1. {{Thematic papers: new concepts in developing brain disorders-autism}}. {Anat Rec (Hoboken)};2011 (Oct);294(10):spc1.
The cover shows a sagittal view of developing human brain, including cerebellum, brainstem and spinal cord. The background reveals the extensive immunohistochemically labeled serotonergic and noradrenergic cortical fibers in the rodent cortex. The individual puzzle blocks are representative data included in this issue.
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2. Aiello TP, Whitaker-Azmitia PM. {{Sexual differentiation and the neuroendocrine hypothesis of autism}}. {Anat Rec (Hoboken)};2011 (Oct);294(10):1663-1670.
The phenotypic expression of autism spectrum disorders varies widely in severity and characteristics and it is, therefore, likely that a number of etiological factors are involved. However, one finding which has been found consistently is that there is a greater incidence of autism in boys than girls. Recently, attention has been given to the extreme male hypothesis-that is that autism behaviors are an extreme form of typical male behaviors, including lack of empathy and language deficits but an increase in so-called systemizing behaviors, such as attention to detail and collecting. This points to the possibility that an alteration during sexual differentiation of the brain may occur in autism. During sexual differentiation of the brain, two brain regions are highly sexually dimorphic-the amygdala and the hypothalamus. Both of these regions are also implicated in the neuroendocrine hypothesis of autism, wherein a balance between oxytocin and cortisol may contribute to the disorder. We are thus proposing that the extreme male hypothesis and the neuroendocrine hypothesis are in fact compatible in that sexual differentiation of the brain towards an extreme male phenotype would result in the neuroendocrine changes proposed in autism. We have preliminary data, treating developing rat pups with the differentiating hormone 17-beta estradiol during a critical time and showing changes in social behaviors and oxytocin, to support this hypothesis. Further studies should be undertaken to confirm the role of extremes of normal sexual differentiation in producing the neuroendocrine changes associated with autism. Anat Rec, 2011. (c) 2011 Wiley-Liss, Inc.
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3. Al-Ayadhi LY, Mostafa GA. {{Low plasma progranulin levels in children with autism}}. {J Neuroinflammation};2011;8:111.
ABSTRACT: BACKGROUND: Autoimmunity to brain may play a pathogenic role in autism. In autoimmune disorders, the formation of antigen-antibody complexes triggers an inflammatory response by inducing the infiltration of neutrophils. Local administration of recombinant progranulin, which is an anti-inflammatory neurotrophic factor, potently inhibit neutrophilic inflammation in vivo, demonstrating that progranulin represents a crucial inflammation-suppressing mediator. We are the first to measure plasma progranulin levels in autism. METHODS: Plasma levels of progranulin were measured, by ELISA, in 40 autistic patients, aged between 3 and 12 years, and 40 healthy-matched children. RESULTS: Autistic children had significantly lower plasma progranulin levels, P = 0.001. Reduced plasma progranulin levels were found in 65% (26/40) of autistic children.On the other hand, there was a non significant difference between plasma progranulin levels of children with mild to moderate autism and patients with severe autism, P = 0.11. CONCLUSIONS: Plasma progranulin levels were reduced in a subgroup of patients with autism. Progranulin insufficiency in some patients with autism may result in many years of reduced neutrotrophic support together with cumulative damage in association with dysregulated inflammation that may have a role in autism. However, these data should be treated with caution until further investigations are performed, with a larger subject population, to determine whether the decrease of plasma progranulin levels is a mere consequence of autism or has a pathogenic role in the disease. The role of progranulin therapy should also be studied in autism.
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4. Al-Ayadhi LY, Mostafa GA. {{Increased serum osteopontin levels in autistic children: Relation to the disease severity}}. {Brain Behav Immun};2011 (Oct);25(7):1393-1398.
Autoimmunity to brain may play an etiopathogenic role in autism. Osteopontin is a pro-inflammatory cytokine that has been shown to play an important role in various autoimmune neuroinflammatory diseases. Osteopontin induces IL-17 production by T-helper 17 lymphocytes, the key players in the pathogenesis of autoimmune disorders. Anti-osteopontin treatment reduces the clinical severity of some autoimmune neuroinflammatory diseases by reducing IL-17 production. We are the first to measure serum osteopontin levels, by ELISA, in 42 autistic children in comparison to 42 healthy-matched children. The relationship between serum osteopontin levels and the severity of autism, which was assessed by using the Childhood Autism Rating Scale (CARS), was also studied. Autistic children had significantly higher serum osteopontin levels than healthy controls (P<0.001). Increased serum osteopontin levels were found in 80.95% (34/42) of autistic children. Children with severe autism had significantly higher serum osteopontin levels than patients with mild to moderate autism (P=0.02). Moreover, serum osteopontin levels of autistic patients had significant positive correlations with CARS (P=0.007). In conclusions, serum osteopontin levels were increased in many autistic children and they were significantly correlated to the severity of autism. Further wide-scale studies are warranted to shed light on the etiopathogenic role of osteopontin in autism and to investigate its relation to IL-17 and brain-specific auto-antibodies, which are indicators of autoimmunity, in these patients. The therapeutic role of anti-osteopontin antibodies in amelioration of autistic manifestations should also be studied.
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5. Anney RJ, Kenny EM, O’Dushlaine C, Yaspan BL, Parkhomenka E, Buxbaum JD, Sutcliffe J, Gill M, Gallagher L, Bailey AJ, Fernandez BA, Szatmari P, Scherer SW, Patterson A, Marshall CR, Pinto D, Vincent JB, Fombonne E, Betancur C, Delorme R, Leboyer M, Bourgeron T, Mantoulan C, Roge B, Tauber M, Freitag CM, Poustka F, Duketis E, Klauck SM, Poustka A, Papanikolaou K, Tsiantis J, Anney R, Bolshakova N, Brennan S, Hughes G, McGrath J, Merikangas A, Ennis S, Green A, Casey JP, Conroy JM, Regan R, Shah N, Maestrini E, Bacchelli E, Minopoli F, Stoppioni V, Battaglia A, Igliozzi R, Parrini B, Tancredi R, Oliveira G, Almeida J, Duque F, Vicente A, Correia C, Magalhaes TR, Gillberg C, Nygren G, Jonge MD, Van Engeland H, Vorstman JA, Wittemeyer K, Baird G, Bolton PF, Rutter ML, Green J, Lamb JA, Pickles A, Parr JR, Couteur AL, Berney T, McConachie H, Wallace S, Coutanche M, Foley S, White K, Monaco AP, Holt R, Farrar P, Pagnamenta AT, Mirza GK, Ragoussis J, Sousa I, Sykes N, Wing K, Hallmayer J, Cantor RM, Nelson SF, Geschwind DH, Abrahams BS, Volkmar F, Pericak-Vance MA, Cuccaro ML, Gilbert J, Cook EH, Guter SJ, Jacob S, Nurnberger Jr JI, McDougle CJ, Posey DJ, Lord C, Corsello C, Hus V, Kolevzon A, Soorya L, Parkhomenko E, Leventhal BL, Dawson G, Vieland VJ, Hakonarson H, Glessner JT, Kim C, Wang K, Schellenberg GD, Devlin B, Klei L, Minshew N, Sutcliffe JS, Haines JL, Lund SC, Thomson S, Coon H, Miller J, McMahon WM, Munson J, Estes A, Wijsman EM. {{Gene-ontology enrichment analysis in two independent family-based samples highlights biologically plausible processes for autism spectrum disorders}}. {Eur J Hum Genet};2011 (Oct);19(10):1082-1089.
Recent genome-wide association studies (GWAS) have implicated a range of genes from discrete biological pathways in the aetiology of autism. However, despite the strong influence of genetic factors, association studies have yet to identify statistically robust, replicated major effect genes or SNPs. We apply the principle of the SNP ratio test methodology described by O’Dushlaine et al to over 2100 families from the Autism Genome Project (AGP). Using a two-stage design we examine association enrichment in 5955 unique gene-ontology classifications across four groupings based on two phenotypic and two ancestral classifications. Based on estimates from simulation we identify excess of association enrichment across all analyses. We observe enrichment in association for sets of genes involved in diverse biological processes, including pyruvate metabolism, transcription factor activation, cell-signalling and cell-cycle regulation. Both genes and processes that show enrichment have previously been examined in autistic disorders and offer biologically plausibility to these findings.
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6. Ashby J. {{Commentary on ‘Helping children with autism spectrum disorders and their families: Are we losing our occupation-centred focus?’}}. {Aust Occup Ther J};2011 (Oct);58(5):390-391.
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7. Azmitia EC, Singh JS, Hou XP, Wegiel J. {{Dystrophic serotonin axons in postmortem brains from young autism patients}}. {Anat Rec (Hoboken)};2011 (Oct);294(10):1653-1662.
Autism causes neuropathological changes in varied anatomical loci. A coherent neural mechanism to explain the spectrum of autistic symptomatology has not been proposed because most anatomical researchers focus on point-to-point functional neural systems (e.g., auditory and social networks) rather than considering global chemical neural systems. Serotonergic neurons have a global innervation pattern. Disorders Research Program, AS073234, Program Project (JW). Their cell bodies are found in the midbrain but they project their axons throughout the neural axis beginning in the fetal brain. This global system is implicated in autism by animal models and by biochemical, imaging, pharmacological, and genetics studies. However, no anatomical studies of the 5-HT innervation of autistic donors have been reported. Our review presents immunocytochemical evidence of an increase in 5-HT axons in postmortem brain tissue from autism donors aged 2.8-29 years relative to controls. This increase is observed in the principle ascending fiber bundles of the medial and lateral forebrain bundles, and in the innervation density of the amygdala and the piriform, superior temporal, and parahippocampal cortices. In autistic donors 8 years of age and up, several types of dystrophic 5-HT axons were seen in the termination fields. One class of these dystrophic axons, the thick heavily stained axons, was not seen in the brains of patients with neurodegenerative diseases. These findings provide morphological evidence for the involvement of serotonin neurons in the early etiology of autism, and suggest new therapies may be effective to blunt serotonin’s trophic actions during early brain development in children. Anat Rec, 2011. (c) 2011 Wiley-Liss, Inc.
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8. Bejerot S, Humble MB, Gardner A. {{Endocrine disruptors, the increase of autism spectrum disorder and its comorbidity with gender identity disorder – a hypothetical association}}. {Int J Androl};2011 (Oct);34(5 Pt 2):e350.
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9. Belger A, Carpenter KL, Yucel GH, Cleary KM, Donkers FC. {{The neural circuitry of autism}}. {Neurotox Res};2011 (Oct);20(3):201-214.
Autism is a complex neurodevelopmental disorder, characterized by deficits in social emotional, and language domains, as well as repetitive restrictive behaviors. The vast heterogeneity of the clinical and behavioral symptoms has made it rather difficult to delineate the neural circuitry affiliated with these domains of dysfunction. The current review aims at broadly outlining the latest research into the neurobiology and neural circuitry underlying the core domains of deficits in autism. We further discuss new avenues of research that can further our understanding of the dimensions of this complex disorder.
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10. Bernhardt EB, Walsh KH, Posey DJ, McDougle CJ. {{Memantine for comorbid obsessive-compulsive disorder and asperger disorder suggests a link in glutamatergic dysregulation}}. {J Clin Psychopharmacol};2011 (Oct);31(5):673-675.
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11. Bishop DV, Jacobs PA, Lachlan K, Wellesley D, Barnicoat A, Boyd PA, Fryer A, Middlemiss P, Smithson S, Metcalfe K, Shears D, Leggett V, Nation K, Scerif G. {{Autism, language and communication in children with sex chromosome trisomies}}. {Arch Dis Child};2011 (Oct);96(10):954-959.
Purpose Sex chromosome trisomies (SCTs) are found on amniocentesis in 2.3-3.7 per 1000 same-sex births, yet there is a limited database on which to base a prognosis. Autism has been described in postnatally diagnosed cases of Klinefelter syndrome (XXY karyotype), but the prevalence in non-referred samples, and in other trisomies, is unclear. The authors recruited the largest sample including all three SCTs to be reported to date, including children identified on prenatal screening, to clarify this issue. Design Parents of children with a SCT were recruited either via prenatal screening or via a parental support group, to give a sample of 58 XXX, 19 XXY and 58 XYY cases. Parents were interviewed using the Vineland Adaptive Behavior Scales and completed questionnaires about the communicative development of children with SCTs and their siblings (42 brothers and 26 sisters). Results Rates of language and communication problems were high in all three trisomies. Diagnoses of autism spectrum disorder (ASD) were found in 2/19 cases of XXY (11%) and 11/58 XYY (19%). After excluding those with an ASD diagnosis, communicative profiles indicative of mild autistic features were common, although there was wide individual variation. Conclusions Autistic features have not previously been remarked upon in studies of non-referred samples with SCTs, yet the rate is substantially above population levels in this sample, even when attention is restricted to early-identified cases. The authors hypothesise that X-linked and Y-linked neuroligins may play a significant role in the aetiology of communication impairments and ASD.
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12. Blatt GJ, Fatemi SH. {{Alterations in GABAergic biomarkers in the autism brain: research findings and clinical implications}}. {Anat Rec (Hoboken)};2011 (Oct);294(10):1646-1652.
Autism is a pervasive developmental disorder characterized by repetitive stereotyped behavior, social-emotional deficits, and delayed or absent language abilities. There are known neuropathologies in the autism brain affecting limbic, cerebellar, and cortical structures but the neurochemical profile of affected individuals, revealed in postmortem tissue studies, is only recently emerging. One major component that appears highly impacted in autism is the GABAergic system. It is now apparent that there are widespread significant effects in many distributed regions in the autism brain revealed by histochemical, autoradiographic, and biochemical studies. The key synthesizing enzymes for GABA, glutamic acid decarboxylase type 65 and 67 (GAD65 and GAD67), are decreased in the cerebellum and closer examination of mRNA levels revealed that it is largely due to decreases in Purkinje cells and a subpopulation of larger dentate neurons as measured by in situ hybridization studies. Other cell types had either normal GAD levels (Golgi cells, smaller dentate interneurons, and stellate cells) or increased levels (basket cells). GABA receptor density, number, and protein expression are all decreased in the cerebellum and in select cortical areas. GABA(A) and GABA(B) subunit protein expression was significantly reduced in cerebellum, BA 9 and BA 40. Benzodiazepine binding sites were significantly reduced in the hippocampus and anterior cingulate cortex (BA 24). Taken together, data from these studies suggest that there is a marked dysregulation of the inhibitory GABA system in the autism brain affecting particular biomarkers localized to specific cell types and lamina likely influencing circuitry and behavior. Anat Rec, 2011. (c) 2011 Wiley-Liss, Inc.
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13. Bowker A, D’Angelo NM, Hicks R, Wells K. {{Treatments for autism: parental choices and perceptions of change}}. {J Autism Dev Disord};2011 (Oct);41(10):1373-1382.
Empirically conducted studies of the efficacy of various treatments for autism are limited, which leaves parents with little evidence on which to base their treatment decisions (Kasari, Journal of Autism and Developmental Disorders, 32: 447-461, 2002). The purpose of this study was to examine the types of treatments in current use by families of children with ASD. In addition, parents’ perceptions of improvement in their child’s functioning were explored. Through an online survey, a sample of 970 parents of ASD children reported on the treatments currently in use, those discontinued, and reasons for discontinuation. Results indicate that most families adopt multiple treatment approaches. Parents were most likely to discontinue non-evidence based treatments when they did not see improvement in their child’s functioning.
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14. Boyd BA, McDonough SG, Rupp B, Khan F, Bodfish JW. {{Effects of a family-implemented treatment on the repetitive behaviors of children with autism}}. {J Autism Dev Disord};2011 (Oct);41(10):1330-1341.
The restricted and repetitive behaviors of children with autism can interfere with family functioning as well as learning and socialization opportunities for the child. To date, neither pharmacological nor comprehensive behavioral treatments have been found to be consistently effective at significantly reducing children’s engagement in repetitive behaviors. We developed Family-Implemented Treatment for Behavioral Inflexibility (FITBI) to target the full variety of repetitive behaviors found in autism. For the current study, a therapist and parents of five children with autism (mean age = 48 months) co-implemented FITBI in a clinic setting over a 12-week treatment period. Using single case design methodology, significant reductions in repetitive behaviors were found for all participants and maintenance of treatment effects for 4 of 5 participants.
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15. Bradshaw J, Shic F, Chawarska K. {{Brief report: face-specific recognition deficits in young children with autism spectrum disorders}}. {J Autism Dev Disord};2011 (Oct);41(10):1429-1435.
This study used eyetracking to investigate the ability of young children with autism spectrum disorders (ASD) to recognize social (faces) and nonsocial (simple objects and complex block patterns) stimuli using the visual paired comparison (VPC) paradigm. Typically developing (TD) children showed evidence for recognition of faces and simple objects, but not complex block patterns. Children with ASD were successful at recognizing novel objects and block patterns, but showed no evidence for face recognition. These findings suggest that young children with ASD have specific impairments in face recognition, and that they may have advantage over TD controls when processing complex nonsocial stimuli.
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16. Breslin CM, Rudisill ME. {{The Effect of Visual Supports on Performance of the TGMD-2 for Children With Autism Spectrum Disorder}}. {Adapt Phys Activ Q};2011 (Oct);28(4):342-353.
The purpose of this study was to examine the effects of visual supports on the performance of the Test of Gross Motor Development (TGMD-2) for children with autism spectrum disorder (ASD). Participants (N = 22) performed the TGMD-2 under three different protocols (traditional protocol, picture task card protocol, and picture activity schedule protocol). Gross motor quotient scores on the TGMD-2 were measured and statistically analyzed using a within-subjects repeated-measures ANOVA. Results indicated statistically significant differences between protocols, while post hoc tests indicated that the picture task card condition produced significantly higher gross motor quotient scores than the traditional protocol and the picture activity schedule. The results suggest that more accurate gross motor quotient scores on the TGMD-2 by children with ASD can be elicited using the picture task card protocol.
17. Brown HK, Ouellette-Kuntz H, Hunter D, Kelley E, Cobigo V, Lam M. {{Beyond an Autism Diagnosis: Children’s Functional Independence and Parents’ Unmet Needs}}. {J Autism Dev Disord};2011 (Oct);41(10):1291-1302.
High demand has resulted in gaps in autism service provision. Our objective was to explore the association between children’s functioning and parents’ perceived unmet needs. We conducted a cross-sectional study of 97 families of school-aged children with an autism spectrum disorder. Log binomial regression was used to examine the relative risk for unmet need. Families of children with high functional independence had lower unmet need than families of children with moderate functional independence (RR = 0.81, 95% CI = 0.67-0.99). Those who experienced greater impact of the child’s disability had greater unmet need (RR = 1.22, 95% CI = 1.03-1.45). The child’s functioning and its impact on the family provide insight into unmet need which may inform service planning.
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18. Canal-Bedia R, Garcia-Primo P, Martin-Cilleros MV, Santos-Borbujo J, Guisuraga-Fernandez Z, Herraez-Garcia L, Del Mar Herraez-Garcia M, Boada-Munoz L, Fuentes-Biggi J, Posada-de la Paz M. {{Modified checklist for autism in toddlers: cross-cultural adaptation and validation in Spain}}. {J Autism Dev Disord};2011 (Oct);41(10):1342-1351.
Early detection and treatment have been shown to be effective in reducing disability severity caused by Autistic Spectrum Disorders (ASDs). As Spanish pediatricians have no detection tool, the Modified Checklist for Autism in Toddlers (M-CHAT) was first translated into and culturally adapted to Spanish. Validity and reliability studies were carried out in two different geographical areas of Spain, where M-CHAT was administered to two different samples, namely: 2,480 high- and low-risk children; and 2,055 low-risk children. The results obtained were similar to those yielded by the original M-CHAT studies. Differences were found in positive predictive value, due to the low ASD frequency observed in this study. M-CHAT is still being studied in a large population-based screening program in Spain.
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19. Cappe E, Wolff M, Bobet R, Adrien JL. {{Quality of life: a key variable to consider in the evaluation of adjustment in parents of children with autism spectrum disorders and in the development of relevant support and assistance programmes}}. {Qual Life Res};2011 (Oct);20(8):1279-1294.
PURPOSE: Our primary objective was to identify cognitive and behavioural profiles that affect adjustment, in order to make relevant recommendations about support and assistance for parents of autistic children. METHOD: One hundred and sixty French parents completed a battery of questionnaires and self-report measures developed or adapted to assess (1) the child and family situations; (2) perceived stress; (3) perceived social support; (4) perceived control; (5) coping strategies; and (6) quality of life. RESULTS: The psychometric properties of the instruments we used proved to be adequate. Our results support the pre-existing data and our findings may prove to be of interest to clinicians. Our primary finding was that emotion-focused coping strategies seem to be less effective. Parents who employed emotion-focused strategies were more stressed and more disturbed in most parts of their life. They also experienced more guilt and reported more false beliefs about PDD. CONCLUSIONS: Our data underscore the need for psychoeducation programmes for parents, focused on handling stress and emotions, modifying false beliefs and solving the daily problems that arise from PDD. We propose a 5-axis intervention model for parents of children with PDD, based on cognitive-behavioural therapies and on a stress management programme.
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20. Chawarska K, Campbell D, Chen L, Shic F, Klin A, Chang J. {{Early generalized overgrowth in boys with autism}}. {Arch Gen Psychiatry};2011 (Oct);68(10):1021-1031.
CONTEXT: Multiple studies have reported an overgrowth in head circumference (HC) in the first year of life in autism. However, it is unclear whether this phenomenon is independent of overall body growth and whether it is associated with specific social or cognitive features. OBJECTIVES: To examine the trajectory of early HC growth in autism compared with control groups; to assess whether HC growth in autism is independent of height and weight growth during infancy; and to examine HC growth from birth to 24 months in relationship to social, verbal, cognitive, and adaptive functioning levels. DESIGN: Retrospective study. SETTING: A specialized university-based clinic. PARTICIPANTS: Boys diagnosed as having autistic disorder (n = 64), pervasive developmental disorder-not otherwise specified (n = 34), global developmental delay (n = 13), and other developmental problems (n = 18) and typically developing boys (n = 55). MAIN OUTCOME MEASURES: Age-related changes in HC, height, and weight between birth and age 24 months; measures of social, verbal, and cognitive functioning at age 2 years. RESULTS: Compared with typically developing controls, boys with autism were significantly longer by age 4.8 months, had a larger HC by age 9.5 months, and weighed more by age 11.4 months (P = .05 for all). None of the other clinical groups showed a similar overgrowth pattern. Boys with autism who were in the top 10% of overall physical size in infancy exhibited greater severity of social deficits (P = .009) and lower adaptive functioning (P = .03). CONCLUSIONS: Boys with autism experienced accelerated HC growth in the first year of life. However, this phenomenon reflected a generalized process affecting other morphologic features, including height and weight. The study highlights the importance of studying factors that influence not only neuronal development but also skeletal growth in autism.
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21. Conti S, Condo M, Posar A, Mari F, Resta N, Renieri A, Neri I, Patrizi A, Parmeggiani A. {{Phosphatase and Tensin Homolog (PTEN) Gene Mutations and Autism: Literature Review and a Case Report of a Patient With Cowden Syndrome, Autistic Disorder and Epilepsy}}. {J Child Neurol};2011 (Sep 29)
Phosphatase and tensin homolog (PTEN) gene mutations are associated with a spectrum of clinical disorders characterized by skin lesions, macrocephaly, hamartomatous overgrowth of tissues, and an increased risk of cancers. Autism has rarely been described in association with these variable clinical features. At present, 24 patients with phosphatase and tensin homolog gene mutation, autism, macrocephaly, and some clinical findings described in phosphatase and tensin homolog syndromes have been reported in the literature. We describe a 14-year-old boy with autistic disorder, focal epilepsy, severe and progressive macrocephaly, and multiple papular skin lesions and palmoplantar punctate keratoses, characteristic of Cowden syndrome. The boy has a de novo phosphatase and tensin homolog gene mutation. Our patient is the first case described to present a typical Cowden syndrome and autism associated with epilepsy.
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22. Courtemanche A, Schroeder S, Sheldon J, Sherman J, Fowler A. {{Observing signs of pain in relation to self-injurious behaviour among individuals with intellectual and developmental disabilities}}. {J Intellect Disabil Res};2011 (Sep 29)
Background Self-injurious behaviour is a chronic condition among people with intellectual and developmental disabilities for which there is no known cure. The pain hypothesis suggests that individuals who engage in self-injury have altered or diminished pain perception. The purpose of the present study was to assess how frequently individuals diagnosed with an intellectual and developmental disability who engage in chronic self-injury displayed non-verbal signs of pain in relation to their self-injury. Methods We videotaped four participants (aged 28-50 years) in their homes during times when they were likely to engage in self-injury. Using continuous recording measures, we coded videotapes for the frequency and duration of self-injury and expressions of non-verbal pain-related behaviours. Sequential analyses were conducted to identify temporal relations between pain-related behaviours and self-injury. Results Our data suggest that the existing measures of pain may be systematically related to instances of self-injury. The relationships, however, appear to vary depending on the person who engages in self-injury, the environmental contexts in which the self-injury occurs, and perhaps, the type of self-injury in which the person engages. Conclusions These results support some of the findings of Symons et al. and they raise questions about the blunted nociception hypothesis of self-injury.
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23. Demb H, Valicenti-McDermott M, Navarro A, Ayoob KT. {{The effect of long-term use of risperidone on body weight of children with an autism spectrum disorder}}. {J Clin Psychopharmacol};2011 (Oct);31(5):669-670.
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24. Fairless AH, Shah RY, Guthrie AJ, Li H, Brodkin ES. {{Deconstructing sociability, an autism-relevant phenotype, in mouse models}}. {Anat Rec (Hoboken)};2011 (Oct);294(10):1713-1725.
Reduced sociability is a core feature of autism spectrum disorders (ASD) and is highly disabling, poorly understood, and treatment refractory. To elucidate the biological basis of reduced sociability, multiple laboratories are developing ASD-relevant mouse models in which sociability is commonly assessed using the Social Choice Test. However, various measurements included in that test sometimes support different conclusions. Specifically, measurements of time the « test » mouse spends near a confined « stimulus » mouse (chamber scores) sometimes support different conclusions from measurements of time the test mouse sniffs the cylinder containing the stimulus mouse (cylinder scores). This raises the question of which type of measurements are best for assessing sociability. We assessed the test-retest reliability and ecological validity of chamber and cylinder scores. Compared with chamber scores, cylinder scores showed higher correlations between test and retest measurements, and cylinder scores showed higher correlations with time spent in social interaction in a more naturalistic phase of the test. This suggests that cylinder scores are more reliable and valid measures of sociability in mouse models. Cylinder scores are reported less commonly than chamber scores, perhaps because little work has been done to establish automated software systems for measuring the former. In this study, we found that a particular automated software system performed at least as well as human raters at measuring cylinder scores. Our data indicate that cylinder scores are more reliable and valid than chamber scores, and that the former can be measured very accurately using an automated video analysis system in ASD-relevant models. Anat Rec, 2011. (c) 2011 Wiley-Liss, Inc.
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25. Fatemi SH, Folsom TD, Kneeland RE, Liesch SB. {{Metabotropic Glutamate Receptor 5 Upregulation in Children with Autism is Associated with Underexpression of Both Fragile X Mental Retardation Protein and GABA(A) Receptor Beta 3 in Adults with Autism}}. {Anat Rec (Hoboken)};2011 (Oct);294(10):1635-1645.
Recent work has demonstrated the impact of dysfunction of the GABAergic signaling system in brain and the resultant behavioral pathologies in subjects with autism. In animal models, altered expression of Fragile X mental retardation protein (FMRP) has been linked to downregulation of GABA receptors. Interestingly, the autistic phenotype is also observed in individuals with Fragile X syndrome. This study was undertaken to test previous theories relating abnormalities in levels of FMRP to GABA(A) receptor underexpression. We observed a significant reduction in levels of FMRP in the vermis of adults with autism. Additionally, we found that levels of metabotropic glutamate receptor 5 (mGluR5) protein were significantly increased in vermis of children with autism versus age and postmortem interval matched controls. There was also a significant decrease in level of GABA(A) receptor beta 3 (GABRbeta3) protein in vermis of adult subjects with autism. Finally, we found significant increases in glial fibrillary acidic protein in vermis of both children and adults with autism when compared with controls. Taken together, our results provide further evidence that altered FMRP expression and increased mGluR5 protein production potentially lead to altered expression of GABA(A) receptors. Anat Rec,, 2011. (c) 2011 Wiley-Liss, Inc.
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26. Flaherty DK. {{The vaccine-autism connection: a public health crisis caused by unethical medical practices and fraudulent science}}. {Ann Pharmacother};2011 (Oct);45(10):1302-1304.
In 1998, Dr. Andrew Wakefield, a British gastroenterologist, described a new autism phenotype called the regressive autism-enterocolitis syndrome triggered by environmental factors such as measles, mumps, and rubella (MMR) vaccination. The speculative vaccination-autism connection decreased parental confidence in public health vaccination programs and created a public health crisis in England and questions about vaccine safety in North America. After 10 years of controversy and investigation, Dr. Wakefield was found guilty of ethical, medical, and scientific misconduct in the publication of the autism paper. Additional studies showed that the data presented were fraudulent. The alleged autism-vaccine connection is, perhaps, the most damaging medical hoax of the last 100 years.
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27. Fuentes CT, Mostofsky SH, Bastian AJ. {{No proprioceptive deficits in autism despite movement-related sensory and execution impairments}}. {J Autism Dev Disord};2011 (Oct);41(10):1352-1361.
Autism spectrum disorder (ASD) often involves sensory and motor problems, yet the proprioceptive sense of limb position has not been directly assessed. We used three tasks to assess proprioception in adolescents with ASD who had motor and sensory perceptual abnormalities, and compared them to age- and IQ-matched controls. Results showed no group differences in proprioceptive accuracy or precision during active or passive tasks. Both groups showed (a) biases in elbow angle accuracy that varied with joint position, (b) improved elbow angle precision for active versus passive tasks, and (c) improved precision for a fingertip versus elbow angle estimation task. Thus, a primary proprioceptive deficit may not contribute to sensorimotor deficits in ASD. Abnormalities may arise at later sensory processing stages.
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28. Gadow KD, Guttmann-Steinmetz S, Rieffe C, Devincent CJ. {{Depression Symptoms in Boys with Autism Spectrum Disorder and Comparison Samples}}. {J Autism Dev Disord};2011 (Sep 30)
This study compares severity of specific depression symptoms in boys with autism spectrum disorder (ASD), attention-deficit hyperactivity disorder (ADHD), or chronic multiple tic disorder (CMTD) and typically developing boys (Controls). Children were evaluated with parent and teacher versions of the Child Symptom Inventory-4 (CSI-4) and a demographic questionnaire. Mothers’ and teachers’ ratings generally indicated the most severe symptoms in boys with ASD +/- ADHD. Associations of depression with ASD severity and IQ varied considerably for specific symptoms of depression, ASD functional domain, and informant. Findings provide additional support for the differential influence of neurobehavioral syndromes on co-occurring symptom severity and illustrate how more fine-grained analyses of clinical phenotypes may contribute to a better understanding of etiology and current nosology.
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29. Gale CM, Eikeseth S, Rudrud E. {{Functional Assessment and Behavioural Intervention for Eating Difficulties in Children with Autism: A study Conducted in the Natural Environment Using Parents and ABA Tutors as Therapists}}. {J Autism Dev Disord};2011 (Oct);41(10):1383-1396.
Two functional assessments (interview and direct observation) were used with three children with autism to identify the functions maintaining mealtime behaviour including acceptance, mouth clean, refusal, and other disruptive behaviours such as crying and pushing the spoon. Based on results of the functional assessments it was hypothesized that appropriate and disruptive mealtime behaviour was maintained by different contingencies. A non-concurrent multiple baseline design across participants was utilized to validate the effectiveness of the intervention. Intervention for all participants included presentation of food on a spoon for 30 s unless acceptance occurred. Acceptance resulted in putative reinforcement. The meal ended after 20 presentations. For all participants, acceptance and mouth cleans increased while disruptive behaviour decreased, and effects were maintained at follow-up.
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30. Gauthier J, Siddiqui TJ, Huashan P, Yokomaku D, Hamdan FF, Champagne N, Lapointe M, Spiegelman D, Noreau A, Lafreniere RG, Fathalli F, Joober R, Krebs MO, Delisi LE, Mottron L, Fombonne E, Michaud JL, Drapeau P, Carbonetto S, Craig AM, Rouleau GA. {{Truncating mutations in NRXN2 and NRXN1 in autism spectrum disorders and schizophrenia}}. {Hum Genet};2011 (Oct);130(4):563-573.
Growing genetic evidence is converging in favor of common pathogenic mechanisms for autism spectrum disorders (ASD), intellectual disability (ID or mental retardation) and schizophrenia (SCZ), three neurodevelopmental disorders affecting cognition and behavior. Copy number variations and deleterious mutations in synaptic organizing proteins including NRXN1 have been associated with these neurodevelopmental disorders, but no such associations have been reported for NRXN2 or NRXN3. From resequencing the three neurexin genes in individuals affected by ASD (n = 142), SCZ (n = 143) or non-syndromic ID (n = 94), we identified a truncating mutation in NRXN2 in a patient with ASD inherited from a father with severe language delay and family history of SCZ. We also identified a de novo truncating mutation in NRXN1 in a patient with SCZ, and other potential pathogenic ASD mutations. These truncating mutations result in proteins that fail to promote synaptic differentiation in neuron coculture and fail to bind either of the established postsynaptic binding partners LRRTM2 or NLGN2 in cell binding assays. Our findings link NRXN2 disruption to the pathogenesis of ASD for the first time and further strengthen the involvement of NRXN1 in SCZ, supporting the notion of a common genetic mechanism in these disorders.
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31. Georgiades S, Szatmari P, Duku E, Zwaigenbaum L, Bryson S, Roberts W, Fombonne E, Mirenda P, Smith I, Vaillancourt T, Volden J, Waddell C, Thompson A. {{Phenotypic overlap between core diagnostic features and emotional/behavioral problems in preschool children with autism spectrum disorder}}. {J Autism Dev Disord};2011 (Oct);41(10):1321-1329.
This study examined the phenotypic overlap between core diagnostic features and emotional/behavioral problems in a sample of 335 preschool children with autism spectrum disorder (ASD). Results from principal component analysis (2 components; 49.70% variance explained) suggested substantial phenotypic overlap between core diagnostic features and emotional/behavioral problems. Component I, Emotional Behavioral Repetitive Problems, was independent of the children’s intellectual, adaptive functioning, and structural language abilities. Component II, Social Communication Deficits, was negatively related to the children’s intellectual, adaptive functioning, and structural language abilities. Both components were positively related to parental stress. This exploratory study contributes to our understanding of the ASD phenotype and provides further support for including emotional/behavioral problems as part of the clinical characterization of children with ASD.
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32. Gomot M, Wicker B. {{A challenging, unpredictable world for people with Autism Spectrum Disorder}}. {Int J Psychophysiol};2011 (Oct 1)
Autism is a pervasive neurodevelopmental disorder characterized by impairment of communication and social interaction, as well as by high levels of repetitive and ritualistic behaviours. This last dimension results in major difficulties in daily life: clinical reports of individuals with Autism Spectrum Disorder (ASD) show that they present tantrums as a response to change, or restricted interests and repetitive behaviours in order to prevent or minimize change. Such a crucial need to maintain sameness suggests substantial differences in how the ASD brain predicts the environment, and this might have a fundamental role in the deficit revealed in the highly unpredictable social world. Several lines of evidence indicating difficulties in generating or using predictions in ASD due to atypical information processing will be presented in this review. For instance, several studies have revealed that people with ASD demonstrate a unique profile of cognitive abilities, with strategies that depend to an abnormally large extent on sensory systems, at the expense of more integrative processing requiring an awareness of contextual subtleties necessary for prediction. At a more elementary level, patients with autism manifest unusual processing of unpredictable events, which might be rooted in a basic difference in how the brain orients to changing, novel sensory stimuli. This review presents results from ERPs and fMRI studies illustrating the psychophysiological mechanisms and neural bases underlying such phenomena in ASD. We propose that such dysfunction in the ability to build flexible prediction in ASD may originate from impaired top-down influence over a variety of sensory and higher level information processing, a physiopathological hypothesis which dovetails with the cortical under connectivity current theory.
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33. Grow LL, Carr JE, Kodak TM, Jostad CM, Kisamore AN. {{A comparison of methods for teaching receptive labeling to children with autism spectrum disorders}}. {J Appl Behav Anal};2011 (Fall);44(3):475-498.
Many early intervention curricular manuals recommend teaching auditory-visual conditional discriminations (i.e., receptive labeling) using the simple-conditional method in which component simple discriminations are taught in isolation and in the presence of a distracter stimulus before the learner is required to respond conditionally. Some have argued that this procedure might be susceptible to faulty stimulus control such as stimulus overselectivity (Green, 2001). Consequently, there has been a call for the use of alternative teaching procedures such as the conditional-only method, which involves conditional discrimination training from the onset of intervention. The purpose of the present study was to compare the simple-conditional and conditional-only methods for teaching receptive labeling to 3 young children diagnosed with autism spectrum disorders. The data indicated that the conditional-only method was a more reliable and efficient teaching procedure. In addition, several error patterns emerged during training using the simple-conditional method. The implications of the results with respect to current teaching practices in early intervention programs are discussed.
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34. Hamilton A, Marshal MP, Murray PJ. {{Autism spectrum disorders and menstruation}}. {J Adolesc Health};2011 (Oct);49(4):443-445.
We assessed the experience of 10-25-year old women with autism spectrum disorders with menstruation through their caregivers by investigating hygiene concerns, dysmenorrhea, premenstrual syndrome, and treatments. Frequent and severe symptoms of dysmenorrhea and premenstrual syndrome were common but had moderate morbidity rates. Hormonal contraception and other treatments were underused.
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35. Harris CD, Lindell AK. {{The influence of autism-like traits on cheek biases for the expression and perception of happiness}}. {Brain Cogn};2011 (Oct);77(1):11-16.
People with autism show attenuated cerebral lateralisation for emotion processing. Given growing appreciation of the notion that autism represents a continuum, the present study aimed to determine whether atypical hemispheric lateralisation is evident in people with normal but above average levels of autism-like traits. One hundred and twenty-seven right-handed participants (M=43, F=84) completed the AQ questionnaire (Baron-Cohen, Wheelwright, Skinner, Martin, & Clubley, 2001), and then (a) posed for a photo expressing happiness, and (b) viewed pairs of left and right cheek poses, making a forced-choice decision indicating which image appeared happier (half the images were mirror-reversed to control for perceptual biases). Results indicated that irrespective of AQ status, people were intuitively aware that the left cheek is more emotionally expressive: participants offered the left cheek when posing to appear happy, and perceived left poses as happier than right poses. As the left cheek is predominantly controlled by the right hemisphere, these findings strongly support the right hemisphere hypothesis. The fact that people with normal but above average levels of autism-like traits did not show a reduced leftward bias for either task indicates that the attenuated emotion lateralisation pattern noted in the clinical population does not extend into the normal spectrum. Instead, the results suggest that people with normal but above average levels of AQ traits are as sensitive to the silent social/emotional cues signalled by a left cheek pose as those with lower AQ scores.
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36. Hunsaker MR, Greco CM, Spath MA, Smits AP, Navarro CS, Tassone F, Kros JM, Severijnen LA, Berry-Kravis EM, Berman RF, Hagerman PJ, Willemsen R, Hagerman RJ, Hukema RK. {{Widespread non-central nervous system organ pathology in fragile X premutation carriers with fragile X-associated tremor/ataxia syndrome and CGG knock-in mice}}. {Acta Neuropathol};2011 (Oct);122(4):467-479.
Fragile X-associated tremor/ataxia syndrome (FXTAS) is an adult-onset neurodegenerative disorder generally presenting with intention tremor and gait ataxia, but with a growing list of co-morbid medical conditions including hypothyroidism, hypertension, peripheral neuropathy, and cognitive decline. The pathological hallmark of FXTAS is the presence of intranuclear inclusions in both neurons and astroglia. However, it is unknown to what extent such inclusions are present outside the central nervous system (CNS). To address this issue, we surveyed non-CNS organs in ten human cases with FXTAS and in a CGG repeat knock-in (CGG KI) mouse model known to possess neuronal and astroglial inclusions. We find inclusions in multiple tissues from FXTAS cases and CGG KI mice, including pancreas, thyroid, adrenal gland, gastrointestinal, pituitary gland, pineal gland, heart, and mitral valve, as well as throughout the associated autonomic ganglia. Inclusions were observed in the testes, epididymis, and kidney of FXTAS cases, but were not observed in mice. These observations demonstrate extensive involvement of the peripheral nervous system and systemic organs. The finding of intranuclear inclusions in non-CNS somatic organ systems, throughout the PNS, and in the enteric nervous system of both FXTAS cases as well as CGG KI mice suggests that these tissues may serve as potential sites to evaluate early intervention strategies or be used as diagnostic factors.
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37. Ingvarsson ET, Hollobaugh T. {{A comparison of prompting tactics to establish intraverbals in children with autism}}. {J Appl Behav Anal};2011 (Fall);44(3):659-664.
We compared the efficacy of tact-to-intraverbal (i.e., using picture prompts) and echoic-to-intraverbal transfer-of-stimulus-control procedures to establish intraverbal responding in 3 boys (4 years old) with autism. For all 3 participants, the picture prompts resulted in fewer trials to criterion, but both prompting tactics were eventually effective.
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38. Joginder Singh S, Iacono T, Gray KM. {{A comparison of Malaysian and Australian speech-language pathologists’ practices with children with developmental disabilities who are pre-symbolic}}. {Int J Speech Lang Pathol};2011 (Oct);13(5):389-398.
The aim of this study was to explore the assessment, intervention, and family-centred practices of Malaysian and Australian speech-language pathologists (SLPs) when working with children with developmental disabilities who are pre-symbolic. A questionnaire was developed for the study, which was completed by 65 SLPs from Malaysia and 157 SLPs from Australia. Data reduction techniques were used prior to comparison of responses across questionnaire items. Results indicated that SLPs relied mostly on informal assessments. Malaysian and Australian SLPs differed significantly in terms of obtaining information from outside the clinic to inform assessment. When providing intervention, SLPs focused mostly on improving children’s pre-verbal skills. A third of Australian SLPs listed the introduction of some form of symbolic communication as an early intervention goal, compared to only a small percentage of Malaysian SLPs. Regarding family involvement, SLPs most often involved mothers, with fathers and siblings being involved to a lesser extent. Overall, it appeared that practices of Malaysian SLPs had been influenced by developments in research, although there were some areas of service delivery that continued to rely on traditional models. Factors leading to similarities and differences in practice of SLPs from both countries as well as clinical and research implications of the study are discussed.
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39. Kobak KA, Stone WL, Ousley OY, Swanson A. {{Web-based training in early autism screening: results from a pilot study}}. {Telemed J E Health};2011 (Oct);17(8):640-644.
Abstract Background: Lack of familiarity with early signs of autism by community service providers has resulted in significant delays in children receiving early intervention services necessary to improve long-term outcomes. The Screening Tool for Autism in Toddlers and Young Children (STAT) was specifically developed to identify early behavioral features of autism. Although STAT training has been available for years, access is limited because of few STAT trainers and geographic concerns. This study evaluated the efficacy and acceptability of Web-based training of the STAT as a means of increasing accessibility to this training. Materials and Methods: Thirty professionals from three geographic areas participated. Roughly 1 of 3 had little or no training on autism assessment. The tutorial contains a general overview, administration and scoring conventions, and item-specific content and concepts. Participants completed a pretest and then completed the STAT tutorial at their own pace, followed by a post-test and a user satisfaction questionnaire. Results: Mean scores on STAT concepts significantly improved after taking the tutorial (p<0.001). At pretest, only 1 person (3%) obtained correct scores on at least 80% of the items (a priori cutoff for a « pass »), compared with 22 (73%) at post-test (p<0.001). The majority of trainees enjoyed taking the tutorial, thought it was well organized, relevant, interesting, and useful, and felt it was easy to understand and operate. Discussion: Results support Web-based training as a promising method for promoting early identification of autism and may help overcome problems associated with the critical shortage of autism-screening professionals.
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40. Kulisevsky J, Pagonabarraga J, Llebaria G, Hernandez B, Arranz J. {{Evaluation of doctor/patient satisfaction with the use of the Parkinson’s Disease Dementia-Short-Screen (PDD-SS): a screening test for dementia in Parkinson’s disease (DIFFUSION study)}}. {Neurologia};2011 (Oct);26(8):461-467.
INTRODUCTION: Parkinson disease (PD) has no specific neuropsychological scales for assessing the most significant cognitive impairment in PD, which has determined the use of subjective criteria or instruments designed for other diseases, making difficult the comparison between studies or the follow-up of patients. A screening test for dementia in PD (Parkinson’s Disease Dementia-Short Screen [PDD-SS]) has recently been validated. To assess the degree of satisfaction of patients and researchers through the use of PDD-SS in clinical practice. PATIENTS AND METHODS: An observational, cross-over, multicentre and national study was conducted on 471 patients with PD. The degree of patient satisfaction was measured using a questionnaire in which the items scored from 0 to 10 on a visual analogue scale (0 = strongly disagree, 10 = completely agree), while the researchers were determined on a 1-5 point Likert scale (1 = strongly disagree, 5 = completely agree). RESULTS: A total of 171 patients (36.3%) patients had dementia associated with PD according to the PDD-SS, of whom 77.3% said they were satisfied with its use. The overall measurement of researcher satisfaction was 3.6+/-0.6 points. Ninety per cent (n=45) of them reported an overall score >3 points in the satisfaction questionnaire. The mean values of perception of applicability, usability and reliability of PDD-SS among researchers was 3.5+/-0.7, 3.7+/-0.6 and 3.1+/-0.5 points, respectively. CONCLUSIONS: PD patients, as well as most of the researchers, were satisfied with the use of PDD-SS in clinical practice.
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41. Lanovaz MJ, Sladeczek IE, Rapp JT. {{Effects of music on vocal stereotypy in children with autism}}. {J Appl Behav Anal};2011 (Fall);44(3):647-651.
We examined the effects of manipulating the intensity (i.e., volume) of music on engagement in vocal stereotypy in 2 children with autism. Noncontingent access to music decreased immediate engagement in vocal stereotypy for each participant, but it produced only marginal effects on subsequent engagement in the behavior (i.e., after withdrawal). Manipulating the intensity of music did not produce differential effects on immediate engagement in vocal stereotypy. The implications of the results and applications for future research are discussed.
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42. Lee EY, Chung HJ, Ki CS, Yoo JH, Choi JR. {{A novel mutation in the MECP2 gene in a Korean patient with Rett syndrome}}. {Ann Clin Lab Sci};2011 (Fall);41(1):93-96.
Rett syndrome (RTT) is a severe X-linked dominant neurodevelopmental disorder. Mutations in the MECP2 gene on chromosome Xq28 have been shown to be the cause of RTT. Using DNA samples from a RTT patient and her parents, we sequenced three exons and flanking intron regions of the MECP2 gene using the polymerase chain reaction. Sequencing of the MECP2 gene in the proband revealed a novel 41-base pair deletion in exon 4 (c.1152_1192del41). This mutation resulted in premature termination of the 487 amino acid protein at the 390th codon, predicting a partial loss of the C-terminal domain. We did not observe this mutation in either parent of the RTT patient, but further studies are needed to evaluate the possibility of germline mosaicism.
43. Lightfoot E, Laliberte T. {{Parental supports for parents with intellectual and developmental disabilities}}. {Intellect Dev Disabil};2011 (Oct);49(5):388-391.
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44. Lin RC. {{Special issue: new concepts in developing brain disorders-autism}}. {Anat Rec (Hoboken)};2011 (Oct);294(10):1613-1614.
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45. Ling CY, Mak WW. {{Coping with challenging behaviours of children with autism: effectiveness of brief training workshop for frontline staff in special education settings}}. {J Intellect Disabil Res};2011 (Sep 29)
Background The present study examined the effectiveness of three staff training elements: psychoeducation (PE) on autism, introduction of functional behavioural analysis (FBA) and emotional management (EM), on the reaction of challenging behaviours for frontline staff towards children with autism in Hong Kong special education settings. Methods A sample of 311 frontline staff in educational settings was recruited to one of the three conditions: control, PE-FBA and PE-FBA-EM groups. A total of 175 participants completed all three sets of questionnaires during pre-training, immediate post-training and 1-month follow-up. Results Findings showed that the one-session staff training workshop increased staff knowledge of autism and perceived efficacy but decrease helping behavioural intention. Conclusions In spite of the limited effectiveness of a one-session staff training workshop, continued staff training is still necessary for the improvement of service quality. Further exploration on how to change emotion response of staff is important.
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46. Luyster RJ, Wagner JB, Vogel-Farley V, Tager-Flusberg H, Nelson Iii CA. {{Neural correlates of familiar and unfamiliar face processing in infants at risk for autism spectrum disorders}}. {Brain Topogr};2011 (Oct);24(3-4):220-228.
Examining the neural correlates associated with processing social stimuli offers a viable option to the challenge of studying early social processing in infants at risk for autism spectrum disorders (ASDs). The present investigation included 32 12-month olds at high risk for ASD and 24 low-risk control infants, defined on the basis of family history. Infants were presented with familiar and unfamiliar faces, and three components of interest were explored for amplitude and latency differences. The anticipated developmental effects of emerging hemispheric asymmetry for face-sensitive components (the N290 and P400) were observed, as were familiarity effects for a component related to attention (the Nc). Although there were no striking group differences in the neural response to faces, there was some evidence for a developmental lag in an attentional component for the high-risk group. The infant ASD endophenotype, though elusive, may be better defined through expanding the age of study and addressing chan
