1
|
Leblanc L, Genest C, Villemaire J, Dodin P, Gauvin-Lepage J. Management of Procedural Pain and Anxiety in Youth With Autism Spectrum Disorder: A Scoping Review. Pain Manag Nurs 2024; 25:265-284. [PMID: 38462401 DOI: 10.1016/j.pmn.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 02/07/2024] [Accepted: 02/11/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND Although there is a body of literature on the implementation of interventions to manage procedural pain and anxiety in youth with autism spectrum disorders (ASD), we found no literature presenting the current state of knowledge on this topic. OBJECTIVES To review the state of knowledge on interventions for the management of procedural pain and anxiety in children and adolescents with ASD. METHOD A scoping review using PRISMA-ScR was conducted. DATA SOURCES PubMed, MEDLINE, all EBM reviews, Embase, APA PsychInfo, EBSCO CINAHL, and ProQuest Dissertations and Theses Global databases were searched. Gray literature was also searched. ANALYSIS METHOD Braun and Clarke's (2006) model for thematic analysis in psychology was used to synthesize the search results. RESULTS Thirty articles were selected. Analysis of the extracted data revealed four elements of intervention for better management of procedural pain and anxiety in the study population: 1) characteristics of the procedure and the immediate environment; 2) parent-child interactions; 3) health care provider-child interactions; and 4) direct pharmacological and nonpharmacological interventions. IMPLICATIONS FOR NURSING PRACTICE Nurses must be able to implement appropriate interventions for the management of procedural pain and anxiety in youth with an autism spectrum disorder.
Collapse
Affiliation(s)
- Laurence Leblanc
- Faculty of Nursing, University of Montreal, Pavillon Marguerite-d'Youville; Research Center of the Sainte-Justine University Hospital Marie-Enfant Rehabilitation Center, Montreal, Quebec, Canada.
| | - Christine Genest
- Faculty of Nursing, University of Montreal, Pavillon Marguerite-d'Youville; Centre d'étude sur le trauma du Centre de recherche de l'Institut universitaire de santé mentale de Montréal; Centre de recherche et d'intervention sur le suicide, les pratiques éthiques et de fin de vie (CRISE), Montreal, Quebec, Canada
| | - Jade Villemaire
- Faculty of Nursing, University of Montreal, Pavillon Marguerite-d'Youville; Centre de recherche et de partage des savoirs InterActions - CIUSSS du Nord-de-l'Île-de-Montréal; Student associate in RQSPAL, CRISE, Montreal, Quebec, Canada
| | - Philippe Dodin
- Sainte-Justine University Hospital, Montreal, Quebec, Canada
| | - Jérôme Gauvin-Lepage
- Director and Vice-Dean, School of Nursing, Faculty of Medicine and Health Sciences, University of Sherbrooke; Associate Scientist, Research Center of the Sainte-Justine University Hospital Marie-Enfant Rehabilitation Center, Montreal, Quebec, Canada
| |
Collapse
|
2
|
Menteşe Babayiğit T, Gümüş-Akay G, Uytun MÇ, Doğan Ö, Serdar MA, Efendi GY, Erman AG, Yürümez E, Öztop DB. Investigation of Liver X Receptor Gene Variants and Oxysterol Dysregulation in Autism Spectrum Disorder. CHILDREN (BASEL, SWITZERLAND) 2024; 11:551. [PMID: 38790546 PMCID: PMC11120122 DOI: 10.3390/children11050551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 04/23/2024] [Accepted: 04/30/2024] [Indexed: 05/26/2024]
Abstract
The NR1H2 gene produces the Liver X Receptor Beta (LXRB) protein, which is crucial for brain cholesterol metabolism and neuronal development. However, its involvement in autism spectrum disorder (ASD) remains largely unexplored, aside from animal studies. This study is the first to explore the potential link between autism and rs2695121/rs17373080 single nucleotide polymorphisms (SNPs) in the regulatory regions of NR1H2, known for their association with neuropsychiatric functions. Additionally, we assessed levels of oxysterols (24-Hydroxycholesterol, 25-Hydroxycholesterol, 27-Hydroxycholesterol), crucial ligands of LXR, and lipid profiles. Our cohort comprised 107 children with ASD and 103 healthy children aged 2-18 years. Clinical assessment tools included the Childhood Autism Rating Scale, Autistic Behavior Checklist, and Repetitive Behavior Scale-Revised. Genotyping for SNPs was conducted using PCR-RFLP. Lipid profiles were analyzed with Beckman Coulter kits, while oxysterol levels were determined through liquid chromatography-tandem mass spectrometry. Significantly higher total cholesterol (p = 0.003), LDL (p = 0.008), and triglyceride (p < 0.001) levels were observed in the ASD group. 27-Hydroxycholesterol levels were markedly lower in the ASD group (p ≤ 0.001). ROC analysis indicated the potential of 27-Hydroxycholesterol to discriminate ASD diagnosis. The SNP genotype and allele frequencies were similar in both groups (p > 0.05). Our findings suggest that disturbances in oxysterol metabolism, previously linked to neurodegeneration, may constitute a risk factor for ASD and contribute to its heterogeneous phenotype.
Collapse
Affiliation(s)
- Tuğba Menteşe Babayiğit
- Department of Child and Adolescent Psychiatry, Aksaray University School of Medicine Training and Research Hospital, Aksaray 68100, Turkey
| | - Güvem Gümüş-Akay
- Department of Physiology, Ankara University School of Medicine, Ankara 06100, Turkey;
- Brain Research Center (AUBAUM), Ankara University, Ankara 06340, Turkey
- Neuroscience and Neurotechnology Center of Excellence (NÖROM), Ankara University, Ankara 06560, Turkey
| | - Merve Çikili Uytun
- Department of Child and Adolescent Psychiatry, Ankara University School of Medicine, Ankara 06100, Turkey; (M.Ç.U.); (E.Y.); (D.B.Ö.)
| | - Özlem Doğan
- Department of Biochemistry, Ankara University School of Medicine, Ankara 06100, Turkey;
| | - Muhittin A. Serdar
- Department of Medical Biochemistry, Acıbadem University School of Medicine, Ankara 06460, Turkey;
| | - Gökçe Yağmur Efendi
- Department of Child and Adolescent Psychiatry, Kocaeli University School of Medicine, Kocaeli 41001, Turkey;
| | - Ayşe Gökçe Erman
- Department of Basic Biotechnology, Ankara University Institute of Biotechnology, Ankara 06135, Turkey;
| | - Esra Yürümez
- Department of Child and Adolescent Psychiatry, Ankara University School of Medicine, Ankara 06100, Turkey; (M.Ç.U.); (E.Y.); (D.B.Ö.)
| | - Didem Behice Öztop
- Department of Child and Adolescent Psychiatry, Ankara University School of Medicine, Ankara 06100, Turkey; (M.Ç.U.); (E.Y.); (D.B.Ö.)
| |
Collapse
|
3
|
Feng P, Zhang Y, Zhao Y, Zhao P, Li E. Combined repetitive transcranial magnetic stimulation and gut microbiota modulation through the gut-brain axis for prevention and treatment of autism spectrum disorder. Front Immunol 2024; 15:1341404. [PMID: 38455067 PMCID: PMC10918007 DOI: 10.3389/fimmu.2024.1341404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/07/2024] [Indexed: 03/09/2024] Open
Abstract
Autism spectrum disorder (ASD) encompasses a range of neurodevelopmental conditions characterized by enduring impairments in social communication and interaction together with restricted repetitive behaviors, interests, and activities. No targeted pharmacological or physical interventions are currently available for ASD. However, emerging evidence has indicated a potential association between the development of ASD and dysregulation of the gut-brain axis. Repetitive transcranial magnetic stimulation (rTMS), a noninvasive diagnostic and therapeutic approach, has demonstrated positive outcomes in diverse psychiatric disorders; however, its efficacy in treating ASD and its accompanying gastrointestinal effects, particularly the effects on the gut-brain axis, remain unclear. Hence, this review aimed to thoroughly examine the existing research on the application of rTMS in the treatment of ASD. Additionally, the review explored the interplay between rTMS and the gut microbiota in children with ASD, focusing on the gut-brain axis. Furthermore, the review delved into the integration of rTMS and gut microbiota modulation as a targeted approach for ASD treatment based on recent literature. This review emphasizes the potential synergistic effects of rTMS and gut microbiota interventions, describes the underlying mechanisms, and proposes a potential therapeutic strategy for specific subsets of individuals with ASD.
Collapse
Affiliation(s)
- Pengya Feng
- Department of Children Rehabilitation, Key Laboratory of Rehabilitation Medicine in Henan, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- The American Psychiatric Association, Key Laboratory of Helicobacter pylori, Microbiota and Gastrointestinal Cancer of Henan Province, Marshall Medical Research Center, Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yangyang Zhang
- Department of Children Rehabilitation, Key Laboratory of Rehabilitation Medicine in Henan, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Yonghong Zhao
- Department of Children Rehabilitation, Key Laboratory of Rehabilitation Medicine in Henan, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Pengju Zhao
- Department of Children Rehabilitation, Key Laboratory of Rehabilitation Medicine in Henan, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Enyao Li
- Department of Children Rehabilitation, Key Laboratory of Rehabilitation Medicine in Henan, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| |
Collapse
|
4
|
Kahveci G, Caylak E, Kara DN. The effect of the home environment on children with autism spectrum disorder. Int J Dev Neurosci 2024; 84:14-21. [PMID: 37776025 DOI: 10.1002/jdn.10304] [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: 07/22/2023] [Revised: 08/29/2023] [Accepted: 09/14/2023] [Indexed: 10/01/2023] Open
Abstract
The estimated prevalence of autism spectrum disorders (ASD) is 1% worldwide. Autistic individuals typically have a high level of sensitivity to the various environmental stimuli (smell, noise, light). These stimuli have a positive or negative influence on the person-environment interaction, and an excess of stimuli may create inappropriate or unanticipated behavioral responses (such as a crisis) effecting their well-being. The Model of Competence, which provides an explanation of the interaction between the individual and the environment, was selected as the conceptual framework to direct this study. The purpose of this study is to investigate the opinions and experiences of mothers regarding the influence of the characteristics of the home environment on autistic individuals. A qualitative interpretative description design was utilized for this study's framework. Participants in the study were mothers who have autistic children. The study with focus groups was continued until data saturation was reached. There was a thematic investigation carried out. The findings show that the factors that have an effect on autistic individuals can be categorized into several subsets like sensory, routines, and physical environment. Despite the fact that the home setting is often a secure and consistent environment, these aspects were identified as crucial. Consequently, one should give some thought to the consequences that this could have in other settings where it would be harder to exercise control. The identification of these factors and the impact they have enables a better understanding of the interaction between an autistic individual and their environment and serves to guide professionals in their interventions.
Collapse
Affiliation(s)
- Gul Kahveci
- Department of Special Education, Faculty of Education, European University of Lefke, Lefka, Cyprus
| | - Emrah Caylak
- Department of Biochemistry, Faculty of Medicine, Girne American University, Kyrenia, Cyprus
| | - Donay Nisa Kara
- Department of Computer Education and Instructional Technology, Girne American University, Kyrenia, Cyprus
| |
Collapse
|
5
|
Dunsky A, Barak S. Health Promotion with Long-Term Physical Activity Program for Adults with Autism Spectrum Disorder. Healthcare (Basel) 2024; 12:247. [PMID: 38255134 PMCID: PMC10815153 DOI: 10.3390/healthcare12020247] [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] [Received: 12/05/2023] [Revised: 12/31/2023] [Accepted: 01/16/2024] [Indexed: 01/24/2024] Open
Abstract
Individuals with autism spectrum disorder (ASD) are at higher risk for developing common chronic diseases. Engagement in physical activity (PA) can prevent health issues; however, people with ASD are known to engage in lower levels of PA in comparison to their peers. This study evaluated the effect of a long-term, 12-month PA intervention on the fitness and quality of life of adults with ASD. A quantitative approach was implemented to assess participants' fitness, functional ability, quality of life, and participation in a range of PA classes at three different time points. Qualitative data were collected via in-depth, semi-structured interviews with three participants with ASD and three staff members. A total of 34 adults with ASD (mean age 39.76 + 7.27) participated in the quantitative part of the study. Approximately 53% of the participants exhibited perseverance and conducted adequate PA each month. Significant improvements were found in one fitness component and two quality-of-life components. Factors revealed for the program's success were the individuals' free choice of the PA classes and supporting people and a budget that tailored the project. Policymakers who plan health promotion programs for adults with ASD should consider long-term PA programs, with freedom of choice among PA modalities and schedules.
Collapse
Affiliation(s)
- Ayelet Dunsky
- Department of Human Movement and Sport Sciences, The Levinsky-Wingate Academic College, Netanya 4290200, Israel;
| | - Sharon Barak
- Nursing Department, School of Health Sciences, Ariel University, Ariel 40700, Israel
- Department of Pediatric Rehabilitation, The Edmond and Lily Safra Children’s Hospital, The Chaim Sheba Medical Center, Ramat-Gan 52621, Israel
| |
Collapse
|
6
|
Schweizer T, Endres D, Dziobek I, Tebartz van Elst L. Psychosocial therapeutic approaches for high-functioning autistic adults. Front Psychiatry 2024; 14:1265066. [PMID: 38274434 PMCID: PMC10808656 DOI: 10.3389/fpsyt.2023.1265066] [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: 07/21/2023] [Accepted: 12/28/2023] [Indexed: 01/27/2024] Open
Abstract
Autism spectrum disorder (ASD) is characterized by impaired social interaction and communication skills, repetitive behaviors, restricted interests, and specific sensory processing. Particularly, adults with high-functioning ASD often remain unrecognized, presumably due to their high compensatory skills, but at the cost of high stress, which is often linked to anxiety and depression. This may further explain the significantly high suicide rates and reduced life expectancy among individuals with ASD. Thus, providing support to high-functioning autistic adults in managing core symptoms, as well as co-occurring anxiety and depression, appears essential. To date, only a limited number of evidence-based psychosocial therapeutic options are available, and very few of them have undergone rigorous evaluation in a clinical context. To obtain a comprehensive understanding, a systematic literature search was conducted according to the PRISMA checklist, and only studies demonstrating robust methodological quality were included and discussed in this review article. Although promising initial key factors and methods have been identified, additional evidence-based studies are imperative to ascertain the optimal treatment and evaluate the long-term outcomes for adults with high-functioning ASD.
Collapse
Affiliation(s)
- Tina Schweizer
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dominique Endres
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Isabel Dziobek
- Department of Psychology, Clinical Psychology of Social Interaction, Faculty of Life Sciences, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Ludger Tebartz van Elst
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| |
Collapse
|
7
|
Peterson T, Sherwin R, Hosey T, Close N, Strale F. The Effects of Hyperbaric Oxygen Treatment on Verbal Scores in Children With Autism Spectrum Disorder: A Retrospective Trial. Cureus 2024; 16:e51654. [PMID: 38318543 PMCID: PMC10839432 DOI: 10.7759/cureus.51654] [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: 11/16/2023] [Accepted: 01/03/2024] [Indexed: 02/07/2024] Open
Abstract
Introduction Autism spectrum disorder (ASD) is a neurodevelopmental condition that affects millions worldwide. Suggested pathophysiology includes cerebral hypoperfusion, inflammation, mitochondrial and immune dysregulation, and oxidative stress. Debate exists concerning the benefit of hyperbaric oxygen therapy (HBOT) in treating ASD and its impacts on verbal behavior. The present study directly assesses the impacts of HBOT treatments on verbal behavior using a novel and unique manner. Materials and methods A two-group quasi-experimental trial using a pretest and a posttest was designed to retrospectively assess (n = 65) any association between HBOT and change in verbal scores in children (n = 65) with ASD. All children completed two verbal tests six months apart, either the Verbal Behavior Milestones Assessment and Placement Program (VBMAPP) or the Assessment of Basic Language and Learning Skills (ABLLS), based on their developmental age. The control cohort received applied behavior analysis (ABA) without HBOT. The experimental cohort received ABA and a minimum of 40 HBOT treatments, breathing 100% oxygen at 2.0 atmosphere absolute (ATA) for 60 minutes. Results Sixty-five children were included, of which 32 received HBOT (mean (M) = 5.1, standard deviation (SD) = 2.93), with an age range of two to 17 years. More than 63% of the subjects had an autism severity level of three. The 23 children administered VBMAPP who received HBOT showed substantial mean differences with high effect sizes (ESs) (-0.743 to -1.65) and a total score (TS) ES equal to -1.23 as measured by Cohen's d. There was a statistically significant improvement (p < 0.05) in all VBMAPP milestone domains and TS. TS change from baseline versus those in the non-HBOT (Control-ABA) group (n=12) was 46.41 ± 20.14 vs 14.42 ± 6.99; p < 0.0001, ES = -1.23. The 30 children administered the ABLLS showed substantial mean difference (TS) change from baseline 268.89 ± 182.05 vs 190.81 ± 135.26 and exhibited small to medium (-.114 to -.773) ESs with a TS ES = -0.487. Due to the high within-group variability (low statistical power) within the ABLLS cohort, there was a non-significant mean difference between the control (ABA) and experimental (ABA + HBO2) groups' difference scores (p > 0.2024), despite the medium (TS) ES. Conclusions The child cohorts administered the VBMAPP and the ABLLS demonstrated substantial improvements between the non-HBOT (control-ABA) and HBOT (experimental-ABA + HBO2) groups as measured by the significant mean differences and small to large ESs. Simply put, the children in the experimental cohort acquired more verbal skills than their counterparts in the control group.
Collapse
Affiliation(s)
- Tami Peterson
- Hyperbaric Oxygen Therapy, The Oxford Center, Brighton, USA
| | - Robert Sherwin
- Hyperbaric Oxygen Therapy, Wayne State University School of Medicine, Detroit, USA
| | - Tiffany Hosey
- Hyperbaric Oxygen Therapy, The Oxford Center, Brighton, USA
| | | | | |
Collapse
|
8
|
Del Hoyo Soriano L, Sterling A, Edgin J, Hamilton DR, Berry-Kravis E, Dimachkie Nunnally A, Thurman AJ, Abbeduto L. Associations Among Sex, Cognitive Ability, and Autism Symptoms in Individuals with Down Syndrome. J Autism Dev Disord 2024; 54:301-311. [PMID: 36315322 PMCID: PMC10184887 DOI: 10.1007/s10803-022-05779-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2022] [Indexed: 11/07/2022]
Abstract
This study explores sex-differences in (a) rates and profiles of autism symptoms as well as in (b) the contribution of intellectual quotient (IQ) to autism symptom presentation in Down syndrome (DS). Participants were 40 males and 38 females with DS, aged 6 to 23 years. Autism symptoms were rated through the Autism Diagnostic Observation Schedule-Second Edition (ADOS-2). Results show no sex differences in the ADOS-2 Calibrated Severity Scores (CSS). However, only females with DS who are classified as DS-Only have higher scores on verbal IQ than those classified as DS + autism. Furthermore, associations between IQ and all CSSs are found for females, but not for males. Findings suggest that verbal cognition may play differential roles for females and males with DS.
Collapse
Affiliation(s)
- Laura Del Hoyo Soriano
- MIND Institute, University of California Davis, 2825 50th Street, Sacramento, CA, USA.
- Department of Psychiatry and Behavioral Sciences, University of California, Davis Health, Sacramento, CA, USA.
| | - Audra Sterling
- Waisman Center, Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, WI, USA
| | - Jamie Edgin
- Department of Psychology, University of Arizona, Tucson, AZ, USA
| | - Debra R Hamilton
- Department of Human Genetics, School of Medicine, Emory University, Atlanta, GA, USA
| | - Elizabeth Berry-Kravis
- Departments of Pediatrics, Neurological Sciences and Biochemistry, Rush University Medical Center, Chicago, USA
| | | | - Angela John Thurman
- MIND Institute, University of California Davis, 2825 50th Street, Sacramento, CA, USA
- Department of Psychiatry and Behavioral Sciences, University of California, Davis Health, Sacramento, CA, USA
| | - Leonard Abbeduto
- MIND Institute, University of California Davis, 2825 50th Street, Sacramento, CA, USA
- Department of Psychiatry and Behavioral Sciences, University of California, Davis Health, Sacramento, CA, USA
| |
Collapse
|
9
|
Long KA, LaRochelle J, Gordillo M, Pariseau EM, DeCelle MG, Orsmond G. Siblings FORWARD: Development of a New Program to Engage Siblings of Autistic Adults in Future Planning. J Autism Dev Disord 2023:10.1007/s10803-023-06178-1. [PMID: 38117420 DOI: 10.1007/s10803-023-06178-1] [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: 10/30/2023] [Indexed: 12/21/2023]
Abstract
The adult service system does not adequately meet the needs of autistic adults, prompting families to continue their supportive roles. Siblings frequently assume these roles when parents are no longer able to do so, often without preparation or planning. We received feedback on the proposed Siblings FORWARD (Focusing on Relationships, Well-being, and Responsibility aheaD) program concept, which would involve 6-7 individualized sessions over ~ 3 months and would facilitate siblings' proactive future planning involvement with their autistic family member. Siblings FORWARD would bolster siblings' skills, knowledge, and self-efficacy to engage in future planning with their family members. We report on perceived need for a sibling program and feedback on the proposed program goals, content, and design. Adult siblings (n = 13), autistic adults (n = 6), and service providers (n = 17) participated in individual interviews or focus groups. Data were systematically coded and analyzed using directed content analysis. Siblings, autistic adults, and service providers expressed high enthusiasm for the Siblings FORWARD concept. Participants indicated that the combination of skill-building and education would promote continued, collaborative future planning that persists after the formal program ends. They had positive impressions of the program concept, goals, content, and design, including the telehealth delivery model. Siblings and autistic adults reported wanting to participate in Siblings FORWARD. This uniform, strong enthusiasm for the Siblings FORWARD concept warrants moving forward to examine preliminary acceptability and feasibility. Ultimately, greater sibling involvement in family future planning may improve autistic adults' functioning through improved continuity of care and support across adulthood.
Collapse
Affiliation(s)
- Kristin A Long
- Department of Psychological & Brain Sciences, Program in Clinical Psychology, Boston University, 900 Commonwealth Ave., Second Floor, Boston, MA, USA.
| | - Jade LaRochelle
- Department of Occupational Therapy, Boston University, Boston, MA, USA
- Newton Wellesley Hospital, Newton, MA, USA
| | - Monica Gordillo
- Department of Psychological & Brain Sciences, Program in Clinical Psychology, Boston University, 900 Commonwealth Ave., Second Floor, Boston, MA, USA
- Nemours Children's Health, Delaware, Wilmington, DE, USA
| | - Emily M Pariseau
- Department of Psychological & Brain Sciences, Program in Clinical Psychology, Boston University, 900 Commonwealth Ave., Second Floor, Boston, MA, USA
- Nemours Children's Health, Delaware, Wilmington, DE, USA
| | - Melissa G DeCelle
- Department of Occupational Therapy, Boston University, Boston, MA, USA
- Boston Children's Hospital, Boston, MA, USA
| | - Gael Orsmond
- Department of Occupational Therapy, Boston University, Boston, MA, USA
| |
Collapse
|
10
|
Mittmann G, Schrank B, Steiner-Hofbauer V. TV Series in Mainstream Media Depicting Autism and Self-Diagnosis of Autism in a General Population of Young Adults. J Autism Dev Disord 2023:10.1007/s10803-023-06150-z. [PMID: 37847319 DOI: 10.1007/s10803-023-06150-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2023] [Indexed: 10/18/2023]
Abstract
PURPOSE The prevalence of autism diagnoses has increased in recent years. The portrayal of autistic characters in mainstream media, such as TV series, may be a contributing factor. This study investigated whether young adults who consume media featuring autistic characters are more likely to self-diagnose with autism. METHODS 348 participants filled out an online questionnaire exploring their media consumption, subjective diagnosis of autism and objective indicators of autism using an Emotion Recognition Task. RESULTS Results from linear regression analysis indicated a significant correlation between media consumption and self-diagnosis, while valence of the series and objective diagnosis did not have a significant influence. The study found no gender differences. CONCLUSION The results suggest a need for further research on the relationship between media consumption and self-diagnosis, including for other forms of media beyond TV series.
Collapse
Affiliation(s)
- Gloria Mittmann
- Research Centre Transitional Psychiatry, Karl Landsteiner University for Health Sciences, Krems, Austria.
| | - Beate Schrank
- Research Centre Transitional Psychiatry, Karl Landsteiner University for Health Sciences, Krems, Austria
- Department of Psychiatry and Psychotherapeutic Medicine, University Hospital Tulln, Tulln, Austria
| | - Verena Steiner-Hofbauer
- Research Centre Transitional Psychiatry, Karl Landsteiner University for Health Sciences, Krems, Austria
| |
Collapse
|
11
|
French B, Daley D, Groom M, Cassidy S. Risks Associated With Undiagnosed ADHD and/or Autism: A Mixed-Method Systematic Review. J Atten Disord 2023; 27:1393-1410. [PMID: 37341291 PMCID: PMC10498662 DOI: 10.1177/10870547231176862] [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] [Indexed: 06/22/2023]
Abstract
BACKGROUND The two most prevalent neurodevelopmental disorders-Attention Deficit Hyperactivity Disorder (ADHD) and Autism (ASD)-(ASD/ADHD) strongly impact individuals' functions. This is worsened when individuals are undiagnosed and risks such as increased imprisonments, depression or drug misuse are often observed. This systematic review synthesizes the risks associated with late/undiagnosed ASD/ADHD. METHODS Four databases were searched (Medline, Scopus, PsychInfor, and Embase). Published studies exploring the impact of undiagnosed ASD/ADHD were included. Exclusion criteria included, lack of diagnosis status, studies not solely on ASD or ADHD, gray literature and studies not in English. The findings were summarize through a narrative synthesis. RESULTS Seventeen studies were identified, 14 on ADHD and three on ASD. The narrative synthesis identified three main themes: (1) Health, (2) Offending behavior, and (3) Day-to-day impact. The risks highlighted a significant impact on mental wellbeing and social interactions, higher risks of substance abuse, accidents and offending behavior as well as lower levels of income and education. DISCUSSION The findings suggest that undiagnosed ASD/ADHD is linked to many risks and negative outcomes affecting individuals, their families, and the wider society. The restricted number of studies on ASD are a limitation to the generalization of these findings Implications for research and practice are discussed, highlighting the importance of screening and acknowledging the possibility of ASD/ADHD in many settings such as psychiatric and forensic.
Collapse
|
12
|
Dückert S, Gewohn P, König H, Schöttle D, Konnopka A, Rahlff P, Erik F, Vogeley K, Schulz H, David N, Peth J. Barriers and needs in mental healthcare of adults with autism spectrum disorder in Germany: a qualitative study in autistic adults, relatives, and healthcare providers. BMC Psychiatry 2023; 23:528. [PMID: 37479974 PMCID: PMC10362719 DOI: 10.1186/s12888-023-05026-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 07/13/2023] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND Autism refers to a neurodevelopmental condition with characteristic impairments in social interaction and communication, restrictive and repetitive behaviors, as well as difficulties in sensory information processing and daily living skills. Even though symptoms persist from early childhood throughout the lifespan and often require long-term support, there is a lack of mental health services that sufficiently meet the needs of autistic adults. Previous evidence suggested individual, professional and structural barriers to healthcare for autistic adults. Here, using a peer research approach, we sought to systematically investigate barriers and needs in mental healthcare of autistic adults in Germany at the three relevant levels (individual, professional, structural) and from three relevant perspectives (autistic adults, relatives and healthcare providers), in order to obtain specific recommendations for optimized healthcare. METHODS Maximum variation sampling was used to account for the complexity of the research field. Semi-structured, open-ended interviews were conducted with autistic adults (n = 15) and focus groups with relatives/partners (n = 12), and healthcare providers of several professions (n = 15). Data analysis was performed using the codebook approach of thematic analysis. RESULTS Poor mental healthcare of autistic adults in Germany was characterized by six central and overarching themes: (i) lack of knowledge about autism, (ii) a need for increased participation/involvement, (iii) consideration of autism-specific needs in treatment, (iv) lack of services, (v) limited access to services, and (vi) improvement of stakeholder collaboration. Themes were similarly reported across participants, emphasizing dissatisfaction in all stakeholders. CONCLUSIONS We identified major barriers to mental healthcare for autistic adults in Germany that affect autistic adults, but are also of concern to relatives and healthcare providers. Our results point to specific and generic areas for improvement, independent of stakeholder perspectives, which could guide future development of needs- and evidence-based services, recommendations and guidelines of mental healthcare for people with autism across the lifespan. TRIAL REGISTRATION This study protocol was preregistered at the Open Science Framework ( https://osf.io/5x8pg ).
Collapse
Affiliation(s)
- Sophia Dückert
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Petia Gewohn
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg- Eppendorf, Hamburg, Germany
| | - Hannah König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Daniel Schöttle
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg- Eppendorf, Hamburg, Germany
| | - Alexander Konnopka
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Pascal Rahlff
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Frank- Erik
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Kai Vogeley
- Department of Psychiatry, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Holger Schulz
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Nicole David
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Judith Peth
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| |
Collapse
|
13
|
Ghanouni P, Seaker L. What does receiving autism diagnosis in adulthood look like? Stakeholders' experiences and inputs. Int J Ment Health Syst 2023; 17:16. [PMID: 37291614 DOI: 10.1186/s13033-023-00587-6] [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] [Received: 10/23/2022] [Accepted: 05/25/2023] [Indexed: 06/10/2023] Open
Abstract
INTRODUCTION The age of diagnosis is crucial for optimal health outcomes; however, some individuals with Autism Spectrum Disorder (ASD) may not be diagnosed until adulthood. Limited information is available about the lived experience of receiving a diagnosis during adulthood. Thus, we aimed to investigate stakeholders' experiences about the ASD diagnosis during adulthood. METHOD We interviewed 18 individuals including 13 adults with ASD who had received a late diagnosis during adulthood and 5 parents of individuals with ASD from various Canadian provinces. RESULTS Using a thematic analysis, three main themes emerged: (a) noticing differences and similarities, (b) hindering elements to diagnosis, and (c) emotional response to diagnostic odyssey. CONCLUSION This study adds to the literature about experiences of receiving ASD diagnosis in adulthood. Given the impact of diagnosis on individuals, it is important to minimize the barriers to ensure individuals who require ASD-related supports can access them in a timely and effective manner. This study highlights the importance of receiving an ASD diagnosis and facilitates positive health outcomes. The findings from the current study can be used to guide adult diagnostic processes and practices to help make ASD diagnosis more accessible.
Collapse
Affiliation(s)
- Parisa Ghanouni
- Department of Occupational Therapy, Dalhousie University, PO Box 15000, Halifax, NS, B3H 4R2, Canada.
| | - Liam Seaker
- Department of Occupational Therapy, Dalhousie University, PO Box 15000, Halifax, NS, B3H 4R2, Canada
| |
Collapse
|
14
|
Barzegari A, Mahdirejei HA, Hanani M, Esmaeili MH, Salari AA. Adolescent swimming exercise following maternal valproic acid treatment improves cognition and reduces stress-related symptoms in offspring mice: Role of sex and brain cytokines. Physiol Behav 2023; 269:114264. [PMID: 37295664 DOI: 10.1016/j.physbeh.2023.114264] [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: 12/16/2022] [Revised: 05/20/2023] [Accepted: 06/06/2023] [Indexed: 06/12/2023]
Abstract
Valproic acid (VPA) treatment during pregnancy is a risk factor for developing autism spectrum disorder, cognitive deficits, and stress-related disorders in children. No effective therapeutic strategies are currently approved to treat or manage core symptoms of autism. Active lifestyles and physical activity are closely associated with health and quality of life during childhood and adulthood. This study aimed to evaluate whether swimming exercise during adolescence can prevent the development of cognitive dysfunction and stress-related disorders in prenatally VPA-exposed mice offspring. Pregnant mice received VPA, afterwards, offspring were subjected to swimming exercise. We assessed neurobehavioral performances and inflammatory cytokines (interleukin-(IL)6, tumor-necrosis-factor-(TNF)α, interferon-(IFN)γ, and IL-17A) in the hippocampus and prefrontal cortex of offspring. Prenatal VPA treatment increased anxiety-and anhedonia-like behavior and decreased social behavior in male and female offspring. Prenatal VPA exposure also increased behavioral despair and reduced working and recognition memory in male offspring. Although prenatal VPA increased hippocampal IL-6 and IFN-γ, and prefrontal IFN-γ and IL-17 in males, it only increased hippocampal TNF-α and IFN-γ in female offspring. Adolescent exercise made VPA-treated male and female offspring resistant to anxiety-and anhedonia-like behavior in adulthood, whereas it only made VPA-exposed male offspring resistant to behavioral despair, social and cognitive deficits in adulthood. Exercise reduced hippocampal IL-6, TNF-α, IFN-γ, and IL-17, and prefrontal IFN-γ and IL-17 in VPA-treated male offspring, whereas it reduced hippocampal TNF-α and IFN-γ in VPA-treated female offspring. This study suggests that adolescent exercise may prevents the development of stress-related symptoms, cognitive deficits, and neuroinflammation in prenatally VPA-exposed offspring mice.
Collapse
Affiliation(s)
- Ali Barzegari
- Department of Exercise Physiology, Payame Noor University (PNU), Tehran, Iran
| | | | - Masoumeh Hanani
- Department of Exercise Physiology, Faculty of Physical Education and Sport Sciences, Kish International Campus, University of Tehran, Kish, Iran
| | | | - Ali-Akbar Salari
- Salari Institute of Cognitive and Behavioral Disorders (SICBD), Karaj, Alborz, Iran; Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands.
| |
Collapse
|
15
|
Bylemans T, Heleven E, Asselman E, Baetens K, Deroost N, Baeken C, Van Overwalle F. Sex differences in autistic adults: A preliminary study showing differences in mentalizing, but not in narrative coherence. Acta Psychol (Amst) 2023; 236:103918. [PMID: 37071947 DOI: 10.1016/j.actpsy.2023.103918] [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: 12/29/2022] [Revised: 02/27/2023] [Accepted: 04/14/2023] [Indexed: 04/20/2023] Open
Abstract
Studying autism might be a complex endeavor due to its clinical heterogeneity. Little is currently known about potential sex differences in autistic adults, especially regarding mentalizing and narrative coherence. In this study, male and female participants told a personal story about one of their most positive and most negative life events and performed two mentalizing tasks. One of these mentalizing tasks was a recently developed Picture and Verbal Sequencing task that has shown cerebellar recruitment, and which requires mentalizing in a sequential context (i.e., participants chronologically ordered scenarios that required true and false belief mentalizing). Our preliminary comparison shows that males were faster and more accurate on the Picture Sequencing task compared to female participants when ordering sequences involving false beliefs, but not true beliefs. No sex differences were found for the other mentalizing and narrative tasks. These results highlight the importance of looking at sex differences in autistic adults and provide a possible explanation for sex-related differences in daily life mentalizing functions, which suggest a need for more sensitive diagnosis and tailored support.
Collapse
Affiliation(s)
- Tom Bylemans
- Brain Body and Cognition, Department of Psychology, and Center for Neuroscience, Vrije Universiteit Brussel, Belgium.
| | - Elien Heleven
- Brain Body and Cognition, Department of Psychology, and Center for Neuroscience, Vrije Universiteit Brussel, Belgium.
| | - Emma Asselman
- Brain Body and Cognition, Department of Psychology, and Center for Neuroscience, Vrije Universiteit Brussel, Belgium.
| | - Kris Baetens
- Brain Body and Cognition, Department of Psychology, and Center for Neuroscience, Vrije Universiteit Brussel, Belgium.
| | - Natacha Deroost
- Brain Body and Cognition, Department of Psychology, and Center for Neuroscience, Vrije Universiteit Brussel, Belgium.
| | - Chris Baeken
- Ghent University: Department of Head and Skin (UZGent), Ghent Experimental Psychiatry (GHEP) Lab, Belgium; Vrije Universiteit Brussel (VUB), Department of Psychiatry, University Hospital (UZ Brussel), Brussels, Belgium; Eindhoven University of Technology, Department of Electrical Engineering, Eindhoven, the Netherlands.
| | - Frank Van Overwalle
- Brain Body and Cognition, Department of Psychology, and Center for Neuroscience, Vrije Universiteit Brussel, Belgium.
| |
Collapse
|
16
|
Henderson LM, St Clair M, Knowland V, van Rijn E, Walker S, Gaskell MG. Stronger Associations Between Sleep and Mental Health in Adults with Autism: A UK Biobank Study. J Autism Dev Disord 2023; 53:1543-1559. [PMID: 34860312 PMCID: PMC10066094 DOI: 10.1007/s10803-021-05382-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2021] [Indexed: 12/26/2022]
Abstract
This study examined sleep and its cognitive and affective correlates in adults with and without autism spectrum disorder (ASD), utilizing UK Biobank data. There were no group differences in subjective sleep duration [n = 220 ASD; n = 2200 general population (GP)]. Accelerometer measures of sleep duration or nighttime activity did not differ by group, but sleep efficiency was marginally lower in ASD (n = 83 ASD; n = 824 GP). Sleep efficiency was associated with wellbeing and mental health, and pathways between accelerometer sleep measures and wellbeing and mental health were significantly stronger for adults with ASD (who also reported substantially poorer wellbeing and > 5 × likelihood of experiencing mental distress). These findings highlight the need to monitor sleep to maintain good mental health in adult ASD.
Collapse
Affiliation(s)
- Lisa M Henderson
- Department of Psychology, University of York, York, YO10 5DD, UK.
| | - M St Clair
- Department of Psychology, University of Bath, Bath, UK
| | - V Knowland
- Department of Speech and Language Sciences, University of Newcastle, Newcastle, Australia
| | - E van Rijn
- Department of Psychology, University of York, York, YO10 5DD, UK
| | - S Walker
- Department of Psychology, University of York, York, YO10 5DD, UK
| | - M G Gaskell
- Department of Psychology, University of York, York, YO10 5DD, UK
| |
Collapse
|
17
|
Bylemans T, Heleven E, Baetens K, Deroost N, Baeken C, Van Overwalle F. Mentalizing and narrative coherence in autistic adults: Cerebellar sequencing and prediction. Neurosci Biobehav Rev 2023; 146:105045. [PMID: 36646260 DOI: 10.1016/j.neubiorev.2023.105045] [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: 10/29/2022] [Revised: 01/11/2023] [Accepted: 01/11/2023] [Indexed: 01/15/2023]
Abstract
BYLEMANS, T., et al. Mentalizing and narrative coherence in autistic adults: Cerebellar sequencing and prediction. NEUROSCI BIOBEHAV REV, 2022. - This review focuses on autistic adults and serves 4 purposes: (1) providing an overview of their difficulties regarding mentalizing (understanding others' mental states) and narrative coherence (structured storytelling), (2) highlighting the relations between both skills by examining behavioral observations and shared neural substrates, (3) providing an integrated perspective regarding novel diagnostic tools and support services, and (4) raising awareness of adult autism. We suggest that mentalizing and narrative coherence are related at the behavioral level and neural level. In addition to the traditional mentalizing network, the cerebellum probably serves as an important hub in shared cerebral networks implicated in mentalizing and narrative coherence. Future autism research and support services should tackle new questions within a framework of social cerebellar (dys)functioning.
Collapse
Affiliation(s)
- Tom Bylemans
- Brain, Body and Cognition, Department of Psychology, and Center for Neuroscience, Vrije Universiteit Brussel, Brussels, Belgium.
| | - Elien Heleven
- Brain, Body and Cognition, Department of Psychology, and Center for Neuroscience, Vrije Universiteit Brussel, Brussels, Belgium.
| | - Kris Baetens
- Brain, Body and Cognition, Department of Psychology, and Center for Neuroscience, Vrije Universiteit Brussel, Brussels, Belgium.
| | - Natacha Deroost
- Brain, Body and Cognition, Department of Psychology, and Center for Neuroscience, Vrije Universiteit Brussel, Brussels, Belgium.
| | - Chris Baeken
- Ghent University: Department of Head and Skin (UZGent), Ghent Experimental Psychiatry (GHEP) Lab, Belgium; Vrije Universiteit Brussel (VUB), Department of Psychiatry, University Hospital (UZ Brussel), Brussels, Belgium; Eindhoven University of Technology, Department of Electrical Engineering, Eindhoven, the Netherlands.
| | - Frank Van Overwalle
- Brain, Body and Cognition, Department of Psychology, and Center for Neuroscience, Vrije Universiteit Brussel, Brussels, Belgium.
| |
Collapse
|
18
|
Holmes LG, Anderson K, Sieber GS, Shattuck PT. Sexual and reproductive health services for autistic young people in the United States: A conceptual model of utilization. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2023; 55:49-61. [PMID: 36751875 DOI: 10.1363/psrh.12221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
BACKGROUND Sexual and reproductive health services promote the ability of people to have safe, satisfying, non-coercive sexual experiences and make informed decisions about pregnancy. Stakeholder input is needed to understand barriers or facilitators to service access for autistic people, who report unmet needs. METHODS We recruited 18 autistic people, 15 parents, and 15 service providers in the United States to participate in an interview and two surveys. Using their input, we created a conceptual model of sexual and reproductive health service needs, access barriers, and facilitators. RESULTS Stakeholders rated a variety of sexual and reproductive health services as important for autistic people, including those with intellectual disability or minimal verbal language. Stakeholders identified barriers to sexual and reproductive health service utilization including lack of service availability, lack of service providers with autism or neurodiversity training, lack of accurate information about autism and sexuality, verbal and communication differences that are not accommodated by service providers, and socio-cultural attitudes about sexuality. Stakeholders identified facilitators to service access including person-centered, trauma-informed care, service accommodations such as clear and detailed expectations, and long-enough appointments. We created a conceptual model based on the social ecological model of health to organize these utilization factors and support future research, provider, and policy action. Stakeholders provided feedback and responded favorably on the model's accuracy, utility for spurring research, practice, and policy improvements, and application to diverse groups of autistic people. CONCLUSIONS The model shows the many feasible ways to support equitable access to services for autistic people.
Collapse
Affiliation(s)
- Laura Graham Holmes
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania, USA
- Silberman School of Social Work, Hunter College, City University of New York, New York City, New York, USA
| | - Kristy Anderson
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania, USA
- Florida State University College of Social Work, Tallahassee, Florida, USA
| | - Greg S Sieber
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania, USA
| | | |
Collapse
|
19
|
“I Always Knew I Was Different”: Experiences of Receiving a Diagnosis of Autistic Spectrum Disorder in Adulthood—a Meta-Ethnographic Systematic Review. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2023. [DOI: 10.1007/s40489-023-00356-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
AbstractA broadening of diagnostic criteria and increased awareness of autism has led to a large number of individuals whose difficulties remained undetected until adulthood. This systematic review aimed to synthesise empirical evidence of the experience of individuals who received their diagnosis of autism in adulthood. Eight studies met the inclusion criteria. A meta-ethnographic approach was used to synthesise the findings. Analysis revealed two meta-themes: feeling “like an alien” and the “not guilty” verdict, each with three associated subthemes. The findings indicate the need for timely diagnosis and provision of post-diagnostic support to alleviate the mental health implications of not having a framework to understand one’s experiences and to support the process of adjustment to the diagnosis.
Collapse
|
20
|
A systematic review of predictors of suicidal thoughts and behaviors among autistic adults: Making the case for the role of social connection as a protective factor. Clin Psychol Rev 2023; 99:102235. [PMID: 36459876 DOI: 10.1016/j.cpr.2022.102235] [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: 03/28/2022] [Revised: 09/21/2022] [Accepted: 11/23/2022] [Indexed: 11/29/2022]
Abstract
Autistic adults are a high-risk population for suicidal thoughts and behaviors (STBs). Accordingly, this systematic review aims to review the prevalence of STBs among autistic adults, review the risk and protective factors for STBs in autistic adults, and formulate a disorder-specific conceptualization of risk in this population. We systematically searched PsycINFO and Google Scholar for all studies published prior to March 28th, 2022. We included empirical articles focused on autistic adults, ages 18 years and older, reporting on suicide-related outcomes. In total, 45 peer-reviewed empirical articles were included in the current systematic review. The most frequently studied factors in relation to suicide risk among autistic adults were interpersonal constructs (42.4% of total studies looking at risk/protective factors) and depressive symptoms (36.4% of total studies looking at risk/protective factors). We conclude by summarize two key content areas: exploring social and interpersonal constructs and better understanding the role of depressive symptoms in autism. As researchers continue to explore STBs among autistic adults, it will be necessary to addressing the overreliance on autistic symptoms instead of autism diagnoses, measurement issues of STBs, and a need for treatment adaptations.
Collapse
|
21
|
Stone B, Cameron A, Dowling S. The autistic experience of homelessness: Implications from a narrative enquiry. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:489-499. [PMID: 35757980 DOI: 10.1177/13623613221105091] [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] [Indexed: 02/02/2023]
Abstract
LAY ABSTRACT Recent research suggests many autistic people experience homelessness. However, little is known about the types of homelessness autistic people experience and what barriers autistic people face when trying to exit homelessness. This study involved gathering life stories of autistic people who had experienced homelessness. Ten autistic participants talked about their pathways through homelessness and the difficulties they had in accessing support. After first becoming homeless, participants tended to experience rough sleeping and sofa surfing. When participants approached housing and homelessness services, they were often told they were not eligible for support. This could happen when support workers were not aware of autism, or when autism was not considered 'severe' enough. Overcrowding, confrontation and lack of control over routine and environment were particular issues for participants when they entered homelessness hostels. Some participants chose to sleep on the streets rather than stay in environments which increased social anxiety and sensory difficulties. This study discusses ways in which homelessness and housing services can increase accessibility and improve engagement for autistic people. It is important to increase awareness of autism while understanding that autistic people who experience homelessness may have complex needs. In addition, services need to listen to autistic people with lived experience of homelessness to decide what changes will have the most impact.
Collapse
|
22
|
Yule AM, DiSalvo M, Biederman J, Wilens TE, Dallenbach NT, Taubin D, Joshi G. Decreased risk for substance use disorders in individuals with high-functioning autism spectrum disorder. Eur Child Adolesc Psychiatry 2023; 32:257-265. [PMID: 34363537 PMCID: PMC8936975 DOI: 10.1007/s00787-021-01852-0] [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: 02/26/2021] [Accepted: 07/26/2021] [Indexed: 10/20/2022]
Abstract
The objective of this study was to evaluate the risk for developing a substance use disorder (SUD, alcohol or drug abuse or dependence) in individuals with high-functioning autism spectrum disorder (ASD). Subjects with high-functioning ASD were derived from consecutive referrals to a specialized ambulatory program for ASD at a major academic center from 2007 to 2016. Age-matched controls and attention-deficit hyperactivity disorder (ADHD) comparison subjects were derived from three independent studies of children and adults with and without ADHD using identical assessment methodology. Cox proportional hazard models were used to analyze the prevalence of SUD (alcohol or drug use disorder). Age of onset of SUD was analyzed with linear regression models. Our sample included 230 controls, 219 subjects with ADHD, and 230 subjects with ASD. The mean age for the ASD subjects was 20.0 ± 10.3 years. Among ASD subjects, 69% had a lifetime prevalence of ADHD, and the ASD subjects had significantly higher rates of other psychiatric psychopathology compared to ADHD and control subjects (p < 0.001) ASD subjects were at significantly decreased risk for developing a SUD compared to ADHD (hazard ratio (HR) = 0.22, p < 0.001) and control subjects (HR = 0.62, p = 0.04). The age of onset of a SUD was significantly older in ASD subjects, mean age 21.7 years, when compared to ADHD and control subjects (both p < 0.005). Individuals with ASD are at decreased risk to develop a SUD, and when they do, the onset is significantly later than ADHD and controls.
Collapse
Affiliation(s)
- Amy M Yule
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Warren Building 705, 55 Fruit Street, Boston, MA, 02114, USA.
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA.
- Department of Psychiatry, Boston Medical Center and Boston University School of Medicine, Boston, MA, 02118, USA.
| | - Maura DiSalvo
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Warren Building 705, 55 Fruit Street, Boston, MA, 02114, USA
| | - Joseph Biederman
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Warren Building 705, 55 Fruit Street, Boston, MA, 02114, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA
| | - Timothy E Wilens
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Warren Building 705, 55 Fruit Street, Boston, MA, 02114, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA
| | - Nina T Dallenbach
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Warren Building 705, 55 Fruit Street, Boston, MA, 02114, USA
| | - Daria Taubin
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Warren Building 705, 55 Fruit Street, Boston, MA, 02114, USA
| | - Gagan Joshi
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Warren Building 705, 55 Fruit Street, Boston, MA, 02114, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA
| |
Collapse
|
23
|
Talcer MC, Duffy O, Pedlow K. A Qualitative Exploration into the Sensory Experiences of Autistic Mothers. J Autism Dev Disord 2023; 53:834-849. [PMID: 34251566 PMCID: PMC9944021 DOI: 10.1007/s10803-021-05188-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2021] [Indexed: 12/22/2022]
Abstract
Research has found 96% of autistic individuals experience sensory processing difficulties, and being a parent presents many sensory demands that may be especially challenging for autistic mothers. Despite the high prevalence, no research exists exploring the sensory experiences of autistic mothers, highlighting the gap in current knowledge. Semi-structured interviews were conducted with 7 autistic mothers, data were analysed using thematic analysis identifying 5 major themes: antenatal experiences, sensory experiences in motherhood, the impact of sensory processing difficulties, strategies and needs, diagnosis. This research provides greater insight and understanding into the sensory experiences of autistic mothers which can influence earlier diagnosis and inform appropriate support and adaptations for autistic mothers in a variety of different sectors and highlights a possible emerging role for Occupational Therapists.
Collapse
Affiliation(s)
| | - Orla Duffy
- Centre for Health and Rehabilitation Technologies, Institute of Nursing and Health Research, Ulster University, Shore Road, Newtownabbey, BT37 0QB, UK.
| | - Katy Pedlow
- grid.12641.300000000105519715Centre for Health and Rehabilitation Technologies, Institute of Nursing and Health Research, Ulster University, Shore Road, Newtownabbey , BT37 0QB UK
| |
Collapse
|
24
|
Lockwood Estrin G, Aseervatham V, De Barros CM, Chapple T, Churchard A, Harper M, Jones EJH, Mandy W, Milner V, O’Brien S, Senju A, Smith C, Smith J. Homelessness in autistic women: Defining the research agenda. WOMEN'S HEALTH (LONDON, ENGLAND) 2022; 18:17455057221141291. [PMID: 36515431 PMCID: PMC9756367 DOI: 10.1177/17455057221141291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Current evidence suggests that autistic individuals are at high risk for becoming and remaining in a cycle of homelessness. Key risk factors for homelessness disproportionately affect autistic people; however, we have limited understanding of how to best support autistic individuals accessing services. This gap in the evidence base is particularly acute for autistic women. OBJECTIVE As a first step to address this gap, we aimed to (1) map gaps in knowledge and practice; (2) identify priority areas for research and (3) develop recommendations for how to implement novel research and practice in this area. METHODS We conducted a collaborative workshop with an interdisciplinary group of 26 stakeholders to address our aims. Stakeholders included autistic women with experience of homelessness, researchers, health professionals, NGO representatives, and service providers. RESULTS AND RECOMMENDATIONS Two research priority areas were identified to map the prevalence and demographics of autistic women experiencing homelessness, and to delineate risk and protective factors for homelessness. Priority areas for improving provision of support included staff training to improve communication, awareness of autism and building trust with service providers, and recommendations for practical provision of support by services. CONCLUSIONS Future research is critical to increase our knowledge of the pathways leading to homelessness for autistic women, and barriers to engaging with homelessness and social services. We need to use this knowledge to develop new ways of delivering targeted and inclusive support for autistic women, which could prevent or shorten periods of homelessness.
Collapse
Affiliation(s)
- Georgia Lockwood Estrin
- Department of Psychological Sciences, Birkbeck, University of London, London, UK,School of Psychology, University of East London, London, UK,Georgia Lockwood Estrin, School of Psychology, University of East London, London, E16 2RD UK.
| | | | | | | | - Alasdair Churchard
- Oxford Institute of Clinical Psychology Training and Research, Oxford, UK
| | | | - Emily JH Jones
- Department of Psychological Sciences, Birkbeck, University of London, London, UK
| | - William Mandy
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Victoria Milner
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Sarah O’Brien
- Faculty of Nursing, Midwifery & Palliative Care, King’s College London, London, UK
| | - Atsushi Senju
- Department of Psychological Sciences, Birkbeck, University of London, London, UK,Research Center for Child Mental Development, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | | | - Jonathan Smith
- Department of Psychological Sciences, Birkbeck, University of London, London, UK
| |
Collapse
|
25
|
Badal KK, Puthanveettil SV. Axonal transport deficits in neuropsychiatric disorders. Mol Cell Neurosci 2022; 123:103786. [PMID: 36252719 DOI: 10.1016/j.mcn.2022.103786] [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: 08/04/2022] [Revised: 10/02/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022] Open
Abstract
Axonal transport is a major cellular process that mediates bidirectional signaling between the soma and synapse, enabling both intracellular and intercellular communications. Cellular materials, such as proteins, RNAs, and organelles, are transported by molecular motor proteins along cytoskeletal highways in a highly regulated manner. Several studies have demonstrated that axonal transport is central to normal neuronal function, plasticity, and memory storage. Importantly, disruptions in axonal transport result in neuronal dysfunction and are associated with several neurodegenerative disorders. However, we do not know much about axonal transport deficits in neuropsychiatric disorders. Here, we briefly discuss our current understanding of the role of axonal transport in schizophrenia, bipolar and autism.
Collapse
Affiliation(s)
- Kerriann K Badal
- Department of Neuroscience, UF Scripps Biomedical Research, University of Florida, 130 Scripps Way, Jupiter, FL 33458, USA; Integrative Biology PhD Program, Charles E. Schmidt College of Science, Florida Atlantic University, Jupiter, FL 33458, USA
| | | |
Collapse
|
26
|
Brook Y. How talking therapists experience working with adult clients who have autism. COUNSELLING & PSYCHOTHERAPY RESEARCH 2022. [DOI: 10.1002/capr.12591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Yvette Brook
- Counselling and Psychotherapy Newman University Birmingham England UK
| |
Collapse
|
27
|
Golan O, Terner M, Israel-Yaacov S, Allison C, Baron-Cohen S. The Autism-Spectrum Quotient-Hebrew version: Psychometric properties of a full and a short form, adapted for DSM-5. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 27:796-807. [PMID: 36053012 PMCID: PMC10074759 DOI: 10.1177/13623613221117020] [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: 11/16/2022]
Abstract
LAY ABSTRACT Despite the attempt to diagnose autism at an early age, there are still many individuals who would only get an autism diagnosis in adulthood. For these adults, a questionnaire that could assist in highlighting their need to seek diagnostic assessment is needed. The Autism-Spectrum Quotient is a self-report scale used to assess autistic traits. It was tested cross-culturally, and a short version was recommended to help identify adults who should be referred for an autism assessment. However, its relevance for the up-to-date diagnostic criteria, according to the Diagnostic and Statistical Manual of Mental Disorders (5th ed.), has not been tested. This study aimed to examine the psychometric properties of the Hebrew version of the Autism-Spectrum Quotient and to create a short version of the Hebrew Autism-Spectrum Quotient, based on items which map on to Diagnostic and Statistical Manual of Mental Disorders (5th ed.) criteria. Ninety-three autistic adults (24 females), aged 18-51, clinically diagnosed according to Diagnostic and Statistical Manual of Mental Disorders (5th ed.), and 147 comparable controls (34 females) filled out the Hebrew version of the Autism-Spectrum Quotient. Ten clinicians who specialize in diagnosing autism in adults classified the Autism-Spectrum Quotient's items according to Diagnostic and Statistical Manual of Mental Disorders (5th ed.) criteria. The short version of the Hebrew Autism-Spectrum Quotient comprised items that best differentiated between adults with and without autism, five items representing each of the Diagnostic and Statistical Manual of Mental Disorders (5th ed.) diagnostic domains. The overall probability for participants to be correctly classified as autistic or neurotypical was 86% for the Hebrew version of the Autism-Spectrum Quotient and 88% for the short version of the Hebrew Autism-Spectrum Quotient. We conclude that both versions are reliable and sensitive instruments that can help referring adults for autism assessment.
Collapse
Affiliation(s)
- Ofer Golan
- Bar-Ilan University, Israel.,Association for Children at Risk, Israel.,University of Cambridge, UK
| | | | | | | | | |
Collapse
|
28
|
Autism spectrum disorders: current issues and future directions. Ir J Psychol Med 2022; 39:237-239. [DOI: 10.1017/ipm.2022.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractThis edition of Irish Journal of Psychological Medicine is a Special Themed Issue on Autism Spectrum Disorders (ASD). Mental health services are not currently meeting the needs of autistic people across the lifespan. We have limited evidence based treatments for core symptoms and comorbidities and there is lack of awareness and under-recognition of ASD, particularly in adults and certain groups of individuals. The key themes in this edition focus on challenges with recognition and diagnosis and address these from both clinical and research perspectives. Co-occurring conditions also feature, which are also under-recognised and can contribute to less optimal outcomes. New and existing research developments in stratification for clinical trials and neuroimaging are also discussed. We hope this Issue highlights relevant current issues in ASD, and provides insights which can help address the challenges in providing evidence based pathways to better meet the needs of autistic people into the future.
Collapse
|
29
|
Bylemans T, Heleven E, Baetens K, Deroost N, Baeken C, Van Overwalle F. A narrative sequencing and mentalizing training for adults with autism: A pilot study. Front Behav Neurosci 2022; 16:941272. [PMID: 36062258 PMCID: PMC9433774 DOI: 10.3389/fnbeh.2022.941272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 08/01/2022] [Indexed: 12/24/2022] Open
Abstract
Adults diagnosed with autism experience difficulties with understanding the mental states of others, or themselves (mentalizing) and with adequately sequencing personal stories (narrative coherence). Given that the posterior cerebellum is implicated in both skills, as well as in the etiology of autism, we developed a narrative sequencing and mentalizing training for autistic adults. Participants with an official autism diagnosis were randomly assigned to a Training group (n = 17) or a waiting-list Control group (n = 15). The Training group took part in six weekly sessions in groups of three participants lasting each about 60 min. During training, participants had to (re)tell stories from the perspective of the original storyteller and answer questions that required mentalizing. We found significant improvements in mentalizing about others’ beliefs and in narrative coherence for the Training group compared to the Control group immediately after the training compared to before the training. Almost all participants from the Training group expressed beneficial effects of the training on their mood and half of the participants reported positive effects on their self-confidence in social situations. All participants recommended the current training to others. Results are discussed in light of cerebellar theories on sequencing of social actions during mentalizing. Further improvements to the program are suggested. Our results highlight the potential clinical utility of adopting a neuroscience-informed approach to developing novel therapeutic interventions for autistic populations.
Collapse
Affiliation(s)
- Tom Bylemans
- Brain Body and Cognition, Department of Psychology, Center for Neuroscience, Vrije Universiteit Brussels, Brussels, Belgium
- *Correspondence: Tom Bylemans,
| | - Elien Heleven
- Brain Body and Cognition, Department of Psychology, Center for Neuroscience, Vrije Universiteit Brussels, Brussels, Belgium
| | - Kris Baetens
- Brain Body and Cognition, Department of Psychology, Center for Neuroscience, Vrije Universiteit Brussels, Brussels, Belgium
| | - Natacha Deroost
- Brain Body and Cognition, Department of Psychology, Center for Neuroscience, Vrije Universiteit Brussels, Brussels, Belgium
| | - Chris Baeken
- Ghent Experimental Psychiatry (GHEP) Lab, Department of Head and Skin (UZGent), Ghent University, Ghent, Belgium
- Department of Psychiatry, University Hospital (UZ Brussel), Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Frank Van Overwalle
- Brain Body and Cognition, Department of Psychology, Center for Neuroscience, Vrije Universiteit Brussels, Brussels, Belgium
| |
Collapse
|
30
|
Sakdalan J, Maxwell Y. The application of adapted dialectical behaviour therapy concepts and skills in the treatment of adults with autistic spectrum disorder who display challenging or offending behaviours. ADVANCES IN AUTISM 2022. [DOI: 10.1108/aia-01-2022-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Despite some advances in the assessment and treatment of autism spectrum disorder (ASD), there remains a paucity of intervention and research literature in treating adults with ASD. There is growing evidence supporting a relationship between the core features of ASD and emotion dysregulation. There is an overlap between ASD and borderline personality disorder (BPD) characteristics such as emotional dysregulation, sensory issues and social skills deficits. This paper aims to explore the applications of dialectical behaviour therapy (DBT) concepts and skills in treating ASD individuals who display challenging or offending behaviours. The similarities in characteristics between ASD and BPD and the core issue of emotion dysregulation hold promise in the utility of DBT with ASD.
Design/methodology/approach
This is a conceptual paper that includes a case vignette.
Findings
A DBT-informed treatment approach using the adaptations and reconceptualization, i.e. risky mind–wise mind outlined in this paper, can be considered promising in addressing issues for ASD individuals, particularly those with challenging and/or offending behaviours. DBT incorporates different elements of applied behaviour analysis, cognitive behavioural therapy, mindfulness skills, sensory-based treatments, psychosocial interventions and emotion regulation skills, which makes it a more cohesive and integrated approach to treatment. The authors assert that DBT can be considered a more integrated, strengths-based, habilitative and trauma-informed approach which can be promising in its application to address challenging behaviours or offending in ASD individuals.
Research limitations/implications
It is recommended that research be carried out to evaluate the effectiveness of adapted DBT programs in treating ASD individuals presenting with challenging and/or offending behaviours. Future research can focus on evaluating the effectiveness of the different DBT concepts and skills and the different DBT modules to determine which components of the program are particularly useful for this client group.
Practical implications
Treatment manuals have already been developed for clients with intellectual disability and developmental disabilities who exhibit challenging and/or offending behaviour; hence, it is recommended that modifications be made to make it more applicable and appropriate for ASD individuals. Modifications should address ASD-specific issues (e.g. black and white thinking, cognitive rigidity, sensory issues, impaired theory of mind, emotion dysregulation issues, social skills deficits and anxiety issues). The use of DBT has much wider implications regarding addressing comorbid mental health conditions and personality issues in this client group.
Originality/value
There are limited psychological interventions that prove to be useful for individuals with ASD with complex presentations and challenging or offending behaviours. This paper discusses the application of adapted DBT concepts and skills that appear to be promising in the treatment of this client group.
Collapse
|
31
|
Sidhu HK, Greene MC. A scoping review of disparities in health and health-care service provisions experienced by adults with autism spectrum disorder. ADVANCES IN AUTISM 2022. [DOI: 10.1108/aia-03-2022-0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Adults with autism spectrum disorder (ASD) are more likely to have a poor health status because of being diagnosed with a range of physical and mental health conditions and experience disparities in health care. The purpose of this study is to find barriers to health care experienced by adults with ASD and find gaps in health care which health-care providers can work to fill.
Design/methodology/approach
This scoping review aimed to identify studies that report on disparities in health and health-care service provisions experienced by adults with ASD. The authors included articles that described health-care disparities for patients with ASD and were published in peer-reviewed journals between January 2010 and April 2022. The authors searched the following databases and medical journals to search for eligible studies: Google Scholar, Pubmed, Elsevier, Sage Publications and Embase. The authors comprehensively searched key terms related to ASD, health care and disparities.
Findings
The core defining features of ASD, which include communication and social impairments and deficits in sensory processing, were found to be barriers in the health-care experience of adults with ASD. Continued research and changes in health care, such as developing interventions to empower patients, adequately training providers and increasing the accessibility of the health-care system, are necessary to ensure adults with ASD receive adequate medical care.
Research limitations/implications
Additionally, clarifying the current literature on this topic can guide future research efforts to explore the influence of factors such as gender and the spectrum of autism itself leading to various levels of abilities and their influence on the health-care experience of adults with ASD.
Practical implications
Overall, the findings from this scoping review underline the importance of providing readily accessible evidence-based, age-appropriate primary and hospital health care for adults with ASD.
Social implications
Further interventions are needed to empower patients, adequately train providers, increase the accessibility of the health-care system, increase support for ASD patients and decrease discrimination.
Originality/value
This paper is a scoping literature review of the original work done by researchers in the field of developmental disorders and health care.
Collapse
|
32
|
Frigaux A, Vacant C, Evrard R. Le devenir autiste au féminin : difficultés diagnostiques et ressources subjectives. Une revue de littérature. EVOLUTION PSYCHIATRIQUE 2022. [DOI: 10.1016/j.evopsy.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
33
|
Elesawy RO, El-Deeb OS, Eltokhy AK, Arakeep HM, Ali DA, Elkholy SS, Kabel AM. Postnatal baicalin ameliorates behavioral and neurochemical alterations in valproic acid-induced rodent model of autism: The possible implication of sirtuin-1/mitofusin-2/ Bcl-2 pathway. Biomed Pharmacother 2022; 150:112960. [PMID: 35447549 DOI: 10.1016/j.biopha.2022.112960] [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: 02/09/2022] [Revised: 03/30/2022] [Accepted: 04/11/2022] [Indexed: 11/19/2022] Open
Abstract
Autism spectrum disorder (ASD) is characterized by pervasive impairments in social communication along with repetitive or stereotyped behaviors. Although its distinctive etiology isn`t completely understood, genetic and environmental risk factors were incriminated. Being a flavonoid of high biomedical value, baicalin was recently verified as an emerging medicinal herb with numerous pharmacological activities. The objective of this study was to investigate the feasible effects of baicalin on valproic acid (VPA)-induced autism regarding its potential mitochondrial modulatory, antioxidant, and antiapoptotic effects. The present study was performed using a rodent model of autism by exposing rat fetuses to VPA on the 12.5th day of gestation. Ten male Wistar rats that were born from control pregnant females were considered as group I (control group). Twenty male Wistar rats that were born from prenatal VPA- treated females were further divided into two groups: Group II (VPA- induced ASD) and group III (VPA + Baicalin). Postnatal baicalin promoted postnatal growth and maturation. In addition, it improved motor development and ameliorated repetitive behavior as well as social deficits in prenatally exposed VPA rats. Moreover, baicalin enhanced neuronal mitochondrial functions as evidenced by elevation of mitochondrial adenosine triphosphate (ATP) level and promotion of mitofusin-2 expression. Furthermore, baicalin elevated sirtuin-1 (SIRT1) level in VPA rats' brain tissues and restored the antioxidant defense mechanisms. Besides, it abrogated the neuronal histopathological changes in the brain tissues. Based on the data herein, baicalin may provide a promising pre-clinical therapeutic line in ASD as a mitochondrial function modulator, antioxidant and anti-apoptotic agent.
Collapse
Affiliation(s)
- Rasha O Elesawy
- Pharmacology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Omnia S El-Deeb
- Medical Biochemistry Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Amira K Eltokhy
- Medical Biochemistry Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Heba M Arakeep
- Anatomy and Embryology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Dina A Ali
- Clinical Pathology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Sanad S Elkholy
- Physiology Department, Faculty of Medicine, Kafrelsheikh University, Kafr El-Shaikh, Egypt
| | - Ahmed M Kabel
- Pharmacology Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
| |
Collapse
|
34
|
Chiri G, Bergey M, Mackie TI. Deserving but not entitled: The social construction of autism spectrum disorder in federal policy. Soc Sci Med 2022; 301:114974. [PMID: 35452891 DOI: 10.1016/j.socscimed.2022.114974] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 03/30/2022] [Accepted: 04/08/2022] [Indexed: 11/24/2022]
Abstract
Public policies play an influential role in shaping public opinion about health conditions, who is affected by them, and potential pathways for identification and intervention. This study draws upon a social constructionist perspective of policy design and disability to examine how autism spectrum disorder (ASD) has been framed in United States federal legislation. Qualitative content analysis of autism legislation passed between 1973 and 2019 indicates that policies reinforced ASD as a largely medicalized, neurobiological condition of childhood; this was reflected in both the policy aims, sources of knowledge and groups prioritized to address ASD; and the symbolic or material resources committed (or not committed) by enacted federal legislation to specific constituencies. Policy aims of early ASD legislation were symbolic in nature, focusing predominantly on framing children with ASD as a group worthy of public recognition. More recent legislation, in contrast, conferred material resources - albeit in targeted ways. Funding for surveillance and medical research on causation, early detection, treatment, and health professional training were prioritized with little attention to either service delivery needs of individuals with ASD and their families, supports over the lifecourse, or the social factors influencing ASD.
Collapse
Affiliation(s)
- Giuseppina Chiri
- RTI International, Center for the Health of Populations, Waltham, MA, USA.
| | - Meredith Bergey
- Department of Sociology and Criminology, Villanova University, Villanova, PA, USA
| | - Thomas I Mackie
- Department of Health Policy and Management, School of Public Health, State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, NY, USA
| |
Collapse
|
35
|
Crompton CJ, Hallett S, McAuliffe C, Stanfield AC, Fletcher-Watson S. "A Group of Fellow Travellers Who Understand": Interviews With Autistic People About Post-diagnostic Peer Support in Adulthood. Front Psychol 2022; 13:831628. [PMID: 35369218 PMCID: PMC8964394 DOI: 10.3389/fpsyg.2022.831628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/14/2022] [Indexed: 11/23/2022] Open
Abstract
Receiving a diagnosis of autism in adulthood can be a life changing event, impacting identity, relationships, and mental health. A lack of post-diagnostic support has been highlighted by autistic adults, their allies, clinicians, and service providers. It can be a source of distress for autistic adults, reinforcing feelings of social isolation and rejection. Peer support could be a cost-effective, flexible, and sustainable model to provide community-based support for autistic adults. However, there is little research on the value of peer support, despite calls from the autistic community. This qualitative study explored autistic experiences and needs post-diagnosis, identifying specific ways that peer support may benefit them, and exploring the limitations of peer support. Twelve autistic adults who had all received an autism diagnosis in adulthood completed a semi-structured interview focussing on the diagnostic experience, post-diagnostic support needed and provided, engagement with the autistic community, and post-diagnostic peer support. Thematic analysis of interview transcripts resulted in four themes: (1) Mismatch in support needed and provided; (2) Community connection; (3) Flexible and personalised support; and (4) Sustainability. Participants indicated that peer support may be a useful mechanism to support autistic adults’ post-diagnosis and offers unique opportunities not available through other support channels. Though informal peer support exists, it could be more sustainable and effective if well-supported and funded.
Collapse
Affiliation(s)
- Catherine J Crompton
- Patrick Wild Centre, Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom.,Salvesen Mindroom Research Centre, University of Edinburgh, Edinburgh, United Kingdom
| | - Sonny Hallett
- The Autistic Mutual Aid Society Edinburgh, Edinburgh, United Kingdom
| | | | - Andrew C Stanfield
- Patrick Wild Centre, Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Sue Fletcher-Watson
- Salvesen Mindroom Research Centre, University of Edinburgh, Edinburgh, United Kingdom
| |
Collapse
|
36
|
Human forebrain organoids reveal connections between valproic acid exposure and autism risk. Transl Psychiatry 2022; 12:130. [PMID: 35351869 PMCID: PMC8964691 DOI: 10.1038/s41398-022-01898-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 03/04/2022] [Accepted: 03/11/2022] [Indexed: 12/13/2022] Open
Abstract
Valproic acid (VPA) exposure as an environmental factor that confers risk of autism spectrum disorder (ASD), its functional mechanisms in the human brain remain unclear since relevant studies are currently restricted to two-dimensional cell cultures and animal models. To identify mechanisms by which VPA contribute to ASD risk in human, here we used human forebrain organoids (hFOs), in vitro derived three-dimensional cell cultures that recapitulate key human brain developmental features. We identified that VPA exposure in hFOs affected the expression of genes enriched in neural development, synaptic transmission, oxytocin signaling, calcium, and potassium signaling pathways, which have been implicated in ASD. Genes (e.g., CAMK4, CLCN4, DPP10, GABRB3, KCNB1, PRKCB, SCN1A, and SLC24A2) that affected by VPA were significantly overlapped with those dysregulated in brains or organoids derived from ASD patients, and known ASD risk genes, as well as genes in ASD risk-associated gene coexpression modules. Single-cell RNA sequencing analysis showed that VPA exposure affected the expression of genes in choroid plexus, excitatory neuron, immature neuron, and medial ganglionic eminence cells annotated in hFOs. Microelectrode array further identified that VPA exposure in hFOs disrupted synaptic transmission. Taken together, this study connects VPA exposure to ASD pathogenesis using hFOs, which is valuable for illuminating the etiology of ASD and screening for potential therapeutic targets.
Collapse
|
37
|
Passos-Bueno MR, Costa CIS, Zatz M. Dystrophin genetic variants and autism. DISCOVER MENTAL HEALTH 2022; 2:4. [PMID: 37861890 PMCID: PMC10501027 DOI: 10.1007/s44192-022-00008-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 02/07/2022] [Indexed: 10/21/2023]
Abstract
Loss-of-function variants in the dystrophin gene, a well-known cause of muscular dystrophies, have emerged as a mutational risk mechanism for autism spectrum disorder (ASD), which in turn is a highly prevalent (~ 1%) genetically heterogeneous neurodevelopmental disorder. Although the association of intellectual disability with the dystrophinopathies Duchenne (DMD) and Becker muscular dystrophy (BMD) has been long established, their association with ASD is more recent, and the dystrophin genotype-ASD phenotype correlation is unclear. We therefore present a review of the literature focused on the ASD prevalence among dystrophinopathies, the relevance of the dystrophin isoforms, and most particularly the relevance of the genetic background to the etiology of ASD in these patients. Four families with ASD-DMD/BMD patients are also reported here for the first time. These include a single ASD individual, ASD-discordant and ASD-concordant monozygotic twins, and non-identical ASD triplets. Notably, two unrelated individuals, which were first ascertained because of the ASD phenotype at ages 15 and 5 years respectively, present rare dystrophin variants still poorly characterized, suggesting that some dystrophin variants may compromise the brain more prominently. Whole exome sequencing in these ASD-DMD/BMD individuals together with the literature suggest, although based on preliminary data, a complex and heterogeneous genetic architecture underlying ASD in dystrophinopathies, that include rare variants of large and medium effect. The need for the establishment of a consortia for genomic investigation of ASD-DMD/BMD patients, which may shed light on the genetic architecture of ASD, is discussed.
Collapse
Affiliation(s)
- Maria Rita Passos-Bueno
- Departamento de Genética e Biologia Evolutiva, Centro de Estudos do Genoma Humano e Células-Tronco, Instituto de Biociências, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Claudia Ismania Samogy Costa
- Departamento de Genética e Biologia Evolutiva, Centro de Estudos do Genoma Humano e Células-Tronco, Instituto de Biociências, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Mayana Zatz
- Departamento de Genética e Biologia Evolutiva, Centro de Estudos do Genoma Humano e Células-Tronco, Instituto de Biociências, Universidade de São Paulo, São Paulo, SP, Brazil
| |
Collapse
|
38
|
Lundbergh B, Enevoldsen AS, Stark KD, Ritz C, Lauritzen L. Fish oil supplementation may improve attention, working memory and attention-deficit/hyperactivity disorder symptoms in adults with autism spectrum disorder: a randomised crossover trial. Br J Nutr 2022; 128:1-11. [PMID: 35144699 DOI: 10.1017/s0007114522000393] [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: 11/07/2022]
Abstract
Marine n-3 fatty acids (n-3LCPUFA) have shown neurocognitive benefits in children with attention-deficit/hyperactivity disorder (ADHD), but few trials have examined effects in adults with autism spectrum disorder (ASD). We explored, if n-3LCPUFA affect cognitive functions in adults with ASD, and if effects are modified by comorbid ADHD. In a 2 × 4 week crossover study, twenty-six participants were randomised to sequence of supplementation with fish oil (FO, 5·2 g/d n-3PUFA) and safflower oil (SO). At baseline and after each period, we measured primary outcomes: attention (d2-test) and spatial working memory (Corsi test) and secondary outcomes: flexibility (Stroop word-colour test), ADHD symptoms (Conners scales), executive functions (Behavioural Inventory of Executive Function) and social behaviour (Social Responsiveness Scale). The dropout rate was 15 %. Compliance was 94 % and correlated with whole-blood n-3LCPUFA. Corsi scores improved by ∼0·3 × sd (P = 0·032) after FO v. SO, and the odds for d2 errors were 30 % lower (P = 0·016), which was supported by improved Conners scores of attention (P = 0·023). Improvement in Conners ADHD symptom score was limited to participants with ADHD (-3·5(-6·0; -1·0), n 10 v. -0·2(-2·5;2·2), n 11 without ADHD, Pinteraction = 0·096), who also improved their behavioural regulation index by 0·3 × sd after FO (Pinteraction = 0·016). Participants without ADHD gained most in d2 test performance (OR = 0·4(0·2;0·7) v. 0·9(0·6;1·3) in those with ADHD, Pinteraction = 0·002), but their executive function score was exacerbated after FO (5·9(0·0,11·8), Pinteraction = 0·039). Our results did not show any effects on ASD symptoms, but suggest that FO may improve attention and working memory in adults with ASD and ameliorate ADHD symptoms in those with comorbid ADHD.
Collapse
Affiliation(s)
- Bjørn Lundbergh
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark
| | | | - Ken D Stark
- Department of Kinesiology, University of Waterloo, Ontario, Canada
| | - Christian Ritz
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark
| | - Lotte Lauritzen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark
| |
Collapse
|
39
|
Clos SM, Kidwai F, Sperry S, Leontieva L. Diagnostic Difficulties in Discriminating Autism Spectrum Disorder in an Adult With Periodic Psychosis Versus Schizophrenia Spectrum Condition: An Insight From Psychological Testing. Cureus 2022; 14:e21887. [PMID: 35273852 PMCID: PMC8901156 DOI: 10.7759/cureus.21887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2022] [Indexed: 11/29/2022] Open
Abstract
It has long been recognized that the biological underpinnings of autism spectrum disorder (ASD) and schizophrenia spectrum disorder (SSD) may share a common basis; however, the two conditions remain separate in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) due to a few distinguishing characteristics. Both disorders are characterized by cognitive and social deficits and have been presumed to be linked to multiple genes. We describe a 46-year-old male who presented atypically with three previous and one current episode of schizoaffective-like symptoms. We describe his previous inpatient admissions, current inpatient course, psychological test results, and treatment. The patient initially presented with schizoaffective disorder, but with a thorough interview, collateral information review, and psychological evaluation, it was determined that he instead was presenting with a previously undiagnosed case of ASD with brief psychosis when under stress. This case serves as an example of an atypical presentation of ASD which can be mistaken for schizoaffective disorder. It is important to establish the correct diagnosis, as the subsequent treatment and management of the patient’s problems will depend on it. In such a patient, a low dose of atypical antipsychotic medication with serotonergic properties and psychotherapy would be the treatment of choice.
Collapse
|
40
|
Brede J, Cage E, Trott J, Palmer L, Smith A, Serpell L, Mandy W, Russell A. “We Have to Try to Find a Way, a Clinical Bridge” - autistic adults' experience of accessing and receiving support for mental health difficulties: A systematic review and thematic meta-synthesis. Clin Psychol Rev 2022; 93:102131. [DOI: 10.1016/j.cpr.2022.102131] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 12/04/2021] [Accepted: 01/28/2022] [Indexed: 12/28/2022]
|
41
|
Correale C, Borgi M, Cirulli F, Laghi F, Trimarco B, Ferraro M, Venerosi A. The Impact of Health and Social Services on the Quality of Life in Families of Adults with Autism Spectrum Disorder (ASD): A Focus Group Study. Brain Sci 2022; 12:brainsci12020177. [PMID: 35203938 PMCID: PMC8869802 DOI: 10.3390/brainsci12020177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/21/2022] [Accepted: 01/26/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Autism spectrum disorder (ASD) is a complex developmental condition that affects the whole family. The gap between childrens’ needs and their satisfaction, especially regarding what concerns the presence of social and healthcare services, is still a source of burden, particularly after the transition to adulthood. Our study aimed to gather a comprehensive view on how parents of adults with ASD perceive (and interact with) health and social services, and how the provision of care impacts family quality of life with the aim to advise ASD intervention programs. The goal is to identify specific areas of change useful to influence autism intervention strategies so that they more effectively meet the needs of young people with autism and their families. Methods: We conducted two focus groups with parents of young adults with ASD. A semi-structured focus group methodology was adopted. The QoL conceptual framework guided data collection and analysis as part of a directed theory-driven content analysis approach. Results: The lack of structured care pathways and the low level of integration of different services were the main limits reported by parents during the focus group, while a shared positive perception of the experience conducted together as caring families emerged. Conclusions: The experience here reported claims for a greater role of the institutions in order to facilitate the building of networks that are really inclusive for persons with autism in society and to support the implementation of innovative solutions for the welfare system. Furthermore, parents stressed the need for the provision of support to the family.
Collapse
Affiliation(s)
- Cinzia Correale
- Cooperativa Sociale Agricola Integrata «Giuseppe Garibaldi», 00179 Rome, Italy; (C.C.); (B.T.); (M.F.)
- Center for Behavioral Sciences and Mental Health, Istituto Superiore di Sanità, 00161 Rome, Italy; (M.B.); (F.C.)
| | - Marta Borgi
- Center for Behavioral Sciences and Mental Health, Istituto Superiore di Sanità, 00161 Rome, Italy; (M.B.); (F.C.)
| | - Francesca Cirulli
- Center for Behavioral Sciences and Mental Health, Istituto Superiore di Sanità, 00161 Rome, Italy; (M.B.); (F.C.)
| | - Fiorenzo Laghi
- Department of Developmental and Social Psychology, Sapienza University of Rome, 00185 Rome, Italy;
| | - Barbara Trimarco
- Cooperativa Sociale Agricola Integrata «Giuseppe Garibaldi», 00179 Rome, Italy; (C.C.); (B.T.); (M.F.)
| | - Maurizio Ferraro
- Cooperativa Sociale Agricola Integrata «Giuseppe Garibaldi», 00179 Rome, Italy; (C.C.); (B.T.); (M.F.)
| | - Aldina Venerosi
- Center for Behavioral Sciences and Mental Health, Istituto Superiore di Sanità, 00161 Rome, Italy; (M.B.); (F.C.)
- Correspondence:
| |
Collapse
|
42
|
Yu H, Niu Y, Jia G, Liang Y, Chen B, Sun R, Wang M, Huang S, Zeng J, Lu J, Li L, Guo X, Yao P. Maternal diabetes-mediated RORA suppression in mice contributes to autism-like offspring through inhibition of aromatase. Commun Biol 2022; 5:51. [PMID: 35027651 PMCID: PMC8758718 DOI: 10.1038/s42003-022-03005-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 12/23/2021] [Indexed: 01/31/2023] Open
Abstract
Retinoic acid-related orphan receptor alpha (RORA) suppression is associated with autism spectrum disorder (ASD) development, although the mechanism remains unclear. In this study, we aim to investigate the potential effect and mechanisms of RORA suppression on autism-like behavior (ALB) through maternal diabetes-mediated mouse model. Our in vitro study in human neural progenitor cells shows that transient hyperglycemia induces persistent RORA suppression through oxidative stress-mediated epigenetic modifications and subsequent dissociation of octamer-binding transcription factor 3/4 from the RORA promoter, subsequently suppressing the expression of aromatase and superoxide dismutase 2. The in vivo mouse study shows that prenatal RORA deficiency in neuron-specific RORA null mice mimics maternal diabetes-mediated ALB; postnatal RORA expression in the amygdala ameliorates, while postnatal RORA knockdown mimics, maternal diabetes-mediated ALB in offspring. In addition, RORA mRNA levels in peripheral blood mononuclear cells decrease to 34.2% in ASD patients (n = 121) compared to the typically developing group (n = 118), and the related Receiver Operating Characteristic curve shows good sensitivity and specificity with a calculated 84.1% of Area Under the Curve for ASD diagnosis. We conclude that maternal diabetes contributes to ALB in offspring through suppression of RORA and aromatase, RORA expression in PBMC could be a potential marker for ASD screening. Hong Yu, Yanbin Niu, Guohua Jia et al. integrate in vitro, in vivo, and human experiments to examine a link between RORA expression on autism-like behavior. Their results suggest that maternal diabetes may contribute to autism-like behavior via RORA suppression.
Collapse
Affiliation(s)
- Hong Yu
- Department of Pediatrics, Foshan Maternity and Child Health Care Hospital, Foshan, 528041, P. R. China
| | - Yanbin Niu
- Teachers College, Columbia University, New York, NY, 10027, USA
| | - Guohua Jia
- Hainan Women and Children's Medical Center, Haikou, 570206, P. R. China
| | - Yujie Liang
- Department of Child Psychiatry, Kangning Hospital of Shenzhen, Shenzhen Mental Health Center, Shenzhen, 518020, P. R. China
| | - Baolin Chen
- Department of Pediatrics, Foshan Maternity and Child Health Care Hospital, Foshan, 528041, P. R. China
| | - Ruoyu Sun
- Department of Pediatrics, Foshan Maternity and Child Health Care Hospital, Foshan, 528041, P. R. China
| | - Min Wang
- Hainan Women and Children's Medical Center, Haikou, 570206, P. R. China
| | - Saijun Huang
- Department of Pediatrics, Foshan Maternity and Child Health Care Hospital, Foshan, 528041, P. R. China
| | - Jiaying Zeng
- Department of Pediatrics, Foshan Maternity and Child Health Care Hospital, Foshan, 528041, P. R. China
| | - Jianpin Lu
- Department of Child Psychiatry, Kangning Hospital of Shenzhen, Shenzhen Mental Health Center, Shenzhen, 518020, P. R. China
| | - Ling Li
- Hainan Women and Children's Medical Center, Haikou, 570206, P. R. China.
| | - Xiaoling Guo
- Department of Pediatrics, Foshan Maternity and Child Health Care Hospital, Foshan, 528041, P. R. China.
| | - Paul Yao
- Department of Pediatrics, Foshan Maternity and Child Health Care Hospital, Foshan, 528041, P. R. China. .,Hainan Women and Children's Medical Center, Haikou, 570206, P. R. China.
| |
Collapse
|
43
|
De Hert M, Loos S, Sterckx S, Thys E, Van Assche K. Improving control over euthanasia of persons with psychiatric illness: Lessons from the first Belgian criminal court case concerning euthanasia. Front Psychiatry 2022; 13:933748. [PMID: 35928783 PMCID: PMC9343580 DOI: 10.3389/fpsyt.2022.933748] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 06/30/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Belgium is one of very few countries that legally allow euthanasia for suffering caused by psychiatric illness. In the first criminal trial in Belgium of physicians involved in euthanasia, three physicians recently faced the accusation of "murder by poisoning," for allegedly having failed to comply with several requirements of the Belgian Euthanasia Law in granting the euthanasia request a woman suffering from psychiatric illness. Although all three physicians were acquitted, the case generated much debate among policy makers, medical professionals, and the general public. METHOD We use this trial as the starting point for a critical analysis of the adequacy of the three-level control system established in the Euthanasia Law, as it is applied in the evaluation of euthanasia requests from persons who suffer unbearably from a psychiatric illness. This analysis is based on information presented during the criminal trial as well as information on the euthanasia that was published in the press. RESULTS Our analysis highlights substantial problems in the assessment and granting of the euthanasia request. The patient was euthanized without it having been substantiated that her psychiatric illness had no prospect of improvement and that her suffering could not be alleviated. The three-step control system enshrined in the Law and promoted by the Federal Control and Evaluation Commission for Euthanasia appears to have failed at each level. CONCLUSION To evaluate requests for euthanasia for mental suffering caused by psychiatric illness, the requirements of the Belgian Euthanasia Law should be complemented by mandating the advice of two psychiatrists, and face-to-face discussions between all physicians involved. In parallel with the process of evaluating the euthanasia request, a treatment track should be guaranteed where reasonable evidence-based treatments and recovery-oriented options are tried.
Collapse
Affiliation(s)
- Marc De Hert
- University Psychiatric Centre, Katholieke Universiteit Leuven, Leuven, Belgium.,Department of Neurosciences, Centre for Clinical Psychiatry, Katholieke Universiteit Leuven, Leuven, Belgium.,Leuven Brain Institute, Katholieke Universiteit Leuven, Leuven, Belgium.,Antwerp Health Law and Ethics Chair, University of Antwerp, Antwerp, Belgium
| | - Sien Loos
- Research Group Personal Rights and Property Rights, Faculty of Law, University of Antwerp, Antwerp, Belgium.,Leuven Institute for Healthcare Policy, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Sigrid Sterckx
- Bioethics Institute Ghent, Department of Philosophy and Moral Sciences, Ghent University, Ghent, Belgium
| | - Erik Thys
- University Psychiatric Centre, Katholieke Universiteit Leuven, Leuven, Belgium.,Department of Neurosciences, Centre for Clinical Psychiatry, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Kristof Van Assche
- Antwerp Health Law and Ethics Chair, University of Antwerp, Antwerp, Belgium.,Research Group Personal Rights and Property Rights, Faculty of Law, University of Antwerp, Antwerp, Belgium
| |
Collapse
|
44
|
Calleja S, Kingsley J, Amirul Islam FM, McDonald R. Barriers to Accessing Healthcare: Perspectives from Autistic Adults and Carers. QUALITATIVE HEALTH RESEARCH 2022; 32:267-278. [PMID: 34906008 DOI: 10.1177/10497323211050362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Autistic adults have higher health needs compared to most, yet they continue to experience barriers to accessing appropriate healthcare. Presently, no qualitative research exists exploring these barriers which impact overall physical and mental health. We conducted a qualitative analysis in Victoria (Australia) of the perceived experiences of healthcare access for autistic adults (n = 9) and primary caregivers of autistic adults (n = 7). Specifically, a three-staged phenomenological approach was applied involving: (i) a communicative checklist, (ii) a health status survey and (iii) face-to-face interviews. Elements such as support, responsibilities and protective factors exhibited by caregivers, may impact healthcare access for autistic adults. Results indicate the need for further research exploring interdependent factors that impact healthcare access by caregivers, so evidence-based interventions can be developed to support caregivers in the future.
Collapse
Affiliation(s)
- Shenae Calleja
- Faculty of Health, Arts and Design, 3783Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Jonathan Kingsley
- Faculty of Health, Arts and Design, 3783Swinburne University of Technology, Hawthorn, VIC, Australia
- Centre of Urban Transitions, 3783Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Fakir M Amirul Islam
- Faculty of Health, Arts and Design, 3783Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Rachael McDonald
- Faculty of Health, Arts and Design, 3783Swinburne University of Technology, Hawthorn, VIC, Australia
| |
Collapse
|
45
|
Backer van Ommeren T, Vreugdenhil M, Koot HM, Spek A, Scheeren AM, Jertberg RM, Begeer S. A New Real-Life Test for Reciprocity in Autistic Adults: The Interactive Drawing Test. Front Psychiatry 2022; 13:842902. [PMID: 35386524 PMCID: PMC8977513 DOI: 10.3389/fpsyt.2022.842902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 02/04/2022] [Indexed: 12/05/2022] Open
Abstract
Impaired social-emotional reciprocity is a defining feature of Autism Spectrum Disorder (ASD). Deficits in reciprocity can be difficult to assess, particularly in adults with average or above average intelligence. The recently developed Interactive Drawing Test (IDT) measures reciprocity in children and adolescents with and without ASD based on spontaneous non-verbal interactions during the joint creation of a drawing. In this study, we examined if the IDT is able to differentiate between 19 normally intelligent adults with ASD and 18 without ASD. The IDT total reciprocity score, including the number of meaningful contributions to objects initially drawn by the examiner, was lower in the autistic adults compared to those without ASD. By assessing both the quantity and quality of spontaneous reciprocal behavior, the IDT was able to identify subtle differences in reciprocal behavior of adults with and without ASD with average intelligence. Even though a larger sample is required to determine its psychometric properties, the IDT appears a promising tool to enrich the diagnostic process of ASD in adults. Impaired social-emotional reciprocity is a defining feature of Autism Spectrum Disorder (ASD). The clinical field lacks sensitive tests for assessing impaired reciprocity. The recently developed Interactive Drawing Test (IDT) for reciprocity was tested in autistic and non-autistic adults. During the IDT, an examiner and participant make a joint drawing, taking turns, without specifying what they will draw. We aimed to investigated whether autistic adults showed less reciprocal behavior on the IDT compared to non-autistic participants. Autistic participants were less likely to jointly draw with the examiner, in particular when the examiner initiated a topic. The IDT revealed subtle but characteristic differences in reciprocal behavior related to ASD, suggesting it may be a promising diagnostic tool.
Collapse
Affiliation(s)
- Tineke Backer van Ommeren
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, and Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Marianne Vreugdenhil
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, and Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Hans M Koot
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, and Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | | | - Anke M Scheeren
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, and Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Robert M Jertberg
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, and Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Sander Begeer
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, and Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| |
Collapse
|
46
|
Zhang B, Hu X, Li Y, Ni Y, Xue L. Identification of methylation markers for diagnosis of autism spectrum disorder. Metab Brain Dis 2022; 37:219-228. [PMID: 34427843 DOI: 10.1007/s11011-021-00805-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 07/23/2021] [Indexed: 10/20/2022]
Abstract
Autism spectrum disorder (ASD) is a hereditary heterogeneous neurodevelopmental disorder characterized by social and speech dysplasia. We collected the expression profiles of ASD in GSE26415, GSE42133 and GSE123302 from the gene expression omnibus (GEO) database, as well as methylation data of GSE109905. Differentially expressed genes (DEGs) between ASD and controls were obtained by differential expression analysis. Enrichment analysis identified the biological functions and signaling pathways involved by common genes in three groups of DEGs. Protein-protein interaction (PPI) networks were used to identify genes with the highest connectivity as key genes. In addition, we identified methylation markers by associating differentially methylated positions. Key methylation markers were identified using the least absolute shrink and selection operator (LASSO) model. Receiver operating characteristic curves and nomograms were used to identify the diagnostic role of key methylation markers for ASD. A total of 57 common genes were identified in the three groups of DEGs. These genes were mainly enriched in Sphingolipid metabolism and PPAR signaling pathway. In the PPI network, we identified seven key genes with higher connectivity, and used qRT-PCR experiments to verify the expressions. In addition, we identified 31 methylation markers and screened 3 key methylation markers (RUNX2, IMMP2L and MDM2) by LASSO model. Their methylation levels were closely related to the diagnostic effects of ASD. Our analysis identified RUNX2, IMMP2L and MDM2 as possible diagnostic markers for ASD. Identifying different biomarkers and risk genes will contribute to the diagnosis of ASD and the development of new clinical and drug treatments.
Collapse
Affiliation(s)
- Bei Zhang
- Department of quality management, The Fourth People's Hospital of Urumqi, Jianquan street, Urumqi, Xinjiang, 830002, China
| | - Xiaoyuan Hu
- Xinjiang Uighur Autonomous Region Center for Disease Control and Prevention, Jianquan street, Tianshan District, Urumqi, Xinjiang, 830001, China
| | - Yuefei Li
- School of Public Health, Xinjiang Medical University, Liyushan Road, Xinshi District, Urumqi, Xinjiang, 830000, China
| | - Yongkang Ni
- School of Public Health, Xinjiang Medical University, Liyushan Road, Xinshi District, Urumqi, Xinjiang, 830000, China
| | - Lin Xue
- Department of quality management, The Fourth People's Hospital of Urumqi, Jianquan street, Urumqi, Xinjiang, 830002, China.
| |
Collapse
|
47
|
Ohsawa S, Yoshimoto H, Ohsawa R, Takahashi S, Yokoya S. Challenges in the Management of Home-Based Care Experienced by a Caregiver with Autism Spectrum Disorder. Palliat Med Rep 2021; 2:324-327. [PMID: 34927158 PMCID: PMC8675273 DOI: 10.1089/pmr.2021.0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2021] [Indexed: 11/30/2022] Open
Abstract
We describe the case of a 37-year-old woman with autism spectrum disorder (ASD) who lived with a mother with end-stage breast cancer and a visually impaired father. She was the main caregiver for her mother, who was receiving home-based palliative care. The caregiver needed training on communication and task management so that she could manage the communication with home care staff and perform more house chores. It was also necessary to share information with home care staff about ASD and how to treat her with understanding and respect. Although most support for people with ASD focuses on schools and workplaces, to offer successful end-of-life care at home, medical and home staff need to understand and communicate well with people with ASD and provide multiple types of support. Research, guidebooks, and visuals about main caregivers who have ASD and improving the inclusivity among staff members are necessary for providing successful home care and meeting caregivers' and patients' needs and expectations.
Collapse
Affiliation(s)
- Sayaka Ohsawa
- Kitaibaraki Center for Family Medicine, Kitaibaraki, Japan
| | - Hisashi Yoshimoto
- Kitaibaraki Center for Family Medicine, Kitaibaraki, Japan.,Department of Family Medicine, General Practice and Community Health, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Ryo Ohsawa
- Kitaibaraki Center for Family Medicine, Kitaibaraki, Japan
| | - Satoko Takahashi
- Kitaibaraki Center for Family Medicine, Kitaibaraki, Japan.,Takahashi Clinic, Saitama, Japan
| | - Shoji Yokoya
- Kitaibaraki Center for Family Medicine, Kitaibaraki, Japan.,Department of Family Medicine, General Practice and Community Health, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| |
Collapse
|
48
|
Ghanouni P, Hood G, Weisbrot A, McNeil K. Utilization of health services among adults with autism spectrum disorders: Stakeholders' experiences. RESEARCH IN DEVELOPMENTAL DISABILITIES 2021; 119:104120. [PMID: 34736105 DOI: 10.1016/j.ridd.2021.104120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 10/01/2021] [Accepted: 10/24/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Autism spectrum disorder (ASD) is a lifelong disorder, beginning in early childhood, which often accompanies with several healthcare challenges. There is a need for consistent and continued healthcare services throughout the life of an individual with ASD. The majority of previous studies have examined healthcare services in children with ASD and there is limited evidence about healthcare needs of adults with ASD. OBJECTIVE The aim of this project was to capture the experiences of stakeholders including adults with ASD in receiving healthcare services. METHOD We interviewed 22 stakeholders, including adults with ASD (n = 13), parents of adults with ASD (n = 5), and service providers (n = 4). Open-ended questions were used to explore their experiences with the healthcare system. We analysed the data thematically to develop the overarching themes. RESULTS Three themes emerged from interviews including a) availability and accessibility of healthcare services, b) provision of quality healthcare and service delivery, and c) striving for better health outcomes. CONCLUSION This study found that many adults with ASD can experience a continued lack of access to services and the care they receive is often of limited quality. The unmet healthcare needs lead stakeholders to feel stress, frustration, exhaustion, and possible burnout. The detrimental cost of limited services not only impacts adults with ASD but also their caregivers.
Collapse
Affiliation(s)
- Parisa Ghanouni
- Department of Occupational Therapy, Dalhousie University, Halifax, Canada.
| | - Graham Hood
- Department of Occupational Therapy, Dalhousie University, Halifax, Canada
| | - Abby Weisbrot
- Department of Occupational Therapy, Dalhousie University, Halifax, Canada
| | - Karen McNeil
- Department of Family Medicine, Dalhousie University, Halifax, Canada
| |
Collapse
|
49
|
Riese B, Mukherjee RA. The experiences of autistic adults during the COVID-19 pandemic in the UK and implications for autism services development. ADVANCES IN AUTISM 2021. [DOI: 10.1108/aia-06-2021-0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
COVID-19 has been challenging for many in the UK. This is no different to many with autism spectrum disorder. Based on the experiences and issues raised by a small group of autistic women in an ongoing support group, consideration if this holds true for the wider adult autistic community across further lockdowns and restrictions to public life was explored.
Design/methodology/approach
An online questionnaire was created based on the issues raised. Participants indicated the degree to which they agreed or disagreed with each statement.
Findings
Autistic adults experienced an increase in anxiety and poor mental health, which in turn has exacerbated autistic features, such as rigidity. The data indicates that autistic adults can adapt to change provided there is support in maintaining routines.
Research limitations/implications
The research is limited due to the small number of participants (N = 120), as well as national variations in service provision.
Practical implications
Our data raises wider questions about the nature of support for autistic adults without cognitive impairments during times of crises and how services can respond and may even be shaped in the future to provide support that is cost-effective and relevant to autistic adults.
Social implications
To ensure that services have an awareness of how crises impact on autistic adults and how relatively simple changes may avert poor mental health.
Originality/value
That the creation of local support networks, and the ability to access these, is a key feature of autism-specific support.
Collapse
|
50
|
Kittana M, Ahmadani A, Al Marzooq F, Attlee A. Dietary Fat Effect on the Gut Microbiome, and Its Role in the Modulation of Gastrointestinal Disorders in Children with Autism Spectrum Disorder. Nutrients 2021; 13:3818. [PMID: 34836074 PMCID: PMC8618510 DOI: 10.3390/nu13113818] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/23/2021] [Accepted: 10/24/2021] [Indexed: 12/19/2022] Open
Abstract
Children with autism spectrum disorder (ASD) report a higher frequency and severity of gastrointestinal disorders (GID) than typically developing (TD) children. GID-associated discomfort increases feelings of anxiety and frustration, contributing to the severity of ASD. Emerging evidence supports the biological intersection of neurodevelopment and microbiome, indicating the integral contribution of GM in the development and function of the nervous system, and mental health, and disease balance. Dysbiotic GM could be a contributing factor in the pathogenesis of GID in children with ASD. High-fat diets may modulate GM through accelerated growth of bile-tolerant bacteria, altered bacterial ratios, and reduced bacterial diversity, which may increase the risk of GID. Notably, saturated fatty acids are considered to have a pronounced effect on the increase of bile-tolerant bacteria and reduction in microbial diversity. Additionally, omega-3 exerts a favorable impact on GM and gut health due to its anti-inflammatory properties. Despite inconsistencies in the data elaborated in the review, the dietary fat composition, as part of an overall dietary intervention, plays a role in modulating GID, specifically in ASD, due to the altered microbiome profile. This review emphasizes the need to conduct future experimental studies investigating the effect of diets with varying fatty acid compositions on GID-specific microbiome profiles in children with ASD.
Collapse
Affiliation(s)
- Monia Kittana
- Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain P.O. Box 15551, United Arab Emirates; (M.K.); (A.A.)
| | - Asma Ahmadani
- Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain P.O. Box 15551, United Arab Emirates; (M.K.); (A.A.)
| | - Farah Al Marzooq
- Department of Medical Microbiology and Immunology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain P.O. Box 15551, United Arab Emirates;
| | - Amita Attlee
- Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain P.O. Box 15551, United Arab Emirates; (M.K.); (A.A.)
| |
Collapse
|