30 mars 2017

Thérapie par l'équitation pour une personne sourde-aveugle activée par une interface haptique

Aperçu: G.M.
L'étude présente une interface haptique pour aider les sourds-aveugles à pratiquer l'équitation comme activité récréative et thérapeutique.
es réponses aux questionnaires remplis par le cavalier, la famille et l'instructeur montrent que notre technique donne au coureur un plus grand sens de l'indépendance et plus de joie par rapport à l'équitation standard où l'instructeur marche avec le cheval. 


Assist Technol. 2017 Mar 27:1-8. doi: 10.1080/10400435.2017.1288178

Horseback riding therapy for a deafblind individual enabled by a haptic interface

Author information

1
a Department of Bioengineering , Imperial College of Science, Technology and Medicine , London , United Kingdom.
2
b Shadow Robot Company LTD , London , United Kingdom.
3
c School of Electronic Engineering and Computer Science , Queen Mary University of London , London , United Kingdom.

Abstract

We present a haptic interface to help deafblind people to practice horseback riding as a recreational and therapeutic activity. Horseback riding is a form of therapy which can improve self-esteem and sensation of independence. It has been shown to benefit people with various medical conditions-including autism. However, in the case of deafblind riders, an interpreter must stand by at all times to communicate with the rider by touch. We developed a simple interface that enables deafblind people to enjoy horseback riding while the instructor is remotely providing cues, which improves their independence. Experiments demonstrated that an autistic deafblind individual exhibits similar responses to navigational cues as an unimpaired rider. Motivation is an important factor in therapy, and is frequently determinant of its outcome; therefore, the user attitude toward the therapy methods is key. The answers to questionnaires filled by the rider, family, and the instructor show that our technique gives the rider a greater sense of independence and more joy compared to standard riding where the instructor is walking along with the horse.
PMID: 28346067
DOI: 10.1080/10400435.2017.1288178

La variabilité accrue de la force est associée à une modification de la modulation de l'activité de l'activité d'ensemble de motoneurones dans le trouble du spectre de l'autisme

Aperçu: G.M.
Les déficits de contrôle de la force ont été documentés à plusieurs reprises dans le trouble du spectre de l'autisme (TSA). Ils sont associés à une plus grande détérioration des habiletés sociales et de la vie quotidienne chez les personnes, ce qui suggère que développer une compréhension plus mécanique des processus centraux et périphériques qui les causent peut aider à guider le développement de traitements qui améliorent les résultats multiples dans le TSA.
Les personnes avec un diagnostic de TSA présentaient une plus grande variabilité de force que les témoins lorsqu'ils essayaient de maintenir une force constante. Ces résultats suggèrent que des altérations des mécanismes centraux qui contrôlent le déclenchement d'ensembles de motoneurones peuvent sous-tendre les symptômes communs et souvent invalidants des TSA.


Int J Mol Sci. 2017 Mar 25;18(4). pii: E698. doi: 10.3390/ijms18040698.

Increased Force Variability Is Associated with Altered Modulation of the Motorneuron Pool Activity in Autism Spectrum Disorder (ASD)

Wang Z1,2,3, Kwon M4,5,6, Mohanty S7, Schmitt LM8,9,10, White SP11, Christou EA12, Mosconi MW13,14,15.

Author information

1
Schiefelbusch Institute for Life Span Studies, University of Kansas, 1000 Sunnyside Ave., Lawrence, KS 66045, USA. zhengwang@ku.edu
2
Clinical Child Psychology Program, University of Kansas, 1000 Sunnyside Ave., Lawrence, KS 66045, USA. zhengwang@ku.edu.
3
Kansas Center for Autism Research and Training (K-CART), University of Kansas Medical School, Overland Park, KS 66213, USA. zhengwang@ku.edu.
4
Schiefelbusch Institute for Life Span Studies, University of Kansas, 1000 Sunnyside Ave., Lawrence, KS 66045, USA. minhyuk.kwon@marquette.edu.
5
Clinical Child Psychology Program, University of Kansas, 1000 Sunnyside Ave., Lawrence, KS 66045, USA. minhyuk.kwon@marquette.edu.
6
Kansas Center for Autism Research and Training (K-CART), University of Kansas Medical School, Overland Park, KS 66213, USA. minhyuk.kwon@marquette.edu.
7
Center for Autism and Developmental Disabilities, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA. smohanty3@humana.com.
8
Schiefelbusch Institute for Life Span Studies, University of Kansas, 1000 Sunnyside Ave., Lawrence, KS 66045, USA. lmschmitt@ku.edu.
9
Clinical Child Psychology Program, University of Kansas, 1000 Sunnyside Ave., Lawrence, KS 66045, USA. lmschmitt@ku.edu.
10
Kansas Center for Autism Research and Training (K-CART), University of Kansas Medical School, Overland Park, KS 66213, USA. lmschmitt@ku.edu.
11
Center for Autism and Developmental Disabilities, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA. Stormi.White@UTsouthwestern.edu.
12
Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL 32611, USA. eachristou@hhp.ufl.edu.
13
Schiefelbusch Institute for Life Span Studies, University of Kansas, 1000 Sunnyside Ave., Lawrence, KS 66045, USA. mosconi@ku.edu.
14
Clinical Child Psychology Program, University of Kansas, 1000 Sunnyside Ave., Lawrence, KS 66045, USA. mosconi@ku.edu.
15
Kansas Center for Autism Research and Training (K-CART), University of Kansas Medical School, Overland Park, KS 66213, USA. mosconi@ku.edu.

Abstract

Force control deficits have been repeatedly documented in autism spectrum disorder (ASD). They are associated with worse social and daily living skill impairments in patients suggesting that developing a more mechanistic understanding of the central and peripheral processes that cause them may help guide the development of treatments that improve multiple outcomes in ASD. The neuromuscular mechanisms underlying force control deficits are not yet understood. Seventeen individuals with ASD and 14 matched healthy controls completed an isometric index finger abduction test at 60% of their maximum voluntary contraction (MVC) during recording of the first dorsal interosseous (FDI) muscle to determine the neuromuscular processes associated with sustained force variability. Central modulation of the motorneuron pool activation of the FDI muscle was evaluated at delta (0-4 Hz), alpha (4-10 Hz), beta (10-35 Hz) and gamma (35-60 Hz) frequency bands. ASD patients showed greater force variability than controls when attempting to maintain a constant force. Relative to controls, patients also showed increased central modulation of the motorneuron pool at beta and gamma bands. For controls, reduced force variability was associated with reduced delta frequency modulation of the motorneuron pool activity of the FDI muscle and increased modulation at beta and gamma bands. In contrast, delta, beta, and gamma frequency oscillations were not associated with force variability in ASD. These findings suggest that alterations of central mechanisms that control motorneuron pool firing may underlie the common and often impairing symptoms of ASD.
PMID: 28346344
DOI: 10.3390/ijms18040698

Stimulation magnétique transcrânienne répétitive pour le traitement des déficits des fonctions exécutives dans le trouble du spectre de l'autisme: approche par essai clinique

Aperçu: G.M.
Les déficits de la fonction exécutive (EF) chez les personnes avec un diagnostic de trouble du spectre de l'autisme (TSA) sont omniprésents et peu étudiés. En outre, il n'existe pas de traitements efficaces basés sur la neuroscience pour traiter cette caractéristique invalidante des TSA.
La stimulation magnétique transcrânienne répétitive (SMTr) a démontré la promesse de s'attaquer aux déficits de l'EF dans les troubles neuropsychiatriques chez l'adulte. L'article décrit la conception d'un essai randomisé et contrôlé, actuellement en cours, de rTMS bilatéral de 20MHz, , appliquée au cortex préfrontal dorsolatéral (DLPFC) pour le traitement des déficits de l'EF dans les TSA .

J Child Adolesc Psychopharmacol. 2017 Mar 27. doi: 10.1089/cap.2016.0146.

Repetitive Transcranial Magnetic Stimulation for the Treatment of Executive Function Deficits in Autism Spectrum Disorder: Clinical Trial Approach

Author information

1
1 Centre for Brain and Mental Health, The Hospital for Sick Children , Toronto, Canada .
2
2 The Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Campbell Family Mental Health Research Institute, The Centre for Addiction and Mental Health, University of Toronto , Toronto, Canada .
3
3 Department of Psychiatry, Faculty of Medicine, University of Toronto , Toronto, Canada .
4
4 Temerty Centre for Therapeutic Brain Intervention, Campbell Family Mental Health Research Institute , Centre for Addiction and Mental Health, Toronto, Ontario, Canada .
5
5 Genetics and Genome Biology and Autism Research Unit, The Centre for Applied Genomics, The Hospital for Sick Children , Toronto, Canada .
6
6 Program in Neurosciences and Mental Health, Research Institute , The Hospital for Sick Children, Toronto, Canada .
7
7 Department of Psychology, Faculty of Graduate Studies, University of Toronto , Toronto, Canada .
8
8 Division of Child and Adolescent Psychiatry, Department of Psychiatry and Psychology, Mayo Clinic , Rochester, Minnesota.

Abstract

OBJECTIVE:

Executive function (EF) deficits in patients with autism spectrum disorder (ASD) are ubiquitous and understudied. Further, there are no effective, neuroscience-based treatments to address this impairing feature of ASD. Repetitive transcranial magnetic stimulation (rTMS) has demonstrated promise in addressing EF deficits in adult neuropsychiatric disorders. This article will outline the design of a novel randomized-controlled trial of bilateral, 20 Hz, rTMS applied to the dorsolateral prefrontal cortex (DLPFC) for treatment of EF deficits in ASD that is currently ongoing. We describe prior therapeutic rTMS research for ASD and prior rTMS trials targeting EFs in adult neuropsychiatric disorders. A neurophysiological rationale for rTMS treatment of EF deficits in ASD is presented.

METHODS:

An ongoing protocol will enroll participants aged 16-35 with ASD and no intellectual disability. Psychotropic medications will be continued during the 4-week trial of active 20 Hz versus sham rTMS applied to the DLPFC. Twenty, active treatment sessions consisting of 25 stimulation trains at a 90% motor threshold will be administered. The primary outcome measure is the Cambridge Neuropsychological Test Automated Battery (CANTAB) spatial working memory task. At present, recruitment, enrollment, and treatment within the described clinical trial are ongoing.

CONCLUSIONS:

EF deficits are common and impairing symptoms of ASD. There are no evidence-based treatments for EF deficits in ASD. The protocol described here will provide important preliminary data on the feasibility and efficacy of 20 Hz rTMS to DLPFC for EF deficits in ASD.

PMID: 28346865
DOI: 10.1089/cap.2016.0146

Stimulation magnétique transcrânienne répétitive pour le traitement des déficits des fonctions exécutives dans le trouble du spectre de l'autisme: approche par essai clinique

Aperçu: G.M.


J Child Adolesc Psychopharmacol. 2017 Mar 27. doi: 10.1089/cap.2016.0146.

Repetitive Transcranial Magnetic Stimulation for the Treatment of Executive Function Deficits in Autism Spectrum Disorder: Clinical Trial Approach

Author information

1
1 Centre for Brain and Mental Health, The Hospital for Sick Children , Toronto, Canada .
2
2 The Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Campbell Family Mental Health Research Institute, The Centre for Addiction and Mental Health, University of Toronto , Toronto, Canada .
3
3 Department of Psychiatry, Faculty of Medicine, University of Toronto , Toronto, Canada .
4
4 Temerty Centre for Therapeutic Brain Intervention, Campbell Family Mental Health Research Institute , Centre for Addiction and Mental Health, Toronto, Ontario, Canada .
5
5 Genetics and Genome Biology and Autism Research Unit, The Centre for Applied Genomics, The Hospital for Sick Children , Toronto, Canada .
6
6 Program in Neurosciences and Mental Health, Research Institute , The Hospital for Sick Children, Toronto, Canada .
7
7 Department of Psychology, Faculty of Graduate Studies, University of Toronto , Toronto, Canada .
8
8 Division of Child and Adolescent Psychiatry, Department of Psychiatry and Psychology, Mayo Clinic , Rochester, Minnesota.

Abstract

OBJECTIVE:

Executive function (EF) deficits in patients with autism spectrum disorder (ASD) are ubiquitous and understudied. Further, there are no effective, neuroscience-based treatments to address this impairing feature of ASD. Repetitive transcranial magnetic stimulation (rTMS) has demonstrated promise in addressing EF deficits in adult neuropsychiatric disorders. This article will outline the design of a novel randomized-controlled trial of bilateral, 20 Hz, rTMS applied to the dorsolateral prefrontal cortex (DLPFC) for treatment of EF deficits in ASD that is currently ongoing. We describe prior therapeutic rTMS research for ASD and prior rTMS trials targeting EFs in adult neuropsychiatric disorders. A neurophysiological rationale for rTMS treatment of EF deficits in ASD is presented.

METHODS:

An ongoing protocol will enroll participants aged 16-35 with ASD and no intellectual disability. Psychotropic medications will be continued during the 4-week trial of active 20 Hz versus sham rTMS applied to the DLPFC. Twenty, active treatment sessions consisting of 25 stimulation trains at a 90% motor threshold will be administered. The primary outcome measure is the Cambridge Neuropsychological Test Automated Battery (CANTAB) spatial working memory task. At present, recruitment, enrollment, and treatment within the described clinical trial are ongoing.

CONCLUSIONS:

EF deficits are common and impairing symptoms of ASD. There are no evidence-based treatments for EF deficits in ASD. The protocol described here will provide important preliminary data on the feasibility and efficacy of 20 Hz rTMS to DLPFC for EF deficits in ASD.

PMID: 28346865
DOI: 10.1089/cap.2016.0146

Axe Cerveau-intestin et comportement

Aperçu: G.M.
Au cours des 5 dernières années, l'intérêt pour les interactions entre le microbiome intestinal, le cerveau et le comportement a explosé. Des preuves cliniques prouvent le rôle du microbiome intestinal dans les réponses comportementales associées à la douleur, aux émotions, aux interactions sociales et à l'apport alimentaire.Alors que les études réalisées chez des patients souffrant de dépression et de modèles de rongeurs générés par le transfert microbien fécal de ces patients suggèrent une causalité, il n'existe pas d'évidence d'une influence des altérations microbiennes aiguës sur les paramètres comportementaux et cliniques humains. Il y a peu de temps encore, une thérapie de transfert microbien ouverte chez des enfants avec un diagnostic de TSA a validé provisoirement le microbiote intestinal comme cible thérapeutique.


Nestle Nutr Inst Workshop Ser. 2017;88:45-53. doi: 10.1159/000461732. Epub 2017 Mar 27.

Gut-Brain Axis and Behavior

Abstract

In the last 5 years, interest in the interactions among the gut microbiome, brain, and behavior has exploded. Preclinical evidence supports a role of the gut microbiome in behavioral responses associated with pain, emotion, social interactions, and food intake. Limited, but growing, clinical evidence comes primarily from associations of gut microbial composition and function to behavioral and clinical features and brain structure and function. Converging evidence suggests that the brain and the gut microbiota are in bidirectional communication. Observed dysbiotic states in depression, chronic stress, and autism may reflect altered brain signaling to the gut, while altered gut microbial signaling to the brain may play a role in reinforcing brain alterations. On the other hand, primary dysbiotic states due to Western diets may signal to the brain, altering ingestive behavior. While studies performed in patients with depression and rodent models generated by fecal microbial transfer from such patients suggest causation, evidence for an influence of acute gut microbial alterations on human behavioral and clinical parameters is lacking. Only recently has an open-label microbial transfer therapy in children with autism tentatively validated the gut microbiota as a therapeutic target. The translational potential of preclinical findings remains unclear without further clinical investigation.
PMID: 28346923
DOI: 10.1159/000461732

Atténuation de la fonction sociale chez les jeunes femmes ayant une Anorexie nerveuse récente et des personnes rétablies

Aperçu: G.M.
Un sous-groupe de personnes souffrant d'anorexie mentale (AN) présente des difficultés sociales; Cependant, il n'est pas clair si les personnes avec un une comorbidite de TSA expliquent ces difficultés. 
L'étude a porté sur 43 jeunes femmes ayant eu un premier épisode anorexique sans TSA, 23 personnes ayant récupéré à l'adolescente d'une anorexie et 41 sans troubles.
Les participants ayant un premier épisode AN et ceux ayant récupéré d'une AN ont présenté des difficultés dans la fonction sociale, qui n'étaient pas associées à l'indice de masse corporelle ou à d'autres facteurs liés à un trouble chez les patients ayant un premier épisode AN. Les troubles de l'humeur et l'anxiété n'étaient pas associés à ces difficultés. 
Finalement, seuls les participants se sont remis de l'AN ont démontré des déficits dans des domaines spécifiques de la cognition sociale: perception de gestes corporels non verbaux et prosodie vocale. 

29 mars 2017

Auto-immunité, autoanticorps et trouble du spectre de l'autisme

Aperçu: G.M.
De façon alarmante, dans la majorité des cas, les causes des TSA sont largement inconnues.
Bien que les recherches aient porté sur l'identification des anomalies génétiques, les études émergentes suggèrent de plus en plus que le dysfonctionnement immunitaire est un facteur de risque viable contribuant aux déficits neurodéveloppementaux observés dans le TSA.

Biol Psychiatry. 2017 Mar 1;81(5):383-390. doi: 10.1016/j.biopsych.2016.08.031. Epub 2016 Sep 1.

Autoimmunity, Autoantibodies, and Autism Spectrum Disorder

Author information

1
Division of Rheumatology/Allergy and Clinical Immunology, University of California, Davis, Davis, California; The M.I.N.D. Institute, University of California, Davis, Davis, California.
2
The M.I.N.D. Institute, University of California, Davis, Davis, California; NIEHS Center for Children's Environmental Health, University of California, Davis, Davis, California; Department of Medical Microbiology and Immunology, University of California, Davis, Davis, California.
3
Division of Rheumatology/Allergy and Clinical Immunology, University of California, Davis, Davis, California; The M.I.N.D. Institute, University of California, Davis, Davis, California; NIEHS Center for Children's Environmental Health, University of California, Davis, Davis, California. Electronic address: javandewater@ucdavis.edu

Abstract

Auism spectrum disorder (ASD) now affects one in 68 births in the United States and is the fastest growing neurodevelopmental disability worldwide. Alarmingly, for the majority of cases, the causes of ASD are largely unknown, but it is becoming increasingly accepted that ASD is no longer defined simply as a behavioral disorder, but rather as a highly complex and heterogeneous biological disorder. Although research has focused on the identification of genetic abnormalities, emerging studies increasingly suggest that immune dysfunction is a viable risk factor contributing to the neurodevelopmental deficits observed in ASD. This review summarizes the investigations implicating autoimmunity and autoantibodies in ASD.
PMID: 28340985
DOI: 10.1016/j.biopsych.2016.08.031

A travers l'optique kinesthésique: Observation de l'inadéquation sociale dans les troubles du spectre de l'autisme



Aperçu: G.M.  
La thérapie de mouvement de danse (DMT) est une intervention psychothérapeutique qui est utilisée avec les participants avec ASD dans divers environnements. une étude systématique du développement des comportements de syntonie sociale des participants avec un diagnostic de TSA tout au long d'une intervention DMT n'était pas encore disponible.
Une perspective axée sur le mouvement peut être utile pour inventorier les changements dans les comportements d'harmonisation sociale chez les participants.

Cliquer ici pour accéder à l'intégralité de l'article en anglais

Behav Sci (Basel). 2017 Mar 18;7(1). pii: E14. doi: 10.3390/bs7010014.

Through the Kinesthetic Lens: Observation of Social Attunement in Autism Spectrum Disorders

Author information

1
Codarts University of the Arts, MA Arts Therapies, Kruisplein 26, 3012 CC Rotterdam, The Netherlands. rasamaritter@codarts.nl

KenVaK Research Centre for the Arts Therapies, PO Box 550, 6400 AN Heerlen, The Netherlands. rasamaritter@codarts.nl
3
School of Education, University of Hertfordshire, Hatfield AL10 9EU, UK. h.l.payne@herts.ac.uk

Abstract

This paper will present a movement-informed perspective to social attunement in Autism Spectrum Disorders (ASD).

BACKGROUND:

Dance movement therapy (DMT) is a psychotherapeutic intervention that is used with participants with ASD in various settings. Regular clinical outcome monitoring in an outpatient setting in the Netherlands had shown positive effects on social attunement capacities in young people with ASD. However, a systematic study of the development of social attunement movement behaviors of participants with ASD throughout a DMT intervention was not yet available.

METHODS:

A series of individual cases of DMT with young people with ASD (mean age 12.2 years.) were analyzed for changes in interpersonal movement behaviors employing video-based retrospective observation.

RESULTS:

The findings were summarized in an observation scale for interpersonal movement behaviors. This scale was then tested for its applicability for the monitoring of social attunement behaviors throughout therapy.

DISCUSSION:

A movement-informed perspective may be helpful to inventory changes in social attunement behaviors in participants with ASD. The relevance of a movement-informed perspective for the concept of social attunement in ASD will be discussed.

PMID: 28335467
DOI: 10.3390/bs7010014

28 mars 2017

Antagonistes de la dopamine pour la résistance au traitement dans les troubles du spectre de l'autisme: examiner et se concentrer sur les stimulateurs du BDNF, la loxapine et l'amitriptyline

Aperçu: G.M.
Le développement de médicaments est urgent pour les personnes avec un diagnostic de trouble du spectre de l'autisme (TSA) et des comorbidités psychiatriques, qui se présentent souvent comme l'agression et l'automutilation.
L'ancien antipsychotique loxapine est discuté en termes de preuves préliminaires, bien que limitées pour l'efficacité et la sécurité, ainsi que les possibles effets neurotrophiques dans le cerveau.
Les antipsychotiques classiques sont encore souvent utilisés dans la poly pharmacologie antipsychotique cependant les personnes avec TSA sont plus sensibles aux effets secondaires neuromoteurs qui peuvent tard compromettre la mobilité aussi bien que provoquer une dyskinésie tardive et un syndrome malin neuroleptique. 
Les nouveaux antipsychotiques risperidone et aripiprazole sont approuvés par la FDA pour l'irritabilité chez les enfants plus de 5 ans. Cependant, les personnes avec un diagnostic de TSA sont plus sujettes au gain de poids, au diabète de type II et aux effets secondaires associés.
La pratique courante de prescrire des ISRS qui inhibent le métabolisme de nombreux médicaments psychoactifs avec des antipsychotiques aggrave les effets secondaires.  
Une faible dose de loxapine possède des propriétés des antipsychotiques classiques et nouveaux mais elle semble surtout plus neutre en poids, et avec une utilisation prometteuse chez les adolescents et les adultes avec TSA. 
L'amitriptyline semble efficace dans les TSA pour l'irritabilité, l'agressivité impulsive, les problèmes gastro-intestinaux et l'insomnie, chez les enfants, les adolescents et les adultes. 

Expert Opin Pharmacother. 2017 Mar 24. doi: 10.1080/14656566.2017.1308483.

Dopamine antagonists for treatment resistance in autism spectrum disorders: review and focus on BDNF stimulators loxapine and amitriptyline

Author information

1
a University of Missouri-Kansas City , Kansas City Regional Center of Missouri Department of Mental Health , Kansas City Missouri , USA.
2
b The Ohio State University Nisonger Center , Columbus , Ohio , USA.
3
c University of Tennessee , 454R Le Bonheur Children's Foundation Research Center , Memphis , Tennessee , USA.

Abstract

INTRODUCTION:

Drug development is urgently needed for individuals with autism spectrum disorders (ASD) and psychiatric comorbidity, which often presents as aggression and self-injury. At the same time, most psychiatric medications are drugs that have been repurposed following clinical observations of efficacy for a new treatment purpose. Areas Covered: This review aims to provide an overview of dopamine antagonists, including classical and atypical, as well as unconventional antipsychotics in ASD, since they are a mainstay of treatment for such problems. In the event of only partial treatment response practitioners urgently need other prescribing options. The older antipsychotic loxapine is discussed in terms of preliminary albeit limited evidence for efficacy and safety, as well as possible neurotrophic effects in the brain. Emerging promise of the unconventional weak dopamine blocking/tricyclic antidepressant amitriptyline in ASD is discussed more briefly. Promising BDNF effects of loxapine and amitriptyline are included. The need for any antipsychotic tapering plan to be extremely gradual, unless neuroleptic malignant syndrome is present, is also emphasized. Expert Opinion: While behavioral treatments can improve core symptoms in ASD, pharmacotherapy and specifically dopamine antagonists are often prescribed for serious challenging behaviors including aggression. The classical antipsychotics received some study and are still often used in antipsychotic polypharmacy however individuals with ASD are more susceptible to the neuromotor side effects which may further impair already compromised mobility as well as cause tardive dyskinesia and neuroleptic malignant syndrome. The novel antipsychotics risperidone and aripiprazole have received most study in ASD and are FDA-approved for irritability in children over age 5 years. However individuals with ASD are more prone to weight gain, Type II diabetes and associated side effects, for which most novel antipsychotics carry a black box warning. The common practice of prescribing SSRIs that inhibit metabolism of many psychoactive drugs together with antipsychotics compounds the side effects. Low dose loxapine has properties of classical as well as novel antipsychotics but importantly appears more weight neutral, and with promising use in adolescents and adults with ASD. Amitriptyline appears effective in ASD for irritability, impulsive aggression, gastrointestinal problems, and insomnia, in children, adolescents and adults however our adult data on amitriptyline in ASD is still in preparation for publication. Both loxapine and amitriptyline may have positive BDNF effects. Further studies are warranted of both medications in ASD.

PMID: 28335658 

DOI: 10.1080/14656566.2017.1308483

Anomalies de l'épaisseur corticale dans les troubles du spectre autistique au cours de l'enfance, l'adolescence et l'âge adulte: une étude IRM à grande échelle

Aperçu: G.M.
Les études de neuroimagerie dans les troubles du spectre de l'autisme (TSA) ont fourni des preuves incohérentes d'anomalies corticales. Cela s'explique probablement par la faible taille des échantillons utilisés dans la plupart des études et par les différences importantes dans les caractéristiques de l'échantillon, notamment l'âge, ainsi que l'hétérogénéité du trouble.
Les résultats montrent une augmentation de l'épaisseur corticale dans le TSA, principalement latéralisé à gauche, à partir de 6 ans, avec des différences diminuant au cours de l'âge adulte. La gravité des symptômes liés à l'affect social et la communication est corrélée avec ces anomalies corticales. 

Cereb Cortex. 2017 Feb 18:1-11. doi: 10.1093/cercor/bhx038.

Cortical Thickness Abnormalities in Autism Spectrum Disorders Through Late Childhood, Adolescence, and Adulthood: A Large-Scale MRI Study

Author information

1
Montreal Neurological Institute, McGill University, Montreal, QC, CanadaH3H2P1.

Abstract

Neuroimaging studies in autism spectrum disorders (ASDs) have provided inconsistent evidence of cortical abnormality. This is probably due to the small sample sizes used in most studies, and important differences in sample characteristics, particularly age, as well as to the heterogeneity of the disorder. To address these issues, we assessed abnormalities in ASD within the Autism Brain Imaging Data Exchange data set, which comprises data from approximately 1100 individuals (~6-55 years). A subset of these data that met stringent quality control and inclusion criteria (560 male subjects; 266 ASD; age = 6-35 years) were used to compute age-specific differences in cortical thickness in ASD and the relationship of any such differences to symptom severity of ASD. Our results show widespread increased cortical thickness in ASD, primarily left lateralized, from 6 years onwards, with differences diminishing during adulthood. The severity of symptoms related to social affect and communication correlated with these cortical abnormalities. These results are consistent with the conjecture that developmental patterns of cortical thickness abnormalities reflect delayed cortical maturation and highlight the dynamic nature of morphological abnormalities in ASD.
PMID: 28334080
DOI: 10.1093/cercor/bhx038

Âge de la première identification du trouble du spectre de l'autisme: une analyse de deux enquêtes américaines

Aperçu: G.M.
Des données probantes concernant l'âge auquel le trouble du spectre autistique est identifié sont essentielles pour améliorer le dépistage précoce. L'objectif de la recherche était d'estimer la répartition par âge pour la première identification des TSA dans les enquêtes nationales auprès des parents.
Dans deux enquêtes nationales, la majorité des parents d'enfants avec un diagnostic de TSA ont déclaré avoir eu une identification après 3 ans, lorsque l'admissibilité aux services d'intervention précoce a expiré et beaucoup ont déclaré avoir eu une identification de TSA après l'âge scolaire. L'identification tardive des enfants présentant des symptômes plus légers met en évidence la nécessité d'un dépistage précoce qui est sensible à toutes les formes de TSA, quelle que soit la gravité. 

J Am Acad Child Adolesc Psychiatry. 2017 Apr;56(4):313-320. doi: 10.1016/j.jaac.2017.01.012. Epub 2017 Feb 3.

Age at First Identification of Autism Spectrum Disorder: An Analysis of Two US Surveys

Author information

1
Tufts Medical Center, Boston. Electronic address: rsheldrick@tuftsmedicalcenter.org
2
University of Massachusetts, Boston.

Abstract

OBJECTIVE:

Evidence regarding the age at which autism spectrum disorder (ASD) is identified is essential for improving early detection, yet many extant studies have not applied time-to-event analyses, which account for statistical biases that arise from sampling in cross-sectional surveys by adjusting for child age at time of parental report. Our objective was to estimate age distributions for first identification of ASD in national parent surveys using time-to-event analyses.

METHOD:

We conducted time-to-event analyses of responses to identical questions in the 2011 to 2012 National Survey of Children's Health (n = 95,677) and the 2009 to 2010 National Survey of Children with Special Health Care Needs (n = 371,617).

RESULTS:

Parents in both surveys reported that a minority of ASD cases were identified before age 3 years, and that one-third to one-half of cases were identified after 6 years. In both surveys, a majority of parents described their child's ASD severity as mild, and these parents reported the oldest age at identification (mean, 5.6 and 8.6 years). In contrast, parents who described their child's ASD as severe reported earlier age at identification (mean, 3.7 and 4.5 years). Time-to-event analyses yielded older estimates of age at identification than analyses based on raw distributions.

CONCLUSION:

In two national surveys, a majority of parents of children with ASD reported identification after 3 years, when eligibility for early intervention services expires, and many reported identification of ASD after school age. Later identification of children with milder symptoms highlights the need for early screening that is sensitive to all forms of ASD, regardless of severity.
PMID: 28335875
DOI: 10.1016/j.jaac.2017.01.012