Pubmed du 26/06/19

mercredi 26 juin 2019

1. Gulsrud A, Carr T, Williams J, Panganiban J, Jones F, Kimbrough J, Shih W, Kasari C. Developmental screening and early intervention in a childcare setting for young children at risk for autism and other developmental delays : A feasibility trial. Autism Res ;2019 (Jun 26)

Efforts to decrease disparity in diagnosis and treatment for under-resourced children with developmental delays, such as autism spectrum disorder, have led to increased interest in developing programs in community settings. One potential setting that has already demonstrated feasibility in conducting universal screening is the childcare setting. The current study conducted developmental screening in a total of 116 children ages 16-80 months of age in an urban low-income community childcare center. Parents of 20 children who screened positive were enrolled in the intervention phase of the study, where children received a staff-delivered targeted early intervention or a waitlist control condition. Given the small and imbalanced sample sizes, confidence intervals from mixed effect models were used to measure changes across time for each group. Of the children who received treatment, there was an average increase in child initiated joint engagement, symbolic play, and language use. This study provides initial feasibility data for the implementation of a screening and early intervention program to service a predominantly low-resource and ethnically diverse population within the childcare system in a large metropolitan city. Autism Res 2019, (c) 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY : Identifying and delivering treatment services for young children with developmental delays, such as autism spectrum disorder, may be most successful in community settings, especially for those children from under-resourced areas. This study found preliminary evidence that the childcare setting is a good place to conduct screening and deliver early interventions for children at risk for autism and other developmental delays.

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2. Hirvikoski T, Boman M, Chen Q, D’Onofrio BM, Mittendorfer-Rutz E, Lichtenstein P, Bolte S, Larsson H. Individual risk and familial liability for suicide attempt and suicide in autism : a population-based study. Psychol Med ;2019 (Jun 26):1-12.

BACKGROUND : Studies on the individual gender-specific risk and familial co-aggregation of suicidal behaviour in autism spectrum disorder (ASD) are lacking. METHODS : We conducted a matched case-cohort study applying conditional logistic regression models on 54 168 individuals recorded in 1987-2013 with ASD in Swedish national registers : ASD without ID n = 43 570 (out of which n = 19035, 43.69% with ADHD) ; ASD + ID n = 10 598 (out of which n = 2894 individuals, 27.31% with ADHD), and 270 840 controls, as well as 347 155 relatives of individuals with ASD and 1 735 775 control relatives. RESULTS : The risk for suicidal behaviours [reported as odds ratio OR (95% confidence interval CI)] was most increased in the ASD without ID group with comorbid ADHD [suicide attempt 7.25 (6.79-7.73) ; most severe attempts i.e. requiring inpatient stay 12.37 (11.33-13.52) ; suicide 13.09 (8.54-20.08)]. The risk was also increased in ASD + ID group [all suicide attempts 2.60 (2.31-2.92) ; inpatient only 3.45 (2.96-4.02) ; suicide 2.31 (1.16-4.57)]. Females with ASD without ID had generally higher risk for suicidal behaviours than males, while both genders had highest risk in the case of comorbid ADHD [females, suicide attempts 10.27 (9.27-11.37) ; inpatient only 13.42 (11.87-15.18) ; suicide 14.26 (6.03-33.72) ; males, suicide attempts 5.55 (5.10-6.05) ; inpatient only 11.33 (9.98-12.86) ; suicide 12.72 (7.77-20.82)]. Adjustment for psychiatric comorbidity attenuated the risk estimates. In comparison to controls, relatives of individuals with ASD also had an increased risk of suicidal behaviour. CONCLUSIONS : Clinicians treating patients with ASD should be vigilant for suicidal behaviour and consider treatment of psychiatric comorbidity.

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3. Lindor ER, van Boxtel JJA, Rinehart NJ, Fielding J. Motor difficulties are associated with impaired perception of interactive human movement in autism spectrum disorder : A pilot study. J Clin Exp Neuropsychol ;2019 (Jun 26):1-19.

Introduction : The ability to accurately perceive human movement is fundamental to social functioning and known to be influenced by one’s own motor skills. In Autism Spectrum Disorder (ASD), there is ongoing debate about whether human movement perception is impaired. Given that motor skills vary considerably among these individuals, it may be that human movement perception is differentially affected as a function of motor proficiency. The aim of the current study was, thus, to explore whether individuals with ASD with and without motor difficulties differ in the way they visually attend to and perceive human movement. Method : Three groups of children aged 6 to 14 completed the study : an ASD group with motor difficulties (ASDMD), an ASD group without motor difficulties (ASDNMD), and a typically-developing control group (TD). All participants (N = 31) underwent eye-tracking while they viewed communicative interactions performed by two point-light actors. Primary analyses considered group differences in perceptual accuracy and gaze patterns. Results : Results revealed poorer perceptual accuracy in the ASDMD group compared to the ASDNMD and TD groups. Both ASD groups also exhibited gaze anomalies. Unlike the ASDNMD and TD groups who preferentially allocated their gaze to the actor initiating the interaction, the ASDMD group gazed at both actors equally. In contrast, the ASDNMD group shifted their gaze between the actors more frequently than the other groups. Conclusions : These preliminary findings suggest that individuals with ASD and co-occurring motor difficulties employ an atypical attentional style that may hinder accurate human movement perception, whereas those without motor difficulties may employ a compensatory attentional style that facilitates typical perception. Improving our understanding of how attention and perception are affected across the ASD spectrum has the potential to provide insight into the mechanisms that underlie the core social deficits that define this disorder.

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4. Shefer S, Leon Attia O, Rosenan R, Wald OA, Ende H, Gabis LV. Benefits of medical clowning in the treatment of young children with autism spectrum disorder. Eur J Pediatr ;2019 (Jun 26)

We investigated the contribution of group therapy delivered by a medical clown to young children diagnosed with autism spectrum disorder (ASD). So far, scientific publications regarding medical clowning focus on general health advantages. The current study is the first controlled research examining the use of medical clowning in the therapy for children with ASD. Twenty-four children aged 2-6 years old with ASD enrolled in our special education intensive program were examined before and after group sessions with clown intervention (CI) and other intervention (OI). We tested stereotypic behaviors, verbal expression, play reciprocity, and social smiles. Data was collected during 12 weeks of intervention, and the trajectory of change was evaluated in addition to the pre-/post-intervention.Conclusion : improvement over time in all measures : Significant increase in word production, play reciprocity, and amount of social smiles during CI as compared with OI. We also found a reduction in frequency of stereotypic behaviors during and following CI as compared with before CI. These preliminary results indicate that medical clowning may be beneficial for young children with ASD, since it promotes communication and social reciprocity in a fun and lively interventional setting. What is Known : * Many therapies are used and proven as efficacious interventions for children with ASD. * So far, medical clowning was not tested as an intervention or therapy for ASD. What is New : * Medical clowning sessions with children with ASD elicited enhanced communication during the interventions as compared with other interventions. * Medical clowning sessions contributed to a decrease in frequency of stereotypic movements over time, in children with ASD.

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