1. Birch RC, Foley KR, Pollack A, Britt H, Lennox N, Trollor JN. {{Problems managed and medications prescribed during encounters with people with autism spectrum disorder in Australian general practice}}. {Autism};2017 (Sep 01):1362361317714588.
Autism spectrum disorder is associated with high rates of co-occurring health conditions. While elevated prescription rates of psychotropic medications have been reported in the United Kingdom and the United States, there is a paucity of research investigating clinical and prescribing practices in Australia. This study describes the problems managed and medications prescribed by general practitioners in Australia during encounters where an autism spectrum disorder was recorded. Information was collected from 2000 to 2014 as part of the Bettering the Evaluation and Care of Health programme. Encounters where patients were aged less than 25 years and autism spectrum disorder was recorded as one of the reasons for encounter and/or problems managed ( n = 579) were compared to all other Bettering the Evaluation and Care of Health programme encounters with patients aged less than 25 years ( n = 281,473). At ‘autism spectrum disorder’ encounters, there was a significantly higher management rate of psychological problems, and significantly lower management rates of skin, respiratory and general/unspecified problems, than at ‘non-autism spectrum disorder’ encounters. The rate of psychological medication prescription was significantly higher at ‘autism spectrum disorder’ encounters than at ‘non-autism spectrum disorder’ encounters. The most common medications prescribed at ‘autism spectrum disorder’ encounters were antipsychotics and antidepressants. Primary healthcare providers need adequate support and training to identify and manage physical and mental health concerns among individuals with autism spectrum disorder.
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2. Brookman-Frazee L, Stadnick N, Chlebowski C, Baker-Ericzen M, Ganger W. {{Characterizing psychiatric comorbidity in children with autism spectrum disorder receiving publicly funded mental health services}}. {Autism};2017 (Sep 01):1362361317712650.
Publicly funded mental health programs play a significant role in serving children with autism spectrum disorder. Understanding patterns of psychiatric comorbidity for this population within mental health settings is important to implement appropriately tailored interventions. This study (1) describes patterns of psychiatric comorbidity in children with autism spectrum disorder who present to mental health services with challenging behaviors and (2) identifies child characteristics associated with comorbid conditions. Data are drawn from baseline assessments from 201 children with autism spectrum disorder who participated in a community effectiveness trial across 29 publicly funded mental health programs. Non-autism spectrum disorder diagnoses were assessed using an adapted Mini-International Neuropsychiatric Interview, parent version. Approximately 92% of children met criteria for at least one non-autism spectrum disorder diagnosis (78% attention deficit hyperactivity disorder, 58% oppositional defiant disorder, 56% anxiety, 30% mood). Logistic regression indicated that child gender and clinical characteristics were differentially associated with meeting criteria for attention deficit hyperactivity disorder, oppositional defiant disorder, an anxiety, or a mood disorder. Exploratory analyses supported a link between challenging behaviors and mood disorder symptoms and revealed high prevalence of these symptoms in this autism spectrum disorder population. Findings provide direction for tailoring intervention to address a broad range of clinical issues for youth with autism spectrum disorder served in mental health settings.
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3. Bryson S, Garon N, McMullen T, Brian J, Zwaigenbaum L, Armstrong V, Roberts W, Smith I, Szatmari P. {{Impaired disengagement of attention and its relationship to emotional distress in infants at high-risk for autism spectrum disorder}}. {J Clin Exp Neuropsychol};2017 (Sep 15):1-15.
INTRODUCTION: We provide data on visual orienting and emotional distress in infants at high and low risk for autism spectrum disorder (ASD). METHOD: Participants included 83 high-risk (HR) infants with an older sibling with ASD and 53 low-risk (LR) control infants with no family history of ASD. Infants were assessed on the gap-overlap task and a parent-completed temperament questionnaire at 6 and 12 months of age. At 36 months of age, an independent, gold standard diagnostic assessment for ASD was conducted. RESULTS: HR infants subsequently diagnosed with ASD were distinguished at 12 months by an asymmetric disengage impairment (for left- vs. right-sided stimuli) that was associated with an increase in latencies between 6 and 12 months. Across groups, prolonged left-directed disengage latencies at 12 months were associated with emotional distress (high irritability and difficult to soothe). CONCLUSIONS: The asymmetry in our findings raises the question of whether the disengage problem in ASD is at base one of orienting or alerting attention. Our findings also raise the question of whether attention training might be a critical ingredient in the early treatment of ASD.
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4. Duncan A, Ruble LA, Meinzen-Derr J, Thomas C, Stark LJ. {{Preliminary efficacy of a daily living skills intervention for adolescents with high-functioning autism spectrum disorder}}. {Autism};2017 (Sep 01):1362361317716606.
Daily living skills deficits are strongly associated with poor adult outcomes for individuals with high-functioning autism spectrum disorder, and yet, there are no group interventions targeting daily living skills. Seven adolescents with autism spectrum disorder and their parents participated in a feasibility pilot of a 12-week manualized group treatment targeting specific daily living skills (i.e. morning routine, cooking, laundry, and money management). Outcomes included the Vineland Adaptive Behavior Scales, Second Edition (Vineland-II) age equivalence scores and four goal attainment scaling scores. Adolescents demonstrated significant improvement on two Vineland-II subdomains and on all goal attainment scaling scores at post-treatment and 6-month follow-up. The intervention has promise for improving critical daily living skills’ deficits that affect independent living and employment. Limitations and implications for future studies are discussed.
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5. George R, Stokes MA. {{Gender identity and sexual orientation in autism spectrum disorder}}. {Autism};2017 (Sep 01):1362361317714587.
Clinical impressions indicate that there is an overrepresentation of gender-dysphoria within the autism spectrum disorder. However, little is presently known about the demographics of gender-identity issues in autism spectrum disorder. Based upon what little is known, we hypothesized that there would be an increased prevalence of gender-dysphoria among those with autism spectrum disorder compared to a typically developing population. We surveyed gender-dysphoria with the Gender-Identity/Gender-Dysphoria Questionnaire among 90 males and 219 females with autism spectrum disorder and compared these rates to those of 103 males and 158 females without autism spectrum disorder. When compared to typically developing individuals, autistic individuals reported a higher number of gender-dysphoric traits. Rates of gender-dysphoria in the group with autism spectrum disorder were significantly higher than reported in the wider population. Mediation analysis found that the relationship between autistic traits and sexual orientation was mediated by gender-dysphoric traits. Results suggest that autism spectrum disorder presents a unique experience to the formation and consolidation of gender identity, and for some autistic individuals, their sexual orientation relates to their gender experience. It is important that clinicians working with autism spectrum disorder are aware of the gender-diversity in this population so that the necessary support for healthy socio-sexual functioning and mental well-being is provided.
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6. Guler J, de Vries PJ, Seris N, Shabalala N, Franz L. {{The importance of context in early autism intervention: A qualitative South African study}}. {Autism};2017 (Sep 01):1362361317716604.
The majority of individuals with autism spectrum disorder live in low- and middle-income countries and receive little or no services from health or social care systems. The development and validation of autism spectrum disorder interventions has almost exclusively occurred in high-income countries, leaving many unanswered questions regarding what contextual factors would need to be considered to ensure the effectiveness of interventions in low- and middle-income countries. This study qualitatively explored contextual factors relevant to the adaptation of a caregiver-mediated early autism spectrum disorder intervention in a low-resource South African setting. We conducted four focus groups and four in-depth interviews with 28 caregivers of young children with autism spectrum disorder and used thematic analysis to identify key themes. Eight contextual factors including culture, language, location of treatment, cost of treatment, type of service provider, support, parenting practices, and stigma emerged as important. Caregivers reported a preference for an affordable, in-home, individualized early autism spectrum disorder intervention, where they have an active voice in shaping treatment goals. Distrust of community-based health workers and challenges associated with autism spectrum disorder-related stigma were identified. Recommendations that integrate caregiver preferences with the development of a low-cost and scalable caregiver-mediated early autism spectrum disorder intervention are included.
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7. Hartley T, Potter R, Badalato L, Smith AC, Jarinova O, Boycott KM. {{Fragile X testing as a second-tier test}}. {Genet Med};2017 (Sep 14)
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8. Li L, Li XL, Wu WX, Cai XF, Fan XL, Wei XH, Sun TT. {{[Cross-sectional survey of autism spectrum disorders in children aged 0-6 years in Hainan province]}}. {Zhonghua Liu Xing Bing Xue Za Zhi};2017 (Sep 10);38(9):1187-1190.
Objective: To understand the prevalence of autism spectrum disorders (ASD) in children aged 0-6 years old and influencing factors in Hainan province. Methods: A total of 37 862 children aged 0-6 years were selected from 18 counties in Hainan province for a screening by using questionnaire of »warning signs in child development », then field diagnosis was made, and general descriptive statistic analysis was conducted. The prevalence of ASD and related factors were analyzed with chi(2) test and unconditional logistic regression model. Results: Among 37 862 children aged 0-6 years, 235 were diagnosed with ASD, the prevalence of ASD was 0.62% (0.99% in boys, 0.17% in girls), the differences was significant (chi(2)=101.91, P=0.000). The prevalence of ASD increased with age (chi(2)=288.62, P=0.000). The prevalence of ASD was significantly higher in urban area than in other areas (chi(2)=114.77, P=0.000). Factors such as full term pregnancy or not, neonatal asphyxia, father’s characteristics, father’s habit of chewing areca or smoking, mother’s general mood, and mother’s induced abortion history were the influencing factors for ASD. Conclusion: The prevalence of ASD in children aged 0-6 years was high in Hainan and was influenced by genetic factors, pregnancy and delivery process, parents unhealthy habit before and during pregnancy and other factors.
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9. Li W, Wang Z, Zhang L, Qiao L, Shen D. {{Remodeling Pearson’s Correlation for Functional Brain Network Estimation and Autism Spectrum Disorder Identification}}. {Front Neuroinform};2017;11:55.
Functional brain network (FBN) has been becoming an increasingly important way to model the statistical dependence among neural time courses of brain, and provides effective imaging biomarkers for diagnosis of some neurological or psychological disorders. Currently, Pearson’s Correlation (PC) is the simplest and most widely-used method in constructing FBNs. Despite its advantages in statistical meaning and calculated performance, the PC tends to result in a FBN with dense connections. Therefore, in practice, the PC-based FBN needs to be sparsified by removing weak (potential noisy) connections. However, such a scheme depends on a hard-threshold without enough flexibility. Different from this traditional strategy, in this paper, we propose a new approach for estimating FBNs by remodeling PC as an optimization problem, which provides a way to incorporate biological/physical priors into the FBNs. In particular, we introduce an L1-norm regularizer into the optimization model for obtaining a sparse solution. Compared with the hard-threshold scheme, the proposed framework gives an elegant mathematical formulation for sparsifying PC-based networks. More importantly, it provides a platform to encode other biological/physical priors into the PC-based FBNs. To further illustrate the flexibility of the proposed method, we extend the model to a weighted counterpart for learning both sparse and scale-free networks, and then conduct experiments to identify autism spectrum disorders (ASD) from normal controls (NC) based on the constructed FBNs. Consequently, we achieved an 81.52% classification accuracy which outperforms the baseline and state-of-the-art methods.
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10. McDougall F, Willgoss T, Hwang S, Bolognani F, Murtagh L, Anagnostou E, Rofail D. {{Development of a patient-centered conceptual model of the impact of living with autism spectrum disorder}}. {Autism};2017 (Sep 01):1362361317718987.
The aim of this study was to generate a patient-centered conceptual model of the impact of living with autism spectrum disorder, which can be used to support the selection of outcome measures for clinical trials. Following an initial literature review to identify preliminary concepts and inform an interview guide, in-depth face-to-face interviews were conducted with adolescents and adults with autism spectrum disorder (IQ 70) (n = 10), as well as parents of children, adolescents, and adults with autism spectrum disorder (IQ 70) (n = 26). Data were analyzed using established qualitative research methods. The resultant conceptual model contains three interrelated domains reflecting core symptoms of autism spectrum disorder (communication deficits, socialization deficits, and restrictive, repetitive patterns of behavior), three domains reflecting associated symptoms of autism spectrum disorder (physical, cognitive, and emotional/behavioral), and three domains representing the impacts of living with autism spectrum disorder (impacts on activities of daily living, school/work, and social life). Interview respondents also cited social communication deficits as priority targets for new treatments. The conceptual model provides a patient-centered perspective of relevant concepts of autism spectrum disorder from the perspectives of people with autism spectrum disorder and their parents and offers a valuable tool for identifying valid patient-centered outcome measures for future clinical trials.
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11. Richman KA, Bidshahri R. {{Autism, theory of mind, and the reactive attitudes}}. {Bioethics};2017 (Sep 15)
Whether to treat autism as exculpatory in any given circumstance appears to be influenced both by models of autism and by theories of moral responsibility. This article looks at one particular combination of theories: autism as theory of mind challenges and moral responsibility as requiring appropriate experience of the reactive attitudes. In pursuing this particular combination of ideas, we do not intend to endorse them. Our goal is, instead, to explore the implications of this combination of especially prominent ideas about autism and about moral responsibility. These implications can be quite serious and practical for autists and those who interact directly with autists, as well as for broader communities as they attend to the fair, compassionate, and respectful treatment of increasing numbers of autistic adults. We find that these theories point to a limited range of situations in which autists should not be blamed for transgressive actions for which neurotypical individuals should be blamed. We build on what others have written on these issues by bringing in a recent cognitive model of the role theory of mind plays in empathy, by discussing the social implications of the theoretical findings, and by raising questions about the compatibility of reactive attitude theories of moral responsibility with the neurodiversity approach to autism.
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12. Ryan S, Lai J, Weiss JA. {{Mental Health Service Use Among Youth with Autism Spectrum Disorder}}. {J Dev Behav Pediatr};2017 (Sep 07)
OBJECTIVE: Although youth with autism have elevated rates of mental health problems compared to typically developing youth, little is known about the mental health services that they receive. The current study examines predisposing, enabling, and clinical need factors as they relate to mental health service use in youth with autism. METHODS: The current study surveyed parents of 2337 children and adolescents with autism, compared their access to behavioral management and mental health treatment (MHT), and isolated the correlates of such receipt. RESULTS: Children used behavioral management more than adolescents, whereas the opposite was true for MHT. Mental health treatment receipt was associated with caregiver-related and mental health problems in both age groups, with routine health service use in children and with behavioral problems in adolescents. Behavioral management was correlated with caregiver-related services and behavioral problems in both age groups, and with sex and intellectual disability in adolescents. CONCLUSION: Clinical needs and caregiver service use are consistently associated with mental health care across ages, whereas the role of youth characteristics is particularly relevant when considering service use for adolescents.
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13. Stahlhut M, Hill K, Bisgaard AM, Jensen AK, Andersen M, Leonard H, Downs J. {{Measurement of Sedentary Behaviors or « Downtime » in Rett Syndrome}}. {J Child Neurol};2017 (Oct);32(12):1009-1013.
This study aimed to validate measures of sedentary time in individuals with Rett syndrome. Twenty-six individuals (median [IQR] age 16.0 (9.4-20.6) years) wore an activPAL accelerometer during video-taped activities and agreement was determined between sedentary time determined by the activPAL and observation. For 11 individuals (median [IQR] age 14.5 (11.5-25.6) years), linear regression was used to determine the relationship between sedentary time recorded on the modified Bouchard activity record diary card and measured using the activPAL. In comparison to observation, the activPAL accurately measured duration of sedentary time with a mean difference (limit of agreement) of -1.0 (6.3) minutes. The duration of Bouchard activity record downtime accounted for 73% of the variance of sedentary time measured by the activPAL (coefficient 0.762, 95% CI 0.413 to 1.111). These data provide clinicians and caregivers with capacity to investigate strategies that would aim to increase activity in the nonexercise component of the activity continuum.
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14. Tint A, Weiss JA. {{A qualitative study of the service experiences of women with autism spectrum disorder}}. {Autism};2017 (Sep 01):1362361317702561.
It is recognized that the experiences of women with autism spectrum disorder are often underrepresented in the literature. In this study, 20 women with autism spectrum disorder participated in five focus groups with discussions centered on their service use, unmet service needs, and barriers to care. Overall, women emphasized high unmet service needs, particularly with respect to mental health concerns, residential supports, and vocational and employment services. Participants also perceived many service providers as disregarding or misunderstanding women’s service needs. Findings of the current exploratory study are discussed in relation to areas of future research required to ensure effective care for this understudied population.
