Pubmed du 02/05/23

Pubmed du jour

1. Alon N, Wheaton MG, Schlachte B, Elbogen R, Lin K, Strandberg J. Parents’ long-term experiences in a recreational dance program for their children with autism spectrum disorder. Heliyon. 2023; 9(4): e15496.

BACKGROUND AND AIMS: Motor impairments are associated with Autism Spectrum Disorder (ASD); yet few children receive appropriate therapy. Dance interventions are known to have diverse benefits, but research is lacking in how dance can benefit those with ASD. Ballet for all Kids is a novel program that has taught recreational dance classes to those with ASD for over a decade. We aimed to analyze families’ experiences in the program over many years, specifically examining why they continue to participate. METHODS AND PROCEDURE: Semi-structured interviews were conducted with 20 parents and/or legal guardians of long-term participants of Ballet for All Kids. Inductive thematic analysis was conducted to elucidate their experience in the program. OUTCOMES AND RESULTS: In examining the program’s retention factors, thematic analysis identified five themes: (1) authentic ballet training, (2) person centered program, (3) sensory integration and self-regulation, (4) skill development, and (5) interpersonal relationships. CONCLUSIONS AND IMPLICATIONS: Parents’ reports add to the literature that dance can benefit participants psychologically, physically, and socially. High retention rates demonstrate the need and desire for a recreational dance program. The authenticity and individualized support of Ballet for All Kids was emphasized by parents and should inform the direction of similar programs.

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2. Araujo AGR, da Silva MA, Bandeira PFR, Gillespie-Lynch K, Zanon RB. Stigma and knowledge about autism in Brazil: A psychometric and intervention study. Autism : the international journal of research and practice. 2023: 13623613231168917.

To promote the full inclusion of autistic people, we must change the knowledge and attitudes of non-autistic individuals. Unfortunately, access to autism information and support remains limited in Brazil, and stigma is also common. Brazilian researchers reached out to a researcher in the United States to co-develop Brazilian surveys to measure autism stigma and knowledge. Together, they made Brazilian versions of stigma and knowledge surveys which autistic people in the United States had helped make. They also adapted an online autism training used in other countries with help from three Brazilian autistic people and the mother of an autistic child. They used the new measures to see if the autism training improved autism stigma and knowledge among Brazilians. The surveys, called EARPA and ECAT in Brazil, were translated into Portuguese in a previous study. In the first study in this article, 532 Brazilians completed the stigma measure and 510 completed the knowledge measure. The researchers used exploratory graph analysis, which uses the connections between items in a survey to understand which items belong together. Seventy-nine Brazilians participated in the training. They were mostly white, female university students. The EGA showed that the stigma survey measured one big idea while the knowledge survey measured four ideas: diagnosis/cause; socio-communicative development; stimming and special interests; and autism in adulthood. Both scales are promising and may be helpful in future Brazilian and cross-cultural studies about autism. Participants reported more knowledge and less stigma after the autism training, which has been found in other countries too.

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3. Berkovits L, Blacher J, Eisenhower A, Daniel S. The Emotion Regulation Checklist with Young Autistic Children: Data Set for Comparative Use in Intervention Studies. Journal of autism and developmental disorders. 2023.

PURPOSE: Comparative data of autism-sensitive standardized measures of emotion regulation and lability, describing percentage change over time for populations of young autistic children, are currently publicly unavailable. We propose publication of such data as a support for future therapeutic intervention studies. METHODS: We generate and present data of the Emotion Regulation Checklist (and subscales) for a comparative array of percentage change over time (10 months) for autistic children not receiving psychological or behavioral therapies (N = 98, ages 4-8). RESULTS: Comparative data summaries are presented here, and the full data set is presented as Online Resource 1. CONCLUSION: We propose that this autism-sensitive measure, now with autism-specific comparative data to provide a comparison group in studies of therapeutic intervention, is well placed to assess co-occurring affective, regulatory, and behavioral factors of personal development for autistic children.

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4. Bonagura A, Jeglic E. Criminal Sexual Behavior of Individuals With Autism Spectrum Disorder and Recommendations for Correctional Professionals. Journal of correctional health care : the official journal of the National Commission on Correctional Health Care. 2023.

Continued uncertainty on overrepresentation of autism spectrum disorder (ASD) in the criminal justice system (CJS), although important, has shifted focus away from other questions of CJS treatment of neurodiverse individuals and left little guidance on best practice for people with ASD. For ASD individuals involved in sex offenses, there remains even less guidance. Because aspects of ASD symptomatology can highly influence sexual behaviors in ways that differ from neurotypical sex offending, it is imperative that clinicians and correctional professionals know more about this potential influence of ASD on sex offending behaviors. This knowledge should then inform efforts to enact more effective and equitable policies when interacting with the ASD population. This article reviews the connection between ASD symptoms and sexual behaviors as well as the lack of ASD-oriented sex education that could result in sex offending charges. A review of literature examining sex offending risk and its relation to ASD follows. Recommendations for more equitable treatment are discussed for different aspects of the correctional system, including forensic assessment, treatment efforts, and correctional staff interactions.

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5. Bullock JL, Gradick K, Proctor C, Rogers MA, Hobson WL. Interprofessional Collaboration Improves Quality of Life of a Young Adult With Rett Syndrome. Cureus. 2023; 15(3): e36921.

Rett syndrome (RTT) is a genetic neurodevelopmental disease characterized by early normal development followed by regression in motor and language skills. Patients with RTT often exhibit seizure disorders, growth failure, heart and lung disorders, bruxism, and dental caries. We report on a female patient in her 20s with Rett syndrome who presented to her primary care clinic with increasing agitation and pain. This case reports describes a collaborative, interprofessional approach between medical and dental providers who work in an integrated outpatient setting. It demonstrates that interprofessional collaboration, goals of care discussions, and attention to social drivers of health can improve quality of life for a medically and socially complex patient.

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6. Cassidy S, McLaughlin E, McGranaghan R, Pelton M, O’Connor R, Rodgers J. Is camouflaging autistic traits associated with defeat, entrapment, and lifetime suicidal thoughts? Expanding the Integrated Motivational Volitional Model of Suicide. Suicide & life-threatening behavior. 2023.

INTRODUCTION: The current study explored whether camouflaging autistic traits is associated with defeat and entrapment and lifetime suicidal thoughts, as predicted by the Integrated Volitional Model of Suicide (IMV model). METHODS: 180 UK undergraduate students (76.7% female 18-67 years) completed a cross-sectional online survey from February 5 to March 23, 2020, including self-report measures of defeat and entrapment (SDES), autistic traits (AQ-10), depression (PHQ-9), anxiety (GAD-7), camouflaging autistic traits (CAT-Q), and lifetime suicidal thoughts and behaviors (SBQ-R item 1). RESULTS: After controlling for age, gender, current depression, and anxiety symptoms, autistic traits accounted for significantly more of the variance in defeat and entrapment (1.1%), and camouflaging accounted for a further 3.2% of the variance. The association between autistic traits and lifetime suicidality was significantly mediated by camouflaging, defeat, and entrapment. After controlling for age, gender, current depression, and anxiety symptoms, defeat and entrapment (but not camouflaging) accounted for significantly more variance in lifetime suicidal thoughts. The interaction between camouflaging, defeat and entrapment predicted significantly less variance in lifetime suicidal thoughts than either variable alone. CONCLUSION: Results suggest that camouflaging autistic traits is a transdiagnostic risk factor for lifetime suicidality, relevant to the defeat and entrapment constructs of the IMV model.

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7. Chalkiadaki K, Hooshmandi M, Lach G, Statoulla E, Simbriger K, Amorim IS, Kouloulia S, Zafeiri M, Pothos P, Bonneil É, Gantois I, Popic J, Kim SH, Wong C, Cao R, Komiyama NH, Atlasi Y, Jafarnejad SM, Khoutorsky A, Gkogkas CG. Mnk1/2 kinases regulate memory and autism-related behaviours via Syngap1. Brain : a journal of neurology. 2023; 146(5): 2175-90.

MAPK interacting protein kinases 1 and 2 (Mnk1/2) regulate a plethora of functions, presumably via phosphorylation of their best characterized substrate, eukaryotic translation initiation factor 4E (eIF4E) on Ser209. Here, we show that, whereas deletion of Mnk1/2 (Mnk double knockout) impairs synaptic plasticity and memory in mice, ablation of phospho-eIF4E (Ser209) does not affect these processes, suggesting that Mnk1/2 possess additional downstream effectors in the brain. Translational profiling revealed only a small overlap between the Mnk1/2- and phospho-eIF4E(Ser209)-regulated translatome. We identified the synaptic Ras GTPase activating protein 1 (Syngap1), encoded by a syndromic autism gene, as a downstream target of Mnk1 because Syngap1 immunoprecipitated with Mnk1 and showed reduced phosphorylation (S788) in Mnk double knockout mice. Knockdown of Syngap1 reversed memory deficits in Mnk double knockout mice and pharmacological inhibition of Mnks rescued autism-related phenotypes in Syngap1+/- mice. Thus, Syngap1 is a downstream effector of Mnk1, and the Mnks-Syngap1 axis regulates memory formation and autism-related behaviours.

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8. Darling Rasmussen P. ‘I was never broken-I just don’t fit in this world.’ A case report series of misdiagnosed women with higher functioning ASD. Nordic journal of psychiatry. 2023; 77(4): 352-9.

BACKGROUND: Differentiating between autism spectrum disorders (ASD) and borderline personality disorder (BPD) is hampered by diagnostic difficulties as there seems to be a significant overlap in symptoms. METHODS: A case series of six women with ASD and a previous diagnosis of BPD is presented. RESULTS: In retrospect, the women did not present with significant symptoms until they had developed comorbidity, which clinicians in turn misinterpreted. The missed diagnosis or misdiagnosis had significant implications for their prognosis and current level of functioning. This suggests in line with previous research, that women with higher functioning ASD are more at risk of being overlooked. CONCLUSION: It is suggested in the literature and supported by this case series that ASD should be ruled out by obtaining a thorough developmental history by an experienced clinician before considering a BPD diagnosis.

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9. Dean M, Chang YC, Shih W, Orlich F, Kasari C. Social engagement and loneliness in school-age autistic girls and boys. Women’s health (London, England). 2023; 19: 17455057231170973.

OBJECTIVES: This study examines the relationship between social engagement and loneliness in female and male autistic children and adolescents in school-based social settings. Secondary aims sought to explore the emergence of loneliness across different age groups and differences in social engagement and loneliness between genders. METHODS: This study conducted an analysis of previously collected data from two multi-site randomized control trials. This study included 58 autistic students (29 females, 29 males) between the ages 6 through 18 years. Female and male participants were matched on age and intelligence quotient. Concurrent mixed methods were used to examine participants’ social engagement and loneliness. RESULTS: Findings revealed a significant relationship between joint engagement and loneliness, such that autistic students reported more loneliness when they were mutually engaged with social groups than when they were isolated or alone. Positive correlations between joint engage and loneliness were identified in elementary-age girls and secondary-age boys, suggesting that being mutually engaged with peers leads to increased loneliness. Negative correlations between parallel and loneliness identified in secondary-age boys suggested that boys in close proximity to peers felt less lonely than boys who were mutually engaged with peers. Qualitative analysis of social behaviors indicated that elementary girls and secondary boys were more likely to be mutually engaged or in close proximity to activities, but they had difficulty sustaining this engagement throughout the entire social period. Secondary girls and elementary boys, on the other hand, were more likely to be solitary and less likely to engage with peer groups. CONCLUSION: Study findings highlight the relationship between social engagement and loneliness in school-based autistic populations, and that more engagement itself can lead to more loneliness for younger girls and older boys. The influence of age and gender on engagement and loneliness highlights a need to tailor social interventions to leverage existing social strengths.

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10. Doherty M, McCowan S, Shaw SC. Autistic SPACE: a novel framework for meeting the needs of autistic people in healthcare settings. British journal of hospital medicine (London, England : 2005). 2023; 84(4): 1-9.

Autistic people experience significant health disparities and reduced life expectancy. Barriers to accessing healthcare are associated with adverse health outcomes. Autism training and healthcare professionals’ knowledge about autism is variable, and heterogeneity among autistic people leads to additional educational and clinical complexities. Autism remains nebulous for many practitioners, who are unclear about communication differences, access needs or life experiences common to autistic people. Healthcare environments can be challenging for all patients but autistic people may require specific accommodations to allow equitable access. The authors have developed a simple framework which may facilitate equitable clinical services at all points of access and care, using the acronym ‘SPACE’. This encompasses five core autistic needs: Sensory needs, Predictability, Acceptance, Communication and Empathy. Three additional domains are represented by physical space, processing space and emotional space. This simple yet memorable framework encompasses commonalities shared by autistic people.

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11. Guo X, Cao Y, Liu J, Zhang X, Zhai G, Chen H, Gao L. Dysregulated dynamic time-varying triple-network segregation in children with autism spectrum disorder. Cerebral cortex (New York, NY : 1991). 2023; 33(9): 5717-26.

One of the remarkable characteristics of autism spectrum disorder (ASD) is the dysregulation of functional connectivity of the triple-network, which includes the salience network (SN), default mode network (DMN), and central executive network (CEN). However, there is little known about the segregation of the triple-network dynamics in ASD. This study used resting-state functional magnetic resonance imaging data including 105 ASD and 102 demographically-matched typical developing control (TC) children. We compared the dynamic time-varying triple-network segregation and triple-network functional connectivity states between ASD and TC groups, and examined the relationship between dynamic triple-network segregation alterations and clinical symptoms of ASD. The average dynamic network segregation value of the DMN with SN and the DMN with CEN in ASD was lower but the coefficient of variation (CV) of dynamic network segregation of the DMN with CEN was higher in ASD. Furthermore, partially reduced triple-network segregation associated with the DMN was found in connectivity states analysis of ASD. These abnormal average values and CV of dynamic network segregation predicted social communication deficits and restricted and repetitive behaviors in ASD. Our findings indicate abnormal dynamic time-varying triple-network segregation of ASD and highlight the crucial role of the triple-network in the neural mechanisms underlying ASD.

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12. Kirby L, Payne KL. Knowledge of autism gained by learning from people through a local UK Autism Champion Network: A health and social care professional perspective. Autism : the international journal of research and practice. 2023: 13623613231167902.

The Autism Act 10 Years On found few autistic adults thought health and social care professionals had a good understanding of autism. Autism training has been made law in the United Kingdom for health and social care staff to tackle health inequality. The county wide Autism Champion Network evaluated here is an equal partnership of interested staff across sectors (Autism Champions) and autistic experts by virtue of lived experience (Autism Advisory Panel). With knowledge flowing both ways, the Autism Champions take learning back to teams to support continuous development of services to meet autistic need. Seven health and social sector professionals from the Network participated in semi-structured interviews on sharing knowledge of autism gained with their teams. All participants provide care and support for autistic people, some working in specialist positions. Results showed that developing new relationships with people outside their own team to signpost to, answer questions and share resources, and informal learning from autistic people, was more valued and used in practice than information gained from presentations. These results have implications in developing learning for those who need above a basic knowledge of autism and may be useful for others considering setting up an Autism Champion Network.

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13. Low HM, Zainal MS, Pang JC, Ang Y, de Vries M. Self-reported autistic traits and psychosocial outcomes among university students in Malaysia. Autism : the international journal of research and practice. 2023: 13623613231167501.

Most research on autism spectrum conditions is done on young children and not as much on young adults with autism spectrum conditions. Because of this, not much is known about how common autism spectrum conditions are in young adults and how they affect their mental and social health, especially in Southeast Asia. Based on self-reports, 2.8% of the 2732 university students we looked at in Malaysia might have been diagnosed or thought to have an autism spectrum condition. Students who said they had or thought they had autism spectrum conditions had lower self-efficacy, more stress and a lower quality of life than students who said they did not have autism spectrum conditions. The results showed that university students with autism spectrum condition are more likely to have bad psychological and social outcomes than their peers without autism spectrum condition. Also, the link between autistic traits and psychosocial outcomes could depend on the culture.

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14. Mazza M, Le Donne I, Vagnetti R, Attanasio M, Greco MP, Pino MC, Valenti M. EXPRESS: Normative Values and Diagnostic Optimisation of Three Social Cognition Measures For Autism And Schizophrenia Diagnosis in a healthy adolescent and adult sample. Quarterly journal of experimental psychology (2006). 2023: 17470218231175613.

Awareness of the importance of assessing social cognition skills in conditions showing atypical social behaviours has increased over the years. However, the evaluation of the psychometric properties of the measures and the availability of normative values for the clinical context are still limited. This study aims to revise, provide normative values and evaluate the clinical validity of the Italian version of three social cognition measures: Advanced Theory of Mind (A-ToM) task, the Emotion Attribution Task (EAT) and the Social Situation Task (SST). Measures were administered to 580 adolescents and adult healthy controls (age range 14-50). We performed differential item functioning and Rasch analysis to revise each task, so normative data of the revised measures were calculated. Moreover, the revised measures were administered to 38 individuals with autism spectrum disorder (ASD) and 35 individuals with schizophrenia spectrum disorders (SSD): ASD and SSD were matched by age, gender and IQ with a control sample to evaluate clinical validity. ROC analysis showed that the SST is the best measure differentiating between healthy and clinical groups, compared to the A-ToM (AUCASD = 0.70; AUCSSD = 0.65) and EAT (AUCASD= 0.67; AUCSSD = 0.50), which showed poorer performance. For SSD diagnosis, two SST subscales (Violation and Gravity score) indicated the best accuracy (AUCs of 0.88 and 0.84, respectively); for the ASD diagnosis we propose a combined score between the SST subscale and A-ToM (AUC = 0.86). The results suggest that the proposed measures can be used to support the diagnostic process and clinical practice.

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15. Osredkar J, Kumer K, Fabjan T, Jekovec Vrhovšek M, Maček J, Zupan M, Bobrowska-Korczak B, Gątarek P, Rosiak A, Giebułtowicz J, Bjørklund G, Chirumbolo S, Kałużna-Czaplińska J. Determination of modified nucleosides in the urine of children with autism spectrum disorder. Acta biochimica Polonica. 2023.

Metabolic disorders and nutritional deficiencies in ASD children may be identified by the determination of urinary-modified compounds. In this study, levels of selected seven modified compounds: O-methylguanosine, 7-methylguanosine, 1-methyladenosine, 1-methylguanine, 7-methylguanine, 3-methyladenine, and 8-hydroxy-2`-deoxyguanosine in the group of 143 ASD children and 68 neurotypical controls were analyzed. An ancillary aim was to verify if the reported levels differed depending on the pathogenetic scoring of ASD (mild deficit, moderate deficit, severe deficit). Elevated O-methylguanosine and 7-methylguanosine levels and significantly lower levels of 3-methyladenine, 1-methylguanine, 1-methyladenosine, 7-methylguanine, and 8-hydroxy-‘2’-deoxyguanosine were observed in ASD children compared to controls. O-methylguanosine levels were elevated in the mild and moderate groups, while the levels of 1-methylguanine, 1-methyladenosine, 7-methylguanine, and 8-hydroxy-‘2’-deoxyguanosine in the same groups were lower than in neurotypical controls. The reported evidence shows that modified nucleosides/bases can play a potential role in the pathophysiology of ASD and that each nucleoside/base shows a unique pattern depending on the degree of the deficit.

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16. Rhodes SM, Eaton CB, Oldridge J, Rodgers J, Chan S, Skouta E, McKechanie AG, Mackie L, Stewart TM. Lived experiences of depression in autistic children and adolescents: A qualitative study on child and parent perspectives. Research in developmental disabilities. 2023; 138: 104516.

BACKGROUND: Depression is highly prevalent in autistic children and adolescents. Despite this, little is known about the nature of the autistic child’s subjective experience of depression and the impact of depression on their lives. METHODS: We therefore conducted a qualitative study using thematic analysis with 7 autistic children and adolescents and their parents to identify common themes and individual differences. All children had previously experienced at least one depressive episode. RESULTS: Six main themes were identified: (1) Autism related experiences; (2) Difficulties with peer relationships; (3) Co-occurring relationships between anxiety and depression; (4) Impactful pessimism and anhedonia; (5) Impactful difficulties with focus and concentration and (6) Feelings of irritability, including aggressive behaviours. Parent’s accounts of their children’s experience of depression mirrored the child’s perspective. Novel findings included reports of depression related restriction of diet variety and masking of mental health difficulties. Children and parents linked being autistic and developing depression, referring to the difficulties of being autistic in a complex, neurotypical world. CONCLUSIONS: These results highlight key challenges that autistic children and their families experience, calling for increased awareness of the impact of depression on autistic young people.

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17. Shahane V, Kilyk A, Srinivasan SM. Effects of physical activity and exercise-based interventions in young adults with autism spectrum disorder: A systematic review. Autism : the international journal of research and practice. 2023: 13623613231169058.

Young adults with autism spectrum disorder over 18 years of age are an underserved population, and there is presently limited evidence examining the effects of physical activity programs in this population. Our review synthesizes the evidence to date from studies that have assessed the effects of physical activity/exercise programs in young adults with autism spectrum disorder between 19 and 30 years. We reviewed 22 studies that included a total of 763 young adults with autism spectrum disorder. There is the strongest evidence for improvements in physical fitness, followed by motor skills, psychological function, and quality of life following physical activity interventions in young adults with autism spectrum disorder. Specifically, aerobic and resistance training as well as programs focused on movement skill and sport-specific training lead to improved physical fitness and movement performance. Holistic interventions focusing on physical activity, dietary changes, and lifestyle modifications lead to improvements in body composition and quality of life of young adults with autism spectrum disorder. There is presently limited evidence to support the use of exercise/activity programs to improve physical activity levels and core autism symptoms in young adults with autism spectrum disorder. Based on our review results, we also provide practical recommendations for clinicians working with young adults with autism spectrum disorder.

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18. Wallace-Watkin C, Sigafoos J, Woods L, Waddington H. Parent reported barriers and facilitators to support services for autistic children in Aotearoa New Zealand. Autism : the international journal of research and practice. 2023: 13623613231168240.

Parents might have problems in getting support services for their autistic child due to certain barriers. However, there might also be things that can ease or facilitate parents’ access to support services. In this study, New Zealand parents were asked about their experiences in getting support services for their autistic child. We also looked at differences in reported barriers and facilitators based on several demographic factors with a focus on family level of financial resourcing. A total of 173 parents completed a survey. The results suggested that parents experienced several barriers, particularly related to service pathways. Facilitators were also experienced, predominantly related to providers. Financial resourcing predicted the number of parent-reported barriers. Both lower level of family financial resourcing and having a non-binary child predicted parents’ rating of the extent of barriers. Child age and level of speech were predictors for reports of experiencing a higher number of facilitators, with parents of younger children or of non-speaking autistic children reporting a greater number of facilitators. We discuss how these results may be useful to support service delivery and identify areas for future research.

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19. Watanabe T, Akechi T. The mediating role of psychological flexibility in the association of autistic-like traits with burnout and depression in medical students during clinical clerkships in Japan: a university-based cross-sectional study. BMC psychiatry. 2023; 23(1): 302.

BACKGROUND: Burnout and depression among medical students is linked to serious problems that require appropriate solutions. Subthreshold autism traits or autistic-like traits (ALTs) may be possible factors associated with burnout and depression. The effectiveness of acceptance and commitment therapy (ACT) for burnout and depression has been widely reported. The treatment aims to improve psychological flexibility, a concept indicating engagement in personal value-based behaviors without avoiding uncomfortable private experiences. This study examined whether ALTs were associated with burnout or depression among medical students during clinical clerkships in Japan, and then investigated what psychological flexibility processes might mediate these associations. METHODS: A cross-sectional survey was administered to 284 medical students at Nagoya City University School of Medical Sciences who had been in clinical clerkships for 10 months or longer. Linear multiple regressions were performed with each burnout factor or depression as the outcome variable using validated tools measuring burnout (Maslach Burnout Inventory), anxiety and depression (Hospital Anxiety and Depression Scale), ALT (Autism-Spectrum Quotient Japanese version-21), and psychological flexibility processes (Cognitive Fusion Questionnaire-7 and Valuing Questionnaire). Additionally, a mediation analysis was conducted using structural equation modeling. RESULTS: A linear multiple regression analysis that controlled for age and gender found that ALTs were significantly associated with lower personal accomplishment, a factor of burnout, and depression. Lower personal accomplishment was also associated with males and lower progress toward values of the psychological flexibility process. Depression was also associated with males and higher cognitive fusion, lower progress towards values, and higher obstruction to values of the psychological flexibility process. Surprisingly, emotional exhaustion and depersonalization were not significantly associated with ALTs. The mediation analysis revealed that the relationship between ALTs and personal accomplishment was partially mediated by a process of progress toward values, while the relationship between ALTs and depression was partially mediated by both processes of progress toward values and cognitive fusion. CONCLUSIONS: ALTs were significantly associated with lower personal accomplishment of burnout and depression among medical students in clinical clerkships. Consideration should be given to the psychological flexibility processes that focus on interventions targeting psychological flexibility for medical students with ALTs to reduce burnout and depression.

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20. Wei X, Zhang S, Zhang J, Yu J. Mathematics performance, response time, and enjoyment of eighth-grade autistic students and their general education peers. Autism : the international journal of research and practice. 2023: 13623613231168241.

For autistic students receiving special education services, little is known about their relative strengths, weaknesses, and enjoyment across different math content areas; their overall math interest and persistence are also not well-studied. Using the 2017 eighth-grade National Assessment of Education Progress data, this study finds, relative to general education peers with the same math proficiency level, autistic students scored higher and exhibited faster speed in solving visuospatial problems (e.g. identifying figures), but scored lower on math word problems with complex language or social context. Autistic students reported a higher level of enjoyment in solving math problems related to finding areas of shapes or figures but a lower level of persistence than their non-autistic, general education peers. Our work points out the need to help autistic students overcome their weaknesses in word problems and develop their mathematical persistence.

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