1. {{Autism spectrum disorders revisited. Several recent studies raise new questions about cause and prevention}}. {Harv Ment Health Lett};2011 (Oct);28(4):1-3.
2. Abdallah MW, Greaves-Lord K, Grove J, Norgaard-Pedersen B, Hougaard DM, Mortensen EL. {{Psychiatric comorbidities in autism spectrum disorders: findings from a Danish Historic Birth Cohort}}. {Eur Child Adolesc Psychiatry};2011 (Dec);20(11-12):599-601.
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3. Al Abdulmohsen T, Kruger TH. {{The contribution of muscular and auditory pathologies to the symptomatology of autism}}. {Med Hypotheses};2011 (Dec);77(6):1038-1047.
Most research concerning the pathology of autism is focused on the search for central abnormalities that account for the production of symptoms. We, however, instead of looking at muscular and auditory features as merely associated manifestations, propose that they are somatic contributors by which some of the main clinical features of autism might be explained. Evidence suggests that muscles affect emotional experience. We think certain muscular dysfunctioning can impair communication and social interaction, and create stereotypic behavior, giving rise to the diagnostic features of autism. Furthermore, because speech is synchronized with facial movements and voice is controlled mainly through auditory feedback, a distortion of auditory feedback could disrupt voice, which in turn might cause parallel abnormal facial muscle functioning.
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4. Andersen LM, Naswall K, Manouilenko I, Nylander L, Edgar J, Ritvo RA, Ritvo E, Bejerot S. {{The Swedish Version of the Ritvo Autism and Asperger Diagnostic Scale: Revised (RAADS-R). A Validation Study of a Rating Scale for Adults}}. {J Autism Dev Disord};2011 (Dec);41(12):1635-1645.
There is a paucity of diagnostic instruments for adults with autism spectrum disorder (ASD). This study evaluates the psychometric properties of the Swedish version of the Ritvo Autism and Asperger Diagnostic Scale-Revised (RAADS-R), an 80-item self-rating scale designed to assist clinicians diagnosing ASD in adults. It was administered to 75 adults with ASD and 197 comparison cases. Also, a subset completed the Autism Spectrum Quotient (AQ). Three out of four subscales had high internal consistency. Sensitivity was 91% and specificity was 93%. The ASD subjects had significantly higher mean scores on all subscales. ASD females had higher scores than ASD males on the sensory motor subscale, a dimension not included in the AQ. RAADS-R showed promising test re-test reliability.
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5. Buhler E, Bachmann C, Goyert H, Heinzel-Gutenbrunner M, Kamp-Becker I. {{Differential diagnosis of autism spectrum disorder and attention deficit hyperactivity disorder by means of inhibitory control and ‘theory of mind’}}. {J Autism Dev Disord};2011 (Dec);41(12):1718-1726.
Autism spectrum disorders (ASD) and attention deficit hyperactivity disorders (ADHD) are both associated with deficits in executive control and with problems in social contexts. This study analyses the variables inhibitory control and theory of mind (ToM), including a developmental aspect in the case of the latter, to differentiate between the disorders. Participants with an ASD (N = 86), an ADHD (N = 84) and with both disorders (N = 52) in the age range of 5-22 years were compared. Results were differences in inhibitory control (ADHD < ASD) and in the ToM performance among younger (ASD < ADHD) but not among older children. We discuss whether common deficits in ToM differ in the developmental course.
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6. Cagran B, Schmidt M, Brown I. {{Assessment of the quality of life in families with children who have intellectual and developmental disabilities in Slovenia}}. {J Intellect Disabil Res};2011 (Dec);55(12):1164-1175.
Background Research was conducted, within the framework of the International Family Quality of Life Project, on the quality of life of families with a member who has a disability. We concentrated on the nine specific domains that the family life measure used, and recorded data from five of its six measurement dimensions: Importance, Opportunities, Initiative, Attainment and Satisfaction. Method The sample consisted of 20 families from Slovenia with children who have intellectual or developmental disabilities. The data were collected using the Family Quality of Life Survey-2006. Results Except for Community Interaction, the other domains (Health, Financial Well-Being, Family Relations, Support from Others, Support Services, Influence of Values, Careers, Leisure and Recreation) show statistically significant differences among the five dimensions measured. Importance was rated highest, and Attainment and Opportunities were rated lowest, while Initiative and Satisfaction were evaluated lower than Importance but higher than Attainment and Opportunities. Among the domains of family life, Family Relations was evaluated the highest from the perspective of all five dimensions. Conclusions The family members rated Importance high for all of the quality of family life domains, but it appears from the lower Opportunities scores that their opportunities are limited; this may result in fewer possibilities for attaining a better quality of life. The results of our research are useful to Slovene researchers who work in the areas of special pedagogy and rehabilitation, politicians, non-governmental organisations and social services. The quality of life of families with children with disabilities, their empowerment and their inclusion into community life should be significantly enhanced when consideration is given to all the family members’ support and service needs.
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7. Calahorro F, Ruiz-Rubio M. {{Caenorhabditis elegans as an experimental tool for the study of complex neurological diseases: Parkinson’s disease, Alzheimer’s disease and autism spectrum disorder}}. {Invert Neurosci};2011 (Dec);11(2):73-83.
The nematode Caenorhabditis elegans has a very well-defined and genetically tractable nervous system which offers an effective model to explore basic mechanistic pathways that might be underpin complex human neurological diseases. Here, the role C. elegans is playing in understanding two neurodegenerative conditions, Parkinson’s and Alzheimer’s disease (AD), and a complex neurological condition, autism, is used as an exemplar of the utility of this model system. C. elegans is an imperfect model of Parkinson’s disease because it lacks orthologues of the human disease-related genes PARK1 and LRRK2 which are linked to the autosomal dominant form of this disease. Despite this fact, the nematode is a good model because it allows transgenic expression of these human genes and the study of the impact on dopaminergic neurons in several genetic backgrounds and environmental conditions. For AD, C. elegans has orthologues of the amyloid precursor protein and both human presenilins, PS1 and PS2. In addition, many of the neurotoxic properties linked with Abeta amyloid and tau peptides can be studied in the nematode. Autism spectrum disorder is a complex neurodevelopmental disorder characterised by impairments in human social interaction, difficulties in communication, and restrictive and repetitive behaviours. Establishing C. elegans as a model for this complex behavioural disorder is difficult; however, abnormalities in neuronal synaptic communication are implicated in the aetiology of the disorder. Numerous studies have associated autism with mutations in several genes involved in excitatory and inhibitory synapses in the mammalian brain, including neuroligin, neurexin and shank, for which there are C. elegans orthologues. Thus, several molecular pathways and behavioural phenotypes in C. elegans have been related to autism. In general, the nematode offers a series of advantages that combined with knowledge from other animal models and human research, provides a powerful complementary experimental approach for understanding the molecular mechanisms and underlying aetiology of complex neurological diseases.
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8. Carey JC. {{Abbreviations and terminology surrounding autism spectrum disorders and intellectual disability}}. {Am J Med Genet A};2011 (Dec);155(12):2905.
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9. Caria A, Venuti P, de Falco S. {{Functional and dysfunctional brain circuits underlying emotional processing of music in autism spectrum disorders}}. {Cereb Cortex};2011 (Dec);21(12):2838-2849.
Despite intersubject variability, dramatic impairments of socio-communicative skills are core features of autistic spectrum disorder (ASD). A deficit in the ability to express and understand emotions has often been hypothesized to be an important correlate of such impairments. Little is known about individuals with ASD’s ability to sense emotions conveyed by nonsocial stimuli such as music. Music has been found to be capable of evoking and conveying strong and consistent positive and negative emotions in healthy subjects. The ability to process perceptual and emotional aspects of music seems to be maintained in ASD. Individuals with ASD and neurotypical (NT) controls underwent a single functional magnetic resonance imaging (fMRI) session while processing happy and sad music excerpts. Overall, fMRI results indicated that while listening to both happy and sad music, individuals with ASD activated cortical and subcortical brain regions known to be involved in emotion processing and reward. A comparison of ASD participants with NT individuals demonstrated decreased brain activity in the premotor area and in the left anterior insula, especially in response to happy music excerpts. Our findings shed new light on the neurobiological correlates of preserved and altered emotional processing in ASD.
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10. Catarino A, Churches O, Baron-Cohen S, Andrade A, Ring H. {{Atypical EEG complexity in autism spectrum conditions: A multiscale entropy analysis}}. {Clin Neurophysiol};2011 (Dec);122(12):2375-2383.
OBJECTIVE: Intrinsic complexity subserves adaptability in biological systems. One recently developed measure of intrinsic complexity of biological systems is multiscale entropy (MSE). Autism spectrum conditions (ASC) have been described in terms of reduced adaptability at a behavioural level and by patterns of atypical connectivity at a neural level. Based on these observations we aimed to test the hypothesis that adults with ASC would show atypical intrinsic complexity of brain activity as indexed by MSE analysis of electroencephalographic (EEG) activity. METHODS: We used MSE to assess the complexity of EEG data recorded from 15 participants with ASC and 15 typical controls, during a face and chair matching task. RESULTS: Results demonstrate a reduction of EEG signal complexity in the ASC group, compared to typical controls, over temporo-parietal and occipital regions. No significant differences in EEG power spectra were observed between groups, indicating that changes in complexity values are not a reflection of changes in EEG power spectra. CONCLUSIONS: The results are consistent with a model of atypical neural integrative capacity in people with ASC. SIGNIFICANCE: Results suggest that EEG complexity, as indexed by MSE measures, may also be a marker for disturbances in task-specific processing of information in people with autism.
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11. Cauda F, Geda E, Sacco K, D’Agata F, Duca S, Geminiani G, Keller R. {{Grey matter abnormality in autism spectrum disorder: an activation likelihood estimation meta-analysis study}}. {J Neurol Neurosurg Psychiatry};2011 (Dec);82(12):1304-1313.
Background Autism spectrum disorder (ASD) is defined on a clinical basis by impairments in social interaction, verbal and non-verbal communication, and repetitive or stereotyped behaviours. Voxel based morphometry (VBM), a technique that gives a probabilistic measure of local grey matter (GM) and white matter concentration, has been used to study ASD PATIENTS: modifications in GM volume have been found in various brain regions, such as the corpus callosum, brainstem, amygdala, hippocampus and cerebellum. However, the findings are inconsistent with respect to the specific localisation and direction of GM modifications, and no paper has attempted to statistically summarise the results available in the literature. Methods The present study is a quantitative meta-analysis of the current VBM findings aimed at delineating the cortical regions with consistently increased or reduced GM concentrations. The activation likelihood estimation (ALE) was used, which is a quantitative voxel based meta-analysis method which can be used to estimate consistent activations across different imaging studies. Co-occurrence statistics of a PubMed query were generated, employing ‘autism spectrum disorder’ as the neuroanatomical lexicon. Results Significant ALE values related to GM increases were observed bilaterally in the cerebellum, in the middle temporal gyrus, in the right anterior cingulate cortex, caudate head, insula, fusiform gyrus, precuneus and posterior cingulate cortex, and in the left lingual gyrus. GM decreases were observed bilaterally in the cerebellar tonsil and inferior parietal lobule, in the right amygdala, insula, middle temporal gyrus, caudate tail and precuneus and in the left precentral gyrus.
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12. Chen KL, Chiang FM, Tseng MH, Fu CP, Hsieh CL. {{Responsiveness of the Psychoeducational Profile-third Edition for Children with Autism Spectrum Disorders}}. {J Autism Dev Disord};2011 (Dec);41(12):1658-1664.
The aim of this study was to examine the responsiveness of the Psychoeducational Profile-third edition (PEP-3) in children with Autism Spectrum Disorders (ASD). We investigated the responsiveness in terms of three types of scores (i.e., raw scores, developmental ages, and percentile ranks) of the subtests and composites of the PEP-3 and three methods of analysis were used: effect size, standardized response mean, and paired t test. The findings generally support the use of the PEP-3 as an outcome measure. We suggest using the raw scores and developmental ages of the PEP-3 when evaluating program effectiveness and developmental changes for children with ASD.
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13. Chown N. {{Modified hermeneutic phenomenological approach toward individuals who have autism: A response to newman, cashin and waters}}. {Res Nurs Health};2011 (Dec);34(6):435-436.
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14. Cohen MM, Jr. {{ASD is an incorrect abbreviation for autism spectrum disorders}}. {Am J Med Genet A};2011 (Dec);155(12):2906.
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15. Dawson G, Burner K. {{Behavioral interventions in children and adolescents with autism spectrum disorder: a review of recent findings}}. {Curr Opin Pediatr};2011 (Dec);23(6):616-620.
PURPOSE OF REVIEW: The study provides an overview of recent studies on behavioral interventions for children and adolescents with autism spectrum disorder (ASD). RECENT FINDINGS: Recent reviews of the effectiveness of early intensive behavioral intervention (EIBI) conclude that EIBI can improve language and cognitive skills. The first randomized controlled trial (RCT) of a comprehensive early intervention for toddlers with ASD demonstrated gains in language, cognitive abilities, and adaptive behavior. Targeted, brief behavioral interventions are efficacious for improving social communication in young children with ASD. Parents can be taught to deliver behavioral interventions, which are associated with improvements in parent-child interaction; effects on child outcome, however, have been mixed. Several studies show that social skills interventions are efficacious for improving peer relationships and social competence. Behavioral interventions are also effective for reducing anxiety symptoms and aggression. Medication combined with behavioral intervention was found to be more effective for reducing aggression than medication alone. SUMMARY: Behavioral interventions are effective for improving language, cognitive abilities, adaptive behavior, and social skills, and reducing anxiety and aggression. Medication combined with behavioral intervention appears to be more effective for reducing aggressive behavior than medication alone.
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16. De Felice C, Signorini C, Durand T, Oger C, Guy A, Bultel-Ponce V, Galano JM, Ciccoli L, Leoncini S, D’Esposito M, Filosa S, Pecorelli A, Valacchi G, Hayek J. {{F2-dihomo-isoprostanes as potential early biomarkers of lipid oxidative damage in Rett syndrome}}. {J Lipid Res};2011 (Dec);52(12):2287-2297.
Oxidative damage has been reported in Rett syndrome (RTT), a pervasive developmental disorder caused in up to 95% of cases by mutations in the X-linked methyl-CpG binding protein 2 gene. Herein, we have synthesized F(2)-dihomo-isoprostanes (F(2)-dihomo-IsoPs), peroxidation products from adrenic acid (22:4 n-6), a known component of myelin, and tested the potential value of F(2)-dihomo-IsoPs as a novel disease marker and its relationship with clinical presentation and disease progression. F(2)-dihomo-IsoPs were determined by gas chromatography/negative-ion chemical ionization tandem mass spectrometry. Newly synthesized F(2)-dihomo-IsoP isomers [ent-7(RS)-F(2t)-dihomo-IsoP and 17-F(2t)-dihomo-IsoP] were used as reference standards. The measured ions were the product ions at m/z 327 derived from the [M-181](-) precursor ions (m/z 597) produced from both the derivatized ent-7(RS)-F(2t)-dihomo-IsoP and 17-F(2t)-dihomo-IsoP. Average plasma F(2)-dihomo-IsoP levels in RTT were about one order of magnitude higher than those in healthy controls, being higher in typical RTT as compared with RTT variants, with a remarkable increase of about two orders of magnitude in patients at the earliest stage of the disease followed by a steady decrease during the natural clinical progression. hese data indicate for the first time that quantification of F(2)-dihomo-IsoPs in plasma represents an early marker of the disease and may provide a better understanding of the pathogenic mechanisms behind the neurological regression in patients with RTT.
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17. Dow CT. {{Mycobacterium paratuberculosis and autism: Is this a trigger?}}. {Med Hypotheses};2011 (Dec);77(6):977-981.
Autism is a heterogeneous group of life-long neurologic problems that begin in childhood. Success in efforts to understand and treat autism has been mostly elusive. The role of autoimmunity in autism has gained recognition both for associated systemic autoimmune disease and the presence of brain autoantibodies in autistic children and their family members. There is an acknowledged genetic susceptibility to autism – most notably allotypes of complement C4. C4 defects are associated with several autoimmune diseases and also confer susceptibility to mycobacterial infections. Mycobacterium avium ss. paratuberculosis (MAP) causes an enteric inflammatory disease in ruminant animals (Johne’s disease) and is the putative cause of the very similar Crohn’s disease in humans. Humans are widely exposed to MAP in food and water. MAP has been also linked to ulcerative colitis, irritable bowel syndrome, sarcoidosis, Blau syndrome, autoimmune (Type 1) diabetes, Hashimoto’s thyroiditis and multiple sclerosis. Environmental agents are thought to trigger autism in the genetically at risk. Molecular mimicry is the proposed mechanism by which MAP is thought to trigger autoantibodies. Autoantibodies to brain myelin basic protein (MBP) is a common feature of autism. This article considers the subset of autoimmunity-related autism patients and postulates that MAP, through molecular mimicry to its heat shock protein HSP65, triggers autism by stimulating antibodies that cross react with myelin basic protein (MBP).
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18. Essa MM, Guillemin GJ, Waly MI, Al-Sharbati MM, Al-Farsi YM, Hakkim FL, Ali A, Al-Shafaee MS. {{Increased Markers of Oxidative Stress in Autistic Children of the Sultanate of Oman}}. {Biol Trace Elem Res};2011 (Nov 30)
Autism spectrum disorder (ASD) is a neurodevelopmental disorder of early childhood, and an enumeration about its etiology and consequences is still limited. Oxidative stress-induced mechanisms are believed to be the major cause for ASD. In this study 19 autistic and 19 age-matched normal Omani children were recruited to analyze their degree of redox status and a prewritten consent was obtained. Blood was withdrawn from subjects in heparin-coated tube, and plasma was separated. Plasma oxidative stress indicators such as nitric oxide (NO), malondialdehyde (MDA), protein carbonyl, and lactate to pyruvate ratio were quantified using commercially available kits. A significant elevation was observed in the levels of NO, MDA, protein carbonyl, and lactate to pyruvate ratio in the plasma of Omani autistic children as compared to their age-matched controls. These oxidative stress markers are strongly associated with major cellular injury and manifest severe mitochondrial dysfunction in autistic pathology. Our results also suggest that oxidative stress might be involved in the pathogenesis of ASD, and these parameters could be considered as diagnostic markers to ensure the prevalence of ASD in Omani children. However, the oxidative stress-induced molecular mechanisms in ASD should be studied in detail.
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19. Gastgeb HZ, Wilkinson DA, Minshew NJ, Strauss MS. {{Can individuals with autism abstract prototypes of natural faces?}}. {J Autism Dev Disord};2011 (Dec);41(12):1609-1618.
There is a growing amount of evidence suggesting that individuals with autism have difficulty with face processing. One basic cognitive ability that may underlie face processing difficulties is the ability to abstract a prototype. The current study examined prototype formation with natural faces using eye-tracking in high-functioning adults with autism and matched controls. Individuals with autism were found to have significant difficulty forming prototypes of natural faces. The eye-tracking data did not reveal any between group differences in the general pattern of attention to the faces, indicating that these difficulties were not due to attentional factors. Results are consistent with previous studies that have found a deficit in prototype formation and extend these deficits to natural faces.
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20. Good P. {{Do salt cravings in children with autistic disorders reveal low blood sodium depleting brain taurine and glutamine?}}. {Med Hypotheses};2011 (Dec);77(6):1015-1021.
Because boys are four times more likely than girls to develop autism, the role of male hormones (androgens) has received considerable scrutiny. Some researchers implicate arginine vasopressin, an androgen-dependent hormone from the pituitary gland that elicits male behavior. Elevated vasopressin is also the most common cause of low blood sodium (hyponatremia) – most serious in the brains of children. Hyponatremia causes astrocytes to swell, then release the amino acids taurine and glutamine and their water to compensate. Taurine – the brain osmolyte/inhibitory neurotransmitter that suppresses vasopressin – was the amino acid most wasted or depleted in urine of autistic children. Glutamine is a critical metabolic fuel in brain neurons, astrocytes, endothelial cells, and the intestines, especially during hypoglycemia. Because glutamine is not thought to cross the blood-brain barrier significantly, the implications of low blood glutamine in these children are not recognized. Yet children with high brain glutamine from urea cycle disorders are rarely diagnosed with autistic disorders. Other common events in autistic children that release vasopressin are gastrointestinal inflammation, hypoglycemia, and stress. Signs of hyponatremia in these children are salt cravings reported online and anecdotally, deep yellow urine revealing concentration, and relief of autistic behavior by fluid/salt diets. Several interventions offer promise: (a) taurine to suppress vasopressin and replenish astrocytes; (b) glutamine as fuel for intestines and brain; (c) arginine to spare glutamine, detoxify ammonia, and increase brain blood flow; and (d) oral rehydration salts to compensate dilutional hyponatremia. This hypothesis appears eminently testable: Does your child crave salt? Is his urine deep yellow?
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21. Guenole F, Godbout R, Nicolas A, Franco P, Claustrat B, Baleyte JM. {{Melatonin for disordered sleep in individuals with autism spectrum disorders: systematic review and discussion}}. {Sleep Med Rev};2011 (Dec);15(6):379-387.
Sleep disturbance is common in autism spectrum disorders (ASD) and melatonin is widely prescribed in such cases despite a lack of guidelines. The aim of this paper is to provide a systematic review of efficacy and safety of exogenous melatonin for treating disordered sleep in individuals with ASD. We performed a Pubmed((R)) documentary search enlarged by a manual review of references, which finally supplied 12 citations (4 case reports, 3 retrospective studies, 2 open-label clinical trials, and 3 placebo-controlled trials). As a whole, we found that the literature supports the existence of a beneficial effect of melatonin on sleep in individuals with ASD, with only few and minor side effects. However, considering the small number of studies and their methodological limits, these conclusions cannot yet be regarded as evidence-based. Randomized controlled trials and long-term follow-up data are still lacking to better assess efficacy and safety of exogenous melatonin for disordered sleep in individuals with ASD.
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22. Hamlin A, Liu Y, Nguyen DV, Tassone F, Zhang L, Hagerman RJ. {{Sleep apnea in fragile X premutation carriers with and without FXTAS}}. {Am J Med Genet B Neuropsychiatr Genet};2011 (Dec);156B(8):923-928.
This report seeks to establish the prevalence of sleep apnea in patients with the fragile X mental retardation 1 (FMR1) premutation with and without fragile X-associated tremor/ataxia syndrome (FXTAS) and to determine any correlation between CGG repeat and FMR1 mRNA levels with sleep apnea prevalence. Demographic and medical data from 430 (229 males, 201 females) participants were used in this analysis. Participants included premutation carriers with (n = 118) and without FXTAS (n = 174) as well as controls without the premutation (n = 123). Logistic regression models were employed to estimate the odds ratio of sleep apnea relative to controls, adjusted for age and gender, and also to examine potential association with CGG size and FMR1 mRNA expression level. The observed proportion of sleep apnea in premutation carriers with and without FXTAS and controls are 31.4% (37/118), 8.6% (15/174), and 13.8% (17/123), respectively. The adjusted odds of sleep apnea for premutation carriers with FXTAS is about 3.4 times that compared to controls (odds ratio, OR = 3.4, 95% confidence interval (CI) 1.8-7.4; P = 0.001), and similarly relative to premutation carriers without FXTAS (OR = 2.9, 95% CI 1.2-6.9; P = 0.014). The risk of sleep apnea was not different between controls and premutation carriers without FXTAS. The presence of sleep apnea is not associated with CGG repeat numbers nor FMR1 mRNA expression level among premutation carriers. Our data supports a higher prevalence and risk of sleep apnea in patients with FXTAS. We recommend that all patients diagnosed with FXTAS be screened for sleep apnea given the negative and perhaps accelerative impact sleep apnea may have on their FXTAS progression.
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23. Hara M, Nishi Y, Yamashita Y, Yoh J, Takahashi S, Nagamitsu S, Kakuma T, Hosoda H, Kangawa K, Kojima M, Matsuishi T. {{Ghrelin levels are reduced in Rett syndrome patients with eating difficulties}}. {Int J Dev Neurosci};2011 (Dec);29(8):899-902.
Most patients with Rett syndrome (RTT) have both gastrointestinal problems and somatic growth failure, including microcephaly. Ghrelin is a peptide hormone involved in growth hormone secretion, interdigestive motility, and feeding behavior. Plasma ghrelin assays have previously been described for other neurodevelopmental disorders. To examine the pathophysiology of RTT, we measured plasma levels of ghrelin in patients with RTT. A case-control study examining plasma levels of ghrelin, serum growth hormone, and insulin-like growth factor-1 (IGF-1) was performed on 27 patients with RTT and 53 controls. Plasma levels of total (T)- and octanoyl (O)-ghrelin were significantly lower in patients with RTT than in controls. Plasma levels of T-ghrelin correlated significantly with serum IGF-1 levels and head circumference. Significantly lower levels of plasma T-ghrelin and O-ghrelin were observed in RTT patients with eating difficulties, while lower levels of plasma T-ghrelin were observed in RTT patients with constipation, in comparison to patients without either of these symptoms. Alterations in plasma ghrelin levels may reflect various clinical symptoms and signs in RTT patients, including growth failure, acquired microcephalus, autonomic nerve dysfunction, and feeding difficulties. We describe the role of ghrelin in RTT and suggest this peptide as a novel biological marker in patients with RTT.
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24. Heilman KJ, Harden ER, Zageris DM, Berry-Kravis E, Porges SW. {{Autonomic regulation in fragile X syndrome}}. {Dev Psychobiol};2011 (Dec);53(8):785-795.
Autonomic reactivity was studied in individuals with fragile X syndrome (FXS), a genetic disorder partially characterized by abnormal social behavior. Relative to age-matched controls, the FXS group had faster baseline heart rate and lower amplitude respiratory sinus arrhythmia (RSA). In contrast to the typically developing controls, there was a decrease in RSA with age within the FXS group. Moreover, within the FXS group heart rate did not slow with age. The FXS group also responded with an atypical increase in RSA to the social challenge, while the control group reduced RSA. In a subset of the FXS group, the autonomic profile did not change following 2 months and 1 year of lithium treatment. The observed indices of atypical autonomic regulation, consistent with the Polyvagal Theory, may contribute to the deficits in social behavior and social communication observed in FXS. (c) 2011 Wiley Periodicals, Inc. Dev Psychobiol 53:785-795, 2011.
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25. Hemsley B, Balandin S, Worrall L. {{Nursing the patient with developmental disability in hospital: roles of paid carers}}. {Qual Health Res};2011 (Dec);21(12):1632-1642.
Our aim in this narrative inquiry was to understand the roles of paid carers supporting adults with developmental disability and complex communication needs in hospital, from the perspectives of 15 paid carers, 15 adults with developmental disability, and 15 hospital nurses. Results demonstrated that paid carers have an important role in supporting the adult with disability, providing information, delivering basic care, and facilitating communication. Stories reflected paid carer volunteerism; lack of orientation of carers and hospital staff to the paid carers’ roles; blurred role boundaries between paid carers, family carers, and nurses; and paid carers being uncertain about their own responsibilities for staff and patient safety. New policies and practice guidelines are needed to guide both health and disability services in clarifying paid carer roles and role boundaries, and to enable paid carers and hospital staff to work together effectively on the ward in the care of adults with developmental disability.
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26. Huang YP, St John W, Tsai SW, Chen HJ. {{Taiwanese fathers’ experiences of having their child diagnosed with a developmental disability}}. {J Nurs Res};2011 (Dec);19(4):239-249.
BACKGROUND: : Receiving a diagnosis of a developmental disability in a child can be a crisis event for parents. Gender differences in parental roles are worth considering when exploring the impact of having a child with a disability. However, most studies on this topic have focused on the mother’s experience, and little is known about what the father goes through as the parent of a child diagnosed with a disability. Even less is known regarding this experience in the context of the Chinese culture. PURPOSE: : The goal of this study was to explore fathers’ experiences of having a child diagnosed with a developmental disability in a Chinese cultural context. METHODS: : This study used a hermeneutic phenomenological approach informed by the philosophical world views of Heidegger. The 16 fathers who participated in the study were purposively sampled from a teaching hospital in central Taiwan. Data were collected using in-depth and semistructured interviews and were analyzed using hermeneutic analysis. RESULTS: : Data analysis revealed four shared meanings: losing hope, feelings of failure, being frustrated with family conflicts, and searching for positive coping strategies. CONCLUSIONS/IMPLICATIONS FOR PRACTICE:: Fathers feel shock and despair as well as personally devalued when learning that their child has been diagnosed with a developmental disability. Chinese cultural beliefs and values can elicit different experiences for fathers while helping them make sense of their experiences and accept their child in meaningful ways. Nurses can actively engage fathers as well as mothers to understand their feelings and thoughts about their child’s disability to provide appropriate emotional and informational support. Providing support or referral is necessary particularly when fathers encounter issues with the child’s grandparents. Nurses can assist fathers to find a way to make sense of having a child with a disability within their cultural frame of reference by adapting cultural beliefs and values to their situation and to make meaning of their child’s life.
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27. Hultman CM, Sandin S, Levine SZ, Lichtenstein P, Reichenberg A. {{Advancing paternal age and risk of autism: new evidence from a population-based study and a meta-analysis of epidemiological studies}}. {Mol Psychiatry};2011 (Dec);16(12):1203-1212.
Advanced paternal age has been suggested as a risk factor for autism, but empirical evidence is mixed. This study examines whether the association between paternal age and autism in the offspring (1) persists controlling for documented autism risk factors, including family psychiatric history, perinatal conditions, infant characteristics and demographic variables; (2) may be explained by familial traits associated with the autism phenotype, or confounding by parity; and (3) is consistent across epidemiological studies. Multiple study methods were adopted. First, a Swedish 10-year birth cohort (N=1 075 588) was established. Linkage to the National Patient Register ascertained all autism cases (N=883). Second, 660 families identified within the birth cohort had siblings discordant for autism. Finally, meta-analysis included population-based epidemiological studies. In the birth cohort, autism risk increased monotonically with increasing paternal age. Offspring of men aged >/=50 years were 2.2 times (95% confidence interval: 1.26-3.88: P=0.006) more likely to have autism than offspring of men aged </=29 years, after controlling for maternal age and documented risk factors for autism. Within-family analysis of discordant siblings showed that affected siblings had older paternal age, adjusting for maternal age and parity (P<0.0001). Meta-analysis demonstrated advancing paternal age association with increased risk of autism across studies. These findings provide the strongest evidence to date that advanced paternal age is a risk factor for autism in the offspring. Possible biological mechanisms include de novo aberration and mutations or epigenetic alterations associated with aging.
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28. Ingersoll B, Hopwood CJ, Wainer A, Brent Donnellan M. {{A comparison of three self-report measures of the broader autism phenotype in a non-clinical sample}}. {J Autism Dev Disord};2011 (Dec);41(12):1646-1657.
Three self-report measures of the broader autism phenotype (BAP) were evaluated in terms of their internal consistency, distribution of scores, factor structure, and criterion-related validity in a non-clinical sample. All measures showed a continuous distribution. The SRS-A and BAPQ showed expected sex differences and were superior to the AQ in terms of internal consistency. The proposed factor structure of the BAPQ replicated better than the proposed structures of the other measures. All measures showed evidence of criterion validity via correlations with related constructs and each measure incremented the others in predicting related constructs. However, the SRS-A and BAPQ were generally stronger in this domain. Recommendations for the use of these instruments for measuring the BAP in non-clinical populations are discussed.
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29. Kana RK, Libero LE, Moore MS. {{Disrupted cortical connectivity theory as an explanatory model for autism spectrum disorders}}. {Phys Life Rev};2011 (Dec);8(4):410-437.
Recent findings of neurological functioning in autism spectrum disorder (ASD) point to altered brain connectivity as a key feature of its pathophysiology. The cortical underconnectivity theory of ASD (Just et al., 2004) provides an integrated framework for addressing these new findings. This theory suggests that weaker functional connections among brain areas in those with ASD hamper their ability to accomplish complex cognitive and social tasks successfully. We will discuss this theory, but will modify the term underconnectivity to ‘disrupted cortical connectivity’ to capture patterns of both under- and over-connectivity in the brain. In this paper, we will review the existing literature on ASD to marshal supporting evidence for hypotheses formulated on the disrupted cortical connectivity theory. These hypotheses are: 1) underconnectivity in ASD is manifested mainly in long-distance cortical as well as subcortical connections rather than in short-distance cortical connections; 2) underconnectivity in ASD is manifested only in complex cognitive and social functions and not in low-level sensory and perceptual tasks; 3) functional underconnectivity in ASD may be the result of underlying anatomical abnormalities, such as problems in the integrity of white matter; 4) the ASD brain adapts to underconnectivity through compensatory strategies such as overconnectivity mainly in frontal and in posterior brain areas. This may be manifested as deficits in tasks that require frontal-parietal integration. While overconnectivity can be tested by examining the cortical minicolumn organization, long-distance underconnectivity can be tested by cognitively demanding tasks; and 5) functional underconnectivity in brain areas in ASD will be seen not only during complex tasks but also during task-free resting states. We will also discuss some empirical predictions that can be tested in future studies, such as: 1) how disrupted connectivity relates to cognitive impairments in skills such as Theory-of-Mind, cognitive flexibility, and information processing; and 2) how connection abnormalities relate to, and may determine, behavioral symptoms hallmarked by the triad of Impairments in ASD. Furthermore, we will relate the disrupted cortical connectivity model to existing cognitive and neural models of ASD.
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30. Kannikeswaran N, Chen X, Sethuraman U. {{Utility of endtidal carbon dioxide monitoring in detection of hypoxia during sedation for brain magnetic resonance imaging in children with developmental disabilities}}. {Paediatr Anaesth};2011 (Dec);21(12):1241-1246.
BACKGROUND: We have shown previously that children with developmental disabilities have three times higher incidence of sedation-related hypoxia when compared with normal children. OBJECTIVES: Our objectives were to describe the changes in endtidal carbon dioxide (ETCO(2)) values and the utility of ETCO(2) monitoring in earlier identification of hypoxia during sedation for brain magnetic resonance imaging (MRI) in children with developmental disabilities. METHODS: We conducted a prospective observational study of a convenience sample of 150 children with developmental disabilities aged 1-10 years who received intravenous sedation for brain MRI. Children were sedated and monitored according to the institution’s sedation protocol. We recorded ETCO(2) levels, hypoxia, and adverse events during sedation. Hypoxia was defined as SpO(2) < 93%. A change in ETCO(2) level >/= 10 mm Hg from presedation baseline, an intra-sedation >/= 50 mm Hg, and loss of capnographic waveform were considered as significant ETCO(2) abnormalities. RESULTS: Of the children, 80.7% (121/150) were sedated with a combination of pentobarbital and fentanyl. ETCO(2) abnormalities were noted in 42.6% (64/150) of sedation encounters. Hypoxia occurred in 18% (27/150) of subjects. ETCO(2) abnormalities were documented in 19(70%) patients with hypoxia before changes in pulse oximetry were noted. ETCO(2) changes were noted a mean of 4.38 +/- 1.89 min prior to occurrence of hypoxia. CONCLUSIONS: ETCO(2) abnormalities and hypoxia occur commonly during sedation in children with developmental disabilities. ETCO(2) monitoring is useful in early recognition of impending hypoxia during sedation in children with developmental disabilities.
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31. Khwaja OS, Sahin M. {{Translational research: Rett syndrome and tuberous sclerosis complex}}. {Curr Opin Pediatr};2011 (Dec);23(6):633-639.
PURPOSE OF REVIEW: Rare genetic diseases that affect behavior and cognition provide a unique opportunity to study the mechanisms of neurodevelopmental disorders through the examination of animal models, which can lead to development of hypotheses and treatments testable in human beings. Rett syndrome (RTT) and tuberous sclerosis complex (TSC) are both Mendelian disorders that present with autism, epilepsy, and intellectual disability, in which animal model work has been directly translated into clinical treatment trials currently underway. Here, we review the recent advances in our understanding of RTT and TSC pathogenesis and signaling pathways that may be targeted for novel treatments. RECENT FINDINGS: Animal models generated by engineering mutant forms of the mouse homologs of human genes involved in RTT and TSC have allowed dissection of the molecular pathology. They have further acted as in-vivo assays of potential therapeutic strategies that have translated to human clinical trials. SUMMARY: Single-gene disorders associated with neurodevelopmental disorders provide powerful model systems to study the roles of individual molecules and associated signaling pathways in the genesis of autism, epilepsy, cognitive impairment, and neuropsychiatric symptoms. These diseases are leading to disease-modifying human therapies that may eventually translate to wider therapeutic strategies for autism.
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32. Kobak KA, Stone WL, Wallace E, Warren Z, Swanson A, Robson K. {{A web-based tutorial for parents of young children with autism: results from a pilot study}}. {Telemed J E Health};2011 (Dec);17(10):804-808.
Abstract Objective: Early intervention can significantly improve long-term outcomes for children with autism. Unfortunately, many children do not receive early intervention services due to a critical shortage of trained professionals in this area. To bridge this gap, we evaluated a Web-based parent training tutorial (Enhancing Interactions), based on evidence-based practices and utilizing the Web-based platform to maximize learning. Methods: Twenty-three parents with a child between 18 months and 6 years with an autism spectrum disorder participated. Pre- and posttest scores of parents’ knowledge were used to evaluate tutorial effectiveness. The system usability scale (SUS) evaluated technical user-friendliness and the user satisfaction questionnaire (USQ), gauged satisfaction with content. Results: The mean number of correct items on the posttest significantly increased, from 12.6 to 20.4, p<0.001. The mean SUS score was 85 (standard deviation=17), corresponding to a score of « excellent. » All participants found the tutorial user friendly, well integrated, and 96% (all but one participant) thought it was easy to use, felt confident using the technical features, and would use a tutorial like this again. On the USQ, all participants found that the tutorial was well organized, clearly presented, and easy to understand; that it increased their knowledge about communicating with their child; and that they felt capable of applying these techniques with their child. Conclusions: The tutorial appears effective in increasing parents’ knowledge with high user satisfaction.
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33. Kroger A, Hanig S, Seitz C, Palmason H, Meyer J, Freitag CM. {{Risk factors of autistic symptoms in children with ADHD}}. {Eur Child Adolesc Psychiatry};2011 (Dec);20(11-12):561-570.
Autistic symptoms are frequently observed in children with attention-deficit/hyperactivity disorder (ADHD), but their etiology remains unclear. The main aim of this study was to describe risk factors for increased autistic symptoms in children with ADHD without an autism or autism-spectrum diagnosis. Comorbid psychiatric disorders, developmental delay, current medication, prenatal biological and postnatal psychosocial risk factors as well as parental autistic traits were assessed in 205 children with ADHD. Linear regression models identified maternal autistic traits, current familial risk factors and hyperactive symptoms as predictors of autistic symptoms in children with ADHD. Findings are indicative of possible genetic as well as environmental risk factors mediating autistic symptoms in children with ADHD. An additional validity analysis by ROC, area under the curve (AUC), suggested a cut-off of 11 to differentiate between ADHD and high-functioning ASD by the Social Communication Questionnaire (SCQ).
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34. Kushki A, Chau T, Anagnostou E. {{Erratum to: Handwriting Difficulties in Children with Autism Spectrum Disorders: A Scoping Review}}. {J Autism Dev Disord};2011 (Dec);41(12):1717.
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35. Kushki A, Chau T, Anagnostou E. {{Handwriting difficulties in children with autism spectrum disorders: a scoping review}}. {J Autism Dev Disord};2011 (Dec);41(12):1706-1716.
Functional handwriting involves complex interactions among physical, cognitive and sensory systems. Impairments in many aspects of these systems are associated with Autism spectrum disorders (ASD), suggesting a heightened risk of handwriting difficulties in children with ASD. This scoping review aimed to: (1) survey the existing evidence about potential contributions to compromised handwriting function in children with ASD, and (2) map out the existing studies documenting handwriting difficulties in children with ASD. The current evidence implicates impairments in fine motor control and visual-motor integration as likely contributors to handwriting difficulties in children with ASD, though the role of the latter is not well-understood. Moreover, diminished overall legibility and compromised letter formation are emerging points of convergence among existing studies of handwriting quality in children with ASD.
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36. Lanovaz MJ, Sladeczek IE. {{Vocal Stereotypy in Individuals With Autism Spectrum Disorders: A Review of Behavioral Interventions}}. {Behav Modif};2011 (Nov 29)
Vocal stereotypy is a common problem behavior in individuals with autism spectrum disorders that may interfere considerably with learning and social inclusion. To assist clinicians in treating the behavior and to guide researchers in identifying gaps in the research literature, the authors provide an overview of research on vocal stereotypy in individuals with autism spectrum disorders. Specifically, the authors review the research literature on behavioral interventions to reduce engagement in vocal stereotypy with an emphasis on the applicability of the procedures in the natural environment and discuss the clinical implications and limitations of research conducted to date. Researchers have shown that several antecedent-based and consequence-based interventions may be effective at reducing vocal stereotypy. However, the review suggests that more research is needed to assist clinicians in initially selecting interventions most likely to produce desirable changes in vocal stereotypy and collateral behavior in specific circumstances.
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37. Leehey MA, Legg W, Tassone F, Hagerman R. {{Fibromyalgia in fragile X mental retardation 1 gene premutation carriers}}. {Rheumatology (Oxford)};2011 (Dec);50(12):2233-2236.
Objective. FM is a disorder of altered pain regulation and is characterized by pain, fatigue, poor sleep and psychological impairments; thus, it is classified as a central sensitivity syndrome. Female carriers of a premutation in the fragile X mental retardation 1 (FMR1) gene frequently have widespread musculoskeletal pain and sometimes have been diagnosed with FM, especially if they have the motor signs of fragile X-associated tremor ataxia syndrome (FXTAS). Studies suggest that FM occurs in persons with a genetic predisposition. We describe the clinical features of female FMR1 premutation carriers with symptoms of FM. Methods. A sample of patients was selected that participated in studies at two tertiary referral academic centres on the phenotype and therapy of FXTAS. Results. This selected sample of patients, five female premutation carriers, has FM symptoms or diagnoses and other central sensitivity syndromes. Conclusion. Since FM affects 2-4% of the world’s population and about 1 in 250 females are FMR1 carriers, a study screening females with FM for the presence of the FMR1 premutation is worthwhile. A finding of increased prevalence of FMR1 carriers among females with FM would impact the standard evaluation of FM. Presently, guidelines for FMR1 genetic testing includes early menopause, congenital intellectual disability, autism spectrum disorder, tremor or ataxia, and a family history of FXTAS or fragile X syndrome. The latter is a common cause of autism and developmental delay. Such testing is important because female carriers are at risk of having a child with fragile X syndrome.
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38. Liu X, Malenfant P, Reesor C, Lee A, Hudson ML, Harvard C, Qiao Y, Persico AM, Cohen IL, Chudley AE, Forster-Gibson C, Rajcan-Separovic E, Lewis MS, Holden JJ. {{2p15-p16.1 microdeletion syndrome: molecular characterization and association of the OTX1 and XPO1 genes with autism spectrum disorders}}. {Eur J Hum Genet};2011 (Dec);19(12):1264-1270.
Reports of unrelated individuals with autism spectrum disorder (ASD) and similar clinical features having overlapping de novo interstitial deletions at 2p15-p16.1 suggest that this region harbors a gene(s) important to the development of autism. We molecularly characterized two such deletions, selecting two genes in this region, exportin 1 (XPO1) and orthodenticle homolog 1 (OTX1) for association studies in three North American cohorts (Autism Spectrum Disorder – Canadian American Research Consortium (ASD-CARC), New York, and Autism Genetic Resource Exchange (AGRE)) and one Italian cohort (Societa Italiana per la Ricerca e la Formazione sull’Autismo (SIRFA)) of families with ASD. In XPO1, rs6735330 was associated with autism in all four cohorts (P<0.05), being significant in ASD-CARC cohorts (P-value following false discovery rate correction for multiple testing (P(FDR))=1.29 x 10(-5)), the AGRE cohort (P(FDR)=0.0011) and the combined families (P(FDR)=2.34 x 10(-9)). Similarly, in OTX1, rs2018650 and rs13000344 were associated with autism in ASD-CARC cohorts (P(FDR)=8.65 x 10(-7) and 6.07 x 10(5), respectively), AGRE cohort (P(FDR)=0.0034 and 0.015, respectively) and the combined families (P(FDR)=2.34 x 10(-9) and 0.00017, respectively); associations were marginal or insignificant in the New York and SIRFA cohorts. A significant association (P(FDR)=2.63 x 10(-11)) was found for the rs2018650G-rs13000344C haplotype. The above three SNPs were associated with severity of social interaction and verbal communication deficits and repetitive behaviors (P-values <0.01). No additional deletions were identified following screening of 798 ASD individuals. Our results indicate that deletion 2p15-p16.1 is not commonly associated with idiopathic ASD, but represents a novel contiguous gene syndrome associated with a constellation of phenotypic features (autism, intellectual disability, craniofacial/CNS dysmorphology), and that XPO1 and OXT1 may contribute to ASD in 2p15-p16.1 deletion cases and non-deletion cases of ASD mapping to this chromosome region.
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39. Maski KP, Jeste SS, Spence SJ. {{Common neurological co-morbidities in autism spectrum disorders}}. {Curr Opin Pediatr};2011 (Dec);23(6):609-615.
PURPOSE OF REVIEW: Autism spectrum disorders (ASDs) are heterogeneous neurodevelopmental disorders associated with various co-morbidities. Neurological co-morbidities include motor impairments, epilepsy, and sleep dysfunction. These impairments have been receiving more attention recently, perhaps because of their significant impact on the behavior and cognitive function of children with ASDs. Here, we review the epidemiology, etiology, and clinical approach to these neurological co-morbidities and highlight future research directions. RECENT FINDINGS: Motor impairments include stereotypies, motor delays, and deficits, such as dyspraxia, incoordination, and gait problems. Sleep dysfunction typically presents as difficulty with sleep onset and prolonged awakenings during the night. Recent data suggest that abnormalities in melatonin may affect sleep and may be a potential treatment target. There is no classic epilepsy syndrome associated with ASDs. Intellectual disability, syndromic autism, and female sex are specific risk factors. Recent research has focused on identifying the overlapping pathways between these neurological co-morbidities and the core deficits in ASDs, which may have direct and powerful implications for treatment and prognosis. SUMMARY: Motor impairment, epilepsy, and sleep dysfunction are common neurological co-morbidities in ASDs. Clinicians should be aware that recognition and treatment of these issues may improve the function and outcome of children with ASDs.
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40. McPartland JC, Coffman M, Pelphrey KA. {{Recent advances in understanding the neural bases of autism spectrum disorder}}. {Curr Opin Pediatr};2011 (Dec);23(6):628-632.
PURPOSE OF REVIEW: This article reviews current work investigating the neural bases of autism spectrum disorder (ASD) within the discipline of electrophysiological brain research. The manuscript focuses primarily on advances in understanding related to social information processing and interconnectivity among brain systems in ASD. RECENT FINDINGS: Recent research indicates anomalous function of social brain regions in ASD and highlights the specificity of processing problems to these systems. Atypical activity in this circuitry may reflect genetic susceptibility for ASD, with increased activity in compensatory areas marking the distinction between developing and not developing the disorder. Advances in understanding connectivity in ASD are highlighted by novel work providing initial evidence of atypical interconnectivity in infancy. SUMMARY: Emerging understanding of neural dysfunction in ASD indicates consistent but heterogeneous dysfunction across brain systems in ASD. Key objectives for the immediate future include the use of multimethod approaches that encompass temporal and spatial imaging; behavioral phenotyping carried out in developmental context to reveal subgroups defined uniquely by trajectories; and individual-specific profiles of behavioral performance and brain function.
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41. Montgomery J, Storey K, Post M, Lemley J. {{The use of auditory prompting systems for increasing independent performance of students with autism in employment training}}. {Int J Rehabil Res};2011 (Dec);34(4):330-335.
In this study a self-operated auditory prompting system is introduced to determine if it can increase the on-task behavior for two students with autism participating in an employment training program. In addition, the amount of prompts provided by support staff is measured. The self-operated auditory prompting system consisted of tape recordings of music interspersed with prompts of self-evaluation and encouragement related to the job tasks being performed in the employment setting. The results of the study indicated a potential positive relationship between the self-operated auditory prompting system and the on-task behavior of the participants as well as a positive relationship between the decreased amounts of prompts used by support staff.Im Rahmen der vorliegenden Studie wird ein selbsttatig bedienbares System mit akustischen Impulsen vorgestellt, das Aufschluss daruber geben soll, ob es das On-task-Verhalten von zwei autistischen Teilnehmern an einem Berufsbildungsprogramm verbessern kann. Ausserdem erfolgt eine Messung der Anzahl der von Betreuern gesendeten Impulse. Das selbsttatig bedienbare System mit akustischen Impulsen bestand aus Bandaufnahmen mit abwechselnd Musik und Impulsen zur Selbsteinschatzung und Anregung bzgl. der am Arbeitsplatz auszuubenden Aufgaben. Die Studienergebnisse deuteten auf eine potenzielle positive Beziehung zwischen dem selbsttatig bedienbaren System mit akustischen Impulsen und dem On-task-Verhalten der Teilnehmer hin aber auch auf eine positive Beziehung zwischen der geringeren Anzahl der von den Betreuern gesendeten Impulse.Este estudio presenta un sistema automatico de senales auditivas que tiene como objetivo mejorar la disciplina de trabajo de dos estudiantes con autismo que participan en un programa de formacion profesional. Asimismo, el estudio tambien evalua la cantidad de ayuda proporcionada por el personal de apoyo. El sistema automatico de senales auditivas consistia en grabaciones de musica combinadas con directrices de autoevaluacion y estimulo en relacion con tareas aplicadas al contexto laboral. Los resultados del estudio indicaron una posible relacion positiva entre el sistema automatico de senales auditivas y la disciplina de trabajo de los participantes, asi como una relacion positiva con la disminucion del numero de pautas necesarias por parte del personal de apoyo.Dans cette etude, un systeme auditif d’invite auto-gere est introduit pour determiner s’il peut augmenter le comportement d’execution des taches de deux eleves autistes participant a un programme de formation a l’emploi. En outre, la quantite d’invites communiquees par le personnel d’encadrement est mesuree. Le systeme auditif d’invite auto-gere se compose d’enregistrements de musique entrecoupes d’invites d’auto-evaluation et d’encouragement associees aux taches executees dans un cadre d’emploi. Les resultats de l’etude ont indique une eventuelle relation positive entre le sy
