Pubmed du 19/09/19

jeudi 19 septembre 2019

1. Charbonneau G, Bertone A, Veronneau M, Girard S, Pelland M, Mottron L, Lepore F, Collignon O. Within- and Cross-Modal Integration and Attention in the Autism Spectrum. J Autism Dev Disord ;2019 (Sep 19)

Although impairment in sensory integration is suggested in the autism spectrum (AS), empirical evidences remain equivocal. We assessed the integration of low-level visual and tactile information within and across modalities in AS and typically developing (TD) individuals. TD individuals demonstrated increased redundancy gain for cross-modal relative to double tactile or visual stimulation, while AS individuals showed similar redundancy gain between cross-modal and double tactile conditions. We further observed that violation of the race model inequality for cross-modal conditions was observed over a wider proportion of the reaction times distribution in TD than AS individuals. Importantly, the reduced cross-modal integration in AS individuals was not related to atypical attentional shift between modalities. We conclude that AS individuals displays selective decrease of cross-modal integration of low-level information.

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2. Crane L, Davidson I, Prosser R, Pellicano E. Understanding psychiatrists’ knowledge, attitudes and experiences in identifying and supporting their patients on the autism spectrum : online survey. BJPsych Open ;2019 (Apr 5) ;5(3):e33.

BACKGROUND : Psychiatrists play a critical role in identifying and supporting their patients on the autism spectrum in the UK, yet little is known about their knowledge, attitudes and experiences in this regard. AIMS : To understand psychiatrists’ experiences of working with autistic individuals, their confidence in making diagnostic/management decisions and the factors that affect such decisions. METHOD : A total of 172 psychiatrists took part in an online self-report survey. RESULTS : Most psychiatrists reported receiving useful training on autism and were knowledgeable about the condition, particularly those with a personal connection to autism. Higher confidence in working with autistic patients was linked to greater levels of autism knowledge, experience and training. Several systemic and autism-specific factors were highlighted by psychiatrists, which were felt to challenge their ability to provide effective care and support for their patients on the autism spectrum. CONCLUSIONS : Psychiatrists’ views corroborated previous research with the autism community, highlighting the need to co-design services that are accessible, respectful and person-centred. DECLARATION OF INTEREST : I.D. is the Royal College of Psychiatrists’ Autism Champion.

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3. Habayeb S, Dababnah S, John A, Rich B. Cultural Experiences of Arab American Caregivers Raising Children with Autism Spectrum Disorder. J Autism Dev Disord ;2019 (Sep 17)

Research on families’ experiences raising children with Autism Spectrum Disorder (ASD) is limited in minority ethnic and cultural groups, such as the Arab American community. Twenty Arab American caregivers raising children with ASD completed online questionnaires regarding their experiences with stigma and acculturation. Nine participants completed follow-up phone interviews. Perceived stigma fell in the low to moderate range. Acculturation related to social interactions indicated slightly greater assimilation compared to separation, and slightly greater integration over marginalization. During interviews, participants discussed the impact of disability stigma, distancing from their communities, and parent gender roles. By better understanding Arab American families raising children with ASD professionals can work towards improving clinical services for these families.

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4. Hollingdale J, Woodhouse E, Young S, Fridman A, Mandy W. Autistic spectrum disorder symptoms in children and adolescents with attention-deficit/hyperactivity disorder : a meta-analytical review. Psychol Med ;2019 (Sep 18):1-14.

BACKGROUND : Research identifies highly variable prevalence estimates for autism spectrum disorder (ASD) in children and adolescents with attention deficit hyperactivity disorder (ADHD), particularly between community and clinical samples, warranting quantitative meta-analyses to investigate the true prevalence of ASD in children and adolescents with ADHD. METHODS : Studies were identified through a systematic literature search of PsycINFO, MEDLINE and Web of Science through January 2018. Twenty-two publications met inclusion criteria (total N = 61 985). Two random effects meta-analyses were conducted : (1) to identify the proportion of children and adolescents with ADHD that met criteria for ASD ; and (2) to compare the severity of dimensionally-measured ASD symptomology in children and adolescents with and without ADHD. RESULTS : The overall pooled effect for children and adolescents with ADHD who met threshold for ASD was 21%. There was no significant difference between community samples (19%) and clinical samples (24%) or between US studies v. those from other countries. Children and adolescents with ADHD had substantially more dimensionally-measured ASD traits compared with those who did not have ADHD (d = 1.23). CONCLUSION : The findings provide further evidence that ADHD and ASD are associated in nature. Clinical and research implications are discussed.

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5. Levy G, Oppenheim D, Koren-Karie N, Ariav-Paraira I, Gal N, Yirmiya N. Disrupted maternal communication and attachment disorganization in children with autism spectrum disorder. Attach Hum Dev ;2019 (Sep 18):1-14.

We examined whether disrupted maternal communication, which is associated with disorganized attachment in typically developing children, is also associated with disorganized attachment in children with ASD. The attachments of 45 boys with ASD and maternal disruption were assessed in the Strange Situation Procedure. Analyses revealed a link between low cognitive functioning and resistant/ambivalent and disorganized attachment, and children’s functioning was therefore controlled. Contrary to expectations, mothers of children with disorganized attachments did not show more disrupted communication than mothers of children with organized attachments. However, the 4-way attachment breakdown showed that the mothers of disorganized and ambivalent/resistant children had higher disruption scores than mothers of secure and avoidant children. The findings suggest that the expected associations between maternal disruption and attachment disorganization apply to children with ASD as well, but raise questions whether disrupted behavior is a unique antecedent of disorganized attachment or also of resistant/ambivalent attachment.

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6. Maher GM, O’Keeffe GW, Dalman C, Kearney PM, McCarthy FP, Kenny LC, Khashan AS. Association between preeclampsia and autism spectrum disorder : a population-based study. J Child Psychol Psychiatry ;2019 (Sep 17)

BACKGROUND : The environmental contribution of autism spectrum disorder (ASD) is approximately 17%-50%, highlighting the importance of investigating factors potentially contributing to the likelihood of its development, and of gaining a greater understanding of the pathogenesis surrounding ASD. The objective of this study was to examine the association between preeclampsia and ASD using a population-based cohort study. METHODS : All singleton live births in Sweden from 1982 to 2010 were included, using data from Swedish National Registers. Exposures of interest included : (a) preeclampsia (classified according to ICD-8, ICD-9 and ICD-10) and (b) preeclampsia and small for gestational age (SGA) combined, used as a proxy for preeclampsia with placental dysfunction. ASD status was based on ICD-9 and ICD-10. The cohort consisted of 2,842,230 children, with 54,071 cases of ASD. Follow-up began from the child’s first birthday, and data were censored at first diagnosis of ASD, death, migration or end of study period (31st December 2016). We conducted multivariate Cox proportional hazards regression analysis, adjusting for several perinatal and sociodemographic factors, selected a priori. We further controlled for shared genetic and familial confounding using sibling-matched analysis. RESULTS : In the adjusted Cox proportional hazards regression analysis, preeclampsia was associated with a 25% increase in the likelihood of ASD (Hazard Ratio (HR) : 1.25, 95% CI:1.19, 1.30) compared with those unexposed to preeclampsia, while in the sibling-matched analysis the HR was 1.17 (95% CI : 1.06, 1.28). The HR for preeclampsia and SGA combined was 1.66 (95% CI : 1.49, 1.85) in the adjusted Cox model and 1.95 (95% CI : 1.53, 2.48) in the sibling-matched analysis. CONCLUSIONS : Exposure to preeclampsia or preeclampsia/SGA (i.e. SGA baby exposed to preeclampsia) was associated with ASD. The stronger association with preeclampsia/SGA than preeclampsia alone suggests that placental pathology may be a mechanism for the increased likelihood of ASD.

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7. Makombe CBT, Shabalala N, Viljoen M, Seris N, de Vries PJ, Franz L. Sustainable implementation of early intervention for autism spectrum disorder through caregiver coaching : South African perspectives on barriers and facilitators. Pediatr Med ;2019 (Aug) ;2

Background : A lack of specialists, and insufficient infrastructure and funding to scale early interventions for autism spectrum disorder (ASD) characterize low-resource settings. Integration of early intervention methods that utilize non-specialists, and involve caregivers, into existing systems of care, offers the best hope to address such unmet needs. In South Africa, a caregiver coaching intervention, informed by principles of the Early Start Denver Model (ESDM) was adapted for delivery by non-specialist Early Childhood Development (ECD) practitioners. This study explored perceived barriers and facilitators to sustainable implementation of this approach. Methods : Nine stakeholders including caregivers, ECD practitioners, ECD school supervisors, and certified South African ESDM therapists involved in intervention implementation were purposively sampled, and individual in-depth interviews were conducted. Interviews were transcribed verbatim and thematically analyzed. Results : Implementation facilitators included : ECD practitioner ASD knowledge and ongoing supervision ; a positive coaching experience ; and clear illustration of intervention concepts. Implementation barriers included : complexity of some intervention and coaching concepts ; logistical challenges such as time constraints and internet access ; and mismatch between video content and the South African context. Facilitators to sustain the intervention included perceived positive child and caregiver outcomes ; and ongoing supervision. Barriers to sustain the intervention included socio-economic contextual factors. Conclusions : In spite of the potential for positive child and caregiver outcomes from caregiver coaching, broader contextual and system-level issues such as poverty, the need for ongoing supervision, and access to local coaching materials in South African languages, may challenge sustainable implementation. Findings from this study will inform tailoring of the intervention training and supervision approach for next step evaluation.

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8. Markova N. Dysbiotic microbiota in autistic children and their mothers : persistence of fungal and bacterial wall-deficient L-form variants in blood. Sci Rep ;2019 (Sep 16) ;9(1):13401.

Based on our hypothesis for existing microbiota of wall-deficient variants (L-forms) in human blood, we created an innovative methodology, which allowed for the development of L-form populations from blood of all investigated people. In contrast to healthy controls, blood L-forms from autistic children and their mothers converted under appropriate conditions of cultivation into detectable opportunistic bacteria and fungi, small a, Cyrillic process demonstrated by light and transmission electron microscopy. It can be distinguished into two types of states - "eubiotic" blood microbiota in healthy individuals, and "dysbiotic" in autistic children and their mothers. Remarkably, the unifying finding for autistic children and their mothers was the presence in blood of wall-free variants from life-cycle of filamentous fungi. Increased specific IgG, IgM and IgA, together with typical mold growth were a decisive argument for proven presence of Aspergillus fumigatus in almost all of the autistic children. As it was demonstrated in our previous study, filterable L-forms can be transmitted by vertical pathway from mother to child before birth. Thus, it can be suggested that autistic children may be born already colonized with fungi, while a "silent aspergillosis" could contribute or even be a leading cause for neurodevelopmental disorders in the early childhood.

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9. Marques JG, Pires S. Psychosis in Autistic Patients With Splinter Skills (Savant Syndrome) Presenting Abnormal Cerebellar Anatomy Misdiagnosed as Disorganized (Hebephrenic) Schizophrenia. Prim Care Companion CNS Disord ;2019 (Sep 12) ;21(5)

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10. Saroukhani S, Samms-Vaughan M, Lee M, Bach MA, Bressler J, Hessabi M, Grove ML, Shakespeare-Pellington S, Loveland KA, Rahbar MH. Perinatal Factors Associated with Autism Spectrum Disorder in Jamaican Children. J Autism Dev Disord ;2019 (Sep 19)

Mode of delivery, preterm birth, and low birth weight (LBW) are hypothesized to be associated with autism spectrum disorder (ASD) in the offspring. Using data from 343 ASD cases (2-8 years) and their age- and sex-matched typically developing controls in Jamaica we investigated these hypotheses. Our statistical analyses revealed that the parish of residence could modify the association between cesarean delivery and ASD, with a difference found in this relationship in Kingston parish [matched odds ratio (MOR) (95% confidence interval (CI)) 2.30 (1.17-4.53)] and other parishes [MOR (95% CI) 0.87 (0.48-1.59)]. Although the associations of LBW and preterm birth with ASD were not significant, we observed a significant interaction between LBW and the household socioeconomic status. These findings require replication.

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11. Stevanovic M, Henttonen P, Koskinen E, Perakyla A, Nieminen von-Wendt T, Sihvola E, Tani P, Ravaja N, Sams M. Physiological responses to affiliation during conversation : Comparing neurotypical males and males with Asperger syndrome. PLoS One ;2019 ;14(9):e0222084.

We examined the emotional and psychophysiological underpinnings of social interaction in the context of autism spectrum disorder, more specifically, involving participants diagnosed with Asperger syndrome (AS). We recorded participants’ autonomic nervous system (ANS) activation (electrodermal activity, heart rate, and heart rate variability) and facial muscle activation during conversations in two different types of male dyads : (1) ten dyads where one participant has been diagnosed with AS (AS/NT dyads) and (2) nine dyads where both participants are neurotypical (NT/NT dyads). Afterwards, three independent raters assessed continuously each participant’s affiliative and dominant behaviors during the first and last 10 minutes of the conversations. The relationship between the assessed data and ANS responses was examined. We found that, in the NT/NT dyads, a high level of affiliation displayed by the conversational partner calms down the participant when they are actively dominating the interaction. In contrast, when the participants themselves expressed affiliation, their psychophysiological responses indicated increase in arousal, which suggests that the giving of affiliation is physiologically "hard work." The affiliation-related ANS responses were similar in those NT participants whose conversational partner had AS, while some differences in facial muscle activation did occur in comparison to NT/NT dyads. In the AS participants, in contrast, a high level of affiliation provided by the conversational partner was associated with increase in arousal, suggesting heightened alertness and stress. As for their own affiliative behavior, the AS participants exhibited similar indicators of alertness and stress as the NT participants, but only when their own level of dominance was low. Our results increase understanding of how individuals with AS experience social interaction at the physiological level, and how this experience differs from that in NT individuals. Moreover, our results confirm and further specify our earlier results, where we proposed that affiliation involves the type of "sharing of the burden" that also reverberates in the participants’ bodies.

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12. Strunecka A, Strunecky O. Chronic Fluoride Exposure and the Risk of Autism Spectrum Disorder. Int J Environ Res Public Health ;2019 (Sep 16) ;16(18)

The continuous rise of autism spectrum disorder (ASD) prevalent in the past few decades is causing an increase in public health and socioeconomic concern. A consensus suggests the involvement of both genetic and environmental factors in the ASD etiopathogenesis. Fluoride (F) is rarely recognized among the environmental risk factors of ASD, since the neurotoxic effects of F are not generally accepted. Our review aims to provide evidence of F neurotoxicity. We assess the risk of chronic F exposure in the ASD etiopathology and investigate the role of metabolic and mitochondrial dysfunction, oxidative stress and inflammation, immunoexcitotoxicity, and decreased melatonin levels. These symptoms have been observed both after chronic F exposure as well as in ASD. Moreover, we show that F in synergistic interactions with aluminum’s free metal cation (Al(3+)) can reinforce the pathological symptoms of ASD. This reinforcement takes place at concentrations several times lower than when acting alone. A high ASD prevalence has been reported from countries with water fluoridation as well as from endemic fluorosis areas. We suggest focusing the ASD prevention on the reduction of the F and Al(3+) burdens from daily life.

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13. Suren P, Saasen-Havdahl A, Bresnahan M, Hirtz D, Hornig M, Lord C, Reichborn-Kjennerud T, Schjolberg S, Oyen AS, Magnus P, Susser E, Lipkin WI, Stoltenberg C. Sensitivity and specificity of early screening for autism. BJPsych Open ;2019 (May 17) ;5(3):e41.

BACKGROUND : Early identification and diagnosis is beneficial for children with autism spectrum disorder (ASD). Universal early screening is recommended by many experts, but disputed because evidence is limited, and sensitivity and specificity in general populations are largely unknown. AIMS : To estimate the sensitivity and specificity of early population-based screening for ASDs. METHOD : The study was based on the Norwegian Mother and Child Cohort Study. The 36-month cohort questionnaire included the Social Communication Questionnaire (SCQ), a 40-item screening instrument for ASD. RESULTS : A total of 58 520 mothers (58%) responded to the questionnaire. By the end of follow-up on 31 December 2015, 385 (0.7%) individuals with ASD had been identified among the responders’ children. The distributions of SCQ scores in those with ASD and other children had large degrees of overlap. With the cut-off of 15 recommended in the SCQ manual, screening sensitivity was 20% (95% CI 16-24) for ASD overall. For children with ASD who had not developed phrase speech at 36 months, sensitivity was 46% (95% CI 35-57%), whereas it was 13% (95% CI 9-17) for children with ASD with phrase speech. Screening specificity was 99% (95% CI 99-99). With the currently recommended cut-off of 11, sensitivity increased to 42% for ASD overall (95% CI 37-47), 69% (95% CI 58-79) for ASD without phrase speech and 34% (95% CI 29-40) for ASD with phrase speech. Specificity was then reduced to 89% (95% CI 89-90). CONCLUSIONS : Early ASD screening with a parent checklist had low sensitivity. It identified mainly individuals with ASD with significant developmental delay and captured very few children with ASD with cognitive skills in the normal range. Increasing sensitivity was not possible without severely compromising specificity. DECLARATION OF INTEREST : C.L. receives royalty for the Social Communication Questionnaire, which she has co-authored.

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14. Voinsky I, Bennuri SC, Svigals J, Frye RE, Rose S, Gurwitz D. Peripheral Blood Mononuclear Cell Oxytocin and Vasopressin Receptor Expression Positively Correlates with Social and Behavioral Function in Children with Autism. Sci Rep ;2019 (Sep 17) ;9(1):13443.

The peptide hormone oxytocin is an established regulator of social function in mammals, and dysregulated oxytocin signaling is implicated in autism spectrum disorder (ASD). Several clinical trials examining the effects of intranasal oxytocin for improving social and behavioral function in ASD have had mixed or inclusive outcomes. The heterogeneity in clinical trials outcomes may reflect large inter-individual expression variations of the oxytocin and/or vasopressin receptor genes OXTR and AVPR1A, respectively. To explore this hypothesis we examined the expression of both genes in peripheral blood mononuclear cells (PBMC) from ASD children, their non-ASD siblings, and age-matched neurotypical children aged 3 to 16 years of age as well as datamined published ASD datasets. Both genes were found to have large inter-individual variations. Higher OXTR and AVPR1A expression was associated with lower Aberrant Behavior Checklist (ABC) scores. OXTR expression was associated with less severe behavior and higher adaptive behavior on additional standardized measures. Combining the sum expression levels OXTR, AVPR1A, and IGF1 yielded the strongest correlation with ABC scores. We propose that future clinical trials in ASD children with oxytocin, oxytocin mimetics and additional tentative therapeutics should assess the prognostic value of their PBMC mRNA expression of OXTR, AVPR1A, and IGF1.

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15. Zurita MF, Cardenas PA, Sandoval ME, Pena MC, Fornasini M, Flores N, Monaco MH, Berding K, Donovan SM, Kuntz T, Gilbert JA, Baldeon ME. Analysis of gut microbiome, nutrition and immune status in autism spectrum disorder : a case-control study in Ecuador. Gut Microbes ;2019 (Sep 18):1-12.

Most studies on autism spectrum disorder (ASD) risk factors have been conducted in developed countries where ethnicity and environment are different than in developing countries. We compared nutritional status, immune response and microbiota composition in mestizo children with ASD with matched controls in Ecuador. Twenty-five cases and 35 controls were matched by age, sex and school location. The prevalence of under- and overweight was higher in children with ASD. Nutritional differences were accompanied by abnormal food habits and more frequent gastrointestinal symptoms in children with ASD. Also, greater serum concentrations of TGF-beta1 were observed in children with ASD. Finally, there was greater alpha diversity and abundance of Bacteroides (2 OTUs), Akkermansia, Coprococcus and different species of Ruminococcus in ASD children.

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