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Pearson DA, Hendren RL, Heil MF, McIntyre WR, Raines SR. Pancreatic Replacement Therapy for Maladaptive Behaviors in Preschool Children With Autism Spectrum Disorder. JAMA Netw Open 2023; 6:e2344136. [PMID: 38032645 PMCID: PMC10690476 DOI: 10.1001/jamanetworkopen.2023.44136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 10/10/2023] [Indexed: 12/01/2023] Open
Abstract
Importance There is an urgent unmet need for a treatment addressing the core symptoms and associated maladaptive symptoms of autism spectrum disorder (ASD), especially in preschool populations. Objectives To evaluate whether treatment of children with ASD aged 3 to 6 years treated with high-protease pancreatic therapy produces long- and short-term improvements in autism-associated maladaptive behaviors. Design, Setting, and Participants This cohort study at 32 sites across the US used a double-blind parallel group, delayed-start design comprising a 2-week blinded placebo run-in, and a double-blind, randomized, placebo-controlled segment (12 weeks). Children were recruited into the study in 2015, with data collection continuing until 2021. The analyses were completed from June 2021 to February 2022. Interventions All participants were randomly assigned to receive either 900 mg high-protease pancreatic replacement therapy or placebo with food 3 times a day for 12 weeks, followed by all receiving 900 mg high-protease pancreatic replacement therapy for 24 weeks. Main Outcomes and Measures The primary outcome was the irritability/agitation subscale of the Aberrant Behavior Checklist (ABC-I). All potential participants were screened using the Social Communication Questionnaire (SCQ) with diagnosis confirmed by the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision) for ASD and the Autism Diagnostic Inventory-Revised (ADI-R). Outcomes were measured at the conclusion of the 12-week double-blind segment and at the conclusion of the 24-week open-label segment (total 36 weeks). Results A total of 190 participants (150 male [79%]), aged 3 to 6 (mean [SD] age, 4.5 [0.8]) years were randomized. Mixed model for repeated measures analysis performed on ABC-I demonstrated statistically significant differences of -2.49 (95% CI, -4.66 to -0.32; Cohen d = 0.364; P = .03) at the 12-week timepoint and -3.07 (95% CI, -5.81 to -0.33; Cohen d = 0.516; P = .03) at 36-week timepoint. No convergence was noted. Our high-protease pancreatic replacement (CM-AT) was well tolerated with no emergent safety concerns or related serious adverse events noted. Conclusions and Relevance This cohort study of preschool children sustained cumulative reduction in the maladaptive behavior of irritability in autism. This delayed-start analysis, used to demonstrate disease and condition modification, may prove to be an important tool to evaluate treatments for ASD. Trial Registration ClinicalTrials.gov Identifier: NCT02410902 and NCT02649959.
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Affiliation(s)
- Deborah A. Pearson
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, Houston, Texas
| | - Robert L. Hendren
- Division of Child and Adolescent Psychiatry, Weill Institute, School of Medicine, University of California, San Francisco
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Abstract
Autism spectrum disorder (ASD) is a neurodevelopmental disorder that affects 0.6%-1.7% of children. The etiology of autism is hypothesized to include both biological and environmental factors (Watts, 2008). In addition to the core symptoms of social-communication delay and restricted, repetitive interests, co-occurring irritability/aggression, hyperactivity, and insomnia negatively impact adaptive functioning and quality of life of patients and families. Despite years of effort, no pharmacologic agent has been found that targets the core symptoms of ASD. The only FDA-approved agents are risperidone and aripiprazole for agitation and irritability in ASD, not for core symptoms. Though they effectively reduce irritability/violence, they do so at the expense of problematic side effects: metabolic syndrome, elevated liver enzymes, and extrapyramidal side effects. Thus, it is not surprising that many families of children with ASD turn to nonallopathic treatment, including dietary interventions, vitamins, and immunomodulatory agents subsumed under complementary-integrative medicine (CIM). Per recent studies, 27% to 88% of families report using a CIM treatment. In an extensive population-based survey of CIM, families of children with more severe ASD, comorbid irritability, GI symptoms, food allergies, seizures, and higher parental education tend to use CIM at higher rates. The perceived safety of CIM treatments as "natural treatment" over allopathic medication increases parental comfort in using these agents. The most frequently used CIM treatments include multivitamins, an elimination diet, and Methyl B12 injections. Those perceived most effective are sensory integration, melatonin, and antifungals. Practitioners working with these families should improve their knowledge about CIM as parents currently perceive little interest in and poor knowledge of CIM by physicians. This article reviews the most popular complementary treatments preferred by families with children with autism. With many of them having limited or poor quality data, clinical recommendations about the efficacy and safety of each treatment are discussed using the SECS versus RUDE criteria.
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Affiliation(s)
- Pankhuree Vandana
- Division of Child & Adolescent Psychiatry, Columbia University Valegos College of Physicians and Surgeons, Center for Autism and the Developing Brain, 21 Bloomingdale Road, White Plains, NY 10605, USA.
| | | | - Robert L Hendren
- University of California San Francisco, Pritzker Building, 675 18th Street, San Francisco, CA 94143-3132, USA
| | - L Eugene Arnold
- Department of Psychiatry and Behavioral Health, Ohio State University, McCampbell 395E, 1581 Dodd Drive, Columbus, OH 43210, USA
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Hossain B, Bent S, Parenteau C, Widjaja F, Davis M, Hendren RL. The Associations Between Sluggish Cognitive Tempo, Internalizing Symptoms, and Academic Performance in Children With Reading Disorder: A Longitudinal Cohort Study. J Atten Disord 2022; 26:1576-1590. [PMID: 35373641 PMCID: PMC9373189 DOI: 10.1177/10870547221085493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To investigate whether sluggish cognitive tempo (SCT) was associated with anxiety, depression, and academic performance (AP) in children with reading disorder (RD), and whether ADHD-Inattention (ADHD-IN) moderated these relationships. METHOD Parents and teachers of children with RD (N = 147, ages 6-18) completed evaluations of SCT, ADHD, anxiety, depression, and AP, every 3 months for 18 months. Baseline and longitudinal associations between SCT and outcomes, and effect moderation of ADHD-IN, were assessed. RESULTS Teacher-rated SCT was positively associated with teacher-rated anxiety (p < .001) and negatively associated with AP (p < .001) cross-sectionally and longitudinally, with significant effect modification by ADHD-IN for both outcomes. SCT was not associated with depression in adjusted cross-sectional and longitudinal analyses. There were no significant findings for any parent-reported measures. CONCLUSION SCT has negative effects on anxiety and AP in children with RD among individuals with low ADHD-IN according to teacher report. Targeted treatment of SCT may provide substantial benefits.
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Affiliation(s)
- Bushra Hossain
- University of California, San
Francisco, CA, USA,Bushra Hossain, Department of Psychiatry,
University of California, 401 Parnassus Avenue, San Francisco, CA 94143, USA.
| | - Stephen Bent
- University of California, San
Francisco, CA, USA
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Hossain B, Chen Y, Bent S, Parenteau C, Widjaja F, Haft SL, Hoeft F, Hendren RL. The role of grit and resilience in children with reading disorder: a longitudinal cohort study. Ann Dyslexia 2022; 72:1-27. [PMID: 34324164 PMCID: PMC8898035 DOI: 10.1007/s11881-021-00238-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 06/24/2021] [Indexed: 06/13/2023]
Abstract
Prior studies have suggested that grit and resilience predict both academic and career success. However, these qualities have not been examined in children with reading disorder (RD). We therefore investigated whether grit and resilience were associated with anxiety, depression, academic performance, and quality of life (QOL) in these students. This 3-year longitudinal cohort study included 163 participants with RD from 3 schools. Evaluations were completed by parents and/or teachers every 3 months. The Grit and Resilience Scale was adapted from the 10-item Connor-Davidson Resilience Scale and the 12-item Grit Scale. Outcome measures included anxiety (School Anxiety Scale - Teacher Report and the 8-item Spence Children's Anxiety Scale), depression (Short Mood and Feelings Questionnaire), academic performance, and QOL (Pediatric QOL Inventory 4.0). Multivariate linear regression models (adjusting for age and sex) assessed the associations at baseline. Repeated measures analysis using mixed-effects models assessed the relationship longitudinally. There were statistically significant associations between grit and resilience and all outcomes at baseline and over time. After adjusting for age and sex, improved grit and resilience was associated with decreased anxiety (β = - 0.4, p < 0.001) and improved academic performance (β = 0.5, p < 0.001) when grit and resilience was measured by teachers, as well as decreased depression (β = - 0.3, p < 0.001) and improved QOL (β = 0.6, p < 0.001) when grit and resilience was measured by parents. Grit and resilience are significantly related to mental health, academic performance, and QOL in children with RD. This suggests that interventions to improve grit and resilience may lead to positive benefits.
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Affiliation(s)
- Bushra Hossain
- Department of Psychiatry, University of California, San Francisco, 401 Parnassus Ave, San Francisco, CA, 94143, USA.
| | - Yingtong Chen
- Department of Psychiatry, University of California, San Francisco, 401 Parnassus Ave, San Francisco, CA, 94143, USA
| | - Stephen Bent
- Department of Psychiatry, University of California, San Francisco, 401 Parnassus Ave, San Francisco, CA, 94143, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - China Parenteau
- Department of Psychiatry, University of California, San Francisco, 401 Parnassus Ave, San Francisco, CA, 94143, USA
| | - Felicia Widjaja
- Department of Psychiatry, University of California, San Francisco, 401 Parnassus Ave, San Francisco, CA, 94143, USA
| | - Stephanie L Haft
- Department of Psychology, University of California, Berkeley, CA, USA
| | - Fumiko Hoeft
- Department of Psychiatry, University of California, San Francisco, 401 Parnassus Ave, San Francisco, CA, 94143, USA
- Department of Psychological Sciences, University of Connecticut, Mansfield, CT, USA
| | - Robert L Hendren
- Department of Psychiatry, University of California, San Francisco, 401 Parnassus Ave, San Francisco, CA, 94143, USA
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Quan L, Xu X, Cui Y, Han H, Hendren RL, Zhao L, You X. A systematic review and meta-analysis of the benefits of a gluten-free diet and/or casein-free diet for children with autism spectrum disorder. Nutr Rev 2021; 80:1237-1246. [PMID: 34617108 PMCID: PMC8990762 DOI: 10.1093/nutrit/nuab073] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
CONTEXT It has been suggested that a gluten-free and casein-free (GFCF) diet may alleviate the symptoms of autism spectrum disorder (ASD) and facilitate neurodevelopment of children with ASD. Studies to date have been inconclusive. OBJECTIVE This study aimed to evaluate (through quantitative meta-analysis) the efficacy and safety of a GFCF diet for children with ASD. To our knowledge, this is the first time such an analysis has been carried out. DATA SOURCES Eight electronic databases were searched, from the establishment of each database up to March 27, 2020: PubMed, Web of Science, Embase (Ovid), PsycINFO (Ovid), Cochrane Library, CNKI, Wanfang, and VIP databases. DATA EXTRACTION Two authors independently performed the data extraction and risk-of-bias assessment. DATA ANALYSIS A quantitative meta-analysis was performed with standard procedures by using Stata SE 15 software. Within the total of 8 studies, with 297 participants, 5 studies reported significant reductions in stereotypical behaviors [standard mean difference (SMD) = -0.41, 95% confidence interval (CI): -0.68 to -0.15], and 3 studies reported improvements in cognition (SMD = -0.46, 95% CI: -0.91 to -0.01) following GFCF dietary intervention. No statistically significant changes were observed in other symptomatic categories (all P > 0.05). CONCLUSION The current meta-analysis showed that a GFCF diet can reduce stereotypical behaviors and improve the cognition of children with ASD. Though most of the included studies were single-blind, the benefits of a GFCF diet that have been indicated are promising. Additional studies on a larger scale are warranted. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration no. CRD42020177619.
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Affiliation(s)
- Liuliu Quan
- L. Quan, H. Han, L. Zhao, and X. You are with the Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. X. Xu is with the Medical Science Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. Y. Cui is with the Department of Blood Immunity, General Hospital of Shanxi Datong Tongmei Group, Datong, China. R. L. Hendren is with the Department of Psychiatry, University of California, San Francisco, California, USA. L. Zhao and X. You are with the Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China. L. Zhao and X. You are with the National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, China. X. You is with the Autism Special Fund, Peking Union Medical Foundation, Beijing, China
| | - Xinjie Xu
- L. Quan, H. Han, L. Zhao, and X. You are with the Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. X. Xu is with the Medical Science Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. Y. Cui is with the Department of Blood Immunity, General Hospital of Shanxi Datong Tongmei Group, Datong, China. R. L. Hendren is with the Department of Psychiatry, University of California, San Francisco, California, USA. L. Zhao and X. You are with the Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China. L. Zhao and X. You are with the National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, China. X. You is with the Autism Special Fund, Peking Union Medical Foundation, Beijing, China
| | - Yonghong Cui
- L. Quan, H. Han, L. Zhao, and X. You are with the Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. X. Xu is with the Medical Science Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. Y. Cui is with the Department of Blood Immunity, General Hospital of Shanxi Datong Tongmei Group, Datong, China. R. L. Hendren is with the Department of Psychiatry, University of California, San Francisco, California, USA. L. Zhao and X. You are with the Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China. L. Zhao and X. You are with the National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, China. X. You is with the Autism Special Fund, Peking Union Medical Foundation, Beijing, China
| | - Heze Han
- L. Quan, H. Han, L. Zhao, and X. You are with the Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. X. Xu is with the Medical Science Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. Y. Cui is with the Department of Blood Immunity, General Hospital of Shanxi Datong Tongmei Group, Datong, China. R. L. Hendren is with the Department of Psychiatry, University of California, San Francisco, California, USA. L. Zhao and X. You are with the Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China. L. Zhao and X. You are with the National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, China. X. You is with the Autism Special Fund, Peking Union Medical Foundation, Beijing, China
| | - Robert L Hendren
- L. Quan, H. Han, L. Zhao, and X. You are with the Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. X. Xu is with the Medical Science Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. Y. Cui is with the Department of Blood Immunity, General Hospital of Shanxi Datong Tongmei Group, Datong, China. R. L. Hendren is with the Department of Psychiatry, University of California, San Francisco, California, USA. L. Zhao and X. You are with the Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China. L. Zhao and X. You are with the National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, China. X. You is with the Autism Special Fund, Peking Union Medical Foundation, Beijing, China
| | - Lidan Zhao
- L. Quan, H. Han, L. Zhao, and X. You are with the Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. X. Xu is with the Medical Science Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. Y. Cui is with the Department of Blood Immunity, General Hospital of Shanxi Datong Tongmei Group, Datong, China. R. L. Hendren is with the Department of Psychiatry, University of California, San Francisco, California, USA. L. Zhao and X. You are with the Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China. L. Zhao and X. You are with the National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, China. X. You is with the Autism Special Fund, Peking Union Medical Foundation, Beijing, China
| | - Xin You
- L. Quan, H. Han, L. Zhao, and X. You are with the Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. X. Xu is with the Medical Science Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. Y. Cui is with the Department of Blood Immunity, General Hospital of Shanxi Datong Tongmei Group, Datong, China. R. L. Hendren is with the Department of Psychiatry, University of California, San Francisco, California, USA. L. Zhao and X. You are with the Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China. L. Zhao and X. You are with the National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, China. X. You is with the Autism Special Fund, Peking Union Medical Foundation, Beijing, China
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Hendren RL. Editorial: Addressing the "Cliff" for Adults With Autism Spectrum Disorder. J Am Acad Child Adolesc Psychiatry 2021; 60:946-947. [PMID: 33539916 DOI: 10.1016/j.jaac.2021.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 01/22/2021] [Indexed: 11/24/2022]
Abstract
Parents of young children diagnosed with autism spectrum disorder (ASD) desperately search for a cure for their child's disorder. Depending on their child's severity or lack of progress, parents shift from looking for a cure to finding arrangements where their child can live a fulfilling life as an adult when they are less involved and less able to help. Sadly, they too often find that the resources they have fought for their children to receive disappear when their youngsters leave school.
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Affiliation(s)
- Robert L Hendren
- Weill Institute for Neurosciences, Division of Child and Adolescent Psychiatry, University of California, San Francisco.
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Abstract
Rigid, repetitive behaviors (RRBs) as a part of autism spectrum disorder (ASD) are perplexing and challenging to treat effectively. First, how is it that they associate with deficits in social communication and social interaction to create a strong symptomatic association for the DSM-5 diagnosis of ASD?1 Deficits in social communication make sense in how they define a developmental disorder, but what is the mechanism by which social interaction and RRBs connect to define the classification of ASD? Perhaps it is that, rather than by neurotransmitters or linked structural brain regions, ASD is a neural systems condition mediated by abnormalities in regionally distributed cortical networks.2.
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Affiliation(s)
- Robert L Hendren
- Division of Child and Adolescent Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco.
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Kaliukhovich DA, Manyakov NV, Bangerter A, Ness S, Skalkin A, Goodwin MS, Dawson G, Hendren RL, Leventhal B, Hudac CM, Bradshaw J, Shic F, Pandina G. Social attention to activities in children and adults with autism spectrum disorder: effects of context and age. Mol Autism 2020; 11:79. [PMID: 33076994 PMCID: PMC7574440 DOI: 10.1186/s13229-020-00388-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 10/01/2020] [Indexed: 11/10/2022] Open
Abstract
Background Diminished visual monitoring of faces and activities of others is an early feature of autism spectrum disorder (ASD). It is uncertain whether deficits in activity monitoring, identified using a homogeneous set of stimuli, persist throughout the lifespan in ASD, and thus, whether they could serve as a biological indicator (“biomarker”) of ASD. We investigated differences in visual attention during activity monitoring in children and adult participants with autism compared to a control group of participants without autism. Methods Eye movements of participants with autism (n = 122; mean age [SD] = 14.5 [8.0] years) and typically developing (TD) controls (n = 40, age = 16.4 [13.3] years) were recorded while they viewed a series of videos depicting two female actors conversing while interacting with their hands over a shared task. Actors either continuously focused their gaze on each other’s face (mutual gaze) or on the shared activity area (shared focus). Mean percentage looking time was computed for the activity area, actors’ heads, and their bodies. Results Compared to TD participants, participants with ASD looked longer at the activity area (mean % looking time: 58.5% vs. 53.8%, p < 0.005) but less at the heads (15.2% vs. 23.7%, p < 0.0001). Additionally, within-group differences in looking time were observed between the mutual gaze and shared focus conditions in both participants without ASD (activity: Δ = − 6.4%, p < 0.004; heads: Δ = + 3.5%, p < 0.02) and participants with ASD (bodies: Δ = + 1.6%, p < 0.002). Limitations The TD participants were not as well characterized as the participants with ASD. Inclusion criteria regarding the cognitive ability [intelligence quotient (IQ) > 60] limited the ability to include individuals with substantial intellectual disability. Conclusions Differences in attention to faces could constitute a feature discriminative between individuals with and without ASD across the lifespan, whereas between-group differences in looking at activities may shift with development. These findings may have applications in the search for underlying biological indicators specific to ASD. Trial registration ClinicalTrials.gov identifier NCT02668991.
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Affiliation(s)
| | | | - Abigail Bangerter
- Janssen Research & Development, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ, 08560, USA
| | - Seth Ness
- Janssen Research & Development, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ, 08560, USA
| | - Andrew Skalkin
- Datagrok, INC, 1800 JFK Blvd Suite 300 PMB 90078, Philadelphia, PA, 19103, USA
| | - Matthew S Goodwin
- 312E Robinson Hall, Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, 360 Huntington Avenue, Boston, MA, 02115, USA
| | - Geraldine Dawson
- Duke Center for Autism and Brain Development and Duke Institute for Brain Sciences, Duke University School of Medicine, 2608 Erwin Road, Suite 30, Durham, NC, 27705, USA
| | - Robert L Hendren
- Benioff Children's Hospital, University of California, San Francisco, 401 Parnassus Avenue, Langley Porter, San Francisco, CA, 94143-0984, USA
| | - Bennett Leventhal
- Benioff Children's Hospital, University of California, San Francisco, 401 Parnassus Avenue, Langley Porter, San Francisco, CA, 94143-0984, USA
| | - Caitlin M Hudac
- Center for Youth Development and Intervention, University of Alabama, Box 870348, Tuscaloosa, AL, 35487-0348, USA
| | - Jessica Bradshaw
- Department of Psychology, University of South Carolina, 1512 Pendleton Street, Columbia, SC, 29201, USA
| | - Frederick Shic
- Department of Pediatrics, Seattle Children's Research Institute, Center for Child Health, Behavior and Development, University of Washington, 6200 NE 74th Street, Ste 110, Seattle, WA, 98115-8160, USA
| | - Gahan Pandina
- Janssen Research & Development, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ, 08560, USA
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Parenteau CI, Bent S, Hossain B, Chen Y, Widjaja F, Breard M, Hendren RL. COVID-19 Related Challenges and Advice from Parents of Children with Autism Spectrum Disorder. SciMed J 2020. [DOI: 10.28991/scimedj-2020-02-si-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
With the rise of the COVID-19 pandemic and shelter-in-place, families with children with autism spectrum disorder (ASD) face a unique set of challenges related to a diverse set of issues. A qualitative study was conducted in the form of semi-structured interviews from fifteen parents of children and adolescents from a non-public school for children with ASD. Questions covered the following topic areas: general COVID-19 experiences and concerns, changes in the child’s mood and behavior, changes in parent mood and behavior, and coping/advice. Quotes and descriptions from the participants were reviewed and grouped into thematic areas. Findings showed that parents of children with ASD are facing a wide range of challenges, including explaining COVID-19 and safety precautions to their child in a comprehensible way, assisting with e-learning, and guiding their child back into social situations and the community. As children with ASD have difficulties with transitions, parents stated the importance of creating structure in the home by creating schedules and boundaries, while allowing for flexibility as to not over enforce the rigidity children with autism often face. Advice on coping with the additional stressors were also shared. Parents recommended finding time for themselves to reset, utilizing support systems, and reflecting on daily pleasures as positive coping mechanisms. This study aimed to both develop an initial guide for families, teachers and clinicians caring for children with ASD and to create awareness in the community about the challenges presented by COVID-19 and shelter-in-place.
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Bent S, Wahlberg J, Chen Y, Widjaja F, McDonald MG, Hendren RL. Quality of Life Among School-Age Children With Autism: The Oak Hill School Outcomes Study. Semin Pediatr Neurol 2020; 34:100808. [PMID: 32446439 DOI: 10.1016/j.spen.2020.100808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Prior studies have documented a lower quality of life (QOL) in children with autism spectrum disorder (ASD) compared to typically developing peers, but few studies have examined the trajectory of QOL over time in the same population. We conducted a 2-year cohort study in 29 children attending a specialized school for ASD with quarterly measures of parent-rated QOL as well as parent and teacher measures of behavior and social skills to determine the trajectory of change in QOL and predictors of change. The average change in QOL was constant (no change over time), but there was substantial variation with some students showing significant gains and others showing declines. Exploratory analyses revealed that improvements in behavior and social skills were greater (nonsignificantly) among children with improvements in QOL. Children with improved QOL were also younger and had a lower initial symptom burden. This study suggests that early intervention programs that provide social skills and behavioral management strategies may improve QOL in children with ASD. The study also highlights the need to develop and study novel, qualitative measures of QOL in this population.
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Affiliation(s)
- Stephen Bent
- Department of Psychiatry, University of California, San Francisco, CA; Department of Epidemiology and Biostatistics, University of California, San Francisco, CA.
| | - Jessica Wahlberg
- Department of Psychiatry, University of California, San Francisco, CA
| | - Yingtong Chen
- Department of Psychiatry, University of California, San Francisco, CA
| | - Felicia Widjaja
- Department of Psychiatry, University of California, San Francisco, CA
| | | | - Robert L Hendren
- Department of Psychiatry, University of California, San Francisco, CA
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Fraguas D, Díaz-Caneja CM, Pina-Camacho L, Moreno C, Durán-Cutilla M, Ayora M, González-Vioque E, de Matteis M, Hendren RL, Arango C, Parellada M. Dietary Interventions for Autism Spectrum Disorder: A Meta-analysis. Pediatrics 2019; 144:peds.2018-3218. [PMID: 31586029 DOI: 10.1542/peds.2018-3218] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/05/2019] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Dietary interventions such as restrictive diets or supplements are common treatments for young people with autism spectrum disorder (ASD). Evidence for the efficacy of these interventions is still controversial. OBJECTIVE To assess the efficacy of specific dietary interventions on symptoms, functions, and clinical domains in subjects with ASD by using a meta-analytic approach. DATA SOURCES Ovid Medline, PsycINFO, Embase databases. STUDY SELECTION We selected placebo-controlled, double-blind, randomized clinical trials assessing the efficacy of dietary interventions in ASD published from database inception through September 2017. DATA EXTRACTION Outcome variables were subsumed under 4 clinical domains and 17 symptoms and/or functions groups. Hedges' adjusted g values were used as estimates of the effect size of each dietary intervention relative to placebo. RESULTS In this meta-analysis, we examined 27 double-blind, randomized clinical trials, including 1028 patients with ASD: 542 in the intervention arms and 486 in the placebo arms. Participant-weighted average age was 7.1 years. Participant-weighted average intervention duration was 10.6 weeks. Dietary supplementation (including omega-3, vitamin supplementation, and/or other supplementation), omega-3 supplementation, and vitamin supplementation were more efficacious than the placebo at improving several symptoms, functions, and clinical domains. Effect sizes were small (mean Hedges' g for significant analyses was 0.31), with low statistical heterogeneity and low risk of publication bias. LIMITATIONS Methodologic heterogeneity among the studies in terms of the intervention, clinical measures and outcomes, and sample characteristics. CONCLUSIONS This meta-analysis does not support nonspecific dietary interventions as treatment of ASD but suggests a potential role for some specific dietary interventions in the management of some symptoms, functions, and clinical domains in patients with ASD.
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Affiliation(s)
- David Fraguas
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón and School of Medicine, Universidad Complutense de Madrid, Madrid, Spain; .,Centro de Investigaciòn Biomédica en Red Salud Mental, Madrid, Spain
| | - Covadonga M Díaz-Caneja
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón and School of Medicine, Universidad Complutense de Madrid, Madrid, Spain.,Centro de Investigaciòn Biomédica en Red Salud Mental, Madrid, Spain
| | - Laura Pina-Camacho
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón and School of Medicine, Universidad Complutense de Madrid, Madrid, Spain.,Centro de Investigaciòn Biomédica en Red Salud Mental, Madrid, Spain.,Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
| | - Carmen Moreno
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón and School of Medicine, Universidad Complutense de Madrid, Madrid, Spain.,Centro de Investigaciòn Biomédica en Red Salud Mental, Madrid, Spain
| | - Manuel Durán-Cutilla
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón and School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Miriam Ayora
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón and School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Emiliano González-Vioque
- Centro de Investigaciòn Biomédica en Red Salud Mental, Madrid, Spain.,Unit of Diagnosis and Treatment of Congenital Metabolic Diseases, Hospital Clínico Universitario de Santiago de Compostela, Health Research Institute of Santiago de Compostela, Santiago, Spain; and
| | - Mario de Matteis
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón and School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Robert L Hendren
- Department of Psychiatry, University of California, San Francisco, San Francisco, California
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón and School of Medicine, Universidad Complutense de Madrid, Madrid, Spain.,Centro de Investigaciòn Biomédica en Red Salud Mental, Madrid, Spain
| | - Mara Parellada
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón and School of Medicine, Universidad Complutense de Madrid, Madrid, Spain.,Centro de Investigaciòn Biomédica en Red Salud Mental, Madrid, Spain
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12
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Hardan AY, Hendren RL, Aman MG, Robb A, Melmed RD, Andersen KA, Luchini R, Rahman R, Ali S, Jia XD, Mallick M, Lateiner JE, Palmer RH, Graham SM. Efficacy and safety of memantine in children with autism spectrum disorder: Results from three phase 2 multicenter studies. Autism 2019; 23:2096-2111. [PMID: 31027422 PMCID: PMC6779018 DOI: 10.1177/1362361318824103] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Three phase 2 trials were conducted to assess the efficacy and long-term safety of weight-based memantine extended release (ER) treatment in children with autism spectrum disorder. MEM-MD-91, a 50-week open-label trial, identified memantine extended-release treatment responders for enrollment into MEM-MD-68, a 12-week randomized, double-blind, placebo-controlled withdrawal trial. MEM-MD-69 was an open-label extension trial in which participants from MEM-MD-68, MEM-MD-91, and open-label trial MEM-MD-67 were treated ⩽48 weeks with memantine extended release. In MEM-MD-91, 517 (59.6%) participants were confirmed Social Responsiveness Scale responders at week 12; mean Social Responsiveness Scale total raw scores improved two to three times a minimal clinically important difference of 10 points. In MEM-MD-68, there was no difference between memantine and placebo on the primary efficacy parameter, the proportion of patients with a loss of therapeutic response (defined as ⩾10-point increase from baseline in Social Responsiveness Scale total raw score). MEM-MD-69 exploratory analyses revealed mean standard deviation improvement in Social Responsiveness Scale total raw score of 32.4 (26.4) from baseline of the first lead-in study. No new safety concerns were evident. While the a priori-defined efficacy results of the double-blind trial were not achieved, the considerable improvements in mean Social Responsiveness Scale scores from baseline in the open-label trials were presumed to be clinically important.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Robert H Palmer
- Allergan plc, USA.,Forest Research Institute (currently Allergan plc), USA
| | - Stephen M Graham
- Forest Research Institute (currently Allergan plc), USA.,Newron Pharmaceuticals US Inc., USA
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13
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Bal VH, Hendren RL, Charman T, Abbeduto L, Kasari C, Klinger LG, Ence W, Glavin T, Lyons G, Rosenberg E. Considerations from the 2017 IMFAR Preconference on Measuring Meaningful Outcomes from School-Age to Adulthood. Autism Res 2018; 11:1446-1454. [DOI: 10.1002/aur.2034] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 08/31/2018] [Accepted: 09/18/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Vanessa H. Bal
- Weill Institute for Neurosciences Department of Psychiatry; University of California; San Francisco California
| | - Robert L. Hendren
- Weill Institute for Neurosciences Department of Psychiatry; University of California; San Francisco California
| | - Tony Charman
- King's College London; Institute of Psychiatry, Psychology & Neuroscience (IoPPN); London UK
| | - Leonard Abbeduto
- MIND Institute and Department of Psychiatry and Behavioral Sciences; University of California; Davis California
| | - Connie Kasari
- Center for Autism Research & Treatment; Graduate School of Education & Information Studies, University of California; Los Angles California
| | - Laura Grofer Klinger
- Department of Psychiatry, TEACCH Autism Program; University of North Carolina; Chapel Hill North Carolina
| | - Whitney Ence
- Weill Institute for Neurosciences Department of Psychiatry; University of California; San Francisco California
| | - Tara Glavin
- Weill Institute for Neurosciences Department of Psychiatry; University of California; San Francisco California
| | - Gregory Lyons
- Weill Institute for Neurosciences Department of Psychiatry; University of California; San Francisco California
| | - Erin Rosenberg
- Weill Institute for Neurosciences Department of Psychiatry; University of California; San Francisco California
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14
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Bent S, Lawton B, Warren T, Widjaja F, Dang K, Fahey JW, Cornblatt B, Kinchen JM, Delucchi K, Hendren RL. Identification of urinary metabolites that correlate with clinical improvements in children with autism treated with sulforaphane from broccoli. Mol Autism 2018; 9:35. [PMID: 29854372 PMCID: PMC5975568 DOI: 10.1186/s13229-018-0218-4] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 05/22/2018] [Indexed: 12/14/2022] Open
Abstract
Background Children with autism spectrum disorder (ASD) have urinary metabolites suggesting impairments in several pathways, including oxidative stress, inflammation, mitochondrial dysfunction, and gut microbiome alterations. Sulforaphane, a supplement with indirect antioxidant effects that are derived from broccoli sprouts and seeds, was recently shown to lead to improvements in behavior and social responsiveness in children with ASD. We conducted the current open-label study to determine if we could identify changes in urinary metabolites that were associated with clinical improvements with the goal of identifying a potential mechanism of action. Methods Children and young adults enrolled in a school for children with ASD and related neurodevelopmental disorders were recruited to participate in a 12-week, open-label study of sulforaphane. Fasting urinary metabolites and measures of behavior (Aberrant Behavior Checklist—ABC) and social responsiveness (Social Responsiveness Scale—SRS) were measured at baseline and at the end of the study. Pearson’s correlation coefficient was calculated for the pre- to post-intervention change in each of the two clinical scales (ABS and SRS) versus the change in each metabolite. Results Fifteen children completed the 12-week study. Mean scores on both symptom measures showed improvements (decreases) over the study period, but only the change in the SRS was significant. The ABC improved − 7.1 points (95% CI − 17.4 to 3.2), and the SRS improved − 9.7 points (95% CI − 18.7 to − 0.8). We identified 77 urinary metabolites that were correlated with changes in symptoms, and they clustered into pathways of oxidative stress, amino acid/gut microbiome, neurotransmitters, hormones, and sphingomyelin metabolism. Conclusions Urinary metabolomics analysis is a useful tool to identify pathways that may be involved in the mechanism of action of treatments targeting abnormal physiology in ASD. Trial registration This study was prospectively registered at clinicaltrials.gov (NCT02654743) on January 11, 2016.
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Affiliation(s)
- Stephen Bent
- 1Department of Psychiatry, University of California, San Francisco, 401 Parnassus, LP-119, San Francisco, CA 94143 USA.,2Department of Epidemiology and Biostatistics, University of California, San Francisco, 401 Parnassus, LP-119, San Francisco, CA 94143 USA.,Department of Medicine, UCSF, SFVAMC, 111-A1, 4150 Clement St, San Francisco, CA 94121 USA
| | - Brittany Lawton
- 1Department of Psychiatry, University of California, San Francisco, 401 Parnassus, LP-119, San Francisco, CA 94143 USA
| | - Tracy Warren
- 1Department of Psychiatry, University of California, San Francisco, 401 Parnassus, LP-119, San Francisco, CA 94143 USA
| | - Felicia Widjaja
- 1Department of Psychiatry, University of California, San Francisco, 401 Parnassus, LP-119, San Francisco, CA 94143 USA
| | - Katherine Dang
- 2Department of Epidemiology and Biostatistics, University of California, San Francisco, 401 Parnassus, LP-119, San Francisco, CA 94143 USA
| | - Jed W Fahey
- 3Departments of Medicine, Pharmacology and Molecular Sciences, International Health, and Cullman Chemoprotection Center, Johns Hopkins University, 855 N. Wolfe St. Ste. 625, Baltimore, MD 21205 USA
| | - Brian Cornblatt
- Nutramax Laboratories Consumer Care, Inc, 2208 Lakeside Blvd, Edgewood, MD 21040 USA
| | - Jason M Kinchen
- 5Metabolon, Inc, 617 Davis Dr. Suite 400, Durham, NC 27713 USA
| | - Kevin Delucchi
- 1Department of Psychiatry, University of California, San Francisco, 401 Parnassus, LP-119, San Francisco, CA 94143 USA.,2Department of Epidemiology and Biostatistics, University of California, San Francisco, 401 Parnassus, LP-119, San Francisco, CA 94143 USA
| | - Robert L Hendren
- 1Department of Psychiatry, University of California, San Francisco, 401 Parnassus, LP-119, San Francisco, CA 94143 USA
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15
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Abstract
Reading disorder (RD), a specific learning disorder (SLD) of reading that includes impairment in word reading, reading fluency, and/or reading comprehension, is common in the general population but often is not comprehensively understood or assessed in mental health settings. In education settings, comorbid mental and associated disorders may be inadequately integrated into intervention plans. Assessment and intervention for RD may be delayed or absent in children with frequently co-occurring mental disorders not fully responding to treatment in both school and mental health settings. To address this oversight, this review summarizes current knowledge regarding RDs and common comorbid or co-occurring disorders that are important for mental health and school settings. We chose to highlight RD because it is the most common SLD, and connections to other often comorbid disorders have been more thoroughly described in the literature. Much of the literature we describe is on decoding-based RD (or developmental dyslexia) as it is the most common form of RD. In addition to risk for academic struggle and social, emotional, and behavioral problems, those with RD often show early evidence of combined or intertwined Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition childhood disorders. These include attention deficit hyperactivity disorder, anxiety and depression, disruptive, impulse-control, and conduct disorders, autism spectrum disorders, and other SLDs. The present review highlights issues and areas of controversy within these comorbidities, as well as directions for future research. An interdisciplinary, integrated approach between mental health professionals and educators can lead to comprehensive and targeted treatments encompassing both academic and mental health interventions. Such targeted treatments may contribute to improved educational and health-related outcomes in vulnerable youth. While there is a growing research literature on this association, more studies are needed of when to intervene and of the early and long-term benefits of comprehensive intervention.
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Affiliation(s)
- Robert L Hendren
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, United States.,Dyslexia Center, University of California San Francisco, San Francisco, CA, United States
| | - Stephanie L Haft
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, United States
| | - Jessica M Black
- School of Social Work, Boston College, Chestnut Hill, MA, United States
| | - Nancy Cushen White
- Dyslexia Center, University of California San Francisco, San Francisco, CA, United States.,Department of Pediatrics, University of California San Francisco, San Francisco, CA, United States
| | - Fumiko Hoeft
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, United States.,Dyslexia Center, University of California San Francisco, San Francisco, CA, United States.,University of California Multi-Campus Precision Learning Center (PrecL), San Francisco, CA, United States.,Haskins Laboratories, New Haven, CT, United States.,Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
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16
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Dang K, Bent S, Lawton B, Warren T, Widjaja F, McDonald MG, Breard M, O'Keefe W, Hendren RL. Integrating Autism Care through a School-Based Intervention Model: A Pilot Study. J Clin Med 2017; 6:E97. [PMID: 29048365 PMCID: PMC5664012 DOI: 10.3390/jcm6100097] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 10/13/2017] [Accepted: 10/16/2017] [Indexed: 12/27/2022] Open
Abstract
The purpose of this pilot study is to determine the feasibility of monitoring the progress of children with an autism spectrum disorder (ASD) both in school and at home to promote a school-based integrated care model between parents, teachers, and medical providers. This is a prospective cohort study. To monitor progress, outcome measures were administered via an online platform developed for caregivers and teachers of children (n = 30) attending a school specializing in neurodevelopmental disorders and using an integrated medical and education program. Longitudinal analysis showed improvements in a novel scale, the Teacher Autism Progress Scale (TAPS), which was designed to measure key autism-related gains in a school environment (2.1-point improvement, p = 0.004, ES = 0.324). The TAPS showed a strong and statistically significant correlation, with improvement in aberrant behavior (r = -0.50; p = 0.008) and social responsiveness (r = -0.70; p < 0.001). The results also showed non-statistically significant improvements in aberrant behavior, social responsiveness, and quality of life over time at both school and home. To assess feasibility of ongoing progress measurement, we assessed missing data, which showed caregivers were more likely to miss surveys during summer. Results demonstrate the value and feasibility of online, longitudinal data collection in school to assist with individualized education planning and collaborative care for children with ASD. Lessons learned in this pilot will support school outcomes researchers in developing more efficacious, collaborative treatment plans between clinicians, caregivers, and teachers.
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Affiliation(s)
- Katherine Dang
- Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, CA 94158, USA.
| | - Stephen Bent
- Department of Psychiatry, University of California-San Francisco, San Francisco, CA 94143, USA.
| | - Brittany Lawton
- Department of Psychiatry, University of California-San Francisco, San Francisco, CA 94143, USA.
| | - Tracy Warren
- Department of Psychiatry, University of California-San Francisco, San Francisco, CA 94143, USA.
| | - Felicia Widjaja
- Department of Psychiatry, University of California-San Francisco, San Francisco, CA 94143, USA.
| | | | | | | | - Robert L Hendren
- Department of Psychiatry, University of California-San Francisco, San Francisco, CA 94143, USA.
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17
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Mitra I, Tsang K, Ladd-Acosta C, Croen LA, Aldinger KA, Hendren RL, Traglia M, Lavillaureix A, Zaitlen N, Oldham MC, Levitt P, Nelson S, Amaral DG, Hertz-Picciotto I, Fallin MD, Weiss LA. Correction: Pleiotropic Mechanisms Indicated for Sex Differences in Autism. PLoS Genet 2017; 13:e1006831. [PMID: 28591140 PMCID: PMC5462340 DOI: 10.1371/journal.pgen.1006831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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18
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Aman MG, Findling RL, Hardan AY, Hendren RL, Melmed RD, Kehinde-Nelson O, Hsu HA, Trugman JM, Palmer RH, Graham SM, Gage AT, Perhach JL, Katz E. Safety and Efficacy of Memantine in Children with Autism: Randomized, Placebo-Controlled Study and Open-Label Extension. J Child Adolesc Psychopharmacol 2017; 27:403-412. [PMID: 26978327 PMCID: PMC5510039 DOI: 10.1089/cap.2015.0146] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Abnormal glutamatergic neurotransmission is implicated in the pathophysiology of autism spectrum disorder (ASD). In this study, the safety, tolerability, and efficacy of the glutamatergic N-methyl-d-aspartate (NMDA) receptor antagonist memantine (once-daily extended-release [ER]) were investigated in children with autism in a randomized, placebo-controlled, 12 week trial and a 48 week open-label extension. METHODS A total of 121 children 6-12 years of age with Diagnostic and Statistical Manual of Mental Disorders, 4th ed., Text Revision (DSM-IV-TR)-defined autistic disorder were randomized (1:1) to placebo or memantine ER for 12 weeks; 104 children entered the subsequent extension trial. Maximum memantine doses were determined by body weight and ranged from 3 to 15 mg/day. RESULTS There was one serious adverse event (SAE) (affective disorder, with memantine) in the 12 week study and one SAE (lobar pneumonia) in the 48 week extension; both were deemed unrelated to treatment. Other AEs were considered mild or moderate and most were deemed not related to treatment. No clinically significant changes occurred in clinical laboratory values, vital signs, or electrocardiogram (ECG). There was no significant between-group difference on the primary efficacy outcome of caregiver/parent ratings on the Social Responsiveness Scale (SRS), although an improvement over baseline at Week 12 was observed in both groups. A trend for improvement at the end of the 48 week extension was observed. No improvements in the active group were observed on any of the secondary end-points, with one communication measure showing significant worsening with memantine compared with placebo (p = 0.02) after 12 weeks. CONCLUSIONS This trial did not demonstrate clinical efficacy of memantine ER in autism; however, the tolerability and safety data were reassuring. Our results could inform future trial design in this population and may facilitate the investigation of memantine ER for other clinical applications.
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Affiliation(s)
| | - Robert L. Findling
- Kennedy Krieger Institute, Johns Hopkins University, Baltimore, Maryland
| | - Antonio Y. Hardan
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California
| | - Robert L. Hendren
- Department of Psychiatry, University of California, San Francisco, California
| | - Raun D. Melmed
- Southwest Autism Research & Resource Center, Phoenix, Arizona
| | | | - Hai-An Hsu
- Forest Research Institute, (now Allergan) Jersey City, New Jersey
| | - Joel M. Trugman
- Forest Research Institute, (now Allergan) Jersey City, New Jersey
| | - Robert H. Palmer
- Forest Research Institute, (now Allergan) Jersey City, New Jersey
| | | | - Allyson T. Gage
- Forest Research Institute, (now Allergan) Jersey City, New Jersey
| | - James L. Perhach
- Forest Research Institute, (now Allergan) Jersey City, New Jersey
| | - Ephraim Katz
- Forest Research Institute, (now Allergan) Jersey City, New Jersey
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19
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Bent S, Ailarov A, Dang KT, Widjaja F, Lawton BL, Hendren RL. Open-Label Trial of Vitamin D3 Supplementation in Children with Autism Spectrum Disorder. J Altern Complement Med 2017; 23:394-395. [DOI: 10.1089/acm.2016.0297] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Stephen Bent
- Department of Psychiatry, University of California at San Francisco, San Francisco, CA
| | - Adelina Ailarov
- Department of Psychiatry, University of California at San Francisco, San Francisco, CA
| | - Katherine T. Dang
- Department of Psychiatry, University of California at San Francisco, San Francisco, CA
| | - Felicia Widjaja
- Department of Psychiatry, University of California at San Francisco, San Francisco, CA
| | - Brittany L. Lawton
- Department of Psychiatry, University of California at San Francisco, San Francisco, CA
| | - Robert L. Hendren
- Department of Psychiatry, University of California at San Francisco, San Francisco, CA
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20
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Bent S, Dang K, Widjaja F, Lawton B, Nazneen N, Hendren RL. Examining Clinics for Children with Autism: The Autism Translating To Treatment Study. J Altern Complement Med 2017; 23:340-347. [PMID: 28084799 DOI: 10.1089/acm.2016.0301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Certain clinical providers specialize in providing complementary and integrative medicine (CIM) therapies for children with autism spectrum disorder (ASD). Because many of these providers and their patients/families have reported substantial improvement, the authors developed an online platform to carefully examine these clinical practices. The initial goal was to examine the feasibility of prospective data collection in this setting. The larger goals were to characterize the tests and treatments used in these clinics; examine associations between specific treatments, biomarkers, and improved outcomes; and identify promising treatments for future study. DESIGN Prospective cohort study. SETTING Four CIM clinics specializing in treating children with ASD. PATIENTS Children with ASD age 2-8 years. INTERVENTIONS The study protocol provided no interventions, but all interventions provided by the CIM clinical providers were recorded. OUTCOME MEASURES Aberrant Behavior Checklist (ABC); Social Responsiveness Scale (SRS); and instruments that assessed sensory sensitivity, language, gastrointestinal (GI) symptoms, pediatric quality of life, and caregiver strain. RESULTS Fourteen children were enrolled (mean age, 4.4 years). Over 3 months, the total behavior score (ABC) decreased (improved) from 110.8 to 103.8 (change, -7.0; 95% confidence interval [CI], -27.9 to 13.9), and the total social responsiveness score (SRS) decreased (improved) from 133.8 to 127.2 (change, -6.6; 95% CI, -30.5 to 17.3), but these changes were not statistically significant. Similarly, caregiver strain and pediatric quality of life decreased (improved) but by a nonsignificant amount. More severe GI symptoms and more severe ASD symptoms were associated with lower quality of life (p < 0.001). CONCLUSIONS Barriers to successful data collection were identified. Despite these challenges, this study could confirm interesting associations between data elements, highlighting the future value of similar systems for improving evidence-based care in this population.
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Affiliation(s)
- Stephen Bent
- 1 Department of Psychiatry, University of California , San Francisco, San Francisco, CA.,2 Department of Medicine, San Francisco VA Medical Center, San Francisco, CA
| | - Katherine Dang
- 3 Department of Epidemiology and Biostatistics, University of California , San Francisco, San Francisco, CA
| | - Felicia Widjaja
- 1 Department of Psychiatry, University of California , San Francisco, San Francisco, CA
| | - Brittany Lawton
- 1 Department of Psychiatry, University of California , San Francisco, San Francisco, CA
| | | | - Robert L Hendren
- 1 Department of Psychiatry, University of California , San Francisco, San Francisco, CA
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21
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Hendren RL, James SJ, Widjaja F, Lawton B, Rosenblatt A, Bent S. Randomized, Placebo-Controlled Trial of Methyl B12 for Children with Autism. J Child Adolesc Psychopharmacol 2016; 26:774-783. [PMID: 26889605 DOI: 10.1089/cap.2015.0159] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Children with autism spectrum disorder (ASD) have been reported to have reduced ability to methylate DNA and elevated markers of oxidative stress. We sought to determine if methyl B12, a key metabolic cofactor for cellular methylation reactions and antioxidant defense, could improve symptoms of ASD. METHODS A total of 57 children with ASD were randomly assigned to 8 weeks of treatment with methyl B12 (75 μg/kg) or saline placebo every 3 days in a subcutaneous injection. The primary outcome measure was overall improvement in symptoms of ASD as measured by the Clinical Global Impressions-Improvement (CGI-I) score. Secondary outcome measures included changes in the Aberrant Behavior Checklist (ABC) and the Social Responsiveness Scale (SRS). Laboratory measures of methionine methylation and antioxidant glutathione metabolism were assessed at baseline and 8 weeks. RESULTS A total of 50 children (mean age 5.3 years, 79% male) completed the study. The primary outcome measure - the clinician rated CGI-I score - was statistically significantly better (lower) in the methyl B12 group (2.4) than in the placebo group (3.1) (0.7 greater improvement in the methyl B12 group, 95% CI 1.2-0.2, p = 0.005). Clinical improvement among children treated with methyl B12 was positively correlated with increases in plasma methionine (p = 0.05), decreases in S-adenosyl-l-homocysteine (SAH) (p = 0.007) and improvements in the ratio of S-adenosylmethionine (SAM) to SAH (p = 0.007), indicating an improvement in cellular methylation capacity. No improvements were observed in the parent-rated ABC or SRS. CONCLUSIONS Methyl B12 treatment improved clinician-rated symptoms of ASD that were correlated with improvements in measures of methionine metabolism and cellular methylation capacity. Clinical Trial Registry: Efficacy Study of Subcutaneous Methyl B12 in Children with Autism: NCT01039792 ( clinicaltrials.gov1 ).
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Affiliation(s)
- Robert L Hendren
- 1 Department of Psychiatry, University of California , San Francisco, California
| | - S Jill James
- 2 Arkansas Children's Hospital Institute, Department of Pediatrics, University of Arkansas for Medical Sciences , Little Rock, Arkansas
| | - Felicia Widjaja
- 1 Department of Psychiatry, University of California , San Francisco, California
| | - Brittany Lawton
- 1 Department of Psychiatry, University of California , San Francisco, California
| | - Abram Rosenblatt
- 1 Department of Psychiatry, University of California , San Francisco, California
| | - Stephen Bent
- 1 Department of Psychiatry, University of California , San Francisco, California
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Mitra I, Tsang K, Ladd-Acosta C, Croen LA, Aldinger KA, Hendren RL, Traglia M, Lavillaureix A, Zaitlen N, Oldham MC, Levitt P, Nelson S, Amaral DG, Herz-Picciotto I, Fallin MD, Weiss LA. Pleiotropic Mechanisms Indicated for Sex Differences in Autism. PLoS Genet 2016; 12:e1006425. [PMID: 27846226 PMCID: PMC5147776 DOI: 10.1371/journal.pgen.1006425] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 10/12/2016] [Indexed: 02/07/2023] Open
Abstract
Sexual dimorphism in common disease is pervasive, including a dramatic male preponderance in autism spectrum disorders (ASDs). Potential genetic explanations include a liability threshold model requiring increased polymorphism risk in females, sex-limited X-chromosome contribution, gene-environment interaction driven by differences in hormonal milieu, risk influenced by genes sex-differentially expressed in early brain development, or contribution from general mechanisms of sexual dimorphism shared with secondary sex characteristics. Utilizing a large single nucleotide polymorphism (SNP) dataset, we identify distinct sex-specific genome-wide significant loci. We investigate genetic hypotheses and find no evidence for increased genetic risk load in females, but evidence for sex heterogeneity on the X chromosome, and contribution of sex-heterogeneous SNPs for anthropometric traits to ASD risk. Thus, our results support pleiotropy between secondary sex characteristic determination and ASDs, providing a biological basis for sex differences in ASDs and implicating non brain-limited mechanisms.
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Affiliation(s)
- Ileena Mitra
- Department of Psychiatry and Institute for Human Genetics, University of California, San Francisco, California, United States of America
| | - Kathryn Tsang
- Department of Psychiatry and Institute for Human Genetics, University of California, San Francisco, California, United States of America
| | - Christine Ladd-Acosta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Lisa A. Croen
- Division of Research, Kaiser Permanente Northern California, California, United States of America
| | - Kimberly A. Aldinger
- Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, Washington, United States of America
| | - Robert L. Hendren
- Department of Psychiatry and Institute for Human Genetics, University of California, San Francisco, California, United States of America
| | - Michela Traglia
- Department of Psychiatry and Institute for Human Genetics, University of California, San Francisco, California, United States of America
| | - Alinoë Lavillaureix
- Department of Psychiatry and Institute for Human Genetics, University of California, San Francisco, California, United States of America
- Université Paris Descartes, Sorbonne Paris Cité, Faculty of Medicine, France
| | - Noah Zaitlen
- Department of Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - Michael C. Oldham
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, United States of America
| | - Pat Levitt
- Program in Developmental Neurogenetics, Institute for the Developing Mind, Children’s Hospital Los Angeles and Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
| | - Stanley Nelson
- Department of Human Genetics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, United States of America
| | - David G. Amaral
- Department of Psychiatry and Behavioral Sciences, Medicine and Medical Investigation of Neurodevelopmental Disorders (M.I.N.D.) Institute, University of California, Davis School of Medicine, Sacramento, California, United States of America
| | - Irva Herz-Picciotto
- Department of Public Health Sciences and Medicine and Medical Investigation of Neurodevelopmental Disorders (M.I.N.D.) Institute, University of California, Davis School of Medicine, Sacramento, California, United States of America
| | - M. Daniele Fallin
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Lauren A. Weiss
- Department of Psychiatry and Institute for Human Genetics, University of California, San Francisco, California, United States of America
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Affiliation(s)
- Aaron D. Besterman
- Department of Psychiatry, University of California, San Francisco, California
| | - Robert L. Hendren
- Department of Psychiatry, University of California, San Francisco, California.,Division of Child and Adolescent Psychiatry University of California, San Francisco, California
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Affiliation(s)
- Stephen Bent
- Associate professor of medicine, psychiatry, and epidemiology and biostatistics at the University of California, San Francisco, School of Medicine
| | - Robert L Hendren
- Professor of psychiatry and behavioral science, the director of child and adolescent psychiatry, and vice chair of the Department of Psychiatry at the University of California, San Francisco, School of Medicine
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Choi JE, Widjaja F, Careaga M, Bent S, Ashwood P, Hendren RL. Change in plasma cytokine levels during risperidone treatment in children with autism. J Child Adolesc Psychopharmacol 2014; 24:586-9. [PMID: 24828014 PMCID: PMC4268580 DOI: 10.1089/cap.2013.0108] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Atypical antipsychotics decrease irritability in autism. They also affect the cytokine network. Psychological stress, depression, and, possibly, autism spectrum disorder (ASD) are associated with the production of pro-inflammatory cytokines. We sought to determine if risperidone treatment led to changes in plasma cytokine levels. METHODS Forty-five subjects from an open-label study of risperidone treatment of children and adolescents with ASD, ages 4-18 years, had an analysis of 27 different cytokines at baseline and after 8 weeks of treatment using multiplex assays (Millipore) and read on the Luminex 100(™) platform. We examined changes in each of the cytokine levels in the entire group, and also compared changes in cytokines in responders versus nonresponders. RESULTS After 8 weeks of risperidone treatment, 2 of the 27 plasma cytokines showed statistically significant decreases in median levels: Eotaxin (p=0.0003) and monocyte chemoattractant protein-1 (MCP-1) (p=0.0024). Six of the 48 subjects met two criteria for responders to risperidone, and the median values of interleukin (IL)-5 were significantly higher (p=0.005) in the overall responder group than in nonresponders. CONCLUSIONS Two cytokines, eotaxin and MCP-1, which have previously been identified as abnormally elevated in children with autism, decreased during treatment with risperidone. This suggests a possible mechanism of action of risperidone treatment and a balancing of the immune system in affected subjects in this very preliminary study.
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Affiliation(s)
- Jae Eun Choi
- School of Medicine, University of California, San Diego, California
| | - Felicia Widjaja
- Department of Psychiatry, University of California, San Francisco, California
| | - Milo Careaga
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California, Davis, California
| | - Stephen Bent
- Department of Internal Medicine, University of California, San Francisco, California
| | - Paul Ashwood
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California, Davis, California
| | - Robert L. Hendren
- Department of Psychiatry, University of California, San Francisco, California
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Myers CA, Vandermosten M, Farris EA, Hancock R, Gimenez P, Black JM, Casto B, Drahos M, Tumber M, Hendren RL, Hulme C, Hoeft F. White matter morphometric changes uniquely predict children's reading acquisition. Psychol Sci 2014; 25:1870-83. [PMID: 25212581 DOI: 10.1177/0956797614544511] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
This study examined whether variations in brain development between kindergarten and Grade 3 predicted individual differences in reading ability at Grade 3. Structural MRI measurements indicated that increases in the volume of two left temporo-parietal white matter clusters are unique predictors of reading outcomes above and beyond family history, socioeconomic status, and cognitive and preliteracy measures at baseline. Using diffusion MRI, we identified the left arcuate fasciculus and superior corona radiata as key fibers within the two clusters. Bias-free regression analyses using regions of interest from prior literature revealed that volume changes in temporo-parietal white matter, together with preliteracy measures, predicted 56% of the variance in reading outcomes. Our findings demonstrate the important contribution of developmental differences in areas of left dorsal white matter, often implicated in phonological processing, as a sensitive early biomarker for later reading abilities, and by extension, reading difficulties.
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Affiliation(s)
- Chelsea A Myers
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of California, San Francisco
| | | | - Emily A Farris
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of California, San Francisco Department of Psychology, University of Texas of the Permian Basin
| | - Roeland Hancock
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of California, San Francisco
| | - Paul Gimenez
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of California, San Francisco
| | - Jessica M Black
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of California, San Francisco Graduate School of Social Work, Boston College
| | - Brandi Casto
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of California, San Francisco Pacific Graduate School of Psychology, Palo Alto University
| | - Miroslav Drahos
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of California, San Francisco
| | - Mandeep Tumber
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of California, San Francisco Pacific Graduate School of Psychology, Palo Alto University
| | - Robert L Hendren
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of California, San Francisco
| | - Charles Hulme
- Division of Psychology and Language Sciences, University College London
| | - Fumiko Hoeft
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of California, San Francisco Haskins Laboratories, Yale University Department of Neuropsychiatry, Keio University School of Medicine
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Bent S, Hendren RL, Zandi T, Law K, Choi JE, Widjaja F, Kalb L, Nestle J, Law P. Internet-based, randomized, controlled trial of omega-3 fatty acids for hyperactivity in autism. J Am Acad Child Adolesc Psychiatry 2014; 53:658-66. [PMID: 24839884 PMCID: PMC4076340 DOI: 10.1016/j.jaac.2014.01.018] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 11/22/2013] [Accepted: 03/06/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Preliminary evidence suggests that omega-3 fatty acids may reduce hyperactivity in children with autism spectrum disorder (ASD). We sought to examine the feasibility of a novel, Internet-based clinical trial design to evaluate the efficacy of this supplement. METHOD E-mail invitations were sent to parents of children aged 5 to 8 years enrolled in the Interactive Autism Network. All study procedures, including screening, informed consent, and collection of outcome measures took place over the Internet. The primary outcome measures were parent- and teacher-rated changes in hyperactivity on the Aberrant Behavior Checklist (ABC-H). RESULTS During the 6-week recruitment period, 57 children from 28 states satisfied all eligibility criteria and were randomly assigned to 1.3 grams of omega-3 fatty acids or an identical placebo daily for 6 weeks. Outcome assessments were obtained from all 57 participants and 57 teachers, and the study was completed in 3 months. Children in the omega-3 fatty acid group had a greater reduction in hyperactivity (-5.3 points) compared to the placebo group (-2.6 points), but the difference was not statistically significant (1.9-point greater improvement in the omega-3 group, 95% CI = -2.2 to 5.2). Adverse events were rare and not associated with omega-3 fatty acids. Participant feedback was positive. CONCLUSION Internet-based, randomized controlled trials of therapies in children with ASD are feasible and may lead to marked reductions in the time and cost of completing trials. A larger sample size is required to definitively determine the efficacy of omega-3 fatty acids. Clinical trial registration information-Omega-3 Fatty Acids for Hyperactivity Treatment in Autism Spectrum Disorder; http://clinicaltrials.gov; NCT01694667.
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Abstract
Autism spectrum disorders (ASDs) are complex, heterogeneous disorders caused by an interaction between genetic vulnerability and environmental factors. In an effort to better target the underlying roots of ASD for diagnosis and treatment, efforts to identify reliable biomarkers in genetics, neuroimaging, gene expression, and measures of the body's metabolism are growing. For this article, we review the published studies of potential biomarkers in autism and conclude that while there is increasing promise of finding biomarkers that can help us target treatment, there are none with enough evidence to support routine clinical use unless medical illness is suspected. Promising biomarkers include those for mitochondrial function, oxidative stress, and immune function. Genetic clusters are also suggesting the potential for useful biomarkers.
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Affiliation(s)
| | - Susan R Downs
- Department of Psychiatry, University of California San Francisco , San Francisco, CA , USA
| | - Felicia Widjaja
- Department of Psychiatry, University of California San Francisco , San Francisco, CA , USA
| | - Brittany Lawton
- Department of Psychiatry, University of California San Francisco , San Francisco, CA , USA
| | - Robert L Hendren
- Department of Psychiatry, University of California San Francisco , San Francisco, CA , USA
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29
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Adviento B, Corbin IL, Widjaja F, Desachy G, Enrique N, Rosser T, Risi S, Marco EJ, Hendren RL, Bearden CE, Rauen KA, Weiss LA. Autism traits in the RASopathies. J Med Genet 2014; 51:10-20. [PMID: 24101678 PMCID: PMC4230531 DOI: 10.1136/jmedgenet-2013-101951] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Mutations in Ras/mitogen-activated protein kinase (Ras/MAPK) pathway genes lead to a class of disorders known as RASopathies, including neurofibromatosis type 1 (NF1), Noonan syndrome (NS), Costello syndrome (CS), and cardio-facio-cutaneous syndrome (CFC). Previous work has suggested potential genetic and phenotypic overlap between dysregulation of Ras/MAPK signalling and autism spectrum disorders (ASD). Although the literature offers conflicting evidence for association of NF1 and autism, there has been no systematic evaluation of autism traits in the RASopathies as a class to support a role for germline Ras/MAPK activation in ASDs. METHODS We examined the association of autism traits with NF1, NS, CS and CFC, comparing affected probands with unaffected sibling controls and subjects with idiopathic ASDs using the qualitative Social Communication Questionnaire (SCQ) and the quantitative Social Responsiveness Scale (SRS). RESULTS Each of the four major RASopathies showed evidence for increased qualitative and quantitative autism traits compared with sibling controls. Further, each RASopathy exhibited a distinct distribution of quantitative social impairment. Levels of social responsiveness show some evidence of correlation between sibling pairs, and autism-like impairment showed a male bias similar to idiopathic ASDs. CONCLUSIONS Higher prevalence and severity of autism traits in RASopathies compared to unaffected siblings suggests that dysregulation of Ras/MAPK signalling during development may be implicated in ASD risk. Evidence for sex bias and potential sibling correlation suggests that autism traits in the RASopathies share characteristics with autism traits in the general population and clinical ASD population and can shed light on idiopathic ASDs.
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Affiliation(s)
- Brigid Adviento
- Department of Psychiatry, University of California San Francisco, San Francisco, California, USA
- Institute for Human Genetics, University of California San Francisco, San Francisco, California, USA
| | - Iris L Corbin
- Department of Psychiatry, University of California San Francisco, San Francisco, California, USA
- Institute for Human Genetics, University of California San Francisco, San Francisco, California, USA
- Prenatal Diagnosis Center, Sutter Pacific Medical Foundation, San Francisco, California, USA
| | - Felicia Widjaja
- Department of Psychiatry, University of California San Francisco, San Francisco, California, USA
| | - Guillaume Desachy
- Department of Psychiatry, University of California San Francisco, San Francisco, California, USA
- Institute for Human Genetics, University of California San Francisco, San Francisco, California, USA
| | - Nicole Enrique
- Department of Psychology, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, California, USA
| | - Tena Rosser
- Department of Neurology, Children’s Hospital Los Angeles, Los Angeles, California, USA
| | - Susan Risi
- Department of Psychiatry, University of California San Francisco, San Francisco, California, USA
| | - Elysa J Marco
- Department of Child Neurology, University of California San Francisco, San Francisco, California, USA
| | - Robert L Hendren
- Department of Psychiatry, University of California San Francisco, San Francisco, California, USA
| | - Carrie E Bearden
- Department of Psychology, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, California, USA
- Department of Psychology, University of California Los Angeles, Los Angeles, California, USA
| | - Katherine A Rauen
- Institute for Human Genetics, University of California San Francisco, San Francisco, California, USA
- Department of Pediatrics Genetics, University of California San Francisco, San Francisco, California, USA
| | - Lauren A Weiss
- Department of Psychiatry, University of California San Francisco, San Francisco, California, USA
- Institute for Human Genetics, University of California San Francisco, San Francisco, California, USA
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Hendren RL, Reeve A. Preface. Adolescent psychopharmacology update. Adolesc Med State Art Rev 2013; 24:xi-xiii. [PMID: 24298751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Cheng JX, Widjaja F, Choi JE, Hendren RL. Considering biomedical/CAM treatments. Adolesc Med State Art Rev 2013; 24:446-x. [PMID: 24298758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Complementary and alternative medicine (CAM) is widely used to treat children with psychiatric disorders. In this review, MedLine was searched for various biomedical/CAM treatments in combination with the key words "childre", "adolescents", "psychiatric disorders", and "complementary alternative medicine". The biomedical/CAM treatments most thoroughly researched were omega-3 fatty acids, melatonin, and memantine. Those with the fewest published studies were N-acetylcysteine, vitamin B12, and oxytocin, although many biomedical/CAM treatments have no published studies. Although data are modest, there is evidence to suggest that biomedical/CAM treatments may be helpful for a subgroup of children with psychiatric disorders. Further research and more randomized, controlled trials in children are warranted.
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Affiliation(s)
- Jenna X Cheng
- Department of Psychiatry, University of California, San Francisco, USA
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McBurnett K, Swetye M, Muhr H, Hendren RL. Pharmacotherapy of inattention and ADHD in adolescents. Adolesc Med State Art Rev 2013; 24:391-viii. [PMID: 24298754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
This article reviews the current use of stimulants in adolescents. The evidence base for treatment of attention-deficit/hyperactivity disorder (ADHD) in adolescents is meager compared with that of ADHD in children, and much recent research of older populations with ADHD has been directed toward adults rather than adolescents. The structure of psychosocial treatment of ADHD differs across developmental ranges. For example, in children, treatment of ADHD uses direct behavior modification via parents and teachers. Treatment approaches then change toward contracting in adolescents (acknowledging the emerging independence common at this age) and toward self-management and coaching in adults. Medication for ADHD, however, does not substantially differ across developmental epochs. In supplementation of data, specifically on adolescence, much of our understanding of treating adolescents comes from upward or downward extension of the child and adult data. Symptomatic treatment (treatment for inattention, hyperactivity, or impulsive behavior) has always been a parallel approach to diagnostic and developmentally specific selection of treatment based on an incomplete literature. In recognition, this article assumes that inference from children or adults to adolescents, in the absence of adolescent-specific data, is commonplace and often confirmed with clinical experience. Such inferences, in the face of literature gaps, in no way obviate the need for continued research focused on adolescence.
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Lit L, Sharp FR, Bertoglio K, Stamova B, Ander BP, Sossong AD, Hendren RL. Gene expression in blood is associated with risperidone response in children with autism spectrum disorders. Pharmacogenomics J 2012; 12:368-71. [PMID: 21647175 PMCID: PMC3175502 DOI: 10.1038/tpj.2011.23] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Revised: 03/23/2011] [Accepted: 05/04/2011] [Indexed: 11/30/2022]
Abstract
Children with autism spectrum disorders (ASDs) often have severe behavioral problems. Not all children with these problems respond to atypical antipsychotic medications; therefore, we investigated whether peripheral blood gene expression before treatment with risperidone, an atypical antipsychotic, was associated with improvements in severe behavioral disturbances 8 weeks following risperidone treatment in 42 ASD subjects (age 112.7±51.2 months). Exon expression levels in blood before risperidone treatment were compared with pre-post risperidone change in Aberrant Behavior Checklist-Irritability (ABC-I) scores. Expression of exons within five genes was correlated with change in ABC-I scores across all risperidone-treated subjects: GBP6, RABL5, RNF213, NFKBID and RNF40 (α<0.001). RNF40 is located at 16p11.2, a region implicated in autism and schizophrenia. Thus, these genes expressed before treatment were associated with subsequent clinical response. Future studies will be needed to confirm these results and determine whether this expression profile is associated with risperidone response in other disorders, or alternative antipsychotic response within ASD.
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Affiliation(s)
- L Lit
- Department of Neurology, University of California, Davis, MIND Institute, Davis, CA 95817, USA.
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Abstract
We conducted a pilot randomized controlled trial to determine the feasibility and initial safety and efficacy of omega-3 fatty acids (1.3 g/day) for the treatment of hyperactivity in 27 children ages 3-8 with autism spectrum disorder (ASD). After 12 weeks, hyperactivity, as measured by the Aberrant Behavior Checklist, improved 2.7 (± 4.8) points in the omega-3 group compared to 0.3 (± 7.2) points in the placebo group (p = 0.40; effect size = 0.38). Correlations were found between decreases in five fatty acid levels and decreases in hyperactivity, and the treatment was well tolerated. Although this pilot study did not find a statistically significant benefit from omega-3 fatty acids, the small sample size does not rule out small to moderate beneficial effects.
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Affiliation(s)
- Stephen Bent
- Osher Center for Integrative Medicine, Department of Medicine, University of California, San Francisco VAMC, 111-A1, 4150 Clement St., San Francisco, CA 94121, USA.
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Bent S, Bertoglio K, Ashwood P, Nemeth E, Hendren RL. Brief Report: Hyperbaric Oxygen Therapy (HBOT) in Children with Autism Spectrum Disorder: A Clinical Trial. J Autism Dev Disord 2011; 42:1127-32. [DOI: 10.1007/s10803-011-1337-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Hendren RL. Assessment and Treatment of ADHD: An Update. Psychiatr Ann 2011. [DOI: 10.3928/00485713-20101221-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
Autism is a heterogeneous disorder involving complex mechanisms and systems occurring at diverse times. Because an individual child with autism may have only a subset of all possible abnormalities at a specific time, it may be challenging to identify beneficial effects of an intervention in double-blind, randomized, controlled trials, which compare the mean responses to treatments. Beneficial effects in a small subset of children may be obscured by the lack of effect in the majority. We review the evidence for several potential model systems of biochemical abnormalities that may contribute to the etiology of autism, we describe potential biomarkers or treatment targets for each of these abnormalities, and we provide illustrative treatment trials using this methodology. Potential model systems include immune over and under reactivity, inflammation, oxidative stress, free fatty acid metabolism, mitochondrial dysfunction, and excitotoxicity. Including potential biomarkers and targeted treatments in clinical trials for autism provides a potential method for limiting the heterogeneity of enrolled subjects, which may improve the power of studies to identify beneficial effects of treatments while also improving the understanding of the disease.
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Affiliation(s)
- Stephen Bent
- Department of Psychiatry, University of California, San Francisco, San Francisco, California 94121, USA.
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Bertoglio K, Jill James S, Deprey L, Brule N, Hendren RL. Pilot Study of the Effect of Methyl B12 Treatment on Behavioral and Biomarker Measures in Children with Autism. J Altern Complement Med 2010; 16:555-60. [DOI: 10.1089/acm.2009.0177] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Kiah Bertoglio
- Department of Psychiatry and Behavioral Sciences, University of California, Davis Medical Center, Sacramento, CA
- The M.I.N.D. Institute, University of California, Davis Medical Center, Sacramento, CA
| | - S. Jill James
- Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children's Hospital Research Institute, Autism Metabolic Genomics Laboratory, Little Rock, AR
| | - Lesley Deprey
- The M.I.N.D. Institute, University of California, Davis Medical Center, Sacramento, CA
| | - Norman Brule
- The M.I.N.D. Institute, University of California, Davis Medical Center, Sacramento, CA
| | - Robert L. Hendren
- Child and Adolescent Psychiatry, UCSF Department of Psychiatry, San Francisco, CA
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Bent S, Bertoglio K, Hendren RL. Omega-3 fatty acids for autistic spectrum disorder: a systematic review. J Autism Dev Disord 2009; 39:1145-54. [PMID: 19333748 PMCID: PMC2710498 DOI: 10.1007/s10803-009-0724-5] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2008] [Accepted: 03/08/2009] [Indexed: 01/22/2023]
Abstract
We conducted a systematic review to determine the safety and efficacy of omega-3 fatty acids for autistic spectrum disorder (ASD). Articles were identified by a search of MEDLINE, EMBASE, and the Cochrane Database using the terms autism or autistic and omega-3 fatty acids. The search identified 143 potential articles and six satisfied all inclusion criteria. One small randomized controlled trial (n = 13) noted non-significant improvements in hyperactivity and stereotypy. The remaining five studies were small (n = 30, 22, 19, 9, and 1) with four reporting improvements in a wide range of outcomes including language and learning skills, parental observations of general health and behavior, a clinician-administered symptom scale, and clinical observations of anxiety. Due to the limitations of evidence from uncontrolled studies and the presence of only one small randomized controlled trial, there is currently insufficient scientific evidence to determine if omega-3 fatty acids are safe or effective for ASD.
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Affiliation(s)
- Stephen Bent
- Department of Medicine, Osher Center for Integrative Medicine, University of California, San Francisco VAMC, 111-A1 4150 Clement Street, San Francisco, CA 94121, USA.
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Affiliation(s)
- Malia McCarthy
- Department of Psychiatry and Behavioral Sciences University of California, Davis Medical Investigation of Neurodevelopmental Disorders Institute, Sacramento, CA 95817, USA.
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Bent S, Bertoglio K, Hendren RL. Regarding Omega-3 Fatty Acids in Severe Autism. Arch Med Res 2009; 40:64; author reply 65. [DOI: 10.1016/j.arcmed.2008.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2008] [Accepted: 09/21/2008] [Indexed: 10/21/2022]
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Chiu S, Widjaja F, Bates ME, Voelbel GT, Pandina G, Marble J, Blank JA, Day J, Brule N, Hendren RL. Anterior cingulate volume in pediatric bipolar disorder and autism. J Affect Disord 2008; 105:93-9. [PMID: 17568686 DOI: 10.1016/j.jad.2007.04.019] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2006] [Revised: 04/06/2007] [Accepted: 04/24/2007] [Indexed: 12/13/2022]
Abstract
BACKGROUND An increasing number of studies indicate the anterior cingulate gyrus (ACG) may play a role in the attention deficits associated with pediatric bipolar disorder (BD). Age, medications, and intelligence quotient (IQ) may affect ACG volume; few studies have controlled for these effects. METHODS We recruited 16 children with BD and 24 children with autism spectrum disorder (ASD); 15 children with no psychiatric diagnosis (NP) were also included. All participants were evaluated with the K-SADS and a DSM-IV Autism/Asperger's Checklist; the ADI-R was also administered to ASD participants shortly after the study began. The participants completed a brain MRI scan on a 1.5Tesla Signa GE scanner. We segmented the ACG and compared left and right ACG volumes between groups. The influence of medications on the ACG volume was assessed while controlling for the effects of age and IQ. RESULTS The left ACG volume was significantly smaller in the BD group compared to the NP (p=0.004) and ASD (p=0.006) groups. No significant differences were found in the right ACG volume. These differences do not appear to be attributable to medication use or IQ. CONCLUSIONS Pediatric BD patients have a smaller left ACG volume compared to NP children and children diagnosed with ASD. This replication and extension of previous studies suggest that the ACG volume abnormality may be a biomarker for BD.
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Affiliation(s)
- Sufen Chiu
- Department of Psychiatry and Behavioral Sciences and The Medical Investigation of Neurodevelopmental Disorders Institute, University of California, Davis Medical Center, CA 95817, United States
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Sharp FR, Hendren RL. Psychosis: atypical limbic epilepsy versus limbic hyperexcitability with onset at puberty? Epilepsy Behav 2007; 10:515-20. [PMID: 17416210 PMCID: PMC2680611 DOI: 10.1016/j.yebeh.2007.02.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2006] [Revised: 02/18/2007] [Accepted: 02/22/2007] [Indexed: 11/20/2022]
Abstract
Phencyclidine (PCP), ketamine (Special K), and MK-801 are noncompetitive N-methyl-d-aspartate (NMDA) antagonists that produce acute psychosis in humans. The psychosis produced by these psychomimetic drugs is indistinguishable from schizophrenia and includes both positive and negative symptoms. This drug-induced psychosis occurs after puberty in humans. On the basis of the MK-801-induced spike-and-wave activity in rats and increased blood flow and metabolism in brain of patients with psychosis caused by these psychomimetics, this brief review argues that this psychosis is an atypical form of limbic epilepsy. Moreover, there is a specific limbic thalamcortical psychosis circuit that mediates cell injury in limbic cortex of rodents and may mediate this PCP-induced psychosis in humans. It is proposed that this thalamocortical psychosis circuit develops at puberty and can mediate PCP and ketamine-mediated psychosis and possibly the psychosis of schizophrenia, bipolar disease and other disorders that have their onset at puberty. Finally, based on this developmentally regulated psychosis/epilepsy-related thalamocortical circuitry, it is proposed that antiepileptic drugs that promote GABAergic mechanisms may decrease the probability of episodic psychosis from any cause.
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Affiliation(s)
- Frank R Sharp
- Department of Neurology, MIND Institute, University of California at Davis, Wet Labs Room 2416, 2805 50th Street, Sacramento, CA 95817, USA.
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Voelbel GT, Bates ME, Buckman JF, Pandina G, Hendren RL. Caudate nucleus volume and cognitive performance: Are they related in childhood psychopathology? Biol Psychiatry 2006; 60:942-50. [PMID: 16950212 PMCID: PMC2947855 DOI: 10.1016/j.biopsych.2006.03.071] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2005] [Revised: 12/15/2005] [Accepted: 03/22/2006] [Indexed: 11/26/2022]
Abstract
BACKGROUND Impaired neuropsychological test performance, especially on tests of executive function and attention, is often seen in children diagnosed with autism spectrum disorders (ASD). Structures involved in fronto-striatal circuitry, such as the caudate nucleus, may support these cognitive abilities. However, few studies have examined caudate volumes specifically in children with ASD, or correlated caudate volumes to cognitive ability. METHODS Neuropsychological test scores and caudate volumes of children with ASD were compared to those of children with bipolar disorder (BD) and of typically developing (TD) children. The relationship between test performance and caudate volumes was analyzed. RESULTS The ASD group displayed larger right and left caudate volumes, and modest executive deficits, compared to TD controls. While caudate volume inversely predicted performance on the Wisconsin Card Sorting Test in all participants, it differentially predicted performance on measures of attention across the ASD, BD and TD groups. CONCLUSIONS Larger caudate volumes were related to impaired problem solving. On a test of attention, larger left caudate volumes predicted increased impulsivity and more omission errors in the ASD group as compared to the TD group, however smaller volume predicted poorer discriminant responding as compared to the BD group.
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Affiliation(s)
- Gerald T Voelbel
- Center of Alcohol Studies, Rutgers University, Piscataway, New Jersey 08854, USA
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Abstract
The authors describe a neurodevelopmentally relevant, clinically derived model for understanding and treating aggressive behavior in youth. Based on case experience and literature review, the authors divide aggressive behavior into five symptomatic domains with respective neurobiological/neurodevelopmental underpinnings. These five symptom domains (impulsivity, affective instability, anxious/hyperarousal, cognitive disorganization, and predatory aggression) emerge as logical and clinically useful targets for treatment. The authors aim to establish a relationship between these symptom domains and brain structure and function that offers a clinically relevant approach to the complexities of understanding aggression and its treatment.
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Affiliation(s)
- Steven G Sugden
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, CA, USA
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Hendren RL. Discussion on integrated pharmacologic treatment of attention-deficit hyperactivity disorder (ADHD). Essent Psychopharmacol 2005; 6:291-300. [PMID: 16222913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
- Robert L Hendren
- University of California at Davis Medical Center, Medical Investigation of Neurodevelopmental Disorders Institute, University of California, USA
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Horst RO, Hendren RL. Integrated pharmacologic treatment of attention-deficit hyperactivity disorder (ADHD). Essent Psychopharmacol 2005; 6:250-61. [PMID: 16222910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
This article is a review of what is currently known about optimal treatments for patients with attention-deficit hyperactivity disorder (ADHD). It begins with a description of assessment techniques and the differential diagnosis, which includes learning disorders, anxiety disorders, and bipolar disorder. The high rate of comorbidity in patients with ADHD and the impact of comorbidity on treatment decisions are also discussed. Detailed descriptions of various pharmacologic treatments are provided, including a description of the role of combination pharmacotherapy and the integration of nonpharmacologic therapy. A decision-making model for selecting the most appropriate pharmacologic therapy versus combining pharmacotherapy with psychosocial interventions is described. The advantages and disadvantages of various pharmacologic agents--including long-acting stimulants and atomoxetine--are examined. Particular attention is paid to the recent Multimodal Treatment Study of Attention-Deficit Hyperactivity Disorder, sponsored by the National Institute of Mental Health, which includes a comparison of long-term pharmacotherapy, behavioral therapy, or a combination thereof, as well as an evaluation of the role of community-based therapy (i.e., treatment as usual). This article focuses on children and adolescents, because most of the research on ADHD has been conducted in this age group. However, a brief section on adults is also provided.
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Affiliation(s)
- Robert O Horst
- University of California at Davis Medical Center, Department of Psychiatry and Behavioral Sciences, Sacramento, CA, USA
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Hanft A, Hendren RL. Pharmacotherapy of children and adolescents with pervasive developmental disorders. Essent Psychopharmacol 2004; 6:12-24. [PMID: 15612651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
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Abstract
OBJECTIVES To review recent neuroimaging studies of serious emotional disorders in youth and identify problems and promise of neuroimaging in clinical practice. METHOD Published reports from refereed journals are briefly described, critiqued, and synthesized into a summary of the findings to date. RESULTS Childhood-onset schizophrenia shows progressive ventricular enlargement, reduction in total brain and thalamus volume, changes in temporal lobe structures, and reductions in frontal metabolism. Autistic disorder is associated with cerebellar changes, greater total brain and lateral ventricle volume, and asymmetry. The prefrontal cortex and the basal ganglia are consistently reported as abnormal in attention-deficit/hyperactivity disorder. Patients with anorexia nervosa show enlarged CSF spaces and reductions in gray and white matter that are only partially reversible with weight recovery. CONCLUSIONS Results from neuroimaging studies of childhood-onset psychiatric disorders suggest consistency in the structures found to be abnormal, but inconsistencies in the nature of these abnormalities. Although neuroimaging technology holds great promise for neurodevelopmental research, it is not yet a diagnostic instrument.
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Affiliation(s)
- R L Hendren
- Institute for Quality, Research and Training, UMDNJ-Robert Wood Johnson, New Brunswick 08901, USA
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