Pubmed du 23/10/23

Pubmed du jour

1. Baumer NT, Capone G. Psychopharmacological treatments in Down syndrome and autism spectrum disorder: State of the research and practical considerations. Am J Med Genet C Semin Med Genet;2023 (Oct 23):e32069.

Individuals with Down syndrome (DS) or Autism Spectrum Disorder (ASD), and especially those with both DS and co-occurring ASD (DS + ASD) commonly display behavioral and psychiatric symptoms that can impact quality of life and places increased burden on caregivers. While the mainstay of treatment in DS and ASD is focused on educational and behavioral therapies, pharmacological treatments can be used to reduce symptom burden. There is a paucity of evidence and limited clinical trials in DS and DS + ASD. Some scientific evidence is available, primarily in open label studies and case series that can guide treatment choices. Additionally, clinical decisions are often extrapolated from evidence and experience from those with ASD, or intellectual disability in those without DS. This article reviews current research in pharmacological treatment in DS, ASD, and DS + ASD, reviews co-occurring neurodevelopmental and mental health diagnoses in individuals with DS + ASD across the lifespan, and describes practical approaches to psychopharmacological management.

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2. Bertacchini F, Demarco F, Scuro C, Pantano P, Bilotta E. A social robot connected with chatGPT to improve cognitive functioning in ASD subjects. Front Psychol;2023;14:1232177.

Neurodevelopmental Disorders (NDDs) represent a significant healthcare and economic burden for families and society. Technology, including AI and digital technologies, offers potential solutions for the assessment, monitoring, and treatment of NDDs. However, further research is needed to determine the effectiveness, feasibility, and acceptability of these technologies in NDDs, and to address the challenges associated with their implementation. In this work, we present the application of social robotics using a Pepper robot connected to the OpenAI system (Chat-GPT) for real-time dialogue initiation with the robot. After describing the general architecture of the system, we present two possible simulated interaction scenarios of a subject with Autism Spectrum Disorder in two different situations. Limitations and future implementations are also provided to provide an overview of the potential developments of interconnected systems that could greatly contribute to technological advancements for Neurodevelopmental Disorders (NDD).

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3. Boucher TQ, Lukacs JN, Scheerer NE, Iarocci G. Negative first impression judgements of autistic children by non-autistic adults. Front Psychiatry;2023;14:1241584.

INTRODUCTION: Although autism inclusion and acceptance has increased in recent years, autistic people continue to face stigmatization, exclusion, and victimization. Based on brief 10-second videos, non-autistic adults rate autistic adults less favourably than they rate non-autistic adults in terms of traits and behavioural intentions. In the current study, we extended this paradigm to investigate the first impressions of autistic and non-autistic children by non-autistic adult raters and examined the relationship between the rater’s own characteristics and bias against autistic children. METHOD: Segments of video recorded interviews from 15 autistic and 15 non-autistic children were shown to 346 undergraduate students in audio with video, audio only, video only, transcript, or still image conditions. Participants rated each child on a series of traits and behavioural intentions toward the child, and then completed a series of questionnaires measuring their own social competence, autistic traits, quantity and quality of past experiences with autistic people, and explicit autism stigma. RESULTS: Overall, autistic children were rated more negatively than non-autistic children, particularly in conditions containing audio. Raters with higher social competence and explicit autism stigma rated autistic children more negatively, whereas raters with more autistic traits and more positive past experiences with autistic people rated autistic children more positively. DISCUSSION: These rapid negative judgments may contribute to the social exclusion experienced by autistic children. The findings indicate that certain personal characteristics may be related to more stigmatised views of autism and decreased willingness to interact with the autistic person. The implications of the findings are discussed in relation to the social inclusion and well-being of autistic people.

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4. Briet G, Le Maner-Idrissi G, Seveno T, Le Marec O, Le Sourn-Bissaoui S. Peer mediation in play settings for minimally verbal students with autism Spectrum disorder. Autism Dev Lang Impair;2023 (Jan-Dec);8:23969415231204837.

BACKGROUND AND AIMS: Peer-mediated interventions (PMIs) are effective strategies to foster socialization of children with autism spectrum disorder (ASD) in natural settings. However, research examining the efficacy of peer mediation for students with ASD who have the greatest cognitive and language impairments remains limited. Additionally, previous studies essentially targeted communicative abilities of participants. To address this gap, the present study evaluated the effects of a play-based PMI on three socio-communicative skills (play, social engagement and imitation) of minimally verbal students with ASD who also have a comorbidity of intellectual disability (ID). METHODS: Seven children with ASD attending ordinary school settings and 14 typically developing (TD) preschoolers participated. Seven single-sex groups were formed, and children played together during two 30 min weekly sessions. TD children were trained according to the principles of the integrated play group model. We used a multiple-baseline design across participants to measure the effects of the intervention on play skills, social engagement and motor imitation of students with ASD. RESULTS: Outcomes revealed an intervention effect for most of the participants, despite some variations across children. After the peer training, four children increased their duration of functional/symbolic play, six children improved their duration of interactive play and five children increased their rates of motor imitation. Concerning maintenance gains, inter-individual differences are also important. CONCLUSIONS AND IMPLICATIONS: These findings suggest that a play-based PMI may be a feasible option for targeting inclusive education and improving socio-communicative skills of some minimally verbal students with ASD who also have an ID. However, variations across children invite further research to clarify how individual factors can moderate the effects of PMIs in children with ASD who are the most impaired.

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5. Curnow E, Utley I, Rutherford M, Johnston L, Maciver D. Diagnostic assessment of autism in adults – current considerations in neurodevelopmentally informed professional learning with reference to ADOS-2. Front Psychiatry;2023;14:1258204.

Services for the assessment and diagnosis of autism in adults have been widely criticized and there is an identified need for further research in this field. There is a call for diagnostic services to become more accessible, person-centered, neurodiversity affirming, and respectful. There is a need for workforce development which will increase capacity for diagnostic assessment and support for adults. ADOS-2 is a gold-standard diagnostic assessment tool for autism recommended in clinical guidelines. However, diagnostic procedures such as the ADOS-2 are rooted in the medical model and do not always sit comfortably alongside the neurodiversity paradigm or preferences of the autistic community. Training and educational materials need to account for the differences between these approaches and support clinicians to provide services which meet the needs of the adults they serve. The National Autism Implementation Team worked alongside ADOS-2 training providers to support clinicians in Scotland, to provide effective and respectful diagnostic assessment. The team engaged with clinicians who had attended ADOS training to identify areas of uncertainty or concern. Training materials were developed to support ADOS assessors to incorporate key principles including « nothing about us without us »; « difference not deficit »; « environment first »; « diagnosis matters, » « language and mindsets matter »; and « a neurodevelopmental lens, » to support the provision of neurodiversity affirming assessment practice. The National Autism Implementation Team also provided examples of actions which can be undertaken by clinicians to improve the assessment experience for those seeking a diagnosis. Training materials are based on research evidence, clinical experience, and the needs and wishes of autistic people.

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6. Feng Y, Li Y, Zhou X, Qin X, Deng T, Liu S, Zhang L. Predictors of posttraumatic growth in 475 Chinese parents of children newly diagnosed with autism spectrum disorder. J Pediatr Nurs;2023 (Oct 20)

PURPOSE: To examine the predictive effects of children’s symptom severity, rumination, parental self-efficacy, and social support on posttraumatic growth (PTG) in parents of autistic children. DESIGN AND METHODS: Parents (n = 475) completed the demographic questionnaire, Posttraumatic Growth Inventory, Autism Behavior Checklist, Event Related Rumination Inventory, Parenting Sense of Competence, and Social Support Rating Scale in a cross-sectional survey conducted in a tertiary hospital in Guangzhou, China, between September 2019 and January 2021. Multiple linear regression analyses were conducted using SPSS version 25.0. RESULTS: The PTG score was positively associated with rumination (r = 0.325, P < 0.05), parental self-efficacy (r = 0.219, P < 0.05), and social support (r = 0.374, P < 0.05). Multiple linear regression analysis revealed that household income (β = 0.095, P < 0.05), intrusive rumination (β = -0.100, P < 0.05), deliberate rumination (β = 0.391, P < 0.001), subjective support (β = 0.239, P < 0.001), and children's daily living skills deficiencies as perceived by parents (β = 0.107, P < 0.05) significantly predicted PTG, accounting for 33.3% of the variance [F(P) = 13.444, P < 0.001]. CONCLUSIONS: Psychosocial factors (rumination and subjective support) are essential to facilitate PTG in parents whose children are newly diagnosed with autism. PRACTICE AND IMPLICATIONS: With the consideration of different sociodemographic features, clinicians and researchers are encouraged to explore cognitive-based psychosocial interventions targeting parents' psychological growth and parenting training programs targeting autistic children's self-care ability.

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7. Gupta V, Manoj G, Bhattacharya A, Singh Sengar S, Mishra R, Kar BR, Srivastava C, Agastinose Ronickom JF. A Framework to Diagnose Autism Spectrum Disorder Using Morphological Connectivity of sMRI and XGBoost. Stud Health Technol Inform;2023 (Oct 20);309:33-37.

In this study, we automated the diagnostic procedure of autism spectrum disorder (ASD) with the help of anatomical alterations found in structural magnetic resonance imaging (sMRI) data of the ASD brain and machine learning tools. Initially, the sMRI data was preprocessed using the FreeSurfer toolbox. Further, the brain regions were segmented into 148 regions of interest using the Destrieux atlas. Features such as volume, thickness, surface area, and mean curvature were extracted for each brain region, and the morphological connectivity was computed using Pearson correlation. These morphological connections were fed to XGBoost for feature reduction and to build the diagnostic model. The results showed an average accuracy of 94.16% for the top 18 features. The frontal and limbic regions contributed more features to the classification model. Our proposed method is thus effective for the classification of ASD and can also be useful for the screening of other similar neurological disorders.

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8. Harvey-Lloyd JM, Clements A, Sims N, Harvey-Lloyd AE. Exploring the experiences of parents of Autistic children when attending the diagnostic imaging department for an X-ray examination. Radiography (Lond);2023 (Oct 20);30(1):28-36.

INTRODUCTION: Autism is a neuro-developmental condition which affects the social-emotional skills, behaviour, language, communication skills and flexibility of thoughts of an individual and their sensory processing. This can result in Autistic service users finding it difficult to navigate current healthcare provision and cope with the unpredictable environment. This paper explores the experiences of parents of Autistic children when attending the diagnostic imaging department for an X-ray examination. METHODS: A cross sectional, mixed methods approach was adopted and the initial phase consisting of an online survey for parents to complete is the subject of this paper. The quantitative data was analysed using descriptive statistics and cross comparison between questions was also completed. Thematic analysis was taken to analyse the data from the two open questions at the end of the survey. RESULTS: The online survey results are presented in this paper under four key themes; waiting times and environment, forms of communication, lack of understanding of staff regarding Autism and preparation for the X-ray examination. CONCLUSION: The overall rating of the parents’ experience whilst in the X-ray/diagnostic imaging department was positive, however there are several areas which received low scores which need further attention. These were waiting areas, waiting times, staff development and patient preparation. IMPLICATIONS FOR PRACTICE: The development of more inclusive waiting areas is needed, more effective lines of communication between staff to expedite the patient journey where possible, staff development of both radiographers and also support staff and the review of design of more accessible and inclusive patient information.

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9. Hotez E, Rava J, Russ S, Ware A, Halfon N. Using a life course health development framework to combat stigma-related health disparities for individuals with intellectual and/or developmental disability (I/DD). Curr Probl Pediatr Adolesc Health Care;2023 (Oct 20):101433.

In the U.S., 1 in 6 children has an intellectual and/or developmental disability (I/DD). This population experiences a multitude of negative health outcomes across the life course, relative to the general population. Stigma-the social devaluation of individuals with certain characteristics, identities, or statuses within interpersonal, educational, healthcare, and policy contexts-is a potentially preventable contributor to health disparities. To date, existing approaches for addressing and preventing stigma are limited to discrete and siloed interventions that often fail to address the lifelong, cumulative impacts of the specific types of stigma experienced by the I/DD population. In the current paper, we describe three elements of Life Course Health Development (LCHD)-a novel translational framework that draws on evidence from biology, sociology, epidemiology, and psychology-that healthcare providers can use to prevent stigma-related health disparities and improve outcomes for individuals with I//DDs. We discuss the utility of targeting prevention to sensitive periods; prioritizing interventions for the most damaging types of stigmas; and leveraging supports from multiple service systems and sectors. By incorporating evidence from life course science into efforts to address stigma-related health disparities, providers can more effectively and strategically prevent and combat stigma-related health disparities for the I/DD population in childhood and across the life course.

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10. Huili S, Xiaolin C, Guangsen G, Yu J, Yu L, Wenpei Z. Research on the design of somatosensory interactive games for autistic children based on art therapy. Front Psychiatry;2023;14:1207023.

There is no targeted drug treatment for autistic children. Educational intervention and rehabilitation are the main ways to improve the ability development of autistic children. However, there are great differences in the individual symptoms and abilities. It is an urgent need for educators, practitioners and parents of autistic children to find effective ways to improve their cognitive, social and motor abilities. The author cooperates with the therapist to study and design the somatosensory interaction game for autistic children, which is a formal attempt of art therapy on the treatment tool, with the purpose of studying an effective and safe art intervention method. In order to verify the effect, the author recruited 26 children with mild or moderate autism for a six-week empirical evaluation, and the participants were randomly assigned. Among them, 13 participants participated in the art therapy of the proposed somatosensory game group (the experimental group), and 13 participants participated the traditional picture book group (the control group) that improved the emotion, cognition and skills of children, and the design style was more popular with children. The aesthetic design in the picture book could have an intervention effect on the participants, and its artistic effect could serve as an effective reference for the interface design of the game group. The results showed that the two groups had a significant impact on the participants in different aspects. The game group improved not only in terms of concentration and special ability, but also in terms of physical coordination and activity enhancement, it is inferred that the core factors of game therapy are sub-intervention, interaction and feedback, icon design and color matching system; the picture book group has significant improvement in interpersonal relationship guidance and language learning and communication. The results show that it is necessary to take more comprehensive and richer preliminary research on the development of treatment products for autistic children. Because picture book education requires children’s initial concentration, it is found that picture book therapy has high requirements for teachers’ classroom control and relatively strict requirements for picture book content, and play therapy can be a good complement to these problems.

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11. Jain V, Singh Sengar S, Agastinose Ronickom JF. Age-Specific Diagnostic Classification of ASD Using Deep Learning Approaches. Stud Health Technol Inform;2023 (Oct 20);309:267-271.

Autism Spectrum Disorder (ASD) is a highly heterogeneous condition, due to high variance in its etiology, comorbidity, pathogenesis, severity, genetics, and brain functional connectivity (FC). This makes it devoid of any robust universal biomarker. This study aims to analyze the role of age and multivariate patterns in brain FC and their accountability in diagnosing ASD by deep learning algorithms. We utilized functional magnetic resonance imaging data of three age groups (6 to 11, 11 to 18, and 6 to 18 years), available with public databases ABIDE-I and ABIDE-II, to discriminate between ASD and typically developing. The blood-oxygen-level dependent time series were extracted using the Gordon’s, Harvard Oxford and Diedrichsen’s atlases, over 236 regions of interest, as 236×236 sized FC matrices for each participant, with Pearson correlations. The feature sets, in the form of FC heat maps were computed with respect to each age group and were fed to a convolutional neural network, such as MobileNetV2 and DenseNet201 to build age-specific diagnostic models. The results revealed that DenseNet201 was able to adapt and extract better features from the heat maps, and hence returned better accuracy scores. The age-specific dataset, with participants of ages 6 to 11 years, performed best, followed by 11 to 18 years and 6 to 18 years, with accuracy scores of 72.19%, 71.88%, and 69.74% respectively, when tested using the DenseNet201. Our results suggest that age-specific diagnostic models are able to counter heterogeneity present in ASD, and that enables better discrimination.

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12. Keehn B, Kadlaskar G, McNally Keehn R. Elevated and accelerated: Locus coeruleus activity and visual search abilities in autistic children. Cortex;2023 (Oct 4);169:118-129.

BACKGROUND: Autistic individuals excel at visual search, however, the neural mechanism(s) underlying this advantage remain unclear. The locus coeruleus-norepinephrine (LC-NE) system, which plays a critical role in sensory perception and selective attention, has been shown to function in a persistently elevated state in individuals on the spectrum. However, the relationship between elevated tonic LC-NE activity and accelerated search in autism has not been explored. OBJECTIVE: To examine the relationship between visual search abilities and resting pupil diameter (an indirect measure of tonic LC-NE activation) in autistic and neurotypical children. METHODS: Participants were 24 school-aged autistic children and 24 age- and IQ-matched neurotypical children aged 8-15 years. Children completed two tasks: a resting eye-tracking task and a visual search paradigm. For the resting eye-tracking task, pupil diameter was monitored while participants fixated a central crosshair. For the visual search paradigm, participants were instructed to find the target (vertical line) embedded within an array of tilted (10°) distractor lines. The target was present on 50% of trials, and displayed within set sizes of 18, 24, and 36 items. RESULTS: Consistent with previous studies, autistic children had significantly larger resting pupil size and searched faster and more efficiently compared to their neurotypical peers. Eye-tracking findings revealed that accelerated search was associated with fewer, not shorter, fixations in the autism group. Autistic children also showed reduced leftward search bias. Larger resting pupil size, indicative of increased tonic activation of the LC-NE system, was associated with greater search efficiency, longer fixation durations, and reduced leftward bias. Finally, within both groups reduced leftward bias was associated with increased autism symptomatology. DISCUSSION: Together, these findings add to the existing body of research highlighting superior search in autism, suggest that elevated tonic LC-NE activity may contribute to more efficient search, and link non-social visual-spatial processing strengths to autism symptoms.

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13. Kutuk MO, Tufan AE, Kilicaslan F, Vural P, Gokcen C, Alsen Guney S, Kutuk B, Ozyurt G, Inal N, Mutluer T, Acikalin EY, Ozer FH, Pamuk EN, Yesilmese SC, Karadag M, Hangul Z, Bilginer C, Sahin N, Bilac O, Kandemir H, Ercan ES, Eseroglu Soylemez T, Acikel SB, Guler Aksu G, Dag P, Toros F, Mutlu C, Kardas O, Kardas B, Kizildag S, Demirci E, Ozmen S, Sevicin L, Karagoz YS, Isik U, Aktepe E, Altun H, Yektas Ç, Polat Tuysuz B, Buber A, Cansiz MA, Ogutlu H, Eray S, Taner HA, Altintas E, Kutuk O. functional outcome in late adolescence/early adulthood of patients with autism spectrum disorder and its relationships with parental burnout and depression: A preliminary multi-center, cross-sectional study. Heliyon;2023 (Oct);9(10):e20766.

The aim of this study is to determine the functioning of adults with autism spectrum disorders (ASDs) diagnosed in childhood and depression and burnout levels among their parents. A total of 261 adults with ASDs and their parents were recruited for the study. Both parents completed the Beck Depression and Maslach Burnout Inventories and reported the functioning of their adult offspring with ASDs. Only 5.4 % of our sample reported « good » or « very good » outcomes. The most common psychiatric comorbidities were intellectual disabilities and attention-deficit/hyperactivity disorder. Maternal burnout and depression scores were significantly elevated compared to those of fathers. There is an undeniable urgent need for more research to identify the needs of adults and families suffering from ASD. Modifications for those with ASD may have to be made for support in workplaces, achieving driving licenses, using public transportation and attendance at tertiary education.

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14. Larson C, Eigsti IM, Spaulding T, Parish-Morris J. Language is a critical mediator of autistic experiences within the criminal justice system. Autism Res;2023 (Oct 23)

Autism spectrum disorder is characterized by social communication challenges and restricted and repetitive behaviors and interests, but also by highly heterogeneous language skills. The recent International Society of Autism Research (INSAR) policy statement, Autism and the Criminal Justice System: Policy opportunities and challenges (INSAR, 2022), aims to prevent, reduce, and improve interactions between autistic individuals and the criminal justice system. This policy statement provides a foundation for considering how to include language in these important aims. In this commentary, we outline the centrality of language skills to these interactions and provide specific recommendations that can inform future research and provide guidance for autistic individuals, community partners, and individuals working within the criminal justice system. Considering language as a part of justice system policy for autistic individuals will result in greater equity and inclusion, particularly for autistic individuals with co-occurring language deficits and those who are linguistically diverse. Moreover, it will allow autistic individuals to combat other barriers to effectively navigating interactions with the criminal justice system, such as those related to the core features of autism. We advocate for a greater role for service providers who can assess challenges in language skills, and identify the specific accommodations each autistic individual will need to prevent, reduce, and improve interactions with the criminal justice system.

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15. Moore DJ. Commentary on: A systematic review of self and observer assessment of pain and related functioning in youth with brain-based developmental disabilities. Pain;2023 (Oct 17)

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16. Must A, Curtin C, Bowling A, Broder-Fingert S, Bandini LG. Editorial: Weight-related behaviors and outcomes in children and youth with intellectual and developmental disabilities. Front Pediatr;2023;11:1295630.

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17. Northrup RA, Jacobson LA, Pritchard AE. « It starts with a knock on the door »: Caregiver and provider perspectives on healthcare communication for youth with intellectual and developmental disabilities. Patient Educ Couns;2023 (Oct 11);118:108020.

OBJECTIVES: Effective healthcare communication (HCC) is critical for youth with intellectual and developmental disabilities (IDD) who may have complex healthcare needs. The goal of this study was to gain family caregiver and provider perspectives on facilitators and challenges to effective HCC for youth with IDD. METHODS: Caregivers of, and providers for youth with IDD were recruited from the community to participate in virtual focus group (FG) sessions. FGs were 60-90 min long and were facilitated by a research team consisting of caregivers and providers. The FGs were recorded, transcribed, and coded inductively for HCC themes. RESULTS: Nineteen stakeholders participated in the FGs (caregivers: n = 14; providers: n = 5). Twenty-three themes were coded from the transcripts and were categorized by whether they focused on providers, caregivers, or healthcare systems. CONCLUSIONS: Provider behaviors such as active listening and demonstrating humility were found to be critical for effective HCC. Fewer caregiver factors, such as advocacy, and systems factors such as visit format, emerged from the FG data. FG themes represent challenges that future interventions must address. PRACTICE IMPLICATIONS: Efforts to improve HCC, and thus healthcare outcomes for youth with IDD, should address challenges identified by caregivers and providers.

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18. Noyek S, Jessa JS, Faulkner V, Boerner KE, Dewan T, Doyle D, Genik L, Grainger-Schatz S, McMorris C, McMurtry CM, Nania CG, Oberlander T, Lorenzetti D, Turner K, Birnie KA. A systematic review of self and observer assessment of pain and related functioning in youth with brain-based developmental disabilities. Pain;2023 (Oct 23)

Pain experiences of youth with brain-based developmental disabilities are often overlooked and/or misinterpreted, increasing the risk for poor or inadequate pain assessment and management. Ample measures exist to assess acute and chronic pain, yet their utility and frequency of use in youth with brain-based developmental disabilities is unclear and available measures do not have strong measurement properties for this diverse group. This systematic review identified the scope of self-reported and observer-reported pain assessment in studies of youth (aged 3-24 years) with brain-based developmental disabilities (phase 1) and summarized other measures of pain-related functioning for acute and chronic pain (ie, physical, emotional, social, sleep, and quality of life, within the subset of quantitative studies focused primarily on pain, phase 2). A comprehensive search for English-language studies was conducted in August 2022 in Web of Science, CINAHL, MEDLINE, Cochrane CENTRAL, EMBASE, and APA PsychINFO (PROSPERO registration: CRD42021237444). A total of 17,029 unique records were screened. Of the 707 articles included in phase 1, most assessed chronic pain (n = 314; 62.0%) and primarily used observer-report (n = 155; 31%) over self-report (n = 67; 13%). Of the 137 articles included in phase 2, other outcomes assessed alongside pain intensity included motor ability (16.8%), adaptive functioning (11%), quality of life (8%), pain interference (6.6%), mental health (5.8%), and communication ability (2.9%). Cerebral palsy was the most common population in both phase 1 (n = 343; 48.5%) and phase 2 (n = 83; 59.7%). This review provides a foundational understanding of pain assessment in brain-based developmental disabilities and highlights continued inequities in holistic pain assessment for this population.

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19. O’Hagan B, Foster S, Ursitti A, Crable EL, Friedman AJ, Bartolotti L, Krauss S. Elucidating the Perspectives of Autistic Youth About Their Health Care Experiences: A Qualitative Study. J Dev Behav Pediatr;2023 (Oct 23)

OBJECTIVES: Autistic individuals have higher rates of co-occurring medical conditions and service use. However, autistic individuals and their families also reported lower satisfaction with health care service delivery. Previous studies described health care experiences of autistic adults, but less is known about those of autistic adolescents and young adults. This study aimed to qualitatively describe the health care experiences of autistic youth. METHODS: Four longitudinal/serial focus groups were conducted with 8 autistic adolescents and young adults. Participants were members of an autistic patient advisory board, which is part of a broader initiative at a large, urban, safety-net hospital to improve the health care experiences of autistic patients. Focus groups were conducted virtually and were audio-recorded. Audio recordings were transcribed and verified for accuracy. Transcripts were consensus-coded with an inductive approach using tenets of grounded theory. RESULTS: Findings included 4 recurring themes: accessibility and accommodations, barriers of health service use, patient involvement in health care decisions, and facilitators of patient-clinician relationship. Participants noted that visit preparation, sensory items, and repeated positive interactions with clinician were helpful to build a positive health care experience. CONCLUSION: Our findings support previous research that suggest the need to individualize care, ensure availability of accommodations, apply flexibility in practice whenever possible, and increase health care professional knowledge about this unique patient population.

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20. Oberman LM, Francis SM, Lisanby SH. The use of noninvasive brain stimulation techniques in autism spectrum disorder. Autism Res;2023 (Oct 23)

Noninvasive brain stimulation (NIBS) techniques, including repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), have recently emerged as alternative, nonpharmacological interventions for a variety of psychiatric, neurological, and neurodevelopmental conditions. NIBS is beginning to be applied in both research and clinical settings for the treatment of core and associated symptoms of autism spectrum disorder (ASD) including social communication deficits, restricted and repetitive behaviors, irritability, hyperactivity, depression and impairments in executive functioning and sensorimotor integration. Though there is much promise for these targeted device-based interventions, in other disorders (including adult major depressive disorder (MDD) and obsessive compulsive disorder (OCD) where rTMS is FDA cleared), data on the safety and efficacy of these interventions in individuals with ASD is limited especially in younger children when neurodevelopmental interventions typically begin. Most studies are open-label, small scale, and/or focused on a restricted subgroup of individuals with ASD. There is a need for larger, randomized controlled trials that incorporate neuroimaging in order to develop predictive biomarkers of treatment response and optimize treatment parameters. We contend that until such studies are conducted, we do not have adequate estimates of the safety and efficacy of NIBS interventions in children across the spectrum. Thus, broad off-label use of these techniques in this population is not supported by currently available evidence. Here we discuss the existing data on the use of NIBS to treat symptoms related to ASD and discuss future directions for the field.

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21. Sabet N, Abadi B, Moslemizadeh A, Rajizadeh MA, Arabzadeh F, Vakili Shahrbabaki SS, Soltani Z, Rafie F, Bashiri H. The effect of low- and moderate-intensity interval training on cognitive behaviors of male and female rats with VPA-induced autism. Heliyon;2023 (Oct);9(10):e20641.

INTRODUCTION: This study was performed to evaluate the effects of low and moderate treadmill exercise for one month on social interaction, anxiety-like behaviors, and spatial learning and memory in male and female autistic rats. METHODS: Pregnant rats received valproic acid (VPA) (600 mg/kg/i.p) once on gestational day 12.5 to induce autism-like symptoms in the offspring. After delivery, the offspring were divided into six main groups, each with male and female subgroups: Control (CTL, prenatal normal saline), autism (prenatal VPA), low-intensity training (LIT,normal saline + low treadmill exercise), moderate -intensity training (MIT, normal saline + moderate treadmill exercise), VPA + LIT, and VPA + MIT. On the 60th day, the offspring were tested by the elevated plus maze (EPM), open field test (OFT), social interaction test (SIT), and Morris water maze (MWM). RESULTS: The results showed that both LIT and MIT could partly alleviate anxiety-like behaviors induced by prenatal VPA exposure in two sexes. Social impairment was observed in the autistic rats and was improved by LIT in both sexes and MIT in females. No significant change was seen in the spatial learning and memory of autistic rats by exercise. CONCLUSION: The findings suggest that treadmill exercise can be helpful for improving some autism-like behaviors. Further studies are needed to investigate the involved mechanisms.

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22. Sartor T, Sons S, Kuhn JT, Tröster H. Coping resources and stress due to demands in parents to children with autism spectrum disorder. Front Rehabil Sci;2023;4:1240977.

INTRODUCTION: Parents to children with autism spectrum disorder (ASD) are exposed to numerous demands in their daily lives and exhibit high levels of stress. The present study aims to find out which coping resources are mediators that help parents cope with these demands and which of those coping resources amplify or reduce stress arising from the demands. Studies often only focus on the connection between coping resources and stress without taking the demands into account at the same time. METHODS: For this reason, a mediation model was set up to answer the research question. Data from a German questionnaire survey with N = 266 parents who have children with ASD (two to 23 years old) were used. Subjectively perceived demands in everyday life (scale « Parental demands in everyday life »), parental stress (« Parental Stress Inventory », based on Abidin’s parenting stress model) and the following coping resources were collected: parental self-efficacy beliefs (« Parents’ sense of competence questionnaire »), available social support of parents (scale « Availability of social support ») and parental coping strategies (German version of the Brief COPE). RESULTS: An exploratory factor analysis revealed four mediators: dysfunctional coping, functional coping, social support, and self-efficacy. The use of dysfunctional behavior and parental self-efficacy were found to be significant mediators that mediated between daily demands and parental stress. A direct effect of demands on parental stress was also found, implying partial mediation. The two factors of functional coping and support were not found to be significant mediators. DISCUSSION: Key findings indicate that parental stress resulting from the daily demands of parenting children with ASD can be reduced by high parental self-efficacy and increased by dysfunctional coping. For practice, it can be deduced that dysfunctional coping strategies of parents to children with ASD should be reduced and parental self-efficacy should be strengthened in order to reduce stress which arises from the multiple demands in everyday life.

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23. Shehzad I, Raju M, Jackson I, Beeram M, Govande V, Chiruvolu A, Vora N. Evaluation of Autism Spectrum Disorder Risk in Infants With Intraventricular Hemorrhage. Cureus;2023 (Sep);15(9):e45541.

Background This study evaluates the long-term risk of autism spectrum disorder (ASD) in infants with intraventricular hemorrhage (IVH) using the Modified Checklist for Autism in Toddlers-Revised with Follow-Up (M-CHAT-R/F) screening tool. Methods This retrospective cohort study compared IVH (exposed) infants across all gestational age groups with no-IVH (non-exposed) infants admitted to level IV neonatal intensive care unit (NICU). The M-CHAT-R/F screening tool was used to assess the ASD risk at 16-30 months of age. Discharge cranial ultrasound (CUS) findings also determined the ASD risk. Descriptive statistics comprised median and interquartile range for skewed continuous data and frequencies and percentages for categorical variables. Comparisons for non-ordinal categorical measures in bivariate analysis were carried out using the χ2 test or Fisher exact test. Results Of the 334 infants, 167 had IVH, and 167 had no IVH. High ASD risk (43% vs. 20%, p = 0.044) and cerebral palsy (19% vs. 5%, p = 0.004) were significantly associated with severe IVH. Infants with CUS findings of periventricular leukomalacia had 3.24 odds of developing high ASD risk (odds ratios/OR: 3.24, 95% confidence interval/CI: 0.73-14.34), and those with hydrocephalus needing ventriculoperitoneal (VP) shunt had 4.75 odds of developing high ASD risk (OR: 4.75, 95% CI: 0.73-30.69). Conclusion Severe IVH, but not mild IVH, increased the risk of ASD and cerebral palsy. This study demonstrates the need for timely screening for ASD in high-risk infants. Prompt detection leads to earlier treatment and better outcomes.

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24. Tarrit K, Freedman EG, Francisco AA, Horsthuis DJ, Molholm S, Foxe JJ. No evidence for differential saccadic adaptation in children and adults with an autism spectrum diagnosis. Front Integr Neurosci;2023;17:1232474.

BACKGROUND: Altered patterns of eye-movements during scene exploration, and atypical gaze preferences in social settings, have long been noted as features of the Autism phenotype. While these are typically attributed to differences in social engagement and interests (e.g., preferences for inanimate objects over face stimuli), there are also reports of differential saccade measures to non-social stimuli, raising the possibility that fundamental differences in visuo-sensorimotor processing may be at play. Here, we tested the plasticity of the eye-movement system using a classic saccade-adaptation paradigm to assess whether individuals with ASD make typical adjustments to their eye-movements in response to experimentally introduced errors. Saccade adaptation can be measured in infants as young as 10 months, raising the possibility that such measures could be useful as early neuro-markers of ASD risk. METHODS: Saccade amplitudes were measured while children and adults with ASD (N = 41) and age-matched typically developing (TD) individuals (N = 68) made rapid eye-movements to peripherally presented targets. During adaptation trials, the target was relocated from 20-degrees to 15-degrees from fixation once a saccade to the original target location was initiated, a manipulation that leads to systematic reduction in saccade amplitudes in typical observers. RESULTS: Neither children nor adults with ASD showed any differences relative to TD peers in their abilities to appropriately adapt saccades in the face of persistently introduced errors. CONCLUSION: Of the three studies to date of saccade adaptation in ASD, none have shown deficits in saccade adaptation that are sufficient to generalize to the whole or a subgroup of the ASD population. Unlike prior studies, we found no evidence for a slower adaptation rate during the early adaptation phase, and no of evidence greater variance of saccade amplitudes in ASD. In post hoc analysis, there was evidence for larger primary saccades to non-adapted targets, a finding requiring replication in future work.

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25. Thompson E, Feldman JI, Valle A, Davis H, Keceli-Kaysili B, Dunham K, Woynaroski T, Tharpe AM, Picou EM. A Comparison of Listening Skills of Autistic and Non-Autistic Youth While Using and Not Using Remote Microphone Systems. J Speech Lang Hear Res;2023 (Oct 23):1-17.

OBJECTIVES: The purposes of this study were to compare (a) listening-in-noise (accuracy and effort) and (b) remote microphone (RM) system benefits between autistic and non-autistic youth. DESIGN: Groups of autistic and non-autistic youth that were matched on chronological age and biological sex completed listening-in-noise testing when wearing and not wearing an RM system. Listening-in-noise accuracy and listening effort were evaluated simultaneously using a dual-task paradigm for stimuli varying in type (syllables, words, sentences, and passages). Several putative moderators of RM system effects on outcomes of interest were also evaluated. RESULTS: Autistic youth outperformed non-autistic youth in some conditions on listening-in-noise accuracy; listening effort between the two groups was not significantly different. RM system use resulted in listening-in-noise accuracy improvements that were nonsignificantly different across groups. Benefits of listening-in-noise accuracy were all large in magnitude. RM system use did not have an effect on listening effort for either group. None of the putative moderators yielded effects of the RM system on listening-in-noise accuracy or effort for non-autistic youth that were significant and interpretable, indicating that RM system benefits did not vary according to any of the participant characteristics assessed. CONCLUSIONS: Contrary to expectations, autistic youth did not demonstrate listening-in-noise deficits compared to non-autistic youth. Both autistic and non-autistic youth appear to experience RM system benefits marked by large gains in listening-in-noise performance. Thus, the use of this technology in educational and other noisy settings where speech perception needs enhancement might be beneficial for both groups of children.

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26. Vita A, Barlati S, Deste G, Rossi A, Rocca P, Bertolino A, Aguglia E, Altamura CA, Amore M, Bellomo A, Bucci P, Carpiniello B, Cuomo A, Dell’Osso L, Giuliani L, Marchesi C, Martinotti G, Monteleone P, Montemagni C, Nibbio G, Pasquini M, Pompili M, Rampino A, Roncone R, Rossi R, Siracusano A, Tenconi E, Zeppegno P, Galderisi S, Maj M. Autistic symptoms in unaffected first-degree relatives of people with schizophrenia: results from the Italian Network for Research on Psychoses multicenter study. Eur Psychiatry;2023 (Oct 23):1-25.

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27. Woods SEO, Estes A. Toward a more comprehensive autism assessment: the survey of autistic strengths, skills, and interests. Front Psychiatry;2023;14:1264516.

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