Pubmed du 02/04/22
1. Billeci L, Callara AL, Guiducci L, Prosperi M, Morales MA, Calderoni S, Muratori F, Santocchi E. A randomized controlled trial into the effects of probiotics on electroencephalography in preschoolers with autism. Autism : the international journal of research and practice. 2022: 13623613221082710.
This study investigates the effects of a probiotic on preschoolers’ brain electrical activity with autism spectrum disorder. Autism is a disorder with an increasing prevalence characterized by an enormous individual, family, and social cost. Although the etiology of autism spectrum disorder is unknown, an interaction between genetic and environmental factors is implicated, converging in altered brain synaptogenesis and, therefore, connectivity. Besides deepening the knowledge on the resting brain electrical activity that characterizes this disorder, this study allows analyzing the positive central effects of a 6-month therapy with a probiotic through a randomized, double-blind placebo-controlled study and the correlations between electroencephalography activity and biochemical and clinical parameters. In subjects treated with probiotics, we observed a decrease of power in frontopolar regions in beta and gamma bands, and increased coherence in the same bands together with a shift in frontal asymmetry, which suggests a modification toward a typical brain activity. Electroencephalography measures were significantly correlated with clinical and biochemical measures. These findings support the importance of further investigations on probiotics’ benefits in autism spectrum disorder to better elucidate mechanistic links between probiotics supplementation and changes in brain activity.
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2. Bonnechère B, Amin N, van Duijn C. The Role of Gut Microbiota in Neuropsychiatric Diseases – Creation of An Atlas-Based on Quantified Evidence. Frontiers in cellular and infection microbiology. 2022; 12: 831666.
There is a growing body of evidence highlighting the significant role of gut microbiota in various pathologies. We performed a systematic review to review the different microbiota involved in neuropsychiatric diseases. 50 studies (23 studies for autism spectrum disorders, 18 for major depression, and 9 for schizophrenia), representing 2,137 patients and 2,844 controls. Concerning the microbiota, the genera Prevotella, Clostridium, Bacteroides, Bifidobacterium, Ruminococcus, Megamonas, and Faecalbacterium were the ones detected with the most frequent variation of their relatives abundance. We also assess the overlap between the different pathologies. This study provides new insights into the complex relationship between the brain and the gut and the implications in neuropsychiatric pathologies. The identification of unique signatures in neuropsychiatric diseases suggests new possibilities in targeted anti or probiotic treatment.
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3. Brown HM, Dwyer PSR, Gassner DL, Kapp SK, Ne’eman A, Ryan JG, Waisman TC, Williams ZJ. The Autism Intervention Research Network on Physical Health Autistic Researcher Review Board. Pediatrics. 2022; 149(Suppl 4).
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4. Casseus M. Prevalence of co-occurring autism spectrum disorder and attention deficit/hyperactivity disorder among children in the United States. Autism : the international journal of research and practice. 2022: 13623613221083279.
Autism spectrum disorder and attention deficit/hyperactivity disorder are neurodevelopmental disorders that often co-occur in children. However, there are few large, nationally representative studies examining the prevalence of co-occurring autism spectrum disorder and attention deficit/hyperactivity disorder in children. The aim of this study was to estimate the prevalence of parent-reported co-occurring autism spectrum disorder and attention deficit/hyperactivity disorder in the United States and examine associations between having co-occurring autism spectrum disorder and attention deficit/hyperactivity disorder and sociodemographic and household factors. Data were analyzed from the 2016-2018 National Survey of Children’s Health. A total of 88,051 children aged 3-17 years old were included in the analysis. Statistical analyses were conducted to assess the associations between sociodemographic and household characteristics and current co-occurrence of autism spectrum disorder and attention deficit/hyperactivity disorder. Approximately 1.2% of children (740,816) aged 3-17 years had co-occurring autism spectrum disorder and attention deficit/hyperactivity disorder. Children who were male, older, reported poor health, or had public or combined public and private health insurance were more likely to have co-occurring autism spectrum disorder and attention deficit/hyperactivity disorder. Conversely, children who were Black, non-Hispanic or multi-racial/other, non-Hispanic were less likely to report co-occurring autism spectrum disorder and attention deficit/hyperactivity disorder than White non-Hispanics. Findings suggest implementing early developmental screening and surveillance for co-occurring autism spectrum disorder and attention deficit/hyperactivity disorder, and coordinating strategies that optimize early identification and intervention for all children suspected of having co-occurring autism spectrum disorder and attention deficit/hyperactivity disorder, particularly those from underrepresented groups.
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5. Charlton RA, McQuaid GA, Wallace GL. Social support and links to quality of life among middle-aged and older autistic adults. Autism : the international journal of research and practice. 2022: 13623613221081917.
Social support can take many forms, such as practical help, time spent socially with others, or the satisfaction with personal relationships. Social support is known to affect quality of life (QoL) in both non-autistic older and autistic young adults. QoL reflects how satisfied an individual is with their life either overall or in a certain area. We know little about middle-aged and older autistic adults’ experiences of social support or QoL. In this study, 388 adults aged 40-83 years old, completed online questionnaires asking about background such as age and sex, depression and anxiety symptoms, QoL (physical, psychological, social, environmental, and autism-specific), and different types of social support. Even after taking into account background, depression, and anxiety, social support was important for individuals’ QoL. To our knowledge this is the first paper to examine the relationship between social support and QoL in middle-aged and older autistic adults. Improving social support may have a significant impact on the QoL of older autistic adults. Future studies should examine whether age-related changes in social support (size, content, and arrangement of social networks) that are common in non-autistic aging, also occur among older autistic adults.
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6. Corbett BA, Muscatello RA, Klemencic ME, West M, Kim A, Strang JF. Greater gender diversity among autistic children by self-report and parent-report. Autism : the international journal of research and practice. 2022: 13623613221085337.
Gender diversity broadly refers to the way in which an individual experiences (expressions and/or identities) their gender distinctly to that which would be expected based upon social norms for their gender assigned at birth. Recent research has shown a higher representation of gender diversity among autistic youth. Previous research in this area has relied on parent-report based on a single question from the Child Behavior Checklist Item-110, asking whether their child « Wishes to be the opposite sex. » The Gender Diversity Screening Questionnaire Self-Report and Parent-Report were used to assess the experience of gender diversity in 244 children (140 autism spectrum disorder and 104 typically developing) between 10 and 13 years. The Item-110 was also collected. Results showed that autistic children endorsed much higher rates of Binary Gender Diversity (less identification with their designated sex and more with the other binary sex) and Nonbinary Gender Diversity (identification as neither male nor female) than typically developing children. Similarly, parents of autistic children reported significantly more gender-body incongruence experienced by their child than parents of typically developing children. Specifically, parents of autistic females-assigned-at-birth reported significantly more gender-body incongruence than autistic males-assigned-at-birth. Parent- and self-report measures were largely related. Moreover, statistical comparisons between and within the groups revealed associations between gender profiles and symptoms of anxiety, depression, and suicidality. Results extend previous reports showing increased rates of gender diversity in autistic children, now based on both self-report and parent-report, and highlight the need to better understand and support the unique and complex needs of autistic children who experience gender diversity.
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7. Crucitti J, Hyde C, Enticott PG, Stokes MA. A systematic review of frontal lobe volume in autism spectrum disorder revealing distinct trajectories. Journal of integrative neuroscience. 2022; 21(2): 57.
Frontal lobe volume has been extensively researched in individuals with Autism spectrum disorder (ASD), though findings are yet to be summarised to explain the developmental trends of frontal lobe volume. The aim of the present study is to consolidate all existing frontal lobe volume and age data of autistic individuals below 30 years of age, and compare this data to non-autistic (N-ASD) controls. Following a systematic review, frontal lobe volume data were obtained from seven papers. Raw data, or the means and standard deviations of frontal lobe volume, and age, were obtained from the studies giving 372 autistic and 190 N-ASD participants. Data were plotted and analysed. Findings revealed that regression lines of fit for ASD (R2Linear = 0.33; R2Quadratic = 0.52) and N-ASD (R2Linear = 0.14; R2Quadratic = 0.39) were significantly different by diagnosis (linear p = 0.002, quadratic p = 0.02) with quadratic models providing significantly better fit within ASD (p < 0.001) and N-ASD (p < 0.001). Additional analyses revealed that frontal lobe volume was greater in autistic individuals than N-ASD between two and four years (F(1,31) = 12.965, p < 0.005, η2 = 0.291). In the present study, there were distinct developmental trends for frontal lobe volume between ASD and N-ASD.
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8. Dwyer P, Ryan JG, Williams ZJ, Gassner DL. First Do No Harm: Suggestions Regarding Respectful Autism Language. Pediatrics. 2022; 149(Suppl 4).
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9. Emerson LM, Adams D. Brief Report: Family Accommodation is Associated with the Impact of Childhood Anxiety in Autism. Journal of autism and developmental disorders. 2022.
Anxiety is commonly experienced by children on the autism spectrum, and can negatively impact their lives. Family accommodation has been linked to the impact of anxiety on the child’s life in non-autistic children. This study tested whether the same relationship holds for children on the autism spectrum. A community sample (n = 118) of parents of children on the spectrum completed questionnaires on their child’s autism characteristics and severity and impact of their child’s anxiety, their own anxiety and family accommodation behaviours. Family accommodation was associated with the impact of child anxiety, over and above anxiety severity of the child and parent. Findings support the involvement of parents in psychosocial support for children on the autism spectrum experiencing anxiety.
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10. Fernandes P, Kwak H. Autism and COVID-19. Pediatrics. 2022; 149(Suppl 4).
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11. Fernandes P, Timmerman J, Hotez E, Haley M, Reyes A, Ferguson F, Kuo A. A Residency Program Curriculum to Improve Health Care Transitions for Autistic Individuals. Pediatrics. 2022; 149(Suppl 4).
OBJECTIVES: Physical and mental health outcomes of autistic individuals deteriorate during transition to adulthood. The study aims to identify opportunities to improve physician knowledge in health-care transitions (HCT) for autistic individuals by understanding perceived versus experienced facilitators and barriers in overall HCT curriculum implementation in graduate medical education. METHODS: Medicine-Pediatrics program directors participated in a Health Care Transition Residency Curriculum Collaborative Improvement Network and used an iterative process to develop and improve HCT curricula. Pre- and postcollaborative semistructured interviews were administered to program directors. The study occurred over 9 months (July 2018-February 2019). Recurring interview themes were analyzed utilizing Dedoose qualitative coding software and presented utilizing percentages and proportions. RESULTS: Most program directors developed curricula in response to a gap in their current transition curricula. All program directors partially or completely met their goals during the collaborative. The most common types of curricular delivery were didactic (65%) and clinical experience-based (53%). Some tested unique delivery platforms, like the electronic medical record system (29%) and online modules (24%). Program directors often involved residents in the curricular development process and overwhelmingly (65%) felt this was a major facilitator. Competing priorities of faculty (71%) and of residents (53%) were the most common barriers. CONCLUSIONS: Gaps in HCT curricula delivery were primarily attributed to suboptimal health care systems where training occurs, though existing clinical experiences and diverse learning modalities were successfully leveraged. Using a quality improvement framework and actively engaging resident trainees in curriculum development were successful strategies programs used in the development of HCT curricula.
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12. Gomes AKS, Dantas RM, Yokota BY, Silva A, Griesi-Oliveira K, Passos-Bueno MR, Sertié AL. Interleukin-17a Induces Neuronal Differentiation of Induced-Pluripotent Stem Cell-Derived Neural Progenitors From Autistic and Control Subjects. Frontiers in neuroscience. 2022; 16: 828646.
Prenatal exposure to maternal immune activation (MIA) has been suggested to increase the probability of autism spectrum disorder (ASD). Recent evidence from animal studies indicates a key role for interleukin-17a (IL-17a) in promoting MIA-induced behavioral and brain abnormalities reminiscent of ASD. However, it is still unclear how IL-17a acts on the human developing brain and the cell types directly affected by IL-17a signaling. In this study, we used iPSC-derived neural progenitor cells (NPCs) from individuals with ASD of known and unknown genetic cause as well as from neurotypical controls to examine the effects of exogenous IL-17a on NPC proliferation, migration and neuronal differentiation, and whether IL-17a and genetic risk factors for ASD interact exacerbating alterations in NPC function. We observed that ASD and control NPCs endogenously express IL-17a receptor (IL17RA), and that IL-17a/IL17RA activation modulates downstream ERK1/2 and mTORC1 signaling pathways. Exogenous IL-17a did not induce abnormal proliferation and migration of ASD and control NPCs but, on the other hand, it significantly increased the expression of synaptic (Synaptophysin-1, Synapsin-1) and neuronal polarity (MAP2) proteins in these cells. Also, as we observed that ASD and control NPCs exhibited similar responses to exogenous IL-17a, it is possible that a more inflammatory environment containing other immune molecules besides IL-17a may be needed to trigger gene-environment interactions during neurodevelopment. In conclusion, our results suggest that exogenous IL-17a positively regulates the neuronal differentiation of human NPCs, which may disturb normal neuronal and synaptic development and contribute to MIA-related changes in brain function and behavior.
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13. Goris J, Braem S, Van Herck S, Simoens J, Deschrijver E, Wiersema JR, Paton B, Brass M, Todd J. Reduced primacy bias in autism during early sensory processing. The Journal of neuroscience : the official journal of the Society for Neuroscience. 2022.
Recent theories of autism propose that a core deficit in autism would be a less context-sensitive weighting of prediction errors. There is also first support for this hypothesis on an early sensory level. However, an open question is whether this decreased context-sensitivity is caused by faster updating of one’s model of the world (i.e. higher weighting of new information), proposed by predictive coding theories, or slower model updating. Here, we differentiated between these two hypotheses by investigating how first impressions shape the mismatch negativity (MMN), reflecting early sensory prediction error processing. An autism and matched control group of human adults (both n=27, 8 female) were compared on the multi-timescale MMN paradigm, in which tones were presented that were either standard (frequently occurring) or deviant (rare), and these roles reversed every block. A well-replicated observation is that the initial model (i.e. the standard and deviant sound in the first block) influences MMN amplitudes in later blocks. If autism is characterized by faster model updating, and thus a smaller primacy bias, we hypothesized (and demonstrate using a simple reinforcement learning model) that their MMN amplitudes should be less influenced by the initial context. In line with this hypothesis, we found that MMN responses in the autism group did not differ between the initial deviant and initial standard sounds as they did in the control group. These findings are consistent with the idea that autism is characterized by faster model updating during early sensory processing, as proposed by predictive coding accounts of autism.Significance statement:Recent theories of autism propose that a core deficit in autism is that they are faster to update their models of the world based on new sensory information. Here, we tested this hypothesis by investigating how first impressions shape brain responses during early sensory processing, and hypothesized that individuals with autism would be less influenced by these first impressions. In line with earlier studies, our results show that early sensory processing was influenced by first impressions in a control group. However, this was not the case in an autism group. This suggests that individuals with autism are faster to abandon their initial model, and is consistent with the proposal that they are faster to update their models of the world.
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14. Gragnani CM, Fernandes P. Promoting Healthy Lifestyles and Well-Being in Autistic Youth. Pediatrics. 2022; 149(Suppl 4).
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15. Graham Holmes L, Ames JL, Massolo ML, Nunez DM, Croen LA. Improving the Sexual and Reproductive Health and Health Care of Autistic People. Pediatrics. 2022; 149(Suppl 4).
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16. Graham Holmes L, Rast JE, Roux AM, Rothman EF. Reproductive Health and Substance Use Education for Autistic Youth. Pediatrics. 2022; 149(Suppl 4).
BACKGROUND: We provide an update on reproductive health education (RHE) and substance use prevention education (SUPE) participation for autistic youth compared with other youth with and without individualized education plans (IEPs) and 504 plans. The 800 000 autistic youth served by the US special education system need education to make informed decisions about reproductive health and substance use. METHODS: Data were from the National Longitudinal Transition Study-2012, a survey designed to yield nationally representative estimates of the experiences of US youth. Autistic youth (n = 390) who received RHE and SUPE were compared with youth with all other IEP classifications (n = 4420), with a 504 plan (n = 350), and with no IEP or 504 plan (n = 980). All youth were ≥14 years old and able to self-report on a survey. Bivariate and multivariate regression analyses were performed for each group to identify characteristics associated with RHE and SUPE receipt. RESULTS: Autistic youth reported a significantly lower rate of RHE (47.4%) and SUPE (49.6%) inclusion versus students with no IEP or 504 plan (59.2% and 57.4%, respectively). Autistic girls were more than twice as likely to report RHE receipt than autistic boys (55.1% vs 45.9%). For autistic youth, no markers for receipt of SUPE were identified. CONCLUSIONS: Autistic youth are underserved when it comes to school-based RHE and SUPE, potentially undermining self-determination and leading to poorer lifespan health trajectories. Research and policy advocacy are needed to ensure that these youth have access to RHE and SUPE.
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17. Heyworth M, Chan T, Lawson W. Perspective: Presuming Autistic Communication Competence and Reframing Facilitated Communication. Frontiers in psychology. 2022; 13: 864991.
Debate surrounding the validity of the method of supported typing known as facilitated communication (FC) has been continuous since its inception in the 1990s. Views are polarized on whether FC can be considered an authenticated method for use by people with complex communication needs (CCN) or significant challenges in speech, language, and communication. This perspective article presents an analysis of the research arguing for-and against-the use of FC, combined with the lived experience knowledge of autistic adults who utilize FC, to rehabilitate its current standing as discredited and unevidenced. By considering extant qualitative and quantitative studies, as well as personal accounts of the use of this particular Augmentative and Alternative Communication (AAC) method, the authors argue that the current dismissal of FC is rooted in ableist and outdated approaches. FC research should be reconsidered and reconducted using current best practice autism research approaches, including coproduction and a presumption of autistic communication competence, to assess its validity as a potential AAC method for autistic individuals.
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18. Hurley EN, Ellaway CJ, Johnson AM, Truong L, Gordon R, Galettis P, Martin JH, Lawson JA. Efficacy and safety of cannabidivarin treatment of epilepsy in girls with Rett syndrome: A phase 1 clinical trial. Epilepsia. 2022.
OBJECTIVE: Rett syndrome (RTT), commonly caused by methyl-CpG-binding protein 2 (MECP2) pathogenic variants, has many comorbidities. Fifty to ninety percent of children with RTT have epilepsy, which is often drug-resistant. Cannabidivarin (CBDV), a non-hallucinogenic phytocannabinoid, has shown benefit in MECP2 animal models. This phase 1 trial assessed the safety and tolerability of CBDV in female children with RTT and drug-resistant epilepsy, as well as the effect on mean monthly seizure frequency (MMSF), the electroencephalogram (EEG), and non-epilepsy comorbid symptoms. METHODS: Five female children with drug-resistant epilepsy and a pathogenic MECP2 variant were enrolled. Baseline clinical and laboratory assessments, including monthly seizure frequency, were recorded. CBDV oral solution (50 mg/ml) was prescribed and titrated to 10 mg/kg/day. Data collected included pharmacokinetics, seizure type and frequency, adverse events, EEG, and responses to the Rett Syndrome Behaviour Questionnaire and Rett Syndrome Symptom Severity Index, and were compared to baseline data. RESULTS: All five children reached the maximum CBDV dose of 10 mg/kg/day and had a reduction in MMSF (median = 79% reduction). Three children had MMSF reduction > 75%. This corresponded to an overall reduction in seizure frequency from 32 to 7.2 seizures per month. Ninety-one percent of adverse events were mild or moderate, and none required drug withdrawal. Sixty-two percent were judged to be unrelated to CBDV. Thirty-one percent of adverse events were identified as possibly related, of which nearly all were mild, and the remainder were later assessed as RTT symptoms. Hypersomnolence and drooling were identified as related to CBDV. No serious adverse events reported were related to CBDV. No significant change was noted in EEG or non-epilepsy-related symptoms of RTT. SIGNIFICANCE: A dose of 10 mg/kg/day of CBDV is safe and well tolerated in a pediatric RTT cohort and suggests improved seizure control in children with MECP2-related RTT.
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19. Jiang X, Song M, Qin W, Xiao J, Xu X, Yuan Q. Nonpharmaceutical therapy for autism spectrum disorder: A protocol for systematic review and network meta-analysis. Medicine. 2022; 101(7): e28811.
BACKGROUND: Autism spectrum disorder (ASD) is a widespread developmental disorder of the nervous system with an unclear etiology and pathogenesis. Its global incidence is currently increasing, and no effective drugs are available to improve its core symptoms. Nonpharmaceutical therapy can effectively relieve the core symptoms of autism, has fewer side effects than drugs, and is easily accepted by patients. This systematic and network meta-analysis aimed to evaluate the impact of non-pharmaceutical therapy on autism to explore preferable therapeutic options for autism. METHODS: Online databases, including the China National Knowledge Infrastructure [CNKI], SinoMed, Wanfang Database [WF], China Science and Technology Journal Database [VIP], MEDLINE, Web of Science, EMBASE, and the Cochrane Library will be searched for randomized controlled trials of nonpharmacological interventions for autism published before October 2021. Two researchers will be independently responsible for the literature screening, data extraction, and quality assessment. Standard paired and Bayesian network meta-analyses will be performed using RevMan 5.3 Software and GEMTC 0.14.3, to compare the efficacy and safety of different nonpharmacological regimens. RESULTS: The results of this systematic and network meta-analysis will be submitted to a peer-reviewed journal for publication. CONCLUSION: This study provides a comprehensive and reliable evidence-based reference for the efficacy and safety of different non-pharmacological interventions for autism. PROSPERO REGISTRATION NUMBER: CRD 42021275571.
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20. Kamali M, Sivapalan S, Kata A, Kim N, Shanmugalingam N, Duku E, Zwaigenbaum L, Georgiades S. Program evaluation of a pilot mobile developmental outreach clinic for autism spectrum disorder in Ontario. BMC health services research. 2022; 22(1): 426.
BACKGROUND: Autism spectrum disorder (ASD) is a neurodevelopmental disorder with increasing prevalence worldwide. Early identification of ASD through developmental screening is critical for early intervention and improved behavioural outcomes in children. However due to long wait times, delays in diagnosis continue to occur, particularly among minority populations who are faced with existing barriers in access to care. A novel Mobile Developmental Outreach Clinic (M-DOC) was implemented to deliver culturally sensitive screening and assessment practices to increase access to developmental health services, reduce wait times in diagnoses, and aid in equitable access to intervention programs among vulnerable populations in Ontario. METHODS: This study applied two evaluation frameworks (process and outcome evaluation) to determine whether the delivery model was implemented as intended, and if the program achieved its targeted goals. A mixed-methods design was undertaken to address the study objectives. RESULTS: Between September 2018-February 2020, M-DOC reached 227 families with developmental health concerns for their child, while successfully targeting the intended population and achieving its goals. The mean age of the child-in-need at intake was 31.6 months (SD 9.9), and 70% of the sample were male. The program’s success was attributed to the use of cultural liaisons to break cultural and linguistic barriers, the creation of multiple points of access into the diagnosis pathway, and delivery of educational workshops in local communities to raise awareness and knowledge of autism spectrum disorder. CONCLUSIONS: The findings underscore the need for community-based intervention programs that focus on cultural barriers to accessing health services. The model of delivery of the M-DOC programs highlights the opportunity for other programs to adopt a similar mobile outreach clinic approach as a means to increase access to services, particularly in targeting hard-to-reach and vulnerable populations.
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21. Kapel A, Kovacic T, Kos N, Velnar T. Impact of a 12-month multifaceted neurological physiotherapy intervention on gross motor function in women with Rett syndrome. Journal of integrative neuroscience. 2022; 21(2): 59.
BACKGROUND: Rett syndrome is a rare genetic neurological syndrome that affects mostly females. The syndrome leads to severe impairments impacting all areas of the affected persons’ life, including speech, mobility, eating, and breathing impairments. The most distinct symptoms include stereotyped hand movements, ataxia, and atrophy of the lower limbs, and signs of autism. METHODS: According to the principle of convenience sampling, the quantitative research included five females diagnosed with Rett syndrome subject to their personalized goal oriented neurological physiotherapy. Changes in gross motor function were assessed by the Gross Motor Function Measure 88 and Rett syndrome Gross Motor Scale. RESULTS: It was found that the 12-month multifaceted neurological physiotherapy intervention had statistically significant improvements in both Gross Motor Function Measure 88 (p = 0.005) and Rett syndrome Gross Motor Scale (p = 0.012). Despite positive improvements, the absence of control group made it difficult for a comparative evaluation to determine what interventions had the best possible outcomes. CONCLUSIONS: The quantitative research demonstrates neuro-developmental treatment sessions, hippotherapy, hydrotherapy, physical therapy, a walking program, endurance exercises, active-assisted exercises, and coordination exercises, had a significant impact on improving gross motor function status. Current multifaceted intervention program leads to good improvement of gross motor skills above what can be expected from late motor deterioration.
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22. Kirst S, Diehm R, Bögl K, Wilde-Etzold S, Bach C, Noterdaeme M, Poustka L, Ziegler M, Dziobek I. Fostering socio-emotional competencies in children on the autism spectrum using a parent-assisted serious game: A multicenter randomized controlled trial. Behaviour research and therapy. 2022; 152: 104068.
OBJECTIVE: Serious games are a promising means of fostering socio-emotional skills in children on the autism spectrum (AS). However, empathy and related constructs have not yet been addressed comprehensively and together with emotion recognition, and there is a lack of randomized controlled trials (RCT) to investigate skill maintenance and the transfer to functional behavior. METHOD: The manualized, parent-assisted serious game Zirkus Empathico (ZE) was tested against an active control group, in a six-week multicenter RCT. Eighty-two children aged 5-10 years on the AS were assessed at baseline, post-treatment, and three-month follow-up. Empathy and emotion recognition skills were defined as the primary outcomes. The secondary outcomes included measures of emotional awareness, emotion regulation, autism social symptomatology (Social Responsiveness Scale), and subjective therapy goals. RESULTS: Training effects were observed after the intervention for empathy (d = 0.71) and emotion recognition (d = 0.50), but not at follow-up. Moderate effects on emotional awareness, emotion regulation, and autism social symptomatology were indicated by the short and mid-term assessments. Parents reported treatment goal attainment and positive training transfer. CONCLUSION: While a six-week training with ZE failed to induce lasting changes in empathy and emotion recognition, it may be effective for improving emotional awareness and emotion regulation, and mitigate general autism symptomatology. CLINICAL TRIAL REGISTRATION INFORMATION: Zirkus Empathico – Promoting socioemotional competencies in 5- to 10-year-old children with autism spectrum conditions using a computer-based training program; https://www.drks.de/; DRKS-ID: DRKS00009337; Universal Trial Number (UTN): U1111-1175-5451.
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23. Kuo AA. Promoting Lifespan Health and Well-Being Through the Autism Intervention Research Network. Pediatrics. 2022; 149(Suppl 4).
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24. Kuo AA, Hotez E, Rosenau KA, Gragnani C, Fernandes P, Haley M, Rudolph D, Croen LA, Massolo ML, Graham Holmes L, Shattuck P, Shea L, Wilson R, Martinez-Agosto JA, Brown HM, Dwyer PSR, Gassner DL, Kapp SK, Ne’eman A, Ryan JG, Waisman TC, Williams ZJ, DiBari JN, Foney DM, Ramos LR, Kogan MD. The Autism Intervention Research Network on Physical Health (AIR-P) Charter. Pediatrics. 2022; 149(Suppl 4).
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25. Kuo AA, Hotez E, Rosenau KA, Gragnani C, Fernandes P, Haley M, Rudolph D, Croen LA, Massolo ML, Holmes LG, Shattuck P, Shea L, Wilson R, Martinez-Agosto JA, Brown HM, Dwyer PSR, Gassner DL, Kapp SK, Ne’eman A, Ryan JG, Waisman TC, Williams ZJ, DiBari JN, Foney DM, Ramos LR, Kogan MD. The Autism Intervention Research Network on Physical Health (AIR-P) Research Agenda. Pediatrics. 2022; 149(Suppl 4).
OBJECTIVES: In the United States, autistic individuals experience disproportionate physical and mental health challenges relative to non-autistic individuals, including higher rates of co-occurring and chronic conditions and lower physical, social, and psychological health-related quality of life. The Autism Intervention Research Network on Physical Health (AIR-P) is an interdisciplinary, multicenter research network for scientific collaboration and infrastructure that aims to increase the life expectancy and quality of life for autistic individuals, with a focus on underserved or vulnerable populations. The current paper describes the development of the AIR-P Research Agenda. METHODS: Development of the research agenda involved an iterative and collaborative process between the AIR-P Advisory Board, Steering Committee, and Autistic Researcher Review Board. The methodology consisted of 3 phases: (1) ideation and design, (2) literature review and synthesis; and (3) network engagement. RESULTS: Six core research priorities related to the health of autistic individuals were identified: (1) primary care services and quality, (2) community-based lifestyle interventions, (3) health systems and services, (4) gender, sexuality, and reproductive health, (5) neurology, and (6) genetics. Specific topics within each of these priorities were identified. Four cross-cutting research priorities were also identified: (1) neurodiversity-oriented care, (2) facilitating developmental transitions, (3) methodologically rigorous intervention studies, and (4) addressing health disparities. CONCLUSIONS: The AIR-P Research Agenda represents an important step forward for enacting large-scale health-promotion efforts for autistic individuals across the lifespan. This agenda will catalyze autism research in historically underrepresented topic areas while adopting a neurodiversity-oriented approach to health-promotion.
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26. Kuo AA, Torrest A. Meeting the Primary Care Needs of Autistic Individuals. Pediatrics. 2022; 149(Suppl 4).
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27. Lyall K, Ning X, Aschner JL, Avalos LA, Bennett DH, Bilder DA, Bush NR, Carroll KN, Chu SH, Croen LA, Dabelea D, Daniels JL, Duarte C, Elliott AJ, Fallin MD, Ferrara A, Hertz-Picciotto I, Hipwell AE, Jensen ET, Johnson SL, Joseph RM, Karagas M, Kelly RS, Lester BM, Margolis A, McEvoy CT, Messinger D, Neiderhiser JM, O’Connor TG, Oken E, Sathyanarayana S, Schmidt RJ, Sheinkopf SJ, Talge NM, Turi KN, Wright RJ, Zhao Q, Newschaffer C, Volk HE, Ladd-Acosta C, Environmental Influences On Child Health Outcomes O. Cardiometabolic Pregnancy Complications in Association with Autism-Related Traits as Measured by the Social Responsiveness Scale in ECHO. American journal of epidemiology. 2022.
Prior work has examined associations between cardiometabolic pregnancy complications and autism spectrum disorder (ASD), but not how these complications may relate to social communication traits more broadly. We addressed this question within the Environmental influences on Child Health Outcomes (ECHO) program, with 6,778 participants from 40 cohorts conducted from 1998-2021 with information on ASD-related traits via the Social Responsiveness Scale (SRS). Four metabolic pregnancy complications were examined individually, and combined, in association with SRS scores, using crude and adjusted linear regression as well as quantile regression. We also examined associations stratified by ASD diagnosis, and potential mediation by preterm birth and low birth weight, and modification by child sex and enriched risk of ASD. Increases in ASD-related traits were associated with obesity (ß=4.64, 95% CI 3.27, 6.01) and gestational diabetes (ß=5.21, 95% CI 2.41, 8.02) specifically, but not with hypertension or preeclampsia. Results in children without ASD were similar to main analyses, but weaker among ASD cases. There was not strong evidence for mediation or modification. Results suggest that common cardiometabolic pregnancy complications may influence child ASD-related traits not only above a diagnostic threshold relevant to ASD, but also across the population.
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28. Morgan EH, Rodgers R, Tschida J. Addressing the Intersectionality of Race and Disability to Improve Autism Care. Pediatrics. 2022; 149(Suppl 4).
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29. Rast JE, Roux AM, Fernandes SJ, D’Silva V, Shea LL. Hospital Inpatient Stays for Autistic Youth and Youth With Other Disabilities. Pediatrics. 2022; 149(Suppl 4).
BACKGROUND: Addressing health care needs is complex in autistic youth for many reasons. Increased inpatient care that has been noted in this population, particularly for ambulatory care sensitive conditions (ACSCs), may be a marker of inadequate primary and outpatient care. METHODS: This study used data from hospital inpatient discharges from the National Inpatient Sample 2017. The prevalence, average length of stay, and the average cost per day of the 10 most common principal diagnoses for index stay were calculated for autistic youth and youth with mental, behavioral, and other neurodevelopmental disabilities (MBND), ages 0 to 17. RESULTS: Of every 1000 inpatient stays, 7.3 were for autistic youth and 65.2 for youth with MBND. The rate varied by US region and zip code-level household income. The most common diagnosis associated with stays in autistic youth was mood disorders, as in youth with MBND. Nearly all top 10 principal diagnoses for autistic youth were for ACSCs. The highest average cost per day for autistic youth was for physical injuries ($4320 per day), and the longest stays were for schizophrenia (14 days). CONCLUSIONS: High occurrence of ACSCs in autistic youth suggests that primary care may not adequately address health and mental health needs. Clinical complexity and autism characteristics may be impacting care received in the hospital. Additional considerations need to explore and examine care complexity, racial and ethnic disparities, and the large portion of Medicaid-covered youth. Strategies for the provision of care to these vulnerable populations are of great concern.
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30. Raymaker DM, Sharer M, Maslak J, Powers LE, McDonald KE, Kapp SK, Moura I, Wallington AF, Nicolaidis C. « [I] don’t wanna just be like a cog in the machine »: Narratives of autism and skilled employment. Autism : the international journal of research and practice. 2022: 13623613221080813.
Autistic people are less likely to be employed than the general population. Autistic people with skilled training (e.g. training for jobs in acting, plumbing, science, or social work) might be even less likely to get a good job in their field. Little is known about the experiences of autistic people in skilled employment or what employment success means to them. We interviewed 45 autistic people with skilled training in a wide range of fields, 11 job supervisors, and 8 topic experts. We asked them about their experiences, what they felt helped them to be successful at work, and what employment success means to them. Participants talked about the high stakes of disclosure, taking unconventional pathways to careers, disconnects with service and support systems, mental health challenges from trauma and burnout, the autistic advantages in the workplace, and complex dimensions of discrimination. Participants said success meant opportunities for growth, good work/life balance, financial independence, sense of community, and feeling valued, accepted, and like their work had meaning. Things that helped them be successful included flexible, accepting workplaces, supportive and respectful supervisors, and direct communication. What we learned suggests that an individualized, wholistic approach to autism employment intervention that considers both employers and employees and employee mental health could be useful. We also recommend more research into disclosure and destigmatizing disability at work.
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31. Rosenau KA, Hotez E. Promoting Interdisciplinary and Participatory Autism Research. Pediatrics. 2022; 149(Suppl 4).
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32. Roux AM, Rast JE, Shea LL. Family Perceptions of Health Care Access for Autistic Young Adults Receiving Disability Services. Pediatrics. 2022; 149(Suppl 4).
BACKGROUND: Autistic young adults (YAs) often live with family and present with complex health needs. Adults with developmental disabilities (DDs) who live with family are the least likely to receive preventive health care compared with residents of other settings. No published studies have examined intersectionality between age, race or ethnicity, household income, and health needs in health care access for autistic YA. This study explored health care access among autistic YAs receiving state DD services compared with other age and disability groups. METHODS: We analyzed data from the National Core Indicator’s Adult Family Survey of families of DD service users ages 18 and older who lived in the respondent’s home. We used bivariate analyses and multivariable logistic regression to examine family-reported access to health care providers when needed, the role of sociodemographics, and the complexity of health care needs in predicting consistent care. RESULTS: Approximately 70% of autistic YAs had consistent access to health care when needed, similar to autistic adults but at lower rates than those with other disabilities. Odds of consistent health care access were higher among autistic YAs who were Black or lived in a rural area and lower among those with co-occurring health conditions or who needed extensive personal care support. CONCLUSIONS: Nearly one-third of autistic YAs who lived with family and receive state DD services had difficulty consistently accessing needed health care. Improved surveillance of health care services in this population is needed in addition to innovations in Medicaid waivers, which fund DD services, to address health needs and support families in accessing care.
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33. Schott W, Tao S, Shea L. Emergency Visits for Autistic Children and Children With ADHD. Pediatrics. 2022; 149(Suppl 4).
BACKGROUND AND OBJECTIVES: Autistic children and children with attention-deficit/hyperactivity disorder (ADHD) may have more frequent visits to the emergency department (ED). We aim to identify the primary reasons for ED visits among autistic children and children with ADHD, compared to a random sample of visits. METHODS: Using 2008 to 2017 Nationwide Emergency Department Sample data, we assessed the most frequent primary diagnoses for ED visits among children (ages 3-12 and 13-18 years, separately) (1) with an autism diagnosis, (2) with ADHD, and (3) a random sample (1 000 000 visits). We regressed primary reasons for visits on autism or ADHD diagnosis, controlling for individual characteristics, to assess the odds of presenting for these reasons. RESULTS: Although the 10 most frequent diagnoses among the random sample were physical health conditions, autistic children and children with ADHD often presented for psychiatric conditions. Older children with autism and with ADHD more frequently presented for mood disorders (10%-15% of visits; odds ratios [ORs] = 5.2-8.5) and intentional self-harm (ORs = 3.2-5.0). Younger children with ADHD more commonly presented with mood disorders (6.6% of visits; OR = 18.3) and younger autistic children more often presented with attention-deficit, conduct, and disruptive behavior disorders (9.7% of visits; OR = 9.7). CONCLUSIONS: Autistic children and children with ADHD have higher odds of presenting to the ED for psychiatric conditions than a random sample, including for self-harm. Clinicians should treat these populations sensitively, recognize and assess the risk for self-harm, and facilitate continuing psychiatric care.
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34. Shafqat I, Rosenau KA, Martinez-Agosto JA. The Role of Genetic Testing Among Autistic Individuals. Pediatrics. 2022; 149(Suppl 4).
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35. Shattuck P, Shea L. Improving Care and Service Delivery for Autistic Youths Transitioning to Adulthood. Pediatrics. 2022; 149(Suppl 4).
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36. Sibeoni J, Massoutier L, Valette M, Manolios E, Verneuil L, Speranza M, Revah-Levy A. The sensory experiences of autistic people: A metasynthesis. Autism : the international journal of research and practice. 2022: 13623613221081188.
Sensory atypicalities are very common among autistic people and are integrated in several theories and explanatory models of autism. Qualitative studies have explored these singular sensory experiences from the perspectives of autistic people themselves. This article gathers all these qualitative studies and provides original findings regarding the everyday sensory experience of autistic people, that is, around four dimensions – physical, emotional, relational and social – experienced holistically, as inseparable, and not hierarchically or in terms of cause and effect. Adopting this holistic view could improve the adaptation of the sensory environment in health care facilities and the training of professionals around this specific issue.
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37. Waisman TC, Alba LA, Green SA. Barriers to Inclusive Learning for Autistic Individuals. Pediatrics. 2022; 149(Suppl 4).
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38. Wilson RB. Improving Awareness, Identification, and Treatment of Motor Impairments in Autism. Pediatrics. 2022; 149(Suppl 4).
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39. Yu Y, Huang J, Chen X, Fu J, Wang X, Pu L, Gu C, Cai C. Efficacy and Safety of Diet Therapies in Children With Autism Spectrum Disorder: A Systematic Literature Review and Meta-Analysis. Frontiers in neurology. 2022; 13: 844117.
OBJECTIVE: Autism Spectrum Disorder is a neurodevelopmental disorder, with a rapid increase in recognition over the past decade. Interest in alternative therapies is growing annually, such as dietary therapies including gluten-free and/or casein-free diet, and the ketogenic diet. However, there is no consensus on the efficacy and safety of dietary therapy in children with ASD up to now. This study aimed to assess the efficacy and safety of these diet interventions for children with ASD based on a meta-analysis of global data. METHODS: Seven databases (Cochrane Library, PubMed, EMBASE, Web of Science, VIP, CNKI, and Wanfang) were searched according to the established inclusion criteria, from the inception of the databases to August 18, 2021. The Cochrane Bias risk assessment tool was intended to assess the quality of the included studies. Review Manager 5.4 software was used as an efficacy analysis tool of the included studies, taking the core autistic symptoms and scales of ASD as therapeutic efficacy evaluations. RESULTS: In total, 7 RCTs with 338 participants were finally obtained. All studies assessed the association between core autistic symptoms and therapeutic diet, showing a statistically significant effect (standard mean difference (SMD) of -0.51, 95% confidence interval (Cl): -0.81 to -0.21), in which two studies which followed the GFD diet reported significant reductions in social behaviors (SMD of-0.41, 95% Cl: -0.75 to -0.06), showing no correlation with the length of the interventions (P < 0.05). Two studies were performed in KD diet suggested a significant effect in core symptoms (SMD of -0.67, 95% Cl: -1.04 to -0.31). No statistically significant changes were observed in the GFCF diet, GFD diet, cognition, communication, and stereotypical behaviors subgroups (all P > 0.05). CONCLUSION: The results of a meta-analysis suggest that diet therapies can significantly ameliorate core symptoms of ASD, and GFD diets are conducive to improving social behaviors. Although the results suggest the effectiveness of dietary therapy for ASD, limited by the small sample size of RCTs, more well-designed, and high-quality clinical trials are needed to validate the above conclusions. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42021277565.
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40. Zhang J, Sun Q, Liu X, Yang F. Ultra-Light Clay Intervention Improves Responsiveness and Initiates the Communication of Children With ASD. Frontiers in psychology. 2022; 13: 804488.
The barriers to responsiveness and the initiation of communication are the two key problems encountered by children with autism spectrum disorders (ASD). Prior interventions based on behavioral reinforcement have had an obvious effect on responsive communication but a weak effect on the initiation of communication. Based on psychological development theory, we designed ultra-light clay interventions involving hands-on production or multi-interaction around key concepts and themes, teaching children about basic concepts, relationships, and logic, making abstract knowledge concrete and experience. Two studies (Study 1: N = 3, one-to-one intervention; Study 2: N = 8, one-to-two intervention) showed that ultra-light clay intervention improved both the initiation of and response to communication among children with ASD, but that such improvements show a peer-generalization effect in initiation communication, not in responsive communication. These findings provide a set of ultra-light clay interventions for communication in children with ASD and suggest a relationship between endogenous interventions and the initiation of communication.
