[Screening of the risk of mental and developmental disorders in children of early age in the Russian population (2017-2019)]

Epidemiology of Wilson's Disease and Pathogenic Variants of the ATP7B Gene Leading to Diversified Protein Disfunctions

Wilson's disease (WD) is an autosomal recessive disorder characterized by toxic accumulation of copper in the liver, brain, and other organs. The disease is caused by pathogenic variants in the ATP7B gene, which encodes a P-type copper transport ATPase. Diagnosing WD is associated with numerous difficulties due to the wide range of clinical manifestations and its unknown dependence on the physiological characteristics of the patient. This leads to a delay in the start of therapy and the subsequent deterioration of the patient's condition. However, in recent years, molecular genetic testing of patients using next generation sequencing (NGS) has been gaining popularity. This immediately affected the detection speed of WD. If, previously, the frequency of this disease was estimated at 1:35,000-45,000 people, now, when conducting large molecular genetic studies, the frequency is calculated as 1:7026 people. This certainly points to the problem of identifying WD patients. This review provides an update on the performance of epidemiological studies of WD and describes normal physiological functions of the protein and diversified disfunctions depending on pathogenic variants of the ATP7B gene. Future prospects in the development of WD genetic diagnostics are also discussed.

[The clinic of autistic disorders at an early age]

OBJECTIVE

To study disorders of mental development and psychopathological symptoms in young children with autistic disorders of various origins.

MATERIAL AND METHODS

Two hundred and sixty-five children, aged 9 months to 4 years, (201 boys, 64 girls) with symptoms of autistic disorder were examined. The patients were divided into two age groups - the 1st group consisted of 36 children, aged 9 months to 2 years, the 2nd group consisted of 229 children from 2 years to 4 years. Psychopathological, neurological and clinical-dynamic methods were used, taking into account the results of consultations with a speech therapist, defectologist, psychologist.

RESULTS

The number of visits to a psychiatrist by parents of children older than two years becomes significantly higher - 13.6% (n=36) and 86.4% (n=112), respectively (p≤0.05), as well as the diagnosis of autistic disorder - 8.3% (n=3) and 16.2% (n=37) respectively, p≤0.05). In both age groups, the diagnosis of «Other general developmental disorders» (F84.8) was most often established, with a significant predominance in the younger group - 80.5% and 72%, respectively (p≤0.05). Characteristic symptoms-markers of autism for both age groups are highlighted. It is shown that the diagnoses of childhood autism, Kanner syndrome, exposed at the first treatment, were preserved in all patients after three years. By the age of four, it was possible to clarify the diagnosis in 32% of cases. At the same time, 68% of patients, aged 4 years, retained a clinically undifferentiated diagnosis of F84.8.

CONCLUSION

The study showed an increase in the diagnosis of autistic disorder during the first years of life. The necessity of increasing the knowledge of early-age psychiatry among specialists and the organization of a system of early detection, timely treatment and rehabilitation of autistic disorders in children of the first years of life in children's polyclinics is noted.

Epidemiological Study on the Early Detection of Mental Disorders in Young Children in Russia

BACKGROUND

Assessing the risk of children developing mental, behavioral, and developmental disorders (MBDDs), including autism spectrum disorders (ASDs), as well as achieving early detection of such disorders, has become one of the most important undertakings for public mental health professionals worldwide.

AIM

This study aims to evaluate the risk of developing MBDDs and the prevalence of MBDDs among young children (18-48 months old) in Russia.

METHODS

A two-level epidemiological screening approach was developed and adopted for the purposes of this study. At the first level, the parents of all children between 18 and 48 months old were questioned using Russian national validated Screening Checklist for Parents for Identification of the Risk of Mental, Behavioral, and Developmental Disorders in Early Childhood in nine regions of Russia (Volgograd, Kirov, Moscow, Novosibirsk, Orenburg, Tver, Chelyabinsk, Yaroslavl, and Stavropol). At the second level, children identified at the first level of screening as being at risk of developing MBDDs were assessed by a child psychiatrist on a voluntary basis and diagnosed according to the International Classification of Diseases, Tenth Revision criteria.

RESULTS

The present study revealed that the risk of developing MBDDs stands at 13.07% or 1,307 cases per 10,000 child population aged 18-48 months, whereas the prevalence of confirmed MBDDs is 1.51% or 151 cases per 10,000 among a Russian child population aged 18-48 months.

CONCLUSION

Screening for the risk of developing MBDDs, including ASDs, in Russia among very young children is a promising area of preventive medicine. This initiative allows us to develop optimal algorithms for specialized care measures that could help prevent the development and aggravation of children mental health issues.

Clinical and Neuropsychological Features of Subcortical Structures Cerebral Organization in the Development of Autism Spectrum Mental Disorders in Children

The article deals with the peculiarities of the cerebral organization of subcortical structures in children with autism spectrum disorders. The study involved 48 children aged from 3 to 8 years (M=5.75; SD=2.61) having ICD-10 diagnoses F84.0, F84.1, F84.5. All children underwent registration of acoustic evoked brainstem potentials and neuropsychological examination. The relationship of the indicators of acoustic evoked potentials of the brain stem with the functioning of different blocks of the brain was established: the block of cortical tone and the brain energy block (Block I), the block of reception, processing and storage of exteroceptive information (Block II), the block of programming, regulation and control of the course of mental activity (Block III). For children with difficulties in activation and energy components of activity, perception of auditory information by subcortical structures of the brain causes certain difficulties (difficulties in work of the I block of the brain). Children with difficulties in right hemispheric holistic information processing strategy and a high level of its development are characterized by a reduced level of control over the course of thought activity, with difficulties in automating thinking and speech and difficulties in coordinating movements (difficulties in the work of Block II of the brain). The identified features of the cerebral organization of the processes of perception of auditory information and processes of mental activity in children with autism spectrum disorders are manifested in disorders of the course of thought activity, the function of peripheral receptors and conduction pathways to the cortical centers of the auditory analyzer, in a lowered level of control over the auditory analyzer. In connection with these processes there are difficulties with automatization of thinking and speech, coordination of movements in children.