1. Austin J, Manning-Courtney P, Johnson ML, Weber R, Johnson H, Murray D, Ratliff-Schaub K, Tadlock AM, Murray M. {{Improving Access to Care at Autism Treatment Centers: A System Analysis Approach}}. {Pediatrics};2016 (Feb);137 Suppl 2:S149-157.
OBJECTIVE: The prevalence of autism spectrum disorder is steadily increasing and placing more demands on already overburdened diagnostic and treatment systems. A thoughtful, systematic reorganization of autism service delivery may reduce delays and better meet the growing need. METHODS: Two clinical centers in the Autism Intervention Research Network on Physical Health, Cincinnati Children’s Hospital Medical Center (CCHMC) and Nationwide Children’s Hospital (NCH), undertook a year-long access improvement project to reduce delays to care by using system analysis to identify sources of delay and to target changes by using a set of defined access principles. Although both sites addressed access, they focused on slightly different targets (reducing number of patients with autism spectrum disorders waiting for follow-up appointments at NCH and reducing delay to new diagnosis at CCHMC). RESULTS: Both sites achieved dramatic improvements in their complex, multidisciplinary systems. A 94% reduction in number of patients on the waitlist from 99 to 6 patients and a 22% reduction in median delay for a new ongoing care appointment were realized at NCH. A 94% reduction in third next available appointment for new physician visits for children 3 to 5 years old was realized at CCHMC. CONCLUSIONS: This article demonstrates that 2 different clinical systems improved access to care for autism diagnosis and follow-up care by identifying sources of delay and using targeted changes based on a set of access change principles. With appropriate guidance and data analysis, improvements in access can be made.
Lien vers le texte intégral (Open Access ou abonnement)
2. Benevides TW, Carretta HJ, Mandell DS. {{Differences in Perceived Need for Medical, Therapeutic, and Family Support Services Among Children With ASD}}. {Pediatrics};2016 (Feb);137 Suppl 2:S176-185.
OBJECTIVE: Identifying racial and ethnic differences in perceived need for treatment among families of children with autism spectrum disorder (ASD) will improve understanding of disparities in care seeking. We described racial and ethnic differences in perceived need for services that children with ASD and their families frequently use. METHODS: We conducted bivariate analyses of racial and ethnic categories and perceived need for 6 common services used by children with ASD as found in the 2005 to 2006 (n = 2123) and the 2009 to 2010 (n = 3055) National Survey of Children With Special Health Care Needs data sets. Multivariate logistic regressions within concatenated data sets were conducted to examine associations between racial and ethnic category and perceived service needs while controlling for predisposing, enabling, and child factors. RESULTS: Compared with caregivers of white non-Hispanic children with ASD, caregivers of Hispanic children reported less need for prescription medications in adjusted multivariate analyses. Caregivers of black non-Hispanic children with ASD reported less need for prescription medications and for child and family mental health services than caregivers of white non-Hispanic children. Both English-speaking Hispanic caregivers and black non-Hispanic caregivers reported greater need for occupational, speech, and physical therapy than white non-Hispanic caregivers. No racial or ethnic differences were found in perceived need for specialty medical care or respite care. CONCLUSIONS: Caregivers of children with ASD from different racial and ethnic backgrounds may differentially perceive need for different types of care. Their perceptions may in turn affect how they prioritize and seek care, independent of their child’s specific needs.
Lien vers le texte intégral (Open Access ou abonnement)
3. Bishop SL, Thurm A, Farmer C, Lord C. {{Autism Spectrum Disorder, Intellectual Disability, and Delayed Walking}}. {Pediatrics};2016 (Feb 3)
OBJECTIVE: Delayed onset of independent walking is common in intellectual disability (ID). However, in children with autism spectrum disorders (ASD), delayed walking has not been reported as frequently, despite the high rate of concurrent ID in ASD. This study directly examined the relationship between delayed walking and severity of ID in children with ASD versus other non-ASD diagnoses. METHOD: Participants were 1185 individuals (ASD, n = 903; non-ASD, n = 282) who received an assessment at age 4 to 12 years (6.89 +/- 2.25) that yielded an estimate of nonverbal IQ (NVIQ) and retrospectively reported age of walking from the Autism Diagnostic Interview-Revised. The relationship between diagnostic group and delayed walking (defined as occurring at >/=16 months) as a function of NVIQ was explored using the Cox proportional hazards model. RESULTS: Children with ASD were less likely to exhibit delayed walking than those with non-ASD diagnoses, and this difference was larger at lower levels of NVIQ (P = .002). For example, rates of delayed walking for ASD and non-ASD were 13% and 19%, respectively, in those with NVIQ >85 but 31% and 60% in children with NVIQ <70. CONCLUSIONS: Although lower IQ scores were associated with increased rates of late walking in both ASD and non-ASD groups, children with low IQ were more likely to show delayed walking in the absence of ASD. This raises the possibility of separate etiological pathways to ID in children with and without ASD.
Lien vers le texte intégral (Open Access ou abonnement)
4. Broder-Fingert S, Shui A, Ferrone C, Iannuzzi D, Cheng ER, Giauque A, Connors S, McDougle CJ, Donelan K, Neumeyer A, Kuhlthau K. {{A Pilot Study of Autism-Specific Care Plans During Hospital Admission}}. {Pediatrics};2016 (Feb);137 Suppl 2:S196-204.
BACKGROUND AND OBJECTIVE: Hospital admissions can be difficult for patients with autism spectrum disorder (ASD). We created an autism-specific care plan (ACP) to help improve the hospital experience for patients with ASD, and we tested feasibility and acceptability and compared the experience of care for children with and without an ACP. METHODS: We performed a nonrandomized, retrospective chart review of all patients with ASD and a hospital admission from January 2013 to December 2013 (n = 142) to determine feasibility of the intervention. We then mailed surveys to all 142 families to measure experience with the ACP and to compare experience of care in those who did and did not have an ACP. Using multivariable linear regression we assessed the association of experience of care with ACP use while adjusting for covariates. RESULTS: The ACP was well tolerated by parents and used frequently by staff. Compared with parents who did not use the ACP, parents who used the ACP reported a better experience relating to their general hospital experience (B = 1.48, P < .001) and staff attention to their child's ASD-specific needs (B = 3.07, P < .001). CONCLUSIONS: According to this pilot study, care plans are feasible and hold promise to improve the experience of care for children with ASD and their families in the hospital setting. Lien vers le texte intégral (Open Access ou abonnement)
5. Catani M, Dell’Acqua F, Budisavljevic S, Howells H, Thiebaut de Schotten M, Froudist-Walsh S, D’Anna L, Thompson A, Sandrone S, Bullmore ET, Suckling J, Baron-Cohen S, Lombardo MV, Wheelwright SJ, Chakrabarti B, Lai MC, Ruigrok AN, Leemans A, Ecker C, Consortium MA, Craig MC, Murphy DG. {{Frontal networks in adults with autism spectrum disorder}}. {Brain};2016 (Feb);139(Pt 2):616-630.
It has been postulated that autism spectrum disorder is underpinned by an ‘atypical connectivity’ involving higher-order association brain regions. To test this hypothesis in a large cohort of adults with autism spectrum disorder we compared the white matter networks of 61 adult males with autism spectrum disorder and 61 neurotypical controls, using two complementary approaches to diffusion tensor magnetic resonance imaging. First, we applied tract-based spatial statistics, a ‘whole brain’ non-hypothesis driven method, to identify differences in white matter networks in adults with autism spectrum disorder. Following this we used a tract-specific analysis, based on tractography, to carry out a more detailed analysis of individual tracts identified by tract-based spatial statistics. Finally, within the autism spectrum disorder group, we studied the relationship between diffusion measures and autistic symptom severity. Tract-based spatial statistics revealed that autism spectrum disorder was associated with significantly reduced fractional anisotropy in regions that included frontal lobe pathways. Tractography analysis of these specific pathways showed increased mean and perpendicular diffusivity, and reduced number of streamlines in the anterior and long segments of the arcuate fasciculus, cingulum and uncinate-predominantly in the left hemisphere. Abnormalities were also evident in the anterior portions of the corpus callosum connecting left and right frontal lobes. The degree of microstructural alteration of the arcuate and uncinate fasciculi was associated with severity of symptoms in language and social reciprocity in childhood. Our results indicated that autism spectrum disorder is a developmental condition associated with abnormal connectivity of the frontal lobes. Furthermore our findings showed that male adults with autism spectrum disorder have regional differences in brain anatomy, which correlate with specific aspects of autistic symptoms. Overall these results suggest that autism spectrum disorder is a condition linked to aberrant developmental trajectories of the frontal networks that persist in adult life.
Lien vers le texte intégral (Open Access ou abonnement)
6. Choi GB, Yim YS, Wong H, Kim S, Kim H, Kim SV, Hoeffer CA, Littman DR, Huh JR. {{The maternal interleukin-17a pathway in mice promotes autism-like phenotypes in offspring}}. {Science};2016 (Feb 26);351(6276):933-939.
Viral infection during pregnancy has been correlated with increased frequency of autism spectrum disorder (ASD) in offspring. This observation has been modeled in rodents subjected to maternal immune activation (MIA). The immune cell populations critical in the MIA model have not been identified. Using both genetic mutants and blocking antibodies in mice, we show that retinoic acid receptor-related orphan nuclear receptor gamma t (RORgammat)-dependent effector T lymphocytes [for example, T helper 17 (TH17) cells] and the effector cytokine interleukin-17a (IL-17a) are required in mothers for MIA-induced behavioral abnormalities in offspring. We find that MIA induces an abnormal cortical phenotype, which is also dependent on maternal IL-17a, in the fetal brain. Our data suggest that therapeutic targeting of TH17 cells in susceptible pregnant mothers may reduce the likelihood of bearing children with inflammation-induced ASD-like phenotypes.
Lien vers le texte intégral (Open Access ou abonnement)
7. Choque Olsson N, Rautio D, Asztalos J, Stoetzer U, Bolte S. {{Social skills group training in high-functioning autism: A qualitative responder study}}. {Autism};2016 (Feb 24)
Systematic reviews show some evidence for the efficacy of group-based social skills group training in children and adolescents with autism spectrum disorder, but more rigorous research is needed to endorse generalizability. In addition, little is known about the perspectives of autistic individuals participating in social skills group training. Using a qualitative approach, the objective of this study was to examine experiences and opinions about social skills group training of children and adolescents with higher functioning autism spectrum disorder and their parents following participation in a manualized social skills group training (« KONTAKT »). Within an ongoing randomized controlled clinical trial (NCT01854346) and based on outcome data from the Social Responsiveness Scale, six high responders and five low-to-non-responders to social skills group training and one parent of each child (N = 22) were deep interviewed. Interestingly, both high responders and low-to-non-responders (and their parents) reported improvements in social communication and related skills (e.g. awareness of own difficulties, self-confidence, independence in everyday life) and overall treatment satisfaction, although more positive intervention experiences were expressed by responders. These findings highlight the added value of collecting verbal data in addition to quantitative data in a comprehensive evaluation of social skills group training.
Lien vers le texte intégral (Open Access ou abonnement)
8. Chouinard PA, Unwin KL, Landry O, Sperandio I. {{Susceptibility to Optical Illusions Varies as a Function of the Autism-Spectrum Quotient but not in Ways Predicted by Local-Global Biases}}. {J Autism Dev Disord};2016 (Feb 25)
Individuals with autism spectrum disorder and those with autistic tendencies in non-clinical groups are thought to have a perceptual style privileging local details over global integration. We used 13 illusions to investigate this perceptual style in typically developing adults with various levels of autistic traits. Illusory susceptibility was entered into a principal-component analysis. Only one factor, consisting of the Shepard’s tabletops and Square-diamond illusions, was found to have reduced susceptibility as a function of autistic traits. Given that only two illusions were affected and that these illusions depend mostly on the processing of within-object relational properties, we conclude there is something distinct about autistic-like perceptual functioning but not in ways predicted by a preference of local over global elements.
Lien vers le texte intégral (Open Access ou abonnement)
9. Ezell J, Shui A, Sanders K, Veenstra-VanderWeele J. {{Pattern of Diagnosis and Co-occurring Symptoms in Adopted Children With Autism Spectrum Disorder}}. {Pediatrics};2016 (Feb);137 Suppl 2:S90-97.
OBJECTIVES: To determine whether adopted children with autism spectrum disorder (ASD) differ from the general ASD population in terms of diagnosis, internalizing and externalizing behaviors, sleep problems, and medications. METHODS: We studied 163 adoptees in the Autism Speaks Autism Treatment Network (ATN) in comparison with 5624 nonadopted ATN participants (aged 1.5-17.6 years; mean [SD] = 6.2 [3.4] years). Gender, age, race, ethnicity, IQ, and categorical Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, ASD diagnosis were tested for differences by group (adopted versus nonadopted) by using independent-samples t tests for continuous variables and Fisher’s exact tests for categorical variables. Logistic or linear regression models were used to examine the association between adoption status and several outcome variables, after controlling for covariates. RESULTS: After controlling for demographics and diagnosis, there were significant differences in group characteristics, including greater propensity for externalizing behavior (P < .001), internalizing behavior (P = .001), and sleep problems (P < .001) in the adopted population. Adoptees were also prescribed psychotropic medications (P < .001) more often than the nonadoptees. Adoptees received a diagnosis of pervasive developmental disorder-not otherwise specified significantly more frequently than controls (odds ratio = 1.8; CI = 1.3-2.5; P < .001), despite no significant difference in symptoms on standardized measures. CONCLUSIONS: These results suggest that the population of adopted children with ASD differs from the general ASD population both with regard to diagnostic subtype and co-occurring behavioral problems. Future research should evaluate the contributions of specific factors associated with adoption such as biological family history, pregnancy history, early childhood experience, and age at adoption. Lien vers le texte intégral (Open Access ou abonnement)
10. Fung LK, Mahajan R, Nozzolillo A, Bernal P, Krasner A, Jo B, Coury D, Whitaker A, Veenstra-Vanderweele J, Hardan AY. {{Pharmacologic Treatment of Severe Irritability and Problem Behaviors in Autism: A Systematic Review and Meta-analysis}}. {Pediatrics};2016 (Feb);137 Suppl 2:S124-135.
BACKGROUND: Autism spectrum disorder (ASD) is increasingly recognized as a public health issue. Irritability and aggression (IA) often negatively affect the lives of people with ASD and their families. Although many medications have been tested for IA in ASDs in randomized controlled trials (RCTs), critical quantitative analyses of these trials are lacking in the literature. OBJECTIVES: To systematically review and quantitatively analyze the efficacy and safety of pharmacologic treatments for IA in youth with ASD. DATA SOURCES: Studies were identified from Medline, PsycINFO, Embase, and review articles. METHODS: Original articles on placebo-controlled RCTs of pharmacologic treatments of IA in youth age 2 to 17 years with ASD were included. Data items included study design, study goals, details of study participants, details of intervention, study results, statistical methods, side effects, and risks of bias. The primary study outcome measure was the effect size of reduction in the Aberrant Behavioral Checklist-Irritability (ABC-I) scores in the medication group, as compared with placebo, in RCTs using parallel groups design. RESULTS: Forty-six RCTs were identified. Compared with placebo, 3 compounds resulted in significant improvement in ABC-I at the end of treatment. Risperidone and aripiprazole were found to be the most effective, with the largest effect sizes. Sedation, extrapyramidal sides effects, and weight gain were assessed quantitatively. CONCLUSIONS: Although risperidone and aripiprazole have the strongest evidence in reducing ABC-I in youth with ASD, a few other compounds also showed significant efficacy with fewer potential side effects and adverse reactions in single studies.
Lien vers le texte intégral (Open Access ou abonnement)
11. Greenlee JL, Mosley AS, Shui AM, Veenstra-VanderWeele J, Gotham KO. {{Medical and Behavioral Correlates of Depression History in Children and Adolescents With Autism Spectrum Disorder}}. {Pediatrics};2016 (Feb);137 Suppl 2:S105-114.
BACKGROUND AND OBJECTIVES: Depression is commonly associated with autism spectrum disorder (ASD) across the life span. We sought to identify medical and behavioral problems associated with a history of a parent-reported diagnosis of depression in a large sample of school-aged children and adolescents with ASD. METHODS: A sample of 1272 participants (aged 6-17 years; mean [SD]: 9.56 [2.79] years) from the Autism Speaks Autism Treatment Network consortium were divided into « ever-depressed » (n = 89) and « nondepressed » (n = 1183) groups on the basis of caregiver endorsement of children’s current or previous diagnoses of depression. RESULTS: In total, 7.0% of children with ASD (4.8% of those aged 6-12 years and 20.2% of those aged 13-17 years) were reported to have a history of a depression diagnosis. Positive depression history was associated with greater chronological age, higher IQ, and Asperger disorder diagnosis. After controlling for age, IQ, and within-spectrum categorical diagnosis, the ever-depressed group exhibited significantly greater rates of seizure disorders (odds ratio = 2.64) and gastrointestinal problems (odds ratio = 2.59) and trend-level differences in aggression, somatic complaints, and social impairments. The groups did not differ in autism severity, repetitive behaviors, sleep problems, eating problems, self-injurious behavior, or current intervention use. CONCLUSIONS: Co-occurring depression is a particularly common problem in higher-functioning older children within the Autism Treatment Network. Our findings indicate that children with ASD and a history of a depression diagnosis are more likely to also have co-occurring medical problems, although the presence and direction of causality is unclear.
Lien vers le texte intégral (Open Access ou abonnement)
12. Guillon Q, Roge B, Afzali MH, Baduel S, Kruck J, Hadjikhani N. {{Intact perception but abnormal orientation towards face-like objects in young children with ASD}}. {Sci Rep};2016;6:22119.
There is ample behavioral evidence of diminished orientation towards faces as well as the presence of face perception impairments in autism spectrum disorder (ASD), but the underlying mechanisms of these deficits are still unclear. We used face-like object stimuli that have been shown to evoke pareidolia in typically developing (TD) individuals to test the effect of a global face-like configuration on orientation and perceptual processes in young children with ASD and age-matched TD controls. We show that TD children were more likely to look first towards upright face-like objects than children with ASD, showing that a global face-like configuration elicit a stronger orientation bias in TD children as compared to children with ASD. However, once they were looking at the stimuli, both groups spent more time exploring the upright face-like object, suggesting that they both perceived it as a face. Our results are in agreement with abnormal social orienting in ASD, possibly due to an abnormal tuning of the subcortical pathway, leading to poor orienting and attention towards faces. Our results also indicate that young children with ASD can perceive a generic face holistically, such as face-like objects, further demonstrating holistic processing of faces in ASD.
Lien vers le texte intégral (Open Access ou abonnement)
13. Hansen RL, Blum NJ, Gaham A, Shults J. {{Diagnosis of Autism Spectrum Disorder by Developmental-Behavioral Pediatricians in Academic Centers: A DBPNet Study}}. {Pediatrics};2016 (Feb);137 Suppl 2:S79-89.
OBJECTIVES: To describe the clinical practices of physicians in the Developmental-Behavioral Pediatrics Network (DBPNet) to (1) diagnose autism spectrum disorders (ASDs), identify comorbidities, and evaluate etiology and (2) compare actual practice to established guidelines. METHODS: A total of 56 developmental-behavioral pediatricians completed encounter forms, including demographic/clinical information, for up to 10 consecutive new-patient visits given a diagnosis of ASD. Data were summarized by using descriptive statistics. Analysis of the statistical significance of differences between sites (n = 10) used general estimating equations and mixed-effects logistic regression to adjust for clustering by clinician within site. RESULTS: A total of 284 ASD forms were submitted. Most assessments (56%) were completed in 1 visit (27.5% in 2 visits, 8.6% in 3 visits). Use of the Childhood Autism Rating Scale, Autism Diagnostic Observation Schedule, or Screening Tool for Autism in Toddlers and Young Children varied across sites from 28.6% to 100% of encounters (P < .001). A developmental assessment was reviewed/completed at 87.7% of encounters (range: 77.8%-100%; P = .061), parent behavior rating scales were reviewed/completed at 65.9% (range: 35.7%-91.4%; P = .19), and teacher behavior rating scales were reviewed/completed at 38.4% (range: 15%-69.2%; P = .19). Only 17.3% (95% confidence interval: 12.8%-21.7%) of evaluations were completed by an interdisciplinary team. A majority (71%) of patients had at least 1 comorbid diagnosis (31% had at least 2 and 12% at had least 3). Etiologic evaluations were primarily genetic (karyotype: 49%; microarray: 69.7%; fragile X: 71.5%). CONCLUSIONS: Despite site variability, the majority of diagnostic evaluations for ASD within DBPNet were completed by developmental-behavioral pediatricians without an interdisciplinary team and included a developmental assessment, ASD-specific assessment tools, and parent behavior rating scales. These findings document the multiple components of assessment used by DBPNet physicians and where they align with existing guidelines. Lien vers le texte intégral (Open Access ou abonnement)
14. Heaton TJ, Freeth M. {{Reduced Visual Exploration When Viewing Photographic Scenes in Individuals With Autism Spectrum Disorder}}. {J Abnorm Psychol};2016 (Feb 25)
Individuals with autism spectrum disorder (ASD) often display enhanced attention to detail and exhibit restricted behavior. However, due to a lack of comprehensive eye-movement modeling techniques, it is currently unknown whether these behavioral effects are also evident during scene viewing (i.e., detailed visual inspection and restricted visual exploration). Free-viewing eye-tracking data from observation of everyday photographic scenes were recorded during 2 experiments involving high-functioning adolescents with ASD and matched typically developing (TD) controls (Experiment 1, ASD n = 14; TD n = 22; Experiment 2, ASD n = 16; TD n = 23). Data from both experiments were combined and analyzed using 5 novel methods of eye-tracking, time-course analysis, enabling detailed characterization of viewing strategies. Participants’ verbal descriptions of scenes were also assessed. Scenes either contained a centrally positioned person whose face was in full view or contained no centrally positioned face. For both types of scene, ASD participants displayed significantly less exploration of new areas over time compared with their TD peers. Analyses of scan-path length and recursion suggested a greater tendency to explore areas close to the current fixation in the ASD group, termed visual persistence. Differences were not accounted for by fixation rate. Significantly more areas within the scenes were also missing from the verbal descriptions in the ASD group. Differences were observed for both scene types, suggesting a domain-general difference rather than a specific impairment related to face processing. The observed characteristic viewing patterns may explain relative superior processing of local level information in individuals with ASD. (PsycINFO Database Record
Lien vers le texte intégral (Open Access ou abonnement)
15. Hidding E, Swaab H, de Sonneville LM, van Engeland H, Vorstman JA. {{The role of COMT and plasma proline in the variable penetrance of autistic spectrum symptoms in 22q11.2 Deletion Syndrome}}. {Clin Genet};2016 (Feb 26)
This paper examines how COMT158 genotypes and plasma proline levels are associated with variable penetrance of social behavioural and social-cognitive problems in 22q11.2 deletion syndrome (22q11DS). Severity of autistic spectrum symptoms of 45 participants with 22q11DS was assessed using the Autism Diagnostic Interview Revised. Face and facial emotion recognition was evaluated using standardized computer-based test-paradigms. Associations with COMT158 genotypes and proline levels were examined. High proline levels and poor face recognition in individuals with the COMTMET allele, and poor facial emotion recognition, explained almost 50% of the variance in severity of autism symptomatology in individuals with 22q11DS. High proline levels and a decreased capacity to break down dopamine as a result of the COMTMET variant are both relevant in the expression of the social phenotype in patients. This epistatic interaction effect between the COMT158 genotype and proline on the expression of social deficits in 22q11DS demonstrates how factors other than the direct effects of the deletion itself can modulate the penetrance of associated cognitive and behavioural outcomes. These findings are not only relevant to our insight into 22q11DS, but also provide a model to better understand the phenomenon of variable penetrance in other pathogenic genetic variants.
Lien vers le texte intégral (Open Access ou abonnement)
16. Huijnen CA, Lexis MA, Jansens R, de Witte LP. {{Mapping Robots to Therapy and Educational Objectives for Children with Autism Spectrum Disorder}}. {J Autism Dev Disord};2016 (Feb 24)
The aim of this study was to increase knowledge on therapy and educational objectives professionals work on with children with autism spectrum disorder (ASD) and to identify corresponding state of the art robots. Focus group sessions (n = 9) with ASD professionals (n = 53) from nine organisations were carried out to create an objectives overview, followed by a systematic literature study to identify state of the art robots matching these objectives. Professionals identified many ASD objectives (n = 74) in 9 different domains. State of the art robots addressed 24 of these objectives in 8 domains. Robots can potentially be applied to a large scope of objectives for children with ASD. This objectives overview functions as a base to guide development of robot interventions for these children.
Lien vers le texte intégral (Open Access ou abonnement)
17. Kuhlthau KA, Delahaye J, Erickson-Warfield M, Shui A, Crossman M, van der Weerd E. {{Health Care Transition Services for Youth With Autism Spectrum Disorders: Perspectives of Caregivers}}. {Pediatrics};2016 (Feb);137 Suppl 2:S158-166.
BACKGROUND AND OBJECTIVE: This paper seeks to describe the experience of youth with autism spectrum disorder (ASD) in making the health care transition (HCT) to adult care. METHODS: We surveyed 183 parents and guardians of youth with ASD, assessing the extent to which youth and families experienced and desired HCT services, their satisfaction with services, and obstacles to transition. Descriptive statistics were used to examine HCT measures and Fisher’s exact and t tests assessed whether demographic or health measures were associated with service receipt. Any measures with a P value <.05 were included in a logistic regression model, with service receipt as the dependent variable. RESULTS: The receipt of transition services was low overall, with rates for individual services ranging from 3% to 33% and only 60% of the sample receiving any transition service. Despite these low rates, a majority of respondents reported wanting services (73.3%-91.6%), and satisfaction for received services was high (89%-100%). Regression analyses showed depression to be the only variable significantly associated with service receipt. Youth who were identified by their caregivers as having depression experienced a higher rate of transition service receipt than those not identified as having depression. CONCLUSIONS: Findings suggest that there is a great need to address the provision of HCT services for youth with ASD. Although families who received HCT services were generally satisfied, overall rates of service receipt were quite low, and those who were not provided with services generally desired them. Lien vers le texte intégral (Open Access ou abonnement)
18. Kushak RI, Buie TM, Murray KF, Newburg DS, Chen C, Nestoridi E, Winter HS. {{Evaluation of Intestinal Function in Children with Autism and Gastrointestinal Symptoms}}. {J Pediatr Gastroenterol Nutr};2016 (Feb 20)
OBJECTIVE: Alterations in intestinal function, often characterized as a « leaky gut », have been attributed to children who are on the autism spectrum. Disaccharidase activity, intestinal inflammation and permeability were analyzed in 61 children with autism and 50 non-autistic individuals with gastrointestinal symptoms. METHODS: All patients had duodenal biopsies assayed for lactase, sucrase, maltase and palatinase activity. Intestinal permeability was evaluated by rhamnose/lactulose test and measured by HPLC-MS. Intestinal inflammation was evaluated by fecal calprotectin and lactoferrin levels using ELISA as well as histology. RESULTS: Some autistic children had mild levels of mucosal inflammation on intestinal biopsy. Disaccharidase activity was not different in autistic and non-autistic individuals. Fecal calprotectin and lactoferrin were similar in both groups. Differences between lactulose and rhamnose recovery and lactulose/rhamnose ratio in urine were not statistically different in patients with and without autism. CONCLUSION: This study supports the observation that children with autism who have symptoms of gastrointestinal disorders have objective findings similar to children without autism. Neither non-invasive testing nor endoscopic findings identify gastrointestinal pathology specific to autism, but may be of benefit in identifying children with autism who have atypical symptoms.
Lien vers le texte intégral (Open Access ou abonnement)
19. Lindgren S, Wacker D, Suess A, Schieltz K, Pelzel K, Kopelman T, Lee J, Romani P, Waldron D. {{Telehealth and Autism: Treating Challenging Behavior at Lower Cost}}. {Pediatrics};2016 (Feb);137 Suppl 2:S167-175.
OBJECTIVE: To determine whether challenging behavior in young children with autism and other developmental disabilities can be treated successfully at lower cost by using telehealth to train parents to implement applied behavior analysis (ABA). METHODS: We compared data on the outcomes and costs for implementing evidence-based ABA procedures to reduce problem behavior by using 3 service delivery models: in-home therapy, clinic-based telehealth, and home-based telehealth. Participants were 107 young children diagnosed with autism or other neurodevelopmental disorders, and data analysis focused on the 94 children who completed treatment. RESULTS: All 3 service delivery models demonstrated successful reduction of problem behavior by training parents to conduct functional analysis and functional communication training. The mean percentage reduction in problem behavior was >90% in all 3 groups after treatment, and treatment acceptability based on parent ratings was high for all groups. Total costs for implementing treatment were lowest for home telehealth, but both telehealth models were significantly less costly than in-home therapy. CONCLUSIONS: This research demonstrated that parents can use ABA procedures to successfully treat behavior problems associated with autism spectrum disorders regardless of whether treatment is directed by behavior consultants in person or via remote video coaching. Because ABA telehealth can achieve similar outcomes at lower cost compared with in-home therapy, geographic barriers to providing access to ABA for treating problem behavior can be minimized. These findings support the potential for using telehealth to provide research-based behavioral treatment to any family that has access to the Internet.
Lien vers le texte intégral (Open Access ou abonnement)
20. Malow BA, Katz T, Reynolds AM, Shui A, Carno M, Connolly HV, Coury D, Bennett AE. {{Sleep Difficulties and Medications in Children With Autism Spectrum Disorders: A Registry Study}}. {Pediatrics};2016 (Feb);137 Suppl 2:S98-S104.
OBJECTIVES: Sleep difficulties are common in children with autism spectrum disorders, with wide-ranging effects on the child’s daytime behavior. We reviewed data within our Autism Speaks Autism Treatment Network Registry to determine the prevalence of sleep difficulties and patterns of medication use. METHODS: Data from 1518 children ages 4 to 10 years were analyzed to determine the number of children documented to have sleep difficulties by parent-completed questionnaires and clinician-completed forms and how these findings related to the use of sleep medications. RESULTS: The Children’s Sleep Habits Questionnaire total score was >/=41 (associated with clinically significant sleep problems in past research) in 71% of children. The prevalence of sleep diagnoses was less frequent (30% of children aged 4-10 years; P < .0001). Medications for sleep were prescribed in 46% of 4- to 10-year-olds given a sleep diagnosis. The most common medication used for sleep was melatonin followed by alpha-agonists, with a variety of other medications taken for sleep (anticonvulsants, antidepressants, atypical antipsychotics, and benzodiazepines). Children taking medications for sleep had worse daytime behavior and pediatric quality of life than children not taking sleep medications. CONCLUSIONS: Parent concerns about sleep may not be reflected in the information gathered during a clinic visit, supporting the need to develop screening practice pathways for sleep in autism spectrum disorders. Furthermore, many medications taken for sleep have adverse effects, supporting the need for evidence-based interventions in this population. Lien vers le texte intégral (Open Access ou abonnement)
21. McGuire K, Fung LK, Hagopian L, Vasa RA, Mahajan R, Bernal P, Silberman AE, Wolfe A, Coury DL, Hardan AY, Veenstra-VanderWeele J, Whitaker AH. {{Irritability and Problem Behavior in Autism Spectrum Disorder: A Practice Pathway for Pediatric Primary Care}}. {Pediatrics};2016 (Feb);137 Suppl 2:S136-148.
OBJECTIVE: Pediatric primary care providers (PCPs) caring for patients with autism spectrum disorder (ASD) often encounter irritability (vocal or motoric outbursts expressive of anger, frustration, or distress) and problem behavior (directed acts of aggression toward other people, self, or property). The Autism Intervention Research Network on Physical Health and Autism Speaks Autism Treatment Network charged a multidisciplinary workgroup with developing a practice pathway to assist PCPs in the evaluation and treatment of irritability and problem behavior (I/PB). METHODS: The workgroup reviewed the literature on the evaluation and treatment of contributory factors for I/PB in ASD. The workgroup then achieved consensus on the content and sequence of each step in the pathway. RESULTS: The practice pathway is designed to help the PCP generate individualized treatment plans based on contributing factors identified in each patient. These factors may include medical conditions, which the PCP is in a key position to address; functional communication challenges that can be addressed at school or at home; psychosocial stressors that may be ameliorated; inadvertent reinforcement of I/PB; and co-occurring psychiatric conditions that can be treated. The pathway provides guidance on psychotropic medication use, when indicated, within an individualized treatment plan. In addition to guidance on assessment, referral, and initial treatment, the pathway includes monitoring of treatment response and periodic reassessment. CONCLUSIONS: The pediatric PCP caring for the patient with ASD is in a unique position to help generate an individualized treatment plan that targets factors contributing to I/PB and to implement this plan in collaboration with parents, schools, and other providers.
Lien vers le texte intégral (Open Access ou abonnement)
22. Miller HL, Bugnariu NL. {{Level of Immersion in Virtual Environments Impacts the Ability to Assess and Teach Social Skills in Autism Spectrum Disorder}}. {Cyberpsychol Behav Soc Netw};2016 (Feb 26)
Virtual environments (VEs) may be useful for delivering social skills interventions to individuals with autism spectrum disorder (ASD). Immersive VEs provide opportunities for individuals with ASD to learn and practice skills in a controlled replicable setting. However, not all VEs are delivered using the same technology, and the level of immersion differs across settings. We group studies into low-, moderate-, and high-immersion categories by examining five aspects of immersion. In doing so, we draw conclusions regarding the influence of this technical manipulation on the efficacy of VEs as a tool for assessing and teaching social skills. We also highlight ways in which future studies can advance our understanding of how manipulating aspects of immersion may impact intervention success.
Lien vers le texte intégral (Open Access ou abonnement)
23. Mohammad-Rezazadeh I, Frohlich J, Loo SK, Jeste SS. {{Brain connectivity in autism spectrum disorder}}. {Curr Opin Neurol};2016 (Feb 24)
PURPOSE OF REVIEW: Many studies have reported that individuals with autism spectrum disorder (ASD) have different brain connectivity patterns compared with typically developing individuals. However, the results of more recent studies do not unanimously support the traditional view in which individuals with ASD have lower connectivity between distant brain regions and increased connectivity within local brain regions. In this review, we discuss different methods for measuring brain connectivity and how the use of different metrics may contribute to the lack of convergence of investigations of connectivity in ASD. RECENT FINDINGS: The discrepancy in brain connectivity results across studies may be due to important methodological factors, such as the connectivity measure applied, the age of patients studied, the brain region(s) examined, and the time interval and frequency band(s) in which connectivity was analyzed. SUMMARY: We conclude that more sophisticated electroencephalography analytic approaches should be utilized to more accurately infer causation and directionality of information transfer between brain regions, which may show dynamic changes of functional connectivity in the brain. Moreover, further investigations of connectivity with respect to behavior and clinical phenotype are needed to probe underlying brain networks implicated in core deficits of ASD.
Lien vers le texte intégral (Open Access ou abonnement)
24. Murray DS, Fedele A, Shui A, Coury DL. {{The Autism Speaks Autism Treatment Network Registry Data: Opportunities for Investigators}}. {Pediatrics};2016 (Feb);137 Suppl 2:S72-78.
OBJECTIVE: Patient registries can effectively collect data over a long period of time to provide a better understanding of the typical presentation of specific conditions. The autism spectrum disorders (ASDs) have experienced a marked increase in reported prevalence over the past 20 years for reasons that are not completely clear. The Autism Treatment Network (ATN) Registry was established to facilitate investigations into a variety of questions critical to expanding our understanding of ASDs. Here we describe the establishment of the registry, its components, some of its findings to date, and opportunities for further use of this data. METHODS: Participants are eligible for enrollment into the ATN registry if they are between the ages of 2.0 and 17.6 years at the time of enrollment and meet criteria for ASD as determined by clinical consensus on the basis of specific diagnostic measures (Autism Diagnostic Observation Schedule/Autism Diagnostic Observation Schedule, Second Edition; Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition/Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition). Baseline measures include demographics, autism assessment, cognitive assessment data, behavioral data, sleep habits, quality of life, sensory data, and treatments. Several of the measures are collected at annual follow-up visits. RESULTS: More than 6800 children with ASD have been enrolled in the Autism Speaks ATN registry. Data from the registry have been reported at numerous scientific meetings and in several publications and have led to new recommendations for best practices in the management of ASD. CONCLUSIONS: A patient registry for children and adolescents with ASD has had and will continue to have a significant impact on care for this population. Investigators are encouraged to query this database to further its impact by testing novel hypotheses and conducting preliminary proof-of-concept analyses.
Lien vers le texte intégral (Open Access ou abonnement)
25. Nascimento PP, Bossolani-Martins AL, Rosan DB, Mattos LC, Brandao-Mattos C, Fett-Conte AC. {{Single nucleotide polymorphisms in the CNTNAP2 gene in Brazilian patients with autistic spectrum disorder}}. {Genet Mol Res};2016;15(1)
The role of some genes and their single nucleotide polymorphisms (SNPs) as genetic contributors of complex diseases is still a topic of much investigation. Research on genes related to autism susceptibility has been somewhat challenging, but also promising. Common genomic variants of CNTNAP2 have been associated with autism, and a range of autistic phenotypes such as impaired language function, abnormal social behavior, intellectual deficiency, epilepsy, and schizophrenia have been associated with this gene. Earlier findings have suggested that SNPs in the CNTNAP2 gene may be used as genetic markers for predisposition to autism spectrum disorder (ASD). We analyzed the SNPs (rs7794745 and rs2710102) in the CNTNAP2 gene of 210 individuals with idiopathic ASD and 200 non-autistic individuals by polymerase chain reaction-restriction fragment length polymorphism. The results revealed higher frequency distributions statistically significant (P = 0.034) of the homozygous SNP rs7794745 (presumed risk genotype) in ASD patients as compared with control subjects. The results also showed an association (OR = 1.802, 95%CI = 1.054-3.083, P = 0.042) between the same homozygous genotype and ASD, suggesting that it is a susceptibility factor for autism in this Brazilian population.
Lien vers le texte intégral (Open Access ou abonnement)
26. Nicholas DB, Zwaigenbaum L, Muskat B, Craig WR, Newton AS, Cohen-Silver J, Sharon RF, Greenblatt A, Kilmer C. {{Toward Practice Advancement in Emergency Care for Children With Autism Spectrum Disorder}}. {Pediatrics};2016 (Feb);137 Suppl 2:S205-211.
BACKGROUND AND OBJECTIVE: There is increasing recognition that children with autism spectrum disorder (ASD) experience challenges in busy clinical environments such as the emergency department (ED). ASD may heighten adverse responses to sensory input or transitions, which can impose greater difficulty for a child to cope with situational demands. These problems can be amplified in the ED because of its busy and unpredictable nature, wait times, and bodily care. There is little literature documenting ED-based needs of children with ASD to inform clinical guidelines. The objective was to identify stakeholder perspectives in determining clinical priorities and recommendations to guide ED service delivery for children with ASD. METHODS: After qualitative interviews with children, parents, and health care providers conducted in a previous phase of this study, focus groups were convened with parents of children with ASD, ED clinicians, and ED administrators (total n = 60). Qualitative data were analyzed based on an interpretive description approach. RESULTS: Participants identified the ED and its delivery of care as insufficient to meet the unique needs of children with ASD. The following clinical priorities were identified: ASD-focused preparedness for ED procedures and processes, wait time management, proactive strategies for sedation and restraint, child-focused support, health care provider capacity building, post-ED follow-up resources, and transition planning to adult care. Heightened child- and family-centered care were strongly recommended.
Lien vers le texte intégral (Open Access ou abonnement)
27. Park HY, Harwood RL, Yu SM, Kavanagh L, Lu MC. {{Autism and Other Developmental Disabilities Research Programs of the Maternal and Child Health Bureau}}. {Pediatrics};2016 (Feb);137 Suppl 2:S61-66.
Lien vers le texte intégral (Open Access ou abonnement)
28. Perrin JM, Coury DL, Klatka K, Winklosky B, Wolfe A, Murray D, Kuhlthau KA. {{The Autism Intervention Research Network on Physical Health and the Autism Speaks Autism Treatment Network}}. {Pediatrics};2016 (Feb);137 Suppl 2:S67-71.
Lien vers le texte intégral (Open Access ou abonnement)
29. Pivovarciova A, Durdiakova J, Babinska K, Kubranska A, Vokalova L, Minarik G, Celec P, Murin M, Ostatnikova D. {{Testosterone and Androgen Receptor Sensitivity in Relation to Hyperactivity Symptoms in Boys with Autism Spectrum Disorders}}. {PLoS One};2016;11(2):e0149657.
INTRODUCTION: Autism spectrum disorders (ASD) and hyperactivity symptoms exhibit an incidence that is male-biased. Thus androgen activity can be considered a plausible biological risk factor for these disorders. However, there is insufficient information about the association between increased androgen activity and hyperactivity symptoms in children with ASD. METHODS: In the present study, the relationship between parameters of androgenicity (plasmatic testosterone levels and androgen receptor sensitivity) and hyperactivity in 60 boys (age 3-15) with ASD is investigated. Given well documented differences in parent and trained examiners ratings of symptom severity, we employed a standardized parent`s questionnaire (Nisonger Child Behavior Rating Form) as well as a direct examiner`s rating (Autism diagnostic observation schedule) for assessment of hyperactivity symptoms. RESULTS: Although it was found there was no significant association between actual plasmatic testosterone levels and hyperactivity symptoms, the number of CAG triplets was significantly negatively correlated with hyperactivity symptoms (R2 = 0.118, p = 0.007) in the sample, indicating increased androgen receptor sensitivity in association with hyperactivity symptoms. Direct trained examiner s assessment appeared to be a relevant method for evaluating of behavioral problems in the investigation of biological underpinnings of these problems in our study. CONCLUSIONS: A potential ASD subtype characterized by increased rates of hyperactivity symptoms might have distinct etiopathogenesis and require a specific behavioral and pharmacological approach. We propose an increase of androgen receptor sensitivity as a biomarker for a specific ASD subtype accompanied with hyperactivity symptoms. Findings are discussed in terms of their implications for practice and future research.
Lien vers le texte intégral (Open Access ou abonnement)
30. Robinson AN, Roberts JE, Brady NC, McQuillin SD, Warren SF. {{Physiological Correlates of Maternal Responsivity in Mothers of Preschoolers With Fragile X Syndrome}}. {Am J Intellect Dev Disabil};2016 (Mar);121(2):111-120.
The present study examined the relationship between salivary cortisol and maternal responsiveness in mothers of boys with fragile X syndrome (FXS). Maternal responsivity is strongly associated with child outcomes, and children with FXS are at risk for compromised development due to intellectual disability and problem behavior. Increased understanding of the nature and underlying mechanisms of maternal responsivity in FXS is important to optimize outcomes in children with FXS and contribute to improved family cohesion. Data from 36 mother-child dyads indicated a complex age effect with elevated cortisol levels associated with high maternal responsivity scores when children are young and low responsivity scores when children are older. Implications of these findings and directions for future research are discussed.
Lien vers le texte intégral (Open Access ou abonnement)
31. Rosenberg K. {{A Possible Link Between Antidepressant Use During Pregnancy and Autism Spectrum Disorder}}. {Am J Nurs};2016 (Mar);116(3):58-59.
Lien vers le texte intégral (Open Access ou abonnement)
32. Siniscalco D, Mijatovic T, Bosmans E, Cirillo A, Kruzliak P, Lombardi VC, K DEM, Antonucci N. {{Decreased Numbers of CD57+CD3- Cells Identify Potential Innate Immune Differences in Patients with Autism Spectrum Disorder}}. {In Vivo};2016 (03-04);30(2):83-89.
BACKGROUND/AIM: Autism spectrum disorders (ASD) are complex, and severe heterogeneous neurodevelopmental pathologies with accepted but complex immune system abnormalities. Additional knowledge regarding potential immune dysfunctions may provide a greater understanding of this malady. The aim of this study was to evaluate the CD57+CD3- mature lymphocyte subpopulation of natural killer cells as a marker of immune dysfunction in ASD. MATERIALS AND METHODS: Three-color flow cytometry-based analysis of fresh peripheral blood samples from children with autism was utilized to measure CD57+CD3- lymphocytes. RESULTS: A reduction of CD57+CD3- lymphocyte count was recorded in a significant number of patients with autism. DISCUSSION AND CONCLUSION: We demonstrated that the number of peripheral CD57+CD3- cells in children with autism often falls below the clinically accepted normal range. This implies that a defect in the counter-regulatory functions necessary for balancing pro-inflammatory cytokines exists, thus opening the way to chronic inflammatory conditions associated with ASD.
33. Thomas KC, Williams CS, deJong N, Morrissey JP. {{Examination of Parent Insurance Ratings, Child Expenditures, and Financial Burden Among Children With Autism: A Mismatch Suggests New Hypotheses to Test}}. {Pediatrics};2016 (Feb);137 Suppl 2:S186-195.
OBJECTIVE: Families raising children with autism contribute significant amounts to the cost of care. In this era of health care reform, families have more insurance choices, but people are unfamiliar with health insurance terms. This study uses 2 national data sets to examine health insurance ratings from parents raising children with autism and child expenditures to explore how these measures align. METHODS: Children with autism who met criteria for special health care needs and were continuously insured were examined. Data from the National Survey of Children With Special Health Care Needs 2009-2010 were used to examine parent report of adequate insurance (n = 3702). Pooled data from the Medical Expenditure Panel Survey 2002-2011 were used to examine expenditures (n = 346). Types of health insurance included private alone, Medicaid alone, and combined private and wrap-around Medicaid. RESULTS: Having Medicaid doubled the odds of reporting adequate insurance compared with private insurance alone (P < .0001), and children on Medicaid had the lowest out-of-pocket costs ($150, P < .0001). Children covered by combined private and wrap-around Medicaid had the highest total expenditures ($11 596, P < .05) and the highest expenditures paid by their insurance ($10 638, P < .05). CONCLUSIONS: These findings highlight a mismatch between parent ratings of insurance adequacy, child expenditures, and relative financial burden. Findings generate a number of questions to address within single sources of data. By elaborating the frameworks families use to judge the adequacy of their insurance, future research can develop policy strategies to improve both their satisfaction with their insurance coverage and the service use of children with autism. Lien vers le texte intégral (Open Access ou abonnement)
34. Vasa RA, Mazurek MO, Mahajan R, Bennett AE, Bernal MP, Nozzolillo AA, Arnold LE, Coury DL. {{Assessment and Treatment of Anxiety in Youth With Autism Spectrum Disorders}}. {Pediatrics};2016 (Feb);137 Suppl 2:S115-123.
OBJECTIVES: Anxiety is one of the most prevalent co-occurring symptoms in youth with autism spectrum disorder (ASD). The assessment and treatment recommendations proposed here are intended to help primary care providers with the assessment and treatment of anxiety in ASD. METHODS: The Autism Speaks Autism Treatment Network/Autism Intervention Research on Physical Health Anxiety Workgroup, a multidisciplinary team of clinicians and researchers with expertise in ASD, developed the clinical recommendations. The recommendations were based on available scientific evidence regarding anxiety treatments, both in youth with ASD and typically developing youth, and clinical consensus of the workgroup where data were lacking. RESULTS: Assessment of anxiety requires a systematic approach to evaluating symptoms and potential contributing factors across various developmental levels. Treatment recommendations include psychoeducation, coordination of care, and modified cognitive-behavioral therapy, particularly for children and adolescents with high-functioning ASD. Due to the limited evidence base in ASD, medications for anxiety should be prescribed cautiously with close monitoring of potential benefits and side effects. CONCLUSIONS: Assessment and treatment of clinical anxiety in youth with ASD require a standardized approach to improve outcomes for youth with ASD. Although this approach provides a framework for clinicians, clinical judgment is recommended when making decisions about individual patients.
Lien vers le texte intégral (Open Access ou abonnement)
35. Vlassakova BG, Emmanouil DE. {{Perioperative considerations in children with autism spectrum disorder}}. {Curr Opin Anaesthesiol};2016 (Feb 24)
PURPOSE OF REVIEW: Children with autism often present a challenge to the anesthesiologist. This review summarizes the current experiences and recommendations for the perioperative management of this unique group of patients. RECENT FINDINGS: Autism is the fastest growing neurodevelopmental disorder in the world. Increased recognition and public awareness of the disease is driven largely by the advances in research. A large body of evidence exists that identifies the role of genetic, environmental, biological, and developmental factors in the origin of autism. The anesthesia literature consists mostly of case reports. Recent publications are reporting management strategies and evaluation of this patient population’s perioperative experiences. SUMMARY: Patients with autism spectrum disorder are a heterogeneous group and often need general anesthesia for different procedures and studies. Familiarity with each patient’s behavioral specifics and efforts to alleviate stress is of paramount importance for a smooth perioperative course with minimal adverse events.
