Pubmed du 15/03/20

dimanche 15 mars 2020

1. Black MH, Mahdi S, Milbourn B, Scott M, Gerber A, Esposito C, Falkmer M, Lerner MD, Halladay A, Strom E, D’Angelo A, Falkmer T, Bolte S, Girdler S. Multi-informant International Perspectives on the Facilitators and Barriers to Employment for Autistic Adults. Autism Res. 2020.

Employment rates for autistic individuals are poor, even compared to those from other disability groups. Internationally, there remains limited understanding of the factors influencing employment across the stages of preparing for, gaining, and maintaining employment. This is the third in a series of studies conducted as part of an International Society for Autism Research (INSAR) policy brief intended to improve employment outcomes for autistic individuals. A multi-informant international survey with five key stakeholder groups, including autistic individuals, their families, employers, service providers, and researchers, was undertaken in Australia, Sweden, and the United States to understand the facilitators and barriers to employment for autistic adults. A total of 687 individuals participated, including autistic individuals (n = 246), family members (n = 233), employers (n = 35), clinicians/service providers (n = 123), and researchers (n = 50). Perceptions of the facilitators and barriers to employment differed significantly across both key stakeholder groups and countries, however, ensuring a good job match and focusing on strengths were identified by all groups as important for success. Key barriers to employment included stigma, a lack of understanding of autism spectrum disorder (ASD) and communication difficulties. Results suggest that a holistic approach to employment for autistic individuals is required, aimed at facilitating communication between key stakeholders, addressing attitudes and understanding of ASD in the workplace, using strength-based approaches and providing early work experience. LAY SUMMARY : Autistic individuals experience significant difficulty getting and keeping a job. This article presents a survey study involving autistic individuals, their families, employers, service providers and researchers in Australia, Sweden, and the United States to understand their perspectives on the factors that support or act as barriers to employment. While perspectives varied across key stakeholders, strategies such as using a holistic approach, targeting workplace attitudes and understanding, focusing on strengths, and providing early work experience are important for success. (c) 2020 International Society for Autism Research, Wiley Periodicals, Inc.

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2. Brown CM, Stokes MA. Intersection of Eating Disorders and the Female Profile of Autism. Child and adolescent psychiatric clinics of North America. 2020 ; 29(2) : 409-17.

There is a moderate degree of comorbidity between autism and eating disorders, particularly anorexia nervosa in female individuals. Research indicates that up to 30% of patients with anorexia are autistic, or display high levels of autistic traits. Frequently, an autism diagnosis is secondary to an eating disorder diagnosis, which brings concomitant issues into treatment efficacy and outcomes for both conditions. Less is known about comorbidity with other eating disorder subtypes. Autistic traits can impede standard approaches to eating disorder treatment. Treatment options and settings may need to be modified to better accommodate autistic female individuals.

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3. Coleman-Smith RS, Smith R, Milne E, Thompson AR. ’Conflict versus Congruence’ : A Qualitative Study Exploring the Experience of Gender Dysphoria for Adults with Autism Spectrum Disorder. J Autism Dev Disord. 2020.

An emergent evidence base indicates a higher prevalence of autism exists amongst people attending gender identity clinics. This qualitative study explored adults’ with autism experiences of coming to understand and address their gender dysphoria (GD). Data were collected and analysed using Grounded Theory. Ten adults with autism and GD undertook semi-structured interviews. A tentative theoretical framework of common processes involved in understanding and addressing GD for individuals with autism was developed. The experience is captured in the core category-Conflict versus Congruence. A key finding was the impact of autism as a barrier but sometimes a protective factor in participants’ understanding and addressing GD. Participants appeared to achieve greater personal congruence and wellbeing upon transition. Nevertheless, conflicts remained as they navigated the social world with a continuing fear of hostility and sense of difference due to having two stigmatised identities.

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4. Elster N, Parsi K. Transitioning from Adolescence to Adulthood with Autism Spectrum Disorder : An Overview of Planning and Legal Issues. Child and adolescent psychiatric clinics of North America. 2020 ; 29(2) : 399-408.

The transition to adulthood is complex. It is defined by many objective and subjective milestones. Transition from adolescence to young adulthood is challenging for both neurotypical individuals and individuals with autism spectrum disorders. However, for autistic individuals, this transition is even more complicated and poses a range of legal and ethical considerations. This article discusses how existing legal and social constructs may exacerbate rather than diminish barriers and access for autistic adults and identifies current and potential legal and policy solutions to reducing current systemic barriers. This article ultimately supports a supported decision-making model for autistic adolescents transitioning into adulthood.

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5. Enav Y, Erhard-Weiss D, Goldenberg A, Knudston M, Hardan AY, Gross JJ. Contextual determinants of parental reflective functioning : Children with autism versus their typically developing siblings. Autism. 2020 : 1362361320908096.

LAY ABSTRACT : In this study, we examined parental reflective functioning using the Parental Developmental Interview when parents were talking about their interactions with their child with autism versus the child’s typically developing siblings. Our sample included 30 parents who had a child between the ages of 3 and 18 years with a clinical diagnosis of autism spectrum disorder and at least one typically developing child. Findings indicated that parents exhibited significantly higher reflective functioning when interacting with their child with autism spectrum disorder versus the typically developing siblings, and the difference was moderated by parental self-efficacy.

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6. Flannery KA, Wisner-Carlson R. Autism and Education. Child and adolescent psychiatric clinics of North America. 2020 ; 29(2) : 319-43.

Determining the most effective strategies to educate children and youth with autism spectrum disorder (ASD) can be daunting. Dr Stephen Shore, an autism advocate who is on the spectrum, said, "If you’ve met one person with autism, you’ve met one person with autism." Individuals diagnosed with ASD present with unique strengths and difficulties and experience characteristics of their disability in different ways. General and special educators must be prepared with a variety of evidence-based practices and instructional strategies to engage and educate students diagnosed with autism. This article discusses current methods, techniques, evidence, and controversies for educating individuals diagnosed with autism.

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7. Foster NC, Bennett SJ, Causer J, Elliott D, Bird G, Hayes SJ. Facilitating sensorimotor integration via blocked practice underpins imitation learning of atypical biological kinematics in autism spectrum disorder. Autism. 2020 : 1362361320908104.

LAY ABSTRACT : Autistic people sometimes find it difficult to copy another person’s movement accurately, especially if the movement is unfamiliar or novel (e.g. to use chop sticks). In this study, we found that autistic people were generally less accurate at copying a novel movement than non-autistic people. However, by making a small adjustment and asking people to copy this movement for a set number of attempts in a predictable manner, we showed that autistic people did successfully learn to copy a new movement. This is a very important finding for autistic people because rather than thinking they cannot copy new movements, all that needs to be considered is for parents/guardians, teachers and/or support workers to make a small adjustment so that learning occurs in a predictable manner for new skills to be successfully acquired through copying. The implications from this study are wide-ranging as copying (imitation) and motor learning are important developmental processes for autistic infants and children to acquire in order to interact within the world. Therefore, practising these behaviours in the most effective way can certainly help the developmental pathway.

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8. Freeth M, Morgan E, Bugembe P, Brown A. How accurate are autistic adults and those high in autistic traits at making face-to-face line-of-sight judgements ?. Autism. 2020 : 1362361320909176.

LAY ABSTRACT : In order to effectively understand and consider what others are talking about, we sometimes need to follow their line-of-sight to the location at which they are looking, as this can provide important contextual information regarding what they are saying. If we are not able to follow other people’s line-of-sight, this could result in social communication difficulties. Here we tested how effectively autistic and neurotypical adults are at following a social partner’s line-of-sight during a face-to-face task. In a first study, completed by 14 autistic adult participants of average to above-average verbal ability and 14 neurotypical adult participants, we found that all participants were able to effectively follow the social partner’s line-of-sight. We also found that participants tended to be as effective at making these judgements from both a brief, 1s, glance or a long, 5s, stare. However, autistic adults were less accurate, on average, than neurotypical adults overall. In a second study, a separate group of 65 neurotypical adults completed the same line-of-sight judgement task to investigate whether task performance was related to individual variation in self-reported autistic traits. This found that the amount of self-reported autistic traits was not at all related to people’s ability to accurately make line-of-sight judgements. This research isolates and furthers our understanding of an important component part of the social communication process and assesses it in a real-world context.

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9. Harrison KB, McCredie MN, Reddy MK, Krishnan A, Engstrom A, Posey YS, Morey LC, Loveland KA. Assessing Autism Spectrum Disorder in Intellectually Able Adults with the Personality Assessment Inventory : Normative Data and a Novel Supplemental Indicator. J Autism Dev Disord. 2020.

Differential diagnosis of autism spectrum disorder (ASD) among intellectually-able adults often presents a clinical challenge, particularly when individuals present in crisis without diagnostic history. The Personality Assessment Inventory (PAI) is a multiscale personality and psychopathology instrument utilized across clinical settings, but to date there are no published normative data for use of the PAI with adults with ASD. This study provides normative PAI data for adults diagnosed with ASD, with effect size comparisons to the PAI clinical standardization sample and an inpatient sample. Additionally, a discriminant function was developed and cross-validated for identification of ASD-like symptomatology in a clinical population, which demonstrates promise as a screening tool to aid in the identification of individuals in need of specialized ASD assessment.

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10. Hickey EJ, Bolt D, Rodriguez G, Hartley SL. Bidirectional Relations between Parent Warmth and Criticism and the Symptoms and Behavior Problems of Children with Autism. Journal of abnormal child psychology. 2020.

Family research in the field of ASD has focused on describing the impact of child challenges on parents, usually mothers, and given little attention to the ways in which mothers and fathers reciprocally influence the development of the child with ASD. The current study examined the direction of effects between the emotional quality of the mother-child and father-child relationships and the child’s severity of ASD symptoms and emotional and behavioral problems across three time points spanning 2 years. Using parent Five Minute Speech Samples and teacher ratings of the severity of the child’s ASD symptoms and emotional and behavioral problems, four cross-lagged structural equation models were employed to test bidirectional effects between parent warmth and criticism and child ASD symptoms and emotional and behavioral problems across three waves of data (approximately 12 months apart) in 159 families who had a child with ASD (initially aged 6 to 13 years). Mothers and fathers had an average age of 39.53 (SD=5.55) and 41.66 years (SD=6.19). Children with ASD were predominately male (86.2%) and white, non-Hispanic (76.7%). Crossed-lagged model results indicated bidirectional effects for both mothers and fathers. Warmth in the mother-child relationship and father-child relationship impacted child functioning at earlier time points. In the opposite direction, child functioning impacted father warmth and mother criticism at later time points. Findings indicate that the emotional quality of the parent-child relationships are bidirectionally related to the symptoms and emotional and behavioral problems of children with ASD. Important implications for supporting families are discussed.

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11. Hwang YIJ, Arnold S, Trollor J, Uljarevic M. Factor structure and psychometric properties of the brief Connor-Davidson Resilience Scale for adults on the autism spectrum. Autism. 2020 : 1362361320908095.

LAY ABSTRACT : Adults on the autism spectrum experience high rates of anxiety and depression, and may be particularly vulnerable to difficult and traumatic life experiences, which may contribute to the development and maintenance of these conditions. Resilience is an increasingly popular concept in research, which describes the ability to ’bounce back’ following difficult emotional experiences, and the flexibility to adapt to stressful and demanding situations. The Connor-Davidson Resilience Scale has been used predominantly in studies involving non-autistic adults to measure resilience. While resilience is a potentially important concept for autistic adults, the suitability of the 10-item version of the Connor-Davidson Resilience Scale for use with adults on the spectrum has not yet been studied. In this short report, we investigate whether the Connor-Davidson Resilience Scale 10 is a valid measure to use with this population, and its relationship with other measures of mental well- or ill-being. Participants were 95 autistic adults with a mean age of 44 (63% female) who completed measures of resilience, autism symptoms, depression, anxiety and mental wellbeing. Overall, the findings indicate that the Connor-Davidson Resilience Scale 10 may be reliably used with autistic adults to measure trait resilience, which is associated with positive wellbeing and may serve as a protective factor from negative mental wellbeing. Future studies may use the Connor-Davidson Resilience Scale 10 to investigate resilience as a protective factor from negative mental health outcomes in response to traumatic and adverse emotional events for which autistic individuals may be particularly susceptible.

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12. Jones EA, Fiani T, Stewart JL, Neil N, McHugh S, Fienup DM. Randomized controlled trial of a sibling support group : Mental health outcomes for siblings of children with autism. Autism. 2020 : 1362361320908979.

LAY ABSTRACT : Typically developing siblings of a child with autism spectrum disorder may show mental health difficulties. A support group is one approach to help typically developing siblings. During support groups, typically developing siblings discuss their feelings, learn coping strategies and problem-solving skills, and develop a peer network. We compared a support group to participation in a similar group without a focus on the sibling with autism spectrum disorder. Some areas of mental health improved. Improvements were also impacted by autism spectrum disorder symptom severity in the sibling with autism spectrum disorder. Findings suggest continuing to examine how support groups can help typically developing siblings and for which siblings support groups might be particularly effective.

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13. Kim SK, McKay D, Ehrenreich-May J, Wood J, Storch EA. Assessing treatment efficacy by examining relationships between age groups of children with autism spectrum disorder and clinical anxiety symptoms : Prediction by correspondence analysis. Journal of affective disorders. 2020 ; 265 : 645-50.

INTRODUCTION : Autism spectrum disorders (ASD) are neurodevelopmental in nature and are frequently accompanied by anxiety. To fully assess treatment efficacy, we examined rates of anxiety symptom change by age groups following either cognitive behavioral therapy (CBT) or treatment as usual (TAU). METHODS : One hundred sixty-three children with ASD and ASD-related anxiety symptoms were randomly assigned to either CBT or TAU. Utilizing prediction by correspondence analysis (CA), we evaluated the age effect (defined in three groups ; ages 6-9, 10-12, and 13-16) and the changes in correlations between age and anxiety severity levels over the course of treatment. RESULTS : Significantly greater anxiety symptom reduction was associated with CBT compared with TAU across the three age groups. Of particular note, the children ages 10-12 who received CBT showed the greatest improvement compared to all other groups. Late childhood, prior to adolescence, showed the best response to CBT for anxiety in ASD. DISCUSSION : These findings suggest that treatment programs need to more closely address developmental factors within narrower bands of age groups. The present results are limited in their generalization to the CBT efficacy for a specific age band (ages 10-12). Longitudinal investigations are recommended to confirm whether the similar age group children who receive CBT experience the greatest benefit in reducing their ASD-related anxiety symptoms.

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14. Kurihara M, Ishiura H, Bannai T, Mitsui J, Yoshimura J, Morishita S, Hayashi T, Shimizu J, Toda T, Tsuji S. A Novel de novo KIF1A Mutation in a Patient with Autism, Hyperactivity, Epilepsy, Sensory Disturbance, and Spastic Paraplegia. Internal medicine (Tokyo, Japan). 2020 ; 59(6) : 839-42.

Heterozygous mutations in KIF1A have been reported to cause syndromic intellectual disability or pure spastic paraplegia. However, their genotype-phenotype correlations have not been fully elucidated. We herein report a man with autism and hyperactivity along with sensory disturbance and spastic paraplegia, carrying a novel de novo mutation in KIF1A [c.37C>T (p.R13C)]. Autism and hyperactivity have only previously been reported in a patient with c.38 G>A (R13H) mutation. This case suggests that alterations in this arginine at codon 13 might lead to a common clinical spectrum and further expand the genetic and clinical spectra associated with KIF1A mutations.

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15. Lawson LP, Richdale AL, Haschek A, Flower RL, Vartuli J, Arnold SR, Trollor JN. Cross-sectional and longitudinal predictors of quality of life in autistic individuals from adolescence to adulthood : The role of mental health and sleep quality. Autism. 2020 : 1362361320908107.

LAY ABSTRACT : Research shows that autistic adults are at risk of a range of physical (e.g. sleep difficulties) and mental health (e.g. anxiety) conditions, as well as lower employment and post-secondary education participation ; these all can affect one’s quality of life. However, we have little information about what affects quality of life for autistic individuals across the lifespan and whether this differs from non-autistic people. We determined what factors (e.g. mental or physical health challenges) affected quality of life in a large group of autistic individuals aged 15-80 years compared with similar age non-autistic individuals. We also examined what factors affected quality of life of the autistic group 2 years later. We found a similar pattern of results for the autistic and non-autistic groups ; depression symptoms, psychological well-being, sleep quality and autonomic symptoms (e.g. sweating) were all significant predictors of quality of life. In addition, among the autistic group, baseline quality of life had the most influence on quality of life 2 years later. These results have implications for support services, as they highlight the relationship between mental health (especially depression) and quality of life. Given that sleep challenges (e.g. insomnia) are related to mental health, an intervention addressing both insomnia and mental health may be most useful in helping autistic individuals improve their quality of life.

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16. Levie D, Bath SC, Guxens M, Korevaar TI, Dineva M, Fano E, Ibarluzea JM, Llop S, Murcia M, Rayman MP, Sunyer J, Peeters RP, Tiemeier H. Maternal Iodine Status During Pregnancy Is Not Consistently Associated with Attention-Deficit Hyperactivity Disorder or Autistic Traits in Children. The Journal of nutrition. 2020.

BACKGROUND : Severe iodine deficiency during pregnancy can cause intellectual disability, presumably through inadequate placental transfer of maternal thyroid hormone to the fetus. The association between mild-to-moderate iodine deficiency and child neurodevelopmental problems is not well understood. OBJECTIVES : We investigated the association of maternal iodine status during pregnancy with child attention-deficit hyperactivity disorder (ADHD) and autistic traits. METHODS : This was a collaborative study of 3 population-based birth cohorts : Generation R (n = 1634), INfancia y Medio Ambiente (n = 1293), and the Avon Longitudinal Study of Parents and Children (n = 2619). Exclusion criteria were multiple fetuses, fertility treatment, thyroid-interfering medication use, and pre-existing thyroid disease. The mean age of assessment in the cohorts was between 4.4 and 7.7 y for ADHD symptoms and 4.5 and 7.6 y for autistic traits. We studied the association of the urinary iodine-to-creatinine ratio (UI/Creat) <150 mug/g-in all mother-child pairs, and in those with a urinary-iodine measurement at </=18 weeks and /=93rd percentile cutoff), using logistic regression. The cohort-specific effect estimates were combined by random-effects meta-analyses. We also investigated whether UI/Creat modified the associations of maternal free thyroxine (FT4) or thyroid-stimulating hormone concentrations with ADHD or autistic traits. RESULTS : UI/Creat <150 mug/g was not associated with ADHD (OR : 1.2 ; 95% CI : 0.7, 2.2 ; P = 0.56) or with a high autistic-trait score (OR : 0.8 ; 95% CI : 0.6, 1.1 ; P = 0.22). UI/Creat <150 mug/g in early pregnancy (i.e., </=18 weeks or </=14 weeks of gestation) was not associated with a higher risk of behavioral problems. The association between a higher FT4 and a greater risk of ADHD (OR : 1.3 ; 95% CI : 1.0, 1.6 ; P = 0.017) was not modified by iodine status. CONCLUSIONS : There is no consistent evidence to support an association of mild-to-moderate iodine deficiency during pregnancy with child ADHD or autistic traits.

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17. Maras K, Dando C, Stephenson H, Lambrechts A, Anns S, Gaigg S. The Witness-Aimed First Account (WAFA) : A new technique for interviewing autistic witnesses and victims. Autism. 2020 : 1362361320908986.

LAY ABSTRACT : Autistic people may be more likely to be interviewed by police as a victim/witness, yet they experience social communication difficulties alongside specific memory difficulties that can impact their ability to recall information from memory. Police interviewing techniques do not take account of these differences, and so are often ineffective. We developed a new technique for interviewing autistic witnesses, referred to a Witness-Aimed First Account, which was designed to better support differences in the way that autistic witnesses process information in memory. The Witness-Aimed First Account technique encourages witnesses to first segment the witnessed event into discrete, parameter-bound event topics, which are then displayed on post-it notes while the witness goes onto freely recall as much information as they can from within each parameter-bound topic in turn. Since witnessed events are rarely cohesive stories with a logical chain of events, we also explored autistic and non-autistic witnesses’ recall when the events were witnessed in a random (nonsensical) order. Thirty-three autistic and 30 typically developing participants were interviewed about their memory for two videos depicting criminal events. Clip segments of one video were ’scrambled’, disrupting the event’s narrative structure ; the other video was watched intact. Although both autistic and non-autistic witnesses recalled fewer details with less accuracy from the scrambled video, Witness-Aimed First Account interviews resulted in more detailed and accurate recall from both autistic and non-autistic witnesses, for both scrambled and unscrambled videos. The Witness-Aimed First Account technique may be a useful tool to improve witnesses’ accounts within a legally appropriate, non-leading framework.

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18. Moody CT, Laugeson EA. Social Skills Training in Autism Spectrum Disorder Across the Lifespan. Child and adolescent psychiatric clinics of North America. 2020 ; 29(2) : 359-71.

Social skills training programs for individuals with autism spectrum disorder are effective in improving social competence, although effects are frequently not robust across all outcomes measured. When aggregating across the social skills training programs with the strongest evidence, common elements can be identified in both the treatment delivery method and the social skills content targeted. However, social skills training programs continue to remain limited in their generalizability and scope. Existing research has primarily tested programs designed for school-aged children with autism spectrum disorder, who have average or above average intellectual functioning.

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19. Northrup JB, Goodwin M, Montrenes J, Vezzoli J, Golt J, Peura CB, Siegel M, Mazefsky C. Observed emotional reactivity in response to frustration tasks in psychiatrically hospitalized youth with autism spectrum disorder. Autism. 2020 : 1362361320908108.

LAY ABSTRACT : Large emotional reactions (e.g. outbursts, tantrums) can be common and distressing in the lives of individuals with autism spectrum disorder and their families. Most previous research that has examined these types of emotional responses have used questionnaire data or focused only on young children. In addition, very little research has included individuals across a large range of intellectual and functional abilities or individuals with more severe emotional and/or behavioral difficulties. This study examined emotional reactions to frustrating tasks in 6-21-year-olds with autism spectrum disorder who were psychiatrically hospitalized due to emotional and/or behavioral difficulties. We describe change in the amount, intensity, duration, and range of emotional reactions that the participants displayed from a neutral activity to the frustrating tasks and then to a neutral recovery period. We also examined associations between characteristics of the participants and these emotional reactions. We found that younger children displayed more negative emotions across the neutral and frustrating tasks ; however, age did not relate to how big their reactions to frustration were. Furthermore, we found that individuals with fewer adaptive skills (i.e. age-appropriate life skills) and minimally verbal individuals had bigger reactions and recovered less following the frustration tasks. The results highlight the importance of examining emotional reactions in individuals with lower verbal and adaptive abilities and for interventions to consider the connection between verbal and adaptive skills and emotional reactions.

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20. Pandina G, Ring RH, Bangerter A, Ness S. Current Approaches to the Pharmacologic Treatment of Core Symptoms Across the Lifespan of Autism Spectrum Disorder. Child and adolescent psychiatric clinics of North America. 2020 ; 29(2) : 301-17.

There are no approved medications for autism spectrum disorder (ASD) core symptoms. However, given the significant clinical need, children and adults with ASD are prescribed medication off label for core or associated conditions, sometimes based on limited evidence for effectiveness. Recent developments in the understanding of biologic basis of ASD have led to novel targets with potential to impact core symptoms, and several clinical trials are underway. Heterogeneity in course of development, co-occurring conditions, and age-related treatment response variability hampers study outcomes. Novel measures and approaches to ASD clinical trial design will help in development of effective pharmacologic treatments.

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21. Pazuniak M, Pekrul SR. Obsessive-Compulsive Disorder in Autism Spectrum Disorder Across the Lifespan. Child and adolescent psychiatric clinics of North America. 2020 ; 29(2) : 419-32.

Obsessive-compulsive disorder is a relatively common disorder seen in autism spectrum disorder across the lifespan. Many obsessive-compulsive disorder symptoms can present similarly to the core features of autism spectrum disorder and it is often difficult to differentiate between obsessive-compulsive disorder and stereotypic behaviors or restricted interests in autism spectrum disorder. However, there are differences between the 2 disorders. This article is a review of the current literature with the goal of helping the clinician to diagnose and treat obsessive-compulsive disorder in a patient with autism spectrum disorder.

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22. Peden AE, Willcox-Pidgeon S. Autism spectrum disorder and unintentional fatal drowning of children and adolescents in Australia : an epidemiological analysis. Arch Dis Child. 2020.

OBJECTIVES : This study explored unintentional fatal drowning among children and adolescents (0-19 years) diagnosed with autism spectrum disorder (ASD) in Australia. DESIGN : This total population, cross-sectional audit used data from the Royal Life Saving National Fatal Drowning Database to explore demographic and causal factors in ASD drowning cases between 1 July 2002 and 30 June 2018. Rates and relative risk (RR) with a 95% confidence interval (CI) were calculated for drowning cases with and without ASD, using estimated population-level prevalence data. RESULTS : Of the 667 cases of drowning among 0-19 year olds with known medical history, 27 children and adolescents (4.0%) who drowned had an ASD diagnosis. Children and adolescents with ASD were three times more likely to drown than those without ASD (RR=2.85 ; CI 0.61 to 13.24). Among those with ASD, 0-4 year olds record the highest rate (11.60/100 000 diagnosed). Children and adolescents with ASD were significantly more likely to drown when compared with those without ASD : if aged 5-9 years (44.4% of ASD-yes cases ; 13.3% of ASD-no cases) ; in a lake or dam (25.9% vs 10.0%) and during winter (37.0% vs 13.1%). CONCLUSION : Heightened awareness of drowning risk for children and adolescents with ASD is required, including adult supervision and barriers restricting water access. Further evaluation of the effectiveness of personal alarms to alert caregivers to an unsupervised child is warranted. Challenges exist regarding accurate estimates of population-level ASD prevalence and identification of ASD in coronial files. As the diagnosis of ASD does not often occur until age five, results may be an underestimate.

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23. Saitow F, Takumi T, Suzuki H. Change in serotonergic modulation contributes to the synaptic imbalance of neuronal circuit at the prefrontal cortex in the 15q11-13 duplication mouse model of autism. Neuropharmacology. 2020 ; 165 : 107931.

The prefrontal cortex (PFC) has been extensively studied in autism spectrum disorder (ASD) in an attempt to understand the deficits in executive and other higher brain functions related to sociability and emotion. Disruption of the excitatory/inhibitory (E/I) balance of cortical circuits is thought to underlie the pathophysiology of ASD. Recently, we showed that 15q dup mice (a model for ASD with human chromosome 15q11-13 paternal duplication) exhibit disruption of the E/I balance in layer 2/3 pyramidal neurons of the somatosensory cortex due to a decrease in the number of inhibitory synapses. However, whether there is a pathological abnormality in E/I balance in the PFC of 15q dup mice remains unknown. In this study, we found that 15q dup facilitates the activity-induced LTP of glutamate synapses onto layer 5 pyramidal neurons by shifting the E/I balance to an excitatory state, which this was associated with differences in synaptic glutamatergic and GABAergic inputs onto GABAergic fast-spiking interneurons (FSINs). Furthermore, we found that FSIN excitability was well-modulated and regulated by the constitutive activation of 5-HT2 receptors in PFC microcircuits. These results provide new insights into the cellular mechanisms underlying maintenance of optimal E/I balance in the PFC.

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24. Santore LA, Gerber A, Gioia AN, Bianchi R, Talledo F, Peris TS, Lerner MD. Felt but not seen : Observed restricted repetitive behaviors are associated with self-report-but not parent-report-obsessive-compulsive disorder symptoms in youth with autism spectrum disorder. Autism. 2020 : 1362361320909177.

LAY ABSTRACT : Youth with autism spectrum disorder often exhibit symptoms of obsessive-compulsive disorder ; however, it can be difficult for parents and clinicians to tell the difference between the restricted and repetitive behaviors often seen in autism spectrum disorder and symptoms of obsessive-compulsive disorder. This difficulty in distinguishing symptoms may arise from the fact that these symptoms appear the same to observers but are typically differentiated based on whether the motivation for the behavior is to reduce stress (restricted and repetitive behaviors) or whether the behavior itself is stressful (obsessive-compulsive disorder). It is important to know the difference between these two symptoms as it may impact the treatment prescribed. The goal of this study was to better determine the difference between restricted and repetitive behaviors and symptoms of obsessive-compulsive disorder in youth with autism spectrum disorder. It was found that although parents and clinicians had trouble differentiating between the two, the children were able to provide insight as to their own motivations for behavior, and thus whether they were restricted and repetitive behaviors or symptoms of obsessive-compulsive disorder. It was also found that children may actually have subjective negative experiences when engaging in restricted and repetitive behaviors, which complicates their classification. These results provide guidance for better understanding, distinguishing, and ultimately treating obsessive-compulsive disorder behavior in youth with autism spectrum disorder.

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25. Schall C, Wehman P, Avellone L, Taylor JP. Competitive Integrated Employment for Youth and Adults with Autism : Findings from a Scoping Review. Child and adolescent psychiatric clinics of North America. 2020 ; 29(2) : 373-97.

A scoping review was conducted to map existing literature on effective interventions for competitive employment for individuals with autism spectrum disorder. Empirical database searches were conducted. A filter for level of methodological rigor was implemented. A total of 25 articles met inclusion criteria. Findings were categorized by level of evidence. Findings revealed strong empirical support for a transition-to-work program called Project SEARCH plus ASD Supports and traditional supported employment services. Receipt of specific vocational rehabilitation and transition services in high school were also identified as effective interventions. Recommendations per level of evidence are provided in more detail.

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26. Shulman C, Esler A, Morrier MJ, Rice CE. Diagnosis of Autism Spectrum Disorder Across the Lifespan. Child and adolescent psychiatric clinics of North America. 2020 ; 29(2) : 253-73.

Although autism spectrum disorder (ASD) is one of the most common neurodevelopmental disorders it is also one of the most heterogeneous conditions, making identification and diagnosis complex. The importance of a stable and consistent diagnosis cannot be overstated. An accurate diagnosis is the basis for understanding the individual and establishing an individualized treatment plan. We present those elements that should be included in any assessment for ASD and describe the ways in which ASD typically manifests itself at various developmental stages. The implications and challenges for assessment at different ages and levels of functioning are discussed.

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27. Shulman C, Rice CE, Morrier MJ, Esler A. The Role of Diagnostic Instruments in Dual and Differential Diagnosis in Autism Spectrum Disorder Across the Lifespan. Child and adolescent psychiatric clinics of North America. 2020 ; 29(2) : 275-99.

The heterogeneity inherent in autism spectrum disorder (ASD) makes the identification and diagnosis of ASD complex. We survey a large number of diagnostic tools, including screeners and tools designed for in-depth assessment. We also discuss the challenges presented by overlapping symptomatology between ASD and other disorders and the need to determine whether a diagnosis of ASD or another diagnosis best explains the individual’s symptoms. We conclude with a call to action for the next steps necessary for meeting the diagnostic challenges presented here to improve the diagnostic process and to help understand each individual’s particular ASD profile.

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28. Wisner-Carlson R, Pekrul SR, Flis T, Schloesser R. Autism Spectrum Disorder Grows Up. Child and adolescent psychiatric clinics of North America. 2020 ; 29(2) : xiii-xvi.

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29. Wisner-Carlson R, Uram S, Flis T. The Transition to Adulthood for Young People with Autism Spectrum Disorder. Child and adolescent psychiatric clinics of North America. 2020 ; 29(2) : 345-58.

The transition to adulthood for individuals with autism spectrum disorder is difficult and outcomes are suboptimal. Social cognition deficits and executive dysfunction continue to be barriers to young people’s success, lack of societal acceptance and loss of previous support can exacerbate the condition, and mental health issues increase. All areas of adult functioning are affected. To help manage the transition and improve outcomes for this population, psychiatrists and other health care providers need to be aware of the issues and possible interventions, including social skills training, educational transition programs, and supported employment programs.

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Formations pour les Familles et les Proches

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