1. Abouzed M, Gabr A, Elag KA, Soliman M, Elsaadouni N, Elzahab NA, Barakat M, Elsherbiny A. The prevalence, correlates, and clinical implications of hoarding behaviors in high-functioning autism. Sci Rep;2024 (Nov 18);14(1):28471.

This study aimed to investigate the relationships between hoarding behaviors, autism characteristics, and demographic factors in adults diagnosed with high-functioning ASD (Autism Spectrum Disorder). A total of 112 adults, aged 18-35, with high-functioning ASD completed self-reported assessments on hoarding (Savings Inventory-Revised; SI-R) and autism traits (Autism-Spectrum Quotient; AQ). Additionally, demographic data was gathered. Correlation and regression analyses were performed. The findings revealed positive correlations between hoarding and overall autism traits. Autism quotient scores accounted for 24% of the variance in hoarding inventory scores. Higher AQ scores were associated with increased SI-R scores. Specific AQ subscales were linked to particular SI-R subscales. Gender, age, education level, and employment status were connected to assessment scores. A multiple regression analysis revealed that demographic variables accounted for 19% of the variance in hoarding severity. Gender was found to moderate the impact of age on hoarding behaviors. Significant associations were identified between hoarding tendencies and autism traits in adults with ASD. Demographic variables also played a role in symptom presentation. These findings shed light on the relationship between autism characteristics and hoarding behaviors, as well as how external factors influence them. Further research is necessary to enhance understanding and guide interventions for hoarding in ASD populations.

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2. Ardeleanu K, Steinberg H, Garfield T, Voltaire S, Shea L, Brown M, Chvasta K, Tan CD. Self-identification of autism: Why some autistic adults lack a clinical diagnosis and why this matters for inclusion. Autism;2024 (Nov 18):13623613241297222.

Most autism research and services focus on individuals with formal autism diagnoses. However, autism activists and self-advocates have raised awareness about the challenges that can prevent individuals from seeking or getting an autism diagnosis. We interviewed 65 queer and transgender adults who either self-identified as autistic without a formal diagnosis or who had a formal autism diagnosis. We found that participants made meaning of their autistic diagnosis and/or identity and found affirmation in this, faced significant barriers and deterrents to getting diagnosed, and experienced invalidation as both a barrier to and product of diagnosis. Due to the challenges that individuals face in getting a diagnosis, we recommend that researchers and advocates consider including self-identified autistic individuals in research and services.

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3. Arendt Langhoff A, Søeborg Nyhus A, Hansen ES, Kruse Ifversen F, Kromann Kristiansen SM, Toftgaard Henriksen S, Adjorlu A. VR Dialogues: Enhancing Communication Between Autistic Individuals and Their Special Education Teachers Through Virtual Activities. Stud Health Technol Inform;2024 (Nov 18);320:485-492.

This paper explores the potential of a Virtual Reality (VR) intervention to facilitate communication about sensitive topics between adolescents with Autism Spectrum Disorder and their special education teachers. The VR intervention was developed in collaboration with Special education teachers, incorporating feedback from a design workshop to create a VR application featuring activities like basketball, air hockey, drawing, and avatar customization. The VR application was evaluated through two sessions between one autistic adolescent and a special education teacher at a residential home for autistic adolescents. The results indicate that VR has the potential to be used as a space for sensitive conversation between autistic individuals and their special education teachers.

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4. Boylu ME, Görmez A, Turan Ş, Yeşilkaya Ü H, Boylu FB, Duran A. Offending and clinical characteristics of adults with autism spectrum disorder: Experience at forensic psychiatry center in Türkiye between 2012 and 2022. Autism Res;2024 (Nov 18)

The forensic and clinical need for better understanding of criminal offending in adults with ASD is increasingly recognized. To date, few studies have examined the differences and similarities between criminal offenders with and without ASD with respect to demographics, offending profiles, and clinical characteristics. This study, conducted in Turkey, is the first to conduct such as comparison using a national database of forensic files. Computerized search of the forensic records of 11,583 adults assessed between January 1, 2012, and January 1, 2022, for criminal responsibility by the Turkish Council of Forensic Medicine found 74 adults diagnosed with ASD; they ranged in age from 18 to 40. The demographic, clinical, and offending characteristics of these adults were compared to 100 adults without ASD selected from the remaining 11,779 records based on age (18-40 years) and year of assessment (10 from each year). The ASD group was younger, more likely to be unemployed and not living on their own. The ASD group was more likely to have co-morbid intellectual disability, ADHD, and OCD, while the non-ASD group was more likely to have co-morbid personality disorders, The ASD group was more likely to commit unplanned simple (non-penetrative) sexual and violent offenses against strangers; the non-ASD group was more likely to commit planned, qualified (penetrative) crimes against known persons. Impulsivity and manipulability were more often contributory in persons with ASD; revenge was more often contributory in persons without ASD. Adults with ASD were more likely to commit crimes on social media. In conclusion, this study found that adult offenders with and without ASD differed in demographics, psychiatric co-morbidities, and types of offending behaviors. These differences may have implications for the prevention of criminal offending in persons with ASD and addressing their needs once they are in the criminal justice system.

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5. Brito A, Tocantins FR, Brentani H, Fujita A, Taddei CR, Beltrão-Braga PCB. Autism Spectrum and gastrointestinal health: Screening on the influence of environmental factors on gastrointestinal problems. Autism Res;2024 (Nov 17)

Autism spectrum disorder (ASD) is a complex neurodevelopmental condition that combines genetic and environmental factors. The human microbiota is colonized by permanent or transitory microorganisms, depending on the host and the external factors controlling their permanence. The composition of the gut microbiota (GM) in ASD individuals is notably different from that in controls, which may contribute to the clinical conditions observed in these individuals. This study aimed to indirectly investigate the influence of GM on the gut-brain axis in individuals with ASD and controls by analyzing environmental factors that contribute to the microbiota composition. Two questionnaires were designed to collect data, one for the ASD Group (ASDG) and the other one for the Control Group (CG). The raw data from both questionnaires were collected from 2772 respondents. After triage, answers from 1687 ASD individuals, along with 466 respondents from the CG, were analyzed, resulting in a total of 2237 respondents. Our results showed that gastrointestinal problems (GP) escalate as individuals age and become more prominent in ASD individuals. In contrast, feeding problems (FP) did not appear to escalate in either group as individuals aged, even though the FP decreased in the CG. ANOVA revealed significant differences in breastfeeding status compared to GPs among preterm control individuals born via cesarean section (p-value = 0.027). The mean values of GP for breastfed and nonbreastfed individuals, for ASDG (0.257; 0.268) and CG (0.105; 0.248), highlighted the differences in breastfeeding effects on GP for the study groups. The use of antibiotics during pregnancy seemed to be significant for GPs in the ASDG only for breastfed individuals (p-value <0.001), but not in the CG group. In conclusion, variables such as mode of delivery, FPs, type of birth, and length of breastfeeding do not seem to be determining factors for GP in the ASDG but are relevant for the CG. However, for ASDG individuals whose mothers took antibiotics during pregnancy, breastfeeding may act as a protective factor, as maternal antibiotic administration during pregnancy seems to aggravate GP-values across the ages of the participants. Considering GP as a proxy for GM and recognizing the importance of GM composition for central nervous system (CNS) function, it appears that in individuals with ASD, GM seems to be more dependent on other factors, which might be linked to the genetic background of each one. These findings suggest that future studies of the gut-brain axis in individuals with ASD might consider the individual's genetic background, environmental factors, and GM.

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6. Cheong JLY, Mainzer RM, Doyle LW, Olsen JE, Ellis R, FitzGerald TL, Cameron KL, Rossetti L, Anderson PJ, Spittle AJ. Neurodevelopment at Age 9 Years Among Children Born at 32 to 36 Weeks’ Gestation. JAMA Netw Open;2024 (Nov 4);7(11):e2445629.

IMPORTANCE: Although children born moderate to late preterm (MLP; 32-36 weeks’ gestation) have more neurodevelopmental problems compared with children born early term or later (≥37 weeks’ gestation), detailed understanding of affected domains at school age is lacking. Little is known of risk factors for poorer development. OBJECTIVE: To examine whether being born MLP compared with being born early term or later is associated with neurodevelopmental outcomes at age 9 years and to describe factors associated with poorer neurodevelopment in children born MLP. DESIGN, SETTING, AND PARTICIPANTS: This prospective, longitudinal cohort study recruited children born MLP and children born early term or later with healthy birth weight (≥2500 g) at a single tertiary hospital in Melbourne, Victoria, Australia, between December 7, 2009, and March 26, 2014. Nine-year follow-up occurred between June 20, 2019, and February 27, 2024. EXPOSURE: Moderate to late preterm birth. MAIN OUTCOMES AND MEASURES: Cognitive ability, academic performance, motor function, behavior, and social communication skills, assessed at 9-year follow-up. Group differences were estimated using linear, logistic, or quantile regression adjusted for multiple birth and socioeconomic risk. Multiple imputation was used to account for missing data. Associations of antenatal and neonatal factors and developmental delay at 2 years with poorer 9-year neurodevelopment were explored using univariable regression. RESULTS: Of 201 recruited children born MLP and 201 born early term or later, 159 born MLP (79.1%; 72 [45.3%] male) and 137 born early term or later (68.2%; 75 [54.7%] male) were assessed. Compared with children born early term or later, children born MLP had lower mean (SD) full-scale IQ scores (105.2 [13.6] vs 110.1 [13.0]; adjusted mean difference, -4.4 [95% CI, -7.7 to -1.0]) and poorer performance for cognitive domains, including verbal comprehension, visuospatial, and working memory. They also had poorer academic performance: pseudoword decoding (mean [SD] score, 103.0 [11.3] vs 107.3 [10.5]; adjusted mean difference, -4.0 [95% CI, -7.0 to -1.1]) and mathematics (mean [SD] score, 96.6 [14.7] vs 101.5 [14.5]; adjusted mean difference, -5.0 [95% CI, -8.8 to -1.2]). Children born MLP had similar manual dexterity to those born early term or later (mean [SD] score, 8.4 [3.5] vs 9.1 [3.4]; adjusted mean difference, -0.9 [95% CI, -1.8 to 0.04]) but more behavioral difficulties (50 of 158 [31.7%] vs 29 of 135 [21.5%]; adjusted risk ratio, 1.57 [95% CI, 1.06-2.33]). Developmental delay at 2 years was associated with poorer 9-year neurodevelopment across multiple domains. CONCLUSIONS AND RELEVANCE: In this longitudinal cohort study of children born MLP, neurodevelopmental challenges persisted into school age. An assessment at age 2 years may assist in identifying children born MLP who are at risk of school-age impairments.

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7. Donahue MM, Robson E, Colgin LL. Hippocampal place cell sequences are impaired in a rat model of Fragile X Syndrome. bioRxiv;2024 (Oct 20)

Fragile X Syndrome (FXS) is a neurodevelopmental disorder that can cause impairments in spatial cognition and memory. The hippocampus is thought to support spatial cognition through the activity of place cells, neurons with spatial receptive fields. Coordinated firing of place cell populations is organized by different oscillatory patterns in the hippocampus during specific behavioral states. Theta rhythms organize place cell populations during awake exploration. Sharp wave-ripples organize place cell population reactivation during waking rest. Here, we examined the coordination of CA1 place cell populations during active behavior and subsequent rest in a rat model of FXS ( Fmr1 knockout rats). While the organization of individual place cells by the theta rhythm was normal, the coordinated activation of sequences of place cells during individual theta cycles was impaired in Fmr1 knockout rats. Further, the subsequent replay of place cell sequences was impaired during waking rest following active exploration. Together, these results expand our understanding of how genetic modifications that model those observed in FXS affect hippocampal physiology and suggest a potential mechanism underlying impaired spatial cognition in FXS. SIGNIFICANCE STATEMENT: Fragile X Syndrome (FXS) is a neurodevelopmental disorder that can cause impaired memory and atypical spatial behaviors such as « elopement » (i.e., wandering off and becoming lost). Activity in the CA1 subregion of the hippocampus supports spatial memory and spatial cognition, making it an important candidate to study in the context of FXS; however, how neuronal population activity in CA1 is affected by FXS is poorly understood. In this study, we found that the coordination of populations of CA1 neurons during active behavior and waking rest was impaired in a rat model of FXS. These results reveal hippocampal physiological deficits that may contribute to cognitive impairments in FXS.

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8. Franke CJ, Griffin JW, Naples AJ, Wolf JM, McPartland JC. Social Anxiety Reduces Visual Attention to the Eyes of Emotional Faces in Autistic Youth. J Autism Dev Disord;2024 (Nov 18)

Autism and social anxiety (SA) share behavioral features like reduced eye contact, variable social attention, and differences in social interactions. However, the impact of the co-occurrence of these conditions (e.g., autism with co-occurring SA) on social attention remains unknown. Therefore, we evaluated whether the degree of SA characteristics in autistic youth modulated (e.g., amplified or lessened) a core hallmark feature of autism: social attention, or looking at faces. Fifty-four autistic and 35 non-autistic children and adolescents completed a gaze-contingent eye-tracking (ET) paradigm, in which faces dynamically expressed happy or fearful expressions contingent on participant eye contact. SA characteristics were assessed via standardized self- and parent-report measures. Social attention was measured by calculating the average percent looking time at the face and eye regions of each emotional expression. Autistic participants looked less at faces than non-autistic participants, and higher self-report SA was associated with less looking at eyes in both autistic and non-autistic participants. SA features affect social attention similarly in autistic and non-autistic youth, highlighting the importance of considering co-occurring psychiatric characteristics when assessing social attention and eye contact in autistic individuals.

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9. Goebel S, Cordova-Martinez D, Verselis VK, Francesconi A. Dampened α7 nAChR activity contributes to audiogenic seizures and hyperactivity in a mouse model of Fragile X Syndrome. bioRxiv;2024 (Nov 3)

Fragile X Syndrome (FXS) is the most common form of inherited intellectual disability and often accompanied with debilitating pathologies including seizures and hyperactivity. FXS arises from a trinucleotide repeat expansion in the 5′ UTR of the FMR1 gene that silences expression of the RNA-binding protein FMRP. Despite progress in understanding FMRP functions, the identification of effective therapeutic targets has lagged and at present there are no viable treatment options. Here we identify the α7 nicotinic acetylcholine receptor (nAChR) as candidate target for intervention in FXS. In the early postnatal hippocampus of Fmr1 knockout (KO) mice, an established pre-clinical model of FXS, the α7 nAChR accessory protein Ly6H is abnormally enriched at the neuronal surface and mislocalized in dendrites. Ly6H, a GPI-anchored protein, binds α7 nAChRs with high affinity and can limit α7 nAChR surface expression and signaling. We find that α7 nAChR-evoked Ca (2+) responses are dampened in immature glutamatergic and GABAergic Fmr1 (KO) neurons compared to wild type. Knockdown of endogenous Ly6H in Fmr1 (KO) neurons is sufficient to rescue dampened α7 nAChR Ca (2+) responses in vitro, providing evidence of a cell-autonomous role for Ly6H aberrant expression in α7 nAChR hypofunction. In line with intrinsic deficits in α7 nAChR activity in Fmr1 (KO) neurons, in vivo administration of the α7 nAChR-selective positive allosteric modulator PNU-120596 reduced hyperactivity and seizure severity in adolescent Fmr1 (KO) mice. Our mechanistic studies together with evidence of the in vivo efficacy of α7 nAChR augmentation implicate α7 nAChR hypofunction in FXS pathology. SUMMARY: Correction of α7 nAChR hypofunction in a preclinical murine model of Fragile X syndrome ameliorates seizure severity and hyperactivity.

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10. Hack JB, Watkins JC, Schreiber JM, Hammer MF. Patients carrying pathogenic SCN8A variants with loss- and gain-of-function effects can be classified into five subgroups exhibiting varying developmental and epileptic components of encephalopathy. Epilepsia;2024 (Nov);65(11):3324-3334.

OBJECTIVE: Phenotypic heterogeneity presents challenges in providing clinical care to patients with pathogenic SCN8A variants, which underly a wide disease spectrum ranging from neurodevelopmental delays without seizures to a continuum of mild to severe developmental and epileptic encephalopathies (DEEs). An important unanswered question is whether there are clinically important subgroups within this wide spectrum. Using both supervised and unsupervised machine learning (ML) approaches, we previously found statistical support for two and three subgroups associated with loss- and gain- of- function vari-ants, respectively. Here, we test the hypothesis that the unsupervised subgroups (U1-U3) are distinguished by differential contributions of developmental and epileptic components. METHODS: We predicted that patients in the U1 and U2 subgroups would differ in timing of developmental delay and seizure onset, with earlier and concurrent onset of both features for the U3 subgroup. Standard statistical procedures were used to test these predictions, as well as to investigate clinically relevant associations among all five subgroups. RESULTS: Two-population proportion and Kruskal-Wallis tests supported the hypothesis of a reversed order of developmental delay and seizure onset for patients in U1 and U2, and nearly synchronous developmental delay/seizure onset for the U3 (termed DEE) subgroup. Association testing identified subgroup variation in treatment response, frequency of initial seizure type, and comorbidities, as well as different median ages of developmental delay onset for all five subgroups. SIGNIFICANCE: Unsupervised ML approaches discern differential developmental and epileptic components among patients with SCN8A-related epilepsy. Patients in U1 (termed developmental encephalopathy) typically gain seizure control yet rarely experience improvements in development, whereas those in U2 (termed epileptic encephalopathy) have fewer if any developmental impairments despite difficulty in achieving seizure control. This understanding improves prognosis and clinical management and provides a framework to discover mechanisms underlying variability in clinical outcome of patients with SCN8A-related disorders.

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11. Han X, He Y, Wang Y, Hu W, Chu C, Huang L, Hong Y, Han L, Zhang X, Gao Y, Lin Y, Ma H, Shen H, Ke X, Liu Y, Hu Z. Deficiency of FABP7 Triggers Premature Neural Differentiation in Idiopathic Normocephalic Autism Organoids. Adv Sci (Weinh);2024 (Nov 18):e2406849.

Autism spectrum disorder (ASD), which is caused by heterogeneous genetic and environmental factors, is characterized by diverse clinical phenotypes linked to distinct pathological mechanisms. ASD individuals with a shared clinical phenotype might contribute to revealing the molecular mechanism underlying ASD progression. Here, it is generated induced pluripotent stem cell (iPSC)-derived cerebral organoids from normocephalic individuals with ASD in a prospective birth cohort with a shared clinical diagnosis. Multiple cell lines and time series scRNA-seq combined with a histomorphological analysis revealed premature neural differentiation of neural stem cells (NSCs) and decreased expression of Fatty acid binding protein 7 (FABP7) in ASD organoids. It is subsequently revealed alterations in the phosphorylation levels of Mitogen-Activated Protein Kinase Kinase 1/2 (MEK1/2), which are downstream of FABP7, and the regulation of the FABP7/MEK pathway reversed improper neural differentiation in the ASD organoids. Moreover, both Fabp7-knockdown and MEK2-overexpressing mice exhibited repetitive stereotyped behaviors and social defects relevant to autism. This study reveals the role of the FABP7/MEK pathway in abnormal NSC differentiation in normocephalic individuals with ASD, which might provide a promising therapeutic target for ASD treatment.

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12. Kandeel M, Morsy MA, Al Khodair KM, Alhojaily S. Meta-analysis of the efficacy of camel milk consumption for improving autism symptoms in children in randomized clinical trials. Open Vet J;2024 (Sep);14(9):2441-2452.

BACKGROUND: Camel milk has emerged as a potential complementary therapy for autism spectrum disorder (ASD). AIM: This study aimed to gather evidence from randomized controlled trials (RCTs) on the effectiveness of camel milk consumption in improving symptoms and associated measures in children with ASD. METHODS: Comprehensive searches of multiple databases were conducted up to March 14, 2024, for RCTs that evaluated whether camel milk consumption by children with ASD was more beneficial than the consumption of a control substance. Quality and bias analyses and meta-anlaysis data were synthesized and analyzed. RESULTS: Of 136 records identified, 5 RCTs (n = 299 children) were selected. The mean difference in scores on the childhood autism rating scale (CARS) for the group given camel milk and the control groups was a mean deviation (MD) ‒0.75, 95% CI‒1.97 to 0.47, p = 0.23. The mean difference in CARS scores in the subgroup analyses for raw camel milk was MD‒0.95, 95% CI‒2.33 to 0.44, p = 0.18 and boiled camel milk MD ‒0.50, 95% CI‒1.93 to 0.93, p = 0.49. A qualitative synthesis found that raw camel milk intake led to improvements in various social behaviors in children with ASD. Camel milk consumption resulted in increased levels of anti-inflammatory, antioxidant, and immunomodulatory biomarkers, with some differences observed between patients given raw camel milk and boiled camel milk. CONCLUSION: Camel milk shows promise in improving social behaviors and certain biochemical markers in children with ASD, although the current meta-analysis did not document a significant statistical difference in CARS scores for the children studied. Future studies should focus on rigorous RCTs and larger sample sizes to substantiate these preliminary findings.

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13. Kearney J, Bosyj C, Rombos V, Curran AB, Clark B, Cornell W, Mah S, Mahurin M, Piroddi N, Sohl K, Zwaigenbaum L, Penner M. Correction: Community Provider Perspectives on an Autism Learning Health Network: A Qualitative Study. J Autism Dev Disord;2024 (Nov 18)

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14. Kumar A, Kumar A, Jayakody DNK. Ambiguous facial expression detection for Autism Screening using enhanced YOLOv7-tiny model. Sci Rep;2024 (Nov 18);14(1):28501.

Autism spectrum disorder is a developmental condition that affects the social and behavioral abilities of growing children. Early detection of autism spectrum disorder can help children to improve their cognitive abilities and quality of life. The research in the area of autism spectrum disorder reports that it can be detected from cognitive tests and physical activities of children. The present research reports on the detection of autism spectrum disorder from the facial attributes of children. Children with autism spectrum disorder show ambiguous facial expressions which are different from the facial attributes of normal children. To detect autism spectrum disorder from facial images, this work presents an improvised variant of the YOLOv7-tiny model. The presented model is developed by integrating a pyramid of dilated convolutional layers in the feature extraction network of the YOLOv7-tiny model. Further, its recognition abilities are enhanced by incorporating an additional YOLO detection head. The developed model can detect faces with the presence of autism features by drawing bounding boxes and confidence scores. The entire work has been carried out on a self-annotated autism face dataset. The developed model achieved a mAP value of 79.56% which was better than the baseline YOLOv7-tiny and state-of-the-art YOLOv8 Small model.

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15. Lineback K, Baer HC, Zhang Y, Hartenbach D, Mills-Koonce WR, Willoughby MT, Glowinski AL, Constantino JN, Marrus N. Independent Contributions of Callous-Unemotional Behaviors and Quantitative Autistic Traits to Aggression in Early Childhood. JAACAP Open;2024 (Jun);2(2):100-111.

OBJECTIVE: Callous-unemotional (CU) behaviors and quantitative autistic traits (QATs), heritable domains implicated in social development, are both associated with reduced prosocial behavior and increased aggression at their clinical extremes. However, they are hypothesized to contribute to aggression through separate mechanisms. This study tested whether CU behaviors and QATs exhibited distinct profiles of heritable influences as well as independent contributions to early childhood aggression in a general population sample with enhanced sensitivity to clarify these relationships. METHOD: Parents of 3- to 4-year-old epidemiologically representative twins ascertained from birth records (N = 113 pairs) completed questionnaires measuring CU behaviors, QATs, and aggression. Correlation coefficients indexed overlap across behaviors. Intraclass correlations were compared between monozygotic and dizygotic twins to characterize relative genetic and environmental influences. Generalized estimating equations tested contributions of CU subdomains, verified via factor analysis, and QATs to aggression. RESULTS: Total CU scores strongly correlated with QATs (r = 0.54) and aggression (r = 0.55), while QATs correlated moderately with aggression (r = 0.38). Among 3 identified CU factors, the uncaring factor strongly correlated with QATs (r = 0.52), while unemotional and callous factors showed small correlations (r = 0.25 and r = 0.16, respectively). QATs, aggression, and all CU factors except the callous factor showed heritable influences. Uncaring and callous factors as well as QATs demonstrated unique and shared contributions to aggression, with the callous factor being moderated by sex. CONCLUSION: Partially overlapping relations support distinct mechanisms whereby CU behaviors, in particular the callous factor, and QATs contribute to early aggression. In-depth social developmental assessment may enhance personalized intervention for aggression in early childhood. DIVERSITY & INCLUSION STATEMENT: We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure sex balance in the selection of non-human subjects. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. In this cross-sectional dimensional approach, authors evaluated the extent to which callous unemotional behaviors and quantitative autistic traits showed independent contributions to aggression at age 3 to 4 years based on heritable and environmental influences that set the stage for future outcomes. In 224 preschool-aged twins, callous-unemotional behaviors and quantitative autistic traits were independently associated with reduced prosocial behavior and increased aggression, accounting for almost 30% of the variance in aggression and evidence of some shared genetic influences. Callous-unemotional behaviors accounted for a greater unique contribution to variation in aggression than autistic traits. Callous behavior is also strongly influenced by environmental factors and showed a stronger relationship with aggression in boys than in girls. These results suggest that in early childhood, quantitative autistic traits and callous-unemotional behaviors may represent distinct pathways to aggression. eng

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16. Ma W, Dai X, Zhang H. Perception and Production of Pitch Information in Mandarin-Speaking Children with Autism Spectrum Disorders. J Autism Dev Disord;2024 (Nov 18)

This study investigated the categorical perception (CP) of linguistic pitch (lexical tones) and nonlinguistic pitch (pure tones), as well as tonal production in Mandarin-speaking children with autism spectrum disorders (ASD). A total of 26 Mandarin-speaking children with ASD and 29 age-matched typically developing (TD) children were recruited for this study. The Mandarin T2-T3 contrast and corresponding pure tones with identical pitch contours were adopted to assess the nuanced pitch processing abilities of the child participants via the CP paradigm. Accordingly, tonal production was focused on T2 and T3 with analyses of the dynamic pitch contours and tonal differentiation. Mandarin-speaking children with ASD exhibited atypical CP for linguistic pitch in comparison with their TD peers. However, the categorization of linguistic pitch exceeded that of nonlinguistic pitch among the ASD participants, indicating a global over local processing pattern contrary to autistic individuals in non-tonal languages. Additionally, despite atypical pitch contours in producing T2 and T3, the ASD group showed comparable differentiable degrees of the two tones in production to the TD group. Findings of this study served as a foray into contesting current theories’ claims of local bias and/or global impairment in the autistic population, prompting further inspections on individuals with different language backgrounds and stimuli processing with various complexities. Additionally, findings of this study underscore the necessity of developing tailored assessments and interventions to enhance the perception and production of complex and confusable tones, thereby improving perceptual robustness and communication skills in Mandarin-speaking children with ASD.

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17. Matsumoto N, Mitsui T, Kadowaki T, Mitsuhashi T, Hirota T, Masuyama H, Yorifuji T. In vitro fertilization and long-term child health and development: nationwide birth cohort study in Japan. Eur J Pediatr;2024 (Nov 18);184(1):24.

The aim of this study is to compare long-term health outcomes between IVF-conceived children and non-IVF-conceived children in Japan, in the context of strong recommendation for single embryo transfer. Using data from a nationwide birth cohort linked with perinatal database, this study analyzed 2140 children born in Japan in May 2010. It compared child health and development outcomes up to 9 years of age between IVF-conceived and non-IVF-conceived children (binary exposure). A Poisson regression with robust variance to estimate the risk ratios for the association between IVF and various long-term child health and developmental outcomes. After adjusting for confounding factors, no significant differences were observed between IVF-conceived and naturally conceived children for most outcomes, including hospitalization, obesity, and developmental milestones. IVF-conceived children showed a slightly lower risk of attention problems at 8 years (adjusted Risk Ratio [aRR]: 0.73, 95% CI: 0.53-1.00). In subgroup analyses, IVF-conceived term children and singletons demonstrated reduced risk of cognitive delays at 5.5 years (aRR: 0.31, 95% CI: 0.10-0.96 and aRR: 0.37, 95% CI: 0.14-0.98, respectively).Conclusion: In this Japanese cohort, IVF conception was not associated with adverse long-term health or developmental outcomes. These findings provide reassurance about the safety of IVF, particularly in the context of single embryo transfer policies. Further research is needed to explore specific IVF protocols and subgroups.

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18. Mehta V, Tripathy S, Merchant Y, Mathur A, Negi S, Shamim MA, Abullais SS, Al-Qarni MA, Karobari MI. Oral health status of children with intellectual and developmental disabilities in India: a systematic review and meta-analysis. BMC Pediatr;2024 (Nov 18);24(1):748.

INTRODUCTION: India has committed to the Sustainable Development Goals (SDGs) 2030 principle of « Leave No One Behind », which seeks to reduce disparities and vulnerabilities. The dearth of data on the oral health conditions of children with intellectual and developmental (IDD) disabilities in India is significant. Our systematic review intended to collate and synthesise data on the oral health status of children with IDD. METHODS: Online electronic databases such as PubMed-MEDLINE, Embase, and Scopus were searched using appropriate keywords from the earliest available data until 31st March 2024, with no language restriction. Cross-sectional studies conducted amongst individuals below 18 years of age with intellectual, or developmental disabilities, in India were included. Quality assessment and meta-analysis using a random-effects model for variables reported from four or more studies and a prediction interval was calculated. RESULTS: Out of 2388 studies, a total of 15 studies were included. Our study showed that 91% (95% [confidence interval] CI: 0.80-0.96) of IDD children use toothbrushes regularly. However, poor oral hygiene was found among 38% (95% CI = 0.21-0.59) of IDD children. The pooled prevalence of dental caries among children was found to be 64% (95% CI: 0.45-0.79). Periodontal disease was reported in only one study among 54.20% of IDD children. CONCLUSIONS: Our findings suggest that despite brushing regularly the incidence of caries and poor oral hygiene in children with IDD is high. Flexible, tailored interventions that go beyond a uniform approach must be implemented to effectively address oral health requirements of children with IDD. Specific Health Programmes should be established for their preventive oral care.

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19. Miozzo F, Murru L, Maiellano G, di Iasio I, Zippo AG, Zambrano Avendano A, Metodieva VD, Riccardi S, D’Aliberti D, Spinelli S, Canu T, Chaabane L, Hirano S, Kas MJH, Francolini M, Piazza R, Moretto E, Passafaro M. Disruption of the autism-associated Pcdh9 gene leads to transcriptional alterations, synapse overgrowth, and defective network activity in the CA1. J Neurosci;2024 (Nov 18)

Protocadherins, a family of adhesion molecules with crucial role in cell-cell interactions, have emerged as key players in neurodevelopmental and psychiatric disorders. In particular, growing evidence links genetic alterations in Protocadherin 9 (PCDH9) gene with Autism Spectrum Disorder (ASD) and Major Depressive Disorder (MDD). Furthermore, Pcdh9 deletion induces neuronal defects in the mouse somatosensory cortex, accompanied by sensorimotor and memory impairment. However, the synaptic and molecular mechanisms of PCDH9 in the brain remain largely unknown, particularly concerning its impact on brain pathology. To address this question, we conducted a comprehensive investigation of PCDH9 role in the male mouse hippocampus at the ultrastructural, biochemical, transcriptomic, electrophysiological and network level. We show that PCDH9 mainly localizes at glutamatergic synapses and its expression peaks in the first week after birth, a crucial time window for synaptogenesis. Strikingly, Pcdh9 KO neurons exhibit oversized presynaptic terminal and postsynaptic density (PSD) in the CA1. Synapse overgrowth is sustained by the widespread up-regulation of synaptic genes, as revealed by single-nucleus RNA-seq (snRNA-seq), and the dysregulation of key drivers of synapse morphogenesis, including the SHANK2/CORTACTIN pathway. At the functional level, these structural and transcriptional abnormalities result into increased excitatory postsynaptic currents (mEPSC) and reduced network activity in the CA1 of Pcdh9 KO mice. In conclusion, our work uncovers Pcdh9 pivotal role in shaping the morphology and function of CA1 excitatory synapses, thereby modulating glutamatergic transmission within hippocampal circuits.Significance statement Converging evidence indicates that genetic alterations in Protocadherin 9 (PCDH9) gene are associated with Autism Spectrum Disorder (ASD) and Major Depressive Disorder (MDD). However, our understanding of PCDH9 physiological role and molecular mechanisms in the brain, as well as its connection to synaptic dysfunction and brain pathology, remains limited. Here we demonstrate that Pcdh9 regulates the transcriptional profile, morphology and function of glutamatergic synapses in the CA1, thereby tuning hippocampal network activity. Our results elucidate the molecular and synaptic mechanisms of a gene implicated in neurodevelopmental and psychiatric disorders, and suggest potential hippocampal alterations contributing to the cognitive deficits associated with these conditions.

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20. Mpaka DM, Lukusa L, Muchanga SMJ, Vogels A, Ndjukendi AO, Mutonji AB, Kavira DL, Nzuzi JM, Matonda-Ma-Nzuzi T, Mampunza SM, Mukau JE. Determinants of Positive Evolution of Symptoms in Children with Autism Spectrum Disorders (ASD) during the COVID-19 Lockdown in the Democratic Republic of Congo. (DRC). J Autism Dev Disord;2024 (Nov 18)

Lockdown imposed by the COVID 19 pandemic increased the time families spent together at home. A negative impact of the lock-down on children with autism has been reported. Few studies described the positive impact of parents’ presence on the severity of their children’s autism symptoms during lockdown. To describe the positive impact of the COVID-19 lockdown on the evolution of Children’ Symptoms with autism and parents’ emotional status and to determine which variables had a positive or negative impact on the severity of autism features in Kinshasa. From April 15 to July 15, 2020, we analyzed the evolution of core symptoms of 68 children with autism and correlated these findings with the presence of a parent at home during lockdown. We performed multivariate logistic regression to assess the factors associated to autism symptoms improvement after adjustment by sex, age at ASD diagnosis, education, parent occupation, child’s occupancy time, presence of parent’s depression, and presence of comorbidities and core symptoms in children. Parents reported ASD symptom improvement in 42.6% of children. Factors positively associate with ASD symptoms improvement were presence of a parent for more than 8 h per day, improvement of social communication and autonomy. In contrast, severe to moderate depression in parents and presence of main comorbidities in children were associated with more severe autistic symptoms in their children. The presence of a parent at home, improved child communication and autonomy improved autism symptoms. On the other hand, parental depression and comorbidities in children with ASD aggravated the symptoms during lockdown in Kinshasa/DRC. These findings emphasize the importance of the physical presence of parents as well as the length of time they spend with their children with ASD. In addition, they show that depressive feelings in parents and comorbidities in ASD have a negative impact in the severity of their symptoms during lockdown.

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21. Murray SO, Seczon DL, Pettet M, Rea HM, Woodard KM, Kolodny T, Webb SJ. Increased alpha power in autistic adults: Relation to sensory behaviors and cortical volume. Autism Res;2024 (Nov 18)

Alpha-band (~10 Hz) neural oscillations, crucial for gating sensory information, may offer insights into the atypical sensory experiences characteristic of autism spectrum disorder (ASD). We investigated alpha-band EEG activity in autistic adults (n = 29) compared with a nonautistic group (n = 23) under various stimulus-driven and resting-state conditions. The autistic group showed consistently higher alpha amplitude across all time points. In addition, there was proportionally more suppression of alpha at stimulus onset in the autistic group, and alpha amplitude in this stimulus-onset period correlated with sensory behaviors. Recent research suggests a link between subcortical structures’ volume and cortical alpha magnitude. Prompted by this, we explored the association between alpha power and the volume of subcortical structures and total cortical volume in ASD. Our findings indicate a significant correlation with total cortical volume and a group by hippocampal volume interaction, pointing to the potential role of anatomical structural characteristics as potential modulators of cortical alpha oscillations in ASD. Overall, the results highlight altered alpha in autistic individuals as potentially contributing to the heightened sensory symptoms in autistic compared with nonautistic adults.

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22. Poulsen R, Williams Z, Dwyer P, Pellicano E, Sowman PF, McAlpine D. How auditory processing influences the autistic profile: A review. Autism Res;2024 (Nov 17)

We need to combine sensory data from various sources to make sense of the world around us. This sensory data helps us understand our surroundings, influencing our experiences and interactions within our everyday environments. Recent interest in sensory-focused approaches to supporting autistic people has fixed on auditory processing-the sense of hearing and the act of listening-and its crucial role in language, communications, and social domains, as well as non-social autism-specific attributes, to understand better how sensory processing might differ in autistic people. In this narrative review, we synthesize published research into auditory processing in autistic people and the relationship between auditory processing and autistic attributes in a contextually novel way. The purpose is to understand the relationship between these domains more fully, drawing on evidence gleaned from experiential perspectives through to neurological investigations. We also examine the relationship between auditory processing and diagnosable auditory conditions, such as hyperacusis, misophonia, phonophobia, and intolerance to loud sounds, as well as its relation to sleep, anxiety, and sensory overload. Through reviewing experiential, behavioral and neurological literature, we demonstrate that auditory processes interact with and shape the broader autistic profile-something not previously considered. Through a better understanding of the potential impact of auditory experiences, our review aims to inform future research on investigating the relationship between auditory processing and autistic traits through quantitative measures or using qualitative experiential inquiry to examine this relationship more holistically.

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23. Rivera-Figueroa K, Milan S, Dumont-Mathieu T, Quinn D, Eigsti IM. Racial and ethnic group differences in service utilization in children with autism spectrum disorder: The role of parental stigma. Autism;2024 (Nov 18):13623613241298043.

Racial and ethnic disparities in service utilization in autism are widely documented. Autism-related parental stigma may play a role if parents from racial/ethnic minoritized backgrounds experience dual stigma from autism and from membership in a marginalized group. This study examines racial/ethnic differences in autism-related stigma and compares the impact of stigma on service utilization in a large, diverse sample of US-based parents of autistic children (final sample = 764; White 41.6%, Black 16.6%, Latino/a/x/Hispanic 20.9%, Asian 7.5%, Multiracial 9.6%, Native American 1.8%, Pacific Islander 0.5%, Middle Eastern 0.2%, and Other 0.2%). Parents completed online surveys assessing affiliate and community stigma, service utilization, and perceived unmet treatment needs. Small but significant racial/ethnic group differences emerged in some aspects of stigma and service utilization. Specifically, Asian and Latino/a/x parents were less likely to fully engage in recommended services; Asian parents endorsed less service availability; Latino/a/x and multiracial parents reported more unmet needs; and Asian and White parents reported significantly more affiliate stigma. There was little indication that stigma contributed to racial/ethnic differences in service utilization, except for Asian families. Results indicate that socioeconomic factors interact with race/ethnicity to impact service use and stigma.

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24. Ryan S, Ribenfors F, Mikulak M, Coles D. Between epistemic injustice and therapeutic jurisprudence: Coronial processes involving families of autistic people, people with learning disabilities and/or mental ill health. Sociol Health Illn;2024 (Nov 18)

Understanding how and why someone dies unexpectedly is key to bereaved family members. The coronial process in England investigates instances where the cause of death is unknown, violent or unnatural and/or occurred in state detention. Families are held to be at the centre of this process and the coroner’s role has extended to concern about therapeutic jurisprudence, that is, how legal processes can minimise negative consequences for participants without jeopardising due process. Therapeutic jurisprudence involves unresolved tensions, however, and an epistemic power imbalance. Within the inquest, knowledge is produced, evaluated and contested, and epistemic privilege may be unevenly distributed. The inquest is also a process that, as we demonstrate, requires epistemic courage and resistance on the part of families. Families with relatives who are autistic, have learning disabilities and/or mental ill health can experience epistemic and structural injustice before an unexpected death which makes the distinctiveness of their experiences important to understand. Here, we report on a qualitative interview project which focused on how bereaved families experience the coronial process after their relative died in receipt of health and/or social care support.

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25. Sivathasan S, Eldeeb S, Northrup JB, Antezana L, Ionadi A, Wakschlag LS, Mazefsky CA. Early Childhood Aggression in Autistic and Non-Autistic Preschoolers: Prevalence, Topography, and Relationship to Emotional Reactivity. JAACAP Open;2024 (Jun);2(2):112-125.

OBJECTIVE: Despite heightened rates of aggressive behaviors among older autistic youth relative to non-autistic peers, less is known about these behaviors during early childhood. This study included 3 objectives to address this gap: (1) to establish the prevalence and topography (frequency, severity, type, context) of aggressive behaviors in a large sample of preschool-aged children using a developmentally sensitive parent-report measure; (2) to identify clinical correlates of aggression; and (3) to investigate whether different subgroups of autistic children can be identified based on their profiles of aggression, emotional reactivity, and autism traits. METHOD: Data were analyzed from parents of 1,199 children 2 to 5 years of age (n = 622 autistic children) who completed the Multidimensional Assessment Profiles Scales (MAPS) aggression subscale and the Emotion Dysregulation Inventory-Young Child (EDI-YC) reactivity subscale. RESULTS: Autistic preschoolers had 2 to 6 times higher odds of experiencing frequent aggression (more days than not) compared with non-autistic preschoolers. Hierarchical multiple regression analyses revealed that autism diagnosis, traits, and suspected and diagnosed attention-deficit/hyperactivity disorder (ADHD) were positively associated with aggression; however, heightened emotional reactivity explained the greatest degree of added variance in aggression total scores. Machine learning clustering techniques revealed 3 distinct subgroups of autistic preschoolers, with cluster membership driven primarily by aggression and reactivity scores, and less so by autism traits. CONCLUSION: Autistic preschoolers display more frequent parent-reported aggressive behaviors, and emotional reactivity may play an important role in aggressive behavior presentation. Future developmental screening and early intervention tailoring for aggression may benefit from assessing reactivity early in development. DIVERSITY & INCLUSION STATEMENT: One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. One or more of the authors of this paper self-identifies as living with a disability. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work. In this study of 1,199 children aged 2 to 5 years of age (n = 622 autistic children), parents completed validated questionnaires quantifying disruptive behaviors and emotion dysregulation to evaluate prevalence and topography of aggressive behaviors, identifying clinical correlates of aggression, and determining distinct subgroups of children with autism based on patterns of aggression, reactivity, and autism traits. The authors found that preschoolers with autism had higher rates of frequent aggressive behaviors compared to non-autistic children. Although more aggression was associated with having an autism diagnosis, greater levels of autism traits, and attention-deficit/hyperactivity disorder, high levels of aggression were most strongly associated with heightened emotional reactivity. Subgroups of preschoolers with autism emerged principally on their aggression and emotional reactivity scores, rather than on their levels of autistic traits. eng

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26. Stransky ML, Cobb L, Menon N, Barnard E, Belfleur C, Scahill L, Kuhn J. Reinvigorating the Promise of the National Database for Autism Research (NDAR) to Advance Autism Knowledge. J Autism Dev Disord;2024 (Nov 18)

The National Institute of Mental Health created the National Database for Autism Research (NDAR) to accelerate autism knowledge through data sharing and collaboration. However, our experience using NDAR reveals systematic challenges across several aspects of data submission, selection, management, and analysis that limit utility of this resource. We describe our NDAR experience in an ongoing project examining autism intervention outcomes among marginalized racial, ethnic, and gender groups. For this study, we planned to gather data from NDAR to conduct an individual participant data meta-analysis. Eighteen studies met inclusion criteria and reported data on participants at more than one point in time on the Vineland Adaptive Behavior Scales (Vineland) and the Autism Diagnostic Observation Schedule (ADOS). The difficulties with submitting, selecting, downloading, and managing data from NDAR posed limitations on data availability and analysis. Of the 3,850 unique participants in the selected studies, data at multiple time points were available for 312 participants on the Vineland and 278 on the ADOS. No participants had data on all assessment domains. To accelerate autism research via data sharing and collaboration with NDAR necessitates improving the processes for submitting, selecting, and managing data.

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27. Touati R, Guénolé F, Guillery-Girard B, Wantzen P. Exploring the development of past and future episodic memory in adolescents with autism spectrum disorder: A preliminary longitudinal study. Cortex;2024 (Nov 8);181:194-203.

Adolescence is a critical period where individuals build their identity and consolidate how they interact with others. However, for adolescents with autism spectrum disorder (ASD), the development of identity and social bounds is at stake. These challenges with the development of identity and social bonds could be linked to difficulties in autobiographical memory (AM), whether recalling past events (past episodic memory; past EM) or imagining future scenarios (episodic future thinking; EFT). To date, developmental patterns of AM over time remain poorly understood in ASD. Eleven adolescents with ASD or typical development (TD) completed an assessment of past EM and EFT once per year for three years. Preliminary results show that past EM becomes more detailed over the years for adolescents with ASD, while there is no change for TD adolescents. Interestingly, only the content elements of the narrated events are increasing, not the context elements. Furthermore, EFT evolves in the TD group but remains stable in the ASD group. This first multi-case longitudinal study of AM needs to be replicated with more participants, but it seems to indicate a heterogeneous evolution of AM in ASD. For future studies, these results will lead us to explore the hypothesis of developmental delay and the factors influencing AM development in ASD. Finally, understanding these developmental pathways highlights the importance of personalized therapeutic approaches to support social integration, identity construction, and future projects for adolescents with ASD.

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28. Vanderplow AM, Dodis GE, Rhee Y, Cikowski JJ, Gonzalez S, Smith ML, Gogliotti RG. Site-blocking antisense oligonucleotides as a mechanism to fine-tune MeCP2 expression. Rna;2024 (Nov 18);30(12):1554-1571.

Rett syndrome (RTT) is a neurodevelopmental disorder caused by loss-of-function mutations in the methyl-CpG-binding protein 2 (MECP2) gene. Despite its severe phenotypes, studies in mouse models suggest that restoring MeCP2 levels can reverse RTT symptomology. Nevertheless, traditional gene therapy approaches are hindered by MeCP2’s narrow therapeutic window, complicating the safe delivery of viral constructs without overshooting the threshold for toxicity. The 3′ untranslated region (3′ UTR) plays a key role in gene regulation, where factors like miRNAs bind to pre-mRNA and fine-tune expression. Given that each miRNA’s contribution is modest, blocking miRNA binding may represent a potential therapeutic strategy for diseases with high dosage sensitivity, like RTT. Here, we present a series of site-blocking antisense oligonucleotides (sbASOs) designed to outcompete repressive miRNA binding at the MECP2 3′ UTR. This strategy aims to increase MeCP2 levels in patients with missense or late-truncating mutations, where the hypomorphic nature of the protein can be offset by enhanced abundance. Our results demonstrate that sbASOs can elevate MeCP2 levels in a dose-dependent manner in SH-SY5Y and patient fibroblast cell lines, plateauing at levels projected to be safe. Confirming in vivo functionality, sbASO administration in wild-type mice led to significant Mecp2 upregulation and the emergence of phenotypes associated with Mecp2 overexpression. In a T158M neural stem cell model of RTT, sbASO treatment significantly increased MeCP2 expression and levels of the downstream effector protein brain-derived neurotrophic factor (BDNF). These findings highlight the potential of sbASO-based therapies for MeCP2-related disorders and advocate for their continued development.

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29. Woods S, Doherty A, Hill J. Dietary interventions in autism: a critical appraisal and commentary on the findings of a systematic review. Br J Neurosci Nurs;2024 (Aug 2);20(4):142-147.

An estimated 1% of the global population is believed to be autistic. Clinical focus is often on interventions that target social functioning, sensory processing and communication. Dietary interventions are often explored as a means of targeting these core symptoms. However, research findings are often inconclusive due to small sample sizes. This commentary critically examines a meta-analysis focused on dietary interventions – including omega-3, vitamins, and other supplements – in the treatment of autism. It evaluates the study’s findings and contextualizes their implications for neurological nursing practice.

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30. Zhang H, Zhang L, Liu Z, Ma J. Prevalence and Clinical Correlates of Autistic Features in Patients with Initial-Treatment and Drug-Naive Schizophrenia. Alpha Psychiatry;2024 (Sep);25(5):611-616.

OBJECTIVE: A distinct subtype of schizophrenia (SCZ) is the one accompanied with autistic features (AF). This study aimed to determine the prevalence of AF in initial-treatment and drug-naive (ITDN) patients with SCZ and investigate its influencing factors. METHODS: The study recruited 710 ITDN patients with SCZ. Their sociodemographic data and general clinical information were collected, and a clinical psychological assessment was performed to quantify their psychopathology and disease severity. The severity of AF was calculated based on psychopathology scores. RESULTS: Overall, 19.01% (135/710) patients with SCZ showed AF. Patients with AF exhibited higher levels of thyroid-stimulating hormone (TSH) (t = -4.54, P < .001) and lower levels of free triiodothyronine (FT(3)) and free tetraiodothyronine (FT(4)) (t = 2.38, P = .018; t = 3.19, P = .002) than those with AF. Binary logistic regression analysis revealed waist circumference (B = 0.03, P = .022, odds ratio (OR) = 1.03) and TSH level (B = 0.54, P < .001, OR = 1.71) as risk factors for AF, and deemed low-density lipoprotein cholesterol (B = -0.43, P = .025, OR = 0.65), fasting blood glucose (B = -0.72, P = .013, OR = 0.49), FT(3) (B = -0.32, P = .034, OR = 0.73), and FT(4) (B = -0.08, P = .025, OR = 0.93) levels as protective factors. Multiple linear regression analysis identified FT(3) level (B = -0.85, t = -2.22, P = .028, 95%, Confidence Intervals (CI): -1.61- -0.09) as a protective factor influencing AF severity. CONCLUSION: This study reports the prevalence of AF in the target SCZ population and identifies factors associated with its development and severity. The discernment of these distinctive clinical features may facilitate formulation of tailored prevention strategies and interventions for this precise subset of SCZ patients.

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