1. Barnhill K, Gutierrez A, Ghossainy M, Marediya Z, Marti CN, Hewitson L. {{Growth status of children with autism spectrum disorder: a case-control study}}. {J Hum Nutr Diet};2016 (Jul 14)
BACKGROUND: Children with autism spectrum disorder are at risk of a compromised dietary intake and nutritional status that could impact growth over both the short and long term. The limited body of published research addressing this concern has been contradictory and inconclusive to date. METHODS: This case-control study investigated the height, weight, body mass index (BMI) and other anthropometric measurements of children diagnosed with autism spectrum disorder (ASD). Eighty-six children with ASD and 57 healthy controls participated in the study. Caregivers of participants who met the inclusion criteria completed a health history questionnaire, provided information on dietary intake and feeding behaviour, and completed a nutrition physical with a healthcare professional, which provided all of the anthropometric measurements required for the study. RESULTS: Body mass index and BMI Z-scores for females with ASD and corresponding healthy controls were significantly different. Female participants with ASD had significantly lower BMI and BMI Z-scores than control participants. The prevalence of risk for failure-to-thrive status was consistent across ASD subjects and controls. The prevalence of overweight and obesity was consistent across ASD subjects and controls. Children with ASD comprised 60% of the total number of children across BMI categories and mid-arm muscle circumference percentile ranges, which is consistent with the proportion of children in the overall sample. CONCLUSIONS: More research is needed to fully assess physical status and potential growth concerns of children with ASD. A full physical assessment should be a component of primary care for all children with ASD.
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2. Castro K, Faccioli LS, Baronio D, Gottfried C, Perry IS, Riesgo R. {{Feeding behavior and dietary intake of male children and adolescents with Autism Spectrum Disorder: a case-control study}}. {Int J Dev Neurosci};2016 (Jul 15)
Autism spectrum disorder (ASD) is a neurodevelopmental disorder associated with restrictive or repetitive behaviors and difficulties with verbal and interpersonal communication, in which some problems involving nutrition may be present. This study aims to evaluate dietary intake and identify feeding behavioral problems in male children and adolescents with ASD when compared to matched controls, as well as parents or caregivers’ feelings about strategies for dealing with eating problems. A 3-day food record was performed and nutrient intake was compared to the Dietary Reference Intake according to age. To evaluate children feeding behavior and parents or caregivers’ feelings, the Behavior Pediatrics Feeding Assessment Scale (BPFA) was used. ASD patients consumed in average more calories than controls (though with a high patient’s frequency above and below calorie range references), had a limited food repertoire, high prevalence of children with inadequate calcium, sodium, iron vitamin B5, folate, and vitamin C intake. BPFA scores were also higher in the ASD group when compared to controls for all frequencies (child behavior, parents and total). These findings lead us to endorse the importance of evaluating feeding problems in the clinical routine, considering also the singular features of the patients.
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3. Charman T, Young GS, Brian J, Carter A, Carver LJ, Chawarska K, Curtin S, Dobkins K, Elsabbagh M, Georgiades S, Hertz-Picciotto I, Hutman T, Iverson JM, Jones EJ, Landa R, Macari S, Messinger DS, Nelson CA, Ozonoff S, Saulnier C, Stone WL, Tager-Flusberg H, Webb SJ, Yirmiya N, Zwaigenbaum L. {{Non-ASD outcomes at 36 months in siblings at familial risk for autism spectrum disorder (ASD): A baby siblings research consortium (BSRC) study}}. {Autism Res};2016 (Jul 15)
This study characterized developmental outcomes of a large sample of siblings at familial high-risk of autism spectrum disorder (ASD), who themselves did not have ASD (n = 859), and low-risk controls with no family history of ASD (n = 473). We characterized outcomes at age 3 years using a developmental assessment of language and learning and an observational measure of ASD symptoms and, where available, parent interviews about ASD behaviors and adaptive functioning. Around one-in-ten high-risk siblings had mild-to-moderate levels of developmental delay, a rate significantly higher than the low-risk controls. The groups did not differ in the proportion of toddlers with mild-to-moderate language delay. High-risk siblings were also more likely to have higher levels of observer-rated and parent-reported levels of ASD symptoms and lower adaptive functioning. Males were more likely to show higher levels of ASD symptoms and lower levels of developmental ability and adaptive behavior than females across most measures. Lower maternal education was associated with lower developmental and adaptive behavior outcomes. We discuss these findings as evidence for early emerging characteristics related to the « broader autism phenotype » previously described in older family members of individuals with ASD. There is a need for ongoing clinical monitoring of high-risk siblings who do not show clear signs of ASD by age 3 years, as well as continued follow-up into school age to determine their developmental and behavioral outcomes.
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4. Daroles L, Gribaudo S, Doulazmi M, Scotto-Lomassese S, Dubacq C, Mandairon N, Greer CA, Didier A, Trembleau A, Caille I. {{Fragile X Mental Retardation Protein and Dendritic Local Translation of the Alpha Subunit of the Calcium/Calmodulin-Dependent Kinase II Messenger RNA Are Required for the Structural Plasticity Underlying Olfactory Learning}}. {Biol Psychiatry};2016 (Jul 15);80(2):149-159.
BACKGROUND: In the adult brain, structural plasticity allowing gain or loss of synapses remodels circuits to support learning. In fragile X syndrome, the absence of fragile X mental retardation protein (FMRP) leads to defects in plasticity and learning deficits. FMRP is a master regulator of local translation but its implication in learning-induced structural plasticity is unknown. METHODS: Using an olfactory learning task requiring adult-born olfactory bulb neurons and cell-specific ablation of FMRP, we investigated whether learning shapes adult-born neuron morphology during their synaptic integration and its dependence on FMRP. We used alpha subunit of the calcium/calmodulin-dependent kinase II (alphaCaMKII) mutant mice with altered dendritic localization of alphaCaMKII messenger RNA, as well as a reporter of alphaCaMKII local translation to investigate the role of this FMRP messenger RNA target in learning-dependent structural plasticity. RESULTS: Learning induces profound changes in dendritic architecture and spine morphology of adult-born neurons that are prevented by ablation of FMRP in adult-born neurons and rescued by an metabotropic glutamate receptor 5 antagonist. Moreover, dendritically translated alphaCaMKII is necessary for learning and associated structural modifications and learning triggers an FMRP-dependent increase of alphaCaMKII dendritic translation in adult-born neurons. CONCLUSIONS: Our results strongly suggest that FMRP mediates structural plasticity of olfactory bulb adult-born neurons to support olfactory learning through alphaCaMKII local translation. This reveals a new role for FMRP-regulated dendritic local translation in learning-induced structural plasticity. This might be of clinical relevance for the understanding of critical periods disruption in autism spectrum disorder patients, among which fragile X syndrome is the primary monogenic cause.
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5. Dawkins T, Meyer AT, Van Bourgondien ME. {{The Relationship Between the Childhood Autism Rating Scale: Second Edition and Clinical Diagnosis Utilizing the DSM-IV-TR and the DSM-5}}. {J Autism Dev Disord};2016 (Jul 15)
The Childhood Autism Rating Scale, Second Edition (CARS2; 2010) includes two rating scales; the CARS2-Standard Version (CARS2-ST) and the newly developed CARS2-High Functioning Version (CARS2-HF). To assess the diagnostic agreement between the CARS2 and DSM-IV-TR versus DSM-5 criteria for Autism Spectrum Disorder (ASD), clinicians at community based centers of the University of North Carolina TEACCH Autism Program rated participants seen for a diagnostic evaluation on symptoms of autism using both the DSM-IV-TR and DSM-5 criteria and either the CARS2-HF or the CARS2-ST. Findings suggest that overall, the diagnostic agreement of the CARS2 remains high across DSM-IV and DSM-5 criteria for autism.
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6. Edmiston EK, Blain SD, Corbett BA. {{Salivary cortisol and behavioral response to social evaluative threat in adolescents with autism spectrum disorder}}. {Autism Res};2016 (Jul 15)
Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by deficits in social behavior. One possible explanation for social communication deficits in ASD could be differences in biological systems that support responses to environmental stimuli. If so, it is unclear if differences in the arousal response to social stimuli in ASD are due to reduced interest in social information, or to an increased stress response. The hypothalamic pituitary adrenal axis facilitates arousal and the stress response to sensory input, including social stimuli. Previous research shows blunted cortisol response to social evaluative threat in children with ASD. The majority of prior work has focused on children with ASD, but adolescents with ASD are understudied. The adolescent period is of interest, as this developmental epoch is associated with increased salience of social evaluative threat in typically developing (TD) populations. In this study, we employed the Trier Social Stress Test (TSST), a laboratory paradigm that involves exposure to social evaluative threat, to study the cortisol and behavioral response to social evaluative threat in ASD and TD adolescents. Salivary cortisol data were collected at six time points before and after the TSST. Behavioral data were collected using video recordings of the TSST, which were then operationalized and coded. Paired sample t-tests were used to calculate within-group cortisol response to the TSST. Cortisol significantly increased in response to the TSST in the TD group but not the ASD group. The TD group showed a trend for more self-soothing behaviors during the stressor than the ASD group. The lack of a cortisol response to the TSST in the ASD group suggests that the TSST is not interpreted as stressful or salient for ASD adolescents. Autism Res 2016. (c) 2016 International Society for Autism Research, Wiley Periodicals, Inc.
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7. Elsabbagh M, Johnson MH. {{Autism and the Social Brain: The First-Year Puzzle}}. {Biol Psychiatry};2016 (Jul 15);80(2):94-99.
The atypical features of social perception and cognition observed in individuals with a diagnosis of autism have been explained in two different ways. First, domain-specific accounts are based on the assumption that these end-state symptoms result from specific impairments within component structures of the social brain network. Second, domain-general accounts hypothesize that rather than being localized, atypical brain structure and function are widespread, or hypothesize that the apparent social brain differences are the consequence of adaptations to earlier occurring widespread changes in brain function. Critical evidence for resolving this basic issue comes from prospective longitudinal studies of infants at risk for later diagnosis. We highlight selected studies from the newly emerging literature on infants at familial risk for autism to shed light on this issue. Despite multiple reports of possible alterations in brain function in the first year of life, overt behavioral symptoms do not emerge until the second year. Our review reveals only mixed support, within this very early period, for localized deficits in social brain network systems and instead favors the view that atypical development involving perceptual, attentional, motor, and social systems precede the emerging autism phenotype.
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8. Elton A, Di Martino A, Hazlett HC, Gao W. {{Neural Connectivity Evidence for a Categorical-Dimensional Hybrid Model of Autism Spectrum Disorder}}. {Biol Psychiatry};2016 (Jul 15);80(2):120-128.
BACKGROUND: Autism spectrum disorder (ASD) encompasses a complex manifestation of symptoms that include deficits in social interaction and repetitive or stereotyped interests and behaviors. In keeping with the increasing recognition of the dimensional characteristics of ASD symptoms and the categorical nature of a diagnosis, we sought to delineate the neural mechanisms of ASD symptoms based on the functional connectivity of four known neural networks (i.e., default mode network, dorsal attention network, salience network, and executive control network). METHODS: We leveraged an open data resource (Autism Brain Imaging Data Exchange) providing resting-state functional magnetic resonance imaging data sets from 90 boys with ASD and 95 typically developing boys. This data set also included the Social Responsiveness Scale as a dimensional measure of ASD traits. Seed-based functional connectivity was paired with linear regression to identify functional connectivity abnormalities associated with categorical effects of ASD diagnosis, dimensional effects of ASD-like behaviors, and their interaction. RESULTS: Our results revealed the existence of dimensional mechanisms of ASD uniquely affecting each network based on the presence of connectivity-behavioral relationships; these were independent of diagnostic category. However, we also found evidence of categorical differences (i.e., diagnostic group differences) in connectivity strength for each network as well as categorical differences in connectivity-behavioral relationships (i.e., diagnosis-by-behavior interactions), supporting the coexistence of categorical mechanisms of ASD. CONCLUSIONS: Our findings support a hybrid model for ASD characterization that includes a combination of categorical and dimensional brain mechanisms and provide a novel understanding of the neural underpinnings of ASD.
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9. Fung LK, Reiss AL. {{Moving Toward Integrative, Multidimensional Research in Modern Psychiatry: Lessons Learned From Fragile X Syndrome}}. {Biol Psychiatry};2016 (Jul 15);80(2):100-111.
The field of psychiatry is approaching a major inflection point. The basic science behind cognition, emotion, behavior, and social processes has been advancing rapidly in the past 20 years. However, clinical research supporting the classification system in psychiatry has not kept up with these scientific advances. To begin organizing the basic science of psychiatry in a comprehensive manner, we begin by selecting fragile X syndrome, a neurogenetic disease with cognitive-behavioral manifestations, to illustrate key concepts in an integrative, multidimensional model. Specifically, we describe key genetic and molecular mechanisms (e.g., gamma-aminobutyric acidergic dysfunction and metabotropic glutamate receptor 5-associated long-term depression) relevant to the pathophysiology of fragile X syndrome as well as neural correlates of cognitive-behavioral symptoms. We then describe what we have learned from fragile X syndrome that may be applicable to other psychiatric disorders. We conclude this review by discussing current and future opportunities in diagnosing and treating psychiatric diseases.
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10. Lane JD, Shepley C, Lieberman-Betz R. {{Promoting Expressive Language in Young Children with or At-Risk for Autism Spectrum Disorder in a Preschool Classroom}}. {J Autism Dev Disord};2016 (Jul 15)
Young children with autism spectrum disorder (ASD) often demonstrate delays in expressive communication, impacting their ability to independently function in typical environments. Individuals with ASD who develop expressive language during early childhood experience better outcomes later in life; therefore, examination of naturalistic language interventions (NLIs) remain an important area of investigation. The current study used a multiple probe design across participants to examine the effects of a classroom-based NLI on various expressive language targets in three preschool-aged children demonstrating characteristics of ASD. Findings suggest the intervention had positive and maintained effects on trial-based use of language targets, as well as concomitant changes in commenting, requesting, and phrase complexity. Implications regarding implementation of NLIs within typical classroom play activities are discussed.
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11. Picci G, Gotts SJ, Scherf KS. {{A theoretical rut: revisiting and critically evaluating the generalized under/over-connectivity hypothesis of autism}}. {Dev Sci};2016 (Jul);19(4):524-549.
In 2004, two papers proposed that pervasive functional under-connectivity (Just et al., ) or a trade-off between excessive local connectivity at the cost of distal under-connectivity (Belmonte et al., ) characterizes atypical brain organization in autism. Here, we take stock of the most recent and rigorous functional and structural connectivity findings with a careful eye toward evaluating the extent to which they support these original hypotheses. Indeed, the empirical data do not support them. From rsfMRI studies in adolescents and adults, there is an emerging consensus regarding long-range functional connections indicating cortico-cortical under-connectivity, specifically involving the temporal lobes, combined with subcortical-cortical over-connectivity. In contrast, there is little to no consensus regarding local functional connectivity or findings from task-based functional connectivity studies. The structural connectivity data suggest that white matter tracts are pervasively weak, particularly in the temporal lobe. Together, these findings are revealing how deeply complex the story is regarding atypical neural network organization in autism. In other words, distance and strength of connectivity as individual factors or as interacting factors do not consistently explain the patterns of atypical neural connectivity in autism. Therefore, we make several methodological recommendations and highlight developmental considerations that will help researchers in the field cultivate new hypotheses about the nature and mechanisms of potentially aberrant functional and structural connectivity in autism.
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12. Ragland JD, Solomon M. {{Categorical Dimensions of Social Impairment and Disrupted Functional Connectivity in Autism Spectrum Disorders: When Does Continuous Become Discrete?}}. {Biol Psychiatry};2016 (Jul 15);80(2):90-91.
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13. Schoorl J, van Rijn S, de Wied M, van Goozen S, Swaab H. {{Emotion Regulation Difficulties in Boys with Oppositional Defiant Disorder/Conduct Disorder and the Relation with Comorbid Autism Traits and Attention Deficit Traits}}. {PLoS One};2016;11(7):e0159323.
Previous research has pointed towards a link between emotion dysregulation and aggressive behavior in children. Emotion regulation difficulties are not specific for children with persistent aggression problems, i.e. oppositional defiant disorder or conduct disorder (ODD/CD), children with other psychiatric conditions, such as autism spectrum disorders or attention-deficit/hyperactivity disorder, have emotion regulation difficulties too. On a behavioral level some overlap exists between these disorders and comorbidity is high. The aim of this study was therefore twofold: 1) to examine emotion regulation difficulties in 65 boys with ODD/CD in comparison to a non-clinical control group (NC) of 38 boys (8-12 years) using a performance measure (Ultimatum Game), parent report and self-report, and 2) to establish to what extent emotion regulation in the ODD/CD group was correlated with severity of autism and/or attention deficit traits. Results on the Ultimatum Game showed that the ODD/CD group rejected more ambiguous offers than the NC group, which is seen as an indication of poor emotion regulation. Parents also reported that the ODD/CD group experienced more emotion regulation problems in daily life than the NC group. In contrast to these cognitive and behavioral measures, self-reports did not reveal any difference, indicating that boys with ODD/CD do not perceive themselves as having impairments in regulating their emotions. Emotional decision making within the ODD/CD group was not related to variation in autism or attention deficit traits. These results support the idea that emotion dysregulation is an important problem within ODD/CD, yet boys with ODD/CD have reduced awareness of this.
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14. Sevgi M, Diaconescu AO, Tittgemeyer M, Schilbach L. {{Social Bayes: Using Bayesian Modeling to Study Autistic Trait-Related Differences in Social Cognition}}. {Biol Psychiatry};2016 (Jul 15);80(2):112-119.
BACKGROUND: Autism is characterized by impairments of social interaction, but the underlying subpersonal processes are still a matter of controversy. It has been suggested that the autistic spectrum might be characterized by alterations of the brain’s inference on the causes of socially relevant signals. However, it is unclear at what level of processing such trait-related alterations may occur. METHODS: We used a reward-based learning task that requires the integration of nonsocial and social cues in conjunction with computational modeling. Healthy subjects (N = 36) were selected based on their Autism Quotient Spectrum (AQ) score, and AQ scores were assessed for correlations with model parameters and task scores. RESULTS: Individual differences in AQ were inversely correlated with participants’ task scores (r = -.39, 95% confidence interval [CI] [-.68, -.13]). Moreover, AQ scores were significantly correlated with a social weighting parameter that indicated how strongly the decision was influenced by the social cue (r = -.42, 95% CI [-.66, -.19]), but not with other model parameters. Also, more pronounced social weighting was related to higher scores (r = .50, 95% CI [.20, .86]). CONCLUSIONS: Our results demonstrate that higher autistic traits in healthy subjects are related to lower scores in a learning task that requires social cue integration. Computational modeling further demonstrates that these trait-related performance differences are not explained by an inability to process the social stimuli and its causes, but rather by the extent to which participants take into account social information during decision making.
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15. Soares A, Shiozawa P, Trevizol AP, Paula CS, Lowenthal R, Cordeiro Q. {{Effects of augmentation agents in autistic disorder patients treated with risperidone: a systematic review and a meta-analysis}}. {Trends Psychiatry Psychother};2016 (Apr-Jun);38(2):114-116.
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16. Tan BW, Pooley JA, Speelman CP. {{A Meta-Analytic Review of the Efficacy of Physical Exercise Interventions on Cognition in Individuals with Autism Spectrum Disorder and ADHD}}. {J Autism Dev Disord};2016 (Jul 13)
This review evaluates the efficacy of using physical exercise interventions on improving cognitive functions in individuals with autism spectrum disorder (ASD) and/or attention deficit hyperactivity disorder (ADHD). This review includes a meta-analysis based on a random-effects model of data reported in 22 studies with 579 participants aged 3-25 year old. The results revealed an overall small to medium effect of exercise on cognition, supporting the efficacy of exercise interventions in enhancing certain aspects of cognitive performance in individuals with ASD and/or ADHD. Specifically, similar to the general population literature, the cognitive benefits of exercise are not consistent across all aspects of cognitive functions (i.e., some areas are not improved). The clinical significance of the reported effect sizes is also considered.
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17. Torrico B, Chiocchetti AG, Bacchelli E, Trabetti E, Hervas A, Franke B, Buitelaar JK, Rommelse N, Yousaf A, Duketis E, Freitag CM, Caballero-Andaluz R, Martinez-Mir A, Scholl FG, Ribases M, Battaglia A, Malerba G, Delorme R, Benabou M, Maestrini E, Bourgeron T, Cormand B, Toma C. {{Lack of replication of previous autism spectrum disorder GWAS hits in European populations}}. {Autism Res};2016 (Jul 15)
Common variants contribute significantly to the genetics of autism spectrum disorder (ASD), although the identification of individual risk polymorphisms remains still elusive due to their small effect sizes and limited sample sizes available for association studies. During the last decade several genome-wide association studies (GWAS) have enabled the detection of a few plausible risk variants. The three main studies are family-based and pointed at SEMA5A (rs10513025), MACROD2 (rs4141463) and MSNP1 (rs4307059). In our study we attempted to replicate these GWAS hits using a case-control association study in five European populations of ASD patients and gender-matched controls, all Caucasians. Results showed no association of individual variants with ASD in any of the population groups considered or in the combined European sample. We performed a meta-analysis study across five European populations for rs10513025 (1,904 ASD cases and 2,674 controls), seven European populations for rs4141463 (2,855 ASD cases and 36,177 controls) and five European populations for rs4307059 (2,347 ASD cases and 2,764 controls). The results showed an odds ratio (OR) of 1.05 (95% CI = 0.84-1.32) for rs10513025, 1.0002 (95% CI = 0.93-1.08) for rs4141463 and 1.01 (95% CI = 0.92-1.1) for rs4307059, with no significant P-values (rs10513025, P = 0.73; rs4141463, P = 0.95; rs4307059, P = 0.9). No association was found when we considered either only high functioning autism (HFA), genders separately or only multiplex families. Ongoing GWAS projects with larger ASD cohorts will contribute to clarify the role of common variation in the disorder and will likely identify risk variants of modest effect not detected previously. Autism Res 2016. (c) 2016 International Society for Autism Research, Wiley Periodicals, Inc.
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18. Wang J, Zhang J, Wang ZZ, Liu XY, Yang H, Liu WL. {{[Characteristics of attention in school-age children with mild autism spectrum disorder]}}. {Zhongguo Dang Dai Er Ke Za Zhi};2016 (Jul);18(7):589-593.
OBJECTIVE: To investigate the characteristics of attention in school-age children with mild autism spectrum disorder (ASD), and to provide a basis for clinical treatment. METHODS: A total of 20 school-age children with mild ASD were enrolled, and the intermediate visual and auditory continuous performance test (IVA-CPT) was used to assess their attention. A total of 20 children with attention deficit hyperactivity disorder (ADHD) and 40 healthy children were enrolled as controls. RESULTS: Compared with the normal control group, the ASD group showed significantly lower scores of full scale attention quotient, full scale response control quotient, visual/auditory full scale response control quotient, visual/auditory prudence quotient, auditory perseverance quotient, visual consistency quotient, visual/auditory vigilance quotient, visual attention quotient, visual speed quotient, number of correct visual/auditory reactions, and visual mean reaction time of the second and third phases (P<0.05). Compared with the ADHD group, the ASD group showed significantly higher scores of full scale response control quotient and auditory consistency quotient (P<0.05), as well as significantly lower scores of visual vigilance quotient and visual speed quotient (P<0.05). CONCLUSIONS: School-age children with mild ASD have attention deficit mainly manifested as the defect in the ability to focus attention, which is similar to the defect in children with ADHD, but ASD children have a lower degree of attention control impairment compared with children with ADHD. The defect in the ability to focus visual attention is more severe than that in the ability to focus auditory attention, while there is no significant difference between the defects in visual and auditory attention control. Lien vers Pubmed
19. Xu L, Mitchell LC, Richman AR, Clawson K. {{What Do Parents Think about Chromosomal Microarray Testing? A Qualitative Report from Parents of Children with Autism Spectrum Disorders}}. {Autism Res Treat};2016;2016:6852539.
Background. Chromosomal Microarray Analysis (CMA) is increasingly utilized to detect copy number variants among children and families affected with autism spectrum disorders (ASD). However, CMA is controversial due to possible ambiguous test findings, uncertain clinical implications, and other social and legal issues related to the test. Methods. Participants were parents of children with ASD residing in the North Eastern region of North Carolina, USA. We conducted individual, face-to-face interviews with 45 parents and inquired about their perceptions of CMA. Results. Three major themes dominated parents’ perceptions of CMA. None of the parents had ever heard of the test before and the majority of the parents postulated positive attitudes toward the test. Parents’ motivations in undergoing the test were attributed to finding a potential cause of ASD, to being better prepared for having another affected child, and to helping with future reproductive decisions. Perceived barriers included the cost of testing, risk/pain of CMA testing, and fear of test results. Conclusion. This study contributes to the understanding of psychosocial aspects and cultural influences towards adoption of genetic testing for ASD in clinical practice. Genetic education can aid informed decision-making related to CMA genetic testing among parents of children with ASD.
