1. Aman M, Rettiganti M, Nagaraja HN, Hollway JA, McCracken J, McDougle CJ, Tierney E, Scahill L, Arnold LE, Hellings J, Posey DJ, Swiezy NB, Ghuman J, Grados M, Shah B, Vitiello B. {{Tolerability, Safety, and Benefits of Risperidone in Children and Adolescents with Autism: 21-Month Follow-up After 8-Week Placebo-Controlled Trial}}. {J Child Adolesc Psychopharmacol}. 2015; 25(6): 482-93.
OBJECTIVE: Risperidone has demonstrated efficacy for acute (8 week) and intermediate length (6 month) management of severe irritability and aggression in children and adolescents with autism. Less is known about the long-term effects of risperidone exposure in this population. We examined the tolerability, safety, and therapeutic benefit of risperidone exposure over a 1-2 year follow-up period. METHODS: In a naturalistic study, 84 children and adolescents 5-17 years of age (from an original sample of 101) were assessed an average of 21.4 months after initial entry into a placebo-controlled 8 week trial of risperidone for children and adolescents with autism and severe irritability. They were assessed at baseline and at follow-up on safety and tolerability measures (blood, urinalysis, electrocardiogram [ECG], medical history, vital signs, neurological symptoms, other adverse events), developmental measures (adaptive behavior, intelligence quotient [IQ]), and standardized rating instruments. Treatment over the follow-up period, after completion of protocol participation, was uncontrolled. Statistical analyses assessed outcome over time with or without prolonged risperidone therapy. RESULTS: Two-thirds of the 84 subjects continued to receive risperidone (mean 2.47 mg/day, S.D. 1.29 mg). At follow-up, risperidone was associated with more enuresis, more excessive appetite, and more weight gain, but not more adverse neurological effects. No clinically significant events were noted on blood counts, chemistries, urinalysis, ECG, or interim medical history. Regardless of drug condition at follow-up, there was considerable improvement in maladaptive behavior compared with baseline, including core symptoms associated with autism. Height and weight gains were elevated with risperidone. Social skills on Vineland Adaptive Behavior Scale (VABS) improved with risperidone. Parent-rated Aberrant Behavior Checklist (ABC) Irritability subscale scores were reduced in those taking risperidone at follow-up. Several other measures of maladaptive behavior (some related to socialization) also showed improved functioning in association with risperidone on the ABC or on the Modified Real Life Rating Scale. CONCLUSIONS: Increased appetite, weight gain, and enuresis are risks associated with long-term risperidone. Our data suggest that these risks were balanced by longer-term behavioral and social benefits for many children over 1.8 years of ongoing treatment.
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2. Beddows N, Brooks R. {{Inappropriate sexual behaviour in adolescents with autism spectrum disorder: what education is recommended and why}}. {Early Interv Psychiatry}. 2015.
AIM: Autism spectrum disorder (ASD) is a neurodevelopmental disorder impairing social skills and communication. Adolescents with ASD have sexual needs, but may not understand their physical and emotional development resulting in inappropriate sexual behaviour. The aim of this review is to describe the type of inappropriate behaviour that presents in these adolescents, explain why such behaviours occur, suggest what education is suitable and identify current gaps in research. METHOD: The databases EMBASE, OVID MEDLINE and PSYCINFO were searched for relevant articles. In total, 5241 articles were found, with an additional 15 sources found via soft searches, of which 42 met inclusion criteria and were subsequently reviewed. RESULTS: Sexual behaviours that occur in these adolescents with ASD include hypermasturbation, public masturbation, inappropriate romantic gestures, inappropriate arousal and exhibitionism. Such behaviours are thought to be caused via a lack of understanding of normal puberty, the absence of appropriate sex education, the severity of their ASD and other associated problems. It is suggested that individualized, repetitive education should be started from an early age in an accessible form. Social skills development is also important before more technical aspects of sex education are taught. CONCLUSION: Despite being such a common problem for schools, institutions and families to manage, it is surprising how sparse literature is particularly regarding why inappropriate behaviour occurs and what education is effective.
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3. Del Pilar Trelles Thorne M, Khinda N, Coffey BJ. {{Posttraumatic Stress Disorder in a Child with Autism Spectrum Disorder: Challenges in Management}}. {J Child Adolesc Psychopharmacol}. 2015; 25(6): 514-7.
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4. Gona JK, Newton CR, Rimba K, Mapenzi R, Kihara M, Van de Vijver FJ, Abubakar A. {{Parents’ and Professionals’ Perceptions on Causes and Treatment Options for Autism Spectrum Disorders (ASD) in a Multicultural Context on the Kenyan Coast}}. {PLoS One}. 2015; 10(8): e0132729.
OBJECTIVE: To explore parents’ and professionals’ perceived causes and treatment of Autism Spectrum Disorders (ASD) on the Kenyan Coast. METHODS: In-depth interviews and focus group discussions using guiding questions were utilized in data collection. One hundred and three participants, who included parents of children with ASD, special needs teachers, clinicians, and social workers from diverse cultural background, participated in this study. The interviews and focus groups were recorded, transcribed verbatim and then translated to English. Themes were generated using content analysis. RESULTS: Preternatural causes were mentioned and included evil spirits, witchcraft, and curses. Biomedical causes comprised infections, drug abuse, birth complications, malnutrition, and genetic related problems. Treatment varied from traditional and spiritual healing to modern treatment in health facilities, and included consultations with traditional healers, offering prayers to God, and visits to hospitals. CONCLUSIONS: The results suggest that regardless of cultural backgrounds, people on the Kenyan Coast have similar views on perceived causes and treatment of ASD. These findings provide valuable conceptual understanding for professionals when planning and implementing community based rehabilitation interventions targeting children with ASD within a local context.
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5. Kim SH, Macari S, Koller J, Chawarska K. {{Examining the phenotypic heterogeneity of early Autism Spectrum Disorder: subtypes and short-term outcomes}}. {J Child Psychol Psychiatry}. 2015.
BACKGROUND: Phenotypic heterogeneity among toddlers presenting with ASD symptoms complicates diagnostic considerations and limits our ability to predict long-term outcomes. To address this concern, we sought to identify more homogeneous subgroups within ASD based on toddlers’ clinical profiles in the second year of life, evaluating diagnostic stability and clinical outcomes within the subgroups 1-2 years later. METHODS: One hundred toddlers referred for suspected ASD underwent comprehensive assessments at 22 months (SD = 3) and 37 months (SD = 4). At 22 months, they were clustered based on symptom severity, developmental skills, and adaptive functioning. Diagnostic stability and clinical outcomes were evaluated within the clusters. RESULTS: Four clusters characterized by distinct clinical profiles at the time of the first diagnosis were identified. Diagnostic stability was excellent in 3 out of 4 clusters (93%-100%) and was lowest in the initially least affected cluster (85%). Autism symptom severity was stable, except for one group where it increased over time (16% of the sample). A large proportion of toddlers showed significant improvements in verbal and communication skills. Only a small group (17%) exhibited very low levels of functioning and limited gains over time. CONCLUSIONS: Diagnostic stability and developmental progression from the second to third year of life in toddlers with ASD vary depending on their initial early profiles of relative strengths and deficits. Although a small minority of toddlers with more complex clinical presentations may not retain their diagnoses by the age of three, most children continue to exhibit symptoms of autism. Despite limited improvements in symptom severity, many children show significant gains in verbal functioning. Only a small proportion of children (17%) exhibit very limited gains despite intensive intervention. These findings support continued efforts to examine determinants of developmental trajectories including factors mediating and moderating response to treatment.
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6. Levy F. {{Commentary on Autism Spectrum Disorder: Presentation and prevalence in a nationally representative Australian sample – Service implications}}. {Aust N Z J Psychiatry}. 2015.
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7. Lewis S. {{Genes and disease: Organoids assist in ASD research}}. {Nat Rev Neurosci}. 2015.
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8. Najjar F, Owley T, Mosconi MW, Jacob S, Hur K, Guter SJ, Sweeney JA, Gibbons RD, Cook EH, Bishop JR. {{Pharmacogenetic Study of Serotonin Transporter and 5HT2A Genotypes in Autism}}. {J Child Adolesc Psychopharmacol}. 2015; 25(6): 467-74.
OBJECTIVE: The purpose of this study was to determine whether polymorphisms in the serotonin transporter (SLC6A4) and serotonin-2A receptor (HTR2A) genes are associated with response to escitalopram in patients with autism spectrum disorder (ASD). METHODS: Forty-four participants with ASD were enrolled in a 6 week, forced titration, open label examination of the selective serotonin reuptake inhibitor (SSRI) escitalopram. Doses increased at weekly intervals starting at 2.5mg daily with a maximum possible dose of 20 mg daily achieved by the end of the study. If adverse events were experienced, participants subsequently received the previously tolerated dose for the duration of study. SLC6A4 (5-HTTLPR) and HTR2A (rs7997012) genotype groups were assessed in relation to treatment outcomes and drug doses. RESULTS: Insistence on sameness and irritability symptoms significantly improved over the course of the 6 week treatment period (p<0.0001) in this open-label trial. There were no significant differences observed in the rate of symptom improvement over time across genotype groups. Similarly, dosing trajectory was not significantly associated with genotype groups. CONCLUSIONS: Previous studies have identified SLC6A4 and HTR2A associations with SSRI response in patients with depression and 5-HTTLPR (SLC6A4) associations with escitalopram response in ASD. We did not observe evidence for similar relationships in this ASD study.
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9. Parma V, de Marchena AB. {{Motor signatures in Autism Spectrum Disorder: The importance of variability}}. {J Neurophysiol}. 2015: jn 00647 2015.
In a recent study, Wang and colleagues (2015) used a precision grip force control task to unveil the contribution of feed-forward and feedback mechanisms to sensorimotor dysfunction in autism spectrum disorder (ASD). Impairment of both motor control mechanisms was observed, along with significant variability in the motor response. Here we discuss these findings within the conceptual framework of the grasping circuit, and within the broader context of clinical and research applications based on motor behavior.
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10. Ruzich E, Allison C, Smith P, Watson P, Auyeung B, Ring H, Baron-Cohen S. {{Erratum: Measuring autistic traits in the general population: a systematic review of the Autism-Spectrum Quotient (AQ) in a nonclinical population sample of 6,900 typical adult males and females}}. {Mol Autism}. 2015; 6: 45.
[This corrects the article DOI: 10.1186/2040-2392-6-2.].
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11. Sanz-Cervera P, Pastor-Cerezuela G, Fernandez-Andres MI, Tarraga-Minguez R. {{Sensory processing in children with Autism Spectrum Disorder: Relationship with non-verbal IQ, autism severity and Attention Deficit/Hyperactivity Disorder symptomatology}}. {Res Dev Disabil}. 2015; 45-46: 188-201.
The main objective of this study was to analyze in a sample of children with ASD the relationship between sensory processing, social participation and praxis impairments and some of the child’s characteristics, such as non-verbal IQ, severity of ASD symptoms and the number of ADHD symptoms (inattention and hyperactivity/impulsivity), both in the home and main-classroom environments. Participants were the parents and teachers of 41 children with ASD from 5 to 8 years old (M=6.09). They completed the Sensory Processing Measure (SPM) to evaluate sensory processing, social participation and praxis; the Gilliam Autism Rating Scale (GARS-2) to evaluate autism severity; and a set of items (the DSM-IV-TR criteria) to evaluate the number of inattention and hyperactivity/impulsivity symptoms in the child. Non-verbal IQ – measured by the Raven’s Coloured Progressive Matrices Test – did not show a relationship with any of the SPM variables. The SPM variables were significant predictors of autism severity and had similar weights in the two environments. In the case of ADHD symptoms, the SPM variables had a greater weight in the home than in the classroom environment, and they were significant predictors of both inattention and hyperactivity/impulsivity – especially inattention – only in the family context. The moderate association between inattention and auditory processing found in the main-classroom suggests the possible utility of certain measures aimed to simplify any classroom’s acoustic environment.
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12. Stroganova TA, Butorina AV, Sysoeva OV, Prokofyev AO, Nikolaeva AY, Tsetlin MM, Orekhova EV. {{Altered modulation of gamma oscillation frequency by speed of visual motion in children with autism spectrum disorders}}. {J Neurodev Disord}. 2015; 7(1): 21.
BACKGROUND: Recent studies link autism spectrum disorders (ASD) with an altered balance between excitation and inhibition (E/I balance) in cortical networks. The brain oscillations in high gamma-band (50-120 Hz) are sensitive to the E/I balance and may appear useful biomarkers of certain ASD subtypes. The frequency of gamma oscillations is mediated by level of excitation of the fast-spiking inhibitory basket cells recruited by increasing strength of excitatory input. Therefore, the experimental manipulations affecting gamma frequency may throw light on inhibitory networks dysfunction in ASD. METHODS: Here, we used magnetoencephalography (MEG) to investigate modulation of visual gamma oscillation frequency by speed of drifting annular gratings (1.2, 3.6, 6.0 degrees /s) in 21 boys with ASD and 26 typically developing boys aged 7-15 years. Multitaper method was used for analysis of spectra of gamma power change upon stimulus presentation and permutation test was applied for statistical comparisons. We also assessed in our participants visual orientation discrimination thresholds, which are thought to depend on excitability of inhibitory networks in the visual cortex. RESULTS: Although frequency of the oscillatory gamma response increased with increasing velocity of visual motion in both groups of participants, the velocity effect was reduced in a substantial proportion of children with ASD. The range of velocity-related gamma frequency modulation correlated inversely with the ability to discriminate oblique line orientation in the ASD group, while no such correlation has been observed in the group of typically developing participants. CONCLUSIONS: Our findings suggest that abnormal velocity-related gamma frequency modulation in ASD may constitute a potential biomarker for reduced excitability of fast-spiking inhibitory neurons in a subset of children with ASD.
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13. Urbain CM, Pang EW, Taylor MJ. {{Atypical spatiotemporal signatures of working memory brain processes in autism}}. {Transl Psychiatry}. 2015; 5: e617.
Working memory (WM) impairments may contribute to the profound behavioural manifestations in children with autism spectrum disorder (ASD). However, previous behavioural results are discrepant as are the few functional magnetic resonance imaging (fMRI) results collected in adults and adolescents with ASD. Here we investigate the precise temporal dynamics of WM-related brain activity using magnetoencephalography (MEG) in 20 children with ASD and matched controls during an n-back WM task across different load levels (1-back vs 2-back). Although behavioural results were similar between ASD and typically developing (TD) children, the between-group comparison performed on functional brain activity showed atypical WM-related brain processes in children with ASD compared with TD children. These atypical responses were observed in the ASD group from 200 to 600 ms post stimulus in both the low- (1-back) and high- (2-back) memory load conditions. During the 1-back condition, children with ASD showed reduced WM-related activations in the right hippocampus and the cingulate gyrus compared with TD children who showed more activation in the left dorso-lateral prefrontal cortex and the insulae. In the 2-back condition, children with ASD showed less activity in the left insula and midcingulate gyrus and more activity in the left precuneus than TD children. In addition, reduced activity in the anterior cingulate cortex was correlated with symptom severity in children with ASD. Thus, this MEG study identified the precise timing and sources of atypical WM-related activity in frontal, temporal and parietal regions in children with ASD. The potential impacts of such atypicalities on social deficits of autism are discussed.
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14. Van Herwegen J, Smith TJ, Dimitriou D. {{Exploring different explanations for performance on a theory of mind task in Williams syndrome and autism using eye movements}}. {Res Dev Disabil}. 2015; 45-46: 202-9.
The current study explored the looking behaviours of young children with Autism Spectrum Disorders (ASD), Williams syndrome (WS), and typically developing (TD) children while they were administered a low-verbal Theory of Mind (ToM) task. Although ToM performance in both clinical groups was impaired, only participants with WS showed small differences in looking behaviour at the start of the video. Furthermore, while TD children who passed the ToM task looked longer at the original hiding place there was no such contrast in the clinical groups. This shows that looking behaviour in ASD and WS is not necessarily atypical when saliency aspects such as language, background, and colour are removed and that differences in looking behaviour cannot explain ToM performance.
