Pubmed du 02/01/18

mardi 2 janvier 2018

1. Cheung V, McCarthy ML, Cicero MX, Leventhal JM, Weitzman C. Emergency Medical Responders and Adolescents With Autism Spectrum Disorder. Pediatric emergency care. 2018.

OBJECTIVES : Because of the high prevalence of Autism Spectrum Disorder (ASD) and wandering behavior, emergency medical responders (EMRs) will likely encounter children and adolescents with ASD. The objectives were to describe interactions between EMRs and children and adolescents with ASD, to evaluate EMRs’ ability to recognize ASD in a simulated trauma setting, and to determine if EMRs’ demographic characteristics affected their interactions with ASD youth. METHODS : A study of 75 videos of a simulated school bus crash was performed. The simulation included an adolescent with ASD portrayed by an actor. Videos were coded based on 5 domains : (1) reassurance attempts by the EMR, (2) quality of the EMR’s interactions, (3) EMR’s elicitation of information, (4) EMR’s interactions with others, and (5) EMR’s recognition of a disability. Two clinicians coded the videos independently, and consensus was reached for any areas of disagreement. RESULTS : Of 75 interactions, 27% provided reassurance to the adolescent with ASD, 1% elicited information, 11% asked bystanders for information or assistance, and 35% suggested a disability with 13% considering ASD. No differences across domains were found based on the EMR’s sex. Emergency medical responders with greater than or equal to 5 years of experience were significantly more likely to elicit information than those with less than 5 years of experience, and paramedics had significantly higher total performance scores than paramedic students or those with EMT-Basic. CONCLUSIONS : Few EMRs in this study optimally interacted with adolescents with ASD or recognized a disability. These findings suggest a strong need for targeted educational interventions.

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2. Degroote S, Hunting D, Takser L. Periconceptional folate deficiency leads to autism-like traits in Wistar rat offspring. Neurotoxicology and teratology. 2018.

BACKGROUND : Folates in their role as key one carbon donors, are essential for two major pathways : the synthesis of DNA and RNA precursors and DNA methylation. A growing body of evidence from epidemiological studies indicates a possible association between nutritional and functional deficiency in folates and Autism Spectrum Disorders (ASD). However, there are no available behavioral animal studies on periconceptional onecarbon donor deficiency during gestation and the autistic phenotype. OBJECTIVE : The objective of this study was to determine if the periconceptional alteration of onecarbon metabolism induced with a folate deficient diet would affect the behaviour of rat offspring. METHODS : Female Wistar rats were divided in two groups : control (basal diet, in compliance with standards of regular laboratory diets), or exposed during one month before breeding until Gestational Day 15 to a modified diet with no added folic acid (0.2mg/kg of food), reduced choline (750mg/kg of food), and added 1% SST (a non-absorbable antibiotic used to inhibit folate synthesis by gut bacteria). We administered behavioral tests to offspring, i.e., open field (P20), social interactions (P25), marble burying (P30), elevated plus maze (P35), and prepulse inhibition of the acoustic startle reflex (sensorimotor gating) (P45). Blood homocysteine levels were used to confirm the deficit in onecarbon donors. RESULTS : Compared to controls, offspring with the periconceptional deficit in folate showed : (i) congenital body malformations ; (ii) reduced social interactions, with a 30% decrease in social sniffing behavior ; (iii) reduced exploration of the open arm by 50% in the elevated plus maze test, indicating increased anxiety ; (iv) a 160% increased number of marbles buried, indicating repetitive behaviors ; and (v) altered sensorimotor gating, with a global 50% decrease in startle inhibition. CONCLUSION : Maternal periconceptional deficit in folate provokes alterations in the behavior of offspring relevant to the autistic-like phenotype.

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3. Dudas RB, Lovejoy C, Cassidy S, Allison C, Smith P, Baron-Cohen S. Correction : The overlap between autistic spectrum conditions and borderline personality disorder. PLoS One. 2018 ; 13(1) : e0190727.

[This corrects the article DOI : 10.1371/journal.pone.0184447.].

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4. Lyall K, Yau VM, Hansen R, Kharrazi M, Yoshida CK, Calafat AM, Windham G, Croen LA. Prenatal Maternal Serum Concentrations of Per- and Polyfluoroalkyl Substances in Association with Autism Spectrum Disorder and Intellectual Disability. Environmental health perspectives. 2018 ; 126(1) : 017001.

BACKGROUND : Emerging work has examined neurodevelopmental outcomes following prenatal exposure to per- and polyfluoroalkyl substances (PFAS), but few studies have assessed associations with autism spectrum disorder (ASD). OBJECTIVES : Our objective was to estimate associations of maternal prenatal PFAS concentrations with ASD and intellectual disability (ID) in children. METHODS : Participants were from a population-based nested case-control study of children born from 2000 to 2003 in southern California, including children diagnosed with ASD (n=553), ID without autism (n=189), and general population (GP) controls (n=433). Concentrations of eight PFAS from stored maternal sera collected at 15-19 wk gestational age were quantified and compared among study groups. We used logistic regression to obtain adjusted odds ratios for the association between prenatal PFAS concentrations (parameterized continuously and as quartiles) and ASD versus GP controls, and separately for ID versus GP controls. RESULTS : Geometric mean concentrations of most PFAS were lower in ASD and ID groups relative to GP controls. ASD was not significantly associated with prenatal concentrations of most PFAS, though significant inverse associations were found for perfluorooctanoate (PFOA) and perfluorooctane sulfonate (PFOS) [adjusted ORs for the highest vs. lowest quartiles 0.62 (95% CI : 0.41, 0.93) and 0.64 (95% CI : 0.43, 0.97), respectively]. Results for ID were similar. CONCLUSIONS : Results from this large case-control study with prospectively collected prenatal measurements do not support the hypothesis that prenatal exposure to PFAS is positively associated with ASD or ID.

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5. Mathews TL, Lugo AM, King ML, Needelman LL, McArdle PE, Romer N, Terry M, Menousek K, Evans JH, Higgins WJ. Expanding Access to Clinical Services for Toddlers with Autism Spectrum Disorders. J Pediatr Health Care. 2017.

Autism spectrum disorder (ASD) is a neurodevelopmental disorder typically diagnosed in the toddler and preschool years. Intensive early intervention (EI) using applied behavior analytic procedures is the evidenced-based intervention most effective in improving developmental outcomes. Unfortunately, there are numerous barriers to accessing EI services for toddlers with ASD. This article addresses (a) the process of developing an EI program using primarily applied behavior analytic services with multidisciplinary health care providers, (b) a description of the service delivery provided, (c) educational and training programs to increase qualified staff, and (d) advocacy efforts to improve community capacity. The EI program has sustained growth, improved child developmental outcomes, served as a training ground for EI providers, and yielded high parent satisfaction ratings. Suggestions for continued advocacy, education, research, and policy development related to the lack of access to EI for children with ASD is offered for pediatric health care providers.

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6. Owada K, Kojima M, Yassin W, Kuroda M, Kawakubo Y, Kuwabara H, Kano Y, Yamasue H. Computer-analyzed facial expression as a surrogate marker for autism spectrum social core symptoms. PLoS One. 2018 ; 13(1) : e0190442.

To develop novel interventions for autism spectrum disorder (ASD) core symptoms, valid, reliable, and sensitive longitudinal outcome measures are required for detecting symptom change over time. Here, we tested whether a computerized analysis of quantitative facial expression measures could act as a marker for core ASD social symptoms. Facial expression intensity values during a semi-structured socially interactive situation extracted from the Autism Diagnostic Observation Schedule (ADOS) were quantified by dedicated software in 18 high-functioning adult males with ASD. Controls were 17 age-, gender-, parental socioeconomic background-, and intellectual level-matched typically developing (TD) individuals. Statistical analyses determined whether values representing the strength and variability of each facial expression element differed significantly between the ASD and TD groups and whether they correlated with ADOS reciprocal social interaction scores. Compared with the TD controls, facial expressions in the ASD group appeared more "Neutral" (d = 1.02, P = 0.005, PFDR < 0.05) with less variation in Neutral expression (d = 1.08, P = 0.003, PFDR < 0.05). Their expressions were also less "Happy" (d = -0.78, P = 0.038, PFDR > 0.05) with lower variability in Happy expression (d = 1.10, P = 0.003, PFDR < 0.05). Moreover, the stronger Neutral facial expressions in the ASD participants were positively correlated with poorer ADOS reciprocal social interaction scores (rho = 0.48, P = 0.042). These findings indicate that our method for quantitatively measuring reduced facial expressivity during social interactions can be a promising marker for core ASD social symptoms.

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7. Xu G, Strathearn L, Liu B, Bao W. Prevalence of Autism Spectrum Disorder Among US Children and Adolescents, 2014-2016. Jama. 2018 ; 319(1) : 81-2.

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8. Zahorodny W, Shenouda J, Mehta U, Yee E, Garcia P, Rajan M, Goldfarb M. Preliminary Evaluation of a Brief Autism Screener for Young Children. J Dev Behav Pediatr. 2018.

OBJECTIVE : Our objective was to assess the operating characteristics of the Psychological Development Questionnaire-1 (PDQ-1), an autism screener for use with young children. METHODS : In Phase 1, we evaluated the concordance of the PDQ-1 with established autism scales, determined test-retest reliability, and identified a risk threshold score. In Phase 2, a population of 1959 toddler-age children was prospectively screened through multiple pediatric practices in a diverse metropolitan region, using the new instrument. Screen-positive children were referred for diagnostic evaluation. Screened children received follow-up at age 4 years to identify autism cases missed by screening and to specify the scale’s psychometric properties. RESULTS : By screening a diverse population of low risk children, age 18 to 36 months, with the PDQ-1, we detected individuals with autism who had not come to professional attention. Overall, the PDQ-1 showed a positive predictive value (PPV) of 91%, with a sensitivity of 85% and specificity of 99% in a low risk population. High specificity, good sensitivity, and PPV were observed across the 18 to 36 month age-range. CONCLUSION : The findings provide preliminary empirical support for this parent report-based indicator of toddler psychological development and suggest that the PDQ-1 may be a useful supplement to developmental surveillance of autism. Additional research is needed with high risk samples and large, unselected populations under real-world conditions.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

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