1. Chen Q, Wang X, Cao MQ, Chen JJ, Liu SY, Zeng JJ, Jing J. [Visual fixation patterns during basic facial emotion recognition and its correlation with social impairment among children with high-functioning autism spectrum disorder]. Zhonghua er ke za zhi = Chinese journal of pediatrics. 2021; 59(6): 484-8.

Objective: To explore the visual fixation patterns during facial emotion recognition and the association between fixation duration percentage (FDP) of eye region with social impairment among high-functioning autism spectrum disorders (HFASD). Methods: Children were recruited from the Child and Adolescent Behavior Research Center of Sun Yat-sen University, Guangzhou, between July and December 2019 for case control study. A total of 42 children with HFASD and 23 age-and gender-matched typical development (TD) children were enrolled. Based on their performance during the facial emotion recognition task, HFASD children were further divided into ASD-1 group (correctly recognized both happy and fear emotions) and ASD-2 group (recognized happy emotions only). During the free viewing task, an infrared eye tracker was used to record the gazing data of children in the three groups. The social responsiveness scales (SRS) was utilized to evaluate HFASD children’s social impairment, with the cutoff score of 75 to differentiate those from mild and severe social impairment. The differences of FDP among the three groups were analyzed by the Analysis of Variance (ANOVA) model. Mixed linear regression model was conducted to evaluate the associations between social impairment and FDP of eye region among HFASD children. Results: The final sample consists of 25 ASD-1 (20 males, aged (7.9±1.0) years), 17 ASD-2(14 males, aged (7.2±1.2) years), and 23 TD (12 males, aged (7.7±1.3) years) children. There were no significant differences in age and gender among three groups (F=2.05, χ²=10.08, P=0.14 and 0.07, respectively). For the happy emotion, there are significant differences in eye FDP among the three groups (TD: 0.37±0.20, ASD-1: 0.35±0.20, ASD-2: 0.47±0.24, F=3.97, P=0.02). Mixed linear regression model revealed that, adjusting for emotion, gender, age and intelligence quotient, ASD children’s eye FDP negatively associates with social impairment (OR=0.15, 95%CI: 0.06-0.35, P<0.01). Conclusions: Longer FDP is associated with milder social impairment among HFASD children. HFASD children with facial emotion recognition difficulties require longer fixation to recognize happy emotions.

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2. De Toro V, Aedo K, Urrejola P. [Avoidant/Restrictive Food Intake Disorder (ARFID): What the pediatrician should know]. Andes pediatrica : revista Chilena de pediatria. 2021; 92(2): 298-307.

Feeding problems during childhood have been described over time by various authors. In 2013, Avoi dant/Restrictive Food Intake Disorder (ARFID) was included in the Diagnostic and Statistical Ma nual of Mental Disorders, 5th Edition (DSM-5), as a new diagnosis within the Feeding and Eating di sorders, to describe a group of patients with avoidant or restrictive eating behaviors unrelated to body image disorder or weight loss desire. ARFID may appear as significant weight loss and/or nutritional deficiency and/or a marked interference in psychosocial functioning. There are three forms of pre sentation, which can co-occur or occur independently. The first one includes children with sensory aversions (selective), who reject certain foods due to their taste, texture, smell, or shape; the second one includes those children with poor appetite or limited intake (limited intake); and the third one includes those children who reject certain foods or stop eating as a result of a traumatic event (aversi- ve). Due to the recent incorporation of ARFID into the DSM-5, there is a lack of information regar ding its treatment. The purpose of this review is to clarify diagnostic criteria and to describe targeted management and treatment interventions with a multidisciplinary approach, without deepening on the treatment of organic medical causes.

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3. Doherty DP, Coffey K, Weissman L, Dwyer PA. Keys to Success: A Professional Development Program to Support Care of Patients With Autism Spectrum Disorder. Journal for nurses in professional development. 2021.

Patients with autism spectrum disorder present with an extensive range of communication and social skills that require healthcare workers to have a comprehensive understanding of best practices for providing holistic care. This article presents the planning, curriculum development, implementation, and evaluation of a professional development program aimed at providing interprofessional staff with strategies and resources to use when caring for patients with autism spectrum disorder.

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4. Ganesh K, Umapathy S, Thanaraj Krishnan P. Deep learning techniques for automated detection of autism spectrum disorder based on thermal imaging. Proceedings of the Institution of Mechanical Engineers Part H, Journal of engineering in medicine. 2021; 235(10): 1113-27.

Children with autism spectrum disorder have impairments in emotional processing which leads to the inability in recognizing facial expressions. Since emotion is a vital criterion for having fine socialisation, it is incredibly important for the autistic children to recognise emotions. In our study, we have chosen the facial skin temperature as a biomarker to measure emotions. To assess the facial skin temperature, the thermal imaging modality has been used in this study, since it has been recognised as a promising technique to evaluate emotional responses. The aim of this study was the following: (1) to compare the facial skin temperature of autistic and non-autistic children by using thermal imaging across various emotions; (2) to classify the thermal images obtained from the study using the customised convolutional neural network compared with the ResNet 50 network. Fifty autistic and fifty non-autistic participants were included for the study. Thermal imaging was used to obtain the temperature of specific facial regions such as the eyes, cheek, forehead and nose while we evoked emotions (Happiness, anger and sadness) in children using an audio-visual stimulus. Among the emotions considered, the emotion anger had the highest temperature difference between the autistic and non-autistic participants in the region’s eyes (1.9%), cheek (2.38%) and nose (12.6%). The accuracy obtained by classifying the thermal images of the autistic and non-autistic children using Customised Neural Network and ResNet 50 Network was 96% and 90% respectively. This computer aided diagnostic tool can be a predictable and a steadfast method in the diagnosis of the autistic individuals.

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5. García R, Irarrázaval M, López I, Riesle S, Cabezas M, Moyano A. Survey for caregivers of people in the autism spectrum in Chile: first concerns, age of diagnosis and clinical characteristics. Andes pediatrica : revista Chilena de pediatria. 2021; 92(1): 25-33.

INTRODUCTION: Autism Spectrum Disorders (ASD) are neurodevelopmental disorders of increasing prevalence. People with ASD have multiple health, education, and community needs, yet there is little information about their situation in Chile. OBJECTIVE: To learn about the demographic and clinical characteristics, caregiver’s first concerns, and age of diagnosis of ASD individuals. PATIENTS AND METHOD: Participants were parents/caregivers of ASD persons, who answered the Caregiver Needs Survey, developed by Autism Speaks specifically for this purpose, and translated into Spanish. The survey is comprised of 4 sections: demographic information, characteristics of the ASD individual, past and present use of Health and Education Services, and parents/caregivers’ perceptions of satisfaction, impact, stigma, and quality of life. Data from the first two sections are reported in this paper. RESULTS: The survey was answered by 291 caregivers (86% mothers) of 291 mostly male ASDs (89%), aged between 1-40 years (X: 10.4 SD: 6.1). The average age of parents’ first concerns was 29.2m (SD: 23.8) where the main ones were: interaction difficulties (79.4%), unusual response to sensory stimuli (69.8%), behavioral problems (65.3%), unusual gestures/movements (64.3%), and lack of eye contact (63.6%). The ave rage age of diagnosis was 58m (SD: 36.5), with an average delay of diagnosis of 29m. The diagnosis was most frequently made by pediatric neurologists (44.7%), child psychiatrists (19.2%), and pedia tricians (5.5%). The most frequent comorbidities were language impairment, cognitive deficit, and behavioral problems. CONCLUSIONS: The late age of diagnosis of ASD and the large gap between the age of first concerns and diagnosis, represent a critical loss of treatment opportunities and jeopardize the chances of a better long-term outcome.

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6. Guo S, Zhou KL, Dong S, Xue XN, Wei PD, Yang JY, Fu GB, Liu ZB, Cui X. Efficacy and safety of massage therapy for autism spectrum disorders: A protocol for systematic review and meta-analysis. Medicine. 2021; 100(19): e25874.

BACKGROUND: Autism spectrum disorder is a neurodevelopmental disorder with increasing incidence. At present, the global incidence of the disease is on the rise, and the cause is unknown. There is no specific treatment for this disease at present, mainly education and training. Traditional Chinese medicine treatment has a certain effect on the improvement of the symptoms of the disease. The treatment methods are mainly oral Chinese medicine and acupuncture, but children are often not easy to cooperate. As a safe and effective green therapy, massage is easy to be accepted by children. METHODS: We will search the following electronic databases for randomized controlled trials to evaluate the effectiveness and safety of massage therapy in treating autism spectrum disorders: Wanfang and PubMed Database, China National Knowledge Infrastructure Database, Cochrane Central Register of Controlled Trials, Cumulative Index of Nursing and Allied Health Literature, and Excerpta Medica database. Each database will be searched from inception to March 2021. The entire process will include study selection, data extraction, risk of bias assessment, and meta-analyses. RESULTS: This proposed study will evaluate the effectiveness and safety of massage therapy for patients with autism spectrum disorders. The outcomes will include changes in autism spectrum disorder relief and adverse effect. CONCLUSION: This proposed systematic review will evaluate the existing evidence on the effectiveness and safety of massage therapy for patients with autism spectrum disorders. DISSEMINATION AND ETHICS: The results of this review will be disseminated through peer-reviewed publication. Because all of the data used in this systematic review and meta-analysis have been published, this review does not require ethical approval. Furthermore, all data will be analyzed anonymously during the review process.

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7. Hopkins ZL, Yuill N, Branigan HP. Autistic children’s language imitation shows reduced sensitivity to ostracism. Journal of autism and developmental disorders. 2022; 52(5): 1929-41.

In dialogue, speakers tend to imitate, or align with, a partner’s language choices. Higher levels of alignment facilitate communication and can be elicited by affiliation goals. Since autistic children have interaction and communication impairments, we investigated whether a failure to display affiliative language imitation contributes to their conversational difficulties. We measured autistic children’s lexical alignment with a partner, following an ostracism manipulation which induces affiliative motivation in typical adults and children. While autistic children demonstrated lexical alignment, we observed no affiliative influence on ostracised children’s tendency to align, relative to controls. Our results suggest that increased language imitation-a potentially valuable form of social adaptation-is unavailable to autistic children, which may reflect their impaired affective understanding.

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8. Liu Q, Wang Q, Li X, Gong X, Luo X, Yin T, Liu J, Yi L. Social synchronization during joint attention in children with autism spectrum disorder. Autism research : official journal of the International Society for Autism Research. 2021; 14(10): 2120-30.

We explored the social synchronization of gaze-shift behaviors when responding to joint attention in children with autism spectrum disorder (ASD). Forty-one children aged 5 to 8 with ASD and 43 typically developing (TD) children watched a video to complete the response to joint attention (RJA) tasks, during which their gaze data were collected. The synchronization of gaze-shift behaviors between children and the female model in the video was measured with the cross-recurrence quantification analysis (CRQA). Ultimately, we discovered that children with ASD had the ability to synchronize their gaze shifts with the female model in the video during RJA tasks. Compared to the TD children, they displayed lower levels of synchronization and longer latency in this synchronized behavior. These findings provide a new avenue to deepen our understanding of the impairments of social interaction in children with ASD. Notably, the analytic method can be further applied to explore the social synchronization of numerous other social interactive behaviors in ASD. LAY SUMMARY: This study explored how autistic children synchronized their gazed shifts with others’ gaze cues during joint attention. We found that compared to typical children, autistic children synchronized their gazed shifts less and needed more time to follow others’ gaze. These findings provide a new avenue to deepen our understanding of the impairments of social interaction in children with ASD.

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9. Manyukhina VO, Rostovtseva EN, Prokofyev AO, Obukhova TS, Schneiderman JF, Stroganova TA, Orekhova EV. Visual gamma oscillations predict sensory sensitivity in females as they do in males. Scientific reports. 2021; 11(1): 12013.

Gamma oscillations are driven by local cortical excitatory (E)-inhibitory (I) loops and may help to characterize neural processing involving excitatory-inhibitory interactions. In the visual cortex reliable gamma oscillations can be recorded with magnetoencephalography (MEG) in the majority of individuals, which makes visual gamma an attractive candidate for biomarkers of brain disorders associated with E/I imbalance. Little is known, however, about if/how these oscillations reflect individual differences in neural excitability and associated sensory/perceptual phenomena. The power of visual gamma response (GR) changes nonlinearly with increasing stimulation intensity: it increases with transition from static to slowly drifting high-contrast grating and then attenuates with further increase in the drift rate. In a recent MEG study we found that the GR attenuation predicted sensitivity to sensory stimuli in everyday life in neurotypical adult men and in men with autism spectrum disorders. Here, we replicated these results in neurotypical female participants. The GR enhancement with transition from static to slowly drifting grating did not correlate significantly with the sensory sensitivity measures. These findings suggest that weak velocity-related attenuation of the GR is a reliable neural concomitant of visual hypersensitivity and that the degree of GR attenuation may provide useful information about E/I balance in the visual cortex.

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10. Mash LE, Linke AC, Gao Y, Wilkinson M, Olson MA, Jao Keehn RJ, Müller RA. Blood Oxygen Level-Dependent Lag Patterns Differ Between Rest and Task Conditions, but Are Largely Typical in Autism. Brain connectivity. 2022; 12(3): 234-45.

Background/Introduction: Autism spectrum disorder (ASD) is characterized by atypical functional connectivity (FC) within and between distributed brain networks. However, FC findings have often been inconsistent, possibly due to a focus on static FC rather than brain dynamics. Lagged connectivity analyses aim at evaluating temporal latency, and presumably neural propagation, between regions. This approach may, therefore, reveal a more detailed picture of network organization in ASD than traditional FC methods. Methods: The current study evaluated whole-brain lag patterns in adolescents with ASD (n = 28) and their typically developing peers (n = 22). Functional magnetic resonance imaging data were collected during rest and during a lexico-semantic decision task. Optimal lag was calculated for each pair of regions of interest by using cross-covariance, and mean latency projections were calculated for each region. Results: Latency projections did not regionally differ between groups, with the same regions emerging among the « earliest » and « latest. » Although many of the longest absolute latencies were preserved across resting-state and task conditions, lag patterns overall were affected by condition, as many regions shifted toward zero-lag during task performance. Lag structure was also strongly associated with literature-derived estimates of arterial transit time. Discussion: Results suggest that lag patterns are broadly typical in ASD but undergo changes during task performance. Moreover, lag patterns appear to reflect a combination of neural and vascular sources, which should be carefully considered when interpreting lagged FC. Impact statement Altered brain dynamics have been proposed in autism spectrum disorder (ASD). Lagged functional connectivity analysis uses cross-correlation between functional magnetic resonance imaging (fMRI) time series to determine regional latency. Few studies have examined blood oxygen level-dependent (BOLD) lag in ASD, and findings have been inconsistent. Using multi-echo fMRI data with improved artifact detection and removal, we find differences in lag structure between task and rest states, but not between adolescents with ASD and typically developing peers. Additional analyses exploring links with arterial transit time, however, highlight the impact of vascular organization on BOLD lag patterns and its potential to confound measures of neural dynamics.

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11. Posar A, Visconti P, Giuberti V. The impact of the COVID-19 pandemic on the assessment of autism spectrum disorder. Turkish archives of pediatrics. 2021; 56(3): 280-2.

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12. Reardon AM, Li K, Langley J, Hu XP. Subtyping Autism Spectrum Disorder Via Joint Modeling of Clinical and Connectomic Profiles. Brain connectivity. 2022; 12(2): 193-205.

Background: Autism spectrum disorder (ASD) is a highly heterogeneous developmental disorder with diverse clinical manifestations. Neuroimaging studies have explored functional connectivity (FC) of ASD through resting-state functional magnetic resonance imaging studies; however, the findings have remained inconsistent, thus reflecting the possibility of multiple subtypes. Identification of the relationship between clinical symptoms and FC measures may help clarify the inconsistencies in earlier findings and advance our understanding of ASD subtypes. Methods: Canonical correlation analysis was performed on 210 ASD subjects from the Autism Brain Imaging Data Exchange to identify significant linear combinations of resting-state connectomic and clinical profiles of ASD. Then, hierarchical clustering defined ASD subtypes based on distinct brain-behavior relationships. Finally, a support vector machine (SVM) classifier was used to verify that subtypes comprised subjects with distinct clinical and connectivity features. Results: Three ASD subtypes were identified. Subtype 1 exhibited increased intra-network FC, increased Intelligence Quotient (IQ) scores, and restricted and repetitive behaviors. Subtype 2 was characterized by decreased whole-brain FC and more severe Autism Diagnostic Interview-Revised and Social Responsiveness Scale symptoms. Subtype 3 demonstrated mixed FC, low IQ scores, as well as social motivation and verbal deficits. To verify subtype assignment, a multi-class SVM using connectomic and clinical profiles yielded an average accuracy of 71.3% and 65.2% respectively for subtype classification, which is significantly higher than chance (33.3%). Conclusion: The present study demonstrates that combining connectomic and behavioral measures is a powerful approach for disease subtyping and suggests that there are ASD subtypes with distinct connectomic and clinical profiles.

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13. Ringshaw JE, Hamilton K, Malcolm-Smith S. Theory of Mind and Moral Decision-Making in the Context of Autism Spectrum Disorder. Journal of autism and developmental disorders. 2022; 52(4): 1693-711.

Social impairment in Autism Spectrum Disorder (ASD) has been linked to Theory of Mind (ToM) deficits. However, little research has investigated the relationship between ToM and moral decision-making in children with ASD. This study compared moral decision-making and ToM between aggregate-matched ASD and neurotypical boys (n = 38 per group; aged 6-12). In a third-party resource allocation task manipulating recipient merit, wealth, and health, neurotypical children allocated significantly more resources to the morally deserving recipient, suggesting equitable allocation. A comparatively larger portion of the ASD group allocated equally. ToM emerged as a predictor of moral decision-making. We suggest that ToM (cognitive empathy) deficits may underly atypical moral decision-making in ASD by limiting the integration of empathic arousal (affective empathy) with moral information.

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14. Sahito AM. Migraine and Autism Spectrum Disorder: A Shared Hereditary Basis [Letter]. Neuropsychiatric disease and treatment. 2021; 17: 1733-4.

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15. Sparapani N, Reinhardt VP, Hooker JL, Morgan L, Schatschneider C, Wetherby AM. Evaluating Teacher Language Within General and Special Education Classrooms Serving Elementary Students with Autism. Journal of autism and developmental disorders. 2022; 52(5): 2284-99.

This study examined how teachers and paraprofessionals in 126 kindergarten-second grade general and special education classrooms talked with their 194 students with autism, and further, how individual student characteristics in language, autism symptoms, and social abilities influenced this talk. Using systematic observational methods and factor analysis, we identified a unidimensional model of teacher language for general and special education classrooms yet observed differences between the settings, with more language observed in special education classrooms-much of which included directives and close-ended questions. Students’ receptive vocabulary explained a significant amount of variance in teacher language beyond its shared covariance with social impairment and problem behavior in general education classrooms but was non-significant within special education classrooms. Research implications are discussed.

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16. van den Berk-Smeekens I, de Korte MWP, van Dongen-Boomsma M, Oosterling IJ, den Boer JC, Barakova EI, Lourens T, Glennon JC, Staal WG, Buitelaar JK. Pivotal Response Treatment with and without robot-assistance for children with autism: a randomized controlled trial. European child & adolescent psychiatry. 2021.

Pivotal response treatment (PRT) is a promising intervention focused on improving social communication skills in children with autism spectrum disorder (ASD). Since robots potentially appeal to children with ASD and may contribute to their motivation for social interaction, this exploratory randomized controlled trial (RCT) was conducted comparing PRT (PRT and robot-assisted PRT) with treatment-as-usual (TAU). Seventy-three children (PRT: n = 25; PRT + robot: n = 25; TAU: n = 23) with ASD, aged 3-8 years were assessed at baseline, after 10 and 20 weeks of intervention, and at 3-month follow-up. There were no significant group differences on parent- and teacher-rated general social-communicative skills and blindly rated global functioning directly after treatment. However, at follow-up largest gains were observed in robot-assisted PRT compared to other groups. These results suggest that robot-assistance may contribute to intervention efficacy for children with ASD when using game scenarios for robot-child interaction during multiple sessions combined with motivational components of PRT. This trial is registered at https://www.trialregister.nl/trial/4487 ; NL4487/NTR4712 (2014-08-01).

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17. Weissheimer G, Mazza VA, Santana JM, Ruthes V, Freitas C. Information demands from families of children with Autism Spectrum Disorder. Revista brasileira de enfermagem. 2021; 74(5): e20200642.

OBJECTIVE: to identify the information demands of families of children with Autism Spectrum Disorder. METHOD: this is a qualitative study conducted through semi-structured and audio-recorded interviews with 55 family members, in the states of Paraná, Ceará, and Macapá, between September 2018 and September 2019. Thematic category analysis and Qualitative Data Analysis Software resources were used for data organization. RESULTS: it was identified that families need information regarding the characteristics of Autism Spectrum Disorder (definition, cause, possibility of cure, prognosis and the probability of having another child with Autism Spectrum Disorder); child’s routine and behavior; future rights and expectations. FINAL CONSIDERATIONS: information demands are relevant to support professionals, health managers and other services in health care organization to support families of children with autism.

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18. Winnard R, Roy M, Butler-Coyne H. Motherhood: Female Perspectives and Experiences of Being a Parent with ASC. Journal of autism and developmental disorders. 2022; 52(5): 2314-24.

Little is known about the emotional pressures and practical management of daily challenges and, intra and interpersonal demands of raising a child as a parent with a diagnosis of Autistic Spectrum Conditions. The present study utilised a qualitative approach to understand perceptions of females diagnosed on the autistic spectrum of ‘being a parent’. Eight semi-structured interviews were analysed using Interpretative Phenomenological Analysis. Benefits and challenges of being a parent were highlighted alongside population-specific skill and characteristics associated with strength and resilience, love, nurture, routine and sensory considerations. Findings identify the need for population-specific specialist parenting support, provide direction for professionals in clinical settings and expand the paucity of research in this area.

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19. Zhao Z, Tang H, Zhang X, Zhu Z, Xing J, Li W, Tao D, Qu X, Lu J. Characteristics of Visual Fixation in Chinese Children with Autism During Face-to-Face Conversations. Journal of autism and developmental disorders. 2021.

Few eye tracking studies have examined how people with autism spectrum disorder (ASD) visually attend during live interpersonal interaction, and none with the Chinese population. This study used an eye tracker to record the gaze behavior in 20 Chinese children with ASD and 23 children with typical development (TD) when they were engaged in a structured conversation. Results demonstrated that children with ASD looked significantly less at the interlocutor’s mouth and whole-face, and more at background. Additionally, gaze behavior was found to vary with the conversational topic. Given the great variability in eye tracking findings in existing literature, future explorations might consider investigating how fundamental factors (i.e., participant’s characteristics, tasks, and context) influence the gaze behavior in people with ASD.

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