediatrics, University School of Medicine, Boston Medical Center, Boston, MA
| | - Audrey Christiansen
- Boston University School of Medicine, Boston, MA
- Boston Medical Center, Boston, MA
- Department of Pediatrics, University School of Medicine, Boston Medical Center, Boston, MA
| | - Belinda O'Hagan
- Boston Medical Center, Boston, MA
- Department of Pediatrics, University School of Medicine, Boston Medical Center, Boston, MA
| | - Emily Jansen
- Boston University School of Medicine, Boston, MA
- Department of Quality and Patient Safety, Boston, MA
| | - Marilyn Augustyn
- Boston University School of Medicine, Boston, MA
- Boston Medical Center, Boston, MA
- Department of Pediatrics, University School of Medicine, Boston Medical Center, Boston, MA
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26
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Yin B, Li H, Zhao P, Zhao Y, Zheng R, Feng P, Xu C, Li E, Li L. GM1 Reduced the Symptoms of Autism Spectrum Disorder by Suppressing α-Syn Through Activating Autophagy. J Mol Neurosci 2023; 73:287-296. [PMID: 37084025 DOI: 10.1007/s12031-023-02110-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 02/24/2023] [Indexed: 04/22/2023]
Abstract
Autism spectrum disorder (ASD) is a neurodevelopmental disorder that cannot be cured. The ASD rat model was developed in this study to demonstrate the role and mechanism of ganglioside GM1 (GM1). Rats were given valproic acid (VPA) to create the ASD rat model. The rats' behaviors were assessed using the Y-maze test, open-field test, three-chamber social interaction test, and Morris water maze test. Relative levels of glutathione (GSH), malondialdehyde (MDA), catalase (CAT), reactive oxygen species (ROS), and superoxide dismutase (SOD) were quantitated using relative kits. Nissl, TUNEL, immunofluorescent, and immunohistochemistry staining techniques were used. GM1 treatment improved the ASD model rats' behavior disorders, including locomotor activity and exploratory behavior, social interaction, learning and memory capacity, and repetitive behavior. Following GM1 injection, striatal neurons grew and apoptosis decreased. GM1 reduced the excessively elevated α-Syn in ASD by encouraging autophagy. The behavior disorder of ASD model rats was exacerbated by autophagy inhibition, which also increased α-Syn levels. By increasing autophagy, GM1 reduced α-Syn levels and, ultimately, improved behavioral abnormalities in ASD model rats.
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Affiliation(s)
- Baoqi Yin
- Department of Children Rehabilitation, The Fifth Affiliated Hospital of Zhengzhou University, No.3 Rehabilitation Street, Zhengzhou, 450052, People's Republic of China
| | - Honglei Li
- Department of Children Rehabilitation, The Fifth Affiliated Hospital of Zhengzhou University, No.3 Rehabilitation Street, Zhengzhou, 450052, People's Republic of China
| | - Pengju Zhao
- Department of Children Rehabilitation, The Fifth Affiliated Hospital of Zhengzhou University, No.3 Rehabilitation Street, Zhengzhou, 450052, People's Republic of China
| | - Yonghong Zhao
- Department of Children Rehabilitation, The Fifth Affiliated Hospital of Zhengzhou University, No.3 Rehabilitation Street, Zhengzhou, 450052, People's Republic of China
| | - Ruijuan Zheng
- Department of Children Rehabilitation, The Fifth Affiliated Hospital of Zhengzhou University, No.3 Rehabilitation Street, Zhengzhou, 450052, People's Republic of China
| | - Pengya Feng
- Department of Children Rehabilitation, The Fifth Affiliated Hospital of Zhengzhou University, No.3 Rehabilitation Street, Zhengzhou, 450052, People's Republic of China
| | - Cuixiang Xu
- Department of Children Rehabilitation, The Fifth Affiliated Hospital of Zhengzhou University, No.3 Rehabilitation Street, Zhengzhou, 450052, People's Republic of China
| | - Enyao Li
- Department of Children Rehabilitation, The Fifth Affiliated Hospital of Zhengzhou University, No.3 Rehabilitation Street, Zhengzhou, 450052, People's Republic of China.
| | - Liguo Li
- Department of Rehabilitation Medicine, Zhengzhou Health Vocational College, No. 69 Jingxiang Road, Zhengzhou, 450000, People's Republic of China.
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27
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Alban AQ, Alhaddad AY, Al-Ali A, So WC, Connor O, Ayesh M, Ahmed Qidwai U, Cabibihan JJ. Heart Rate as a Predictor of Challenging Behaviours among Children with Autism from Wearable Sensors in Social Robot Interactions. ROBOTICS 2023. [DOI: 10.3390/robotics12020055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Abstract
Children with autism face challenges in various skills (e.g., communication and social) and they exhibit challenging behaviours. These challenging behaviours represent a challenge to their families, therapists, and caregivers, especially during therapy sessions. In this study, we have investigated several machine learning techniques and data modalities acquired using wearable sensors from children with autism during their interactions with social robots and toys in their potential to detect challenging behaviours. Each child wore a wearable device that collected data. Video annotations of the sessions were used to identify the occurrence of challenging behaviours. Extracted time features (i.e., mean, standard deviation, min, and max) in conjunction with four machine learning techniques were considered to detect challenging behaviors. The heart rate variability (HRV) changes have also been investigated in this study. The XGBoost algorithm has achieved the best performance (i.e., an accuracy of 99%). Additionally, physiological features outperformed the kinetic ones, with the heart rate being the main contributing feature in the prediction performance. One HRV parameter (i.e., RMSSD) was found to correlate with the occurrence of challenging behaviours. This work highlights the importance of developing the tools and methods to detect challenging behaviors among children with autism during aided sessions with social robots.
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Affiliation(s)
- Ahmad Qadeib Alban
- Department of Computer Science and Engineering, Qatar University, Doha P.O. Box 2713, Qatar
| | - Ahmad Yaser Alhaddad
- Department of Mechanical and Industrial Engineering, Qatar University, Doha P.O. Box 2713, Qatar
| | - Abdulaziz Al-Ali
- Department of Computer Science and Engineering, Qatar University, Doha P.O. Box 2713, Qatar
- KINDI Computing Research Center, Qatar University, Doha P.O. Box 2713, Qatar
| | - Wing-Chee So
- Department of Educational Psychology, Faculty of Education, The Chinese University of Hong Kong, New Territories, Hong Kong
| | - Olcay Connor
- Step by Step Centre for Special Needs, Doha P.O. Box 47613, Qatar
| | - Malek Ayesh
- Department of Computer Science and Engineering, Qatar University, Doha P.O. Box 2713, Qatar
| | - Uvais Ahmed Qidwai
- Department of Computer Science and Engineering, Qatar University, Doha P.O. Box 2713, Qatar
| | - John-John Cabibihan
- Department of Mechanical and Industrial Engineering, Qatar University, Doha P.O. Box 2713, Qatar
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28
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Petretto DR, Lucarelli L, Farris P, Penna V, Valinotti S, Pietro CG, Gaviano L, Berti R, Pili L, Zolo B, Pili R. Children with autism spectrum disorders and severe visual impairments: Some general principles for intervention according to the perspective of clinical psychology of disability. J Public Health Res 2023; 12:22799036231166314. [PMID: 37035448 PMCID: PMC10074621 DOI: 10.1177/22799036231166314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 03/10/2023] [Indexed: 04/05/2023] Open
Abstract
In the last decades, an increasing number of researchers addressed the relationship between autism spectrum disorders (ASD) and severe visual impairment (SVI) (like blindness or very low visual acuity) and nowadays autism could be considered one of the most reported coexisting developmental disorders in children with blindness or other severe visual impairment. As ASD and SVI’ signs and symptoms affect functioning and quality of life and different domains of functioning of children with this comorbidity, it is very important to support individuals and their families as soon as possible in the cycle of life and to promote specific interventions aimed to promote developmental potential of everyone with both ASD and VI, based on the unique balance between strengths, needs and abilities of everyone. Children and individuals with SVI and ASD and SVI are a very heterogeneous group, both about the areas of social interaction, communication, and behaviour, as well as about visual abilities and about all the other aspects of their neuropsychological and functional profiles that are influenced by their visual impairments itself, their ASD itself and the combination of them. In this paper, we aim to discuss some general principles useful to design and to develop specific interventions and to promote inclusion of children with ASD and SVI.
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Affiliation(s)
- Donatella Rita Petretto
- Department of Education, Psychology and Philosophy – University of Cagliari, Cagliari, Italy
| | - Loredana Lucarelli
- Department of Education, Psychology and Philosophy – University of Cagliari, Cagliari, Italy
| | | | | | | | - Carrogu Gian Pietro
- Department of Education, Psychology and Philosophy – University of Cagliari, Cagliari, Italy
| | - Luca Gaviano
- Department of Education, Psychology and Philosophy – University of Cagliari, Cagliari, Italy
| | - Roberta Berti
- Department of Education, Psychology and Philosophy – University of Cagliari, Cagliari, Italy
| | - Lorenzo Pili
- Department of Education, Psychology and Philosophy – University of Cagliari, Cagliari, Italy
| | | | - Roberto Pili
- IERFOP Onlus, Cagliari, Italy
- Comunità Mondiale della Longevità, Cagliari, Italy
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29
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Garikipati A, Ciobanu M, Singh NP, Barnes G, Decurzio J, Mao Q, Das R. Clinical Outcomes of a Hybrid Model Approach to Applied Behavioral Analysis Treatment. Cureus 2023; 15:e36727. [PMID: 36998917 PMCID: PMC10047423 DOI: 10.7759/cureus.36727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2023] [Indexed: 03/29/2023] Open
Abstract
Objective This study examines the implementation of a hybrid applied behavioral analysis (ABA) treatment model to determine its impact on autism spectrum disorder (ASD) patient outcomes. Methods Retrospective data were collected for 25 pediatric patients to measure progress before and after the implementation of a hybrid ABA treatment model under which therapists consistently captured session notes electronically regarding goals and patient progress. ABA treatment was streamlined for consistent delivery, with improved software utilization for tracking scheduling and progress. Eleven goals within three domains (behavioral, social, and communication) were examined. Results After the implementation of the hybrid model, the goal success rate improved by 9.7% compared to the baseline; 41.8% of goals showed improvement, 38.4% showed a flat trend, and 19.8% showed deterioration. Multiple goals trended upwards in 76% of the patients. Conclusion This pilot study demonstrated that enhancing the consistency with which ABA treatment is monitored/delivered can improve patient outcomes as seen through improved attainment of goals.
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30
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Kral TVE, O’Malley L, Johnson K, Benvenuti T, Chittams J, Quinn RJ, Thomas JG, Pinto-Martin JA, Levy SE, Kuschner ES. Effects of a mobile health nutrition intervention on dietary intake in children who have autism spectrum disorder. Front Pediatr 2023; 11:1100436. [PMID: 36873654 PMCID: PMC9975727 DOI: 10.3389/fped.2023.1100436] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 01/19/2023] [Indexed: 02/17/2023] Open
Abstract
Background Children who have Autism Spectrum Disorder (ASD) show preferences for processed foods, such as salty and sugary snacks (SSS) and sugar-sweetened beverages (SSB), while healthier foods, such as fruits and vegetables (FV), are consumed less. Innovative tools are needed that can efficiently disseminate evidence-based interventions and engage autistic children to improve their diet. Aim The aim of this 3-month randomized trial was to test the initial efficacy of a mobile health (mHealth) nutrition intervention on changing consumption of targeted healthy (FV) and less healthy foods/beverages (SSS, SSB) in children who have ASD, ages 6-10, who were picky eaters. Methods Thirty-eight parent-child dyads were randomly assigned to either an intervention (technology) group or a wait list control (education) group. The intervention included behavioral skills training, a high level of personalization for dietary goals, and involved parents as "agents of change." Parents in the education group received general nutrition education and the dietary goals but did not receive skills training. Children's intake was assessed at baseline and at 3 months using 24-hour dietary recalls. Results While there were no significant group-by-time interactions (P > 0.25) for any of the primary outcomes, we found a significant main effect of time for FV intake (P = 0.04) indicating that both groups consumed more FV at 3 months (2.58 ± 0.30 servings/day) than at baseline (2.17 ± 0.28 servings/day; P = 0.03). Children in the intervention group who consumed few FV at baseline and showed high engagement with the technology increased their FV intake by 1.5 servings/day (P < 0.01). Children's taste/smell sensitivity significantly predicted their FV intake (P = 0.0446); for each unit of lower taste/smell sensitivity (indicating greater sensory processing abnormalities), FV intake increased by 0.13 ± 0.1 servings/day. Discussion This mHealth intervention did not yield significant between-group differences for changing consumption of targeted foods/beverages. Only children who consumed few FV at baseline and highly engaged with the technology increased their FV intake at 3 months. Future research should test additional strategies to expand the intervention's impact on a wider range of foods while also reaching a broader group of children who have ASD. This trial was registered at clinicaltrials.gov as NCT03424811.Clinical Trial Registration: This study was registered at clinicaltrials.gov as NCT03424811.
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Affiliation(s)
- Tanja V. E. Kral
- Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Lauren O’Malley
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Kelsey Johnson
- CHDI Management/CHDI Foundation, Princeton, NJ, United States
| | | | - Jesse Chittams
- Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
| | - Ryan J. Quinn
- Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
| | - J. Graham Thomas
- Weight Control and Diabetes Research Center, Brown University School of Medicine and The Miriam Hospital, Providence, RI, United States
| | - Jennifer A. Pinto-Martin
- Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Susan E. Levy
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Emily S. Kuschner
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Departments of Psychiatry and Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, United States
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31
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Pai Khot AJ, Choudhury AR, Ankola AV, Sankeshwari RM, Hampiholi V, Hebbal M, Jalihal S, Kumar RS, Kabra L, Kotha SL. Evaluation of a "Picture Assisted Illustration Reinforcement" (PAIR) System for Oral Hygiene in Children with Autism: A Double-Blind Randomized Controlled Trial. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020369. [PMID: 36832499 PMCID: PMC9955023 DOI: 10.3390/children10020369] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 02/02/2023] [Accepted: 02/08/2023] [Indexed: 02/16/2023]
Abstract
This study evaluated the potential of a novel pre-validated "Picture Assisted Illustration Reinforcement" (PAIR) communication system and conventional verbal techniques for Oral Health Education (OHE) in terms of dentition status, gingival health, oral hygiene status, and practices in 7- to 18-year-old children with Autism Spectrum Disorder (ASD). A double-blind randomized controlled trial was undertaken in a school for children with autism from July to September 2022. A total of 60 children were randomly assigned into two groups: a PAIR group (n = 30) and a Conventional group (n = 30). Cognition and pre-evaluation of all the children were assessed by standardized scaling measures. A pre-validated closed-ended questionnaire was administered to caregivers of both groups. At a 12-week post-intervention, a clinical examination was performed using the World Health Organization (WHO) Oral Health Assessment form 2013, gingival and Oral Hygiene Index Simplified (OHI-S). The gingival scores in the PAIR group (0.35 ± 0.12) exhibited a statistically significant decline in scores as compared to Conventional group (0.83 ± 0.37), p = 0.043. Meanwhile, the oral hygiene scores in the PAIR group and Conventional group were 1.22 ± 0.14 and 1.94 ± 0.15, respectively (p < 0.05). A significant improvement in oral hygiene practices was observed in the PAIR group. Incorporating the PAIR technique resulted in significant progress in child cognitive ability and adaptive behavior, which reduced gingival scores and improved oral hygiene scores, consequently improving oral hygiene practices among children with ASD.
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Affiliation(s)
- Atrey J. Pai Khot
- Department of Public Health Dentistry, KLE VK Institute of Dental Sciences, KLE Academy of Higher Education and Research (KLE University), Belagavi 590010, Karnataka, India
| | - Abhra Roy Choudhury
- Department of Public Health Dentistry, KLE VK Institute of Dental Sciences, KLE Academy of Higher Education and Research (KLE University), Belagavi 590010, Karnataka, India
| | - Anil V. Ankola
- Department of Public Health Dentistry, KLE VK Institute of Dental Sciences, KLE Academy of Higher Education and Research (KLE University), Belagavi 590010, Karnataka, India
| | - Roopali M. Sankeshwari
- Department of Public Health Dentistry, KLE VK Institute of Dental Sciences, KLE Academy of Higher Education and Research (KLE University), Belagavi 590010, Karnataka, India
| | - Vinuta Hampiholi
- Department of Periodontics, KLE VK Institute of Dental Sciences, KLE Academy of Higher Education and Research (KLE University), Belagavi 590010, Karnataka, India
| | - Mamata Hebbal
- Department of Preventive Dental Sciences, College of Dentistry, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia
| | - Sagar Jalihal
- Department of Public Health Dentistry, KLE VK Institute of Dental Sciences, KLE Academy of Higher Education and Research (KLE University), Belagavi 590010, Karnataka, India
| | - Ram Surath Kumar
- Department of Public Health Dentistry, KLE VK Institute of Dental Sciences, KLE Academy of Higher Education and Research (KLE University), Belagavi 590010, Karnataka, India
| | - Laxmi Kabra
- Department of Public Health Dentistry, KLE VK Institute of Dental Sciences, KLE Academy of Higher Education and Research (KLE University), Belagavi 590010, Karnataka, India
| | - Sree Lalita Kotha
- Department of Basic Dental Sciences, College of Dentistry, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia
- Correspondence: ; Tel.: +966-11-8234922
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Liu BM, Paskov K, Kent J, McNealis M, Sutaria S, Dods O, Harjadi C, Stockham N, Ostrovsky A, Wall DP. Racial and Ethnic Disparities in Geographic Access to Autism Resources Across the US. JAMA Netw Open 2023; 6:e2251182. [PMID: 36689227 PMCID: PMC9871799 DOI: 10.1001/jamanetworkopen.2022.51182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 11/22/2022] [Indexed: 01/24/2023] Open
Abstract
Importance While research has identified racial and ethnic disparities in access to autism services, the size, extent, and specific locations of these access gaps have not yet been characterized on a national scale. Mapping comprehensive national listings of autism health care services together with the prevalence of autistic children of various races and ethnicities and evaluating geographic regions defined by localized commuting patterns may help to identify areas within the US where families who belong to minoritized racial and ethnic groups have disproportionally lower access to services. Objective To evaluate differences in access to autism health care services among autistic children of various races and ethnicities within precisely defined geographic regions encompassing all serviceable areas within the US. Design, Setting, and Participants This population-based cross-sectional study was conducted from October 5, 2021, to June 3, 2022, and involved 530 965 autistic children in kindergarten through grade 12. Core-based statistical areas (CBSAs; defined as areas containing a city and its surrounding commuter region), the Civil Rights Data Collection (CRDC) data set, and 51 071 autism resources (collected from October 1, 2015, to December 18, 2022) geographically distributed into 912 CBSAs were combined and analyzed to understand variation in access to autism health care services among autistic children of different races and ethnicities. Six racial and ethnic categories (American Indian or Alaska Native, Asian, Black or African American, Hispanic or Latino, Native Hawaiian or other Pacific Islander, and White) assigned by the US Department of Education were included in the analysis. Main Outcomes and Measures A regularized least-squares regression analysis was used to measure differences in nationwide resource allocation between racial and ethnic groups. The number of autism resources allocated per autistic child was estimated based on the child's racial and ethnic group. To evaluate how the CBSA population size may have altered the results, the least-squares regression analysis was run on CBSAs divided into metropolitan (>50 000 inhabitants) and micropolitan (10 000-50 000 inhabitants) groups. A Mann-Whitney U test was used to compare the model estimated ratio of autism resources to autistic children among specific racial and ethnic groups comprising the proportions of autistic children in each CBSA. Results Among 530 965 autistic children aged 5 to 18 years, 83.9% were male and 16.1% were female; 0.7% of children were American Indian or Alaska Native, 5.9% were Asian, 14.3% were Black or African American, 22.9% were Hispanic or Latino, 0.2% were Native Hawaiian or other Pacific Islander, 51.7% were White, and 4.2% were of 2 or more races and/or ethnicities. At a national scale, American Indian or Alaska Native autistic children (β = 0; 95% CI, 0-0; P = .01) and Hispanic autistic children (β = 0.02; 95% CI, 0-0.06; P = .02) had significant disparities in access to autism resources in comparison with White autistic children. When evaluating the proportion of autistic children in each racial and ethnic group, areas in which Black autistic children (>50% of the population: β = 0.05; <50% of the population: β = 0.07; P = .002) or Hispanic autistic children (>50% of the population: β = 0.04; <50% of the population: β = 0.07; P < .001) comprised greater than 50% of the total population of autistic children had significantly fewer resources than areas in which Black or Hispanic autistic children comprised less than 50% of the total population. Comparing metropolitan vs micropolitan CBSAs revealed that in micropolitan CBSAs, Black autistic children (β = 0; 95% CI, 0-0; P < .001) and Hispanic autistic children (β = 0; 95% CI, 0-0.02; P < .001) had the greatest disparities in access to autism resources compared with White autistic children. In metropolitan CBSAs, American Indian or Alaska Native autistic children (β = 0; 95% CI, 0-0; P = .005) and Hispanic autistic children (β = 0.01; 95% CI, 0-0.06; P = .02) had the greatest disparities compared with White autistic children. Conclusions and Relevance In this study, autistic children from several minoritized racial and ethnic groups, including Black and Hispanic autistic children, had access to significantly fewer autism resources than White autistic children in the US. This study pinpointed the specific geographic regions with the greatest disparities, where increases in the number and types of treatment options are warranted. These findings suggest that a prioritized response strategy to address these racial and ethnic disparities is needed.
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Affiliation(s)
- Bennett M. Liu
- Department of Pediatrics, Division of Systems Medicine, Stanford University, Stanford, California
| | - Kelley Paskov
- Department of Pediatrics, Division of Systems Medicine, Stanford University, Stanford, California
| | - Jack Kent
- Department of Pediatrics, Division of Systems Medicine, Stanford University, Stanford, California
| | - Maya McNealis
- Department of Pediatrics, Division of Systems Medicine, Stanford University, Stanford, California
| | - Soren Sutaria
- Department of Pediatrics, Division of Systems Medicine, Stanford University, Stanford, California
| | - Olivia Dods
- Department of Pediatrics, Division of Systems Medicine, Stanford University, Stanford, California
| | - Christopher Harjadi
- Department of Pediatrics, Division of Systems Medicine, Stanford University, Stanford, California
| | - Nate Stockham
- Department of Pediatrics, Division of Systems Medicine, Stanford University, Stanford, California
| | | | - Dennis P. Wall
- Department of Pediatrics, Division of Systems Medicine, Stanford University, Stanford, California
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Ben-Sasson A, Jacobs K, Ben-Sasson E. Early childhood tracking application: Correspondence between crowd-based developmental percentiles and clinical tools. Health Informatics J 2023; 29:14604582231164695. [PMID: 36914414 DOI: 10.1177/14604582231164695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
Barriers to child developmental screening lead to delayed diagnosis and intervention. babyTRACKS, a mobile application for tracking developmental milestones, presents parents their child's percentiles computed relative to crowd-based data. This study evaluated correspondence between crowd-based percentiles and traditional development measures. Research analyzed babyTRACKS diaries of 1951 children. Parents recorded attainment age for milestones across Gross Motor, Fine Motor, Language, Cognitive, and Social domains. Fifty-seven parents completed the Ages and Stages Questionnaire (ASQ-3), and 13 families participated in the Mullen Scales of Early Learning (MSEL) expert assessment. Crowd-based percentiles were compared with: Centers for Disease Control (CDC) norms for comparable milestones, ASQ-3 and MSEL scores. babyTRACKS percentiles correlated with the percentage of unmet CDC milestones, and with higher ASQ-3 and MSEL scores across several domains. Children who did not meet CDC age thresholds had lower babyTRACKS percentiles by about 20 points and those at ASQ-3 risk had lower babyTRACKS Fine Motor and Language scores. Repeated measures tests showed significantly higher MSEL versus babyTRACKS percentiles in the Language domain. Although ages and milestones in diary varied, the app percentiles corresponded with traditional measures, particularly in fine motor and language domains. Future research is needed for determining referral thresholds while minimizing false alarms.
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Affiliation(s)
- Ayelet Ben-Sasson
- Department of Occupational Therapy, Faculty of Social Welfare and Health Sciences, 26748University of Haifa, Haifa, Israel
| | - Kayla Jacobs
- Computer Science Department, Technion, Haifa, Israel
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Kilicaslan F, Karatas H, Kulu H, Solmaz A. Knowledge about childhood autism among nurses in family health centers in southeast Turkey. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2022; 70:824-832. [PMID: 39131755 PMCID: PMC11308978 DOI: 10.1080/20473869.2022.2149063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 11/09/2022] [Accepted: 11/10/2022] [Indexed: 08/13/2024]
Abstract
Objective: This study was carried out to determine the knowledge levels of nurses working in Family Health Centers (FHCs) about childhood autism. Methods: This study is a descriptive and cross-sectional study. The sample of the study consisted of 361 nurses working in FHCs in the province with the highest child population rate in Turkey. Data were obtained using the personal information form and the Knowledge about Childhood Autism among Health Workers (KCAHW) questionnaire. Results: The findings show that the mean score for the KCAHW questionnaire was 10.95 ± 3.7. Gender, education level, previous employment in a mental health clinic, the presence of a person with autism in their environment or family, their previous participation in any autism-related education program, and knowledge of the autism screening and follow-up program conducted by the Ministry of Health significantly affected the scores that were obtained from the KCAHW questionnaire (p < 0.05). Conclusion: Educational practices that will increase the knowledge and awareness of nurses about autism can contribute to the diagnosis of children with autism at an earlier age.
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Affiliation(s)
- Fethiye Kilicaslan
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Harran University, Şanlıurfa, Turkey
| | - Hulya Karatas
- Department of Pediatric Nursing, Faculty of Health Sciences, Harran University, Şanlıurfa, Turkey
| | - Hasan Kulu
- Department of Pediatric Nursing, Faculty of Health Sciences, Harran University, Şanlıurfa, Turkey
| | - Abdullah Solmaz
- Department of Pediatry, Faculty of Medicine, Harran University, Şanlıurfa, Turkey
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Ostrovsky A, Willa M, Cho T, Strandberg M, Howard S, Davitian C. Data-driven, client-centric applied behavior analysis treatment-dose optimization improves functional outcomes. World J Pediatr 2022:10.1007/s12519-022-00643-0. [PMID: 36394715 PMCID: PMC9672611 DOI: 10.1007/s12519-022-00643-0] [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: 01/24/2022] [Accepted: 10/16/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND With increasing numbers of individuals diagnosed with autism spectrum disorder (ASD) and with affirmation of applied behavior analysis (ABA) as an evidence-based standard of care for ASD, there has been a proliferation of agencies offering ABA services over the last several decades. Disagreement exists among ABA providers and health plans that reimburse those providers on the optimal number of hours of ABA services that should be reimbursed. This study aims to understand whether children who receive more hours of ABA therapy achieve better outcomes and to evaluate the impact of the COVID-19-induced shift to telehealth clinical supervision on outcomes. METHODS A retrospective cohort analysis was performed using data from the Vineland 3 Comprehensive Interview Form to assess function throughout ABA treatment. Paired sample t tests, independent sample t tests, Cohen's D, and Pearson correlations were used to determine relationships between Vineland scores and input variables including hours of service and modality of supervision (in-person vs. telehealth). RESULTS While statistically and clinically significant improvements in function were observed, children appear to have improved outcomes independent of the number of hours of service received. There were also no significant associations between modality of supervision and Vineland standard scores. CONCLUSIONS These findings challenge prior research that demonstrated a linear dose-response relationship. By tailoring treatment dosage to the individual client's needs, providers may be able to better maximize functional progress of the client, to preserve family time, and to utilize health plan dollars more efficiently.
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Affiliation(s)
| | | | - Ted Cho
- UCSF Benioff Children’s Hospital, San Francisco, CA USA
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Raditha C, Handryastuti S, Pusponegoro HD, Mangunatmadja I. Positive behavioral effect of sensory integration intervention in young children with autism spectrum disorder. Pediatr Res 2022; 93:1667-1671. [PMID: 36030319 DOI: 10.1038/s41390-022-02277-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/08/2021] [Accepted: 06/22/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Sensory integration occupational therapy (SI-OT) might be useful for autism spectrum disorders (ASD) in younger age, according to Pusponegoro. Previous studies were still limited, especially in younger age. This study evaluated the effect of SI-OT in improving positive behaviors of ASD children aged 2-5 years. METHODS Non-randomized controlled trial of SI-OT evaluation, assessed with Vineland Adaptive Behavior Scale-II. RESULTS A total of 72 subjects were studied. Following SI-OT, communication skills (expressive, receptive), socialization (coping skills), and daily living skills (personal, community) were improved significantly. CONCLUSIONS SI-OT with Ayres theory in 60 min, twice a week for 12 weeks improved positive behaviors. IMPACT To address the effectivity of sensory integration occupational therapy (SI-OT) in improving positive behaviors of autism spectrum disorders (ASD) children aged 2-5 years. The first study to evaluate evidence of SI-OT in ASD younger than 3 years. Non-randomized controlled trial of SI-OT evaluation of ASD in younger children aged 2-5 years with Vineland Adaptive Behavior Scale-II. SI-OT of Ayres theory in 60 min, twice a week for 12 weeks improves communication domain (expressive, receptive, written) aged 2-4 years, and socialization domain (interpersonal relationship, play, and leisure time) aged 2 years of ASD children.
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Affiliation(s)
- Citra Raditha
- Division of Neurology, Department of Child Health, Faculty of Medicine, Universitas Indonesia Cipto Mangunkusumo National Hospital, Salemba Street No. 6, 10430, Jakarta, Indonesia. .,Division of Neurology, Department of Child Health, Harapan Kita National Women and Children Health Center, Letjend. S Parman Street No. 87, 11420, Jakarta, Indonesia.
| | - Setyo Handryastuti
- Division of Neurology, Department of Child Health, Faculty of Medicine, Universitas Indonesia Cipto Mangunkusumo National Hospital, Salemba Street No. 6, 10430, Jakarta, Indonesia
| | - Hardiono D Pusponegoro
- Division of Neurology, Department of Child Health, Faculty of Medicine, Universitas Indonesia Cipto Mangunkusumo National Hospital, Salemba Street No. 6, 10430, Jakarta, Indonesia
| | - Irawan Mangunatmadja
- Division of Neurology, Department of Child Health, Faculty of Medicine, Universitas Indonesia Cipto Mangunkusumo National Hospital, Salemba Street No. 6, 10430, Jakarta, Indonesia
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Kingsdorf S, Pančocha K, Troshanska J, Rasimi TR. Examining the perceptions of needs, services and abilities of Czech and North Macedonian caregivers of children with autism and trainers. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2022; 70:479-492. [PMID: 38699490 PMCID: PMC11062262 DOI: 10.1080/20473869.2022.2111970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 08/04/2022] [Indexed: 05/05/2024]
Abstract
Effective practices for supporting families with autistic children ensure a match between their needs and the expectations and competencies of the clinician. Applied behavior analysis (ABA) services are a common provision for serving autistic individuals. However, in regions where ABA is in its infancy, like the Czech Republic and North Macedonia, culturally relevant resources, regulations for practice, and standardized coursework are missing. In their absence, it is necessary to investigate the degree to which practitioners in the regions are meeting the behavioral needs of families. Assessing this match can set the stage for establishing more stable and effective services in the areas, as well as neighboring countries with similar historical foundations. Therefore, a survey was conducted to examine the perceptions of caregivers and trainers (those who self-identified as providing support to families with autistic children). A total of 233 caregivers and 204 trainers participated. Analysis of the survey responses verified the lack of behavioral knowledge on the part of the trainers, the apparent lack of access to ABA services for families in both regions, a potential misalignment between family needs and training targets, and the disparities between the two countries. The information evaluated here can be used to guide preservice training, dissemination efforts, and regulations surrounding behavioral practices.
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Affiliation(s)
- Sheri Kingsdorf
- Institute for Research in Inclusive Education, Faculty of Education, Masaryk University, Brno, Czech Republic
| | - Karel Pančocha
- Institute for Research in Inclusive Education, Faculty of Education, Masaryk University, Brno, Czech Republic
| | - Jasmina Troshanska
- Department of Special Education and Rehabilitation, University of Tetovo, Tetovo, North Macedonia
| | - Teuta Ramadani Rasimi
- Department of Special Education and Rehabilitation, University of Tetovo, Tetovo, North Macedonia
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Sachdeva P, Mehdi I, Kaith R, Ahmad F, Anwar MS. Potential natural products for the management of autism spectrum disorder. IBRAIN 2022; 8:365-376. [PMID: 37786737 PMCID: PMC10528773 DOI: 10.1002/ibra.12050] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 06/03/2022] [Accepted: 06/07/2022] [Indexed: 10/04/2023]
Abstract
Autism in a broader sense is a neurodevelopmental disorder, which frequently occurs during early childhood and can last for a lifetime. This condition is primarily defined by difficulties with social engagement, with individuals displaying repetitive and stereotyped behaviors. Numerous neuroanatomical investigations on autistic children have revealed that their brains grow atypically, resulting in atypical neurogenesis, neuronal migration, maturation, differentiation, and degeneration. Special education programs, speech therapy, and occupational therapy have all been used to address autism-related behavioral problems. While widely prescribed antidepressant drugs, antipsychotics, anticonvulsants, and stimulants have demonstrated response in autistic individuals. However, these medications do not fully reverse the core symptoms associated with autism spectrum disorder (ASD). The adverse reactions of ASD medicines and an increased risk of developing various other problems, such as obesity, dyslipidemia, diabetes mellitus, and thyroid disorders, prompted the researchers to investigate herbal medicines for the treatment of autistic individuals. Clinical trials are now being done to establish the efficacy of alternative techniques based on natural substances and to understand better the context in which they may be used to treat autism. This review of literature will look at crucial natural compounds derived from animals and plants that have shown promise as safe and effective autism treatment strategies.
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Affiliation(s)
- Punya Sachdeva
- Amity Institute of Neuropsychology and NeurosciencesAmity UniversityNoidaUttar PradeshIndia
| | - Intizaar Mehdi
- School of Studies in NeuroscienceJiwaji UniversityGwaliorMadhya PradeshIndia
| | - Rohit Kaith
- School of Studies in NeuroscienceJiwaji UniversityGwaliorMadhya PradeshIndia
| | - Faizan Ahmad
- Department of Medical Elementology and ToxicologyJamia Hamdard UniversityDelhiIndia
| | - Md Sheeraz Anwar
- Department of PsychologyUniversity of CampaniaLuigi VanvitelliCasertaItaly
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Cleary DB, Bunney A, Henry L, Renton M, Granich J, Green J, Maybery MT, Whitehouse AJO. A Parent-Mediated Intervention for Newborns at Familial Likelihood of Autism: Initial Feasibility Study in the General Population. ADVANCES IN NEURODEVELOPMENTAL DISORDERS 2022; 6:494-505. [PMID: 35698574 PMCID: PMC9178338 DOI: 10.1007/s41252-022-00262-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/11/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Developmental theory and previous studies support the potential value of prodromal interventions for infants at elevated likelihood of developing autism. Past research has supported the efficacy of parent-mediated prodromal therapies with infants from as early as 7 months. We outline the rationale for implementing interventions following this model from even earlier in development and report on the feasibility of a novel intervention developed following this model of parent-mediated infant interventions. METHODS We report a feasibility study (n = 13) of a parent-mediated, video-aided intervention, beginning during pregnancy, focussed on parent-infant interactions. The study evaluated the feasibility of this intervention initially with a general population sample. Feasibility was assessed across four domains (acceptability, implementation, practicality and integration) using self-report questionnaire, semi-structured interviews with parents and therapists, attendance and assessment completion. RESULTS Feasibility assessment shows that the intervention was acceptable, with all participants reporting that they had benefited from the program, with perceived positive benefits to their understanding of and communication with their infant, and that they had integrated program teachings into everyday life. The intervention was implemented as planned with 100% attendance for the core sessions. Changes to minimise the number of antenatal sessions was suggested to improve practicality. CONCLUSIONS This study found initial feasibility for this intervention in a general population sample. This suggests parent-mediated video feedback interventions are a promising format to be implemented within the perinatal developmental time period.
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Affiliation(s)
- Dominique B. Cleary
- Telethon Kids Institute, The University of Western Australia, 100 Roberts Road, Subiaco, Western Australia 6008 Australia
- School of Psychological Science, The University of Western Australia, Perth, Australia
| | - Angela Bunney
- Telethon Kids Institute, The University of Western Australia, 100 Roberts Road, Subiaco, Western Australia 6008 Australia
| | - Lindy Henry
- Telethon Kids Institute, The University of Western Australia, 100 Roberts Road, Subiaco, Western Australia 6008 Australia
| | - Michelle Renton
- Telethon Kids Institute, The University of Western Australia, 100 Roberts Road, Subiaco, Western Australia 6008 Australia
| | - Joanna Granich
- Telethon Kids Institute, The University of Western Australia, 100 Roberts Road, Subiaco, Western Australia 6008 Australia
| | - Jonathan Green
- Division of Neuroscience & Experimental Psychology, School of Biological Sciences, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Greater Manchester Mental Health NHS Trust, Manchester, UK
| | - Murray T. Maybery
- School of Psychological Science, The University of Western Australia, Perth, Australia
| | - Andrew J. O. Whitehouse
- Telethon Kids Institute, The University of Western Australia, 100 Roberts Road, Subiaco, Western Australia 6008 Australia
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Zhang L, Xu Y, Li H, Li B, Duan G, Zhu C. The role of probiotics in children with autism spectrum disorders: A study protocol for a randomised controlled trial. PLoS One 2022; 17:e0263109. [PMID: 35202432 PMCID: PMC8870536 DOI: 10.1371/journal.pone.0263109] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 01/11/2022] [Indexed: 12/20/2022] Open
Abstract
Background Autism spectrum disorder (ASD) is a neurological and developmental condition that begins in infancy or earlier and lasts through the individual’s lifetime. The aetiology and mechanisms of ASD are not yet fully understood, and current treatment comprises mainly education and rehabilitation, without significant improvement in the core symptoms. Recent studies suggest that microbiota change in children with ASD after the ingestion of probiotics may improve the balance of microbiota and thus ASD symptoms. Objective The objectives of this study are to evaluate the efficacy of probiotics on the symptoms of children with ASD and the possible mechanisms involved. Methods This is a prospective controlled trial. A total of 160 children with ASD will be stratified and allocated to placebo and probiotics groups randomised according to the severity of their ASD symptoms. The probiotics group will be given probiotics supplements orally twice a day for 3 months and the control group will be given a placebo at the same amount, in addition to the baseline therapy of education and rehabilitation. All the children will be evaluated systematically by using different scales, questionnaires before, during, and after 3 months’ treatment, as well as 3 months after discontinuation. The potential impact of probiotics on immunity and inflammation, metabolism, and metagenome will also be investigated. Discussion Our previous study showed that the abundance of intestinal flora was greatly different in children with ASD, and that Bifidobacterium was associated with the severity of ASD. In the present study, we will investigate the impact of probiotics supplementation on the symptoms of Children with ASD, with the purpose of evaluating the possible therapeutic effects of additives on ASD and of providing a reference for clinical treatment. The results will help to disclose as yet unknown relationship between probiotics and ASD. Trial registration This study has been registered with Chinese Clinical Trial Registry (ChiCTR-2000037941).
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Affiliation(s)
- Lingling Zhang
- Henan Key Laboratory of Child Brain Injury and Henan Clinical Research Center for Child Neurological Disorders, Institute of Neuroscience and The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yiran Xu
- Henan Key Laboratory of Child Brain Injury and Henan Clinical Research Center for Child Neurological Disorders, Institute of Neuroscience and The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hongwei Li
- Henan Key Laboratory of Child Brain Injury and Henan Clinical Research Center for Child Neurological Disorders, Institute of Neuroscience and The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Bingbing Li
- Henan Key Laboratory of Child Brain Injury and Henan Clinical Research Center for Child Neurological Disorders, Institute of Neuroscience and The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Guiqin Duan
- Center for Child Behavioral Development, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Changlian Zhu
- Henan Key Laboratory of Child Brain Injury and Henan Clinical Research Center for Child Neurological Disorders, Institute of Neuroscience and The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Göteborg, Sweden
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
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Factor RS, Arriaga RI, Morrier MJ, Mathys JB, Dirienzo M, Miller CA, Southerland AM, Abowd GD, Ousley OY. Development of an interactive tool of early social responsiveness to track autism risk in infants and toddlers. Dev Med Child Neurol 2022; 64:323-330. [PMID: 34427344 DOI: 10.1111/dmcn.15035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 06/01/2021] [Accepted: 07/30/2021] [Indexed: 11/29/2022]
Abstract
AIM To evaluate the psychometric properties of a 4-minute assessment designed to identify early autism spectrum disorder (ASD) status through evaluation of early social responsiveness (ESR). METHOD This retrospective, preliminary study included children between 13 and 24 months (78 males, 79 females mean age 19.4mo, SD 3.1) from two independent data sets (an experimental/training sample [n=120] and a validation/test sample [n=37]). The ESR assessment examined social behaviors (e.g. eye contact, smiling, ease-of-social-engagement) across five common play activities (e.g. rolling a ball, looking at a book). Data analyses examined reliability and accuracy of the assessment in identifying ESR abilities and in discriminating children with and without ASD. RESULTS Results indicated adequate internal consistency and test-retest reliability of the ESR assessment. Receiver operator curve analysis identified a cutoff score that discriminated infants with ASD-risk from peers in the training sample. This score yielded moderate sensitivity and high specificity for best-estimate ASD diagnosis in the validation sample. INTERPRETATION Preliminary findings indicated that brief, systematic observation of ESR may assist in discriminating infants with and without ASD, providing concrete evidence to validate or supplement parents', pediatricians', or clinicians' concerns. Future studies could examine the utility of ESR 'growth curves'.
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Affiliation(s)
- Reina S Factor
- Department of Psychology, Virginia Polytechnic Institute & State University, Blacksburg, VA, USA.,Virginia Tech Center for Autism Research, Blacksburg, VA, USA
| | - Rosa I Arriaga
- School of Interactive Computing, Georgia Institute of Technology, Atlanta, GA, USA
| | - Michael J Morrier
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.,Emory Autism Center, Atlanta, GA, USA
| | - Jennifer B Mathys
- TEACCH Autism Program, University of North Carolina at Chapel Hill, Charlotte, NC, USA
| | | | - Chanel A Miller
- School of Interactive Computing, Georgia Institute of Technology, Atlanta, GA, USA
| | - Audrey M Southerland
- School of Interactive Computing, Georgia Institute of Technology, Atlanta, GA, USA
| | - Gregory D Abowd
- School of Interactive Computing, Georgia Institute of Technology, Atlanta, GA, USA
| | - Opal Y Ousley
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.,Emory Autism Center, Atlanta, GA, USA
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Sohl K, Rynkiewicz A, Nanclares-Nogués V, Brewer Curran A, Scorah J, Steiman M, Lord C, Vasa RA, Słopień A, Janas-Kozik M, Łucka I, Mazur A. Project Extension for Community Health Outcomes (ECHO) Autism: A Successful Model to Increase Capacity in Community-Based Care. Brain Sci 2022; 12:brainsci12030327. [PMID: 35326283 PMCID: PMC8946611 DOI: 10.3390/brainsci12030327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/23/2022] [Accepted: 02/23/2022] [Indexed: 02/01/2023] Open
Abstract
Individuals with autism spectrum disorder (ASD) struggle to access high-quality health care due to the shortage of trained providers. ECHO (Extension for Community Healthcare Outcomes) Autism is a unique educational program that allows ASD experts to provide knowledge and skills to professionals in local communities to deliver evidence-based care to children with ASD and their families. The model teaches clinicians how to screen and diagnose ASD, as well as manage common co-occurring medical and mental health issues. ECHO Autism is particularly useful for addressing the complex needs of children with ASD and reducing disparities often present in rural and underserved communities. The model can be disseminated globally due to its flexibility in accommodating local and regional differences in social norms and constructs. This article provides an overview of the format of the ECHO Autism model, data supporting the model’s efficacy, and discusses future research directions.
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Affiliation(s)
- Kristin Sohl
- ECHO Autism Communities, Department of Child Health, University of Missouri School of Medicine, Columbia, MI 65211, USA; (K.S.); (V.N.-N.); (A.B.C.)
| | - Agnieszka Rynkiewicz
- Department of Psychiatry, College of Medical Sciences, University of Rzeszow, 35-956 Rzeszow, Poland
- Center for Diagnosis, Therapy and Education SPECTRUM ASC-MED, 80-404 Gdansk, Poland
- Correspondence:
| | - Valeria Nanclares-Nogués
- ECHO Autism Communities, Department of Child Health, University of Missouri School of Medicine, Columbia, MI 65211, USA; (K.S.); (V.N.-N.); (A.B.C.)
| | - Alicia Brewer Curran
- ECHO Autism Communities, Department of Child Health, University of Missouri School of Medicine, Columbia, MI 65211, USA; (K.S.); (V.N.-N.); (A.B.C.)
| | - Julie Scorah
- Montreal Neurological Institute-Hospital, Azrieli Centre for Autism Research McGill University, Montreal, QC H3A 2B4, Canada; (J.S.); (M.S.)
| | - Mandy Steiman
- Montreal Neurological Institute-Hospital, Azrieli Centre for Autism Research McGill University, Montreal, QC H3A 2B4, Canada; (J.S.); (M.S.)
| | - Catherine Lord
- Semel Institute for Neuroscience & Human Behavior, University of California Los Angeles, Los Angeles, CA 90095, USA;
| | - Roma A. Vasa
- Center for Autism and Related Disorders, Kennedy Krieger Institute, John Hopkins University School of Medicine, Baltimore, MD 21205, USA;
| | - Agnieszka Słopień
- Department of Child and Adolescent Psychiatry, Poznan University of Medical Sciences, 61-701 Poznan, Poland;
| | - Małgorzata Janas-Kozik
- Department of Psychiatry and Psychotherapy, Medical University of Silesia, 40-635 Katowice, Poland;
- John Paul II Paediatric Centre, 41-218 Sosnowiec, Poland
| | - Izabela Łucka
- Department of Developmental Psychiatry, Psychotic and Geriatric Disorders, Medical University of Gdansk, 80-282 Gdansk, Poland;
| | - Artur Mazur
- Department of Paediatrics, Paediatric Endocrinology and Diabetes, College of Medical Sciences, University of Rzeszow, 35-959 Rzeszow, Poland;
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43
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Meza N, Rojas V, Escobar Liquitay CM, Pérez I, Aguilera Johnson F, Amarales Osorio C, Irarrázaval M, Madrid E, Franco JVA. Non-pharmacological interventions for autism spectrum disorder in children: an overview of systematic reviews. BMJ Evid Based Med 2022:bmjebm-2021-111811. [PMID: 35217568 DOI: 10.1136/bmjebm-2021-111811] [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] [Accepted: 01/25/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To assess the effectiveness of non-pharmacological interventions for the treatment of autism spectrum disorder (ASD) in children. DESIGN Overview of systematic reviews (SRs). PARTICIPANTS Children aged 12 years and under with ASD. SEARCH METHODS In October 2021, we searched Cochrane Central Register of Controlled Trials, MEDLINE, Embase, PsycINFO and Epistemonikos placing no restrictions on language or date of publication. INTERVENTIONS 17 non-pharmacological interventions compared with placebo, no-treatment (including waiting list) or other interventions (ie, usual care, as defined by the authors of each study). DATA COLLECTION AND ANALYSIS We rated the methodological quality of the included SRs using A Measurement Tool to Assess Systematic Reviews (AMSTAR 2). We reported the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) certainty of the evidence (CoE) according to the analysis conducted by the authors of the included SRs. MAIN OUTCOME MEASURES A multidisciplinary group of experts agreed on analysing nine critical outcomes evolving core and non-core ASD symptoms. PUBLIC AND PATIENT INVOLVEMENT STATEMENT Organisations of parents of children with ASD participated in external revision of the final version of the report. RESULTS We identified 52 reports that were within our scope, of which 48 were excluded for various reasons. After excluding less reliable SRs, we included four SRs. Non-pharmacological interventions (ie, Early Intensive Behavioural Intervention, Applied Behaviour Analysis, Picture Exchange Communication System and Naturalistic Developmental Behavioural Interventions) may have favourable effects on some core outcomes including language, social and functioning, play or daily living skills in children with ASD (with either no GRADE assessment, very low or low CoE). In addition, we identified a lack of report for other key outcomes in the included SRs (ie, restricted, repetitive behaviour; play and sensory processing). CONCLUSIONS Synthesised evidence regarding the efficacy of non-pharmacological interventions for children with ASD is scarce. High-quality SRs addressing the variety of both non-pharmacological interventions and relevant outcomes are needed. PROSPERO REGISTRATION NUMBER CRD42020206535.
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Affiliation(s)
- Nicolás Meza
- Interdisciplinary Centre for Health Studies (CIESAL), Cochrane Chile Associate Centre, Universidad de Valparaíso, Viña del Mar, Chile
| | - Valeria Rojas
- School of Medicine, Universidad de Valparaíso, Viña del Mar, Chile
- Autism program, Hospital Dr Gustavo Fricke, Viña del Mar, Chile
| | | | - Ignacio Pérez
- School of Medicine, Universidad de Valparaíso, Viña del Mar, Chile
| | | | - Claudia Amarales Osorio
- School of Medicine, Universidad de Valparaíso, Viña del Mar, Chile
- Pediatric Neurology Unit, Hospital Carlos van Buren, Valparaíso, Chile
| | - Matías Irarrázaval
- Department of Mental Health, Ministry of Health, Santiago, Chile
- Millenium Institute for Research in Depression and Personality, Santiago, Chile
| | - Eva Madrid
- Interdisciplinary Centre for Health Studies (CIESAL), Cochrane Chile Associate Centre, Universidad de Valparaíso, Viña del Mar, Chile
| | - Juan Victor Ariel Franco
- Associate Cochrane Centre - Research Department, Instituto Universitario del Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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44
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DiCarlo GE, Wallace MT. Modeling dopamine dysfunction in autism spectrum disorder: From invertebrates to vertebrates. Neurosci Biobehav Rev 2022; 133:104494. [PMID: 34906613 PMCID: PMC8792250 DOI: 10.1016/j.neubiorev.2021.12.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 11/29/2021] [Accepted: 12/09/2021] [Indexed: 02/03/2023]
Abstract
Autism Spectrum Disorder (ASD) is a highly heterogeneous neurodevelopmental disorder characterized by deficits in social communication and by patterns of restricted interests and/or repetitive behaviors. The Simons Foundation Autism Research Initiative's Human Gene and CNV Modules now list over 1000 genes implicated in ASD and over 2000 copy number variant loci reported in individuals with ASD. Given this ever-growing list of genetic changes associated with ASD, it has become evident that there is likely not a single genetic cause of this disorder nor a single neurobiological basis of this disorder. Instead, it is likely that many different neurobiological perturbations (which may represent subtypes of ASD) can result in the set of behavioral symptoms that we called ASD. One such of possible subtype of ASD may be associated with dopamine dysfunction. Precise regulation of synaptic dopamine (DA) is required for reward processing and behavioral learning, behaviors which are disrupted in ASD. Here we review evidence for DA dysfunction in ASD and in animal models of ASD. Further, we propose that these studies provide a scaffold for scientists and clinicians to consider subcategorizing the ASD diagnosis based on the genetic changes, neurobiological difference, and behavioral features identified in individuals with ASD.
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Affiliation(s)
- Gabriella E DiCarlo
- Massachusetts General Hospital, Department of Medicine, Boston, MA, United States
| | - Mark T Wallace
- Vanderbilt University Brain Institute, Nashville, TN, United States; Department of Psychology, Vanderbilt University, Nashville, TN, United States; Department of Hearing & Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, United States; Department of Pharmacology, Vanderbilt University, Nashville, TN, United States; Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, United States.
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45
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Dance intervention for negative symptoms in individuals with autism spectrum disorder: A systematic review and meta-analysis. Complement Ther Clin Pract 2022; 47:101565. [DOI: 10.1016/j.ctcp.2022.101565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 01/14/2022] [Accepted: 02/19/2022] [Indexed: 11/23/2022]
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46
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Mukhamedshina YO, Fayzullina RA, Nigmatullina IA, Rutland CS, Vasina VV. Health care providers' awareness on medical management of children with autism spectrum disorder: cross-sectional study in Russia. BMC MEDICAL EDUCATION 2022; 22:29. [PMID: 35012536 PMCID: PMC8751116 DOI: 10.1186/s12909-021-03095-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 12/22/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Autism spectrum disorder (ASD) is a complex developmental range of conditions that involves difficulties with social interaction and restricted/repetitive behaviors. Unfortunately, health care providers often experience difficulties in diagnosis and management of individuals with ASD, and may have no knowledge about possible ways to overcome barriers in ASD patient interactions in healthcare settings. At the same time, the provision of appropriate medical services can have positive effects on habilitative progress, functional outcome, life expectancy and quality of life for individuals with ASD. METHODS This online survey research study evaluated the awareness and experience of students/residents (n = 247) and physicians (n = 100) in the medical management of children with ASD. It also gathered the views and experiences of caregivers to children with ASD (n = 158), all based in Russia. RESULTS We have established that the Russian medical community has limited ASD knowledge among providers, and have suggested possible reasons for this. Based on results from online surveys completed by students/residents, non-psychiatric physicians, and caregivers of children diagnosed with ASD, the main problems pertaining to medical management of individuals with ASD were identified. Possible problem solving solutions within medical practice were proposed. CONCLUSIONS The results from this study should be considered when implementing measures to improve healthcare practices, and when developing models for effective medical management, due to start not only in Russia but also in a number of other countries.
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Affiliation(s)
- Y O Mukhamedshina
- Clinical Research Center for Precision and Regenerative Medicine, Kazan Federal University, Kremlevskaya St 18, Kazan, 420008, Tatarstan, Russia.
- Department of Histology, Cytology and Embryology, Kazan State Medical University, Kazan, Russia.
| | - R A Fayzullina
- Department of Propaedeutics of Pediatric Diseases and Faculty Pediatrics, Kazan State Medical University, Kazan, Russia
| | - I A Nigmatullina
- Department of Psychology and Pedagogy of Special Education, Kazan (Volga region) Federal University, Kazan, Russia
| | - C S Rutland
- School of Veterinary Medicine and Science, University of Nottingham, Nottingham, UK
| | - V V Vasina
- Department of Psychology and Pedagogy of Special Education, Kazan (Volga region) Federal University, Kazan, Russia
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47
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Nakagami A, Yasue M, Nakagaki K, Nakamura M, Kawai N, Ichinohe N. Reduced childhood social attention in autism model marmosets predicts impaired social skills and inflexible behavior in adulthood. Front Psychiatry 2022; 13:885433. [PMID: 35958665 PMCID: PMC9357878 DOI: 10.3389/fpsyt.2022.885433] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 06/27/2022] [Indexed: 11/16/2022] Open
Abstract
Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized by social and communication impairments and restricted and repetitive behavior. Although there is currently no established cure for ASD, early interventions for deficits of attention to other individuals are expected to reduce the progression of ASD symptoms in later life. To confirm this hypothesis and improve early therapeutic interventions, it is desirable to develop an animal model of ASD in which social attention is impaired in childhood and ASD-like social behavior is observed in adulthood. However, rodent models of ASD have difficulty in recapitulating the deficit of gaze-based social attention. In this study, we examined the direction of gaze toward other conspecifics during childhood and puberty in a three-chamber test setting using an ASD marmoset model produced by maternal exposure to valproic acid (VPA). We also conducted a reversal learning test in adult VPA-exposed marmosets as an indicator of perseveration, a core symptom of ASD that has not previously been investigated in this model. The results showed that time spent gazing at other conspecifics was reduced in VPA-exposed marmosets in childhood, and that mature animals persisted with previous strategies that required long days for acquisition to pass the test. In a longitudinal study using the same animals, deficits in social attention in childhood correlated well with ASD-like social disturbance (inequity aversion and third-party reciprocity) and inflexible behavior in adulthood. Since VPA-exposed marmosets exhibit these diverse ASD-like behaviors that are consistent from childhood to adulthood, VPA-exposed marmosets will provide a valuable means of elucidating mechanisms for early intervention and contribute to the development of early therapies.
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Affiliation(s)
- Akiko Nakagami
- Graduate School of Information Science, Nagoya University, Nagoya, Japan.,Department of Ultrastructural Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Kodaira, Japan.,Department of Psychology, Japan Women's University, Bunkyo-ku, Japan
| | - Miyuki Yasue
- Graduate School of Information Science, Nagoya University, Nagoya, Japan.,Department of Ultrastructural Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Keiko Nakagaki
- Department of Ultrastructural Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Madoka Nakamura
- Graduate School of Information Science, Nagoya University, Nagoya, Japan.,Department of Ultrastructural Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Nobuyuki Kawai
- Graduate School of Information Science, Nagoya University, Nagoya, Japan.,Academy of Emerging Science, Chubu University, Kasugai, Japan
| | - Noritaka Ichinohe
- Department of Ultrastructural Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Kodaira, Japan
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48
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Gabis LV, Attia OL, Goldman M, Barak N, Tefera P, Shefer S, Shaham M, Lerman-Sagie T. The myth of vaccination and autism spectrum. Eur J Paediatr Neurol 2022; 36:151-158. [PMID: 34996019 PMCID: PMC8694782 DOI: 10.1016/j.ejpn.2021.12.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 12/12/2021] [Accepted: 12/14/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Among all of the studied potential causes of autism, vaccines have received some of the most scrutiny and have been the topic of many evidence-based studies. These efforts have led the great majority of scientists, physicians, and public health researchers to refute causation between vaccines and autism. RATIONALE This presumed association and concern has been a major contributor to parents' refusal to immunize their children and has become a major threat to public health in secluded populations over the last two decades, even prior to the COVID-19 pandemic. With the emergence of COVID-19 immunizations, sentiments towards this topic were addressed as a public health concern that may influence the ability to overcome the Corona virus worldwide. SCIENTIFIC REVIEW OF DATA Despite the overwhelming data demonstrating that there is no link between vaccines and autism, many parents are hesitant to immunize their children because of the alleged association. Other contributing factors to the myths and conspiracy theories surrounding the association between vaccines and autism include the fact that the diagnosis of autism is typically made after the age of receiving the main childhood immunizations, as well as the occasional occurrence of regression after the age of first year vaccinations. In spite of vast evidence that the main contribution to the increase in incidence is from improvement of the diagnostic process, this rapid and publicized rise in autism diagnoses feeds parental concerns regarding any medical intervention that may be associated with the health of their children. RECOMMENDATIONS It is plausible that with more evidence-based studies linking autism to specific etiologies the myth will diminish and disappear eventually. In an era where conspiracy theories are prevalent on social media, it is critical that evidence-based studies relating autism to specific etiologies be made public, and that information concerning autism diagnosis and causes be made more readily available through social media and parental organizations.
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Affiliation(s)
- Lidia V Gabis
- Sackler School of Medicine at Tel Aviv University, Israel; Maccabi Health Services, Israel.
| | - Odelia Leon Attia
- Weinberg Developmental Center, at Safra Children's Hospital, Tel Hashomer, Israel.
| | - Mia Goldman
- Sackler School of Medicine at Tel Aviv University, Israel.
| | - Noy Barak
- Department of Industrial Engineering at Tel-Aviv University, Israel.
| | - Paula Tefera
- Sackler School of Medicine at Tel Aviv University, Israel.
| | - Shahar Shefer
- Weinberg Developmental Center, at Safra Children's Hospital, Tel Hashomer, Israel.
| | - Meirav Shaham
- Department of Statistics at University of Haifa, Haifa, Israel.
| | - Tally Lerman-Sagie
- Sackler School of Medicine at Tel Aviv University, Israel; Pediatric Neurology Unit at Wolfson Medical Center, Holon, Israel.
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49
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Dhanjal DS, Bhardwaj S, Chopra C, Singh R, Patocka J, Plucar B, Nepovimova E, Valis M, Kuca K. Millennium Nutrient N,N-Dimethylglycine (DMG) and its Effectiveness in Autism Spectrum Disorders. Curr Med Chem 2021; 29:2632-2651. [PMID: 34823458 DOI: 10.2174/0929867328666211125091811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 10/09/2021] [Accepted: 10/11/2021] [Indexed: 11/22/2022]
Abstract
Autism is a neurodevelopmental disorder belonging to the autism spectrum disorder (ASD). In ASDs, the individuals show substantial impairments in social communication, repetitive behaviours, and sensory behaviours deficits in the early stages of their life. Globally, the prevalence of autism is estimated to be less than 1%, especially in high-income countries. In recent decades, there has been a drastic increase in the incidence of ASD, which has put ASD into the category of epidemics. Presently, two US Food and Drug Administration-approved drugs, aripiprazole and risperidone are used to treat symptoms of agitation and irritability in autistic children. However, to date, no medication has been found to treat the core symptoms of ASD. The adverse side effects of conventional medicine and limited treatment options have led families and parents of autistic children to turn to complementary and alternative medicine (CAM) treatments, which are perceived as relatively safe compared to conventional medicine. Recently, N,N-dimethylglycine (DMG), a dietary supplement, has emerged as a useful supplement to improve the mental and physical state of children with ASD. The current review discusses ASD, the prevalence of ASD, CAM approach and efficacy of CAM treatment in children with ASD. Moreover, it highlights the chemistry, pharmacological effect, and clinical studies of DMG, highlighting its potential for improving the lifestyle of children with ASD.
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Affiliation(s)
- Daljeet Singh Dhanjal
- Department of Biotechnology, School of Bioengineering and Biosciences, Lovely Professional University, Phagwara. India
| | - Sonali Bhardwaj
- Department of Microbiology, School of Bioengineering and Biosciences, Lovely Professional University, Phagwara. India
| | - Chirag Chopra
- Department of Biotechnology, School of Bioengineering and Biosciences, Lovely Professional University, Phagwara. India
| | - Reena Singh
- Department of Biotechnology, School of Bioengineering and Biosciences, Lovely Professional University, Phagwara. India
| | - Jiri Patocka
- Department of Radiology, Toxicology and Population Protection, Faculty of Health and Social Studies, University of South Bohemia in Ceske Budejovice. Czech Republic
| | - Bohumir Plucar
- Reflex Therapy Laboratory, Udolni 393/18, 602 00 Brno. Czech Republic
| | - Eugenie Nepovimova
- Department of Chemistry, Faculty of Science, University of Hradec Kralove, Hradec Kralove. Czech Republic
| | - Martin Valis
- University Hospital Hradec Kralove, Hradec Kralove. Czech Republic
| | - Kamil Kuca
- University Hospital Hradec Kralove, Hradec Kralove. Czech Republic
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50
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Qi Y, Han JX. Rehabilitation Educational Design for Children with Autism Based on the Radial Basis Function Neural Network. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:2961546. [PMID: 34777730 PMCID: PMC8589495 DOI: 10.1155/2021/2961546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/08/2021] [Accepted: 09/24/2021] [Indexed: 11/18/2022]
Abstract
Children with autism need appropriate educational toys to assist rehabilitation training, so as to inhibit the development of autism. Toys and related treatments for children with autism can alleviate some of the deficits of children with autism. By using toys as stimuli and various sensations obtained by children with autism or toys as a result of reinforcement, the improvement of certain capabilities expected by related therapies can be achieved through the process of stimulation and reinforcement. However, in the process of pediatrics toy development, it is difficult for toy designers to assess whether the purpose of stimulation and reinforcement can be achieved. There are many factors that affect the design of rehabilitation toys. The industry has not formed a unified design evaluation standard, and the effects of product rehabilitation training are uneven. A method based on the radial basis function (RBF) neural network was proposed in this research to study the rehabilitation design and evaluation of rehabilitation toys for children with autism. Firstly, according to the three demand indicators for the evaluation of rehabilitation training for children with autism, that is, "useful, educational, and entertaining," the analytic network process (ANP) method was chosen as the weighting method for determining each indicator in the overall evaluation. The RBF neural network rehabilitation model for children with autism was designed and evaluated. The maximum error of the model was less than 10%. The evaluation method was objective and reasonable, so as to provide a reference for the more accurate design evaluation, purchase, and development of rehabilitation toys for children with autism.
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Affiliation(s)
- Yueer Qi
- Zhijiang College of Zhejiang University of Technology, Shaoxing 312030, China
| | - Jia-Xuan Han
- Pan Tianshou College of Architecture, Arts and Design, Ningbo University, Ningbo 315211, China
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