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Shurtz L, Schwartz C, DiStefano C, McPartland JC, Levin AR, Dawson G, Kleinhans NM, Faja S, Webb SJ, Shic F, Naples AJ, Seow H, Bernier RA, Chawarska K, Sugar CA, Dziura J, Senturk D, Santhosh M, Jeste SS. Concomitant medication use in children with autism spectrum disorder: Data from the Autism Biomarkers Consortium for Clinical Trials. Autism 2023; 27:952-966. [PMID: 36086805 PMCID: PMC9995606 DOI: 10.1177/13623613221121425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 01/27/2023]
Abstract
LAY ABSTRACT Children with autism spectrum disorder are prescribed a variety of medications that affect the central nervous system (psychotropic medications) to address behavior and mood. In clinical trials, individuals taking concomitant psychotropic medications often are excluded to maintain homogeneity of the sample and prevent contamination of biomarkers or clinical endpoints. However, this choice may significantly diminish the clinical representativeness of the sample. In a recent multisite study designed to identify biomarkers and behavioral endpoints for clinical trials (the Autism Biomarkers Consortium for Clinical Trials), school-age children with autism spectrum disorder were enrolled without excluding for medications, thus providing a unique opportunity to examine characteristics of psychotropic medication use in a research cohort and to guide future decisions on medication-related inclusion criteria. The aims of the current analysis were (1) to quantify the frequency and type of psychotropic medications reported in school-age children enrolled in the ABC-CT and (2) to examine behavioral features of children with autism spectrum disorder based on medication classes. Of the 280 children with autism spectrum disorder in the cohort, 42.5% were taking psychotropic medications, with polypharmacy in half of these children. The most commonly reported psychotropic medications included melatonin, stimulants, selective serotonin reuptake inhibitors, alpha agonists, and antipsychotics. Descriptive analysis showed that children taking antipsychotics displayed a trend toward greater overall impairment. Our findings suggest that exclusion of children taking concomitant psychotropic medications in trials could limit the clinical representativeness of the study population, perhaps even excluding children who may most benefit from new treatment options.
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Affiliation(s)
| | | | | | | | - April R Levin
- Boston Children’s Hospital, USA
- Harvard University, USA
| | | | | | - Susan Faja
- Boston Children’s Hospital, USA
- Harvard University, USA
| | - Sara J Webb
- University of Washington, USA
- Seattle Children’s Research Institute, USA
| | - Frederick Shic
- University of Washington, USA
- Seattle Children’s Research Institute, USA
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Casas-Alba D, Aguilar A, Alonso I, García MT, Cilio MR, Fons C. Relationship Between Epileptic Activity and Developmental Outcome in KCNQ2-Related Epilepsy. Pediatr Neurol 2023; 144:11-15. [PMID: 37099824 DOI: 10.1016/j.pediatrneurol.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 09/04/2022] [Revised: 01/27/2023] [Accepted: 03/06/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND We aim to describe a cohort of patients with KCNQ2-related epilepsy and evaluate the relationship between epileptic activity and developmental outcome. This topic is relevant for the selection of clinical end points in future clinical trials, since cessation of seizures may or may not be the most important outcome. METHODS This retrospective cohort study of children with self-limited (familial) neonatal epilepsy and developmental and epileptic encephalopathy due to pathogenic variants in KCNQ2 was conducted between 2019 and 2021. We collected clinical, therapeutic, and genetic information. Available electroencephalographic recordings were reviewed by a neurophysiologist. Gross motor function was determined using the Gross Motor Function Classification System (GMFCS). The Vineland Adaptive Behavior Composite standard score (ABC SS) was used to measure adaptive functioning. RESULTS Among 44 children (mean age 8.1 ± 4.0 years, 45.5% were male), 15 of 44 had S(F)NE, and 29 of 44 had DEE. Delayed seizure freedom was more frequent in DEE than in S(F)NE (P = 0.025), but no correlation was observed between age at seizure freedom and developmental outcome in patients with DEE. Multifocal interictal epileptiform abnormalities at epilepsy onset were more frequent in DEE than in S(F)NE (P = 0.014), and were associated with higher GMFCS (P = 0.027) and lower ABC SS (P = 0.048) in patients with DEE. Disorganized background activity at follow-up was more frequent in DEE than in S(F)NE (P = 0.001), and was associated with higher GMFCS levels (P = 0.009) and lower ABC SS (P = 0.005) in patients with DEE. CONCLUSIONS This study shows a partial correlation between epileptic activity and developmental outcome in KCNQ2-related epilepsy.
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Affiliation(s)
- Dídac Casas-Alba
- Pediatric Neurology Department, Hospital Sant Joan de Déu, Full Member of ERN EpiCare, Barcelona University, Barcelona, Spain; Institut de Recerca Sant Joan de Déu, Barcelona, Spain; Department of Genetic Medicine, Pediatric Institute of Rare Diseases (IPER), Hospital Sant Joan de Déu, Barcelona University, Barcelona, Spain.
| | - Anna Aguilar
- Pediatric Neurology Department, Hospital Sant Joan de Déu, Full Member of ERN EpiCare, Barcelona University, Barcelona, Spain; Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - Itziar Alonso
- Pediatric Neurology Department, Hospital Sant Joan de Déu, Full Member of ERN EpiCare, Barcelona University, Barcelona, Spain
| | - María Teresa García
- Pediatric Neurology Unit, Hospital Infantil Universitario Miguel Servet, Zaragoza, Spain
| | - Maria Roberta Cilio
- Division of Pediatric Neurology, Saint-Luc University Hospital, Catholic University of Louvain, Brussels, Belgium
| | - Carmen Fons
- Pediatric Neurology Department, Hospital Sant Joan de Déu, Full Member of ERN EpiCare, Barcelona University, Barcelona, Spain; Institut de Recerca Sant Joan de Déu, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), ISCIII, Madrid, Spain.
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Ruble L, McGrew J, Dale B, Yee M. Goal Attainment Scaling: An Idiographic Measure Sensitive to Parent and Teacher Report of IEP Goal Outcome Assessment for Students with ASD. J Autism Dev Disord 2021; 52:3344-3352. [PMID: 34319498 PMCID: PMC8795202 DOI: 10.1007/s10803-021-05213-3] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2021] [Indexed: 11/30/2022]
Abstract
Young students with ASD have instructional needs in social, communication, and learning skills that should be reflected in their Individualized Education Program (IEP). Research suggests that many of these goal areas present a challenge for special educators because of problems with measurability. The current study utilized an idiographic approach called Goal attainment scaling (GAS) for measuring IEP progress of individualized skills. Cross-sectional analysis of the associations between GAS ratings from an independent observer were correlated against teacher and parent ratings of IEP progress at the end of the school year and with standardized measures of the Behavior Assessment System for Children and Vineland Adaptive Behavior Scales (VABS). GAS scores were associated with parent and teacher ratings, including the VABS.
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Affiliation(s)
- Lisa Ruble
- Department of Special Education, Teachers College, Ball State University, TC745, Muncie, IN, 47306, USA.
| | - John McGrew
- Department of Psychology, Indiana University-Purdue University, Indianapolis, USA
| | - Brittany Dale
- Department of Special Education, Teachers College, Ball State University, TC745, Muncie, IN, 47306, USA
| | - Madison Yee
- Department of Educational, School, and Counseling Psychology, University of Kentucky, Lexington, USA
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Berg AT, Palac H, Wilkening G, Zelko F, Schust Meyer L. SCN2A-Developmental and Epileptic Encephalopathies: Challenges to trial-readiness for non-seizure outcomes. Epilepsia 2020; 62:258-268. [PMID: 33236786 DOI: 10.1111/epi.16750] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 09/14/2020] [Accepted: 10/12/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE SCN2A-associated developmental and epileptic encephalopathies (DEEs) present with seizures, developmental impairments, and often both. We sought to characterize the level and pattern of development in children with SCN2A variants, and to address the sensitivity of the Vineland Adaptive Behavior Scales (VABS) in measuring changes over time in children with SCN2A-DEEs. METHODS Clinical histories for participants with pathogenic SCN2A variants in the Simons SearchLight project were analyzed for descriptive purposes. VABS scores obtained at study entry and yearly thereafter were analyzed for floor and ceiling effects, change with age, and association with epilepsy through use of regression and longitudinal regression methods. RESULTS Sixty-four participants (50 with epilepsy, 30 [47%] female, median age 49 months, interquartile range [IQR] 28 to 101) were included. Histories of birth complications (N = 34, 54%), neonatal neurological signs (N = 45, 74%), and other neurological symptoms (N = 31, 48%) were common and similar in epilepsy and nonepilepsy subgroups. Mean standardized VABS scores (Composite 53.5; Motor, 55.8, Communication, 54.1, Socialization, 59.4, and Daily living skills, 55.1) reflected performance ~3 standard deviations below the normative test average. In longitudinal regression analyses, standardized scores decreased between 1.3 and 2.8 points per year, suggesting regression of abilities. Raw score analyses, however, revealed several subdomains with substantial floor effects (eg, community use); other raw scores increased with increasing age. Participants with epilepsy scored 0.6 to 1 SD lower than those without epilepsy (all P's < .05). SIGNIFICANCE The VABS, as standardly administered, has shortcomings for addressing growth or regression in individuals with SCN2A-DEEs. Some subdomain raw scores reflected substantial floor effects. Raw scores increased so slowly over time that standardized scores declined. Alternative measures sensitive to incremental meaningful change are required if outcomes such as adaptive behavior are to be primary outcomes in short-term clinical trials.
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Affiliation(s)
- Anne T Berg
- Division of Neurology, Epilepsy Center, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Department of Pediatrics, Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - Hannah Palac
- Data Solutions, REDCap Cloud, Encinitas, CA, USA
| | - Greta Wilkening
- Department of Neurology, Children's Hospital of Colorado, Aurora, CO, USA
| | - Frank Zelko
- Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Department of Psychiatry and Behavioral Sciences, Northwestern Feinberg School of Medicine, Chicago, IL, USA
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Clasen O, Hussong J, Wagner C, Flotats-Bastardas M, Meyer S, Zemlin M, von Gontard A. Incontinence in persons with tuberous sclerosis complex. Neurourol Urodyn 2020; 39:1842-1848. [PMID: 32542759 DOI: 10.1002/nau.24436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 06/03/2020] [Indexed: 11/05/2022]
Abstract
AIMS Tuberous sclerosis complex (TSC) is a multisystem genetic disorder caused by a mutation in the TSC1 or TSC2 gene with a broad spectrum of physical and psychological manifestations. The aim of the study was to examine incontinence, psychological problems, and adaptive behavior skills in patients with TSC. METHODS Through a worldwide TSC support group, 26 children (4-17 years) and 15 adults (18-50 years) with TSC were recruited (38.1% male, mean age 16.4 years). Parents or care-givers completed the Developmental Behavior Checklist (DBC), the Parental Questionnaire: Enuresis/urinary Incontinence, and the Vineland Adaptive Behavior Scales (3rd edition). RESULTS A total of 60.0% of the participants had nocturnal enuresis (NE), 51.3% daytime urinary incontinence (DUI) and 52.4% fecal incontinence (FI). 65.4% of children and 50.0% of adults had a clinically relevant DBC score. Psychological symptoms were associated with at least one subtype of incontinence. The mean adaptive behavior composite (ABC) score of the patients was 57.2 (SD = 26.1), with 38.1% in the average or below-average range (IQ >70), 26.2% with a mild, 11.9% with a moderate and 23.8% with a severe/profound intellectual disability. The incontinence rate was significantly higher in the groups with a lower ABC score. CONCLUSION A substantial proportion of patients with TSC are affected by incontinence and psychological symptoms. Incontinence was higher in persons with lower adaptive skills and those with at least one type of incontinence showed a significantly higher DBC score. As incontinence and psychological problems affect daily functioning and well-being, assessment, and treatment are recommended.
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Affiliation(s)
- Oriana Clasen
- Department of Child and Adolescent Psychiatry, Saarland University Medical Center, Homburg, Germany
| | - Justine Hussong
- Department of Child and Adolescent Psychiatry, Saarland University Medical Center, Homburg, Germany
| | - Catharina Wagner
- Department of Child and Adolescent Psychiatry, Saarland University Medical Center, Homburg, Germany
| | - Marina Flotats-Bastardas
- Department of Pediatric Neurology, Saarland Tuberous Sclerosis Complex Center, Saarland University Medical Center, Homburg, Germany
| | - Sascha Meyer
- Department of Pediatric Neurology, Saarland Tuberous Sclerosis Complex Center, Saarland University Medical Center, Homburg, Germany
| | - Michael Zemlin
- Department of Pediatric Neurology, Saarland Tuberous Sclerosis Complex Center, Saarland University Medical Center, Homburg, Germany
| | - Alexander von Gontard
- Department of Child and Adolescent Psychiatry, Saarland University Medical Center, Homburg, Germany
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Di Rezze B, Duku E, Szatmari P, Volden J, Georgiades S, Zwaigenbaum L, Smith IM, Vaillancourt T, Bennett TA, Elsabbagh M, Thompson A, Ungar WJ, Waddell C. Examining Trajectories of Daily Living Skills over the Preschool Years for Children with Autism Spectrum Disorder. J Autism Dev Disord 2020; 49:4390-4399. [PMID: 31372802 DOI: 10.1007/s10803-019-04150-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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: 11/28/2022]
Abstract
Preschool children with autism spectrum disorder (ASD) experience slower development of daily living skills (DLS) that are essential for independent functioning compared to typically developing children. Few studies have examined the trajectories of DLS in preschoolers with ASD and the existing literature has reported conflicting results. This study examined DLS trajectories and potential covariates for preschoolers with ASD from a multi-site longitudinal study following children from diagnosis to the end of grade 1. Multi-level modeling was conducted with DLS domain scores from the Vineland Adaptive Behavior Scales-2. The results demonstrated a positive trajectory of increasing scores over time, associations of age of diagnosis, developmental level, stereotypy, and language skills with the mean score at T4 or age 6 years, whereas rate of change was only associated with ASD symptom severity, such that an improvement in DLS trajectory was associated with lower and improving ASD symptom severity.
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Affiliation(s)
- B Di Rezze
- School of Rehabilitation Sciences, Faculty of Health Sciences, Institute of Applied Health Sciences, McMaster University, Room 436, 1400 Main St. W., Hamilton, ON, L8S 1C7, Canada.
| | - E Duku
- Offord Centre for Child Studies, McMaster University, Hamilton, ON, Canada
| | - P Szatmari
- Centre for Addiction and Mental Health, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - J Volden
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - S Georgiades
- Offord Centre for Child Studies, McMaster University, Hamilton, ON, Canada
| | - L Zwaigenbaum
- Department of Pediatrics, University of Alberta, Edmonton, Canada
| | - I M Smith
- IWK Health Centre, Dalhousie University, Halifax, NS, Canada
| | - T Vaillancourt
- Faculty of Education, School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - T A Bennett
- Offord Centre for Child Studies, McMaster University, Hamilton, ON, Canada
| | - M Elsabbagh
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - A Thompson
- Offord Centre for Child Studies, McMaster University, Hamilton, ON, Canada
| | - W J Ungar
- Program of Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - C Waddell
- Children's Health Policy Centre, Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada
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Zou M, Sun C, Wang J, Kang J, Xu Z, Ma Y, Chen L, Zhang X, Xia W, Wu L. Factors influencing the severity of behavioral phenotype in autism spectrum disorders: Implications for research. Psychiatry Res 2018; 261:290-297. [PMID: 29329050 DOI: 10.1016/j.psychres.2017.12.084] [Citation(s) in RCA: 4] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 11/25/2017] [Accepted: 12/31/2017] [Indexed: 11/26/2022]
Abstract
The phenotypic heterogeneity of Autism Spectrum Disorders (ASD) presents particular research challenges in the assessment of symptom severity, while the standardized Autism Diagnostic Observation Schedule (ADOS) scores present a severity metric, namely calibrated severity scores (CSS) that are relatively impervious to individual characteristics. To date, no studies have examined the convergent validity of CSS in Chinese sample populations. The present study investigated the validity of the ADOS-CSS using a sample of 321 children aged 2-18 years with ASD, and developed upon existing literature examining the influence of non-ASD-specific characteristics on other types of measures including Autism Diagnostic Interview-Revised (ADI-R), Social Responsiveness Scale (SRS), and Vineland Adaptive Behavior Scales (VABS). As expected, the findings revealed that the CSS were less influenced than ADOS-RAW scores by the demographic and developmental-level variables. Moreover, compared to the ADOS-CSS, the ADI-R, SRS and VABS were still strongly correlated with confounding factors, such as chronological age, intelligence quotients, and language-level. The results of this study corroborate the utilization of CSS as a more valid indicator of ASD severity than raw scores from ADOS and other instruments.
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Affiliation(s)
- Mingyang Zou
- Department of Children's and Adolescent Health, Public Health College, Harbin Medical University, Harbin 150081, China
| | - Caihong Sun
- Department of Children's and Adolescent Health, Public Health College, Harbin Medical University, Harbin 150081, China
| | - Jia Wang
- Department of Children's and Adolescent Health, Public Health College, Harbin Medical University, Harbin 150081, China
| | - Jing Kang
- Department of Children's and Adolescent Health, Public Health College, Harbin Medical University, Harbin 150081, China
| | - Zhanbin Xu
- Department of Children's and Adolescent Health, Public Health College, Harbin Medical University, Harbin 150081, China
| | - Yongjuan Ma
- Department of Children's and Adolescent Health, Public Health College, Harbin Medical University, Harbin 150081, China
| | - Lei Chen
- Department of Child Health Care, Dalian Maternal and Child Health Care Hospital, Dalian 116033, China
| | - Xinxi Zhang
- Department of Child Health Care, Yangzhou Maternal and Child Health Care Hospital, Yangzhou 225002, China
| | - Wei Xia
- Department of Children's and Adolescent Health, Public Health College, Harbin Medical University, Harbin 150081, China.
| | - Lijie Wu
- Department of Children's and Adolescent Health, Public Health College, Harbin Medical University, Harbin 150081, China.
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Abstract
The Vineland Adaptive Behavior Scales are used to assess the real life competence of adolescents and adults with autism in France. Real life adaptation is compared with performance on social cognitive tasks, involving the attribution of mental states, and with subjects' age and ability. New scales are used to contrast real life behaviours which appear to require the ability to attribute mental states with those behaviours which are possible without this ability. Subjects with autism who passed social cognitive tasks showed higher intellectual ability, as well as being older. In addition, they were better than subjects who failed tasks in terms of those social and maladaptive behaviours involving understanding minds. However, when their verbal ability was taken into account, these specific differences were no longer significant. These results are discussed in relation to a parallel study carried out in England, where essentially the same results were obtained. Both studies suggest that the stereotype of the aloof, socially indifferent autistic child does not reflect the sociability of adolescents and young adults with autism.
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