Pubmed du 20/08/19

mardi 20 août 2019

1. Bakare MO, Taiwo OG, Bello-Mojeed MA, Munir KM. Autism Spectrum Disorders in Nigeria : A Scoping Review of Literature and Opinion on Future Research and Social Policy Directions. Journal of health care for the poor and underserved. 2019 ; 30(3) : 899-909.

INTRODUCTION : Research about autism spectrum disorder (ASD) in sub-Saharan Africa is sparse and limited. However, research studies coming from Nigeria in West Africa as a country have contributed significantly to the subject of ASD in sub-Saharan Africa. METHODS AND RESULTS : This study is a scoping review of research literature on ASD in Nigeria through June 2017 conducted by searching the key terms autism and Nigeria on PubMed and Google Scholar. Included in the review are works concerning case reports and co-morbidities associated with ASD in Nigeria ; prevalence of ASD ; genetic study of ASD ; clinical characteristics of children with ASD ; knowledge and awareness about ASD ; socio-cultural factors affecting ASD. Expert opinion on social policy and public health issues affecting ASD in Nigeria are discussed. CONCLUSION : Wide research and intervention gaps are noted and we suggest directions for future research, social policy development, and intervention services for individuals with ASD in Nigeria.

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2. Ballester P, Martinez MJ, Inda MD, Javaloyes A, Richdale AL, Muriel J, Belda C, Toral N, Morales D, Fernandez E, Peiro AM. Evaluation of agomelatine for the treatment of sleep problems in adults with autism spectrum disorder and co-morbid intellectual disability. Journal of psychopharmacology (Oxford, England). 2019 : 269881119864968.

PURPOSE : Intellectual disability (ID) and autism spectrum disorder (ASD) are common, co-occurring developmental disorders and are frequently associated with sleep problems. This study aimed to assess the effectiveness and tolerability of agomelatine as a pharmacotherapy for sleep problems in ASD adults with ID. METHOD : A randomised, crossover, triple-blind, placebo-controlled clinical trial, with two three-month periods of treatment starting with either agomelatine or placebo and a washout period of two weeks. Ambulatory circadian monitoring (24 hours/7 days) evaluated total sleep time (TST) as the primary outcome variable. RESULTS : Participants (N=23 ; 35+/-12 years old ; 83% male) had a median of three (interquartile range (IQR) 1-4) co-morbidities and were taking a median of five (IQR 2-7) prescribed drugs. Before agomelatine or placebo treatment, all subjects presented with insomnia symptoms, including sleep latency (100% abnormal, 55+/-23 minutes) or TST (55% abnormal, 449+/-177 minutes), and 66% had circadian rhythm sleep-wake abnormalities with rhythm phase advancements according to the M5 sleep phase marker values. During the three-month agomelatine treatment, night TST significantly increased by a mean of 83 minutes (16% abnormal, 532+/-121 minutes), together with a phase correction (M5 1:45+/-2:28 hours vs. 3:15+/-2:20 hours), improving sleep stability in wrist temperature rhythm (0.43+/-0.29 vs. 0.52+/-0.18 AU). Adverse events were mild and transient. CONCLUSIONS : Agomelatine was effective and well tolerated for treating insomnia and circadian rhythm sleep problems present in adults with ASD and ID.

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3. Harwell C, Bradley E. Caring for Children with Autism in the Emergency Department. Pediatric annals. 2019 ; 48(8) : e333-e6.

Children with autism spectrum disorder (ASD) and similar conditions experience and cope with their surroundings in a unique way. Although a visit to the emergency department (ED) is stressful for any child, the stress for those with ASD and similar conditions can overwhelm their ability to cope. Many elements of visiting the ED contribute to the stress children with ASD experience ; they are not feeling well or have an injury, the environment is foreign and filled with harsh stimuli, and the medical professionals they encounter may not understand their unique needs. Fortunately, through staff education, modifications to the environment, and individualizing care plans, a visit to the ED can be a more positive experience for children with ASD. [Pediatr Ann. 2019 ;48(8):e333-e336.].

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4. Jones KB, Weedon D, Singh N, Carbone PS, Kim J. Cost and Utilization with Enrollment in a Medical Home for Individuals with an Autism Spectrum Disorder and/or Intellectual Disability. Journal of health care for the poor and underserved. 2019 ; 30(3) : 1068-82.

Individuals with intellectual and/or developmental disabilities (IDD) tend to incur high health care costs. The Neurobehavior HOME Program (HOME) is an interdisciplinary program that cares for this population. This study will evaluate the health care costs and utilization of individuals during their first year of enrollment in HOME and identify factors associated with higher cost and utilization. Secondary analysis of claims data were used to identify cost and utilization. Generalized linear regression and negative binomial regression were used to calculate utilization and cost. The mean total cost of care during the initial year of enrollment (n=239) per individual was $11,095.87, with $4,640.83 attributed to inpatient care. Those with diabetes (p=0.01), epilepsy (p=0.02), or mood disorders (p=0.03) were more likely to be admitted to the hospital and utilize the emergency department. These findings will enable systems and payers to better construct health care delivery reforms for this high-need population.

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5. Kasperzack D, Schrott B, Mingebach T, Becker K, Burghardt R, Kamp-Becker I. Effectiveness of the Stepping Stones Triple P group parenting program in reducing comorbid behavioral problems in children with autism. Autism. 2019 : 1362361319866063.

Children with autism spectrum disorders often exhibit comorbid behavioral problems. These problems have an impact on the severity of the core symptoms, the progression of the disorder as well as on the families’ quality of life. We evaluated the effectiveness of the Stepping Stones Triple P group parent training program as a supplementary intervention in the treatment of children with autism spectrum disorder. Therefore, we employed a single group repeated measures design and assessed child variables via parents’ and teachers’ judgments at four successive time points. The participants were parents of 24 children with autism spectrum disorder aged between 3.6 and 12 years. We found a significant reduction of comorbid behavioral problems in the children, primarily in the parents’ judgment at follow-up. Furthermore, a reduction of the autism spectrum disorder core symptoms emerged. The teachers’ judgment particularly revealed an improvement in children’s social relationships. Effect sizes were large (n(2) ranging from 0.14 to 0.23). The findings demonstrate the effectiveness of the Stepping Stones Triple P as a supplementary intervention for reducing comorbid behavioral problems in the treatment of children with autism spectrum disorder. Higher parental self-efficacy and parental attributions, including parents’ ability to influence child problem behaviors, are discussed as important factors for the effectiveness of Stepping Stones Triple P.

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6. Koren G, Moser SS. Does high-dose gestational folic acid increase the risk for autism ? The birth order hypothesis. Med Hypotheses. 2019 ; 132 : 109350.

There has been a dramatic increase in the incidence of autism spectrum disorder (ASD) in recent decades but the causes have not been elucidated. To date, numerous studies have shown that the FDA-recommended doses of folic acid (400mcg/d) render a protective effect against ASD. Yet, a recent prospective study has claimed that while self-reported folic acid supplementation was associated with decreased risk of ASD, very high levels of maternal plasma folate levels (<60.3nmol/L) were associated with 2.5 time increased risk of ASD. This study has led to high levels of public anxiety because many women use high dose folic acid to prevent neural tube defects. We hypothesize that because ASD children have been documented to be much more likely to be first or second born, and women consume significantly more folic acid during their first and second pregnancies, the claim that high dose folic acid causes ASD is based on a previously unrecognized birth order bias. This article presents evidence for the wrong claim that high dose folic acid causes ASD. The question whether high exposure level of folic acid is associated with increased risk of ASD is not merely a theoretical issue, because many women at increased risk for NTD in their offspring need substantially higher daily doses of folic acid (1mg, or 5mg), than the FDA-recommended 400mcg daily.

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7. Lopata C, Donnelly JP, Thomeer ML, Rodgers JD, Volker MA, Booth AJ. Exploratory factor analysis of the Adapted Skillstreaming Checklist for children with autism spectrum disorder. Autism. 2019 : 1362361319868639.

The Adapted Skillstreaming Checklist measures social/social-communication skills and behavioral flexibility/regulation of children with autism spectrum disorder without intellectual disability. Prior studies provided support for the reliability and criterion-related validity of the Adapted Skillstreaming Checklist total score for these children ; however, no studies have examined the Adapted Skillstreaming Checklist factor structure. This exploratory factor analysis examined the factor structure and internal consistency of parent ratings on the Adapted Skillstreaming Checklist for a sample of 331 children, ages 6-12 years, with autism spectrum disorder without intellectual disability. Results yielded a correlated three-factor solution. The individual factors and total score demonstrated very good internal consistency reliability. Findings supported the presence and interpretability of three subscales, as well as derivation of a total composite reflecting overall prosocial and adaptive skills and behaviors. Implications for assessment and research are discussed.

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8. Marco EM. Commentary on "Rett syndrome before regression : a time window of overlooked opportunities for diagnosis and intervention" by Cosentino et al. Neurosci Biobehav Rev. 2019.

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9. McNeill J. Social Validity and Teachers’ Use of Evidence-Based Practices for Autism. J Autism Dev Disord. 2019.

The autism intervention literature focuses heavily on the concept of evidence-based practice, with less consideration of the acceptability, feasibility, and contextual alignment of interventions in practice. A survey of 130 special educators was conducted to quantify this "social validity" of evidence-based practices and analyze its relationship with knowledge level and frequency of use. Results indicate that knowledge, use, and social validity are tightly-connected and rank the highest for modeling, reinforcement, prompting, and visual supports. Regression analysis suggests that greater knowledge, higher perceived social validity, and a caseload including more students with autism predicts more frequent use of a practice. The results support the vital role that social validity plays in teachers’ implementation, with implications for both research and practice.

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10. Naguy A, Ali M, Elsori DH, Alamiri B. A Case of Prepubertal Low-Functioning Autism With Behavioral Decompensation Favorably Responding to Tianeptine. Journal of clinical psychopharmacology. 2019.

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11. Platos M, Pisula E. Service use, unmet needs, and barriers to services among adolescents and young adults with autism spectrum disorder in Poland. BMC health services research. 2019 ; 19(1) : 587.

BACKGROUND : Despite a growing number of adolescents and adults diagnosed with autism spectrum disorder (ASD), little is known about service needs and barriers to services in this population. Existing research shows that youth with ASD are more underserved as they approach final years of their high school education and that adequate services for individuals with ASD after transition to adulthood are even scarcer. However, few studies have directly compared differences in service availability between adolescents and adults with ASD, and even fewer studies are published on service use outside Anglo-Saxon countries. The purpose of the present study was to examine service access, perceived barriers, and unmet needs, as reported by parents of adolescents and young adults with ASD in Poland. METHODS : The study used a subsample of parents of young people with ASD (aged 12-38 years ; N = 311) from the Polish Autism Survey - a survey covering different areas of functioning of people with ASD in Poland, based on a convenience sample. Responding parents were recruited via different service providers, social media, and press, and completed a survey using a web platform or a paper-and-pencil questionnaire. RESULTS : As expected, adults used services less often than adolescents, with 80.1% of adolescents and 61.1% of adults with ASD using services in the previous 12 months. Mental health services were among the most used and the most needed services, followed by educational services, while needs for sensory/motor services remained largely unmet. Young people with a coexisting intellectual disability used more services than those without it. Non-governmental organizations, private clinics, and schools were the most common service providers. Parents indicated that most of young people with ASD had unmet service needs for services (93.5%) and faced barriers to access them (82.7%). Low-income families and those living outside large cities were at the highest risk of facing barriers to service access. CONCLUSIONS : The results confirm still a thin body of evidence from different countries suggesting that adolescents and adults with ASD were both largely underserved populations. Policy-makers should address economic, regional, and age-related inequities in access to services for individuals with ASD.

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12. Reilly C, Atkinson P, Memon A, Jones C, Dabydeen L, Helen Cross J, Das KB, Gillberg C, Neville BGR, Scott RC. Autism, ADHD and parent-reported behavioural difficulties in young children with epilepsy. Seizure. 2019 ; 71 : 233-9.

PURPOSE : To provide data on the prevalence of Autism Spectrum Disorder (ASD), Attention-Deficit/Hyperactivity Disorder (ADHD), and parent reported behaviour difficulties in young children with epilepsy, and to compare results with children with neurodisability (neurodevelopmental/neurological difficulties) without epilepsy. METHOD : Children with epilepsy (1-7 years, n=48) and children with neurodisability (1-7 years, n=48) matched for gender, chronological and developmental age underwent psychological assessment. Parents completed measures of behaviour including the Strengths and Difficulties Questionnaire (SDQ). DSM-5 diagnoses of ASD and ADHD were made at consensus case conferences. Factors associated with child behaviour were analysed using linear regression. RESULTS : Of the children with epilepsy, 18% met ASD criteria and 40% met ADHD criteria (corresponding figures in the non-epilepsy group were 41% and 27%). A large proportion (76%-78%) in both groups scored in the at-risk range on the SDQ and frequently had difficulties across multiple behavioural domains. Children with epilepsy had more concerns expressed regarding attention and mood. None of the epilepsy factors were significantly associated with scores on the behavioural measures. SIGNIFICANCE : Young children with epilepsy had a very high level of parent reported behavioural difficulties and a high risk for ADHD and ASD highlighting the need for comprehensive multidisciplinary assessment. Behavioural concerns were not greater than for other children with non-epilepsy related neurodisability with the exception of attention and mood. Epilepsy related factors were not associated with child behaviour, suggesting that seizures per se do not confer a unique risk for behavioural difficulties.

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13. Spiegel A, Mentch J, Haskins AJ, Robertson CE. Slower Binocular Rivalry in the Autistic Brain. Current biology : CB. 2019.

Autism has traditionally been regarded as a disorder of the social brain. Recent reports of differences in visual perception have challenged this notion, but little evidence for altered visual processing in the autistic brain exists. We have previously observed slower behaviorally reported rates of a basic visual phenomenon, binocular rivalry, in autism [1, 2]. During rivalry, two images-one presented to each eye-vie for awareness, alternating back and forth in perception. This competition is modeled to rely, in part, on the balance of excitation and inhibition in visual cortex [3-8], which may be altered in autism [2, 9-14]. Yet direct neural evidence for this potential marker of excitation/inhibition (E/I) balance in autism is lacking. Here, we report a striking alteration in the neural dynamics of binocular rivalry in individuals with autism. Participants viewed true and simulated frequency-tagged binocular rivalry displays while steady-state visually evoked potentials (SSVEPs) were measured over occipital cortex using electroencephalography (EEG). First, we replicate our prior behavioral findings of slower rivalry and reduced perceptual suppression in individuals with autism compared with controls. Second, we provide direct neural evidence for slower rivalry in autism compared with controls, which strongly predicted individuals’ behavioral switch rates. Finally, using neural data alone, we were able to predict autism symptom severity (ADOS) and correctly classify individuals’ diagnostic status (autistic versus control ; 87% accuracy). These findings clearly implicate atypical visual processing in the neurobiology of autism. Down the road, this paradigm may serve as a non-verbal marker of autism for developmental and cross-species research.

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14. Titlestad KB, Eldevik S. Brief Report : Modest but Clinically Meaningful Effects of Early Behavioral Intervention in Twins with Rett Syndrome-A Case Study. J Autism Dev Disord. 2019.

A growing evidence base supports early intensive behavioral intervention (EIBI) for young children with autism spectrum disorder. We have found only one study exploring the outcome of EIBI for children with Rett syndrome, which reported little effect. It suggested that future studies should employ more fine-grained outcome measures. We provided EIBI for twin 3-year-old girls with Rett syndrome for a period of 3 years. We analyzed raw scores and standard scores from a measure of adaptive behavior and a detailed assessment of skills across 25 areas. We detected moderate but clinically meaningful gains in areas such as communication and self-help. Gains are discussed from a quality of life perspective and whether the moderate effects can justify the resources required in EIBI.

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15. Wang J, Hedley D, Bury SM, Barbaro J. A systematic review of screening tools for the detection of autism spectrum disorder in mainland China and surrounding regions. Autism. 2019 : 1362361319871174.

Screening for autism spectrum disorder is the first step toward early detection and diagnosis, thereby impacting the likelihood of children accessing early intervention and, importantly, improving long-term outcomes. This systematic review aimed to (a) establish a clear baseline of autism spectrum disorder screening tools currently used throughout mainland China and surrounding regions, (b) identify the strengths and limitations of these instruments, and (c) develop specific recommendations regarding screening for autism spectrum disorder throughout Chinese-speaking countries. Databases were searched for recent (2015-2018) articles published in Chinese or English languages. Twenty-two studies (13 Chinese, 9 English) met inclusion criteria ; two from Taiwan and the remainder from mainland China. Studies varied greatly in the extent of psychometric analyses and reported autism spectrum disorder prevalence. The majority of diagnoses were based on Diagnostic and Statistical Manual of Mental Disorders (4th ed. (DSM-IV) or 5th ed. (DSM-5)) criteria, although a small number of studies utilized gold-standard diagnostic assessment instruments. It is recommended that a systematic, multi-tiered, screening network be established to improve the identification of autism spectrum disorder in China and surrounding regions. Assessment and diagnosis need to be culturally appropriate, and amenable to low-resource settings. In addition, increased public awareness programs to reduce stigma will be important in improving outcomes for children with autism spectrum disorder.

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16. Wendt O, Hsu N, Simon K, Dienhart A, Cain L. Effects of an iPad-based Speech-Generating Device Infused into Instruction with the Picture Exchange Communication System for Adolescents and Young Adults with Severe Autism Spectrum Disorder. Behav Modif. 2019 : 145445519870552.

This study used a multiple baseline, single-subject research design to investigate the efficacy of an iPad((R))-based speech-generating device (SGD). The iPad was equipped with the SPEAKall !((R)) application to function as a SGD. SGDs are a form of aided augmentative and alternative communication (AAC) allowing a user to communicate using digitized and/or synthesized speech. Instruction followed a modified version of the intervention phases from the Picture Exchange Communication System (PECS). This modified PECS protocol was implemented with two adolescents and one young adult between the ages of 14 and 23. All three participants were diagnosed with severe autism spectrum disorder and little to no functional speech. Dependent measures included the ability to request for edible and tangible items as the primary measure, and the ability to engage in natural speech production as an ancillary measure to determine simultaneous, additive effects on speech acquisition. Results indicated increases in requesting behaviors for all three participants across intervention and maintenance phases. Once participants mastered requesting of edible items, they were able to generalize the skill to tangible items. However, mixed results were found when targeting natural speech production. Based on the current findings, the infusion of an iPad-based SGD into PECS instruction may be effective in increasing initial requesting skills ; however, a facilitative effect on increasing speech acquisition cannot necessarily be expected for every participant.

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