Effects of COVID-19 on children with autism

Unraveling functional neurological disorder in pediatric populations: A systematic review of diagnosis, treatment, and outcomes

BACKGROUND

Functional neurological disorder (FND) in children is a complex and multifaceted condition characterized by neurological symptoms that cannot be explained by organic pathology. Despite its prevalence, FND in pediatric populations remains under-researched, with challenges in diagnosis and management

AIM

To synthesize the current literature on FND in children, focusing on clinical presentation, diagnostic approaches, treatment strategies, and outcomes.

METHODS

A comprehensive literature search was conducted across multiple databases, including PubMed, Scopus, and Web of Science, for articles published up to August 2024. Studies were included if they addressed FND in pediatric populations, specifically focusing on review articles, research articles, systematic reviews, meta-analyses, case reports, guidelines, expert opinions, and editorials. Data extraction and quality assessment were performed according to PRISMA guidelines. A total of 308 articles were included in the final analysis.

RESULTS

The analysis included 189 review articles, 57 research articles, 3 systematic reviews and meta-analyses, 5 case reports, 2 guidelines, 5 expert opinions, and 2 editorials. Key findings revealed a broad spectrum of symptoms, including motor and sensory disturbances and psychological factors contributing to the onset and persistence of FND. Diagnostic challenges were frequently highlighted, emphasizing the need for interdisciplinary approaches. Treatment strategies varied, with cognitive-behavioral therapy (CBT) and multidisciplinary care emerging as the most effective approaches. The outcomes varied, with early intervention being critical for a better prognosis.

CONCLUSION

Early diagnosis and multidisciplinary care, including CBT, are critical for improving outcomes in pediatric FND. Standardized diagnostic criteria and treatment protocols are needed to enhance clinical management.

Management of critical care emergencies in children with autism spectrum disorder

BACKGROUND

Managing critical care emergencies in children with autism spectrum disorder (ASD) presents unique challenges due to their distinct sensory sensitivities, communication difficulties, and behavioral issues. Effective strategies and protocols are essential for optimal care in these high-stress situations.

AIM

To systematically evaluate and synthesize current evidence on best practices for managing critical care emergencies in children with ASD. The review focuses on key areas, including sensory-friendly environments, communication strategies, behavioral management, and the role of multidisciplinary approaches.

METHODS

A comprehensive search was conducted across major medical databases, including PubMed, Embase, and Cochrane Library, for studies published between 2000 and 2023. Studies were selected based on their relevance to critical care management in children with ASD, encompassing randomized controlled trials, observational studies, qualitative research, and case studies. Data were extracted and analyzed to identify common themes, successful strategies, and areas for improvement.

RESULTS

The review identified 50 studies that met the inclusion criteria. Findings highlighted the importance of creating sensory-friendly environments, utilizing effective communication strategies, and implementing individualized behavioral management plans. These findings, derived from a comprehensive review of current evidence, provide valuable insights into the best practices for managing critical care emergencies in children with ASD. Sensory modifications, such as reduced lighting and noise, visual aids, and augmentative and alternative communication tools, enhanced patient comfort and cooperation. The involvement of multidisciplinary teams was crucial in delivering holistic care. Case studies provided practical insights and underscored the need for continuous refinement of protocols.

CONCLUSION

The review emphasizes the need for a tailored approach to managing critical care emergencies for children with ASD. Sensory-friendly adjustments, effective communication, and behavioral strategies supported by a multidisciplinary team are integral to improving outcomes. Despite progress, ongoing refinement of care practices and protocols is necessary. This ongoing process addresses remaining challenges and engages healthcare professionals in continuous improvement of care for children with ASD in critical settings.

Pre-autism: Advancing early identification and intervention in autism

Autism spectrum disorder (ASD) is often diagnosed long after symptoms have become noticeable. This delay can make it difficult to provide early intervention, which can impact long-term outcomes. The concept of "pre-autism" highlights the phase before a formal diagnosis of ASD, providing an opportunity for earlier identification and intervention, which could be a turning point in ASD management. In a previous article, we explored different ways of diagnosing pre-autism, including historical records, physical markers, laboratory tests, and radiological evidence. This manuscript builds on that foundation by emphasizing the importance of early diagnosis and intervention in ASD. Recent research advancements have clarified that ASD presentations can be complex, and individualized support strategies are necessary. The significance of pre-autism lies in its potential to alter the trajectory of ASD through early detection and intervention despite challenges such as limited awareness and variability in symptom presentation. Biomarkers and diagnostic tools have shown promise as avenues for early detection, but it is essential to exercise caution and not rely too heavily on yet-to-be-established markers. Addressing these challenges requires a collaborative effort to increase awareness, improve access to diagnostic tools, and foster inclusive environments. Ultimately, this manuscript calls for ongoing research, advocacy, and resource allocation to enhance early detection and intervention efforts, ensuring optimal outcomes for individuals on the autism spectrum.

TAAR1 and 5-HT1B receptor agonists attenuate autism-like irritability and aggression in rats prenatally exposed to valproic acid

Despite the rising prevalence of autism spectrum disorder (ASD), there remains a significant unmet need for pharmacotherapies addressing its core and associative symptoms. While some atypical antipsychotics have been approved for managing associated irritability and aggression, their use is constrained by substantial side effects. This study aimed firstly to develop behavioral measures to explore frustration, irritability and aggression phenotypes in the rat prenatal valproic acid (VPA) model of ASD. Additionally, we investigated the potential of two novel mechanisms, 5-HT1B and TAAR1 agonism, to alleviate these behaviors. Male offspring exposed to prenatal VPA were trained to achieve stable performance on a cued operant task, followed by pharmacological assessment in an operant frustration test, bottle brush test and resident intruder test. VPA exposed rats demonstrated behaviors indicative of frustration and irritability, as well as increased aggression compared to controls. The irritability-like behavior and aggression were further exacerbated in animals previously experiencing a frustrative event during the operant test. Single administration of the 5-HT1B agonist CP-94253 or TAAR1 agonist RO5263397 attenuated the frustration-like behavior compared to vehicle. Additionally, both agonists reduced irritability-like behavior under both normal and frustrative conditions. While CP-94253 reduced aggression in the resident intruder test under both conditions, RO5263397 only produced effects in rats that previously experienced a frustrative event. Our study describes previously uncharacterized phenotypes of frustration, irritability, and aggression in the rat prenatal VPA model of ASD. Administration of selective TAAR1 or 5-HT1B receptor agonists alleviated these deficits, warranting further exploration of both targets in ASD treatment.

Sentiment analysis of post-COVID-19 health information needs of autism spectrum disorder community: insights from social media discussions

OBJECTIVE

This study explores the health information needs of individuals with autism spectrum disorder (ASD) and their caregivers in the post-COVID-19 era by analyzing discussions from Reddit, a popular social media platform.

METHODS

Utilizing a mixed-method approach that integrates qualitative content analysis with quantitative sentiment analysis, we analyzed user-generated content from the "r/autism" subreddit to identify recurring themes and sentiments.

RESULTS

The qualitative analysis uncovered key themes, including symptoms, diagnostic challenges, caregiver experiences, treatment options, and stigma, reflecting the diverse concerns within the ASD community. The quantitative sentiment analysis revealed a predominance of positive sentiment across discussions, although significant instances of neutral and negative sentiments were also present, indicating varied experiences and perspectives among community members. Among the machine learning models used for sentiment classification, the Bi-directional Long Short-Term Memory (Bi-LSTM) model achieved the highest performance, demonstrating a validation accuracy of 95.74%.

CONCLUSIONS

The findings highlight the need for improved digital platforms and community resources to address the specific health information needs of the ASD community, particularly in enhancing access to reliable information and fostering supportive environments. These insights can guide future interventions and policies aimed at improving the well-being of autistic persons and their caregivers.

Decoding the genetic landscape of autism: A comprehensive review

BACKGROUND

Autism spectrum disorder (ASD) is a complex neurodevelopmental condition characterized by heterogeneous symptoms and genetic underpinnings. Recent advancements in genetic and epigenetic research have provided insights into the intricate mechanisms contributing to ASD, influencing both diagnosis and therapeutic strategies.

AIM

To explore the genetic architecture of ASD, elucidate mechanistic insights into genetic mutations, and examine gene-environment interactions.

METHODS

A comprehensive systematic review was conducted, integrating findings from studies on genetic variations, epigenetic mechanisms (such as DNA methylation and histone modifications), and emerging technologies [including Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR)-Cas9 and single-cell RNA sequencing]. Relevant articles were identified through systematic searches of databases such as PubMed and Google Scholar.

RESULTS

Genetic studies have identified numerous risk genes and mutations associated with ASD, yet many cases remain unexplained by known factors, suggesting undiscovered genetic components. Mechanistic insights into how these genetic mutations impact neural development and brain connectivity are still evolving. Epigenetic modifications, particularly DNA methylation and non-coding RNAs, also play significant roles in ASD pathogenesis. Emerging technologies like CRISPR-Cas9 and advanced bioinformatics are advancing our understanding by enabling precise genetic editing and analysis of complex genomic data.

CONCLUSION

Continued research into the genetic and epigenetic underpinnings of ASD is crucial for developing personalized and effective treatments. Collaborative efforts integrating multidisciplinary expertise and international collaborations are essential to address the complexity of ASD and translate genetic discoveries into clinical practice. Addressing unresolved questions and ethical considerations surrounding genetic research will pave the way for improved diagnostic tools and targeted therapies, ultimately enhancing outcomes for individuals affected by ASD.

Telemedicine Utilization Patterns and Implications Amidst COVID-19 Outbreaks in Thailand Under Public Universal Coverage Scheme

During COVID-19 pandemic, telemedicine was a strategy to facilitate healthcare service delivery minimizing the risk of direct exposure among people. In Thailand, the National Health Security Office has included telemedicine services under the Universal Coverage Scheme to support social distancing policies to reduce the spread of COVID-19. This study aimed to determine the patterns of telemedicine service use during major COVID-19 outbreaks including Alpha, Delta, and Omicron in Thailand. We retrospectively analyzed a dataset of telemedicine e-claims from the National Health Security Office, which covers services reimbursed under the Universal Coverage Scheme between December 2020 and August 2022. An interrupted time-series analysis, Pearson correlation analysis and binary logistic regression were performed. Almost 70% of the patients using telemedicine services were over 40 years old. Most patients used services for mental health problems (25.6%) and major noncommunicable diseases, including essential hypertension (12.6%) and diabetes mellitus (9.2%). The daily number of using telemedicine service was strongly correlated with the number of COVID-19 new cases detected. An immediate change in the trend of using telemedicine was detected at the onset of outbreaks along with the surge of infection. The follow-up use of telemedicine services was not substantial among female, older adults patients and those with non-communicable diseases except mental health problems, and infectious diseases. Strategies need to be developed to reinforced healthcare resources for telemedicine during the surge of outbreaks and sustain the use of telemedicine services for chronic and infectious diseases, regardless of the pandemic, and promote the efficiency of healthcare systems.

Uncertainty, Sensory Processing, and Stress in Autistic Children During the COVID-19 Pandemic

BACKGROUND

COVID-19 increased uncertainty for most and was especially disruptive to autistic people and their families, due in part to tendencies toward intolerance for uncertainty across this population. As such, COVID presented a natural experiment of uncertainty and its correlates in autism. Previous reports have shown associations between intolerance of uncertainty, sensory difficulty, and stress.

AIMS

We investigated changes in sensory difficulties and stress associated with COVID-related increases in uncertainty.

METHODS AND PROCEDURES

Primary caregivers of 47 autistic children (ages 6-15) completed online surveys containing questions about demographics, experiences, and supports received during the pandemic. Additionally, caregivers filled out measures of intolerance of uncertainty and sensory processing for both pre- and during-COVID conditions.

OUTCOMES AND RESULTS

Eighty nine percent of children had significant sensory difficulties before the pandemic. This group showed significant increases in sensory difficulties and intolerance of uncertainty during the pandemic. These changes were significantly correlated with each other, suggesting that as uncertainty increased so did sensory difficulties. Disruption to routine was also significantly correlated with sensory differences and child, household, and parent stress.

CONCLUSIONS AND IMPLICATIONS

Our findings add to fundamental understanding of the relationship between uncertainty, sensory processing, and stress by leveraging a natural experiment in increased uncertainty. These results have the potential to contribute to improved supports for autistic individuals in clinical, educational, home, and other settings.

Viruses and autism: A Bi-mutual cause and effect

Autism spectrum disorder (ASD) is a group of heterogeneous, multi-factorial, neurodevelopmental disorders resulting from genetic and environmental factors interplay. Infection is a significant trigger of autism, especially during the critical developmental period. There is a strong interplay between the viral infection as a trigger and a result of ASD. We aim to highlight the mutual relationship between autism and viruses. We performed a thorough literature review and included 158 research in this review. Most of the literature agreed on the possible effects of the viral infection during the critical period of development on the risk of developing autism, especially for specific viral infections such as Rubella, Cytomegalovirus, Herpes Simplex virus, Varicella Zoster Virus, Influenza virus, Zika virus, and severe acute respiratory syndrome coronavirus 2. Viral infection directly infects the brain, triggers immune activation, induces epigenetic changes, and raises the risks of having a child with autism. At the same time, there is some evidence of increased risk of infection, including viral infections in children with autism, due to lots of factors. There is an increased risk of developing autism with a specific viral infection during the early developmental period and an increased risk of viral infections in children with autism. In addition, children with autism are at increased risk of infection, including viruses. Every effort should be made to prevent maternal and early-life infections and reduce the risk of autism. Immune modulation of children with autism should be considered to reduce the risk of infection.