Pubmed du 29/12/17

vendredi 29 décembre 2017

1. Coret A, Boyd K, Hobbs K, Zazulak J, McConnell M. Patient Narratives as a Teaching Tool : A Pilot Study of First-Year Medical Students and Patient Educators Affected by Intellectual/Developmental Disabilities. Teaching and learning in medicine. 2017 : 1-11.

PROBLEM : People with intellectual and developmental disabilities (IDD) face complex biopsychosocial challenges and are medically underserved. This is in part due to insufficient resources and supports but can also be attributed to a lack of adequate physician training in addressing the unique needs of this population. INTERVENTION : This study aimed to introduce 1st-year medical students to the IDD population using a blended educational experience that included video narratives of and direct interactions with people affected by IDD. The goal of this intervention was to promote person-centered attitudes and communication among early medical trainees. CONTEXT : The study recruited 27 first-year medical students and randomly assigned each to 1 of 2 groups. The control group received an introductory video lecture about IDD healthcare, followed by a quiz. The narrative group received the same lecture, followed by reflective discussion of videos featuring people living with IDD sharing their perspectives and stories. All students then participated in 4 simulated clinical encounters with patient educators (PEs) who have lived experiences of IDD. Focus groups were conducted with students following the simulated encounters to explore their experiences and perceptions of this blended learning activity. Moreover, secondary quantitative data were collected to assess students’ performance in the clinical encounters, along with self-reports of comfort, confidence, and competence of interacting with people with IDD (pre- and postparticipation). OUTCOME : All students thought that the blended educational experience was valuable and enjoyable, commenting on the importance of adaptable language and engagement of people with IDD, as well as the merits of reflecting on patient narratives. Students also discussed feelings of discomfort stemming from a lack of knowledge and previous exposure to IDD and how this discomfort might motivate them to learn more and develop their skills further. In addition, descriptive analyses revealed that students in the narrative group showed greater self-rated measures of comfort, confidence, and competence compared to control ; they also had higher mean performance scores across all PE interview stations. LESSONS LEARNED : PEs add a powerful real-life dimension to communication skills teaching and have been shown to be a valuable educational modality. Moreover, exposure to and reflection on video-based patient narratives are useful ways of teaching medical students about patients’ lived experiences and promoting person-centered communication, both within and beyond IDD.

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2. Eack SM, Hogarty SS, Greenwald DP, Litschge MY, Porton SA, Mazefsky CA, Minshew NJ. Cognitive enhancement therapy for adult autism spectrum disorder : Results of an 18-month randomized clinical trial. Autism Res. 2017.

Cognitive remediation is a promising approach to treating core cognitive deficits in adults with autism, but rigorously controlled trials of comprehensive interventions that target both social and non-social cognition over a sufficient period of time to impact functioning are lacking. This study examined the efficacy of cognitive enhancement therapy (CET) for improving core cognitive and employment outcomes in adult autism. Verbal adult outpatients with autism spectrum disorder (N = 54) were randomized to an 18-month, single-blind trial of CET, a cognitive remediation approach that integrates computer-based neurocognitive training with group-based training in social cognition, or an active enriched supportive therapy (EST) comparison focused on psychoeducation and condition management. Primary outcomes were composite indexes of neurocognitive and social-cognitive change. Competitive employment was a secondary outcome. Intent-to-treat analyses indicated that CET produced significant differential increases in neurocognitive function relative to EST (d = .46, P = .013). Both CET and EST were associated with large social-cognitive improvements, with CET demonstrating an advantage at 9 (d = .58, P = 0.020), but not 18 months (d = .27, P = 0.298). Effects on employment indicated that participants treated with CET were significantly more likely to gain competitive employment than those in EST, OR = 6.21, P = 0.023, which was mediated by cognitive improvement. CET is a feasible and potentially effective treatment for core cognitive deficits in adult autism spectrum disorder. The treatment of cognitive impairments in this population can contribute to meaningful improvements in adult outcomes. Autism Res 2017. (c) 2017 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY : Cognitive enhancement therapy (CET), an 18-month cognitive remediation intervention designed to improve thinking and social understanding, was found to be more effective than supportive therapy at improving mental quickness, attention, and employment in adults living with autism. Social understanding was equally improved in CET and supportive therapy. Cognitive remediation interventions are feasible and may confer significant functional benefits to adults with autism.

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3. Gasparotto FM, Liveror FA, Tolouei Menegati SEL, Junior AG. Herbal Medicine as an Alternative Treatment in Autism Spectrum Disorder : A Systematic Review. Current drug metabolism. 2017.

This review focuses on the efficacy and safety of herbal medicines in the management of autism spectrum disorder (ASD) in humans and animals. PubMed, Scopus, Google Scholar, Web of Science, and Science Direct databases were searched up to October 30, 2016. The key terms used were "ASD", "Asperger", "autism", "healing plants", "herbal medicine", and "medicinal plants". In each database, the searches consisted of each of the three key terms describing the disorder and subtypes plus each of the terms describing the therapy. All human and animal studies on the effects of herbs with the key outcome of change in autism symptoms were included. In vitro studies were excluded. From the publications perused in the initial database, 3157 results were identified, reviewed and a total of 23 studies were included. Preclinical studies using critically validated models were conducted, with some promising preliminary results. Data availability on controlled clinical studies is currently very limited. The use of different methodologies and the very small number of patients raise doubts about the effects of these preparations. Available data do not yet allow us to suggest the effectiveness of herbal medicines as an add-on in the treatment of ASD symptoms.

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4. Godoy-Gimenez M, Gonzalez-Rodriguez A, Canadas F, Estevez AF, Sayans-Jimenez P. Psychometric Properties of the Spanish Version of the Broad Autism Phenotype Questionnaire : Strengths, Weaknesses, and Future Improvements. J Autism Dev Disord. 2017.

The Broad autism phenotype (BAP) refers to a set of subclinical behavioural characteristics qualitatively similar to those presented in Autism spectrum disorders (ASDs). The BAP questionnaire (BAPQ) has been widely used to assess the BAP both in relatives of ASD people and within the general population. The current study presents the first Spanish version of the BAPQ (BAPQ-SP) and analyses its psychometric properties, including validity evidences based on the BAPQ scores relationship with other variables. Our results only support the use of the Aloof and Rigid sub-scales to assess this phenotype, whereas Pragmatic Language sub-scale seems to be the main source of misfit. This research represents a first step in the study of the BAP features in the Spanish population.

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5. Kashefimehr B, Kayihan H, Huri M. The Effect of Sensory Integration Therapy on Occupational Performance in Children With Autism. OTJR : occupation, participation and health. 2017 : 1539449217743456.

Sensory processing problems and related dysfunctions are among the most common conditions in children with autism spectrum disorder (ASD). This study examined the effect of sensory integration therapy (SIT) on different aspects of occupational performance in children with ASD. The study was conducted on an intervention group ( n = 16) receiving SIT and a control group ( n = 15) with 3- to 8-year-old children with ASD. The Short Child Occupational Profile (SCOPE) was used to compare the two groups in terms of the changes in their occupational performance and the Sensory Profile (SP) was used to assess sensory problems. The intervention group showed significantly greater improvement in all the SCOPE domains, as well as in all the SP domains, except for the "emotional reactions" and "emotional/social responses" domains, ( p < .05). The effectiveness of SIT in improving occupational performance in children with ASD as a health-related factor is supported by our findings.

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6. Novellino F, Vasta R, Alessia S, Chiriaco C, Maria S, Maurizio M, Gennarina A, Sacca V, Nicoletti G, Quattrone A. Relationship between hippocampal subfields and category cued recall in AD and PDD : A multimodal MRI study. Neuroscience. 2017.

Alzheimer’s Disease (AD) and Parkinson’s Disease with Dementia (PDD), are characterized by a different mnesic failure, particularly in memory cued recall. Although hippocampal involvement has been shown in both these diseases, it remains unknown if a selective damage of specific subfields within the hippocampus may be responsible of the peculiar mnesic profile observed in AD and PDD. To explore this topic, we combined a multimodal 3T-MRI hippocampal evaluation (whole-brain T1-weighted and diffusion tensor imaging) with a hippocampal-targeted neuropsychological assessment (Free and Cued Selective-Reminding-Test [FCSRT]) in 22 AD subjects, 18 PDD and 17 healthy controls. Macro- and micro-structural features (volume ; shape ; mean diffusivity[MD] ; fractional anisotropy[FA]) of bilateral hippocampi (whole and subfields) were obtained. Correlations between MRI-derived parameters and neuropsychological evaluations were performed. In the comparison between AD and PDD, the multimodal analysis allowed us to identify that subiculum, CA1 and CA4-DG were differently involved in these diseases and correlated with immediate and delayed total recall items of FCSRT. Moreover, compared to controls, AD showed a reduction in almost all subfields, with a MD increase in the same regions, whereas PDD displayed a volume loss, less severe than AD, more evident in the CA2-3 and presubiculum subfields. Our study provides new evidence that hippocampal subregions had different vulnerability to damage related to AD and PDD. The combination of the in vivo analysis of hippocampal subfields with the FCSRT paradigm provided important insights into whether changes within specific hippocampal subfields are related to the different mnesic profile in AD and PDD patients.

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7. Riccio MP, Franco C, Negri R, Ferrentino RI, Maresca R, D’Alterio E, Greco L, Bravaccio C. Is food refusal in autistic children related to TAS2R38 genotype ?. Autism Res. 2017.

Several studies suggest that atypical eating behaviors, in particular food selectivity, are more frequent in children with autism spectrum disorder (ASD). A link between bitter taste perception, namely PROP/PTC sensitivity and food preferences is known in healthy children. The aim of this study is to investigate whether genetic variants of the TAS2R38 taste receptor responsible for different bitter sensitivity could affect foods preferences and consequently food refusal in ASD children. We recruited 43 children with ASD and 41 with normotypic development (TD) with or without food selectivity, aged between 2 and 11 years. Children were characterized for bitter sensitivity by means of PROP strips and FACS analysis and genotyped for TAS2R38 polymorphisms. Food selectivity was assessed by a validated food preference questionnaire filled by parents. A statistically significant correlation between PROP sensitivity and food refusal was observed. Furthermore, a prevalence of the PAV-sensitive haplotype compared to the AVI-insensitive one was seen in ASD children with food selectivity. In agreement with the initial hypothesis the results show that food refusal in ASD children is mediated by bitter taste sensitivity thus suggesting that the bitter sensitivity test may be used as a device to orientate tailored food proposals for the practical management of food selectivity in ASD. Autism Res 2017. (c) 2017 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY : A variation of the gene TAS2R38, associated with bitter taste sensitivity, can cause a different perception of some foods. In particular, some children are hypersensitive to bitterness and show a more restricted repertoire of accepted foods. We evaluate bitter sensitivity in ASD children with or without food selectivity, through a simple bitter taste test with edible strips. The results show that food refusal in ASD children can be mediated by bitter taste sensitivity thus suggesting that the bitter sensitivity test may be used as a device to orientate tailored food proposals for the practical management of food selectivity in ASD.

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8. Tomasi D, Volkow ND. Reduced Local and Increased Long-Range Functional Connectivity of the Thalamus in Autism Spectrum Disorder. Cereb Cortex. 2017.

It is hypothesized that brain network abnormalities in autism spectrum disorder (ASD) reflect local overconnectivity and long-range underconnectivity. However, this is not a consistent finding in recent studies, which could reflect the developmental nature and the heterogeneity of ASD. Here, we tested 565 ASD and 602 neurotypical (NT) males, and 91 ASD and 233 NT females using local functional connectivity density (lFCD) mapping and seed-voxel correlation analyses to assess how local and long-range connectivities differ in ASD. Compared with NT males, ASD males had lower and weaker age-related increases in thalamic lFCD, which were associated with symptoms of autism. Post-hoc seed-voxel correlation analyses for the thalamus cluster revealed stronger connectivity with auditory, somatosensory, motoric, and interoceptive cortices for ASD than for NT, both in males and in females, which decreased with age in both ASD and NT. These results document the disruption of local thalamic connectivity and dysregulation of thalamo-cortical networks, which might contribute to perceptual, motoric, and interoceptive impairments, and are also consistent with a developmental delay in functional connectivity in ASD.

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9. Twomey C, O’Connell H, Lillis M, Tarpey SL, O’Reilly G. Utility of an abbreviated version of the stanford-binet intelligence scales (5(th) ed.) in estimating ’full scale’ IQ for young children with autism spectrum disorder. Autism Res. 2017.

The fifth edition of the Stanford-Binet Intelligence scales allows ’full scale’ IQ (FSIQ) to be estimated using an abridged version of the test-the abbreviated battery IQ (ABIQ). Set within a public early intervention team service, the current cross-sectional study investigated the utility of the ABIQ in estimating FSIQ for 40 children with autism spectrum disorder (ASD) aged 3-5 years. A strong ABIQ-FSIQ association was yielded (r = 0.89 ; r(2) = 0.808) and the ABIQ did not over-estimate mean FSIQ above a clinically-relevant threshold ; however, clinically significant over-estimation occurred in 17.5% of individual cases. While the findings provide support for the utility of the ABIQ in estimating FSIQ for young children with ASD, caution relating to the over-estimation of FSIQ is warranted. Careful clinical judgment-ideally based on examination of previous cognitive assessment results (if available), thorough interactional observations, and close multi-disciplinary consultation-is necessary to determine the applicability of the ABIQ to individual cases. Autism Res 2017. (c) 2017 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY : We investigated the utility of a shortened version of the Stanford-Binet Intelligence Scales in estimating IQ for 40 young children with autism spectrum disorder (ASD). The findings provide qualified support for the instrument : acceptably accurate IQ estimation was achieved for most cases ; but not so for a sizeable minority (17.5%). Careful clinical judgment is necessary to determine the applicability of the ABIQ to individual cases.

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