Pubmed du 13/03/19

mercredi 13 mars 2019

1. Alice Shillingsburg M, Cariveau T, Talmadge B, Frampton S. A Preliminary Analysis of Procedures to Teach Children with Autism to Report Past Behavior. The Analysis of verbal behavior. 2017 ; 33(2) : 275-82.

Deficits in reporting past behavior may have implications for a child’s social development and safety. Behavioral interpretations of memory and research on do/say correspondence provide valuable strategies to teach reporting past behavior when deficits are observed. The current study examined procedures to teach accurate reporting of past behavior following a delay for two children diagnosed with autism. During baseline, both participants accurately reported past behavior when immediately probed. Neither participant emitted accurate reporting following a delay during end-of-day probes. Treatment procedures included prompting, reinforcement, and fading procedures designed to maintain stimulus control across the delay. Both participants demonstrated accurate reporting of past behavior on delayed probes, including when conducted by a caregiver.

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2. Brown CC, Tilford JM, Payakachat N, Williams DK, Kuhlthau KA, Pyne JM, Hoefman RJ, Brouwer WBF. Measuring Health Spillover Effects in Caregivers of Children with Autism Spectrum Disorder : A Comparison of the EQ-5D-3L and SF-6D. PharmacoEconomics. 2019.

BACKGROUND AND OBJECTIVE : Healthcare interventions that improve the health of children with autism spectrum disorder (ASD) have the potential to affect the health of caregivers. This study compares the three-level EuroQoL-5 Dimension (EQ-5D-3L) and the Short Form-6 Dimension (SF-6D) in their ability to value such spillover effects in caregivers. METHODS : Clinical data collected from two Autism Treatment Network (ATN) sites was combined with survey data of caregivers of children diagnosed with ASD. Caregivers completed instruments by proxy describing child health and completed the EQ-5D-3L and SF-6D preference-weighted instruments to describe their own health. RESULTS : There was a strong correlation between the health utility scores of the two preference-weighted instruments (rho = 0.6172, p < 0.001) measuring caregiver health-related quality of life. There was a similar correlation between both the SF-6D and EQ-5D-3L scores with a previously validated care-related quality of life measure (Care-related Quality of Life instrument [CarerQol-7D]) (rho = 0.569, p < 0.001 and rho = 0.541, p < 0.001, respectively). The mean SF-6D scores for caregivers differed significantly in relation to four of the five child health or behavior measures whereas the EQ-5D-3L differed for only two of them. CONCLUSIONS : Health utility values of caregivers for children with ASD vary by the health characteristics of the child, suggesting significant potential for spillover effects. The comparison of the EQ-5D-3L and SF-6D demonstrated that both instruments can be used to estimate spillover effects of interventions to improve child health, but the SF-6D exhibited greater sensitivity to child health among children with ASD.

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3. Canning DA. Re : Congenital Abnormalities of the Male Reproductive System and Risk of Autism Spectrum Disorders. The Journal of urology. 2019 : 10109701JU000055465262672d8.

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4. Chauhan A, Sahu JK, Jaiswal N, Kumar K, Agarwal A, Kaur J, Singh S, Singh M. Prevalence of autism spectrum disorder in Indian children : A systematic review and meta-analysis. Neurology India. 2019 ; 67(1) : 100-4.

Background : Autism spectrum disorder (ASD) is a developmental disability and is of public health importance. It affects not only the child and the family. It also has direct and indirect cost implications on the nation that are incurred in providing health care, support for education, and rehabilitative services. There is a lack of evidence-based estimate of the population prevalence of ASD in India. Therefore, this systematic review was aimed at determining the prevalence of ASD in the Indian population. Materials and Methods : We conducted a systematic review and meta-analysis of the published studies evaluating the prevalence of ASD in the community setting. A search within the published literature was conducted from different databases (PubMed, OvidSP, and EMBASE). The analysis of data was done using STATA MP12 (StataCorp, College Station, TX, USA). Results : Four studies were included in this systematic review. Of the four included studies, one had studied both urban and rural populations, and the other three had studied the urban populations only. The study from the rural setting showed a pooled percentage prevalence of 0.11 [95% confidence interval (CI) 0.01-0.20] in children aged 1-18 years ; and, four studies conducted in the urban setting showed a pooled percentage prevalence of 0.09 (95% CI 0.02-0.16) in children aged 0-15 years. Conclusion : The scarcity of high-quality population-based epidemiological studies on ASD in India highlights an urgent need to study the burden of ASD in India. The proper acquisition of data related to the prevailing burden of ASD in India would lead to a better development of rehabilitative services in our country.

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5. Dellapiazza F, Michelon C, Oreve MJ, Robel L, Schoenberger M, Chatel C, Vesperini S, Maffre T, Schmidt R, Blanc N, Vernhet C, Picot MC, Baghdadli A. The Impact of Atypical Sensory Processing on Adaptive Functioning and Maladaptive Behaviors in Autism Spectrum Disorder During Childhood : Results From the ELENA Cohort. J Autism Dev Disord. 2019.

Atypical sensory processing is common in autism spectrum disorders (ASD), but their role in adaptive difficulties and problem behaviors is poorly understood. Our aim was to determine the prevalence and type of atypical sensory processing in children with ASD and investigate its impact on their adaptive functioning and maladaptive behaviors. We studied a subsample of 197 children rigorously diagnosed with ASD from the ELENA cohort. Children were divided into atypical and typical sensory processing groups and several independent variables were compared, including adaptive functioning and maladaptive behaviors. Overall, 86.8% of the children had at least one atypical sensory pattern and all sensory modalities were disturbed. Atypical sensory processing explained a significant part of the variance of behavioral problems.

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6. DeSouza AA, Akers JS, Fisher WW. Empirical Application of Skinner’s Verbal Behavior to Interventions for Children with Autism : A Review. The Analysis of verbal behavior. 2017 ; 33(2) : 229-59.

Sundberg and Michael (2011) reviewed the contributions of Skinner’s (1957) Verbal Behavior to the treatment of language delays in children with autism spectrum disorder (ASD) and discussed several aspects of interventions, including mand training, intraverbal repertoire development, and the importance of using Skinner’s taxonomy of verbal behavior in the clinical context. In this article, we provide an update of Sundberg and Michael’s review and expand on some discussion topics. We conducted a systematic review of studies that focused on Skinner’s verbal operants in interventions for children with ASD that were published from 2001 to 2017 and discussed the findings in terms of journal source, frequency, and type of verbal operant studied.

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7. Dixon MR, Stanley C, Belisle J, Galliford ME, Alholail A, Schmick AM. Establishing Derived Equivalence Relations of Basic Geography Skills in Children with Autism. The Analysis of verbal behavior. 2017 ; 33(2) : 290-5.

The present study evaluated the efficacy of a stimulus-equivalence training procedure in teaching basic geography skills to two children with autism. The procedures were taken directly from a standardized training curriculum based in stimulus equivalence theory called Promoting the Emergence of Advanced Knowledge Equivalence Module (PEAK-E). Results suggest that the procedures were efficacious in directly training several geographical relations, as well as promoting the derivation of several untrained relations for three countries and their corresponding continents. In addition, responding generalized from selecting countries on a tabletop paper map to selecting countries on an interactive touchscreen map.

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8. Gulati S, Kaushik JS, Saini L, Sondhi V, Madaan P, Arora NK, Pandey RM, Jauhari P, Manokaran RK, Sapra S, Sharma S, Paul VK, Sagar R. Development and validation of DSM-5 based diagnostic tool for children with Autism Spectrum Disorder. PLoS One. 2019 ; 14(3) : e0213242.

Diagnostic and Statistical Manual of mental disorder-IV (DSM-IV) TR based INCLEN Diagnostic Tool for Autism Spectrum Disorder (INDT-ASD) is an established instrument for the diagnosis of ASD in Indian subcontinent and low-middle income countries (LMIC). The introduction of DSM-5 necessitated revision of existing INDT-ASD tool to incorporate the DSM-5 related changes. This study was undertaken to develop and validate the DSM-5 based All India Institute of Medical Sciences (AIIMS)-Modified-INDT-ASD Tool. The modifications were done using Delphi method and included : (a) rearrangement of questions from the previous tool ; and (b) addition of new questions on sensory symptoms. The modified tool was validated against DSM-5 diagnostic criteria. In addition, receiver operating characteristic (ROC) curves were used to determine the cut-off for total score as compared to Childhood Autism Rating Scale (CARS) score to grade the severity of ASD. Two-hundred-twenty-five children (159 boys, median age = 47months) were enrolled. The modified tool demonstrated sensitivity of 98.4% and specificity of 91.7% to diagnose ASD. A score >/=14 on the tool was suggestive of severe ASD (CARS>36.5) with a sensitivity and specificity of 80% and 80.7% respectively [Area under the curve = 0.89]. AIIMS-Modified-INDT-ASD Tool is a simple and structured instrument based on DSM-5 criteria which can facilitate diagnosis of ASD with acceptable diagnostic accuracy.

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9. Hartley C, Bird LA, Monaghan P. Investigating the relationship between fast mapping, retention, and generalisation of words in children with autism spectrum disorder and typical development. Cognition. 2019 ; 187 : 126-38.

While many studies have investigated how autism spectrum disorder (ASD) impacts how children identify the meanings of new words, this task alone does not constitute learning. Here we investigate fast (referent selection) and slow (retention, generalisation) word learning processes as an integrated system and explore relationships between these mechanisms in ASD and typical development. In Study 1, children with ASD and typically developing (TD) children matched on receptive vocabulary utilised mutual exclusivity to identify referents of unfamiliar words, but showed substantially reduced accuracy on delayed retention and generalisation trials. Thus, Study 2 investigated whether re-directing children’s attention to target objects following referent selection would enhance delayed retention. Participants received either social feedback (target objects were labelled and highlighted via social cues) or non-social feedback (target objects were labelled and highlighted via a flashing light). In both conditions, children with ASD were less accurate in their use of mutual exclusivity to fast-map novel words than TD children. However, children with ASD who received social feedback responded more accurately on delayed retention and generalisation trials than TD controls, and children with ASD who received non-social feedback or no feedback (in Study 1). Our findings imply that fundamental word learning mechanisms, and the relationships between them, are not qualitatively different in ASD. We argue that ASD may affect the efficiency of these mechanisms by disrupting children’s intake of linguistic input in natural environments, but difficulties may be mitigated by presenting visual and auditory stimuli in a way that appeals to the population’s strengths.

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10. Hurt L, Langley K, North K, Southern A, Copeland L, Gillard J, Williams S. Understanding and improving the care pathway for children with autism. International journal of health care quality assurance. 2019 ; 32(1) : 208-23.

PURPOSE : The purpose of this paper is to describe current care pathways for children with autism including enablers and barriers, as experienced by health professionals, education professionals and families in South Wales, UK. DESIGN/METHODOLOGY/APPROACH : This study is based on a mixed-methods approach using focus group discussions, creative writing workshops and visualisation using rich pictures. FINDINGS : The experiences of the care pathways differed significantly across the three groups. Health professionals described the most rigidly structured pathways, with clear entry points and outcomes. Education professionals and parents described more complex and confusing pathways, with parents assuming the responsibility of coordinating the health and education activity in a bid to link the two independent pathways. All three groups identified enablers, although these differed across the groups. The barriers were more consistent across the groups (e.g. poor communication, missing information, lack of transparency, limited post-diagnosis services and access to services based on diagnosis rather than need). PRACTICAL IMPLICATIONS : This research could inform the design of new services which are premised on multi-agency and multi-disciplinary working to ensure children with Autism spectrum disorders (ASD) receive joined up services and support. ORIGINALITY/VALUE : Although this study did not represent all professional groups or all experiences of autism, the authors examined three different perspectives of the ASD pathway. In addition, the authors triangulated high-level process maps with rich pictures and creative writing exercises, which allowed the authors to identify specific recommendations to improve integration and reduce duplication and gaps in provision.

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11. Katsigianni M, Karageorgiou V, Lambrinoudaki I, Siristatidis C. Maternal polycystic ovarian syndrome in autism spectrum disorder : a systematic review and meta-analysis. Mol Psychiatry. 2019.

There is evidence showing a positive correlation between prenatal androgens and their effect on the development of central nervous system and the autistic spectrum disorder (ASD) phenotype in offspring of mothers with polycystic ovary syndrome (PCOS). We applied a systematic review to investigate whether women with PCOS have increased odds of having a child with ASD, while, secondarily, if these women themselves are at high risk of having the disease. Major databases from inception until 14th October 2018 were searched. The primary outcome measure was the odds of an ASD diagnosis in children of mothers with diagnosed PCOS, while the secondary outcome was the odds of ASD diagnosis in women with PCOS. Scheduled subgroup analyses were according to the time of birth and maternal age. We assessed the odds ratio (OR), using a random-effects model ; heterogeneity was assessed by I(2) and tau(2) statistics. The quality of the evidence was evaluated using the Newcastle-Ottawa Scale. Ten studies were eligible for inclusion, including a total of 33,887 ASD children and 321,661 non-ASD children. Diagnosed PCOS was associated with a 1.66 times increase in the odds of ASD in the offspring [95% CI : 1.51, 1.83, p = 1.99 x 10(-25), 7 studies, I(2) = 0%, tau(2) = 0]. Women with PCOS were 1.78 times more likely to be diagnosed with ASD (95% CI : 1.10, 2.87, p = 0.0179, 5 studies, I(2) = 85.4%, tau(2) = 0.2432). Additional analyses did not change the initial result. The overall quality of the evidence was high. The pooled effects size displayed low heterogeneity (I(2) = 0%) for the primary outcome. While the heterogeneity in the secondary outcome appears to attenuate when only high quality studies are synthesized, still the result exhibits significant heterogeneity. Tauhe available data allowed a subgroup analysis only for classification system for PCOS diagnosis and showed a significant increase of ASD diagnosis in the offspring of women with Read Code and ICD diagnosed PCOS. In conclusion, the available evidence suggests that women with PCOS have increased odds of having a child with ASD, an effect size estimate based on a large number of patients from studies of good quality. Regarding the evidence on the prevalence of ASD in PCOS women, results suggest that women with PCOS are more likely to be diagnosed with ASD.

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12. Lee K, Vyas Y, Garner CC, Montgomery JM. Autism-associated Shank3 mutations alter mGluR expression and mGluR-dependent but not NMDA receptor-dependent long-term depression. Synapse (New York, NY). 2019.

SHANK3 is a postsynaptic structural protein localized at excitatory glutamatergic synapses in which deletions and mutations have been implicated in patients with Autism Spectrum Disorders (ASD). The expression of Shank3 ASD mutations causes impairments in ionotropic glutamate receptor-mediated synaptic responses in neurons, which is thought to underlie ASD-related behaviours, thereby indicating glutamatergic synaptopathy as one of the major pathogenic mechanisms. However little is known about the functional consequences of ASD-associated mutations in Shank3 on another important set of glutamate receptors, group I metabotropic glutamate receptors (mGluRs). Here we further assessed how Shank3 mutations identified in patients with ASD (one de novo InsG mutation and two inherited point mutations, R87C and R375C) disrupt group I mGluR (mGluR1 and mGluR5) expression and function. To identify potential isoform-specific deficits induced by ASD-associated Shank3 mutations on group I mGluRs, we surface immuno-labeled mGluR1 and mGluR5 independently. We also induced mGluR-dependent synaptic plasticity (R,S-3,5-dihydroxyphenylglycine [DHPG]-induced long-term depression [LTD]) as well as N-methyl-D-aspartate receptor (NMDAR)-dependent LTD. ASD-associated mutations in Shank3 differentially interfered with the ability of cultured hippocampal neurons to express mGluR5 and mGluR1 at synapses. Intriguingly, all ASD Shank3 mutations impaired mGluR-dependent LTD without altering NMDAR-dependent LTD. Our data show that the specific perturbation in mGluR-dependent synaptic plasticity occurs in neurons expressing ASD-associated Shank3 mutations, which may underpin synaptic dysfunction and subsequent behavioural deficits in ASD. This article is protected by copyright. All rights reserved.

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13. Locke J, Lawson GM, Beidas RS, Aarons GA, Xie M, Lyon AR, Stahmer A, Seidman M, Frederick L, Oh C, Spaulding C, Dorsey S, Mandell DS. Individual and organizational factors that affect implementation of evidence-based practices for children with autism in public schools : a cross-sectional observational study. Implementation science : IS. 2019 ; 14(1) : 29.

BACKGROUND : Children with autism receive most of their intervention services in public schools, but implementation of evidence-based practices (EBPs) for autism varies. Studies suggest that individual (attitudes) and organizational characteristics (implementation leadership and climate) may influence providers’ use of EBPs, but research is relatively limited in this area. This study examined individual and organizational factors associated with implementation of three EBPs-discrete trial training, pivotal response training, and visual schedules-for children with autism in special education classrooms in public elementary schools. METHODS : Participants included 67 autism support teachers and 85 other classroom staff from 52 public elementary schools in the northeastern United States. Participants reported their attitudes toward EBPs (e.g., intuitive appeal, willingness if required, openness, and divergence), implementation leadership and climate of their school, and the frequency with which they deliver each of three EBPs. Linear regression was used to estimate the association of attitudes about EBPs with organizational characteristics and intensity of EBP use. Demographic covariates with a bivariate association with EBP use significant at p < .20 were entered into the adjusted models. RESULTS : There were significant findings for only one EBP, discrete trial training. Teachers who reported higher perceived divergence (perceived difference of usual practice with academically developed or research-based practices) between EBPs and current practices used less discrete trial training (f(2) = .18), and teachers who reported higher appeal (willingness to adopt EBPs given their intuitive appeal) of EBPs used more discrete trial training (f(2) = .22). No organizational factors were significantly associated with implementation with any of the three EBPs. CONCLUSIONS : Attitudes toward EBPs may affect teachers’ decisions to use EBPs ; however, implementation leadership and climate did not predict EBP use. Future implementation efforts ought to consider the type of EBP and its fit within the context in terms of the EBP’s similarities to and differences from existing practices and programs in the setting. Implementation strategies that target individual attitudes about EBPs may be warranted in public schools.

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14. Lodder A, Papadopoulos C, Randhawa G. Stigma of living as an autism carer : a brief psycho-social support intervention (SOLACE). Study protocol for a randomised controlled feasibility study. Pilot and feasibility studies. 2019 ; 5 : 34.

Background : Stigma is prominent in the lives of autistic individuals and their families and contributes significantly to the challenges faced by families raising an autistic child. Parents and carers can feel blamed for their child’s behaviour, feel socially excluded and isolated and suffer from low self-esteem and poor psychological well-being. This increases the risk of experiencing self-stigma which further exacerbates these and other negative consequences. Therefore, there is a need for interventions that help parents/family carers cope with autism-related stigma as well as prevent the internalisation of stigma. Objectives : The primary objective of this study is to assess the feasibility and acceptability of a stigma support intervention for parents and carers of autistic children titled ’Stigma of Living as an Autism Carer (SOLACE)’. The secondary objective is to explore the preliminary impact of the intervention on the mental health of the parents and carers. Methods : A pilot randomised controlled trial feasibility study will be implemented. A group receiving the SOLACE stigma support intervention (n = 12) will be compared against a control group not receiving any additional intervention (n = 12). Family carers of autistic children up to the age of 10, who have been recently diagnosed or are currently undergoing diagnosis, will be recruited for the study. Participants will be randomly allocated to the intervention or control group and will take part in eight weekly group-based sessions designed to improve the well-being of the parents primarily through increasing their resilience to stigma. Feasibility will be determined by recruitment and retention rates and a qualitative focus group evaluating the acceptability of the intervention and outcome measures. The primary outcome of interest is psychological well-being, and depending on the normality of distribution, independent samples T tests will be used to compare the outcome scores between the two groups and dependent samples T tests for differences within the group. Other outcomes of interest are stigma, self-stigma, self-esteem, self-blame, social isolation, self-compassion and perceived responsibility and control. Discussion : Results from the feasibility randomised controlled trial will be used to refine the study protocol and inform the design of an intervention for future use in a larger, powered trial. SOLACE could potentially improve the psychological well-being of parents/family carers of autistic children through increased resistance to stigma. Trial registration : ISRCTN Registry number ISRCTN61093625 (October 13, 2017).

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15. Mullen S, Dixon MR, Belisle J, Stanley C. Establishing auditory-tactile-visual equivalence classes in children with autism and developmental delays. The Analysis of verbal behavior. 2017 ; 33(2) : 283-9.

The current study sought to evaluate the efficacy of a stimulus equivalence training procedure in establishing auditory-tactile-visual stimulus classes with 2 children with autism and developmental delays. Participants were exposed to vocal-tactile (A-B) and tactile-picture (B-C) conditional discrimination training and were tested for the emergence of vocal-picture (A-C) and picture-vocal (C-A) responses. The results demonstrated that, following training, both participants responded successfully on both the training stimulus arrangements and the test probes that were never trained, illustrating emergence of cross-modal transitive and equivalence relations.

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16. Papp LM, Hartley SL. Mothers’ and Fathers’ Prescription Drug Misuse in Family Contexts : Implications for the Adjustment of Parents of Children With and Without Autism. Addiction research & theory. 2018 ; 26(4) : 267-74.

Although prescription drug misuse is an identified risk factor for individuals’ outcomes, less is known about its occurrence in and implications for families. To address this limitation, we examined whether mothers’ and fathers’ prescription drug misuse is associated with the adjustment of parents, including those with a child with autism spectrum disorder (ASD) and those without. Mothers and fathers from families with a child with ASD (n = 178) and comparison families without a child with ASD (n = 174) completed surveys of past-year prescription drug misuse and their personal and relationship adjustment. In total, 7.7% (N = 27) of mothers and 8.2% (N = 29) of fathers reported recent prescription drug misuse. There was significant interdependence between mothers’ and fathers’ recent prescription drug misuse in families with a child with ASD but not in comparison families. Actor-partner interdependence modeling was used to examine associations between parents’ prescription drug misuse and their own and their partner’s adjustment, controlling for medical use of prescription drugs and demographic covariates. Across family diagnosis statuses, mothers’ prescription drug misuse predicted higher levels of their own alcohol problems, whereas fathers’ prescription drug misuse related only to mothers’ poorer sleep quality. Moreover, mothers’ prescription drug misuse was associated with higher levels of their own depression symptoms in ASD-status (but not in comparison) families. Understanding parents’ prescription drug misuse and its effects on family members is critical for informing future research and prevention and treatment strategies.

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17. Reed P, Giles A, White S, Osborne LA. Actual and perceived speedy diagnoses are associated with mothers’ unresolved reactions to a diagnosis of autism spectrum disorder for a child. Autism. 2019 : 1362361319833676.

Reaction to a child’s diagnosis can strongly affect the parent, but little is known about the aspects of the diagnostic process associated with such reactions. The pre-diagnostic levels of anxiety, depression, and parenting stress of 67 volunteer mothers of children subsequently diagnosed with autism spectrum disorder were assessed, along with the children’s functioning. The speed and number of professionals involved in the diagnosis were recorded, and mothers completed a post-diagnosis assessment of their perceptions of the process. Longer actual and perceived diagnosis speeds predicted resolved reactions to diagnosis. Mothers’ psychological states pre-diagnosis did not predict reactions to diagnosis. Providing a measured diagnostic process, and strong relationship with mothers, rather than aiming for speed alone, may well be more productive for the parent and child.

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18. Shulman L, D’Agostino E, Lee S, Valicenti-McDermott M, Seijo R, Tulloch E, Meringolo D, Tarshis N. When an Early Diagnosis of Autism Spectrum Disorder Resolves, What Remains ?. Journal of child neurology. 2019 : 883073819834428.

A chart review was performed of 38 children diagnosed with autism spectrum disorder (ASD) by 3 years of age at an inner-city developmental program who subsequently experienced resolution of ASD symptomatology and no longer met diagnostic criteria for ASD at follow-up an average of 4 years later. Demographic, developmental/cognitive data, Childhood Autism Rating Scale, and Autism Diagnostic Observation Schedule data as available were reviewed from the initial diagnostic evaluation and at the time of follow-up. Services received by the children between the time of diagnosis and follow-up, educational setting at the time of follow-up, and emotional/behavioral and learning diagnoses made by the multidisciplinary team at follow-up were reviewed. The findings indicate that residual emotional/behavioral and learning problems were present at follow-up in the vast majority of children in this group and that the majority continued to require educational support.

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19. Siqueiros Sanchez M, Pettersson E, Kennedy DP, Bolte S, Lichtenstein P, D’Onofrio BM, Falck-Ytter T. Visual Disengagement : Genetic Architecture and Relation to Autistic Traits in the General Population. J Autism Dev Disord. 2019.

Visual disengagement has been hypothesized as an endophenotype for autism. In this study we used twin modelling to assess the role of genetics in basic measures of visual disengagement, and tested their putative association to autistic traits in the general population. We used the Gap Overlap task in a sample of 492 twins. Results showed that most of the covariance among eye movement latencies across conditions was shared and primarily genetic. Further, there were unique genetic contributions to the Gap condition, but not to the Overlap condition-i.e. the one theorized to capture visual disengagement. We found no phenotypic association between autistic traits and disengagement, thus not supporting the hypothesis of visual disengagement as an endophenotype for autistic traits.

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20. Solari EJ, Grimm RP, McIntyre NS, Zajic M, Mundy PC. Longitudinal stability of reading profiles in individuals with higher functioning autism. Autism. 2019 : 1362361318812423.

The reading difficulties of individuals with autism spectrum disorders have been established in the literature, with particular attention drawn toward reading comprehension difficulties. Recent papers have highlighted the heterogeneous nature of reading abilities in this population by utilizing statistical methods that allow for investigations of unique reading profiles. This article extends this literature by investigating reading profiles longitudinally, to investigate the stability of reader profiles across time. Latent profile and transition analyses were conducted to establish categorically distinct reading profiles at two time points, 30 months apart. This study also examined whether age and autism symptom severity were related to the profiles at each time point. Finally, transitions between profiles at each time point were identified. Age did not predict profile membership, but there were significant differences in symptom severity that were largely stable over time. Results indicate that heterogeneous reading profiles exist within the autism population, ranging from average reading ability to severe difficulties across different reading subskills. The data from this study demonstrate that reading profiles of children and adolescents with autism spectrum disorders shift when examined across time.

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21. Stahmer AC, Vejnoska S, Iadarola S, Straiton D, Segovia FR, Luelmo P, Morgan EH, Lee HS, Javed A, Bronstein B, Hochheimer S, Cho E, Aranbarri A, Mandell D, Hassrick EM, Smith T, Kasari C. Caregiver Voices : Cross-Cultural Input on Improving Access to Autism Services. Journal of racial and ethnic health disparities. 2019.

Decades of research have established that racial ethnic minority, low-income, and/or non-English speaking children with autism spectrum disorder (ASD) are diagnosed later than white children, and their families experience greater difficulty accessing services in the USA. Delayed access to timely diagnosis and early intervention may impact child outcomes and family quality of life. Despite their cognition of these disparities and their significant impact on the lives of those affected, explanations for the barriers experienced by underserved families are elusive, likely due to the complex interaction between structural and family factors. This study used qualitative methods to gather family and provider perspectives of perceived barriers and facilitators to obtaining an ASD diagnosis and accessing ASD-related services for underserved families. Themes from focus groups and interviews with families from three cultural groups (black, Hispanic/Latino, and Korean) and three primary languages (English, Korean, and Spanish) highlight specific barriers related to family, community, and systemic challenges as well as facilitators to accessing care for these populations. Family experiences are expanded upon with viewpoints from the providers who work with them. Recommendations are made for reducing disparities in the existing ASD service system including increasing professional, family, and community education ; increasing culturally responsive care ; improving provider-family partnerships ; and addressing practical challenges to service access.

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22. Stauch T, LaLonde K, Plavnick JB, Savana Bak MY, Gatewood K. Intraverbal Training for Individuals with Autism : The Current Status of Multiple Control. The Analysis of verbal behavior. 2017 ; 33(1) : 98-116.

Teaching complex intraverbal responding to children with autism spectrum disorder (ASD) can be challenging and often requires careful programming. Divergent and convergent multiple control are particularly important elements to incorporate into intraverbal training programs, as well as procedures to ensure responding is under control of both discriminative and conditional vocal verbal stimuli. The current study systematically reviewed research articles on intraverbal training methods for individuals with ASD published and available from 2005 to 2016. The purpose of the review was to assess the extent to which divergent and convergent control was incorporated into training and to determine whether systematic instruction ensured correct verbal conditional discriminations. Thirty-six studies met inclusion criteria and were included in this reviewed. A total of 5 studies taught intraverbal responding under divergent control and 21 taught responding under convergent control. Two studies sufficiently described procedures to ensure accurate verbal conditional discriminations across trials. The results highlight the need for additional research on systematic teaching procedures for complex intraverbal repertoires.

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23. Sun X, Allison C, Wei L, Matthews FE, Auyeung B, Wu YY, Griffiths S, Zhang J, Baron-Cohen S, Brayne C. Autism prevalence in China is comparable to Western prevalence. Mol Autism. 2019 ; 10 : 7.

Background : Autism prevalence in the West is approximately 1% of school age children. Autism prevalence in China has been reported to be lower than in the West. This is likely due to at least two reasons : (1) most studies in China only included the special school population, overlooking the mainstream school population ; and (2) most studies in China have not used contemporary screening and diagnostic methods. To address this, we tested total autism prevalence (mainstream and special schools) in Jilin City, and mainstream school autism prevalence in Jiamusi and Shenzhen cities. Methods : The study included a three-step process : (1) screening ; (2) clinical assessment of ’screen positives’ plus controls ; and (3) research diagnostic assessment of those meeting clinical threshold for concerns at step 2. Prevalence estimates per 10,000 children aged 6-10 years old were weighted for study design using diagnostic criteria applied at the research assessment stage. Results : In Jilin City, 77 cases of autism were identified from a total population of 7258, equating to a prevalence of 108 per 10,000 (95% confidence interval (CI) 89, 130). In Shenzhen City : 21,420 children were screened and 35 cases of autism were identified, resulting in a mainstream prevalence of 42 per 10,000 (95% CI 20-89). In Jiamusi City, 16,358 children were screened, with 10 autism cases being identified, with a mainstream prevalence of 19 per 10,000 (95% CI 10-38). Conclusions : Results from Jilin City, where both mainstream and special school data were available, revealed a similar prevalence of autism in China to the West, at around 1%. Results from Shenzhen and Jiamusi cities, where only mainstream data were available, prevalence is also in line with Western estimates. In all three cities, new cases of autism were identified by the study in mainstream schools, reflecting current under-diagnosis. Non-significant variation across different cities is seen indicating the need to explore potential variation of autism across diverse Chinese regions with large sample sizes to achieve a fully robust national picture.

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24. Trutzer IM, Garcia-Cabezas MA, Zikopoulos B. Postnatal development and maturation of layer 1 in the lateral prefrontal cortex and its disruption in autism. Acta neuropathologica communications. 2019 ; 7(1) : 40.

Autism is a neurodevelopmental connectivity disorder characterized by cortical network disorganization and imbalance in excitation/inhibition. However, little is known about the development of autism pathology and the disruption of laminar-specific excitatory and inhibitory cortical circuits. To begin to address these issues, we examined layer 1 of the lateral prefrontal cortex (LPFC), an area with prolonged development and maturation that is affected in autism. We focused on layer 1 because it contains a distinctive, diverse population of interneurons and glia, receives input from feedback and neuromodulatory pathways, and plays a critical role in the development, maturation, and function of the cortex. We used unbiased quantitative methods at high resolution to study the morphology, neurochemistry, distribution, and density of neurons and myelinated axons in post-mortem brain tissue from children and adults with and without autism. We cross-validated our findings through comparisons with neighboring anterior cingulate cortices and optimally-fixed non-human primate tissue. In neurotypical controls we found an increase in the density of myelinated axons from childhood to adulthood. Neuron density overall declined with age, paralleled by decreased density of inhibitory interneurons labeled by calretinin (CR), calbindin (CB), and parvalbumin (PV). Importantly, we found PV neurons in layer 1 of typically developing children, previously detected only perinatally. In autism there was disorganization of cortical networks within layer 1 : children with autism had increased variability in the trajectories and thickness of myelinated axons in layer 1, while adults with autism had a reduction in the relative proportion of thin axons. Neurotypical postnatal changes in layer 1 of LPFC likely underlie refinement of cortical activity during maturation of cortical networks involved in cognition. Our findings suggest that disruption of the maturation of feedback pathways, rather than interneurons in layer 1, has a key role in the development of imbalance between excitation and inhibition in autism.

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25. Yeh ML, Levine ES. Perspectives on the Role of Endocannabinoids in Autism Spectrum Disorders. OBM neurobiology. 2017 ; 1(2).

Autism spectrum disorders (ASDs) are diagnosed on the basis of three behavioral features, namely, (1) deficits in social communication, (2) absence or delay in language and (3) stereotypy. The consensus regarding the neurological pathogenesis of ASDs is aberrant synaptogenesis and synapse function. Further, it is now widely accepted that ASD is neurodevelopmental in nature, placing emphasis on derangements occurring at the level of intra- and intercellular signaling during corticogenesis. At present, there is an ever-growing list of mutations in putative susceptibility genes in affected individuals, preventing effective transformation of knowledge gathered from basic science research to the clinic. In response, the focus of ASD biology has shifted toward the identification of cellular signaling pathways that are common to various ASD-related mutations in hopes that these shared pathways may serve as more promising treatment targets than targeting individual genes or proteins. To this end, the endogenous cannabinoid (endocannabinoid, eCB) system has recently emerged as a promising therapeutic target in the field of ASD research. The eCB system is altered in several neurological disorders, but the role of these bioactive lipids in ASD etiology remains poorly understood. In this perspective, we review current evidence linking eCB signaling to ASDs and put forth the notion that continued focus on eCBs in autism research may provide valuable insight into pathophysiology and treatment strategies. In addition to its role in modulating transmitter release at mature synapses, the eCB signaling system plays important roles in many aspects of cortical development, and disruption of these effects of eCBs may also be related to ASD pathophysiology.

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26. Zablotsky B, Maenner MJ, Blumberg SJ. Geographic disparities in treatment for children with autism spectrum disorder. Academic pediatrics. 2019.

OBJECTIVE : Geographic differences may provide insight into what factors influence the likelihood that a child is diagnosed with ASD in the US, yet there have been few nationally representative surveys that have explored this topic. The current study expands the limited literature by analyzing regional differences in ASD prevalence, service utilization, and the presence of unmet needs within a nationally representative sample of children. METHODS : Data were drawn from the 2014-2016 National Health Interview Survey (NHIS), a nationally representative household survey of the noninstitutionalized US population. Children 3-17 were included in the analytic sample. Prevalence estimates accounted for the complex survey design of the NHIS, and differences between geographic regions were compared using logistic/linear regressions with and without adjustment for child/family characteristics. RESULTS : The prevalence of ASD was highest in the Northeast (3.0%), followed by the Midwest (2.4%), South (2.4%), and West (2.3%). A significant difference was found between the Northeast and West (p<.05). However, after accounting for child and family characteristics, this difference was no longer significant. Children with ASD in the Northeast were the most likely to have seen a specialist in the past year. Approximately 1 in 8 children with ASD experienced at least one unmet need, but there were no differences found by geographic region. CONCLUSIONS : Although differences in prevalence were not significant after adjustment, service utilization differences remained. It appears children with ASD in the Northeast utilize the greatest number of specialty services when compared to children with ASD from other parts of the country.

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