1
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Shiraishi N, Sakata M, Toyomoto R, Yoshida K, Luo Y, Nakagami Y, Tajika A, Suga H, Ito H, Sumi M, Muto T, Ichikawa H, Ikegawa M, Watanabe T, Sahker E, Uwatoko T, Noma H, Horikoshi M, Iwami T, Furukawa TA. Three types of university students with subthreshold depression characterized by distinctive cognitive behavioral skills. Cogn Behav Ther 2024; 53:207-219. [PMID: 38008940 DOI: 10.1080/16506073.2023.2288557] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 11/15/2023] [Indexed: 11/28/2023]
Abstract
Subthreshold depression impairs young people's quality of life and places them at greater risk of developing major depression. Cognitive behavioral therapy (CBT) is an evidence-based approach for addressing such depressive states. This study identified subtypes of university students with subthreshold depression and revealed discrete profiles of five CBT skills: self-monitoring, cognitive restructuring, behavioral activation, assertive communication, and problem solving. Using data from the Healthy Campus Trial (registration number: UMINCTR-000031307), a hierarchical clustering analysis categorized 1,080 students into three clusters: Reflective Low-skilled, Non-reflective High-skilled, and Non-reflective Low-skilled students. Non-reflective Low-skilled students were significantly more depressed than other students (p < .001). The severity of depression seemed to be related to the combination of self-monitoring skills and other CBT skills. Considering the high prevalence of poor self-monitoring skills in persons with autism, the most severe depression was observed in the significant association between Non-reflective Low-skilled students and autistic traits (p = .008). These findings suggest that subthreshold depression can be categorized into three subtypes based on CBT skill profiles. The assessment of autistic traits is also suggested when we provide CBT interventions for Non-reflective Low-skilled students.
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Affiliation(s)
- Nao Shiraishi
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
| | - Masatsugu Sakata
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Rie Toyomoto
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Kazufumi Yoshida
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Yan Luo
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Yukako Nakagami
- Department of Health Service, Kyoto University, Kyoto, Japan
| | - Aran Tajika
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | | | - Hiroshi Ito
- Department of Medical Service Center, Ritsumeikan University, Kyoto, Japan
| | - Michihisa Sumi
- Department of Medical Service Center, Ritsumeikan University, Kyoto, Japan
| | - Takashi Muto
- Department of Psychology, Doshisha University, Kyoto, Japan
| | - Hiroshi Ichikawa
- Department of Medical Life Systems, Doshisha University, Kyoto, Japan
| | - Masaya Ikegawa
- Department of Medical Life Systems, Doshisha University, Kyoto, Japan
| | - Takafumi Watanabe
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
| | - Ethan Sahker
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
- Medical Education Center, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Teruhisa Uwatoko
- Department of Psychiatry, Kyoto University Hospital, Kyoto, Japan
| | - Hisashi Noma
- Department of Data Science, The Institute of Statistical Mathematics, Tokyo, Japan
| | - Masaru Horikoshi
- Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Taku Iwami
- Department of Health Service, Kyoto University, Kyoto, Japan
| | - Toshi A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
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2
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Koumenidou M, Kotzamanidou MC, Panoutsakopoulos V, Siaperas P, Misailidou V, Tsalis GA. The Long-Term Adaptations of a Combined Swimming and Aquatic Therapy Intervention in an Adult Person with High-Functioning Autism (Asperger's Syndrome): A Case Study. Healthcare (Basel) 2023; 11:2986. [PMID: 37998478 PMCID: PMC10671614 DOI: 10.3390/healthcare11222986] [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: 10/15/2023] [Revised: 11/15/2023] [Accepted: 11/16/2023] [Indexed: 11/25/2023] Open
Abstract
Individuals with High-Functioning Autism present impairments in communication, social interaction, and motor development. A low level of motor skills, namely difficulties in gross and fine mobility, and in motor control, discourage individuals with High-Functioning Autism from being involved in physical activities, resulting in fewer opportunities for social interaction. There is not much evidence available about the effects of regular swimming exercise and/or aquatic therapy on health promotion in adults with High-Functioning Autism. An adult male (22 yrs) diagnosed with High-Functioning Autism participated in a combined 6-month swimming and aquatic therapy program (two sessions/week, 60 min each). The pre- and post-intervention assessments consisted of physical fitness, balance, functional ability, and psychomotor tests. The post-intervention assessments showed improvements in the standing long jump (+100%), hand grip force (+71.7%), bend arm hang test (+123.1%), and the physiological parameters in the 6 min walk test (+10.2%). On the opposite, decrements in the sit-up (-12%) and sit-and-reach test (-6.3%) were observed. It was noted that the participant frequently lost interest and focus quickly, resulting in the abandonment of the exercise. Conclusively, there is a great need for further research on this topic examining a larger adult population.
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Affiliation(s)
- Maria Koumenidou
- Faculty of Health Sciences, Metropolitan College of Thessaloniki, 546 24 Thessaloniki, Greece, (V.M.)
| | - Mariana C. Kotzamanidou
- Faculty of Health Sciences, Metropolitan College of Thessaloniki, 546 24 Thessaloniki, Greece, (V.M.)
- Institute of Occupational Science & Rehabilitation, Metropolitan College, 151 25 Athens, Greece;
| | - Vassilios Panoutsakopoulos
- Biomechanics Laboratory, School of Physical Education and Sport Science at Thessaloniki, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece;
| | - Panagiotis Siaperas
- Institute of Occupational Science & Rehabilitation, Metropolitan College, 151 25 Athens, Greece;
- Occupational Therapy Department, Metropolitan College, 151 25 Athens, Greece
| | - Victoria Misailidou
- Faculty of Health Sciences, Metropolitan College of Thessaloniki, 546 24 Thessaloniki, Greece, (V.M.)
| | - George A. Tsalis
- School of Physical Education and Sports Science at Serres, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece;
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Mlincek MM, Roemer EJ, Kraemer C, Iverson JM. Posture Matters: Object Manipulation During the Transition to Arms-Free Sitting in Infants at Elevated vs. Typical Likelihood for Autism Spectrum Disorder. Phys Occup Ther Pediatr 2022; 42:351-365. [PMID: 35086427 PMCID: PMC9203937 DOI: 10.1080/01942638.2022.2027845] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 02/08/2023]
Abstract
Aims: We investigated how infants grasped and transferred toys over a four-week period as they transitioned to arms-free sitting. We compared object manipulation in infants with typical likelihood (TL) and elevated likelihood (EL) for autism spectrum disorder (ASD) as they sat with vs. without support.Methods: Eighteen infants (7 EL; 11 TL; 5-8 months of age at the start of the study) were observed during three sessions at home across the transition to arms-free sitting. At each session, toys were presented to the infants in two different postures: sitting with support from a boppy pillow and sitting independently. Mean percentage of time spent grasping and rates of transferring objects between two hands were calculated for each infant at each session.Results: Both grasping time and transfer rate increased across the transition to arms-free sitting. EL infants, but not TL infants, spent significantly less time grasping toys when sitting independently than when sitting with support.Conclusions: Sitting plays a significant role in the development of object manipulation skills. Our results reveal a need to examine object manipulation skills in multiple posture contexts, especially in infants who exhibit motor delays.
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Affiliation(s)
- Miranda M Mlincek
- Department of Psychology, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Emily J Roemer
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Christen Kraemer
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jana M Iverson
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
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4
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Mole TB, Furlong Y, Clarke RJ, Rao P, Moore JK, Pace G, Van Odyck H, Chen W. Lurasidone for Adolescents With Complex Mental Disorders: A Case Series. J Pharm Pract 2021; 35:800-804. [PMID: 33757374 DOI: 10.1177/0897190021997011] [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] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Lurasidone is a new second generation (atypical) antipsychotic agent with unique receptor affinity and side-effect profiles, but limited literature is available on its use in adolescent populations. Contrasting with research treatment trials which typically recruit patients by stringent selection criteria, this case series examined the effects and tolerability of using lurasidone in adolescents within real-life clinical settings in treating complex cases who had not responded to other therapy options. METHODS We conducted a retrospective case-note audit of 6 adolescents aged 14 to 17 years old attending community child and adolescent mental health services (CAMHS) who were prescribed lurasidone. RESULTS Lurasidone had been prescribed for a range of "hard-to-manage" conditions with complex comorbidities, in adolescents in relation to specific use of lurasidone on the basis of clinical and pharmacological indications after exhausting more conventional treatment options. Case-note review suggested response to lurasidone was clinically positive in 3 cases, equivocal/marginal in 2 cases, and ineffective in 1 case. There were no cases of poor tolerance or adverse effects. Notably, positive responses for depressive and irritable mood symptoms were specifically recorded by prescribing clinicians, indicative of benefits on symptom improvement. No lurasidone attributed weight gain, galactorrhoea, metabolic abnormalities, sexual dysfunction or intolerance were reported. Pro-cognitive effects were not detected; but our findings were constrained by the non-systematic and incomplete information ascertainment, typical in retrospective case-note review. CONCLUSION This case series provides preliminary data supporting lurasidone's potential use in adolescents of complex clinical needs (but without a clinical diagnosis of bipolar disorder) within real-life clinical settings. Lurasidone appears to show a weight-sparing effect, in addition to improving mood symptoms in some cases. Lurasidone deserves further study for its use in the adolescent population (outside the remit of FDA) given its potential more favorable risk-benefit profile in young people. The favorable tolerability appear to be borne out by the pharmacodynamic predictions in our complex patients who would be excluded in formal clinical trial studies.
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Affiliation(s)
- Tom B Mole
- Ramsay Health Care, Perth, Western Australia, Australia
| | - Yulia Furlong
- Child and Adolescent Mental Health Service, Child and Adolescent Health Service, Perth, Western Australia, Australia
| | - Richard J Clarke
- Child and Adolescent Mental Health Service, Child and Adolescent Health Service, Perth, Western Australia, Australia
| | - Pradeep Rao
- Child and Adolescent Mental Health Service, Child and Adolescent Health Service, Perth, Western Australia, Australia.,The University of Western Australia, Faculty of Health and Medical Sciences Perth, Western Australia, Australia.,Telethon Kids Institute, Perth, Western Australia, Australia
| | - Julia K Moore
- Child and Adolescent Mental Health Service, Child and Adolescent Health Service, Perth, Western Australia, Australia
| | - Giulia Pace
- Child and Adolescent Mental Health Service, Child and Adolescent Health Service, Perth, Western Australia, Australia
| | - Hugo Van Odyck
- Child and Adolescent Mental Health Service, Child and Adolescent Health Service, Perth, Western Australia, Australia
| | - Wai Chen
- Mental Health Service, Fiona Stanley Hospital, Perth, Australia.,Child and Adolescent Mental Health Service, West Pilbara Mental Health Service, Australia.,Graduate School of Education, University of Western Australia, Western Australia, Australia.,Department of psychology, Murdoch University, Perth, Australia.,School of Medicine, University of Notre Dame Australia, Fremantle, Australia
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5
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Medavarapu S, Marella LL, Sangem A, Kairam R. Where is the Evidence? A Narrative Literature Review of the Treatment Modalities for Autism Spectrum Disorders. Cureus 2019; 11:e3901. [PMID: 30911457 PMCID: PMC6424545 DOI: 10.7759/cureus.3901] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 11/05/2022] Open
Abstract
The most important thing about autism spectrum disorder (ASD) is that there is, in fact, no cure for this disorder; however, currently, there are many claims of pharmacological and dietary therapies and behavioral interventions that are said to improve outcome or even lead to “cure” or “recovery.” It continues to remain a challenging condition for children and their families. Research conducted on many of these treatment modalities is limited and, consequently, sufficient evidence does not exist to support their use. The primary aim of this paper was to search for the evidence of the efficacy of each treatment for autism till now. We reviewed different treatment modalities and randomized clinical trials on each treatment to look for the evidence. Although there are interventions that may be effective in alleviating some symptoms and improving skills that help autistic persons lead more productive lives, proven benefits were observed only with applied behavioral analysis (ABA) and some psychopharmacologic agents.
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Affiliation(s)
| | | | | | - Ram Kairam
- Pediatrics, Developmental Neurology Associates, New York, USA
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6
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Abstract
Autism spectrum disorder (previously known as pervasive developmental disorders) is characterized by social communication deficits, impaired functioning, and restrictive or repetitive behaviors and interests. Patients with autism spectrum disorder also commonly experience core maladaptive behaviors such as aggression and irritability, self-injurious behaviors, hyperactivity, and sleep abnormalities. These behaviors may be sources of stress for caregivers and patients alike and may require pharmacologic management. Risperidone and aripiprazole are frequently used to treat both irritability and self-injurious behavior related to autism spectrum disorder. The opioid antagonist naltrexone has also been studied for self-injurious behaviors, although long-term data are lacking when used in the autism spectrum disorder population. Methylphenidate, atomoxetine, clonidine, and guanfacine are all potential options for the treatment of hyperactivity or attention-deficient hyperactivity disorder-like symptoms in patients with autism spectrum disorder. Lastly, melatonin is the most widely researched medication strategy for the management of sleep disorders in autism spectrum disorder. Future studies reviewing new pharmacologic treatment approaches in combination with non-pharmacologic therapies are warranted to ensure that target behaviors of autism spectrum disorder are appropriately managed.
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Affiliation(s)
- Kathryn Nash
- Department of Clinical Pharmacy Services, Greenville Health System, Greenville, SC, USA
| | - K Jennifer Carter
- Department of Clinical Pharmacy Services, Greenville Health System, Greenville, SC, USA
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7
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Satoh M, Obara T, Nishigori H, Ooba N, Morikawa Y, Ishikuro M, Metoki H, Kikuya M, Mano N. Prescription trends in children with pervasive developmental disorders: a claims data-based study in Japan. World J Pediatr 2016; 12:443-449. [PMID: 27286689 DOI: 10.1007/s12519-016-0036-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 10/07/2014] [Accepted: 03/19/2015] [Indexed: 01/17/2023]
Abstract
BACKGROUND The only drug approved for pervasive developmental disorders (PDD) in Japan is pimozide. Several psychotropic drugs are also prescribed for offlabel use in Japan, but details regarding their prescription and use are largely unknown. The purpose of this study was to clarify the use of drug treatment in Japanese children with PDD. METHODS Data were extracted from claims data from the Japan Medical Data Center for children younger than 18 years of age who were newly diagnosed with PDD (International Classification of Diseases version 10 codes: F84) from 2005 to 2010 (total of 3276 patients as of 2010). The prescription rates were presented as the percentage of PDD patients who were prescribed each drug. RESULTS Prior to 2010, the prescription rates for atypical antipsychotics, other antipsychotics, psychostimulants, all other central nervous system drugs, anticovnvulsants, non-barbiturates, and Parkinson's disease/syndrome drugs significantly increased among the Anatomical Therapeutic Chemical classifications defined as the "nervous system" (trend P≤0.02). The prescription rate for risperidone consistently increased, reaching 6.9% in 2010 (trend P<0.0001), the highest rate of the surveyed drugs among the antipsychotics. The prescription rate for aripiprazole also increased (trend P<0.0001), reaching 1.9% in 2010. The prescription rate for pimozide showed no annual changes, with a low rate of 0.4% in 2010. CONCLUSION Compared with pimozide, the prescription rates for risperidone, aripiprazole and other psychotropic drugs have increased. Because safety data for these drugs in Japanese children are sparse, there is a need for future safety evaluations of these drugs in Japanese children.
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Affiliation(s)
- Michihiro Satoh
- Department of Pharmaceutical Sciences, Tohoku University Hospital, Sendai, 980-8575, Japan
| | - Taku Obara
- Department of Pharmaceutical Sciences, Tohoku University Hospital, Sendai, 980-8575, Japan. .,Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, 2-1 Seiryo-cho, Aoba-ku, Sendai, Japan. .,Division of Molecular Epidemiology, Tohoku University Graduate School of Medicine, Sendai, Japan.
| | - Hidekazu Nishigori
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | | | - Yoshihiko Morikawa
- Clinical Research Support Center, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Mami Ishikuro
- Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, 2-1 Seiryo-cho, Aoba-ku, Sendai, Japan.,Division of Molecular Epidemiology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hirohito Metoki
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Japan.,Department of Community Medical Supports, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Masahiro Kikuya
- Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, 2-1 Seiryo-cho, Aoba-ku, Sendai, Japan.,Division of Molecular Epidemiology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Nariyasu Mano
- Department of Pharmaceutical Sciences, Tohoku University Hospital, Sendai, 980-8575, Japan
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8
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Abstract
OBJECTIVES We aim to outline the neural correlates of atypical emotional face processing in individuals with ASD. METHODS A comprehensive literature search was conducted through electronic databases to identify functional magnetic resonance imaging (fMRI) studies of whole brain analysis with emotional-face processing tasks in individuals with ASD. The Signed Differential Mapping with random effects model was used to conduct meta-analyses. Identified fMRI studies were further divided into sub-groups based on contrast ("emotional-face vs. non-emotional-face" or "emotional-face vs. non-face") to confirm the results of a meta-analysis of the whole studies. RESULTS Thirteen studies with 226 individuals with ASD and 251 typically developing people were identified. We found ASD-related hyperactivation in subcortical structures, including bilateral thalamus, bilateral caudate, and right precuneus, and ASD-related hypoactivation in the hypothalamus during emotional-face processing. Sub-analyses with more homogeneous contrasts preserved the findings of the main analysis such as hyperactivation in sub-cortical structure. Jackknife analyses showed that hyperactivation of the left caudate was the most robust finding. CONCLUSIONS Abnormalities in the subcortical structures, such as amygdala, hypothalamus and basal ganglia, are associated with atypical emotional-face processing in individuals with ASD.
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Affiliation(s)
- Yuta Aoki
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo , Bunkyo-ku, Tokyo , Japan
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9
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D'Urso G, Bruzzese D, Ferrucci R, Priori A, Pascotto A, Galderisi S, Altamura AC, Bravaccio C. Transcranial direct current stimulation for hyperactivity and noncompliance in autistic disorder. World J Biol Psychiatry 2016; 16:361-6. [PMID: 25800799 DOI: 10.3109/15622975.2015.1014411] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [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
OBJECTIVES To evaluate the safety, efficacy, and feasibility of inhibitory transcranial direct current stimulation (tDCS) for the treatment of behavioural abnormalities of autistic patients. METHODS Twelve young adult patients with autistic disorder were enrolled. All subjects presented intellectual disability and most of them had speech impairment. The Aberrant Behavior Checklist (ABC) was administered as the primary outcome measure before and after a 2-week tDCS course. All subjects received 10 daily applications of 20 min/1.5 mA/cathodal (inhibitory) tDCS over the left dorso-lateral pre-frontal cortex. RESULTS Eight out of 10 study completers improved in their abnormal behaviours, reaching an average reduction of 26.7% of the total ABC score. The remaining two patients showed no changes. In the whole group of completers, among the five subscales contributing to the significant reduction of the total score, the most remarkable and statistically significant change was seen in the subscale assessing hyperactivity and non-compliance (-35.9%, P = 0.002). No adverse effects were reported. CONCLUSIONS Inhibitory tDCS improved the ABC rating scores for autistic behaviours. Owing to its ease of use, cost-effectiveness and the limited availability of specific treatment strategies, tDCS might be a valid therapeutic option to be tested in autistic patients.
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Affiliation(s)
- Giordano D'Urso
- Dipartimento di Salute Mentale e Fisica e Medicina Preventiva, Seconda Università di Napoli , Naples , Italy
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10
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Abstract
INTRODUCTION Individuals with autism spectrum disorder (ASD) commonly present for treatment of emotional and behavioral disturbances associated with ASD's "core" symptoms. Psychotropic medications are widely utilized in alleviating associated emotional and behavioral symptoms. AREAS COVERED Emotional and behavioral disturbances associated with ASD include irritability/severely disruptive behavior, which comprises the heaviest symptom burden; hyperactivity and other Attention-Deficit-Hyperactivity-Disorder (ADHD)-type symptoms; repetitive/stereotyped behaviors; and social withdrawal. Existing evidence for medications for each of these symptom clusters will be examined in this review. EXPERT OPINION Psychopharmacological treatment of core and associated symptoms in ASD is challenging, in large part because of the heterogeneity in the presentation of ASD. Furthermore, children and adolescents with ASD are more vulnerable to the side effects of psychopharmacological intervention than their age-matched, typically developing counterparts. Currently, risperidone and aripiprazole are the only medications that have been (relatively) reliably shown to help treat certain symptom clusters associated with ASD, namely severely disruptive behavior and hyperactivity. Recent studies have begun to look at medications with mechanisms that are novel in the treatment of ASD and that may address underlying pathophysiology and/or core symptoms such as glutamate-modulating agents. Overall, randomized, placebo-controlled studies of medications for the treatment of ASD are scarce.
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Affiliation(s)
- Robert E Accordino
- a Massachusetts General Hospital & McLean Hospital, Child & Adolescent Psychiatry Service , Yawkey Outpatient Care Center , Boston , MA , USA
| | - Christen Kidd
- b Payne-Whitney Clinic , New York-Presbyterian Hospital/Weill-Cornell Medical Center , New York , NY , USA
| | - Laura C Politte
- c Carolina Institute for Developmental Disabilities , University of North Carolina School of Medicine , Carrboro , NC , USA
| | - Charles A Henry
- d Massachusetts General Hospital, Harvard Medical School, Child & Adolescent Psychiatry Service , Yawkey Outpatient Care Center , Boston , MA , USA
| | - Christopher J McDougle
- e Lurie Center for Autism, Massachusetts General Hospital , Harvard Medical School , Lexington , MA , USA
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11
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Yamasue H. Promising evidence and remaining issues regarding the clinical application of oxytocin in autism spectrum disorders. Psychiatry Clin Neurosci 2016; 70:89-99. [PMID: 26394796 DOI: 10.1111/pcn.12364] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [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] [Accepted: 09/18/2015] [Indexed: 12/24/2022]
Abstract
Oxytocin is a potential therapeutic for the core symptoms of autism spectrum disorder (ASD), which is currently untreatable with pharmacotherapy. Previous clinical trials of a single dose of oxytocin have consistently reported significantly positive effects on various experimental measures associated with the core symptoms of ASD. These studies used various experimental measures as surrogate endpoints of the trials. However, to date, randomized clinical trials of continual administration of oxytocin have failed to reveal significant positive effects on clinically meaningful endpoints, such as how those with ASD interact during interpersonal interactions. This article reviews both the negative and positive effects of oxytocin on the core symptoms of ASD and their surrogate markers. Some unresolved and critical issues on the development of oxytocin as a new therapeutic have been extracted: optimization of dose, duration of oxytocin treatment, and the development of objective and reliable measurements of clinically meaningful endpoints for the core symptoms of ASD. Furthermore, optimization to the intranasal delivery system and careful consideration of how individuals respond differently to treatments should be addressed in future studies.
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Affiliation(s)
- Hidenori Yamasue
- Department of Neuropsychiatry, School of Medicine, The University of Tokyo, Tokyo, Japan.,Japan Science and Technology Agency, CREST, Tokyo, Japan
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12
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Abstract
Autism is a complex neuropsychiatric disorder of developmental origin, where multiple genetic and environmental factors likely interact resulting in a clinical continuum between "affected" and "unaffected" individuals in the general population. During the last two decades, relevant progress has been made in identifying chromosomal regions and genes in linkage or association with autism, but no single gene has emerged as a major cause of disease in a large number of patients. The purpose of this paper is to discuss specific methodological issues and experimental strategies in autism genetic research, based on fourteen years of experience in patient recruitment and association studies of autism spectrum disorder in Italy.
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Affiliation(s)
- Roberto Sacco
- Department of Child Neuropsychiatry and Laboratory of Molecular Psychiatry and Neurogenetics, University "Campus Bio-Medico", Rome, I-00128, Italy.,Department of Experimental Neurosciences, I.R.C.C.S. "Fondazione Santa Lucia", Rome, I-00143, Italy
| | - Carla Lintas
- Department of Child Neuropsychiatry and Laboratory of Molecular Psychiatry and Neurogenetics, University "Campus Bio-Medico", Rome, I-00128, Italy.,Department of Experimental Neurosciences, I.R.C.C.S. "Fondazione Santa Lucia", Rome, I-00143, Italy
| | - Antonio M Persico
- Department of Child Neuropsychiatry and Laboratory of Molecular Psychiatry and Neurogenetics, University "Campus Bio-Medico", Rome, I-00128, Italy. .,Department of Experimental Neurosciences, I.R.C.C.S. "Fondazione Santa Lucia", Rome, I-00143, Italy.
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13
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Lozada LE, Nylund CM, Gorman GH, Hisle-Gorman E, Erdie-Lalena CR, Kuehn D. Association of Autism Spectrum Disorders With Neonatal Hyperbilirubinemia. Glob Pediatr Health 2015; 2:2333794X15596518. [PMID: 27335973 PMCID: PMC4784634 DOI: 10.1177/2333794x15596518] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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: 11/21/2022] Open
Abstract
Autism spectrum disorders (ASD) are a common neurodevelopmental disorder of unknown etiology. Studies suggest a link between autism and neonatal jaundice. A 1:3 matched case–control study was conducted with children enrolled in the Military Health System born between October 2002 and September 2009. Diagnostic and procedure codes were used for identifying ASD and hyperbilirubinemia. Two definitions for hyperbilirubinemia were evaluated: an inpatient admission with a diagnosis of jaundice and treatment with phototherapy. A total of 2917 children with ASD and 8751 matched controls were included in the study. After adjustment, there remained an association between ASD in children and an admission with a diagnosis of jaundice (odds ratio = 1.18; 95% confidence interval = 1.06-1.31; P = .001) and phototherapy treatment (odds ratio = 1.33; 95% confidence interval = 1.04-1.69; P = .008). Children who develop ASD are more likely to have an admission with a diagnosis of jaundice in the neonatal period and more likely to require treatment for this jaundice.
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Affiliation(s)
- Luis E Lozada
- Walter Reed National Military Medical Center, Bethesda, MD, USA; Uniformed Services University of Health Sciences, Bethesda, MD, USA
| | - Cade M Nylund
- Uniformed Services University of Health Sciences, Bethesda, MD, USA
| | - Gregory H Gorman
- Uniformed Services University of Health Sciences, Bethesda, MD, USA
| | | | | | - Devon Kuehn
- Uniformed Services University of Health Sciences, Bethesda, MD, USA; East Carolina University, Greenville, NC, USA
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Soltanifar A, Akbarzadeh F, Moharreri F, Soltanifar A, Ebrahimi A, Mokhber N, Minoocherhr A, Ali Naqvi SS. Comparison of parental stress among mothers and fathers of children with autistic spectrum disorder in Iran. Iran J Nurs Midwifery Res 2015; 20:93-8. [PMID: 25709697 PMCID: PMC4325421] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Accepted: 10/04/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Most of the studies about parenting stress among parents of children with autistic spectrum disorder (ASD) have been conducted in western societies. The objective of this research, conducted in Iran, is to evaluate the parenting stress among fathers and mothers of children with ASD and find the correlation between severity of the disorder in children and the level of parental stress. MATERIALS AND METHODS Participants included 42 couples having children aged between 2 and 12 diagnosed with ASD based on Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria. The diagnosis was made by two child and adolescent psychiatrists. Demographic information of the participants was collected using a questionnaire. The severity of pervasive developmental disorder in children was determined based on Childhood Autism Rating Scale (CARS); stress of parents was measured using Parenting Stress Index (PSI). Collected information was analyzed by the SPSS (version 16) software. RESULTS Evaluation of subscales in participants' data showed a positive correlation coefficient between the PSI-parent domain and Childhood Autism Rating Scale-Parent form CARS-P rating (r = 0.339, P =0 0.028) and also between the total stress index and CARS-P rating (r = 0.333, P = 0.031) for fathers. It is thus suggested that fathers of children with more severe developmental disorders experience more stress. The results showed significant differences between fathers and mothers in the three PSI subscales including PSI-child domain score (P < 0.005), PSI-parent domain score (P < 0.005), and the total stress index (P < 0.005). Mothers had significantly more stress than fathers. CONCLUSIONS These findings show that parents with ASD children have many emotional needs which should be considered in planning the effective treatment strategies for their children.
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Affiliation(s)
- Atefeh Soltanifar
- Child and Adolescent Psychiatry, Psychiatry and Behavioral Sciences Research Center, Ibn-E-Sina Hosptal, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Farzad Akbarzadeh
- Psychiatry, Psychiatry and Behavioral Sciences Research Center, Ibn-E-Sina Hosptal, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fatemeh Moharreri
- Child and Adolescent Psychiatry, Psychiatry and Behavioral Sciences Research Center, Ibn-E-Sina Hosptal, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Azadeh Soltanifar
- Psychiatry and Behavioral Sciences Research Center, Ibn-E-Sina Hosptal, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran,Address for correspondence: Dr. Azadeh Soltanifar, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. E-mail:
| | - Alireza Ebrahimi
- Resident of Psychiatry, Psychiatry and Behavioral Sciences Research Center, Ibn-E-Sina Hosptal, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Naghmeh Mokhber
- Psychiatry, Psychiatry and Behavioral Sciences Research Center, Ibn-E-Sina Hosptal, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Minoocherhr
- Psychiatry and Behavioral Sciences Research Center, Ibn-E-Sina Hosptal, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Sandu AL, Paillère Martinot ML, Artiges E, Martinot JL. 1910s' brains revisited. Cortical complexity in early 20th century patients with intellectual disability or with dementia praecox. Acta Psychiatr Scand 2014; 130:227-37. [PMID: 24400850 DOI: 10.1111/acps.12243] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [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] [Accepted: 12/04/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The idea of cortical surface anomalies in subjects with intellectual disability (mental retardation) and schizophrenia can be traced back to early 20th century qualitative observations. Since it is unknown whether modern quantitative measures of cortical complexity and folding would retrieve those early empirical observations, we measured fractal dimension and sulcal span index in photographs of human brains taken in the 1910's. METHOD Brain photographs were compared between 36 patients with mental retardation and 21 patients with dementia praecox for the fractal dimension and sulcal span index. Also, a mental retardation subgroup with no-or-non-understandable speech (n = 12) was compared with a subgroup with comprehensible speech (n = 23). RESULTS Mental retardation group had a lower whole-brain fractal dimension than dementia praecox, and a higher sulcal span index in left posterior cortex. The mental retardation subgroup with comprehensible speech had a lower fractal dimension in left hemisphere than the subgroup with no-or-non-understandable speech and a lower sulcal index in left posterior cortex. CONCLUSION Measures of cortical complexity and folding suggest differences between mental retardation and dementia praecox, and regional variations according to language abilities in mental retardation. The findings provide a unique picture of cortical surface changes in their original untreated form, one century ago.
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Affiliation(s)
- A-L Sandu
- Research Unit 1000, Frédéric Joliot Hospital Department, INSERM -CEA - Paris Sud University, Orsay, France
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Liu J, Liu X, Wang W, McCauley L, Pinto-Martin J, Wang Y, Li L, Yan C, Rogan WJ. Blood lead concentrations and children's behavioral and emotional problems: a cohort study. JAMA Pediatr 2014; 168:737-45. [PMID: 25090293 PMCID: PMC4152857 DOI: 10.1001/jamapediatrics.2014.332] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [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: 01/08/2023]
Abstract
IMPORTANCE The association between lead exposure and children's IQ has been well studied, but few studies have examined the effects of blood lead concentrations on children's behavior. OBJECTIVE To evaluate the association between blood lead concentrations and behavioral problems in a community sample of Chinese preschool children with a mean blood lead concentration of less than 10 µg/dL. DESIGN, SETTING, AND PARTICIPANTS A prospective cohort study was conducted at 4 preschools in Jintan, Jiangsu province of China. Participants included 1341 children aged 3 to 5 years. EXPOSURES Lead. MAIN OUTCOMES AND MEASURES Blood lead concentrations were measured in children aged 3 to 5 years. Behavioral problems were assessed using Chinese versions of the Child Behavior Checklist and Caregiver-Teacher Report Form when children were aged 6 years. RESULTS The mean (SD) blood lead concentration was 6.4 (2.6) µg/dL, with the 75th and 90th percentiles being 7.5 and 9.4 µg/dL, respectively. General linear modeling showed significant associations between blood lead concentrations and increased scores for teacher-reported behavioral problems. A 1-µg/dL increase in the blood lead concentration resulted in a 0.322 (95% CI, 0.058 to 0.587), 0.253 (95% CI, 0.016 to 0.500), and 0.303 (95% CI, 0.046 to 0.560) increase of teacher-reported behavior scores on emotional reactivity, anxiety problems, and pervasive developmental problems, respectively (P < .05), with adjustment for parental and child variables. Spline modeling showed that mean teacher-reported behavior scores increased with blood lead concentrations, particularly for older girls. CONCLUSIONS AND RELEVANCE Blood lead concentrations, even at a mean concentration of 6.4 µg/dL, were associated with increased risk of behavioral problems in Chinese preschool children, including internalizing and pervasive developmental problems. This association showed different patterns depending on age and sex. As such, continued monitoring of blood lead concentrations, as well as clinical assessments of mental behavior during regular pediatric visits, may be warranted.
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Affiliation(s)
- Jianghong Liu
- University of Pennsylvania, School of Nursing, Philadelphia, PA, USA,Address correspondence to: Dr. Jianghong Liu, PhD, FAAN, University of Pennsylvania Schools of Nursing and Medicine, 418 Curie Blvd., Room 426, Claire M. Fagin Hall, Philadelphia, Pennsylvania 19104-6096, , Tel: (215) 898-8293, Fax: (215) 746-3374
| | - Xianchen Liu
- Indiana University, School of Medicine, Indianapolis, IN, USA,Shandong University School of Public Health, Jinan, China
| | - Wei Wang
- Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Linda McCauley
- Emory University, Nell Hodgson School of Nursing, Atlanta, GA, USA
| | | | - Yingjie Wang
- University of Pennsylvania, School of Nursing, Philadelphia, PA, USA
| | - Linda Li
- University of Pennsylvania, School of Nursing, Philadelphia, PA, USA
| | - Chonghuai Yan
- Xinhua Hospital, MOE-Shanghai Key Laboratory of Children's Environmental Health, Shanghai Jiaotong University School of Medicine, China
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Gabriele S, Sacco R, Cerullo S, Neri C, Urbani A, Tripi G, Malvy J, Barthelemy C, Bonnet-Brihault F, Persico AM. Urinary p-cresol is elevated in young French children with autism spectrum disorder: a replication study. Biomarkers 2014; 19:463-70. [PMID: 25010144 DOI: 10.3109/1354750x.2014.936911] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The aromatic compound p-cresol (4-methylphenol) has been found elevated in the urines of Italian autistic children up to 8 years of age. The present study aims at replicating these initial findings in an ethnically distinct sample and at extending them by measuring also the three components of urinary p-cresol, namely p-cresylsulfate, p-cresylglucuronate and free p-cresol. Total urinary p-cresol, p-cresylsulfate and p-cresylglucuronate were significantly elevated in 33 French autism spectrum disorder (ASD) cases compared with 33 sex- and age-matched controls (p < 0.05). This increase was limited to ASD children aged ≤8 years (p < 0.01), and not older (p = 0.17). Urinary levels of p-cresol and p-cresylsulfate were associated with stereotypic, compulsive/repetitive behaviors (p < 0.05), although not with overall autism severity. These results confirm the elevation of urinary p-cresol in a sizable set of small autistic children and spur interest into biomarker roles for p-cresol and p-cresylsulfate in autism.
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Gillberg C. Commentary: PDA--public display of affection or pathological demand avoidance?--reflections on O'Nions et al. (2014). J Child Psychol Psychiatry 2014; 55:769-70. [PMID: 24890260 DOI: 10.1111/jcpp.12275] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [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] [Accepted: 12/11/2013] [Indexed: 11/28/2022]
Abstract
A group of children presents with a rather peculiar type of oppositional behaviours, sometimes now subsumed under the label of 'pathological demand avoidance' syndrome, also increasingly referred to as PDA. Boys and girls with 'this kind of PDA' will do anything to avoid meeting demands of adults and children alike. The behaviours 'used' in maintaining avoidance range from openly oppositional or manipulative to 'extreme shyness', passivity and muteness. These behaviours in terms of expression of affection are rather the opposite of those associated with the commonly used meaning of PDA. However, the avoidant behaviour is quite often 'publicly displayed' and with no feeling for the inappropriateness of the, sometimes even, exhibitionist style of extreme demand avoidance (EDA). The 'disorder' was first heard of in 1980, when Elisabeth Newson presented the first 12 cases of what she believed to be a 'new' and separate syndrome and that she referred to as PDA. Even though PDA has attracted quite a bit of clinical attention in the United Kingdom and other parts of Europe (including Scandinavia), virtually no research has been published in the field so far (Newson, Le Maréchal, & David, ). Experienced clinicians throughout child psychiatry, child neurology and paediatrics testify to its existence and the very major problems encountered when it comes to intervention and treatment. It is therefore a major step forward that O'Nions and co-workers (this issue) have developed a new 'trait measure' for PDA ('the EDA-Q'), a measure that appears to hold considerable promise for research, and eventually for clinical practice.
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Affiliation(s)
- Christopher Gillberg
- Gillberg Neuropsychiatry Centre (GNC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Poddar S, Hameed NT, Pandey JM, Mitra S, Mukherjee U. Psychological interventions in pervasive developmental disorder: An overview. Ind Psychiatry J 2014; 23:94-100. [PMID: 25788797 PMCID: PMC4361986 DOI: 10.4103/0972-6748.151671] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Pervasive developmental disorders (PDDs) are characterized by several impairments in the domains of social communication, social interaction and expression of social attachment, and other aspects of development like symbolic play. As the role of drugs in treating these impairments is extremely limited, a variety of psychological interventions have been developed to deal with them. Some of these have strong empirical support, while others are relatively new and hence controversial. Though it may prove to be a daunting task to begin with, the final reward of being able to improve the life of a child with PDD is enormous and hugely satisfying. Therefore, knowledge of these psychological interventions is important for a mental health professional, in order to be effective in the profession. Present paper presents an overview of these techniques in the management of PDD.
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Affiliation(s)
- Shuvabrata Poddar
- Department of Clinical Psychology, Central Institute of Psychiatry, Agra, India
| | - Noufal T Hameed
- Department of Clinical Psychology, Central Institute of Psychiatry, Agra, India
| | - Jyoti Mishra Pandey
- Department of Psychology, Bharti Vidyapeeth Medical College, Pune, Maharashtra, India
| | - Sayantanava Mitra
- Department of Psychiatry, Sarojini Naidu Medical College, Agra, India
| | - Urbi Mukherjee
- Department of Applied Psychology, University of Calcutta, Kolkata, West Bengal, India
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Kirino E. Efficacy and tolerability of pharmacotherapy options for the treatment of irritability in autistic children. Clin Med Insights Pediatr 2014; 8:17-30. [PMID: 24932108 PMCID: PMC4051788 DOI: 10.4137/cmped.s8304] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Revised: 05/04/2014] [Accepted: 05/05/2014] [Indexed: 11/22/2022]
Abstract
Children with autism have a high rate of irritability and aggressive symptoms. Irritability or self-injurious behavior can result in significant harm to those affected, as well as to marked distress for their families. This paper provides a literature review regarding the efficacy and tolerability of pharmacotherapy for the treatment of irritability in autistic children. Although antipsychotics have not yet been approved for the treatment of autistic children by many countries, they are often used to reduce symptoms of behavioral problems, including irritability, aggression, hyperactivity, and panic. However, among antipsychotics, the Food and Drug Administration has approved only risperidone and aripiprazole to treat irritability in autism. Among atypical antipsychotics, olanzapine and quetiapine are limited in their use for autism spectrum disorders in children because of high incidences of weight gain and sedation. In comparison, aripiprazole and ziprasidone cause less weight gain and sedation. However, potential QTc interval prolongation with ziprasidone has been reported. Contrary to ziprasidone, no changes were evident in the QT interval in any of the trials for aripiprazole. However, head-to-head comparison studies are needed to support that aripiprazole may be a promising drug that can be used to treat irritability in autistic children. On the other hand, risperidone has the greatest amount of evidence supporting it, including randomized controlled trials; thus, its efficacy and tolerability has been established in comparison with other agents. Further studies with risperidone as a control drug are needed.
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Affiliation(s)
- Eiji Kirino
- Department of Psychiatry, Juntendo University School of Medicine, Tokyo, Japan. ; Department of Psychiatry, Juntendo University Shizuoka Hospital, Shizuoka, Japan. ; Juntendo Institute of Mental Health, Saitama Japan
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Volkmar F, Siegel M, Woodbury-Smith M, King B, McCracken J, State M. Practice parameter for the assessment and treatment of children and adolescents with autism spectrum disorder. J Am Acad Child Adolesc Psychiatry 2014; 53:237-57. [PMID: 24472258 DOI: 10.1016/j.jaac.2013.10.013] [Citation(s) in RCA: 329] [Impact Index Per Article: 32.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 10/26/2013] [Indexed: 12/22/2022]
Abstract
Autism spectrum disorder is characterized by patterns of delay and deviance in the development of social, communicative, and cognitive skills that arise in the first years of life. Although frequently associated with intellectual disability, this condition is distinctive in its course, impact, and treatment. Autism spectrum disorder has a wide range of syndrome expression and its management presents particular challenges for clinicians. Individuals with an autism spectrum disorder can present for clinical care at any point in development. The multiple developmental and behavioral problems associated with this condition necessitate multidisciplinary care, coordination of services, and advocacy for individuals and their families. Early, sustained intervention and the use of multiple treatment modalities are indicated.
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Cheslack-Postava K, Jokiranta E, Suominen A, Lehti V, Sourander A, Brown AS. Variation by diagnostic subtype in risk for autism spectrum disorders associated with maternal parity among Finnish births. Paediatr Perinat Epidemiol 2014; 28:58-66. [PMID: 24313668 PMCID: PMC3906718 DOI: 10.1111/ppe.12094] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [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: 11/27/2022]
Abstract
BACKGROUND Associations between maternal parity and outcomes in offspring may provide evidence for involvement of prenatal exposures. The objective of this study was to determine whether risk for autism spectrum disorders (ASD) is associated with maternal parity. METHODS Diagnoses of childhood autism, Asperger syndrome, and pervasive developmental disorder, not otherwise specified (PDD-NOS) were examined separately and as a group. The study was conducted in the Finnish Prenatal Study of Autism, which is based in a national birth cohort. Children born in Finland in 1987-2005 and diagnosed with ASD by 2007 were identified through the Finnish Hospital Discharge Register. Four matched controls were selected for each case using the Finnish Medical Birth Register. The association between parity and each ASD was determined using conditional logistic regression and adjusted for number of children in the sibship and other potential confounders. RESULTS ASDs combined showed a pattern of decreasing risk with increasing parity (odds ratio OR for fourth or greater vs. first-born children, 0.43 [95% confidence interval (CI): 0.35, 0.51]). For childhood autism, an adjusted OR of 1.51 [95% CI 1.27, 1.81] was observed for second vs. first-born children. Associations for Asperger syndrome and PDD-NOS were consistent with those for all ASDs. CONCLUSIONS Differences in patterns of association between maternal parity and ASD subtypes may indicate varying contributions of specific environmental factors to risk; however, differences in diagnosis or in treatment seeking for childhood behavioural problems cannot be ruled out, particularly for higher functioning cases.
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Affiliation(s)
- Keely Cheslack-Postava
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY
| | - Elina Jokiranta
- Department of Child Psychiatry, University of Turku, Turku, Finland
| | - Auli Suominen
- Department of Child Psychiatry, University of Turku, Turku, Finland
| | - Venla Lehti
- Department of Child Psychiatry, University of Turku, Turku, Finland
| | - Andre Sourander
- Department of Child Psychiatry, University of Turku, Turku, Finland,University Hospital of Turku, Turku, Finland,Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York State Psychiatric Institute, New York, NY,RKBU, Faculty of Health Sciences, University of Tromso, Tromso, Norway
| | - Alan S. Brown
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY,Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York State Psychiatric Institute, New York, NY
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Sawa T, Kodaira M, Oiji A, Sasayama D, Iwadare Y, Ushijima H, Usami M, Watanabe K, Saito K. Dysfunction of orbitofrontal and dorsolateral prefrontal cortices in children and adolescents with high-functioning pervasive developmental disorders. Ann Gen Psychiatry 2013; 12:31. [PMID: 24103490 PMCID: PMC3851848 DOI: 10.1186/1744-859x-12-31] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [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] [Received: 08/22/2013] [Accepted: 09/17/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Several lines of evidence suggest that dysfunction of the dorsolateral prefrontal cortex (DLPFC) and orbitofrontal cortex (OFC) contributes to the pathophysiology of pervasive developmental disorders (PDD). The purpose of this study was to investigate neuropsychological dysfunctions in both the DLPFC and OFC of children and adolescents with high-functioning PDD. METHODS The Iowa gambling task (IGT), which reflects OFC function, and the Wisconsin Card Sorting Test (WCST), which reflects DLPFC function, were assigned to 19 children and early adolescents with high-functioning PDD and 19 healthy controls matched for gender, age, and intelligence. RESULTS Compared to healthy controls, patients with high-functioning PDD displayed poorer performance on the IGT and the WCST. CONCLUSIONS These results indicate that both the DLPFC and OFC could be impaired in children and early adolescents with high-functioning PDD.
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Affiliation(s)
- Tetsuji Sawa
- Department of Developmental Psychiatry, Kitasato University Graduate School of Medical Science, 1-15-1 Kitasato, Minami-Ku, Sagamihara, Kanagawa 252-0374, Japan.
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Tran PL, Lehti V, Lampi KM, Helenius H, Suominen A, Gissler M, Brown AS, Sourander A. Smoking during pregnancy and risk of autism spectrum disorder in a Finnish National Birth Cohort. Paediatr Perinat Epidemiol 2013; 27:266-74. [PMID: 23574415 PMCID: PMC3652271 DOI: 10.1111/ppe.12043] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [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: 12/18/2022]
Abstract
BACKGROUND Results of previous population-based studies examining associations between smoking during pregnancy and autism spectrum disorders (ASD) are contradictory. Furthermore, there is a lack of population-based studies examining the relationship between smoking during pregnancy and the main diagnostic subtypes of ASD. METHODS We conducted a population-based nested case-control study based on the Finnish Prenatal Study of Autism (FIPS-A) among liveborn infants delivered in Finland between 1987 and 2005. Data on maternal smoking during pregnancy were available from the Finnish Medical Birth Register (FMBR) since October 1990. Data on ASD in the offspring were obtained from the Finnish Hospital Discharge Register (FHDR). RESULTS Among the three subtypes of ASD, maternal smoking during the whole pregnancy was associated with an increased risk of pervasive developmental disorder (PDD) (odds ratio 1.2, 95% confidence interval 1.0, 1.5). The increase in odds persisted after controlling for maternal age, mother's socio-economic and psychiatric status, and infant's weight for gestational age. However, smoking exposure limited to the first trimester was not associated with PDD or any of the other ASD subtypes. CONCLUSIONS Maternal smoking is related to a modest increase in risk of PDD, while no associations were observed for childhood autism and Asperger's syndrome.
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Affiliation(s)
- Phuong Lien Tran
- University Joseph Fourier, Grenoble, France
,Department of Child Psychiatry, University of Turku, Turku, Finland
| | - Venla Lehti
- Department of Child Psychiatry, University of Turku, Turku, Finland
| | - Katja M. Lampi
- Department of Child Psychiatry, University of Turku, Turku, Finland
| | - Hans Helenius
- Department of Biostatistics, University of Turku, Turku, Finland
| | - Auli Suominen
- Department of Child Psychiatry, University of Turku, Turku, Finland
| | - Mika Gissler
- National Institute of Health and welfare (THL), Helsinki, Finland
| | - Alan S. Brown
- Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York State Psychiatric Institute, Mailman School of Public Health of Columbia University, New York, NY, USA
| | - Andre Sourander
- Department of Child Psychiatry, University of Turku, Turku, Finland
,Department of Child Psychiatry, Turku University Hospital, Turku, Finland
,Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York State Psychiatric Institute, Mailman School of Public Health of Columbia University, New York, NY, USA
,RKBU, Faculty of Health Sciences, University of Tromso, Norway
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Kara B, Mukaddes NM, Altınkaya I, Güntepe D, Gökçay G, Özmen M. Using the modified checklist for autism in toddlers in a well-child clinic in Turkey: adapting the screening method based on culture and setting. Autism 2012; 18:331-8. [PMID: 23175752 DOI: 10.1177/1362361312467864] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [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: 11/15/2022]
Abstract
We aimed to adapt the Modified Checklist for Autism in Toddlers to Turkish culture. The Modified Checklist for Autism in Toddlers was filled out independently by 191 parents while they were waiting for the well-child examination of their child. A high screen-positive rate was found. Because of this high false-positive rate, a second study was done in which the Modified Checklist for Autism in Toddlers was administered by health-care staff in a short interview with two groups of parents. The first group (the high-risk group) comprised 80 children aged 18-36 months, who were initially diagnosed with pervasive developmental disorders. The second group (the low-risk group) comprised 538 children of the same age, who were followed regularly by the well-child clinic. Two screen positives were found in the low-risk group. These two children, a random sample of 120 children from the low-risk group, and all the high-risk group were invited to a clinical evaluation. The diagnostic power of the Modified Checklist for Autism in Toddlers was assessed against clinical diagnosis and the Childhood Autism Rating Scale. The positive predictive value of the Modified Checklist for Autism in Toddlers was found to be 75%. Our findings led us to conclude that the Modified Checklist for Autism in Toddlers is a useful tool in Turkey for screening of pervasive developmental disorders in primary care, but in our culture, it is completed more accurately when health-care personnel ask the parents the questions. This study shows that Modified Checklist for Autism in Toddlers screening should be adapted based on culture and setting.
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Scahill L, McDougle CJ, Aman MG, Johnson C, Handen B, Bearss K, Dziura J, Butter E, Swiezy NB, Arnold LE, Stigler KA, Sukhodolsky DD, Lecavalier L, Pozdol SL, Nikolov R, Ritz L, Hollway JA, Korzekwa P, Gavaletz A, Kohn AE, Koenig K, Grinnon S, Mulick JA, Yu S, Vitiello B. Effects of risperidone and parent training on adaptive functioning in children with pervasive developmental disorders and serious behavioral problems. J Am Acad Child Adolesc Psychiatry 2012; 51:136-46. [PMID: 22265360 PMCID: PMC3941712 DOI: 10.1016/j.jaac.2011.11.010] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [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: 03/07/2011] [Revised: 08/31/2011] [Accepted: 11/22/2011] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Children with Pervasive Developmental Disorders (PDDs) have social interaction deficits, delayed communication, and repetitive behaviors as well as impairments in adaptive functioning. Many children actually show a decline in adaptive skills compared with age mates over time. METHOD This 24-week, three-site, controlled clinical trial randomized 124 children (4 through 13 years of age) with PDDs and serious behavioral problems to medication alone (MED; n = 49; risperidone 0.5 to 3.5 mg/day; if ineffective, switch to aripiprazole was permitted) or a combination of medication plus parent training (PT) (COMB; n = 75). Parents of children in COMB received an average of 11.4 PT sessions. Standard scores and Age-Equivalent scores on Vineland Adaptive Behavior Scales were the outcome measures of primary interest. RESULTS Seventeen subjects did not have a post-randomization Vineland assessment. Thus, we used a mixed model with outcome conditioned on the baseline Vineland scores. Both groups showed improvement over the 24-week trial on all Vineland domains. Compared with MED, Vineland Socialization and Adaptive Composite Standard scores showed greater improvement in the COMB group (p = .01 and .05, and effect sizes = 0.35 and 0.22, respectively). On Age Equivalent scores, Socialization and Communication domains showed greater improvement in COMB versus MED (p = .03 and 0.05, and effect sizes = 0.33 and 0.14, respectively). Using logistic regression, children in the COMB group were twice as likely to make at least 6 months' gain (equal to the passage of time) in the Vineland Communication Age Equivalent score compared with MED (p = .02). After controlling for IQ, this difference was no longer significant. CONCLUSION Reduction of serious maladaptive behavior promotes improvement in adaptive behavior. Medication plus PT shows modest additional benefit over medication alone. Clinical trial registration information-RUPP PI PDD: Drug and Behavioral Therapy for Children With Pervasive Developmental Disorders; http://www.clinicaltrials.gov; NCT00080145.
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Abstract
The validity of Asperger disorder as a distinct syndrome from autism is unclear partly because of the paucity of differentiating neurobiological evidence. Frontal lobe cortical folding between these disorders was compared using the gyrification index. Twenty-three boys underwent structural magnetic resonance imaging: 6 with high-functioning autism, 9 with Asperger disorder, and 8 controls. Using the first coronal slice anterior to the corpus callosum, total and outer cortical contours were traced to calculate the gyrification index. This index was also calculated for superior and inferior regions to examine dorsolateral prefrontal and orbitofrontal cortices, respectively. Analysis of variance revealed differences in the left inferior gyrification index, which was higher in the autism group compared with Asperger and control groups. There were no differences in age, intelligence quotient, and brain volume. These preliminary findings suggest that cortical folding may be abnormally high in the frontal lobe in autism but not Asperger disorder, suggesting distinct frontal lobe neuropathology.
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Affiliation(s)
- Roger J. Jou
- Child Study Center and Investigative Medicine Program, Yale University School of Medicine, New Haven, CT, USA
| | - Nancy J. Minshew
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Matcheri S. Keshavan
- Department of Psychiatry, Beth Israel and Deaconess Medical Center and Massachusetts Mental Health Center, Harvard Medical School, Boston, MA, USA
| | - Antonio Y. Hardan
- Department of Psychiatry and Behavioral Science, Stanford University School of Medicine, Stanford, CA, USA
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Ünal Ö, Özcan Ö, Öner Ö, Akcakin M, Aysev A, Deda G. EEG and MRI findings and their relation with intellectual disability in pervasive developmental disorders. World J Pediatr 2009; 5:196-200. [PMID: 19693463 PMCID: PMC3399588 DOI: 10.1007/s12519-009-0037-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [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: 05/19/2008] [Accepted: 11/26/2008] [Indexed: 11/30/2022]
Abstract
BACKGROUND The diagnostic category pervasive developmental disorders (PDDs) refer to a group of five disorders: autism, Rett syndrome, childhood disintegrative disorder, Asperger syndrome, and pervasive developmental disorder not otherwise specified (PDD-NOS). EEG abnormalities and seizures are considered much frequent in autistic subjects with comorbid intellectual disability (ID). In this study, we aimed to evaluate the EEG and MRI findings and their relation with ID in pervasive developmental disorder. METHODS A retrospective, cross-sectional and non-experimental study was performed. Subjects included 81 patients diagnosed with autism or PDD-NOS according to the DSM-IV criteria. The age range of the patients was 2-15 years (mean 6.6 years, SD 3.0). Among them, 21 (25.9%) were girls and 60 boys (74.1%). RESULTS Patients with severe ID had a higher rate of EEG abnormalities (P=0.03) than patients without ID as well as patients with mild or moderate ID. The association remained significant after the structural MRI abnormalities were controlled (P=0.04). The severity of ID was not associated with abnormal MRI. The most frequent EEG and MRI abnormalities were active epileptic anomaly/paroxysmal abnormality and cerebral atrophy/periventricular leukomalacia, respectively. Almost a third of the EEG abnormalities were associated with temporal cortex and adjacent cortical structures. CONCLUSIONS Consistent with previous studies, almost a fourth of the patients in this relatively large sample of patients with pervasive developmental disorders had EEG and/or MRI abnormalities. EEG results indicate that temporal cortex may play a significant role in pervasive developmental disorders.
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Affiliation(s)
- Özlem Ünal
- Department of Developmental and Behavioral Pediatrics, Ankara University School of Medicine
| | | | - Özgür Öner
- NIMH Fogarty International Mental Health and Developmental Disabilities Program
| | - Melda Akcakin
- Department of Child Psychiatry, Ankara University School of Medicine
| | - Ayla Aysev
- Department of Child Psychiatry, Ankara University School of Medicine
| | - Gülhis Deda
- Department of Child Neurology, Ankara University School of Medicine
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Cascade E, Kalali A, Findling R. Use of antipsychotics in children. Psychiatry (Edgmont) 2009; 6:21-23. [PMID: 19724757 PMCID: PMC2720841] [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] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Over the 2004 through 2008 period, total second-generation antipsychotic prescriptions grew 33 percent from 6.9 million to 9.2 million; second-generation antipsychotic prescriptions for patients under age 18 also increased, but at a slightly slower rate: 24-percent increase from 1.0 million to 1.2 million prescriptions. One-third of patients under age 18 who are prescribed second-generation antipsychotics use them for the treatment of affective psychoses, primarily bipolar disorder (34%). Other common uses for second-generation antipsychotics include hyperkinetic syndrome (12%), pervasive developmental disorders (10%), emotional disorders of children/adolescents (10%), and conduct disturbance (7%). A discussion of the data is provided.
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Affiliation(s)
- Elisa Cascade
- Ms. Cascade is Vice President, Quintiles Inc./iGuard, Falls Church, Virginia
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Virkud YV, Todd RD, Abbacchi AM, Zhang Y, Constantino JN. Familial aggregation of quantitative autistic traits in multiplex versus simplex autism. Am J Med Genet B Neuropsychiatr Genet 2009; 150B:328-34. [PMID: 18618672 PMCID: PMC2819431 DOI: 10.1002/ajmg.b.30810] [Citation(s) in RCA: 155] [Impact Index Per Article: 10.3] [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] [Indexed: 02/01/2023]
Abstract
Recent research has suggested that the mode of inheritance for simplex autism (SA, one individual in the family affected) may be distinct from that for multiplex autism (MA, two or more individuals affected). Since sub clinical autistic traits have been observed in "unaffected" relatives of children with autism, we explored whether the distributions of such traits in families supported differential modes of genetic transmission for SA and MA autism. We measured patterns of familial aggregation of quantitative autistic traits (QAT) in children and parents in 80 SA families and 210 MA families, using the Social Responsiveness Scale. When considering all SA and MA siblings who scored below a uniform quantitative (clinical-level) severity threshold, MA brothers exhibited a distinct pathological shift in the distribution, compared to SA brothers (P < 0.0001). Such aggregation of QAT was also observed in fathers but not among females in MA families. Significant spousal correlations for QAT-suggestive of assortative mating-were observed in both SA and MA families, but neither group was characterized by a greater-than-chance level of concordant elevation among spousal pairs in this volunteer sample. Among male first degree relatives, there exist distinct patterns of QAT manifestation for simplex versus multiplex autism. These findings are consistent with the results of molecular genetic studies that have suggested differential modes of intergenerational transmission for SA and MA. Characterization of QAT and other endophenotypes among close relatives may be useful for reducing sample heterogeneity in future genetic and neurobiologic studies of autism.
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Affiliation(s)
- Yamini V Virkud
- Departments of Psychiatry, Washington University, St. Louis, Missouri, USA
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Jahromi LB, Kasari CL, McCracken JT, Lee LSY, Aman MG, McDougle CJ, Scahill L, Tierney E, Arnold LE, Vitiello B, Ritz L, Witwer A, Kustan E, Ghuman J, Posey DJ. Positive effects of methylphenidate on social communication and self-regulation in children with pervasive developmental disorders and hyperactivity. J Autism Dev Disord 2009; 39:395-404. [PMID: 18752063 PMCID: PMC4374624 DOI: 10.1007/s10803-008-0636-9] [Citation(s) in RCA: 106] [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] [Subscribe] [Scholar Register] [Received: 01/17/2008] [Accepted: 08/07/2008] [Indexed: 11/28/2022]
Abstract
This report examined the effect of methylphenidate on social communication and self-regulation in children with pervasive developmental disorders and hyperactivity in a secondary analysis of RUPP Autism Network data. Participants were 33 children (29 boys) between the ages of 5 and 13 years who participated in a four-week crossover trial of placebo and increasing doses of methylphenidate given in random order each for one week. Observational measures of certain aspects of children's social communication, self-regulation, and affective behavior were obtained each week. A significant positive effect of methylphenidate was seen on children's use of joint attention initiations, response to bids for joint attention, self-regulation, and regulated affective state. The results go beyond the recent literature and suggest that methylphenidate may have positive effects on social behaviors in children with PDD and hyperactivity.
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Affiliation(s)
- Laudan B Jahromi
- School of Social and Family Dynamics, Arizona State University, Box 873701, Tempe, AZ 85287-3701, USA.
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Abstract
This is a review of the clinical trials investigating the efficacy and safety of risperidone in the treatment of children with autistic spectrum disorders (ASD). The main clinical characteristics are impairment in social skills, communication difficulties, repetitive movements and behaviors, including stereotypies. Pharmacotherapy is mainly directed at the so-called target symptoms, ie, behavioral disorders and the various kinds of repetitions associated with ASD. According to the available data, risperidone seems to be moderately efficacious and safe for treating behavioral disorders. 4 double blind controlled trial. 3 reanalysis studies, and 12 open studies have documented the role of risperidone in children with ASD. Controlled studies have been thoroughly considered in this review.
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Affiliation(s)
- Roberto Canitano
- Division of Child Neuropsychiatry, University Hospital of Siena Siena, Viale Bracci 14 53100 Siena, Italy.
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Abstract
AIM To quantitatively examine the influence of study methodology and population characteristics on prevalence estimates of autism spectrum disorders. METHODS Electronic databases and bibliographies were searched and identified papers evaluated against inclusion criteria. Two groups of studies estimated the prevalence of typical autism and all autism spectrum disorders (ASD). The extent of variation among studies and overall prevalence were estimated using meta-analysis. The influence of methodological factors and population characteristics on estimated prevalence was investigated using meta-regression and summarised as odds ratios (OR). RESULTS Forty studies met inclusion criteria, of which 37 estimated the prevalence of typical autism, and 23 the prevalence of all ASD. A high degree of heterogeneity among studies was observed. The overall random effects estimate of prevalence across studies of typical autism was 7.1 per 10,000 (95% CI 1.6 to 30.6) and of all ASD was 20.0 per 10,000 (95% CI 4.9 to 82.1). Diagnostic criteria used (ICD-10 or DSM-IV versus other; OR = 3.36, 95% CI 2.07 to 5.46), age of the children screened (OR = 0.91 per year, 95% CI 0.83 to 0.99), and study location (e.g. Japan versus North America; OR = 3.60, 95% CI 1.73 to 7.46) were all significantly associated with prevalence of typical autism. Diagnostic criteria, age of the sample, and urban or rural location were associated with estimated prevalence of all ASD. CONCLUSIONS Sixty one per cent of the variation in prevalence estimates of typical autism was explained by these models. Diagnostic criteria used, age of children screened, and study location may be acting as proxies for other study characteristics and require further investigation.
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Affiliation(s)
- J G Williams
- Department of Public Health and Primary Care, University of Cambridge, UK.
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