1. Boorom O, Muñoz V, Xin R, Watson M, Lense M. {{Parental Responsiveness During Musical and Non-Musical Engagement in Preschoolers with ASD}}. {Res Autism Spectr Disord}. 2020; 78.
BACKGROUND: Parent-child play interactions offer an important avenue for supporting social development in children with autism spectrum disorder (ASD). Musical play is a natural and ubiquitous form of parent-child play. As a familiar, reinforcing, and predictable activity, musical play may support parent-child interactions by scaffolding children’s attention to the play activities, while also providing parents with a familiar and accessible context to promote parental responsiveness. However, musical play may also impede interactions due to its sensory and repetitive components. METHOD: 12 parent-child dyads of preschoolers with ASD were video-recorded during a ten-minute play session that included musical and non-musical toys. Interactions were coded for parent and child musical engagement, as well as parental responsiveness. RESULTS: Parent-child dyads varied in their amount of musical engagement during play, which was not related to children’s language level. Overall, parents showed similar levels of responsiveness to children’s play across musical and non-musical activities, but type of parental responsiveness differed depending on the play context. Parents provided significantly more physical play responses and significantly fewer verbal responses during musical vs. non-musical engagement with their child. CONCLUSIONS: There are substantial individual differences in children with ASD’s musical engagement during a parent-child free play. Children’s musical engagement impacted type of parental responsiveness, which may relate to the familiarity, accessibility, and sensory nature of musical play/toys. Results suggest that musical play/toys can both support and hinder different types of parental responsiveness with implications for incorporation of musical activities into interventions.
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2. Charles ML. {{Communication experiences of family caregivers of hospitalized adults with intellectual and developmental disabilities-A qualitative study}}. {Nursing open}. 2020; 7(6): 1725-34.
AIM: To explore communication experiences between family caregivers of adults with intellectual and developmental disabilities (I/DD) and healthcare personnel during hospitalization. DESIGN: A qualitative descriptive study approach with interviews of family caregivers was used. METHOD: Face-to-face, semi-structured interviews were conducted from June-September 2015 with ten family caregivers of adults with I/DD. Participants were recruited through an advocacy organization in the north-eastern United States. Data were analysed by content analysis. The Standards for Reporting Qualitative Research was the chosen checklist. RESULTS: The four overarching themes: « Need for Advocacy »; « Need for Better Communication »; « Sense of Abandonment »; and « Lack of Confidence » along with 12 subthemes were identified. Overall, participants reported miscommunications leading to instances of mistrust in hospital staff’s competence to deliver quality patient care.
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3. Eggebrecht AT, Dworetsky A, Hawks Z, Coalson R, Adeyemo B, Davis S, Gray D, McMichael A, Petersen SE, Constantino JN, Pruett JR, Jr. {{Brain function distinguishes female carriers and non-carriers of familial risk for autism}}. {Mol Autism}. 2020; 11(1): 82.
BACKGROUND: Autism spectrum disorder (ASD) is characterized by high population-level heritability and a three-to-one male-to-female ratio that occurs independent of sex linkage. Prior research in a mixed-sex pediatric sample identified neural signatures of familial risk elicited by passive viewing of point light motion displays, suggesting the possibility that both resilience and risk of autism might be associated with brain responses to biological motion. To confirm a relationship between these signatures and inherited risk of autism, we tested them in families enriched for genetic loading through undiagnosed (« carrier ») females. METHODS: Using functional magnetic resonance imaging, we examined brain responses to passive viewing of point light displays-depicting biological versus non-biological motion-in a sample of undiagnosed adult females enriched for inherited susceptibility to ASD on the basis of affectation in their respective family pedigrees. Brain responses in carrier females were compared to responses in age-, SRS-, and IQ-matched non-carrier-females-i.e., females unrelated to individuals with ASD. We conducted a hypothesis-driven analysis focused on previously published regions of interest as well as exploratory, brain-wide analyses designed to characterize more fully the rich responses to this paradigm. RESULTS: We observed robust responses to biological motion. Notwithstanding, the 12 regions implicated by prior research did not exhibit the hypothesized interaction between group (carriers vs. controls) and point light displays (biological vs. non-biological motion). Exploratory, brain-wide analyses identified this interaction in three novel regions. Post hoc analyses additionally revealed significant variations in the time course of brain activation in 20 regions spanning occipital and temporal cortex, indicating group differences in response to point light displays (irrespective of the nature of motion) for exploration in future studies. LIMITATIONS: We were unable to successfully eye-track all participants, which prevented us from being able to control for potential differences in eye gaze position. CONCLUSIONS: These methods confirmed pronounced neural signatures that differentiate brain responses to biological and scrambled motion. Our sample of undiagnosed females enriched for family genetic loading enabled discovery of numerous contrasts between carriers and non-carriers of risk of ASD that may index variations in visual attention and motion processing related to genetic susceptibility and inform our understanding of mechanisms incurred by inherited liability for ASD.
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4. Harrison JL, Brownlow CL, Ireland MJ, Piovesana AM. {{Empathy Measurement in Autistic and Nonautistic Adults: A COSMIN Systematic Literature Review}}. {Assessment}. 2020: 1073191120964564.
Empathy is essential for social functioning and is relevant to a host of clinical conditions. This COSMIN review evaluated the empirical support for empathy self-report measures used with autistic and nonautistic adults. Given autism is characterized by social differences, it is the subject of a substantial proportion of empathy research. Therefore, this review uses autism as a lens through which to scrutinize the psychometric quality of empathy measures. Of the 19 measures identified, five demonstrated « High-Quality » evidence for « Insufficient » properties and cannot be recommended. The remaining 14 had noteworthy gaps in evidence and require further evaluation before use with either group. Without tests of measurement invariance or differential item functioning, the extent to which observed group differences represent actual trait differences remains unknown. Using autism as a test case highlights an alarming tendency for empathy measures to be used to characterize, and potentially malign vulnerable populations before sufficient validation.
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5. Hong JS, Singh V, Kalb L. {{Attention Deficit Hyperactivity Disorder Symptoms in Young Children with Autism Spectrum Disorder}}. {Autism Res}. 2020.
The purpose of the current study was to examine the prevalence of attention deficit hyperactivity disorder (ADHD) symptoms among young children with autism spectrum disorder (ASD), child and parent-related demographic and clinical correlates of ADHD symptoms, and the relationships between co-occurring mental health problems and ADHD symptoms. Data for this cross-sectional study came from 979 toddlers and preschoolers, ages 1.5-5 years, with ASD. The primary outcome, ADHD symptoms, was measured using the Child Behavior Check List 1.5-5 (CBCL). Additional information from the medical record included demographics, parenting stress, and Autism Diagnostic Observation Schedule Second Edition. Descriptive and bivariate (ANOVA, Chi-Square) statistics and multivariate, multinomial regression analyses were used to examine demographic and clinical differences between low, moderate, and high ADHD symptom groups, as defined by 2 ADHD-related subscales. There were 418 (43%) children in the low ADHD symptom group, 294 (30%) in the moderate ADHD symptom group, and 267 (27%) in the high ADHD symptom group. Those with high ADHD symptoms were less likely to be Black or Hispanic and less likely to have parents with a graduate-level education compared to those with low ADHD symptoms. Parenting stress and all CBCL DSM-oriented subscales were positively associated with increasing ADHD symptoms. Among young children with ASD, ADHD symptoms were highly prevalent. The presence of ADHD symptoms was associated with increasing parenting stress and greater levels of other psychopathologies. These data suggest that young children with ASD should be evaluated for ADHD, and mental health as a whole. LAY SUMMARY: We investigated attention deficit hyperactivity disorder (ADHD) symptoms in toddlers and preschoolers with autism spectrum disorder (ASD) from a large sample with diverse race and socioeconomic background. In our study, we found that ADHD symptoms are highly prevalent in young children with ASD and are associated with increasing parenting stress and greater level of other psychopathologies, both internalizing and externalizing problems.
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6. Kasahara Y, Yoshida C, Nakanishi K, Fukase M, Suzuki A, Kimura Y. {{Alterations in the autonomic nerve activities of prenatal autism model mice treated with valproic acid at different developmental stages}}. {Sci Rep}. 2020; 10(1): 17722.
Autism spectrum disorder (ASD) is characterized by impairment of social communication, repetitive behavior and restrictive interest. The risk of ASD is strongly associated with the prenatal period; for instance, the administration of valproic acid (VPA) to pregnant mothers increases risk of ASD in the child. Patients with ASD often exhibit an alteration in the autonomic nervous system. In this study, we assessed the autonomic nervous activity at each prenatal developmental stage of model mice of ASD treated with VPA, to clarify the relationship between timing of exposure and ASD symptoms. The assessment of the autonomic nervous activity was performed based on the analysis of electrocardiography data collected from fetal and adult mice. Interestingly, VPA model mouse fetuses exhibited a significantly lower activity of the sympathetic nervous system. In contrast, sympathetic nervous activity at P0 was significantly higher. In adult VPA model mice, the parasympathetic activity of female VPA mice was suppressed. Moreover, female VPA mice showed reduced the parasympathetic activity after exposure to restraint stress. These results suggest that the autonomic nervous activity of VPA model mice was altered from the fetal stage, and that the assessment of autonomic nervous activities at an early developmental stage could be useful for the understanding of ASD.
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7. Kerub O, Haas EJ, Meiri G, Bilenko N, Flusser H, Michaelovski A, Dinstein I, Davidovitch N, Menashe I. {{Ethnic Disparities in the Diagnosis of Autism in Southern Israel}}. {Autism Res}. 2020.
The prevalence of autism spectrum disorder (ASD) is continuously rising worldwide, with remarkable differences in ASD rates being reported across ethnic and socioeconomic groups. We conducted a prospective cohort study to identify the reasons for differences in ASD rates between the Bedouin and Jewish populations in southern Israel. Screening, referral, and diagnosis of toddlers aged 16-36 months were compared between Bedouin and Jewish populations. ASD screening was conducted at 35 randomly selected mother and child health centers (MCHCs) by trained nurses using the Modified Checklist for Autism in Toddlers with follow-up (M-CHAT/F) instrument. Toddlers screened positive at the MCHCs were monitored throughout the referral and diagnosis process at a single medical center until a diagnosis was determined by a physician specialist using DSM-5 criteria. The study cohort comprised 3,343 toddlers (996 Jewish and 2,347 Bedouin). Bedouin toddlers, compared to Jewish toddlers, were less likely to screen positive with M-CHAT/F (3.0% vs. 3.9%; P = 0.165), were significantly less likely to begin the hospital diagnosis process (HR = 0.38, 95% CI: 0.14-1.08; P = 0.068), and had a higher rates of loss-to-follow-up during the hospital diagnosis process (42.9% vs. 15.6%, respectively; P = 0.001). The results suggest that ethnic-specific barriers in the diagnosis process of ASD contribute to under-diagnosis of ASD in the Bedouin population. Facilitating the diagnosis process for Bedouin families will help to identify more children with ASD at earlier ages and consequently close the ethnic gap in ASD rates. LAY SUMMARY: We followed Bedouin and Jewish toddlers aged 16-36 months from southern Israel through their autism spectrum disorder (ASD) screening referral and diagnosis to identify the reasons for the differences in ASD prevalence between these ethnic groups. Jewish and Bedouin toddlers were equally identified in the ASD screening. However, Bedouin toddlers were less likely to complete the diagnosis process due to higher rates of loss-to-follow-up and slower diagnosis process. Facilitating ASD diagnosis for the Bedouin population will help identifying more toddlers with ASD.
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8. Leader G, Forde J, Naughton K, Maher L, Arndt S, Mannion A. {{Relationships among gastrointestinal symptoms, sleep problems, challenging behaviour, comorbid psychopathology and autism spectrum disorder symptoms in children and adolescents with 15q duplication syndrome}}. {J Intellect Disabil Res}. 2020.
BACKGROUND: Comorbidity is the presence of at least two disorders in one person at one time. This study examined the frequency of gastrointestinal (GI) symptoms, sleep problems, comorbid psychopathology, challenging behaviour and autism spectrum disorder (ASD) symptoms in children and adolescents with duplication 15q syndrome (Dup15q), aged 3-17 years. This study also examined whether challenging behaviour in Dup15q is predicted by age, gender, presence of an intellectual disability, sleep problems, GI symptoms and comorbid psychopathology. METHOD: Parental measures were completed by 101 parents of children and adolescents with Dup15q. Questionnaires were composed of the Children’s Sleep Habits Questionnaire, Behavior Problems Inventory – Short Form, GI Symptom Inventory, Social Communication Questionnaire and the Child Behavior Checklist. RESULTS: Sleep problems (94%), GI symptoms (87%) and challenging behaviour (100%) were common comorbidities represented in the sample in this study. Significant relationships were found between challenging behaviour and the presence of co-occurring sleep problems, GI symptoms, comorbid psychopathology and ASD symptoms. Further analysis revealed that these comorbidities also predicted challenging behaviour. CONCLUSION: This research demonstrated the importance of studying the relationships between GI symptoms, sleep problems, comorbid psychopathology, ASD symptoms and challenging behaviour in Dup15q and how these conditions can shape the Dup15q phenotype.
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9. Leifler E, Carpelan G, Zakrevska A, Bölte S, Jonsson U. {{Does the learning environment ‘make the grade’? A systematic review of accommodations for children on the autism spectrum in mainstream school}}. {Scandinavian journal of occupational therapy}. 2020: 1-16.
BACKGROUND: The 2030 Agenda for Sustainable Development adapted by the United Nations envisions inclusive and equitable quality education. While there is a growing body of research on interventions designed to help children on the autism spectrum adapt to the school environment, accommodations to children needs have been given less attention. OBJECTIVE: To synthesize the literature on accommodations in the learning environment for children on the autism spectrum (ages 5-19 years) in mainstream school, with a specific focus on the effects on functioning, educational outcomes and well-being. METHODS: A systematic search was conducted. The study selection and data extraction were performed by two independent reviewers. Eligible studies were assessed according to the What Works Clearinghouse (WWC) standards. RESULTS: The search yielded 6102 citations. Only 37 eligible studies were identified, of which 14 met the WWC standards. This inconclusive and heterogeneous body of research tentatively suggest that accommodations in the pedagogical and psychosocial leaning environment can improve performance and function in school. CONCLUSION AND SIGNIFICANCE: Accommodations in the learning environment is a promising but understudied approach. Creative research and innovation will be needed to support policy makers and school personnel in their quest to ensure inclusive and equitable education.
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10. Liu X, Bautista J, Liu E, Zikopoulos B. {{Imbalance of laminar-specific excitatory and inhibitory circuits of the orbitofrontal cortex in autism}}. {Mol Autism}. 2020; 11(1): 83.
BACKGROUND: The human orbitofrontal cortex (OFC) is involved in assessing the emotional significance of events and stimuli, emotion-based learning, allocation of attentional resources, and social cognition. Little is known about the structure, connectivity and excitatory/inhibitory circuit interactions underlying these diverse functions in human OFC, as well as how the circuit is disrupted in individuals with autism spectrum disorder (ASD). METHODS: We used post-mortem brain tissue from neurotypical adults and individuals with ASD. We examined the morphology and distribution of myelinated axons across cortical layers in OFC, at the single axon level, as a proxy of excitatory pathways. In the same regions, we also examined the laminar distribution of all neurons and neurochemically- and functionally-distinct inhibitory neurons that express the calcium-binding proteins parvalbumin (PV), calbindin (CB), and calretinin (CR). RESULTS: We found that the density of myelinated axons increased consistently towards layer 6, while the average axon diameter did not change significantly across layers in both groups. However, both the density and diameter of myelinated axons were significantly lower in the ASD group compared with the Control group. The distribution pattern and density of the three major types of inhibitory neurons was comparable between groups, but there was a significant reduction in the density of excitatory neurons across OFC layers in ASD. LIMITATIONS: This study is limited by the availability of human post-mortem tissue optimally processed for high-resolution microscopy and immunolabeling, especially from individuals with ASD. CONCLUSIONS: The balance between excitation and inhibition in OFC is at the core of its function, assessing and integrating emotional and social cues with internal states and external inputs. Our preliminary results provide evidence for laminar-specific changes in the ratio of excitation/inhibition in OFC of adults with ASD, with an overall weakening and likely disorganization of excitatory signals and a relative strengthening of local inhibition. These changes likely underlie pathology of major OFC communications with limbic or other cortices and the amygdala in individuals with ASD, and may provide the anatomic basis for disrupted transmission of signals for social interactions and emotions in autism.
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11. Ludvigsson JF, Winell H, Sandin S, Cnattingius S, Stephansson O, Pasternak B. {{Maternal Influenza A(H1N1) Immunization During Pregnancy and Risk for Autism Spectrum Disorder in Offspring : A Cohort Study}}. {Annals of internal medicine}. 2020; 173(8): 597-604.
BACKGROUND: There are concerns that influenza vaccine exposure during pregnancy may be associated with increased risk for autism spectrum disorder (ASD). OBJECTIVE: To examine the risk for ASD in offspring of mothers who were vaccinated against influenza A(H1N1)pdm09 (« swine flu ») during pregnancy. DESIGN: Population-based cohort study using nationwide registers. SETTING: Seven health care regions in Sweden. PARTICIPANTS: Live births between October 2009 and September 2010, with follow-up through December 2016. In total, 39 726 infants were prenatally exposed to H1N1 vaccine (13 845 during the first trimester) and 29 293 infants were unexposed. MEASUREMENTS: Cox regression was used to estimate hazard ratios (HRs) for the primary outcome, ASD, before and after adjustment for potential confounders. The secondary outcome was autistic disorder (AD). RESULTS: Mean follow-up was 6.7 years in both unexposed and exposed children. During follow-up, 394 (1.0%) vaccine-exposed and 330 (1.1%) unexposed children had a diagnosis of ASD. In adjusted analyses, prenatal exposure to H1N1 vaccination was not associated with a later diagnosis of ASD (adjusted HR [aHR], 0.95 [95% CI, 0.81 to 1.12]) or AD (aHR, 0.96 [CI, 0.80 to 1.16]). The 6-year standardized cumulative incidence difference between the unexposed and exposed children was 0.04% (CI, -0.09% to 0.17%) for ASD and 0.02% (CI, -0.09% to 0.14%) for AD. Restricting the analysis to vaccination in the first trimester of pregnancy did not influence risk estimates (aHR, 0.92 [CI, 0.74 to 1.16] for ASD and 0.91 [CI, 0.70 to 1.18] for AD). LIMITATION: Data on H1N1 influenza infection are lacking. CONCLUSION: This large cohort study found no association between maternal H1N1 vaccination during pregnancy and risk for ASD in the offspring. PRIMARY FUNDING SOURCE: Swedish Research Council.
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12. Malhi P, Venkatesh L, Bharti B, Singhi P. {{Do Atypical Food Preferences in Children with Autism Differ by Severity?}}. {Indian journal of pediatrics}. 2020.
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13. Ohta H, Aoki YY, Itahashi T, Kanai C, Fujino J, Nakamura M, Kato N, Hashimoto RI. {{White matter alterations in autism spectrum disorder and attention-deficit/hyperactivity disorder in relation to sensory profile}}. {Mol Autism}. 2020; 11(1): 77.
BACKGROUND: Autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) have high rates of co-occurrence and share atypical behavioral characteristics, including sensory symptoms. The present diffusion tensor imaging (DTI) study was conducted to examine whether and how white matter alterations are observed in adult populations with developmental disorders (DD) and to determine how brain-sensory relationships are either shared between or distinct to ASD and ADHD. METHODS: We collected DTI data from adult population with DD (a primary diagnosis of ASD: n = 105, ADHD: n = 55) as well as age- and sex-matched typically developing (TD) participants (n = 58). Voxel-wise fractional anisotropy (FA), mean diffusivity, axial diffusivity, and radial diffusivity (RD) were analyzed using tract-based spatial statistics. The severities of sensory symptoms were assessed using the Adolescent/Adult Sensory Profile (AASP). RESULTS: Categorical analyses identified voxel clusters showing significant effects of DD on FA and RD in the posterior portion of the corpus callosum and its extension in the right hemisphere. Furthermore, regression analyses using the AASP scores revealed that slopes in relationships of FA or RD with the degree of sensory symptoms were parallel between the two DDs in large parts of the affected corpus callosum regions. A small but significant cluster did exist showing difference in association between an AASP subscale score and RD across ASD and ADHD. LIMITATIONS: Wide age range of the participants may be oversimplified. CONCLUSIONS: These results indicate that white matter alteration and their relationships to sensory symptoms are largely shared between ASD and ADHD, with localized abnormalities showing significant between-diagnosis differences within DD.
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14. Quaas AM, Kearns WG. {{Antenatal antioxidants to avert autism?}}. {Journal of assisted reproduction and genetics}. 2020.
Paternally derived de novo mutations (DNMs) caused by oxidative stress (OS) have been implicated in the development of autism spectrum disorders (ASDs). Whether preconception antioxidant supplementation can reduce the incidence of ASDs by reducing OS is an area of uncertainty and potentially important future scientific investigation.
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15. Simacek J, Elmquist M, Dimian AF, Reichle J. {{Current Trends in Telehealth Applications to Deliver Social Communication Interventions for Young Children with or at Risk for Autism Spectrum Disorder}}. {Current developmental disorders reports}. 2020: 1-9.
PURPOSE OF REVIEW: Early, intensive, and high-quality interventions can often improve social communication outcomes for children with autism spectrum disorder (ASD). Many children experience barriers to intervention, resulting in significant delays to intervention onset or missed opportunities for intervention altogether. With constant advances in technology, the field is experiencing a rapid increase in investigation of telehealth applications to intervention delivery. This article highlights the current trends in social communication intervention via telehealth used in early intervention practices for children with ASD over the past 5 years, including a brief review of studies (from 2014 to January 2020) and our team’s experiences in this area. RECENT FINDINGS: Based on our experience and the 22 studies we identified in this area, we describe the current trends in telehealth applications used and how interventions were delivered. We also provide recommendations, limitations, and future directions on this topic. SUMMARY: Telehealth offers innovative intervention delivery options by increasing intervention access, overcoming barriers such as geography and costs of service delivery for young children with ASD.
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16. Tiwari A, Rahi S, Mehan S. {{Elucidation of Abnormal Extracellular Regulated Kinase (ERK) Signaling and Associations with Syndromic and Non-syndromic Autism}}. {Current drug targets}. 2020.
Autism is a highly inherited and extremely complex disorder in which results from various cases indicate chro-mosome anomalies, unusual single-gene mutations, and multiplicative effects of particular gene variants, characterized pri-marily by impaired speech and social interaction and restricted behavior. The precise etiology of Autism Spectrum Disorder (ASD) is currently unclear. The extracellular signal-regulated kinase (ERK) signaling mechanism affects neurogenesis and neuronal plasticity during the development of the central nervous mechanism. In this regard, the pathway of ERK has re-cently gained significant interest in the pathogenesis of ASD. The mutation occurs in a few ERK components. Besides, the ERK pathway dysfunction lies in the upstream of modified translation and contributes to synapse pathology in syndromic types of autism. In this review, we highlight the ERK pathway as a target for neurodevelopmental disorder autism. In addi-tion, we summarize the regulation of the ERK pathway with ERK inhibitors in neurological disorders. In conclusion, a better understanding of the ERK signaling pathway provides a range of therapeutic options for autism spectrum disorder.
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17. Villante NK, Lerman DC, Som S, Hunt JC. {{Teaching adults with developmental disabilities to problem solve using electronic flowcharts in a simulated vocational setting}}. {Journal of applied behavior analysis}. 2020.
Teaching job-related problem-solving skills may increase the likelihood that individuals with developmental disabilities obtain and maintain employment (Kaye et al., 2011; Peck & Kirkbride, 2001; Unger, 2002). In this study, we evaluated the use of electronic-based flowcharts on an iPod Touch as a form of self-instruction to increase problem solving skills with 2 men diagnosed with developmental disabilities. An instructor implemented behavioral skills training (BST) to teach the participants how to use an electronic flowchart to solve one problem and then evaluated the participants’ use of electronic flowcharts to solve other types of problems, including those that required more than one solution. Results showed increases in problem solving skills across at least 2 problems that were not associated with BST and increases across all problem exemplars with verbal reminders and feedback. These findings have important implications for increasing independence on the job and decreasing intrusive and costly supports for those with disabilities.
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18. Walsh C, Lydon S, Hehir A, O’Connor P. {{Development and evaluation of a novel caregiver-report tool to assess barriers to physical healthcare for people on the autism spectrum}}. {Res Autism Spectr Disord}. 2020; 79: 101680.
INTRODUCTION: People on the autism spectrum often experience poorer health than the general population despite higher engagement with the health services. This suggests a disparity in the accessibility of appropriate healthcare for autistic individuals. To improve access, barriers the autism community experience in healthcare first need to be identified. This paper aimed to: 1) develop and evaluate a caregiver-report tool; 2) identify barriers to physical healthcare for autistic individuals; and 3) identify potential contributing factors. METHODS: A previously established taxonomy of barriers to healthcare for autistic individuals informed the development of the tool; this was then distributed to caregivers of autistic adults and children. Exploratory factor analysis (EFA) assessed validity and reliability of the tool. Multiple Regressions were performed to identify predictors of barriers. RESULTS: In total, caregivers of 194 autistic children or adults participated in the study. The EFA produced four factors: 1) patient-level barriers; 2) healthcare provider-level (HCP) barriers; 3) healthcare system-level barriers; and 4) barriers related to managing healthcare. The greatest barriers included difficulties with identifying/reporting symptoms (endorsed by 62.4% of participants); difficulties handling the waiting area (60.3% of participants); and a lack of HCP knowledge regarding autism (52.1% of participants). Autism severity, general adjustment problems, anxiety, age and having unmet needs predicted the frequency and/or severity of barriers. CONCLUSIONS: A tool that allows assessment of patient-, HCP-, and system-level barriers to healthcare was developed and evaluated. Patient-level barriers appear to occur frequently and pose substantial challenges. This tool will help identify areas most in need of intervention and support intervention evaluation.
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19. Yin W, Mostafa S, Wu FX. {{Diagnosis of Autism Spectrum Disorder Based on Functional Brain Networks with Deep Learning}}. {Journal of computational biology : a journal of computational molecular cell biology}. 2020.
Autism spectrum disorder (ASD) is a neurological and developmental disorder. Traditional diagnosis of ASD is typically performed through the observation of behaviors and interview of a patient. However, these diagnosis methods are time-consuming and can be misleading sometimes. Integrating machine learning algorithms with neuroimages, a diagnosis method, can possibly be established to detect ASD subjects from typical control subjects. In this study, we develop deep learning methods for diagnosis of ASD from functional brain networks constructed with brain functional magnetic resonance imaging (fMRI) data. The entire Autism Brain Imaging Data Exchange 1 (ABIDE 1) data set is utilized to investigate the performance of our proposed methods. First, we construct the brain networks from brain fMRI images and define the raw features based on such brain networks. Second, we employ an autoencoder (AE) to learn the advanced features from the raw features. Third, we train a deep neural network (DNN) with the advanced features, which achieves the classification accuracy of 76.2% and the receiving operating characteristic curve (AUC) of 79.7%. As a comparison, we also apply the same advanced features to train several traditional machine learning algorithms to benchmark the classification performance. Finally, we combine the DNN with the pretrained AE and train it with the raw features, which achieves the classification accuracy of 79.2% and the AUC of 82.4%. These results show that our proposed deep learning methods outperform the state-of-the-art methods.
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20. You Y, Correas A, Jao Keehn RJ, Wagner LC, Rosen BQ, Beaton LE, Gao Y, Brocklehurst WT, Fishman I, Müller RA, Marinkovic K. {{MEG Theta during Lexico-Semantic and Executive Processing Is Altered in High-Functioning Adolescents with Autism}}. {Cereb Cortex}. 2020.
Neuroimaging studies have revealed atypical activation during language and executive tasks in individuals with autism spectrum disorders (ASD). However, the spatiotemporal stages of processing associated with these dysfunctions remain poorly understood. Using an anatomically constrained magnetoencephalography approach, we examined event-related theta oscillations during a double-duty lexical decision task that combined demands on lexico-semantic processing and executive functions. Relative to typically developing peers, high-functioning adolescents with ASD had lower performance accuracy on trials engaging selective semantic retrieval and cognitive control. They showed an early overall theta increase in the left fusiform cortex followed by greater activity in the left-lateralized temporal (starting at ~250 ms) and frontal cortical areas (after ~450 ms) known to contribute to language processing. During response preparation and execution, the ASD group exhibited elevated theta in the anterior cingulate cortex, indicative of greater engagement of cognitive control. Simultaneously increased activity in the ipsilateral motor cortex may reflect a less lateralized and suboptimally organized motor circuitry. Spanning early sensory-specific and late response selection stages, the higher event-related theta responsivity in ASD may indicate compensatory recruitment to offset inefficient lexico-semantic retrieval under cognitively demanding conditions. Together, these findings provide further support for atypical language and executive functions in high-functioning ASD.
