1. Axmon A, Kristensson J, Ahlstrom G, Midlov P. {{Use of antipsychotics, benzodiazepine derivatives, and dementia medication among older people with intellectual disability and/or autism spectrum disorder and dementia}}. {Res Dev Disabil};2017 (Jan 18);62:50-57.
BACKGROUND: Although people with intellectual disability (ID) and people with dementia have high drug prescription rates, there is a lack of studies investigating drug use among those with concurrent diagnoses of ID and dementia. AIM: To investigate the use of antipsychotics, benzodiazepine derivatives, and drugs recommended for dementia treatment (anticholinesterases [AChEIs] and memantine) among people with ID and dementia. METHODS AND PROCEDURES: Having received support available for people with ID and/or autism spectrum disorder (ASD) was used as a proxy for ID. The ID cohort consisted of 7936 individuals, aged at least 55 years in 2012, and the referent cohort of age- and sex-matched people from the general population (gPop). People with a specialists’ diagnosis of dementia during 2002-2012 were identified (ID, n=180; gPop, n=67), and data on prescription of the investigated drugs during the period 2006-2012 were collected. OUTCOME AND RESULTS: People with ID/ASD and dementia were more likely than people with ID/ASD but without dementia to be prescribed antipsychotics (50% vs 39% over the study period; odds ratio (OR) 1.85, 95% confidence interval 1.13-30.3) and benzodiazepine derivatives (55% vs 36%; OR 2.42, 1.48-3.98). They were also more likely than people with dementia from the general population to be prescribed antipsychotics (50% vs 25%; OR 3.18, 1.59-6.34), but less likely to be prescribed AChEIs (28% vs 45%; OR 0.32, 0.16-0.64).
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2. Giuliano A, Saviozzi I, Brambilla P, Muratori F, Retico A, Calderoni S. {{The effect of age, sex and clinical features on the volume of Corpus Callosum in pre-schoolers with Autism Spectrum Disorder: a case-control study}}. {Eur J Neurosci};2017 (Jan 23)
A growing body of literature has identified volume alterations of the corpus callosum (CC) in subjects with autism spectrum disorders (ASD). However, to date very few investigations have been conducted on preschool-age ASD children. This study aims to compare the volume of CC and its sub-regions between pre-schoolers with ASD and controls (CON) and to examine their relationship to demographic and clinical variables (sex, age, non-verbal IQ -NVIQ-, expressive non-echolalic language, emotional and behavioural problems, and autism severity). The volume of CC of 40 pre-schoolers with ASD (20 males and 20 females; mean age: 49+/-12 months; mean NVIQ: 73+/-22) and 40 sex-, age-, and NVIQ-matched CON subjects (20 M and 20 F; mean age: 49+/-14 months; mean NVIQ: 73+/-23) were quantified applying the FreeSurfer automated parcellation software on Magnetic Resonance images. No significant volumetric differences in CC total volume and in its sub-regions between ASD and CON were found using total brain volume as a covariate. Analogously, absence of CC volumetric differences was evident when boys and girls with ASD were compared to their matched controls. The CC total volume of younger ASD male subjects was found significantly larger with respect to matched CON, which is consistent with the atypical growth trajectory widely reported in these young children. The CC total volume was negatively correlated with autism severity, whereas no association between CC volume and other clinical variables was detected. If replicated, the indirect relationship between CC volume and autism severity suggests the involvement of CC in core ASD symptoms. This article is protected by copyright. All rights reserved.
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3. Gwynette MF, Morriss D, Warren N, Truelove J, Warthen J, Ross CP, Mood G, Snook CA, Borckardt J. {{Social Skills Training for Adolescents With Autism Spectrum Disorder Using Facebook (Project Rex Connect): A Survey Study}}. {JMIR Ment Health};2017 (Jan 23);4(1):e4.
BACKGROUND: Adolescents with autism spectrum disorder (ASD) spend more time using electronic screen media than neurotypical peers; preliminary evidence suggests that computer-assisted or Web-based interventions may be beneficial for social skills acquisition. The current generation of adolescents accesses the Internet through computers or phones almost daily, and Facebook is the most frequently used social media platform among teenagers. This is the first research study to explore the use of Facebook as a therapeutic tool for adolescents with ASD. OBJECTIVE: To study the feasibility and clinical impact of using a Web-based social platform in combination with social skills training for adolescents with ASD. METHODS: This pilot study enrolled 6 participants (all males; mean age 14.1 years) in an online social skills training group using Facebook. Data was collected on the participants’ social and behavioral functioning at the start and conclusion of the intervention. Outcome measures included the Social Responsiveness Scale-2, the Social Skills Improvement System Rating Scale, and the Project Rex Parent Survey. Participants were surveyed at the conclusion of the intervention regarding their experience. RESULTS: No statistically significant differences in measurable outcomes were observed. However, the online addition of Facebook was well received by participants and their parents. The Facebook intervention was able to be executed with a careful privacy protocol in place and at minimal safety risk to participants. CONCLUSIONS: The utilization of Facebook to facilitate delivery of social skills training for adolescents with ASD appears to be feasible, although the clinical impact of such an addition is still unclear. It is important to note that social difficulties of participants persisted with the addition of the online platform and participants still required assistance to engage with peers in an online environment. A Web-based intervention such as the one utilized in this study has the potential to reach a mass number of patients with ASD and could address disparities in access to in-person treatment services. However, the complexity and evolving nature of Facebook’s website and privacy settings leads to a number of unique online safety concerns that may limit its clinical utility. Issues encountered in our study support the development of an alternative and closed Web-based social platform designed specifically for the target audience with ASD; this platform could be a safer and more easily moderated setting for aiding in social skills development. Despite a small sample size with no statistically significant improvements of target symptoms, the use of electronic screen media as a therapeutic tool for adolescents with ASD is still a promising area of research warranting further investigation. Our study helps inform future obstacles regarding feasibility and safety.
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4. Kang DW, Adams JB, Gregory AC, Borody T, Chittick L, Fasano A, Khoruts A, Geis E, Maldonado J, McDonough-Means S, Pollard EL, Roux S, Sadowsky MJ, Lipson KS, Sullivan MB, Caporaso JG, Krajmalnik-Brown R. {{Microbiota Transfer Therapy alters gut ecosystem and improves gastrointestinal and autism symptoms: an open-label study}}. {Microbiome};2017 (Jan 23);5(1):10.
BACKGROUND: Autism spectrum disorders (ASD) are complex neurobiological disorders that impair social interactions and communication and lead to restricted, repetitive, and stereotyped patterns of behavior, interests, and activities. The causes of these disorders remain poorly understood, but gut microbiota, the 1013 bacteria in the human intestines, have been implicated because children with ASD often suffer gastrointestinal (GI) problems that correlate with ASD severity. Several previous studies have reported abnormal gut bacteria in children with ASD. The gut microbiome-ASD connection has been tested in a mouse model of ASD, where the microbiome was mechanistically linked to abnormal metabolites and behavior. Similarly, a study of children with ASD found that oral non-absorbable antibiotic treatment improved GI and ASD symptoms, albeit temporarily. Here, a small open-label clinical trial evaluated the impact of Microbiota Transfer Therapy (MTT) on gut microbiota composition and GI and ASD symptoms of 18 ASD-diagnosed children. RESULTS: MTT involved a 2-week antibiotic treatment, a bowel cleanse, and then an extended fecal microbiota transplant (FMT) using a high initial dose followed by daily and lower maintenance doses for 7-8 weeks. The Gastrointestinal Symptom Rating Scale revealed an approximately 80% reduction of GI symptoms at the end of treatment, including significant improvements in symptoms of constipation, diarrhea, indigestion, and abdominal pain. Improvements persisted 8 weeks after treatment. Similarly, clinical assessments showed that behavioral ASD symptoms improved significantly and remained improved 8 weeks after treatment ended. Bacterial and phagedeep sequencing analyses revealed successful partial engraftment of donor microbiota and beneficial changes in the gut environment. Specifically, overall bacterial diversity and the abundance of Bifidobacterium, Prevotella, and Desulfovibrio among other taxa increased following MTT, and these changes persisted after treatment stopped (followed for 8 weeks). CONCLUSIONS: This exploratory, extended-duration treatment protocol thus appears to be a promising approach to alter the gut microbiome and virome and improve GI and behavioral symptoms of ASD. Improvements in GI symptoms, ASD symptoms, and the microbiome all persisted for at least 8 weeks after treatment ended, suggesting a long-term impact. TRIAL REGISTRATION: This trial was registered on the ClinicalTrials.gov, with the registration number NCT02504554.
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5. Landsiedel J, Williams DM, Abbot-Smith K. {{A Meta-Analysis and Critical Review of Prospective Memory in Autism Spectrum Disorder}}. {J Autism Dev Disord};2017 (Jan 23)
Prospective memory (PM) is the ability to remember to carry out a planned intention at an appropriate moment in the future. Research on PM in ASD has produced mixed results. We aimed to establish the extent to which two types of PM (event-based/time-based) are impaired in ASD. In part 1, a meta-analysis of all existing studies indicates a large impairment of time-based, but only a small impairment of event-based PM in ASD. In Part 2, a critical review concludes that time-based PM appears diminished in ASD, in line with the meta-analysis, but that caution should be taken when interpreting event-based PM findings, given potential methodological limitations of several studies. Clinical implications and directions for future research are discussed.
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6. Milosavljevic B, Shephard E, Happe FG, Johnson MH, Charman T. {{Anxiety and Attentional Bias to Threat in Children at Increased Familial Risk for Autism Spectrum Disorder}}. {J Autism Dev Disord};2017 (Jan 23)
Anxiety and threat bias were examined in 6-8-year-old children at familial-risk for Autism Spectrum Disorder (ASD) and low-risk (LR, n = 37) controls. The high-risk (HR) group was divided into those who met diagnostic criteria for ASD (HR-ASD, n = 15) and those who did not (HR-non ASD, n = 24). The HR-ASD group had highest levels of parent-reported anxiety. The HR-non ASD group exhibited increased threat bias on a spatial-cueing task, while the HR-ASD group did not. Anxiety symptoms were associated with both threat bias and ASD severity. These findings suggest that the mechanisms underlying anxiety in HR siblings without ASD are similar to those in non-ASD populations. However, among children with ASD, hypersensitivity to threat may not underlie anxiety symptoms.
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7. Morrison KE, Pinkham AE, Penn DL, Kelsven S, Ludwig K, Sasson NJ. {{Distinct profiles of social skill in adults with autism spectrum disorder and schizophrenia}}. {Autism Res};2017 (Jan 23)
Overlapping social impairments in Autism Spectrum Disorder (ASD) and Schizophrenia (SCZ) contributed to decades of diagnostic confusion that continues to this day in some clinical settings. The current study provides the first direct and detailed comparison of social behavior in the two disorders by identifying profiles of social skill in adults with ASD (n = 54), SCZ (n = 54), and typically developing (TD) controls (n = 56) during a real-world social interaction. ASD and SCZ groups exhibited poorer social skill, both overall and on most discrete abilities, relative to the TD group. Direct comparison of ASD to SCZ revealed distinct behavioral profiles, with ASD uniquely characterized by fewer interactive behaviors, and SCZ characterized by greater impaired gaze and flat/inappropriate affective responses. Additionally, IQ was associated with both overall social skill and many discrete social skills in SCZ, but was largely unrelated to social skill in ASD. These results indicate that overlapping social deficits in ASD and SCZ are comprised of both shared and distinct social skill impairments. The largest distinctions-reduced social reciprocity but better expressivity in ASD relative to SCZ, and a greater role of IQ in social skill for SCZ than ASD-highlight disorder-specific features that can improve etiological understanding, diagnostic differentiation, and treatment strategies. Autism Res 2016. (c) 2016 International Society for Autism Research, Wiley Periodicals, Inc.
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8. Schaafsma SM, Gagnidze K, Reyes A, Norstedt N, Mansson K, Francis K, Pfaff DW. {{Sex-specific gene-environment interactions underlying ASD-like behaviors}}. {Proc Natl Acad Sci U S A};2017 (Jan 23)
The male bias in the incidence of autism spectrum disorders (ASDs) is one of the most notable characteristics of this group of neurodevelopmental disorders. The etiology of this sex bias is far from known, but pivotal for understanding the etiology of ASDs in general. Here we investigate whether a « three-hit » (genetic load x environmental factor x sex) theory of autism may help explain the male predominance. We found that LPS-induced maternal immune activation caused male-specific deficits in certain social responses in the contactin-associated protein-like 2 (Cntnap2) mouse model for ASD. The three « hits » had cumulative effects on ultrasonic vocalizations at postnatal day 3. Hits synergistically affected social recognition in adulthood: only mice exposed to all three hits showed deficits in this aspect of social behavior. In brains of the same mice we found a significant three-way interaction on corticotropin-releasing hormone receptor-1 (Crhr1) gene expression, in the left hippocampus specifically, which co-occurred with epigenetic alterations in histone H3 N-terminal lysine 4 trimethylation (H3K4me3) over the Crhr1 promoter. Although it is highly likely that multiple (synergistic) interactions may be at work, change in the expression of genes in the hypothalamic-pituitary-adrenal/stress system (e.g., Crhr1) is one of them. The data provide proof-of-principle that genetic and environmental factors interact to cause sex-specific effects that may help explain the male bias in ASD incidence.
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9. Studer N, Gundelfinger R, Schenker T, Steinhausen HC. {{Implementation of early intensive behavioural intervention for children with autism in Switzerland}}. {BMC Psychiatry};2017 (Jan 21);17(1):34.
BACKGROUND: There is a major gap between the US and most European countries regarding the implementation of early intensive behavioural intervention (EIBI) for children with autism. The present paper reports on the current status of EIBI in Switzerland and on the effectiveness of EIBI under clinical conditions in a Swiss pilot project. METHODS: The paper combines a narrative report of the care system for children with autism in Switzerland and an initial evaluation of EIBI as implemented in the Department of Child and Adolescent Psychiatry, University of Zurich. RESULTS: The current situation of the implementation of EIBI for children with autism in Switzerland is characterized by marked deficits in its acceptance. Major reasons include insufficient governmental approval and lacking legal and financial support. In addition, ignorance among health care providers and educational professionals has contributed to this situation precluding that children with autism receive the most beneficial assistance. The authors have initiated and been working in an intervention centre offering EIBI for a decade and report on their experience with the implementation of EIBI. Based on their clinical practice, they document that EIBI also works efficiently under ordinary mental health service conditions. CONCLUSIONS: EIBI needs to be implemented more intensively in Switzerland. Although the effects of EIBI as implemented in Zurich are promising, the results are not as pronounced as under controlled research conditions.
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10. Urbanowicz A, Ciccone N, Girdler S, Leonard H, Downs J. {{Choice making in Rett syndrome: a descriptive study using video data}}. {Disabil Rehabil};2017 (Jan 23):1-10.
PURPOSE: To describe the choice-making abilities of girls and women with Rett syndrome. METHOD: Females with Rett syndrome registered with the Australian Rett Syndrome Database with a pathogenic MECP2 mutation were included in this study. Video clips showing choice making in 64 females at a median age of 11.6 years (range 2.3-35.6 years) were analysed. Video clips were coded for the location and nature of the choice-making interaction, and the actions of the communication partner and female with Rett syndrome. RESULTS: The majority (82.8%, 53/64) of females made a choice, most using eye gaze. Just under half (24/53) used one modality to communicate their choice, 52.8% used two modalities and one used three modalities. Of those who made a choice, 50% did so within 8 s. The length of time to make a choice did not appear to vary with age. During choice making, 57.8% (37/64) of communication partners used language and gestures, 39.1% (25/64) used only language and two used language, gestures and symbols within the interaction. CONCLUSIONS: The provision of adequate time allowing for a response and observation for the use of multiple modalities could promote effective choice making in females with Rett syndrome. Implications for Rehabilitation The provision of adequate time allowing for a response will promote effective choice making in girls and women with Rett syndrome. Although almost all girls and women with Rett syndrome used eye gaze to indicate their choice, communication partners also need to recognise and respond to other communication modalities that are sometimes used like body movements.
