Genetic and epigenetic signatures associated with plasma oxytocin levels in children and adolescents with autism spectrum disorder

Oxytocin (OT), the brain's most abundant neuropeptide, plays an important role in social salience and motivation. Clinical trials of the efficacy of OT in autism spectrum disorder (ASD) have reported mixed results due in part to ASD's complex etiology. We investigated whether genetic and epigenetic variation contribute to variable endogenous OT levels that modulate sensitivity to OT therapy. To carry out this analysis, we integrated genome-wide profiles of DNA-methylation, transcriptional activity, and genetic variation with plasma OT levels in 290 participants with ASD enrolled in a randomized controlled trial of OT. Our analysis identified genetic variants with novel association with plasma OT, several of which reside in known ASD risk genes. We also show subtle but statistically significant association of plasma OT levels with peripheral transcriptional activity and DNA-methylation profiles across several annotated gene sets. These findings broaden our understanding of the effects of the peripheral oxytocin system and provide novel genetic candidates for future studies to decode the complex etiology of ASD and its interaction with OT signaling and OT-based interventions. LAY SUMMARY: Oxytocin (OT) is an abundant chemical produced by neurons that plays an important role in social interaction and motivation. We investigated whether genetic and epigenetic factors contribute to variable OT levels in the blood. To this, we integrated genetic, gene expression, and non-DNA regulated (epigenetic) signatures with blood OT levels in 290 participants with autism enrolled in an OT clinical trial. We identified genetic association with plasma OT, several of which reside in known autism risk genes. We also show statistically significant association of plasma OT levels with gene expression and epigenetic across several gene pathways. These findings broaden our understanding of the factors that influence OT levels in the blood for future studies to decode the complex presentation of autism and its interaction with OT and OT-based treatment.

Gustation in insects: taste qualities and types of evidence used to show taste function of specific body parts

The insect equivalent of taste buds are gustatory sensilla, which have been found on mouthparts, pharynxes, antennae, legs, wings, and ovipositors. Most gustatory sensilla are uniporous, but not all apparently uniporous sensilla are gustatory. Among sensilla containing more than one neuron, a tubular body on one dendrite is also indicative of a taste sensillum, with the tubular body adding tactile function. But not all taste sensilla are also tactile. Additional morphological criteria are often used to recognize if a sensillum is gustatory. Further confirmation of such criteria by electrophysiological or behavioral evidence is needed. The five canonical taste qualities to which insects respond are sweet, bitter, sour, salty, and umami. But not all tastants that insects respond to easily fit in these taste qualities. Categories of insect tastants can be based not only on human taste perception, but also on whether the response is deterrent or appetitive and on chemical structure. Other compounds that at least some insects taste include, but are not limited to: water, fatty acids, metals, carbonation, RNA, ATP, pungent tastes as in horseradish, bacterial lipopolysaccharides, and contact pheromones. We propose that, for insects, taste be defined not only as a response to nonvolatiles but also be restricted to responses that are, or are thought to be, mediated by a sensillum. This restriction is useful because some of the receptor proteins in gustatory sensilla are also found elsewhere.

Autism Spectrum Disorder: A Review

IMPORTANCE

Autism spectrum disorder (ASD), characterized by deficits in social communication and the presence of restricted, repetitive behaviors or interests, is a neurodevelopmental disorder affecting approximately 2.3% children aged 8 years in the US and approximately 2.2% of adults. This review summarizes evidence on the diagnosis and treatment of ASD.

OBSERVATIONS

The estimated prevalence of ASD has been increasing in the US, from 1.1% in 2008 to 2.3% in 2018, which is likely associated with changes in diagnostic criteria, improved performance of screening and diagnostic tools, and increased public awareness. No biomarkers specific to the diagnosis of ASD have been identified. Common early signs and symptoms of ASD in a child's first 2 years of life include no response to name when called, no or limited use of gestures in communication, and lack of imaginative play. The criterion standard for the diagnosis of ASD is a comprehensive evaluation with a multidisciplinary team of clinicians and is based on semistructured direct observation of the child's behavior and semistructured caregiver interview focused on the individual's development and behaviors using standardized measures, such as the Autism Diagnostic Observation Schedule-Second Edition and the Autism Diagnostic Interview. These diagnostic measures have sensitivity of 91% and 80% and specificity of 76% and 72%, respectively. Compared with people without ASD, individuals with ASD have higher rates of depression (20% vs 7%), anxiety (11% vs 5%), sleep difficulties (13% vs 5%), and epilepsy (21% with co-occurring intellectual disability vs 0.8%). Intensive behavioral interventions, such as the Early Start Denver Model, are beneficial in children 5 years or younger for improvement in language, play, and social communication (small to medium effect size based on standardized mean difference). Pharmacotherapy is indicated for co-occurring psychiatric conditions, such as emotion dysregulation or attention-deficit/hyperactivity disorder. Risperidone and aripiprazole can improve irritability and aggression (standardized mean difference of 1.1, consistent with a large effect size) compared with placebo. Psychostimulants are effective for attention-deficit/hyperactivity disorder (standardized mean difference of 0.6, consistent with a moderate effect size) compared with placebo. These medications are associated with adverse effects including, most commonly, changes in appetite, weight, and sleep.

CONCLUSIONS AND RELEVANCE

ASD affects approximately 2.3% of children aged 8 years and approximately 2.2% of adults in the US. First-line therapy consists of behavioral interventions, while co-occurring psychiatric conditions, such as anxiety or aggression, may be treated with specific behavioral therapy or medication.

Adaptive Behavior in Young Autistic Children: Associations with Irritability and ADHD Symptoms

Attention-deficit/hyperactivity disorder (ADHD) symptoms affect 40-60% of autistic children and have been linked to differences in adaptive behavior. It is unclear whether adaptive behavior in autistic youth is directly impacted by co-occurring ADHD symptoms or by another associated feature of both autism and ADHD, such as increased irritability. The current study examined relationships between irritability, ADHD symptoms, and adaptive behavior in 3- to 7-year-old autistic children. Results suggest that, after adjusting for co-occurring ADHD symptoms, higher levels of irritability are associated with differences in social adaptive behavior specifically. Understanding relationships between irritability, ADHD, and adaptive behavior in autistic children is critical because measures of adaptive behavior, such as the Vineland Scales of Adaptive Functioning, are often used as a proxy for global functioning, as well as for developing intervention plans and measuring outcomes as primary endpoints in clinical trials.

Citalopram Did Not Significantly Improve Anxiety in Children with Autism Spectrum Disorder Undergoing Treatment for Core Symptoms: Secondary Analysis of a Trial to Reduce Repetitive Behaviors

Objective: Anxiety disorders are among the most common co-occurring conditions in autism spectrum disorder (ASD). Despite their prevalence and impact, there are no randomized controlled trials (RCTs) aimed at evaluating the efficacy of selective serotonin reuptake inhibitors (SSRIs) for anxiolysis in this population, who may have a different biological basis for anxiety. Methods: Secondary analyses of the STAART double-blind, placebo-controlled RCT of citalopram in children with ASD examined whether citalopram reduced anxiety measured on the parent-reported Child and Adolescent Symptom Inventory-4 (CASI-4) as the primary outcome. An intention-to-treat analysis involving all 149 participants used multiple imputations for missing data and included baseline stratification factors of age group and site, among others. We prespecified as clinically significant a 33% reduction in anxiety in citalopram versus placebo, coinciding with 80% power. We tested whether communicative ability on the Vineland Communication score moderated treatment effect and explored whether initial anxiety was associated with greater adverse events, which could impact on dose titration and achieving optimal dose. Results: Both groups showed substantial reduction in anxiety. Citalopram was associated with a nonsignificant 16.5% greater reduction (observed coefficient = -0.181, bootstrap standard error = 0.126, p = 0.151, confidence interval = -0.428 to 0.066). Anxiety reports were significantly lower in children with reduced communicative ability, but communicative ability did not moderate the treatment effect (interaction p = 0.294). Initial anxiety levels were not associated with increased adverse effects (interaction ps 0.162-0.954). Conclusion: Citalopram did not statistically significantly improve anxiety in children with ASD. Clinicians should be cautious in their use of SSRIs for this indication. There remains a need for well-powered clinical trials testing the efficacy of SSRIs among autistic children with anxiety disorders.

Diet and Nutrition of Adult Spalangia cameroni (Hymenoptera: Pteromalidae), a Parasitoid of Filth Flies

Most parasitoid wasps parasitize herbivorous insects, so nectar from flowers is readily available. However, parasitoid wasps are also an important component of the rich invertebrate communities at livestock facilities in large accumulations of manure, where flowers are largely absent. Little is known about adult parasitoid diet and nutrition in these communities. The present study examined this in Spalangia cameroni Perkins, a pupal parasitoid of filth flies. Like many parasitoid wasps, S. cameroni feed on host fluids, and in the laboratory readily feed on honey or a sucrose solution, which increases their longevity. Here adult longevity in the presence of six potential food sources, bovine manure, sorghum silage, bovine milk, buckwheat inflorescence (Polygonaceae), sweet alyssum inflorescence (Brassicaceae), or dandelion inflorescence (Asteraceae), was compared to that with water or honey. Only parasitoids given buckwheat lived as long as parasitoids given honey, and parasitoids given honey or buckwheat lived longer than parasitoids given water. Parasitoids readily ate buckwheat nectar, avoiding pollen grains. Diet affected the amount of free sugars, glycogen, and lipids in complex ways. Compared to parasitoids that were given just water, parasitoids with access to honey or sucrose had higher sugar and glycogen levels, but not detectably higher lipid levels. Access to buckwheat had no detectable effect on a parasitoid's free sugar, glycogen, or lipid levels; however, then after 4 d with just water, sugar levels were lower and glycogen levels were higher compared to parasitoids that had been given access to only water the entire time.

Adolescents With Eating Disorders in Pediatric Practice - The European Academy of Paediatrics Recommendations

In the face of the growing number of adolescents suffering from eating disorders (EDs) and access to psychiatric care limited by the epidemiological and demographic situation, the primary care pediatrician's role in diagnosing and treating EDs is growing. The European Academy of Paediatrics (EAP) decided to summarize knowledge about EDs and formulate recommendations to support European pediatricians and improve care for adolescents with EDs.

Intranasal Oxytocin in Children and Adolescents with Autism Spectrum Disorder

BACKGROUND

Experimental studies and small clinical trials have suggested that treatment with intranasal oxytocin may reduce social impairment in persons with autism spectrum disorder. Oxytocin has been administered in clinical practice to many children with autism spectrum disorder.

METHODS

We conducted a 24-week, placebo-controlled phase 2 trial of intranasal oxytocin therapy in children and adolescents 3 to 17 years of age with autism spectrum disorder. Participants were randomly assigned in a 1:1 ratio, with stratification according to age and verbal fluency, to receive oxytocin or placebo, administered intranasally, with a total target dose of 48 international units daily. The primary outcome was the least-squares mean change from baseline on the Aberrant Behavior Checklist modified Social Withdrawal subscale (ABC-mSW), which includes 13 items (scores range from 0 to 39, with higher scores indicating less social interaction). Secondary outcomes included two additional measures of social function and an abbreviated measure of IQ.

RESULTS

Of the 355 children and adolescents who underwent screening, 290 were enrolled. A total of 146 participants were assigned to the oxytocin group and 144 to the placebo group; 139 and 138 participants, respectively, completed both the baseline and at least one postbaseline ABC-mSW assessments and were included in the modified intention-to-treat analyses. The least-squares mean change from baseline in the ABC-mSW score (primary outcome) was -3.7 in the oxytocin group and -3.5 in the placebo group (least-squares mean difference, -0.2; 95% confidence interval, -1.5 to 1.0; P = 0.61). Secondary outcomes generally did not differ between the trial groups. The incidence and severity of adverse events were similar in the two groups.

CONCLUSIONS

This placebo-controlled trial of intranasal oxytocin therapy in children and adolescents with autism spectrum disorder showed no significant between-group differences in the least-squares mean change from baseline on measures of social or cognitive functioning over a period of 24 weeks. (Funded by the National Institute of Child Health and Human Development; SOARS-B ClinicalTrials.gov number, NCT01944046.).

Predictors of Caregiver Strain for Parents of Children with Autism Spectrum Disorder

Parents of children with autism spectrum disorder (ASD) face higher levels of caregiver strain compared to parents of children with other disabilities. This study examined child clinical features that predict high levels of caregiver strain for 374 parents of children with ASD. Caregiver strain was measured using the Caregiver Strain Questionnaire (CGSQ) objective, subjective internalized, and subjective externalized subscales. Confirmatory factor analysis indicated an acceptable fit for the original CGSQ three-factor solution. The strongest child predictors across CGSQ subscales were: disruptive behavior for objective strain, autism severity and disruptive behavior for subjective internalized strain, and oppositional behavior and hyperactivity for subjective externalized strain. Individualized interventions that attend to specific elements of parental strain may reduce strain and improve family wellbeing.

Rationale, design, and methods of the Autism Centers of Excellence (ACE) network Study of Oxytocin in Autism to improve Reciprocal Social Behaviors (SOARS-B)

OBJECTIVE

To describe the rationale, design, and methods of the Autism Centers of Excellence (ACE) network Study of Oxytocin in Autism to improve Reciprocal Social Behaviors (SOARS-B).

METHOD

This phase 2 clinical trial was designed to evaluate the use of intranasal oxytocin treatment to improve social difficulties in individuals with autism spectrum disorder (ASD). In total, 290 participants ages 3 to 17 years with a DSM-5 diagnosis of ASD were enrolled to receive 24 weeks of treatment with either oxytocin or a matched placebo at one of seven collaborating sites. Participants were subsequently treated with open-label oxytocin for 24 additional weeks. Post-treatment assessments were done approximately 4 weeks after treatment discontinuation. Plasma oxytocin and oxytocin receptor gene (OXTR) methylation level were measured at baseline, and week 8, 24 and 36 to explore potential relationships between these biomarkers and treatment response.

RESULTS

This report describes the rationale, design, and methods of the SOARS-B clinical trial.

CONCLUSIONS

There is a tremendous unmet need for safe and effective pharmacological treatment options that target the core symptoms of ASD. Several studies support the hypothesis that intranasal oxytocin could improve social orienting and the salience of social rewards in ASD, thereby enhancing reciprocal social behaviors. However, due to conflicting results from a number of pilot studies on the prosocial effects of exogenous oxytocin, this hypothesis remains controversial and inconclusive. SOARS-B is the best powered study to date to address this hypothesis and promises to improve our understanding of the safety and efficacy of intranasal oxytocin in the treatment of social deficits in children with ASD.

A Field-Relevant Concentration of the Insecticide Imidacloprid Affects Grooming, Locomotion, and Longevity in the Biological Control Agent Spalangia endius (Hymenoptera: Pteromalidae)

Foreign materials like insecticides may increase grooming in insects; and generally, grooming may be expected to reduce effects of insecticides, but this may not be the case when grooming involves the mouth and hence a risk of ingestion. To examine this, female Spalangia endius, a wasp that parasitizes filth fly pupae, were exposed to a surface coated with a low concentration of imidacloprid or not. Their mouthparts were sealed or not to determine whether sealing is a useful method for examining effects of mouth grooming. Wasps mouth-groomed more frequently while exposed to imidacloprid than when not. However, imidacloprid did not increase the number of times that a wasp groomed the rest of her body, and this was true regardless of whether or not her mouthparts were sealed. While exposed to imidacloprid, wasps spent less time locomoting only if their mouthparts were not sealed. Having been exposed to imidacloprid also decreased subsequent longevity, from 9 to 7 d. These effects of imidacloprid on grooming, locomotion, and longevity occurred despite exposure being for just 5 min and to only 2% of the amount that will be present in an area immediately after house fly baits are scattered at their recommended coverage. This is such a low amount that, with 48 h of constant exposure, mortality of these wasps is only 10%. Having mouthparts sealed decreased locomotion and longevity regardless of exposure to imidacloprid. Thus, sealing mouthparts is not useful for measuring effects of mouth grooming.

Feeding Response to Select Monosaccharides, Sugar Alcohols, and Artificial Sweeteners Relative to Sucrose in Adult House Flies, Musca domestica (Diptera: Muscidae)

Use of insecticidal baits risks the evolution of resistance to the feeding stimulant in the bait, not just to the active ingredient (toxicant). Sucrose-based baits are widely used against house flies, Musca domestica L. The baits are applied as dry granules, but readily liquefy. The proboscis extension reflex (PER) and consumption of alternative sweeteners, dry or in solution, were examined. Fructose, glucose, and xylitol merit further study as alternatives to sucrose. Dry, fructose, glucose, and xylitol elicited PER much more than sucrose, although not when in solution. Furthermore, dry or in solution, females and males ate as much or more fructose as sucrose. In solution, flies ate as much glucose as sucrose; although when dry, consumption was much less for glucose than sucrose. Dry, xylitol elicited as much consumption as sucrose for females, though less for males. In solution, for both sexes, xylitol elicited less consumption than sucrose did. Acesulfame potassium, sodium cyclamate, and sucralose do not look promising as they did not often elicit PER, whether dry or in solution. Erythritol also does not look promising. Erythritol elicited PER no more than sucrose did when dry and elicited PER much less than sucrose when in solution. Flies ate much less erythritol than sucrose whether dry or in solution.

Overemphasis of the Autism Diagnostic Observation Schedule (ADOS) Evaluation Subverts a Clinician's Ability to Provide Access to Autism Services

A concerning trend has emerged in the diagnosis and treatment of autism spectrum disorder (ASD) that has a negative impact on care. Quite often, a clinician's diagnosis of ASD using DSM-5 criteria is no longer sufficient for individuals with ASD to access services. Insurance companies, school districts, and developmental disability agencies commonly require an Autism Diagnostic Observation Schedule (ADOS) to be eligible for services.

Decaying Organic Matter Does Not Remove Sublethal Effects of Imidacloprid on Mating in Spalangia endius (Hymenoptera: Pteromalidae), a Parasitoid of Filth Flies

Both the parasitoid wasp Spalangia endius Walker and the insecticide imidacloprid are used to control house flies. A recent study found that negative sublethal effects of imidacloprid on killing flies and on offspring production by this parasitoid wasp are eliminated when females have the opportunity to crawl through decaying matter. An enzyme-linked immunosorbent assay showed that the presence of decaying matter reduces the amount of pesticide on their bodies. This study examined whether this was also true for sublethal effects on mating. S. endius were exposed to a realistic concentration of imidacloprid that induces very low mortality. Then, individual parasitoids were allowed to burrow through decaying organic matter or not, followed by mating tests in the absence of decaying matter. Even after 24 h with the decaying matter, copulation for both males and females that had previously been exposed to imidacloprid was delayed compared with no-pesticide controls. Furthermore, for pesticide-exposed males, subsequently burrowing through media made copulation even more delayed than if they were not exposed to media. For pesticide-exposed females, subsequently burrowing through media neither increased or decreased the negative effect of the pesticide exposure. Together with other studies, these results reinforce that use of S. endius and use of imidacloprid are incompatible, even at much lower than recommended concentration, unless application is sufficiently separated in place and time.

An Observational Study With the Janssen Autism Knowledge Engine (JAKE®) in Individuals With Autism Spectrum Disorder

Objective: The Janssen Autism Knowledge Engine (JAKE®) is a clinical research outcomes assessment system developed to more sensitively measure treatment outcomes and identify subpopulations in autism spectrum disorder (ASD). Here we describe JAKE and present results from its digital phenotyping (My JAKE) and biosensor (JAKE Sense) components. Methods: An observational, non-interventional, prospective study of JAKE in children and adults with ASD was conducted at nine sites in the United States. Feedback on JAKE usability was obtained from caregivers. JAKE Sense included electroencephalography, eye tracking, electrocardiography, electrodermal activity, facial affect analysis, and actigraphy. Caregivers of individuals with ASD reported behaviors using My JAKE. Results from My JAKE and JAKE Sense were compared to traditional ASD symptom measures. Results: Individuals with ASD (N = 144) and a cohort of typically developing (TD) individuals (N = 41) participated in JAKE Sense. Most caregivers reported that overall use and utility of My JAKE was "easy" (69%, 74/108) or "very easy" (74%, 80/108). My JAKE could detect differences in ASD symptoms as measured by traditional methods. The majority of biosensors included in JAKE Sense captured sizable amounts of quality data (i.e., 93-100% of eye tracker, facial affect analysis, and electrocardiogram data was of good quality), demonstrated differences between TD and ASD individuals, and correlated with ASD symptom scales. No significant safety events were reported. Conclusions: My JAKE was viewed as easy or very easy to use by caregivers participating in research outside of a clinical study. My JAKE sensitively measured a broad range of ASD symptoms. JAKE Sense biosensors were well-tolerated. JAKE functioned well when used at clinical sites previously inexperienced with some of the technologies. Lessons from the study will optimize JAKE for use in clinical trials to assess ASD interventions. Additionally, because biosensors were able to detect features differentiating TD and ASD individuals, and also were correlated with standardized symptom scales, these measures could be explored as potential biomarkers for ASD and as endpoints in future clinical studies. Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT02668991 identifier: NCT02668991.

Sexual Size and Shape Dimorphism in Three Species of Parasitoid Wasps with Burrowing Females: Spalangia endius, Spalangia nigroaenea, and Spalangia nigra (Hymenoptera: Pteromalidae)

The parasitoid wasps Spalangia endius Walker, Spalangia nigroaenea Curtis, and Spalangia nigra Latrielle (Hymenoptera: Pteromalidae) develop on filth fly pupae. Females burrow through decaying organic matter and parasitize hosts; whereas, at least in S. endius, males tend to stay above ground searching for mates. Both sexes lack obvious digging morphology such as enlarged forelegs and are not known to exhibit physical aggression. Size data were obtained from specimens from Illinois field-collected hosts for all three species and from a Florida laboratory colony for S. endius. The degree of sexual size dimorphism varied with body part and species, but the direction of bias was consistent between the field and laboratory specimens of S. endius. Females had wider abdomens in S. nigroaenea and S. nigra (not measured in S. endius). In all three species, females had longer heads than males, both in absolute size and relative to width. The latter is referred to as narrowness. Forewings were significantly narrower in females compared with in males for both S. endius and S. nigroaenea. Thorax narrowness was either greater in males (S. endius) or was not significantly different between the sexes (S. nigroaenea and S. nigra). Patterns of sexual size dimorphism seem consistent with females' need to store eggs and burrow. For all three species, there was overlap between males and females in all body parts measured. Thus, these size measurements will be unreliable to differentiate the sexes. Size ratios also overlapped.

Autism spectrum disorder: Consensus guidelines on assessment, treatment and research from the British Association for Psychopharmacology

An expert review of the aetiology, assessment, and treatment of autism spectrum disorder, and recommendations for diagnosis, management and service provision was coordinated by the British Association for Psychopharmacology, and evidence graded. The aetiology of autism spectrum disorder involves genetic and environmental contributions, and implicates a number of brain systems, in particular the gamma-aminobutyric acid, serotonergic and glutamatergic systems. The presentation of autism spectrum disorder varies widely and co-occurring health problems (in particular epilepsy, sleep disorders, anxiety, depression, attention deficit/hyperactivity disorder and irritability) are common. We did not recommend the routine use of any pharmacological treatment for the core symptoms of autism spectrum disorder. In children, melatonin may be useful to treat sleep problems, dopamine blockers for irritability, and methylphenidate, atomoxetine and guanfacine for attention deficit/hyperactivity disorder. The evidence for use of medication in adults is limited and recommendations are largely based on extrapolations from studies in children and patients without autism spectrum disorder. We discuss the conditions for considering and evaluating a trial of medication treatment, when non-pharmacological interventions should be considered, and make recommendations on service delivery. Finally, we identify key gaps and limitations in the current evidence base and make recommendations for future research and the design of clinical trials.

Insecticidal Potential of Two Sugar Alcohols to Musca domestica (Diptera: Muscidae)

Pest management plans for house flies, Musca domestica L. (Diptera: Muscidae), often include insecticides. Because of resistance and environmental concerns with traditional insecticides, safe new pesticides and pesticide formulations are needed. The insecticidal potential of two sugar alcohols, xylitol and erythritol, against adult house flies was assessed. Flies consumed both xylitol and erythritol. The proportion of flies that exhibited the proboscis extension reflex, which is associated with feeding, did not differ significantly between the sugar alcohols and sucrose in an experiment with 20% solutions and older flies, but was less for the sugar alcohols in an experiment with 2M solutions and younger flies. When presented alone or mixed with sucrose, both sugar alcohols significantly decreased fly survival relative to just sucrose. There was a strong negative relationship with concentration and mean days survived for xylitol, but no significant relationship for erythritol or sucrose. Relative to sucrose alone, a temporary exposure to xylitol, but not to erythritol, decreased survival when sucrose was subsequently available. Although xylitol and erythritol can both decrease survival of house flies and would meet the criteria for organic farming, deaths were often not very immediate. However, continued investigation of a variety of sweeteners as feeding-stimulant alternatives to sucrose is still useful, to minimize the risk of house flies evolving resistance to the sugar in baits. Our analysis of already published data on house flies that had been repeatedly exposed to a sucrose-based bait is consistent with the evolution of sucrose-feeding avoidance.

Disruption to control network function correlates with altered dynamic connectivity in the wider autism spectrum

Autism is a common developmental condition with a wide, variable range of co-occurring neuropsychiatric symptoms. Contrasting with most extant studies, we explored whole-brain functional organization at multiple levels simultaneously in a large subject group reflecting autism's clinical diversity, and present the first network-based analysis of transient brain states, or dynamic connectivity, in autism. Disruption to inter-network and inter-system connectivity, rather than within individual networks, predominated. We identified coupling disruption in the anterior-posterior default mode axis, and among specific control networks specialized for task start cues and the maintenance of domain-independent task positive status, specifically between the right fronto-parietal and cingulo-opercular networks and default mode network subsystems. These appear to propagate downstream in autism, with significantly dampened subject oscillations between brain states, and dynamic connectivity configuration differences. Our account proposes specific motifs that may provide candidates for neuroimaging biomarkers within heterogeneous clinical populations in this diverse condition.

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Presents the first network-based treatment of dynamic connectivity in autism

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Analyzes whole-brain functional organization at multiple levels simultaneously

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Examines motifs in a large subject group reflecting autism's clinical diversity

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Utilizes a high-order model to delineate a more complete set of brain networks

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Uncovers significant coupling differences among control networks in autism

Effects of Size and Age of the Host Musca domestica (Diptera: Muscidae) on Production of the Parasitoid Wasp Spalangia endius (Hymenoptera: Pteromalidae)

One method of control of house flies, Musca domestica L. (Diptera: Muscidae), and other filth flies is by repeated release of large numbers of pupal parasitoids such as Spalangia endius Walker. Rearing these parasitoids may be facilitated by understanding how host factors affect their production. Previous studies have examined the effects of host size and host age on parasitoid production, but have not examined the interaction between host size and host age or the effects with older females, which may be less capable of drilling tough hosts. Females were given hosts of a single size-age category (small young, small old, large young, or large old) for 2 wk. The effect of host size and of host age on parasitoid production depended on female age. On their first day of oviposition, females produced more offspring from large than from small hosts, but host age had no significant effect. The cumulative number of parasitoids produced in the first week was not significantly affected by host size or host age. However, the cumulative number of parasitoids produced over 2 wk was affected by both host size and host age, with the greatest number of parasitoids produced from small young hosts. Thus, not only are smaller hosts cheaper to produce, but these results suggest that their use may have no effect or a positive effect on the number of parasitoids that can be produced when females are ovipositing for a week or two.

Psychiatric comorbidities in neurodevelopmental disorders

PURPOSE OF REVIEW

Recent changes in the diagnostic criteria for psychiatric and neurodevelopmental disorders as well as increases in the prevalence of both have elevated the focus on these areas of medicine and their clinical overlap.

RECENT FINDINGS

Several recent studies have examined psychiatric comorbidities in neurodevelopmental disorders including autism and specific genetic syndromes. A growing number of reports underscore the genetic overlap between previously distinct clinical disorders. Behavioral and psychiatric features are increasingly identified in association with intellectual developmental disorders.

SUMMARY

As there have been advances in our collective understanding of the genetic underpinnings of certain disorders and the downstream physiological consequences of those genetic alterations, challenges to the way boundaries have been drawn around psychiatric disorders, and by extension, the concept of comorbidity, warrant review.

Behavior and Survival of the Filth Fly Parasitoids Spalangia endius and Urolepis rufipes (Hymenoptera: Pteromalidae) in Response to Three Granular House Fly Baits and Components

Behaviors and mortality of two filth fly parasitoid wasps, Spalangia endius Walker and Urolepis rufipes Ashmead, were tested in response to granular fly baits containing one of the three active ingredients (AI): Golden Malrin (methomyl), QuickBayt (imidacloprid), or Quikstrike (dinotefuran). Behavioral responses to each of the two components of the baits, the AIs and the fly attractant pheromone (Z)-9-tricosene, were also examined independently. Spalangia endius avoided contact with bait granules, regardless of bait type. However, when S. endius contacted bait residue, the imidacloprid bait appeared to be the least harmful of the baits for S. endius, at least in the short term. Spalangia endius was attracted to imidacloprid by itself. However, S. endius avoided (Z)-9-tricosene. In contrast to S. endius' attraction to imidacloprid, S. endius neither avoided nor was attracted to methomyl or dinotefuran. For U. rufipes, the methomyl bait appeared to be especially harmful. Urolepis rufipes avoided bait granules with imidacloprid or dinotefuran but not with methomyl, died quickly in the presence of methomyl bait residue, and had a methomyl LC₅₀ that was lower than that for S. endius The avoidance by U. rufipes of granules with imidacloprid or dinotefuran appears to be related to components other than the AIs or the (Z)-9-tricosene because U. rufipes did not avoid either individually. The behavioral avoidance of the parasitoids in the present study occurred despite no exposure recently, if ever, to these pesticides.

Finding Prospective Mates by the Parasitoid Wasp Urolepis rufipes (Hymenoptera: Pteromalidae)

Cues from emergence sites may be predictive of mating opportunities if potential mates are slow to disperse after emergence, and particularly if emergence sites are clumped, as in the solitary parasitoid wasp Urolepis rufipes Ashmead. Males emerge before females, and the present study suggests that males may use emergence sites of conspecific males to locate mates. In choice experiments, virgin males spent more time on a male-emerged host (a host from which a male had recently emerged) than on a female-emerged host. Relative to when no host was present, virgin males also marked more in the presence of a male-emerged host, but did not mark more in the presence of a female-emerged host. Females, but not other males, are known to be attracted to male marks. Unlike for males, there was no evidence that females distinguished between male-emerged and female-emerged hosts. Virgin females preferred areas where multiple males had marked over areas where a single male had marked. Such areas had more total marks, yet marks per male did not differ between aggregated and solitary males. Thus, through his own attraction to male-emerged hosts and by marking near other males a male may find and attract females, and with no apparent increase in the cost of attraction.

Severity of ASD symptoms and their correlation with the presence of copy number variations and exposure to first trimester ultrasound

Current research suggests that incidence and heterogeneity of autism spectrum disorder (ASD) symptoms may arise through a variety of exogenous and/or endogenous factors. While subject to routine clinical practice and generally considered safe, there exists speculation, though no human data, that diagnostic ultrasound may also contribute to ASD severity, supported by experimental evidence that exposure to ultrasound early in gestation could perturb brain development and alter behavior. Here we explored a modified triple hit hypothesis [Williams & Casanova, ] to assay for a possible relationship between the severity of ASD symptoms and (1) ultrasound exposure (2) during the first trimester of pregnancy in fetuses with a (3) genetic predisposition to ASD. We did so using retrospective analysis of data from the SSC (Simon's Simplex Collection) autism genetic repository funded by the Simons Foundation Autism Research Initiative. We found that male children with ASD, copy number variations (CNVs), and exposure to first trimester ultrasound had significantly decreased non-verbal IQ and increased repetitive behaviors relative to male children with ASD, with CNVs, and no ultrasound. These data suggest that heterogeneity in ASD symptoms may result, at least in part, from exposure to diagnostic ultrasound during early prenatal development of children with specific genetic vulnerabilities. These results also add weight to on-going concerns expressed by the FDA about non-medical use of diagnostic ultrasound during pregnancy. Autism Res 2017, 10: 472-484. © 2016 International Society for Autism Research, Wiley Periodicals, Inc.

Focus on Autism and Related Conditions

Recent advances in genetics and brain imaging have expanded the understanding of autism spectrum disorder as a complex heterogeneous neurodevelopmental disorder in both etiology and symptom severity. Such discoveries have caused changes in diagnostic criteria and are opening new doors for therapeutic options. This article examines the current understanding of autism spectrum disorder. This review includes estimates of prevalence, discussion of etiology, and current and evolving treatments.

Extended-Release Guanfacine for Hyperactivity in Children With Autism Spectrum Disorder

OBJECTIVE

Hyperactivity, impulsiveness, and distractibility are common problems in children with autism spectrum disorder (ASD). Extended-release guanfacine is approved for children with attention deficit hyperactivity disorder but not well studied in ASD.

METHOD

In a multisite, randomized clinical trial, extended-release guanfacine was compared with placebo in children with ASD accompanied by hyperactivity, impulsiveness, and distractibility.

RESULTS

Sixty-two subjects (boys, N=53; girls, N=9; mean age=8.5 years [SD=2.25]) were randomly assigned to guanfacine (N=30) or placebo (N=32) for 8 weeks. The guanfacine group showed a 43.6% decline in scores on the Aberrant Behavior Checklist-hyperactivity subscale (least squares mean from 34.2 to 19.3) compared with a 13.2% decrease in the placebo group (least squares mean from 34.2 to 29.7; effect size=1.67). The rate of positive response (much improved or very much improved on the Clinical Global Impression-Improvement scale) was 50% (15 of 30) for guanfacine compared with 9.4% (3 of 32) for placebo. A brief cognitive battery tapping working memory and motor planning showed no group differences before or after 8 weeks of treatment. The modal dose of guanfacine at week 8 was 3 mg/day (range: 1-4 mg/day), and the modal dose was 3 mg/day (range: 2-4 mg/day) for placebo. Four guanfacine-treated subjects (13.3%) and four placebo subjects (12.5%) exited the study before week 8. The most common adverse events included drowsiness, fatigue, and decreased appetite. There were no significant changes on ECG in either group. For subjects in the guanfacine group, blood pressure declined in the first 4 weeks, with return nearly to baseline by endpoint (week 8). Pulse rate showed a similar pattern but remained lower than baseline at endpoint.

CONCLUSIONS

Extended-release guanfacine appears to be safe and effective for reducing hyperactivity, impulsiveness, and distractibility in children with ASD.

Drilling-in and Chewing-out of Hosts by the Parasitoid Wasp Spalangia endius (Hymenoptera: Pteromalidae) When Parasitizing Musca domestica (Diptera: Muscidae)

Many organisms are protected from natural enemies by a tough exterior. Such protection is particularly important for immobile stages, such as pupae. The pupa of some insects is protected by a puparium, which is a shell formed from the exoskeleton of the last larval instar. However, the puparium of certain fly species is drilled through by adult females of the wasp Spalangia endius Walker. The female wasp then deposits an egg on the fly pupa within the puparium. After the wasp offspring finishes feeding on the fly pupa, it chews through the puparium to complete emergence. Despite the apparent toughness of the puparium, there was no detectable wear on the ovipositor of S. endius females even when females had been encountering fly pupae (Musca domestica L.) for weeks, and regardless of whether the pupae were large or old or both. Energy dispersive spectroscopy did not reveal any metal ions in the ovipositor's cuticle to account for this resistance against wear. Offspring of S. endius that chewed their way out of pupae also showed no detectable wear on their mandibles. Tests with a penetrometer showed that the force required to penetrate the center of a puparium was greater for larger and for older pupae; and an index of overall thickness was greater for large old pupae than for small old pupae. The lack of an effect of pupal size or age on wear may result from wasps choosing locations on the puparium that are easier to get through.

Compatibility of the Parasitoid Wasp Spalangia endius (Hymenoptera: Pteromalidae) and Insecticides against Musca domestica (Diptera: Muscidae) as Evaluated by a New Index

Various insecticides for the control of the house fly Musca domestica L. were tested for compatibility with a biological control agent, the pupal parasitoid Spalangia endius Walker. Bioassays used the mode in which each organism was expected to be harmed by the insecticides, a surface contact bioassay for S. endius and a feeding bioassay for M. domestica. A Pesticide Compatibility Index (PCI) was created that allows comparison of LC50 values when the mode of exposure to a pesticide differs. First LC50 values were converted into units of prescribed dosages (LPR=LC50-to-prescribed dosage ratio). This study used dosages from labels of granular baits. PCI is the ratio of LPRbiological control agent to LPRpest. For these PCI values, order of compatibility with S. endius was spinosad>thiamethoxam>inotefuran>methomyl>imidacloprid. That spinosad was better than imidacloprid or methomyl, both for parasitoid survival and for killing flies, is consistent with conclusions from the LC50 values. Permethrin and nitenpyram were also tested, but their PCIs were not calculated. Permethrin is prescribed as a contact insecticide against flies rather than being consumed as a bait, and nitenpyram has not been formulated as a fly insecticide. Compared with the other insecticides in terms of LC50 values, permethrin was moderately toxic to S. endius but one of the most toxic for M. domestica, whereas nitenpyram was least toxic for both S. endius and the flies.

Substrate-Borne Marking in the Parasitoid Wasp Urolepis rufipes (Hymenoptera: Pteromalidae)

Many animals use pheromone marking as a way to identify their territory or other resources. Among insects, substrate-borne marking is frequently reported for females, which in many species make marks containing oviposition-deterring pheromone, which other females avoid. However, there are fewer reports of substrate-borne marking for males. Here, marking in males of the parasitoid wasp Urolepis rufipes (Ashmead) is described. The conditions under which males mark and whether males and females respond to the males' marks were examined using behavioral observations. Males marked by dragging the tips of their abdomens across a substrate. They marked much more after mating and after consuming honey. They also marked more when with a female, irrespective of copulation, although not when with a male. Females spent more time on or near marked substrates, and males also responded to their own marks. Although males aggressively and successfully defended areas that they had marked against other males, males did not respond to another male's marks in the conspecific's absence. In contrast to males, females did not mark, either on the surface of hosts or on other surfaces, and males showed no detectable response to surfaces which females had recently occupied.

Tuberous sclerosis associated neuropsychiatric disorders (TAND) and the TAND Checklist

BACKGROUND

Tuberous sclerosis complex is a multisystem genetic disorder with a range of physical manifestations that require evaluation, surveillance, and management. Individuals with tuberous sclerosis complex also have a range of behavioral, psychiatric, intellectual, academic, neuropsychologic, and psychosocial difficulties. These may represent the greatest burden of the disease. Around 90% of individuals with tuberous sclerosis complex will have some of these difficulties during their lifetime, yet only about 20% ever receive evaluation and treatment. The Neuropsychiatry Panel at the 2012 Tuberous Sclerosis Complex International Consensus Conference expressed concern about the significant "treatment gap" and about confusion regarding terminology relating to the biopsychosocial difficulties associated with tuberous sclerosis complex.

METHODS

The Tuberous Sclerosis Complex Neuropsychiatry Panel coined the term TAND-tuberous sclerosis complex-associated neuropsychiatric disorders-to bring together these multidimensional manifestations of the disorder, and recommended annual screening for TAND. In addition, the Panel agreed to develop a TAND Checklist as a guide for screening.

RESULTS

Here, we present an outline of the conceptualization of TAND, rationale for the structure of the TAND Checklist, and include the full US English version of the TAND Checklist.

CONCLUSION

We hope that the unified term TAND and the TAND Checklist will raise awareness of the importance of tuberous sclerosis complex-associated neuropsychiatric disorders and of the major burden of disease associated with it, provide a shared language and a simple tool to describe and evaluate the different levels of TAND, alert clinical teams and families or individuals of the importance of screening, assessment, and treatment of TAND, and provide a shared framework for future studies of tuberous sclerosis complex-associated neuropsychiatric disorders.

STX209 (arbaclofen) for autism spectrum disorders: an 8-week open-label study

STX209 (arbaclofen), a selective GABA-B agonist, is hypothesized to modulate the balance of excitatory to inhibitory neurotransmission, and has shown preliminary evidence of benefit in fragile X syndrome. We evaluated its safety, tolerability, and efficacy in non-syndromic autism spectrum disorders, in an 8-week open-label trial enrolling 32 children and adolescents with either Autistic Disorder or Pervasive Developmental Disorder-Not Otherwise Specified, and a score ≥17 on the Aberrant Behavior Checklist (ABC)-Irritability subscale. STX209 was generally well-tolerated. The most common adverse events were agitation and irritability, which typically resolved without dose changes, and were often felt to represent spontaneous variation in underlying symptoms. Improvements were observed on several outcome measures in this exploratory trial, including the ABC-Irritability (the primary endpoint) and the Lethargy/Social Withdrawal subscales, the Social Responsiveness Scale, the CY-BOCS-PDD, and clinical global impression scales. Placebo-controlled study of STX209 is warranted.

Measuring anxiety as a treatment endpoint in youth with autism spectrum disorder

Despite the high rate of anxiety in individuals with autism spectrum disorder (ASD), measuring anxiety in ASD is fraught with uncertainty. This is due, in part, to incomplete consensus on the manifestations of anxiety in this population. Autism Speaks assembled a panel of experts to conduct a systematic review of available measures for anxiety in youth with ASD. To complete the review, the panel held monthly conference calls and two face-to-face meetings over a fourteen-month period. Thirty eight published studies were reviewed and ten assessment measures were examined: four were deemed appropriate for use in clinical trials, although with conditions; three were judged to be potentially appropriate, while three were considered not useful for clinical trials assessing anxiety. Despite recent advances, additional relevant, reliable and valid outcome measures are needed to evaluate treatments for anxiety in ASD.

Seasonal colour and antipredator behaviour in Etheostoma (Percidae)

This study examined how colour varies across season and sex in the fantail darter Etheostoma flabellare and the banded darter Etheostoma zonale. Etheostoma flabellare has male-only parental care and exhibited slight sexual dimorphism in overall colour, with no discernible effect of season on colour; whereas E. zonale does not have parental care and exhibited substantial sexual dimorphism in colour, but only in the breeding season. Additionally, antipredator behaviour of E. zonale was compared between males that were fully coloured during the breeding season and males that were partially coloured at that time, but the effects of colour and season were not consistent across males.

Side effects from use of one or more psychiatric medications in a population-based sample of children and adolescents

OBJECTIVE

The purpose of this study was to investigate the side effect risks from using one or more psychiatric medications (including antipsychotics, antidepressants, α-2 agonists, benzodiazepines, mood stabilizers, and stimulants) among a national cohort of children and adolescents.

METHODS

A questionnaire survey was administered to parents who filled a prescription for a psychiatric medication for their child at a large national retail pharmacy chain. Primary outcome variables were the total count of side effects from a list of 12 problem areas, as well as parent-reported side effect intensity (mild/moderate/severe). Modifiers investigated included specific medication and number of medications utilized, demographics, and difficulties with access to care.

RESULTS

A total of 1347 parents of study subjects ages 3-17 years from 30 U.S. states who were taking psychiatric medications for any indication purchased at one retail pharmacy chain enrolled following a single mail invitation (7.5% response). Of the study subjects, 80% were white/non-Hispanic, 64% were male, 63% had private health insurance, and 67% had used a current medication for >1year. Most (84%) had one or more parent-reported side effect. After adjusting for covariates, subjects with two medications reported 17% (p<0.001) and with three or more medications reported 38% (p=0.002) increases in their average number of side effects than did children taking one medication. Parental reporting of difficulties in accessing care also predicted a 42% (p<0.001) greater number of side effects than for those who had no access difficulties. Side effects were particularly more common in medication combinations including either selective serotonin reuptake inhibitors (SSRIs) (77% higher odds, p<0.001) or antipsychotics (99% higher odds, p<0.001).

CONCLUSIONS

Side effects from psychiatric medications appear to be both more common and more severe overall with increasing numbers of medications utilized, and with perceived difficulty in accessing care. Polypharmacy regimens including either SSRIs or antipsychotics were especially associated with experiencing side effects, within this study sample.

Update on diagnostic classification in autism

PURPOSE OF REVIEW

In the lead up to and following the recent publication of the DSM-5, the diagnostic construct of autism has received intense scrutiny.

RECENT FINDINGS

This article briefly reviews the history of the diagnosis of autism, the changes that have occurred in the diagnosis over time, and the rationale for change. The most significant changes being introduced with the DSM-5 are highlighted, as well as some of the concerns that will be a focus of attention with respect to the potential impacts going forward.

SUMMARY

The categorical divisions that characterized the pervasive developmental disorders are now collapsed into a single entity, autism spectrum disorder. The final DSM-5 criteria have yet to be formally compared prospectively against prior criteria, but early indications suggest that the boundaries around the pervasive developmental disorders have not been substantially altered.

Psychiatric assessment of severe presentations in autism spectrum disorders and intellectual disability

Children with autism spectrum and related disorders and intellectual disability are not protected from the experience of psychiatric illnesses. Many factors can contribute to exacerbation of existing behavioral symptoms or to the emergence of new psychiatric problems. The psychiatric assessment must thus take into account a range of possible etiologic or contributory factors. The approach outlined in this article highlights the value of assessing 4 broad domains, including diagnostic (genetic) factors, medical considerations, developmental influences, and environmental factors. Examples of how the consideration of each of these domains may inform the diagnostic formulation are highlighted.

Livestock bedding effects on two species of parasitoid wasps of filth flies

Choice of livestock bedding has been shown to affect density of filth fly maggots. Here, laboratory experiments indicate that bedding type can also affect natural enemies of the flies, specifically the parasitoid wasps Spalangia endius Walker and Urolepis rufipes (Ashmead) (Hymenoptera: Pteromalidae) parasitizing a natural host, the house fly Musca domestica L. (Diptera: Muscidae). For both parasitoid species, when females parasitized hosts under bedding, cedar shavings resulted in fewer parasitoids compared with pine shavings, but pine shavings did not differ from wood pellets and corn cob pellets. In the absence of exposure to hosts, longevity of adult females was reduced in cedar shavings compared with pine shavings and pellets. In contrast to the effects on parasitization and on adult survival, shavings treatment had no significant effect on the number of parasitoids or flies that emerged when hosts were not exposed to shavings until after parasitization.

Measuring repetitive behaviors as a treatment endpoint in youth with autism spectrum disorder

Restricted interests and repetitive behaviors vary widely in type, frequency, and intensity among children and adolescents with autism spectrum disorder. They can be stigmatizing and interfere with more constructive activities. Accordingly, restricted interests and repetitive behaviors may be a target of intervention. Several standardized instruments have been developed to assess restricted interests and repetitive behaviors in the autism spectrum disorder population, but the rigor of psychometric assessment is variable. This article evaluated the readiness of available measures for use as outcome measures in clinical trials. The Autism Speaks Foundation assembled a panel of experts to examine available instruments used to measure restricted interests and repetitive behaviors in youth with autism spectrum disorder. The panel held monthly conference calls and two face-to-face meetings over 14 months to develop and apply evaluative criteria for available instruments. Twenty-four instruments were evaluated and five were considered “appropriate with conditions” for use as outcome measures in clinical trials. Ideally, primary outcome measures should be relevant to the clinical target, be reliable and valid, and cover the symptom domain without being burdensome to subjects. The goal of the report was to promote consensus across funding agencies, pharmaceutical companies, and clinical investigators about advantages and disadvantages of existing outcome measures.

Mice exposed to diagnostic ultrasound in utero are less social and more active in social situations relative to controls

Clinical use of diagnostic ultrasound imaging during pregnancy has a long history of safety and diagnostic utility, as supported by numerous human case reports and epidemiological studies. However, there exist in vivo studies linking large but clinically relevant doses of ultrasound applied to mouse fetuses in utero to altered learning, memory, and neuroanatomy of those mice. Also, there exists a well-documented significant increase in the likelihood of non-right-handedness in boys exposed to diagnostic ultrasound in utero, potentially relevant given the increased prevalence of autism in males, and reports of excess non-right-handedness in this population. Motivated by these observations, we applied 30 minutes of diagnostic ultrasound to pregnant mice at embryonic day 14.5 and assayed the social behavior of their male pups 3 weeks after their birth. The ultrasound-exposed pups were significantly (P < 0.01) less interested in social interaction than sham-exposed pups in a three-chamber sociability test. In addition, they demonstrated significantly (P < 0.05) more activity relative to the sham-exposed pups, but only in the presence of an unfamiliar mouse. These results suggest that fetal exposure to diagnostic ultrasound applied in utero can alter typical social behaviors in young mice that may be relevant for autism. There exist meaningful differences between the exposure of diagnostic ultrasound to mice versus humans that require further exploration before this work can usefully inform clinical practice. Future work should address these differences as well as clarify the extent, mechanisms, and functional effects of diagnostic ultrasound's interaction with the developing brain.

Baseline factors predicting placebo response to treatment in children and adolescents with autism spectrum disorders: a multisite randomized clinical trial

IMPORTANCE

The finding of factors that differentially predict the likelihood of response to placebo over that of an active drug could have a significant impact on study design in this population.

OBJECTIVE

To identify possible nonspecific, baseline predictors of response to intervention in a large randomized clinical trial of children and adolescents with autism spectrum disorders.

DESIGN, SETTING, AND PARTICIPANTS

Randomized clinical trial of citalopram hydrobromide for children and adolescents with autism spectrum disorders and prominent repetitive behavior. Baseline data at study entry were examined with respect to final outcome to determine if response predictors could be identified. A total of 149 children and adolescents 5 to 17 years of age (mean [SD] age, 9.4 [3.1] years) from 6 academic centers were randomly assigned to citalopram (n = 73) or placebo (n = 76). Participants had autistic disorder, Asperger syndrome, or pervasive developmental disorder, not otherwise specified; had illness severity ratings that were moderate or more than moderate on the Clinical Global Impression-Severity scale; and scored moderate or more than moderate on compulsive behaviors measured with the modified Children's Yale-Brown Obsessive-Compulsive Scale.

INTERVENTIONS

Twelve weeks of treatment with citalopram (10 mg/5 mL) or placebo. The mean (SD) maximum dose of citalopram was 16.5 (6.5) mg by mouth daily (maximum dose, 20 mg/d).

MAIN OUTCOMES AND MEASURES

A positive response was defined as having a score of at least much improved on the Clinical Global Impression-Improvement scale at week 12. Baseline measures included demographic (sex, age, weight, and pubertal status), clinical, and family measures. Clinical variables included baseline illness severity ratings (the Aberrant Behavior Checklist, the Child and Adolescent Symptom Inventory, the Vineland Adaptive Behavior Scales, the Repetitive Behavior Scale-Revised, and the Children's Yale-Brown Obsessive-Compulsive Scale). Family measures included the Caregiver Strain Questionnaire.

RESULTS

Several baseline predictors of response were identified, and a principal component analysis yielded 3 composite measures (disruptive behavior, autism/mood, and caregiver strain) that significantly predicted response at week 12. Specifically, participants in the placebo group were significantly less likely than participants in the citalopram group to respond at week 12 if they entered the study more symptomatic on each of the 3 composite measures, and they were at least 2 times less likely to be responders.

CONCLUSIONS AND RELEVANCE

This analysis suggests strategies that may be useful in anticipating and potentially mitigating the nonspecific response in randomized clinical trials of children and adolescents with autism spectrum disorders.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT00086645.

Revisiting the relationship between autism and schizophrenia: toward an integrated neurobiology

Schizophrenia and autism have been linked since their earliest descriptions. Both are disorders of cerebral specialization originating in the embryonic period. Genetic, molecular, and cytologic research highlights a variety of shared contributory mechanisms that may lead to patterns of abnormal connectivity arising from altered development and topology. Overt behavioral pathology likely emerges during or after neurosensitive periods in which resource demands overwhelm system resources and the individual's ability to compensate using interregional activation fails. We are at the threshold of being able to chart autism and schizophrenia from the inside out. In so doing, the door is opened to the consideration of new therapeutics that are developed based upon molecular, synaptic, and systems targets common to both disorders.

Training of child and adolescent psychiatry fellows in autism and intellectual disability

Patients with autism spectrum disorders and intellectual disability can be clinically complex and often have limited access to psychiatric care. Because little is known about post-graduate clinical education in autism spectrum disorder and intellectual disability, we surveyed training directors of child and adolescent psychiatry fellowship programs. On average, child and adolescent psychiatry directors reported lectures of 3 and 4 h per year in autism spectrum disorder and intellectual disability, respectively. Training directors commonly reported that trainees see 1-5 patients with autism spectrum disorder or intellectual disability per year for outpatient pharmacological management and inpatient treatment. Overall, 43% of directors endorsed the need for additional resources for training in autism spectrum disorder and intellectual disability, which, coupled with low didactic and clinical exposure, suggests that current training is inadequate.

Exploring the manifestations of anxiety in children with autism spectrum disorders

This study explores the manifestation and measurement of anxiety symptoms in 415 children with ASDs on a 20-item, parent-rated, DSM-IV referenced anxiety scale. In both high and low-functioning children (IQ above vs. below 70), commonly endorsed items assessed restlessness, tension and sleep difficulties. Items requiring verbal expression of worry by the child were rarely endorsed. Higher anxiety was associated with functional language, IQ above 70 and higher scores on several other behavioral measures. Four underlying factors emerged: Generalized Anxiety, Separation Anxiety, Social Anxiety and Over-arousal. Our findings extend our understanding of anxiety across IQ in ASD and provide guidance for improving anxiety outcome measurement.