Pubmed du 04/01/20

samedi 4 janvier 2020

1. Al-Mamri W, Idris AB, Dakak S, Al-Shekaili M, Al-Harthi Z, Alnaamani AM, Alhinai FI, Jalees S, Al Hatmi M, El-Naggari MA, Islam MM. Revisiting the Prevalence of Autism Spectrum Disorder among Omani Children : A multicentre study. Sultan Qaboos Univ Med J ;2019 (Nov) ;19(4):e305-e309.

Objectives : This study aimed to provide an updated estimate of the prevalence of autism spectrum disorder (ASD) among Omani children. Methods : This retrospective descriptive study was conducted from December 2011 to December 2018. Data were retrieved from the three main autism diagnostic centres in Oman : Sultan Qaboos University Hospital, Royal Hospital and Al-Massarah Hospital. The ASD diagnosis was made by experienced clinicians based on the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The overall population prevalence estimates per 10,000 children aged 0-14 years old in Oman were calculated using the denominator of the mid-period population data. Results : A total of 1,705 ASD cases were identified with the majority of cases being male (78.1%). The overall prevalence rate of ASD was estimated at 20.35 per 10,000 children (95% confidence interval : 19.39-21.32) between 2012-2018. Boys were found to have a 3.4-fold higher prevalence of ASD than girls (31.23/10,000 versus 9.07/10,000). Regionally, the majority of cases were found in the capital, Muscat, where the highest prevalence was 36.51 cases per 10,000 children. Conclusion : The prevalence of ASD among Omani children is 15-fold higher than estimates from 2011. This increase can be attributed to improvements in diagnostic services, increased awareness of ASD, better screening programmes and changes in diagnostic criteria. In addition, this increase in prevalence suggests a need for a registry of developmental disabilities and more extensive diagnostic and rehabilitation services in Oman.

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2. Brugha T, Tyrer F, Leaver A, Lewis S, Seaton S, Morgan Z, Tromans S, van Rensburg K. Testing adults by questionnaire for social and communication disorders, including autism spectrum disorders, in an adult mental health service population. Int J Methods Psychiatr Res ;2020 (Jan 3):e1814.

OBJECTIVES : Autism is difficult to identify in adults due to lack of validated self-report questionnaires. We compared the effectiveness of the Autism Quotient (AQ) and the Ritvo Autism-Asperger’s Diagnostic Scale-Revised (RAADS-R) questionnaires in adult mental health services in two English counties. METHODS : A subsample of adults who completed the AQ and RAADS-R were invited to take part in an Autism Diagnostic Observation Schedule (ADOS Module 4) assessment with probability of selection weighted by scores on the questionnaires. RESULTS : 364 men and 374 women consented to take part. Recorded diagnoses were most commonly mood disorders (44%) and mental and behavioural disorders due to alcohol/substance misuse (19%). 4.8% (95% CI 2.9-7.5) were identified with autism (ADOS Module 4 10+). One had a pre-existing diagnosis of autism ; 26% (5) had borderline personality disorders (all female) and 17% (3) mood disorders. The AQ and RAADS-R had fair test accuracy (area under Receiver Operating Characteristics (ROC) curve 0.77 and 0.79 respectively). AQ sensitivity was 0.79 (95% CI 0.54-0.94) and specificity 0.77 (95% CI 0.65-0.86) ; RAADS-R sensitivity was 0.75 (95% CI 0.48-0.93) and specificity 0.71 (95% CI 0.60-0.81). CONCLUSIONS : The AQ and RAADS-R can guide decisions to refer adults in mental health services to autism diagnostic services.

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3. Gupta A, Sethi S, Khurana H, Malik AK. Commentary on : Parental care seeking pathway and challenges for autistic spectrum disorder. Indian J Psychiatry ;2019 (Nov-Dec) ;61(6):661-662.

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4. Hirota T, Deserno M, McElroy E. The Network Structure of Irritability and Aggression in Individuals with Autism Spectrum Disorder. J Autism Dev Disord ;2020 (Jan 2)

Irritability and aggression (IA) are highly prevalent in individuals with autism spectrum disorder (ASD). Although clinical correlates of IA in this population have been previously examined, findings from existing studies capturing symptoms as a set of latent variables do not fully explain meaningful associations between the symptoms themselves. In the present study, we conducted network analysis which conceptualizes mental health difficulties as a complex network of directly associated symptoms in 2612 individuals who were diagnosed with ASD through rigorous diagnostic assessment and who were enrolled in the Simons Simplex Collection. Using the Aberrant Behavior Checklist, a validated scale, we investigated the network structure of IA and tried to identify bridge symptoms that link IA and other symptom domains. In our analysis, irritability symptoms had stronger and more direct associations with other nodes than aggression symptoms did. Additionally, depressed mood and oppositionality were identified to function as bridge symptoms. The network structures did not differ between individuals with and without intellectual disability. Our findings indicate that addressing these bridge symptoms through integrated care combining different modalities of treatment could ease the complicated symptom network and thereby reduce IA symptoms in individuals with ASD.

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5. Mahapatra P, Chauhan AS, Pati S. Authors’ response to commentary on : Parental care seeking pathway and challenges for autistic spectrum disorder. Indian J Psychiatry ;2019 (Nov-Dec) ;61(6):662-663.

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6. Manohar H, Kandasamy P, Chandrasekaran V, Rajkumar RP. Can RCTs capture it all ?-Need for qualitative studies on parent-mediated interventions for children with Autism Spectrum Disorder. Asian J Psychiatr ;2019 (Dec 26) ;48:101915.

INTRODUCTION : There is a global rise in the prevalence of Autism Spectrum Disorder (ASD) and treatment gap exists across settings. In low-resource settings, there is a lack of professionals and specialist centres for intervention delivery. ’Parent-mediated interventions’ is an essential strategy to bridge the existing treatment gap. While RCTs are required to establish evidence base, understanding parental perspectives is pivotal in designing culturally-relevant intervention models, to enhance parental involvement and sustainability. The current paper focuses on the results of a qualitative study to understand the parent perspectives and change process before and after a parent-mediated intervention program. METHODS : 30 children (2-6 years) recently diagnosed to have ASD, participated in a brief parent-mediated interventions focusing on core-deficits, for 12 weeks. Parents were asked to narrate their experiences and perception of their child’s disorder and interventions before and after the intervention program, during one-on-one in-depth interview. A narrative guide was used to generate response. The narratives were recorded verbatim and thematic content analysis was carried out. RESULTS : Repetitive themes reflecting impact of the child’s disorder, treatment impact and change process was examined. The broad themes generated included : 1) Change in perception of the child’s developmental disorder after involvement in intervention process. 2) Change in parental attitudes from ’lack of hope’ to ’positive and appropriate expectations’ 3) Gain in knowledge and empowerment 4) Stress reduction 5) Appreciation of micro-gains 6) Validation of ’hands-on training’. Behavioural interventions were the preferred treatment of choice in 66 % of parents, followed by combination therapy in 22 % and pharmacotherapy alone in 12 %. CONCLUSION : Parent’s narratives highlighted the acceptability and feasibility of the parent-mediated interventions in our cultural setting. Understanding parental perspectives, more so when interventions are parent-mediated, is essential for tailoring interventions as well as improving sustainability.

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7. Muller K, Brady NC, Warren SF, Fleming KK. Mothers’ perspectives on challenging behaviours in their children with fragile X syndrome. J Intellect Dev Disabil ;2019 ;44(4):481-491.

Background : Individuals with intellectual and developmental disabilities are more likely to engage in problem behaviours than peers with typical development. The purpose of this study was to provide descriptive and qualitative information about problem behaviours in children with fragile X syndrome (FXS) and how families respond to these behaviours. Method : We examined interview responses from 53 mothers of 9-year-old children with FXS. Results : Defiance, tantrums, inattention, stereotypy, and aggression were the most frequently reported problem behaviours of children with FXS. Stereotypy, physical aggression, self-injury, and elopement were reported more often by mothers of children with dual diagnoses of FXS and autism than by mothers of children with a single diagnosis of FXS. Conclusions : Results indicated that for many families, by 9 years of age, problem behaviours led to frustration and altered family activities.

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8. Mutabbakani R, Callinan C. Mothers’ Perspectives on the Inclusion of Young Autistic Children in Kuwait. J Autism Dev Disord ;2020 (Jan 2)

There is a lack of information on early childhood inclusive education and the parental perspectives towards the inclusion of autistic children in Kuwait. The aim of this study was to explore the perspectives and experiences amongst mothers of young autistic children regarding the inclusion of their children in general education kindergarten settings. Focus group and individual semi-structured interviews were conducted with (n = 34) Kuwaiti mothers of children with (ASD). The study participants were of the opinion that the behaviours unique to (ASD) can only be managed in highly structured special education settings. The themes that emerged from the interviews demonstrate that the general view amongst the study participants is that the inclusive educational model will not meet the autistic children’s needs.

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9. Narasimhan U, Rajendran R, Abraham DA, Rajendran L, Muhasaparur Ganesan R. Prevalence and Pattern of Complementary and Alternative Medicine for Autism Spectrum Disorder in Tamil Nadu. Indian J Pediatr ;2020 (Jan 2)

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10. Trevisan DA, Enns JT, Birmingham E, Iarocci G. Action coordination during a real-world task : Evidence from children with and without autism spectrum disorder. Dev Psychopathol ;2020 (Jan 3):1-11.

"Joint action"-the ability to coordinate actions with others-is critical for achieving individual and interpersonal goals and for our collective success as a species. Joint actions require accurate and rapid inferences about others’ goals, intentions, and focus of attention, skills that are thought to be impaired in individuals with autism spectrum disorder (ASD). Research to date has not investigated joint action abilities in individuals with ASD during real-world social interactions. We conducted an experimental study that required children with ASD and typically developing children to move tables by themselves or collaboratively through a maze. This involved developing innovative methodologies for measuring action coordination-a critical component of the joint action process. We found that children with ASD are less likely to benefit from the collaboration of a peer than are typically developing children, and they are less likely to synchronize their steps when moving the table. However, these differences were masked when scaffolded by an adult. There was no evidence that ASD differences were due to gross motor delays in the participants with ASD. We argue that action coordination is a highly adaptive social process that is intrinsic to successful human functioning that manifests as atypical synchronization of mind and body in children with ASD.

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11. Zablotsky B, Rast J, Bramlett MD, Shattuck PT. Health Care Transition Planning Among Youth with ASD and Other Mental, Behavioral, and Developmental Disorders. Matern Child Health J ;2020 (Jan 2)

OBJECTIVE : To estimate the prevalence of health care transition components among youth with autism spectrum disorder (ASD) aged 12-17 using the 2016 National Survey of Children’s Health (NSCH), compared to youth with other mental, behavioral, or developmental disorders (MBDDs) or youth without MBDDs. METHODS : The 2016 NSCH is a nationally and state representative survey that explores issues of health and well-being among children ages 0-17. Within the NSCH, parents of a subset of youth, ages 12-17, are asked a series of questions about their youth’s eventual transition into the adult health care system. The current study explores components of this transition, comparing youth diagnosed with ASD, youth with other mental, behavioral, or developmental disorders (MBDDs), and youth without MBDDs. RESULTS : Approximately 1-in-4 youth with ASD had actively worked with their doctor to understand future changes to their health care, significantly less than youth with other MBDDs and youth without MBDDs. Fewer than 2-in-5 youth with ASD had met with their doctor privately or had a parent who knew how their youth would be insured when they reached adulthood. CONCLUSIONS : The current analysis of a nationally representative sample of youth reveals discrepancies in the proportion of youth with ASD receiving appropriate health care transition planning compared to youth with other MBDDs and youth without MBDDs. These findings suggest the potential for barriers among youth with ASD to effectively transitioning into the adult health care system.

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