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Adelson RP, Ciobanu M, Garikipati A, Castell NJ, Barnes G, Tawara K, Singh NP, Rumph J, Mao Q, Vaish A, Das R. Family-Centric Applied Behavior Analysis Promotes Sustained Treatment Utilization and Attainment of Patient Goals. Cureus 2024; 16:e62377. [PMID: 39011193 PMCID: PMC11247253 DOI: 10.7759/cureus.62377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND/OBJECTIVES Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by social communication difficulties and restricted repetitive behaviors or interests. Applied behavior analysis (ABA) has been shown to significantly improve outcomes for individuals on the autism spectrum. However, challenges regarding access, cost, and provider shortages remain obstacles to treatment delivery. To this end, parents were trained as parent behavior technicians (pBTs), improving access to ABA, and empowering parents to provide ABA treatment in their own homes. We hypothesized that patients diagnosed with severe ASD would achieve the largest gains in overall success rates toward skill acquisition in comparison to patients diagnosed with mild or moderate ASD. Our secondary hypothesis was that patients with comprehensive treatment plans (>25-40 hours/week) would show greater gains in skill acquisition than those with focused treatment plans (less than or equal to 25 hours/week). Methods: This longitudinal, retrospective chart review evaluated data from 243 patients aged two to 18 years who received at least three months of ABA within our pBT treatment delivery model. Patients were stratified by utilization of prescribed ABA treatment, age, ASD severity (per the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition), and treatment plan type (comprehensive vs. focused). Patient outcomes were assessed by examining success rates in acquiring skills, both overall and in specific focus areas (communication, emotional regulation, executive functioning, and social skills). RESULTS Patients receiving treatment within the pBT model demonstrated significant progress in skill acquisition both overall and within specific focus areas, regardless of cohort stratification. Patients with severe ASD showed greater overall skill acquisition gains than those with mild or moderate ASD. In addition, patients with comprehensive treatment plans showed significantly greater gains than those with focused treatment plans. CONCLUSION The pBT model achieved both sustained levels of high treatment utilization and progress toward patient goals. Patients showed significant gains in success rates of skill acquisition both overall and in specific focus areas, regardless of their level of treatment utilization. This study reveals that our pBT model of ABA treatment delivery leads to consistent improvements in communication, emotional regulation, executive functioning, and social skills across patients on the autism spectrum, particularly for those with more severe symptoms and those following comprehensive treatment plans.
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Affiliation(s)
- Robert P Adelson
- Research and Development, Montera, Inc. DBA Forta, San Francisco, USA
| | - Madalina Ciobanu
- Research and Development, Montera, Inc. DBA Forta, San Francisco, USA
| | - Anurag Garikipati
- Research and Development, Montera, Inc. DBA Forta, San Francisco, USA
| | - Natalie J Castell
- Research and Development, Montera, Inc. DBA Forta, San Francisco, USA
| | - Gina Barnes
- Research and Development, Montera, Inc. DBA Forta, San Francisco, USA
| | - Ken Tawara
- Research and Development, Montera, Inc. DBA Forta, San Francisco, USA
| | - Navan P Singh
- Engineering, Montera, Inc. DBA Forta, San Francisco, USA
| | - Jodi Rumph
- Clinical Team, Montera, Inc. DBA Forta, San Francisco, USA
| | - Qingqing Mao
- Research and Development, Montera, Inc. DBA Forta, San Francisco, USA
| | - Anshu Vaish
- Clinical Team, Montera, Inc. DBA Forta, San Francisco, USA
| | - Ritankar Das
- Executive Leadership, Montera, Inc. DBA Forta, San Francisco, USA
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Adelson RP, Ciobanu M, Garikipati A, Castell NJ, Singh NP, Barnes G, Rumph JK, Mao Q, Roane HS, Vaish A, Das R. Family-Centric Applied Behavior Analysis Facilitates Improved Treatment Utilization and Outcomes. J Clin Med 2024; 13:2409. [PMID: 38673682 PMCID: PMC11051390 DOI: 10.3390/jcm13082409] [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: 03/20/2024] [Revised: 04/15/2024] [Accepted: 04/19/2024] [Indexed: 04/28/2024] Open
Abstract
Background/Objective: Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized by lifelong impacts on functional social and daily living skills, and restricted, repetitive behaviors (RRBs). Applied behavior analysis (ABA), the gold-standard treatment for ASD, has been extensively validated. ABA access is hindered by limited availability of qualified professionals and logistical and financial barriers. Scientifically validated, parent-led ABA can fill the accessibility gap by overcoming treatment barriers. This retrospective cohort study examines how our ABA treatment model, utilizing parent behavior technicians (pBTs) to deliver ABA, impacts adaptive behaviors and interfering behaviors (IBs) in a cohort of children on the autism spectrum with varying ASD severity levels, and with or without clinically significant IBs. Methods: Clinical outcomes of 36 patients ages 3-15 years were assessed using longitudinal changes in Vineland-3 after 3+ months of pBT-delivered ABA treatment. Results: Within the pBT model, our patients demonstrated clinically significant improvements in Vineland-3 Composite, domain, and subdomain scores, and utilization was higher in severe ASD. pBTs utilized more prescribed ABA when children initiated treatment with clinically significant IBs, and these children also showed greater gains in their Composite scores. Study limitations include sample size, inter-rater reliability, potential assessment metric bias and schedule variability, and confounding intrinsic or extrinsic factors. Conclusion: Overall, our pBT model facilitated high treatment utilization and showed robust effectiveness, achieving improved adaptive behaviors and reduced IBs when compared to conventional ABA delivery. The pBT model is a strong contender to fill the widening treatment accessibility gap and represents a powerful tool for addressing systemic problems in ABA treatment delivery.
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Affiliation(s)
- Robert P. Adelson
- Montera, Inc., dba Forta, Research and Development, 548 Market St., PMB 89605, San Francisco, CA 94104-5401, USA; (R.P.A.); (M.C.); (A.G.); (N.J.C.); (N.P.S.); (G.B.); (A.V.); (R.D.)
| | - Madalina Ciobanu
- Montera, Inc., dba Forta, Research and Development, 548 Market St., PMB 89605, San Francisco, CA 94104-5401, USA; (R.P.A.); (M.C.); (A.G.); (N.J.C.); (N.P.S.); (G.B.); (A.V.); (R.D.)
| | - Anurag Garikipati
- Montera, Inc., dba Forta, Research and Development, 548 Market St., PMB 89605, San Francisco, CA 94104-5401, USA; (R.P.A.); (M.C.); (A.G.); (N.J.C.); (N.P.S.); (G.B.); (A.V.); (R.D.)
| | - Natalie J. Castell
- Montera, Inc., dba Forta, Research and Development, 548 Market St., PMB 89605, San Francisco, CA 94104-5401, USA; (R.P.A.); (M.C.); (A.G.); (N.J.C.); (N.P.S.); (G.B.); (A.V.); (R.D.)
| | - Navan Preet Singh
- Montera, Inc., dba Forta, Research and Development, 548 Market St., PMB 89605, San Francisco, CA 94104-5401, USA; (R.P.A.); (M.C.); (A.G.); (N.J.C.); (N.P.S.); (G.B.); (A.V.); (R.D.)
| | - Gina Barnes
- Montera, Inc., dba Forta, Research and Development, 548 Market St., PMB 89605, San Francisco, CA 94104-5401, USA; (R.P.A.); (M.C.); (A.G.); (N.J.C.); (N.P.S.); (G.B.); (A.V.); (R.D.)
| | - Jodi Kim Rumph
- Montera, Inc., dba Forta, Research and Development, 548 Market St., PMB 89605, San Francisco, CA 94104-5401, USA; (R.P.A.); (M.C.); (A.G.); (N.J.C.); (N.P.S.); (G.B.); (A.V.); (R.D.)
| | - Qingqing Mao
- Montera, Inc., dba Forta, Research and Development, 548 Market St., PMB 89605, San Francisco, CA 94104-5401, USA; (R.P.A.); (M.C.); (A.G.); (N.J.C.); (N.P.S.); (G.B.); (A.V.); (R.D.)
| | - Henry S. Roane
- Madison-Irving Medical Center, Upstate Medical University, 475 Irving Avenue, Syracuse, NY 13210-1756, USA;
| | - Anshu Vaish
- Montera, Inc., dba Forta, Research and Development, 548 Market St., PMB 89605, San Francisco, CA 94104-5401, USA; (R.P.A.); (M.C.); (A.G.); (N.J.C.); (N.P.S.); (G.B.); (A.V.); (R.D.)
| | - Ritankar Das
- Montera, Inc., dba Forta, Research and Development, 548 Market St., PMB 89605, San Francisco, CA 94104-5401, USA; (R.P.A.); (M.C.); (A.G.); (N.J.C.); (N.P.S.); (G.B.); (A.V.); (R.D.)
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Kucińska A, Hawuła W, Rutkowska L, Wysocka U, Kępczyński Ł, Piotrowicz M, Chilarska T, Wieczorek-Cichecka N, Połatyńska K, Przysło Ł, Gach A. The Use of CGH Arrays for Identifying Copy Number Variations in Children with Autism Spectrum Disorder. Brain Sci 2024; 14:273. [PMID: 38539661 PMCID: PMC10968557 DOI: 10.3390/brainsci14030273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/01/2024] [Accepted: 03/11/2024] [Indexed: 06/14/2024] Open
Abstract
Autism spectrum disorders (ASDs) encompass a broad group of neurodevelopmental disorders with varied clinical symptoms, all being characterized by deficits in social communication and repetitive behavior. Although the etiology of ASD is heterogeneous, with many genes involved, a crucial role is believed to be played by copy number variants (CNVs). The present study examines the role of copy number variation in the development of isolated ASD, or ASD with additional clinical features, among a group of 180 patients ranging in age from two years and four months to 17 years and nine months. Samples were taken and subjected to array-based comparative genomic hybridization (aCGH), the gold standard in detecting gains or losses in the genome, using a 4 × 180 CytoSure Autism Research Array, with a resolution of around 75 kb. The results indicated the presence of nine pathogenic and six likely pathogenic imbalances, and 20 variants of uncertain significance (VUSs) among the group. Relevant variants were more prevalent in patients with ASD and additional clinical features. Twelve of the detected variants, four of which were probably pathogenic, would not have been identified using the routine 8 × 60 k microarray. These results confirm the value of microarrays in ASD diagnostics and highlight the need for dedicated tools.
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Affiliation(s)
- Agata Kucińska
- Department of Genetics, Polish Mother’s Memorial Hospital-Research Institute, 93-338 Lodz, Poland; (W.H.); (L.R.); (U.W.); (Ł.K.); (M.P.); (T.C.); (N.W.-C.); (A.G.)
| | - Wanda Hawuła
- Department of Genetics, Polish Mother’s Memorial Hospital-Research Institute, 93-338 Lodz, Poland; (W.H.); (L.R.); (U.W.); (Ł.K.); (M.P.); (T.C.); (N.W.-C.); (A.G.)
| | - Lena Rutkowska
- Department of Genetics, Polish Mother’s Memorial Hospital-Research Institute, 93-338 Lodz, Poland; (W.H.); (L.R.); (U.W.); (Ł.K.); (M.P.); (T.C.); (N.W.-C.); (A.G.)
| | - Urszula Wysocka
- Department of Genetics, Polish Mother’s Memorial Hospital-Research Institute, 93-338 Lodz, Poland; (W.H.); (L.R.); (U.W.); (Ł.K.); (M.P.); (T.C.); (N.W.-C.); (A.G.)
| | - Łukasz Kępczyński
- Department of Genetics, Polish Mother’s Memorial Hospital-Research Institute, 93-338 Lodz, Poland; (W.H.); (L.R.); (U.W.); (Ł.K.); (M.P.); (T.C.); (N.W.-C.); (A.G.)
| | - Małgorzata Piotrowicz
- Department of Genetics, Polish Mother’s Memorial Hospital-Research Institute, 93-338 Lodz, Poland; (W.H.); (L.R.); (U.W.); (Ł.K.); (M.P.); (T.C.); (N.W.-C.); (A.G.)
| | - Tatiana Chilarska
- Department of Genetics, Polish Mother’s Memorial Hospital-Research Institute, 93-338 Lodz, Poland; (W.H.); (L.R.); (U.W.); (Ł.K.); (M.P.); (T.C.); (N.W.-C.); (A.G.)
| | - Nina Wieczorek-Cichecka
- Department of Genetics, Polish Mother’s Memorial Hospital-Research Institute, 93-338 Lodz, Poland; (W.H.); (L.R.); (U.W.); (Ł.K.); (M.P.); (T.C.); (N.W.-C.); (A.G.)
| | - Katarzyna Połatyńska
- Department of Developmental Neurology and Epileptology, Polish Mother’s Memorial Hospital-Research Institute, 93-338 Lodz, Poland; (K.P.); (Ł.P.)
| | - Łukasz Przysło
- Department of Developmental Neurology and Epileptology, Polish Mother’s Memorial Hospital-Research Institute, 93-338 Lodz, Poland; (K.P.); (Ł.P.)
| | - Agnieszka Gach
- Department of Genetics, Polish Mother’s Memorial Hospital-Research Institute, 93-338 Lodz, Poland; (W.H.); (L.R.); (U.W.); (Ł.K.); (M.P.); (T.C.); (N.W.-C.); (A.G.)
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Montanaro FAM, Mandarino A, Alesi V, Schwartz C, Sepulveda DJC, Skinner C, Friez M, Piccolo G, Novelli A, Zanni G, Dentici ML, Vicari S, Alfieri P. PTCHD1 gene mutation/deletion: the cognitive-behavioral phenotyping of four case reports. Front Psychiatry 2024; 14:1327802. [PMID: 38288059 PMCID: PMC10823004 DOI: 10.3389/fpsyt.2023.1327802] [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: 10/25/2023] [Accepted: 12/06/2023] [Indexed: 01/31/2024] Open
Abstract
Introduction X-linked PTCHD1 gene has recently been pointed as one of the most interesting candidates for involvement in neurodevelopmental disorders (NDs), such as intellectual disability (ID) and autism spectrum disorder (ASD). PTCHD1 encodes the patched domain-containing protein 1 (PTCHD1), which is mainly expressed in the developing brain and adult brain tissues. To date, major studies have focused on the biological function of the PTCHD1 gene, while the mechanisms underlying neuronal alterations and the cognitive-behavioral phenotype associated with mutations still remain unclear. Methods With the aim of incorporating information on the clinical profile of affected individuals and enhancing the characterization of the genotype-phenotype correlation, in this study, we analyze the clinical features of four individuals (two children and two adults) in which array-CGH detected a PTCHD1 deletion or in which panel for screening non-syndromal XLID (X-linked ID) detected a PTCHD1 gene variant. We define the neuropsychological and psychopathological profiles, providing quantitative data from standardized evaluations. The assessment consisted of clinical observations, structured interviews, and parent/self-reported questionnaires. Results Our descriptive analysis align with previous findings on the involvement of the PTCHD1 gene in NDs. Specifically, our patients exhibited a clinical phenotype characterized by psychomotor developmental delay- ID of varying severity. Interestingly, while ID during early childhood was associated with autistic-like symptomatology, this interrelation was no longer observed in the adult subjects. Furthermore, our cohort did not display peculiar dysmorphic features, congenital abnormalities or comorbidity with epilepsy. Discussion Our analysis shows that the psychopathological and behavioral comorbidities along with cognitive impairment interfere with development, therefore contributing to the severity of disability associated with PTCHD1 gene mutation. Awareness of this profile by professionals and caregivers can promote prompt diagnosis as well as early cognitive and occupational enhancement interventions.
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Affiliation(s)
- Federica Alice Maria Montanaro
- Child and Adolescent Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Alessandra Mandarino
- Child and Adolescent Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Viola Alesi
- Laboratory of Medical Genetics, Translational Cytogenomics Research Unit, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | - Charles Schwartz
- Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, East Lansing, MI, United States
| | | | - Cindy Skinner
- Greenwood Genetic Center, Gregor Mendel Circle, Greenwood, SC, United States
| | - Michael Friez
- Greenwood Genetic Center, Gregor Mendel Circle, Greenwood, SC, United States
| | - Gabriele Piccolo
- Unit of Muscular and Neurodegenerative Disorders, Unit of Developmental Neurology, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Antonio Novelli
- Laboratory of Medical Genetics, Translational Cytogenomics Research Unit, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | - Ginevra Zanni
- Unit of Muscular and Neurodegenerative Disorders, Unit of Developmental Neurology, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Maria Lisa Dentici
- Genetics and Rare Diseases Research Division, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Stefano Vicari
- Child and Adolescent Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Paolo Alfieri
- Child and Adolescent Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
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David A, Stolar O, Berkovitch M, Kohn E, Waisman-Nitzan M, Hartmann I, Gal E. Characteristics for Medical Cannabis Treatment Adherence among Autistic Children and Their Families: A Mixed-Methods Analysis. Med Cannabis Cannabinoids 2024; 7:68-79. [PMID: 39015610 PMCID: PMC11250072 DOI: 10.1159/000538901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 04/08/2024] [Indexed: 07/18/2024] Open
Abstract
Introduction Medical cannabis treatment for autistic children has recently become popular, and studies have focused on examining the treatment's effects on children's symptom presentation, reported side effects, and dropout rates. However, no previous study has investigated the factors influencing adherence and dropout rates in cannabis treatment. Method This explanatory sequential mixed-methods study explored these factors by examining the characteristics of 87 autistic children and their families and deepening parents' perspectives and experiences of the 6-month CBD-rich cannabis treatment's benefits and barriers. Results We found this treatment to have a high (75%) adherence rate, relatively mild side effects, and substantial reported benefits for the children and families. However, this treatment was not free of barriers; the intake regime, some side effects, and in some cases, unrealistic parental expectations made adherence difficult for some families. Conclusion Our results highlight the importance of providing professional guidance and knowledge to parents of autistic children, enhancing their understanding of the impact of CBD-rich cannabis treatment on their children and expected related challenges, and coordinating realistic treatment expectations. We hope that addressing these important aspects will influence parents' ability to adhere to and enjoy the benefits of cannabis treatment for their autistic children.
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Affiliation(s)
- Ayelet David
- Department of Occupational Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Orit Stolar
- Child Development Centers, Sharon District-Maccabi HealthCare Services, Ramat Hasharon, Israel
- Clinical Pharmacology and Toxicology, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel
| | - Matitiahu Berkovitch
- Clinical Pharmacology and Toxicology, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel
- The Andy Lebach Chair of Clinical Pharmacology and Toxicology, Tel-Aviv University, Tel-Aviv, Israel
| | - Elkana Kohn
- Clinical Pharmacology and Toxicology, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel
| | - Michal Waisman-Nitzan
- Department of Occupational Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Inbar Hartmann
- Child Development Center, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel
| | - Eynat Gal
- Department of Occupational Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
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Nisar S, Haris M. Neuroimaging genetics approaches to identify new biomarkers for the early diagnosis of autism spectrum disorder. Mol Psychiatry 2023; 28:4995-5008. [PMID: 37069342 DOI: 10.1038/s41380-023-02060-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 03/23/2023] [Accepted: 03/28/2023] [Indexed: 04/19/2023]
Abstract
Autism-spectrum disorders (ASDs) are developmental disabilities that manifest in early childhood and are characterized by qualitative abnormalities in social behaviors, communication skills, and restrictive or repetitive behaviors. To explore the neurobiological mechanisms in ASD, extensive research has been done to identify potential diagnostic biomarkers through a neuroimaging genetics approach. Neuroimaging genetics helps to identify ASD-risk genes that contribute to structural and functional variations in brain circuitry and validate biological changes by elucidating the mechanisms and pathways that confer genetic risk. Integrating artificial intelligence models with neuroimaging data lays the groundwork for accurate diagnosis and facilitates the identification of early diagnostic biomarkers for ASD. This review discusses the significance of neuroimaging genetics approaches to gaining a better understanding of the perturbed neurochemical system and molecular pathways in ASD and how these approaches can detect structural, functional, and metabolic changes and lead to the discovery of novel biomarkers for the early diagnosis of ASD.
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Affiliation(s)
- Sabah Nisar
- Laboratory of Molecular and Metabolic Imaging, Sidra Medicine, Doha, Qatar
- Department of Diagnostic Imaging, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Mohammad Haris
- Laboratory of Molecular and Metabolic Imaging, Sidra Medicine, Doha, Qatar.
- Center for Advanced Metabolic Imaging in Precision Medicine, Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Laboratory Animal Research Center, Qatar University, Doha, Qatar.
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Rudolph S, Badura A, Lutzu S, Pathak SS, Thieme A, Verpeut JL, Wagner MJ, Yang YM, Fioravante D. Cognitive-Affective Functions of the Cerebellum. J Neurosci 2023; 43:7554-7564. [PMID: 37940582 PMCID: PMC10634583 DOI: 10.1523/jneurosci.1451-23.2023] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 11/10/2023] Open
Abstract
The cerebellum, traditionally associated with motor coordination and balance, also plays a crucial role in various aspects of higher-order function and dysfunction. Emerging research has shed light on the cerebellum's broader contributions to cognitive, emotional, and reward processes. The cerebellum's influence on autonomic function further highlights its significance in regulating motivational and emotional states. Perturbations in cerebellar development and function have been implicated in various neurodevelopmental disorders, including autism spectrum disorder and attention deficit hyperactivity disorder. An increasing appreciation for neuropsychiatric symptoms that arise from cerebellar dysfunction underscores the importance of elucidating the circuit mechanisms that underlie complex interactions between the cerebellum and other brain regions for a comprehensive understanding of complex behavior. By briefly discussing new advances in mapping cerebellar function in affective, cognitive, autonomic, and social processing and reviewing the role of the cerebellum in neuropathology beyond the motor domain, this Mini-Symposium review aims to provide a broad perspective of cerebellar intersections with the limbic brain in health and disease.
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Affiliation(s)
- Stephanie Rudolph
- Department of Neuroscience, Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, New York, New York 10461
| | - Aleksandra Badura
- Department of Neuroscience, Erasmus MC Rotterdam, Rotterdam, 3015 GD, The Netherlands
| | - Stefano Lutzu
- Department of Neuroscience, Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, New York, New York 10461
| | - Salil Saurav Pathak
- Department of Biomedical Sciences, University of Minnesota Medical School, Duluth, Minnesota 55812
| | - Andreas Thieme
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, Essen, D-45147, Germany
| | - Jessica L Verpeut
- Department of Psychology, Arizona State University, Tempe, Arizona 85287
| | - Mark J Wagner
- National Institute of Neurological Disorders & Stroke, National Institutes of Health, Bethesda, Maryland 20814
| | - Yi-Mei Yang
- Department of Biomedical Sciences, University of Minnesota Medical School, Duluth, Minnesota 55812
- Department of Neuroscience, University of Minnesota, Minneapolis, Minnesota 55455
| | - Diasynou Fioravante
- Center for Neuroscience, University of California-Davis, Davis, California 95618
- Department of Neurobiology, Physiology and Behavior, University of California-Davis, Davis, California 95618
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Pascoe MI, Forbes K, de la Roche L, Derby B, Psaradellis E, Anagnostou E, Nicolson R, Georgiades S, Kelley E. Exploring the association between social skills struggles and social communication difficulties and depression in youth with autism spectrum disorder. Autism Res 2023; 16:2160-2171. [PMID: 37615265 DOI: 10.1002/aur.3015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 08/05/2023] [Indexed: 08/25/2023]
Abstract
Autism spectrum disorder is characterized by social communication difficulties and social skills abilities that are significantly differ from neurotypical populations as well as restricted and repetitive behaviors and interests. Furthermore, many autistic youth experience co-occurring conditions, with one of the most common being depression. This depression is suggested to be, in part, the result of the relative social isolation experienced by autistic youth. Therefore, it is important to examine social functioning differences in autistic youth and their association with depression. There has been limited research investigating the association between social communication difficulties and depression, or the association between social skills struggles and depression, and no research investigating both of these in the same population. We found that social communicative symptoms of autism (as measured by the Autism Diagnostic Observation Schedule) were not associated with depression scores (as measured by the Revised Checklist for Anxiety and Depression) after controlling for age, sex, and IQ. In contrast, we did find a significant association between social skills struggles (as measured by the Adaptive Behavior Assessment System-2) and depression in the same sample. Higher social skills struggles were associated with higher depression scores after controlling for age, sex, and IQ. Reasons for the potential discrepancy between these findings are discussed, and clinical implications of these findings are explored.
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Affiliation(s)
- Molly Isabel Pascoe
- Department of Psychology, Queen's University, Kingston, Ontario, Canada
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada
| | - Kaitlyn Forbes
- Department of Psychology, Queen's University, Kingston, Ontario, Canada
| | - Laura de la Roche
- Department of Psychology, Queen's University, Kingston, Ontario, Canada
| | - Brianne Derby
- Department of Psychology, Queen's University, Kingston, Ontario, Canada
| | | | - Evdokia Anagnostou
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Holland Bloorview Research Institute, Toronto, Ontario, Canada
| | - Rob Nicolson
- Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Stelios Georgiades
- Department of Psychiatry and Behavioural Neurosciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Elizabeth Kelley
- Department of Psychology, Queen's University, Kingston, Ontario, Canada
- Department of Psychiatry, Queen's University, Kingston, Ontario, Canada
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van Niekerk K, Stancheva V, Smith C. Caregiver burden among caregivers of children with autism spectrum disorder. S Afr J Psychiatr 2023; 29:2079. [PMID: 37928940 PMCID: PMC10623632 DOI: 10.4102/sajpsychiatry.v29i0.2079] [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: 03/23/2023] [Accepted: 09/13/2023] [Indexed: 11/07/2023] Open
Abstract
Background Autism spectrum disorder (ASD) is a neurodevelopmental disorder with deficits in social communication and interaction, restricted and repetitive patterns of behaviour, interests and activities. Autism spectrum disorder is associated with multiple comorbidities. As a result, caregivers of children with ASD experience increased levels of burden and poor quality of life. However, there is a paucity of information on the burden. Aim The study aimed to describe the sociodemographic profiles and determine the extent of the burden experienced by caregivers of children and adolescents with ASD. Setting The Child, Adolescent and Family Unit (CAFU) outpatient services at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH). Methods A quantitative, descriptive, cross-sectional study was done. Two self-administered questionnaires were used: a sociodemographic questionnaire and the 12-item Zarit Burden Interview questionnaire. Results The questionnaires were completed by 77 caregivers, of which the majority were female (n = 56 or 72.3%), mothers to children with ASD (n = 49 or 64.3%) and identified as Christian (p < 0.001). Most had completed secondary school or had a tertiary education (p = 0.003) and were employed (p < 0.001). Among the caregivers, 41.6% experienced mild to moderate burden, 33.8% experienced high burden and only 24.9% reported no to mild burden. Conclusion Caregivers of children and adolescents with a diagnosis of ASD are mostly mothers and experience mild to moderate levels of caregiver burden, suggesting the need for improved screening and psychosocial support programmes. Contribution This study highlights the burden experienced by primary caregivers of children with ASD and is one of the few comprehensive studies on this issue within the context of South Africa.
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Affiliation(s)
- Karli van Niekerk
- Department of Psychiatry, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Venera Stancheva
- Department of Psychiatry, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Cornelia Smith
- Department of Psychiatry, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
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Saha S, Chatterjee M, Dutta N, Sinha S, Mukhopadhyay K. Analysis of neurotransmitters validates the importance of the dopaminergic system in autism spectrum disorder. World J Pediatr 2023; 19:770-781. [PMID: 36847977 DOI: 10.1007/s12519-023-00702-0] [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: 09/16/2022] [Accepted: 02/03/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND The reasons behind the cardinal symptoms of communication deficits and repetitive, stereotyped behaviors that characterize autism spectrum disorder (ASD) remain unknown. The dopamine (DA) system, which regulates motor activity, goal-directed behaviors, and reward function, is believed to play a crucial role in ASD, although the exact mechanism is still unclear. Investigations have shown an association of the dopamine receptor D4 (DRD4) with various neurobehavioral disorders. METHODS We analyzed the association between ASD and four DRD4 genetic polymorphisms, 5' flanking 120-bp duplication (rs4646984), rs1800955 in the promoter, exon 1 12 bp duplication (rs4646983), and exon 3 48 bp repeats. We also examined plasma DA and its metabolite levels, DRD4 mRNA expression, and correlations of the studied polymorphisms with these parameters by case-control comparative analyses. The expression of DA transporter (DAT), which is important in regulating the circulating DA level, was also evaluated. RESULTS A significantly higher occurrence of rs1800955 "T/TT" was observed in the probands. ASD traits were affected by rs1800955 "T" and the higher repeat alleles of the exon 3 48 bp repeats, rs4646983 and rs4646984. ASD probands exhibited lower DA and norepinephrine levels together with higher homovanillic acid levels than the control subjects. DAT and DRD4 mRNA expression were down-regulated in the probands, especially in the presence of DAT rs3836790 "6R" and rs27072 "CC" and DRD4 rs4646984 higher repeat allele and rs1800955 "T". CONCLUSION This pioneering investigation revealed a positive correlation between genetic variants, hypodopaminergic state, and impairment in socio-emotional and communication reciprocity in Indian subjects with ASD, warranting further in-depth analysis.
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Affiliation(s)
- Sharmistha Saha
- Manovikas Biomedical Research and Diagnostic Centre, Manovikas Kendra, 482 Madudah, Plot I-24, Sector-J, E.M. Bypass, Kolkata, West Bengal, 700107, India
| | - Mahasweta Chatterjee
- Manovikas Biomedical Research and Diagnostic Centre, Manovikas Kendra, 482 Madudah, Plot I-24, Sector-J, E.M. Bypass, Kolkata, West Bengal, 700107, India
| | - Nilanjana Dutta
- Manovikas Biomedical Research and Diagnostic Centre, Manovikas Kendra, 482 Madudah, Plot I-24, Sector-J, E.M. Bypass, Kolkata, West Bengal, 700107, India
| | - Swagata Sinha
- Manovikas Biomedical Research and Diagnostic Centre, Manovikas Kendra, 482 Madudah, Plot I-24, Sector-J, E.M. Bypass, Kolkata, West Bengal, 700107, India
| | - Kanchan Mukhopadhyay
- Manovikas Biomedical Research and Diagnostic Centre, Manovikas Kendra, 482 Madudah, Plot I-24, Sector-J, E.M. Bypass, Kolkata, West Bengal, 700107, India.
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Walsh D, Brooks G, Naka M, Oxburgh G, Kyo A. Forensic interviews conducted with autistic adults in Japan: a review of the literature and directions for future research. PSYCHIATRY, PSYCHOLOGY, AND LAW : AN INTERDISCIPLINARY JOURNAL OF THE AUSTRALIAN AND NEW ZEALAND ASSOCIATION OF PSYCHIATRY, PSYCHOLOGY AND LAW 2023; 31:216-234. [PMID: 38628248 PMCID: PMC11018090 DOI: 10.1080/13218719.2023.2192255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 02/22/2023] [Indexed: 04/19/2024]
Abstract
The interviewing of victims, witnesses and suspects is important in helping resolve criminal investigations. In Japan, developments have recently occurred in the training of the police and their public prosecutors in these key tasks. Whilst literature exists on autism in Japan, studies examining police/public prosecutor interviews with autistic adults conducted in that country (and indeed, any other) remain scant. As elsewhere in the world, identification of those who manifest characteristics prevalent on the autism spectrum disorder (ASD) scale, has been found to be problematical to criminal justice professionals. To help address this deficit in understanding, we provide an overview of the literature concerning contemporary understanding of the challenges facing autistic adults as they attempt to reveal their verbal accounts, as well as suggested techniques when interviewing adults on the ASD scale during criminal investigations, offering lessons learned from research conducted around the world that provide potentially promising solutions for Japan.
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Affiliation(s)
- Dave Walsh
- School of Law, De Montfort University, Leicester, UK
| | - Graham Brooks
- School of Human and Social Sciences, University of West London, London, UK
| | - Makiko Naka
- Department of Psychology, Ritsumeikin University, Osaka, Japan
| | - Gavin Oxburgh
- Department of Social Sciences, Northumbria University, UK
| | - Akira Kyo
- Department of Law, Kwansei Gakuin University, Nishinomiya, Japan
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Semovski V, King C, Lapshina N, Stewart SL. A cross-sectional examination of service complexity in youths with co-occurring autism spectrum disorder and psychiatric or medical diagnoses across service sectors. Front Psychol 2023; 13:1027373. [PMID: 36817386 PMCID: PMC9930473 DOI: 10.3389/fpsyg.2022.1027373] [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: 08/24/2022] [Accepted: 11/28/2022] [Indexed: 02/04/2023] Open
Abstract
Introduction Autism spectrum disorder (ASD) is a heterogeneous, life-long, and complex condition. Youth diagnosed with ASD require several supports addressing core symptoms associated with the disorder, but also those resulting from co-occurring mental and physical health conditions. As a result, their care is overseen by numerous professionals spanning various service sectors, but communication between sectors is hindered due to the absence of a standardized assessment system to identify and triage youth to services. A paucity of information surrounding this population's service use lingers and a siloed delivery system persists. Methods Using archival data collected from 1,020 youth between 12 and 18 years of age, this study explored service complexity among autistic youth with and without psychiatric and medical co-occurring conditions in Ontario, Canada. In doing so, a negative binomial regression was utilized to investigate which predisposing, enabling, and need variables were associated with service complexity. Results Results revealed that experiencing financial difficulties was not associated with service complexity. However, age, sex, caregiver distress, comorbidity, intellectual disability, and evaluated health status were significant predictors. More specifically, female youth and youth with distressed caregivers had greater mental health service complexity scores. Additionally, youth diagnosed with two or more conditions in addition to ASD who required longer durations of programming, controlling for other predictors, had greater mental health service complexity scores. Yet, youth with an intellectual disability had lower service complexity scores. Discussion Clinical implications of this study are discussed to inform future investments into mental health efforts for autistic youth.
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Comorbidities in Androgenetic Alopecia: A Comprehensive Review. Dermatol Ther (Heidelb) 2022; 12:2233-2247. [PMID: 36115913 PMCID: PMC9483356 DOI: 10.1007/s13555-022-00799-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 08/18/2022] [Indexed: 11/06/2022] Open
Abstract
Androgenetic alopecia is the most common form of hair loss, affecting 85% of men and 40% of women. Androgenetic alopecia is a disease caused by multiple factors, such as genetics, hormones, and systemic diseases; however, the exact cause remains undetermined. Recent studies have found that it is associated with a high incidence of endocrine diseases and other comorbidities. It may not only be a skin disease but also an early signal of underlying systemic diseases. Effective management requires timely diagnosis and treatment initiation. However, in current clinical practice, androgenetic alopecia is still not fully understood or treated. Recognizing the true physical, social, and emotional burden of androgenic alopecia, as well as its associated comorbidities, is the first step in improving the prognosis of affected patients. This review aimed to gather the known pathological factors and provide a reference for clinical physicians to understand androgenetic alopecia and its comorbidities in depth, thereby enabling early recognition of the underlying systemic diseases and providing timely treatment.
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Voinsky I, Zoabi Y, Shomron N, Harel M, Cassuto H, Tam J, Rose S, Scheck AC, Karim MA, Frye RE, Aran A, Gurwitz D. Blood RNA Sequencing Indicates Upregulated BATF2 and LY6E and Downregulated ISG15 and MT2A Expression in Children with Autism Spectrum Disorder. Int J Mol Sci 2022; 23:ijms23179843. [PMID: 36077244 PMCID: PMC9456089 DOI: 10.3390/ijms23179843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 08/24/2022] [Accepted: 08/28/2022] [Indexed: 11/16/2022] Open
Abstract
Mutations in over 100 genes are implicated in autism spectrum disorder (ASD). DNA SNPs, CNVs, and epigenomic modifications also contribute to ASD. Transcriptomics analysis of blood samples may offer clues for pathways dysregulated in ASD. To expand and validate published findings of RNA-sequencing (RNA-seq) studies, we performed RNA-seq of whole blood samples from an Israeli discovery cohort of eight children with ASD compared with nine age- and sex-matched neurotypical children. This revealed 10 genes with differential expression. Using quantitative real-time PCR, we compared RNAs from whole blood samples of 73 Israeli and American children with ASD and 26 matched neurotypical children for the 10 dysregulated genes detected by RNA-seq. This revealed higher expression levels of the pro-inflammatory transcripts BATF2 and LY6E and lower expression levels of the anti-inflammatory transcripts ISG15 and MT2A in the ASD compared to neurotypical children. BATF2 was recently reported as upregulated in blood samples of Japanese adults with ASD. Our findings support an involvement of these genes in ASD phenotypes, independent of age and ethnicity. Upregulation of BATF2 and downregulation of ISG15 and MT2A were reported to reduce cancer risk. Implications of the dysregulated genes for pro-inflammatory phenotypes, immunity, and cancer risk in ASD are discussed.
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Affiliation(s)
- Irena Voinsky
- Department of Human Molecular Genetics and Biochemistry, Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Yazeed Zoabi
- Department of Cell and Developmental Biology, Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Edmond J. Safra Center for Bioinformatics, Tel Aviv University, Tel Aviv 69978, Israel
| | - Noam Shomron
- Department of Cell and Developmental Biology, Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Edmond J. Safra Center for Bioinformatics, Tel Aviv University, Tel Aviv 69978, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 69978, Israel
| | - Moria Harel
- Shaare Zedek Medical Center, Jerusalem 91031, Israel
| | | | - Joseph Tam
- Obesity and Metabolism Laboratory, Institute for Drug Research, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 91120, Israel
| | - Shannon Rose
- Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children’s Research Institute, Little Rock, AR 72205, USA
| | - Adrienne C. Scheck
- Barrow Neurological Institute, Phoenix Children’s Hospital, Phoenix, AZ 85016, USA
- Department of Child Health, University of Arizona College of Medicine-Phoenix, Phoenix, AZ 85004, USA
| | - Mohammad A. Karim
- Barrow Neurological Institute, Phoenix Children’s Hospital, Phoenix, AZ 85016, USA
- Department of Child Health, University of Arizona College of Medicine-Phoenix, Phoenix, AZ 85004, USA
| | - Richard E. Frye
- Barrow Neurological Institute, Phoenix Children’s Hospital, Phoenix, AZ 85016, USA
- Department of Child Health, University of Arizona College of Medicine-Phoenix, Phoenix, AZ 85004, USA
- Rossignol Medical Center, Phoenix, AZ 85050, USA
| | - Adi Aran
- Shaare Zedek Medical Center, Jerusalem 91031, Israel
- Obesity and Metabolism Laboratory, Institute for Drug Research, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 91120, Israel
- Correspondence: (A.A.); (D.G.)
| | - David Gurwitz
- Department of Human Molecular Genetics and Biochemistry, Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 69978, Israel
- Correspondence: (A.A.); (D.G.)
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López I, Förster J. Trastornos del neurodesarrollo: dónde estamos hoy y hacia dónde nos dirigimos. REVISTA MÉDICA CLÍNICA LAS CONDES 2022. [DOI: 10.1016/j.rmclc.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Alenezi S, Alnemary F, Alamri A, Albakr D, Abualkhair L, Alnemary F. Psychotropic Medications Use among Children with Autism in Saudi Arabia. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9070966. [PMID: 35883950 PMCID: PMC9322379 DOI: 10.3390/children9070966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 06/19/2022] [Accepted: 06/22/2022] [Indexed: 11/16/2022]
Abstract
Psychotropic medication use is rising among children with autism spectrum disorders (ASD) in Saudi Arabia. Two hundred ninety-three parents of children diagnosed with ASD completed a parental concerns questionnaire (PCQ) online to examine children’s family socio-demographics, health conditions and comorbidities, and past and current exposure to psychotropic medication as prescribed by their primary doctor. Findings revealed that more than one-third of the parents (39.08%) reported that their children were using medications at the time of the survey; risperidone (53%), methylphenidate (30%), and valproic acid (9%) were the most commonly used. A smaller number of parents stated that their children had previously used medications (16.09%). The most often prescribed drugs among this group were risperidone (45%), followed by methylphenidate (32%) and valproic acid (17%). The variables that showed a statistically significant association with the current use of psychotropic drugs were the child’s age (OR = 1.25, 95% CI: 1.12, 1.40, p < 0.001), presence of comorbidities (OR = 7.75, 95% CI: 3.48, 17.24, p < 0.001), communication difficulties (OR = 1.79, 95% CI: 1.09, 2.95, p < 0.021), and anxiety symptoms (OR = 1.70, 95% CI: 1.00, 2.87, p < 0.049). Similarly, the child’s age (OR = 1.23, 95% CI: 1.08, 1.40, p < 0.002) and presence of comorbidities (OR = 2.83, 95% CI: 1.16, 6.29, p < 0.022) showed statistically significant associations with previous use.
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Affiliation(s)
- Shuliweeh Alenezi
- Department of Psychiatry, College of Medicine, King Saud University, Riyadh 11451, Saudi Arabia;
- Correspondence:
| | - Fahad Alnemary
- Department of Special Education, College of Education, Taif University, Taif 21944, Saudi Arabia;
| | - Asma Alamri
- Department of Child Psychiatry, King Abdullah Specialist Children Hospital, Riyadh 14611, Saudi Arabia;
| | - Dalal Albakr
- Department of Psychiatry, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia;
| | - Lamees Abualkhair
- Department of Psychiatry, College of Medicine, King Saud University, Riyadh 11451, Saudi Arabia;
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Jure R. The “Primitive Brain Dysfunction” Theory of Autism: The Superior Colliculus Role. Front Integr Neurosci 2022; 16:797391. [PMID: 35712344 PMCID: PMC9194533 DOI: 10.3389/fnint.2022.797391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 04/19/2022] [Indexed: 11/20/2022] Open
Abstract
A better understanding of the pathogenesis of autism will help clarify our conception of the complexity of normal brain development. The crucial deficit may lie in the postnatal changes that vision produces in the brainstem nuclei during early life. The superior colliculus is the primary brainstem visual center. Although difficult to examine in humans with present techniques, it is known to support behaviors essential for every vertebrate to survive, such as the ability to pay attention to relevant stimuli and to produce automatic motor responses based on sensory input. From birth to death, it acts as a brain sentinel that influences basic aspects of our behavior. It is the main brainstem hub that lies between the environment and the rest of the higher neural system, making continuous, implicit decisions about where to direct our attention. The conserved cortex-like organization of the superior colliculus in all vertebrates allows the early appearance of primitive emotionally-related behaviors essential for survival. It contains first-line specialized neurons enabling the detection and tracking of faces and movements from birth. During development, it also sends the appropriate impulses to help shape brain areas necessary for social-communicative abilities. These abilities require the analysis of numerous variables, such as the simultaneous evaluation of incoming information sustained by separate brain networks (visual, auditory and sensory-motor, social, emotional, etc.), and predictive capabilities which compare present events to previous experiences and possible responses. These critical aspects of decision-making allow us to evaluate the impact that our response or behavior may provoke in others. The purpose of this review is to show that several enigmas about the complexity of autism might be explained by disruptions of collicular and brainstem functions. The results of two separate lines of investigation: 1. the cognitive, etiologic, and pathogenic aspects of autism on one hand, and two. the functional anatomy of the colliculus on the other, are considered in order to bridge the gap between basic brain science and clinical studies and to promote future research in this unexplored area.
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Bowling AB, Frazier JA, Staiano AE, Broder-Fingert S, Curtin C. Presenting a New Framework to Improve Engagement in Physical Activity Programs for Children and Adolescents With Social, Emotional, and Behavioral Disabilities. Front Psychiatry 2022; 13:875181. [PMID: 35599761 PMCID: PMC9122030 DOI: 10.3389/fpsyt.2022.875181] [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: 02/13/2022] [Accepted: 03/14/2022] [Indexed: 12/03/2022] Open
Abstract
Children and adolescents with psychiatric and neurodevelopmental diagnoses such as anxiety, depression, autism, and attention-deficit/hyperactivity disorder (ADHD) face enormous health disparities, and the prevalence of these disorders is increasing. Social, emotional, and behavioral disabilities (SEBD) often co-occur with each other and are associated with unique barriers to engaging in free-living physical activity (PA), community-based exercise and sports programming, and school-based physical education. Some examples of these barriers include the significantly depleted parental reserve capacity associated with SEBD in children, child dysregulation, and previous negative experiences with PA programming and/or exclusion. Importantly, most SEBD are "invisible," so these parents and children may face more stigma, have less support, and fewer inclusive programming opportunities than are typically available for children with physical or intellectual disabilities. Children's challenging behavioral characteristics are not visibly attributable to a medical or physical condition, and thus are not often viewed empathetically, and cannot easily be managed in the context of programming. Existing research into PA engagement barriers and facilitators shows significant gaps in existing health behavior change (HBC) theories and implementation frameworks that result in a failure to address unique needs of youth with SEBD and their parents. Addressing these gaps necessitates the creation of a simple but comprehensive framework that can better guide the development and implementation of engaging, effective, and scalable PA programming for these youth and their families. Therefore, the aim of this article is to: (1) summarize existing research into SEBD-related child and parent-level barriers and facilitators of PA evidence-based program engagement; (2) review the application of the most commonly used HBC and disability health theories used in the development of evidence-based PA programs, and implementation science frameworks used in adaptation and dissemination efforts; (3) review the SEBD-related gaps that may negatively affect engagement; and (4) describe the new Pediatric Physical Activity Engagement for Invisible Social, Emotional, and Behavioral Disabilities (PAID) Framework, a comprehensive adapted PA intervention development and implementation adaptation framework that we created specifically for youth with SEBD and their parents.
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Affiliation(s)
- April B. Bowling
- School of Health Sciences, Merrimack College, North Andover, MA, United States
- Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, MA, United States
- Eunice Kennedy Shriver Center, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Jean A. Frazier
- Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, MA, United States
- Eunice Kennedy Shriver Center, University of Massachusetts Chan Medical School, Worcester, MA, United States
- Department of Pediatrics, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Amanda E. Staiano
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, United States
| | - Sarabeth Broder-Fingert
- Eunice Kennedy Shriver Center, University of Massachusetts Chan Medical School, Worcester, MA, United States
- Department of Pediatrics, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Carol Curtin
- Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, MA, United States
- Eunice Kennedy Shriver Center, University of Massachusetts Chan Medical School, Worcester, MA, United States
- Department of Family and Community Medicine, University of Massachusetts Chan Medical School, Worcester, MA, United States
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Utilizing the Child Behavior Checklist (CBCL) as an Autism Spectrum Disorder Preliminary Screener and Outcome Measure for the PEERS® Intervention for Autistic Adolescents. J Autism Dev Disord 2022; 52:2061-2074. [PMID: 34052960 PMCID: PMC9926906 DOI: 10.1007/s10803-021-05103-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2021] [Indexed: 12/27/2022]
Abstract
Exploration of potential preliminary screeners, and examination of social intervention outcomes for effects on comorbid symptoms is imperative. The Child Behavior Checklist (CBCL; Achenbach & Rescorla, Achenbach and Rescorla, Manual for the ASEBA school-age forms & profiles, University of Vermont, Research Center for Children, Youth & Families, 2001) provides a potential ASD screener and intervention outcome evaluation. This study had two aims: (1) to examine CBCL scales scores as a potential ASD screener; (2) to investigate PEERS® outcomes via the CBCL for Autistic adolescents. Results indicated elevated scores on four CBCL scales in the ASD groups, contrasted to a typically-developing group. Furthermore, decreases in the two CBCL scales for adolescents that received the intervention were found. Findings support prior research indicating a unique CBCL elevation pattern as a potential screener for ASD, and provide additional support for the efficaciousness of PEERS®.
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Immune Dysregulation in Autism Spectrum Disorder: What Do We Know about It? Int J Mol Sci 2022; 23:ijms23063033. [PMID: 35328471 PMCID: PMC8955336 DOI: 10.3390/ijms23063033] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/03/2022] [Accepted: 03/09/2022] [Indexed: 02/06/2023] Open
Abstract
Autism spectrum disorder (ASD) is a group of complex multifactorial neurodevelopmental disorders characterized by a wide and variable set of neuropsychiatric symptoms, including deficits in social communication, narrow and restricted interests, and repetitive behavior. The immune hypothesis is considered to be a major factor contributing to autism pathogenesis, as well as a way to explain the differences of the clinical phenotypes and comorbidities influencing disease course and severity. Evidence highlights a link between immune dysfunction and behavioral traits in autism from several types of evidence found in both cerebrospinal fluid and peripheral blood and their utility to identify autistic subgroups with specific immunophenotypes; underlying behavioral symptoms are also shown. This review summarizes current insights into immune dysfunction in ASD, with particular reference to the impact of immunological factors related to the maternal influence of autism development; comorbidities influencing autism disease course and severity; and others factors with particular relevance, including obesity. Finally, we described main elements of similarities between immunopathology overlapping neurodevelopmental and neurodegenerative disorders, taking as examples autism and Parkinson Disease, respectively.
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Al-Biltagi M, Saeed NK, Qaraghuli S. Gastrointestinal disorders in children with autism: Could artificial intelligence help? Artif Intell Gastroenterol 2022; 3:1-12. [DOI: 10.35712/aig.v3.i1.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 02/12/2022] [Accepted: 02/20/2022] [Indexed: 02/06/2023] Open
Abstract
Autism is one of the pervasive neurodevelopmental disorders usually associated with many medical comorbidities. Gastrointestinal (GI) disorders are pervasive in children, with a 46%-84% prevalence rate. Children with Autism have an increased frequency of diarrhea, nausea and/or vomiting, gastroesophageal reflux and/or disease, abdominal pain, chronic flatulence due to various factors as food allergies, gastrointestinal dysmotility, irritable bowel syndrome (IBS), and inflammatory bowel diseases (IBD). These GI disorders have a significant negative impact on both the child and his/her family. Artificial intelligence (AI) could help diagnose and manage Autism by improving children's communication, social, and emotional skills for a long time. AI is an effective method to enhance early detection of GI disorders, including GI bleeding, gastroesophageal reflux disease, Coeliac disease, food allergies, IBS, IBD, and rectal polyps. AI can also help personalize the diet for children with Autism by microbiome modification. It can help to provide modified gluten without initiating an immune response. However, AI has many obstacles in treating digestive diseases, especially in children with Autism. We need to do more studies and adopt specific algorithms for children with Autism. In this article, we will highlight the role of AI in helping children with gastrointestinal disorders, with particular emphasis on children with Autism.
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Affiliation(s)
- Mohammed Al-Biltagi
- Department of Pediatrics, Faculty of Medicine, Tanta University, Tanta 31511, Alghrabia, Egypt
- Department of Pediatrics, University Medical Center, King Abdulla Medical City, Arabian Gulf University, Dr Sulaiman Al Habib Medical Group, Manama 26671, Manama, Bahrain
| | - Nermin Kamal Saeed
- Medical Microbiology Section, Pathology Department, Salmaniya Medical Complex, Ministry of Health, Kingdom of Bahrain, Manama 12, Manama, Bahrain
- Microbiology Section, Pathology Department, Irish Royal College of Surgeon, Bahrain, Busaiteen 15503, Muharraq, Bahrain
| | - Samara Qaraghuli
- Department of Pharmacognosy and Medicinal Plant, Faculty of Pharmacy, Al-Mustansiriya University, Baghdad 14022, Baghdad, Iraq
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Abstract
The rural areas have been at the receiving end amidst mental health disparity across the USA. There is a serious and concerning divide among ones with autism spectrum disorders (ASDs) living in underserved areas as compared to urban residents. With the higher than ever prevalence of ASD as per the recent reports of the Centers for Disease Control and Prevention; there is a need for a closer look at the prevailing issues. The trends are reflecting marked underdiagnosis, late diagnosis, lack of evidence-based diagnostic measures and interventions. These factors interplay in worsening the mental health crisis and there is an urgent need for corrective measures to address these highly modifiable problems.
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Maddouri O, Qian X, Yoon BJ. Deep graph representations embed network information for robust disease marker identification. Bioinformatics 2022; 38:1075-1086. [PMID: 34788368 DOI: 10.1093/bioinformatics/btab772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 09/30/2021] [Accepted: 11/04/2021] [Indexed: 02/03/2023] Open
Abstract
MOTIVATION Accurate disease diagnosis and prognosis based on omics data rely on the effective identification of robust prognostic and diagnostic markers that reflect the states of the biological processes underlying the disease pathogenesis and progression. In this article, we present GCNCC, a Graph Convolutional Network-based approach for Clustering and Classification, that can identify highly effective and robust network-based disease markers. Based on a geometric deep learning framework, GCNCC learns deep network representations by integrating gene expression data with protein interaction data to identify highly reproducible markers with consistently accurate prediction performance across independent datasets possibly from different platforms. GCNCC identifies these markers by clustering the nodes in the protein interaction network based on latent similarity measures learned by the deep architecture of a graph convolutional network, followed by a supervised feature selection procedure that extracts clusters that are highly predictive of the disease state. RESULTS By benchmarking GCNCC based on independent datasets from different diseases (psychiatric disorder and cancer) and different platforms (microarray and RNA-seq), we show that GCNCC outperforms other state-of-the-art methods in terms of accuracy and reproducibility. AVAILABILITY AND IMPLEMENTATION https://github.com/omarmaddouri/GCNCC. SUPPLEMENTARY INFORMATION Supplementary data are available at Bioinformatics online.
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Affiliation(s)
- Omar Maddouri
- Department of Electrical and Computer Engineering, Texas A&M University, College Station, TX 77843, USA
| | - Xiaoning Qian
- Department of Electrical and Computer Engineering, Texas A&M University, College Station, TX 77843, USA.,Computational Science Initiative, Brookhaven National Laboratory, Upton, NY 11973, USA
| | - Byung-Jun Yoon
- Department of Electrical and Computer Engineering, Texas A&M University, College Station, TX 77843, USA.,Computational Science Initiative, Brookhaven National Laboratory, Upton, NY 11973, USA
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Lung FW, Shu BC. The synergistic interaction between urbanicity and maternal education affecting childcare pressure related to autism spectrum disorder in two national birth cohort studies. Eur Child Adolesc Psychiatry 2022:10.1007/s00787-022-01945-4. [PMID: 35059850 DOI: 10.1007/s00787-022-01945-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 01/07/2022] [Indexed: 11/03/2022]
Abstract
To gain a holistic approach for parental help-seeking behavior and ASD diagnosis, this study aimed to use two national birth cohort study datasets to investigate the pathway relationship between personal and social/environmental factors, including maternal perceived childcare pressure, maternal level of education, urbanization at age 3, and the chance of receiving a autism spectrum disorder (ASD) diagnosis at when children are aged 5.5 years (2.5 years later). The 2003 Taiwan Birth Cohort Pilot Study (TBCS-p; N = 1618) and 2005 Taiwan Birth Cohort Study (TBCS; N = 19,183) datasets were used. The TBCS-p and TBCS both showed similar prevalence of ASD (0.3-0.4%). Children with ASD characteristics, as measured using the Modified Checklist of Autism in Toddlers, had 8.27-18.20 times increased likelihood of receiving ASD diagnosis [TBCS confidence interval (CF) of 5.32-12.86; TBCS-p CF of 2.03-163.46]. Pathway analysis showed that, although having a mother with higher education or who lived in a city decreased the chance for ASD diagnosis, the interactive effect of a maternal higher level of education and living in a city led to an increased likelihood for ASD diagnosis. Additionally, mothers who perceived a higher level of childcare pressure were also more likely to seek medical assistance and diagnosis. Access to healthcare (living in the city), maternal level of awareness (level of education), and perceived childcare pressure are all factors that influence help-seeking behavior and diagnosis. Therefore, medical professionals should pay special attention to the developmental condition of children in underserved backgrounds and rural areas to prevent delayed diagnosis.
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Affiliation(s)
- For-Wey Lung
- Calo Psychiatric Center, Pingtung County, Taiwan.,Graduate Institute of Medical Science, National Defense Medical Center, Taipei, Taiwan.,International Graduate Program of Education and Human Development, National Sun Yat-Sen University, Kaohsiung, Taiwan.,Institute of Education, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Bih-Ching Shu
- Department of Nursing, College of Medicine, Institute of Allied Health Sciences, National Cheng Kung University, No. 1 Da-Hsueh Rd., Tainan, 701, Taiwan.
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Dean DD, Agarwal S, Muthuswamy S, Asim A. Brain exosomes as minuscule information hub for Autism Spectrum Disorder. Expert Rev Mol Diagn 2021; 21:1323-1331. [PMID: 34720032 DOI: 10.1080/14737159.2021.2000395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Autism spectrum disorder (ASD) is a neurodevelopmental disorder initiating in the first three years of life. Early initiation of management therapies can significantly improve the health and quality of life of ASD subjects. Thus, indicating the need for suitable biomarkers for the early identification of ASD. Various biological domains were investigated in the quest for reliable biomarkers. However, most biomarkers are in the preliminary stage, and clinical validation is yet to be defined. Exosome based research gained momentum in various Central Nervous System disorders for biomarker identification. However, the utility and prospect of exosomes in ASD is still underexplored. AREAS COVERED In the present review, we summarized the biomarker discovery current status and the future of brain-specific exosomes in understanding pathophysiology and its potential as a biomarker. The studies reviewed herein were identified via systematic search (dated: June 2021) of PubMed using variations related to autism (ASD OR autism OR Autism spectrum disorder) AND exosomes AND/OR biomarkers. EXPERT OPINION As exosomess are highly relevant in brain disorders like ASD, direct access to brain tissue for molecular assessment is ethically impossible. Thus investigating the brain-derived exosomes would undoubtedly answer many unsolved aspects of the pathogenesis and provide reliable biomarkers.
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Affiliation(s)
- Deepika Delsa Dean
- Deptartment of Medical Genetics, Sanjay Gandhi Post Graduate Institute of Medical Sciences (Sgpgims), Lucknow, India
| | - Sarita Agarwal
- Deptartment of Medical Genetics, Sanjay Gandhi Post Graduate Institute of Medical Sciences (Sgpgims), Lucknow, India
| | | | - Ambreen Asim
- Deptartment of Medical Genetics, Sanjay Gandhi Post Graduate Institute of Medical Sciences (Sgpgims), Lucknow, India
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26
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Symptoms of Autism, Comorbid Mental Health Conditions and Challenging Behaviors among Toddlers with Down Syndrome at Low Risk for ASD-Characterization Using the BISCUIT-Parts 1-3. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010684. [PMID: 34682430 PMCID: PMC8535697 DOI: 10.3390/ijerph182010684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/29/2021] [Accepted: 10/09/2021] [Indexed: 11/17/2022]
Abstract
Background: Autism spectrum disorder (ASD) may coexist with Down syndrome (DS). Most studies on this topic involve school-age children, adolescents, or adults with DS. This study looked at ASD symptoms, other mental health problems, and challenging behaviors in toddlers with DS at low risk of ASD. Methods: We used screening tools for autism in toddlers; BISCUIT–Parts 1–3 and Q-CHAT. We compared four groups of children aged 17–37 months: DS, ASD, Atypical Development (AD), and Typically Developing (TD). Results: Children with DS showed lower symptoms of ASD than children with ASD (without DS) and higher than TD children, except for repetitive behaviors/restricted interests. For comorbid mental health problems and difficult behaviors, children with DS scored lower than children with ASD. There were no differences between children with DS and TD children in this regard. Conclusions: The study results indicate that BISCUIT–Parts 1–3 are valid instruments to differentiate toddlers with DS from toddlers with ASD. However, they also show that toddlers with DS at low ASD risk are a very heterogeneous group when the ASD symptoms are considered. Autistic characteristics should be taken into account in supporting young children with this genetic condition.
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27
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Lee JG, Cho HJ, Jeong YM, Lee JS. Genetic Approaches Using Zebrafish to Study the Microbiota-Gut-Brain Axis in Neurological Disorders. Cells 2021; 10:cells10030566. [PMID: 33807650 PMCID: PMC8002147 DOI: 10.3390/cells10030566] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/26/2021] [Accepted: 02/28/2021] [Indexed: 12/12/2022] Open
Abstract
The microbiota-gut-brain axis (MGBA) is a bidirectional signaling pathway mediating the interaction of the microbiota, the intestine, and the central nervous system. While the MGBA plays a pivotal role in normal development and physiology of the nervous and gastrointestinal system of the host, its dysfunction has been strongly implicated in neurological disorders, where intestinal dysbiosis and derived metabolites cause barrier permeability defects and elicit local inflammation of the gastrointestinal tract, concomitant with increased pro-inflammatory cytokines, mobilization and infiltration of immune cells into the brain, and the dysregulated activation of the vagus nerve, culminating in neuroinflammation and neuronal dysfunction of the brain and behavioral abnormalities. In this topical review, we summarize recent findings in human and animal models regarding the roles of the MGBA in physiological and neuropathological conditions, and discuss the molecular, genetic, and neurobehavioral characteristics of zebrafish as an animal model to study the MGBA. The exploitation of zebrafish as an amenable genetic model combined with in vivo imaging capabilities and gnotobiotic approaches at the whole organism level may reveal novel mechanistic insights into microbiota-gut-brain interactions, especially in the context of neurological disorders such as autism spectrum disorder and Alzheimer's disease.
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Affiliation(s)
- Jae-Geun Lee
- Disease Target Structure Research Center, KRIBB, 125 Gwahak-ro, Yuseong-gu, Daejeon 34141, Korea; (J.-G.L.); (H.-J.C.); (Y.-M.J.)
- KRIBB School, University of Science and Technology, 125 Gwahak-ro, Yuseong-gu, Daejeon 34141, Korea
| | - Hyun-Ju Cho
- Disease Target Structure Research Center, KRIBB, 125 Gwahak-ro, Yuseong-gu, Daejeon 34141, Korea; (J.-G.L.); (H.-J.C.); (Y.-M.J.)
| | - Yun-Mi Jeong
- Disease Target Structure Research Center, KRIBB, 125 Gwahak-ro, Yuseong-gu, Daejeon 34141, Korea; (J.-G.L.); (H.-J.C.); (Y.-M.J.)
- Dementia DTC R&D Convergence Program, KIST, Hwarang-ro 14 gil 5, Seongbuk-gu, Seoul 02792, Korea
| | - Jeong-Soo Lee
- Disease Target Structure Research Center, KRIBB, 125 Gwahak-ro, Yuseong-gu, Daejeon 34141, Korea; (J.-G.L.); (H.-J.C.); (Y.-M.J.)
- KRIBB School, University of Science and Technology, 125 Gwahak-ro, Yuseong-gu, Daejeon 34141, Korea
- Dementia DTC R&D Convergence Program, KIST, Hwarang-ro 14 gil 5, Seongbuk-gu, Seoul 02792, Korea
- Correspondence: ; Tel.: +82-42-860-4643
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28
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Manolova H, Hristova M, Staykova S. The Importance of Early Psychological Assessment for Differential Diagnosis and Detection of Comorbidity in Children With Autism Spectrum Disorder. Front Psychiatry 2021; 12:671744. [PMID: 34054622 PMCID: PMC8149738 DOI: 10.3389/fpsyt.2021.671744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 04/12/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Harieta Manolova
- Department of Psychiatry and Medical Psychology, Medical University - Sofia, Sofia, Bulgaria
| | - Mihaela Hristova
- Department of Psychiatry and Medical Psychology, Medical University - Sofia, Sofia, Bulgaria
| | - Svetla Staykova
- Department of Psychiatry and Medical Psychology, Medical University - Sofia, Sofia, Bulgaria
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29
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Glans MR, Thelin N, Humble MB, Elwin M, Bejerot S. The Relationship Between Generalised Joint Hypermobility and Autism Spectrum Disorder in Adults: A Large, Cross-Sectional, Case Control Comparison. Front Psychiatry 2021; 12:803334. [PMID: 35211037 PMCID: PMC8861852 DOI: 10.3389/fpsyt.2021.803334] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 12/27/2021] [Indexed: 12/21/2022] Open
Abstract
Autism spectrum disorder (ASD) and generalised joint hypermobility (GJH) share a number of clinical manifestations including proprioceptive impairment, motor difficulties, sensory hypersensitivity, and autonomic dysfunction. Clinical observations suggest that GJH is overrepresented in ASD. However, there are currently few systematic studies available. Knowledge about comorbidities may unfold common aetiopathological pathways underlying the association and improve the clinical management. The aim of this large, cross-sectional comparative study is to evaluate the relationship between ASD and GJH in adults. Data on joint hypermobility, symptoms associated with both hypermobility spectrum disorders (HSD) and hypermobile Ehlers-Danlos syndrome (hEDS), lifetime psychiatric diagnoses, psychiatric rating scales for ASD and attention deficit hyperactivity disorder (ADHD), and socio-demographics was collected for 199 individuals with ASD and 419 non-ASD community controls. Logistic regression models adjusting for covariates (age, sex, ethnicity) revealed a significant relationship between ASD and GJH and between ASD and symptomatic GJH, with adjusted odds ratios of 3.1 (95% CI: 1.9, 5.2; p < 0.001) and 4.9 (95% CI: 2.6, 9.0; p < 0.001), respectively. However, the high prevalence of comorbid ADHD in the study sample reduces the generalizability of the results among individuals with ASD without comorbid ADHD. Possibly, an additional ADHD phenotype is the primary driver of the association between ASD and GJH. Furthermore, GJH with additional self-reported symptoms, suggestive of HSD/hEDS, showed a stronger association with ASD than did non-specified GJH, indicating that symptomatic GJH plays a greater role in the relationship than non-specified GJH does. Therefore, the current study underscores the need of careful sample subclassifications. ASD with GJH may represent a novel subgroup of ASD in terms of aetiopathology and clinical presentation. Future research should elucidate the aetiological factors behind the association between ASD and GJH and evaluate how the comorbidity of GJH affects ASD outcomes.
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Affiliation(s)
- Martin R Glans
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Nils Thelin
- Division of Psychiatry, Linköping University Hospital, Linköping, Sweden
| | - Mats B Humble
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Marie Elwin
- Faculty of Medicine and Health, University Health Care Research Centre, Örebro University, Örebro, Sweden
| | - Susanne Bejerot
- School of Medical Sciences, Örebro University, Örebro, Sweden.,Faculty of Medicine and Health, University Health Care Research Centre, Örebro University, Örebro, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet (KI), Solna, Sweden
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30
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Sarovic D. A Unifying Theory for Autism: The Pathogenetic Triad as a Theoretical Framework. Front Psychiatry 2021; 12:767075. [PMID: 34867553 PMCID: PMC8637925 DOI: 10.3389/fpsyt.2021.767075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 10/27/2021] [Indexed: 12/27/2022] Open
Abstract
This paper presents a unifying theory for autism by applying the framework of a pathogenetic triad to the scientific literature. It proposes a deconstruction of autism into three contributing features (an autistic personality dimension, cognitive compensation, and neuropathological risk factors), and delineates how they interact to cause a maladaptive behavioral phenotype that may require a clinical diagnosis. The autistic personality represents a common core condition, which induces a set of behavioral issues when pronounced. These issues are compensated for by cognitive mechanisms, allowing the individual to remain adaptive and functional. Risk factors, both exogenous and endogenous ones, show pathophysiological convergence through their negative effects on neurodevelopment. This secondarily affects cognitive compensation, which disinhibits a maladaptive behavioral phenotype. The triad is operationalized and methods for quantification are presented. With respect to the breadth of findings in the literature that it can incorporate, it is the most comprehensive model yet for autism. Its main implications are that (1) it presents the broader autism phenotype as a non-pathological core personality domain, which is shared across the population and uncoupled from associated features such as low cognitive ability and immune dysfunction, (2) it proposes that common genetic variants underly the personality domain, and that rare variants act as risk factors through negative effects on neurodevelopment, (3) it outlines a common pathophysiological mechanism, through inhibition of neurodevelopment and cognitive dysfunction, by which a wide range of endogenous and exogenous risk factors lead to autism, and (4) it suggests that contributing risk factors, and findings of immune and autonomic dysfunction are clinically ascertained rather than part of the core autism construct.
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Affiliation(s)
- Darko Sarovic
- Gillberg Neuropsychiatry Centre, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden.,MedTech West, Gothenburg, Sweden
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