L'effet de la thérapie par l'exercice physique sur les troubles du spectre de l'autisme: une revue systématique et une méta-analyse

 Aperçu: G.M.

Résumé 

Contexte :
La thérapie par l'exercice physique (TEP) est de plus en plus utilisée dans le traitement des troubles du spectre de l'autisme (TSA), mais les preuves empiriques de son efficacité restent ambiguës. Cette étude systématique et cette méta-analyse ont pour but d'étudier l'efficacité de la thérapie par l'exercice physique pour les personnes avec un diagnosti de TSA, afin de fournir un soutien factuel à la recherche clinique et scientifique.

Méthodes :
Nous avons effectué des recherches systématiques dans quatre bases de données internationales (Medline via PubMed, Embase, Cochrane Libraries et Web of Science) et trois bases de données chinoises (CNKI, Wanfang et VIP Libraries) jusqu'au 31 juillet 2023. La recherche a été effectuée en anglais et en chinois pour trouver des articles de recherche originaux utilisant des essais contrôlés randomisés (ECR) pour étudier les effets de la TEP sur les personnes ayant reçu un diagnostic de TSA selon les critères du DSM ou d'autres critères établis. Les résultats coprimaires étaient axés sur la gravité globale de l'autisme, tandis que les résultats secondaires comprenaient des mesures des comportements stéréotypés, des déficits sociaux, des aptitudes sociales et des fonctions exécutives. Les données des études incluses ont été synthétisées et analysées à l'aide de RevMan 5.4. Cette revue systématique est enregistrée auprès de PROSPERO (CRD42023443951).

Résultats :
Au total, 28 ECR comprenant 1 081 participants ont été analysés. Seules trois de ces études répondaient à des normes de haute qualité.
Comparativement aux groupes témoins, le TEP a montré une amélioration d'au moins un symptôme central de l'autisme, y compris la performance motrice (SMD=1,72, 95%CI[1,01, 2,44], I2=90%), les comportements répétitifs restreints (SMD=-0,81, 95%CI[-1,00, -0,62], I2=0%), le dysfonctionnement social (SMD=-0,76, 95%CI[-1,06, -0,46], I2=47%).

Conclusions :
La TEP peut permettre de réduire la gravité globale et les symptômes associés chez les personnes avec un diagnostic de TSA. Toutefois, compte tenu du risque global élevé de biais dans les études incluses, ces résultats doivent être interprétés avec prudence.

 

. 2024 Jul 6:339:116074.

doi: 10.1016/j.psychres.2024.116074. Online ahead of print.

The effect of physical exercise therapy on autism spectrum disorder:a systematic review and meta-analysis

Yifan Wu  ¹ , Lu Ding  ² , Qiao Zhang  ² , Yu Dong  ² , Chenyang Tao  ² , Zhenyuan Li  ³ , Zhaowei Li  ¹ , Liming Lu  ⁴

Affiliations

• PMID: 38986177
• DOI: 10.1016/j.psychres.2024.116074

Abstract

Background: Physical Exercise Therapy (PET) is increasingly applied in the treatment of Autism Spectrum Disorders (ASD), yet the empirical evidence supporting its efficacy remains ambiguous. This systematic review and meta-analysis aimed to investigate the effectiveness of PET for individuals with ASD, providing evidence-based support for clinical and scientific research.

Methods: We systematically searched four international databases (Medline via PubMed, Embase, Cochrane Libraries, and Web of Science) and three Chinese databases (CNKI, Wanfang, and VIP Libraries) up to July 31, 2023. The search was conducted in both English and Chinese for original research articles employing randomized-controlled-trial (RCT) designs to study PET's effects on individuals diagnosed with ASD according to DSM or other established criteria. Co-primary outcomes focused on the overall severity of autism, while secondary outcomes included measures of stereotyped behaviors, social deficits, social skills, and executive functioning. Data from the included studies were synthesized and analyzed using RevMan 5.4. This systematic review is registered with PROSPERO (CRD42023443951).

Results: A total of 28 RCTs comprising 1081 participants were analyzed. Of these, only three studies met high-quality standards. Compared to control groups, PET showed improvement in at least one core symptom of autism, including Motor Performance (SMD=1.72, 95%CI[1.01, 2.44], I²=90%), Restricted Repetitive Behaviors (SMD=-0.81, 95%CI[-1.00, -0.62], I²=0%), Social Dysfunction (SMD=-0.76, 95%CI[-1.06, -0.46], I²=47%).

Conclusions: PET may offer benefits in reducing the overall severity and associated symptoms in individuals with ASD. However, given the high overall risk of bias in the included studies, these findings should be interpreted with caution.

Keywords: Autism spectrum disorder; Meta-analysis; Physical exercise therapy; Systematic review.

Comportements inadaptés chez les enfants autistes et désespoir parental : le rôle modérateur du fonctionnement réflexif parental

Aperçu: G.M.

Le désespoir chez les parents a des répercussions sur leur propre bien-être ainsi que sur leur capacité à répondre aux besoins de leurs enfants.
Dans la présente étude, nous avons examiné l'effet des comportements inadaptés chez les enfants autistes sur le désespoir parental, en accordant une attention particulière à la question de savoir si le fonctionnement réflexif parental modérerait l'effet des comportements inadaptés sur le désespoir parental.

Notre échantillon comprenait 68 parents d'enfants autistes âgés de 3 à 18 ans.
Les résultats ont révélé une relation positive significative entre les comportements inadaptés chez les enfants et le désespoir chez les parents. De plus, le fonctionnement réflexif parental a modéré l'effet des comportements inadaptés de l'enfant sur le désespoir parental, de sorte que les comportements inadaptés des enfants étaient positivement associés au désespoir parental chez les parents ayant un fonctionnement réflexif faible (mais pas élevé).
Les résultats suggèrent que le fonctionnement réflexif parental peut être un facteur de protection contre le désespoir parental, et donc une cible possible pour les interventions en cas de désespoir chez les parents dont les enfants autistes présentent des comportements inadaptés plus importants. 

 

. 2022 Nov 5.

doi: 10.1002/aur.2841. Online ahead of print.

Maladaptive behaviors in children with autism and parental hopelessness: The moderating role of parental reflective functioning

Yael Enav  ¹ , Marguerite V Knudtson  ² , Antonio Y Hardan  ² , James J Gross  ²

Affiliations

• PMID: 36333959
• DOI: 10.1002/aur.2841

Abstract

Hopelessness in parents has implications for parents' own well-being as well as their ability to meet the needs of their children. In the present study, we examined the effect of maladaptive behaviors in children with autism on parental hopelessness, with particular attention to whether parental reflective functioning would moderate the effect of maladaptive behaviors on parental hopelessness. Our sample included 68 parents of children with autism between the ages of 3 and 18. Findings revealed a significant positive relationship between maladaptive behaviors in the children and hopelessness in the parents. Moreover, parental reflective functioning moderated the effect of child maladaptive behaviors on parental hopelessness, such that children's maladaptive behaviors were positively associated with parental hopelessness in parents with low (but not high) reflective functioning. Findings suggest parental reflective functioning may be a protective factor against parental hopelessness, and thus a possible target for interventions for hopelessness in parents whose children with autism exhibit greater maladaptive behaviors.

Keywords: adults; affect/emotion; children; clinical psychology; restricted/repetitive behaviors.

© 2022 The Authors. Autism Research published by International Society for Autism Research and Wiley Periodicals LLC.

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Les sous-types de comportement social-communicatif déséquilibré et de comportement répétitif restreint du "trouble du spectre de l'autisme" présentent des circuits neuronaux différents

Aperçu: G.M.

La communication sociale (SC) et les comportements répétitifs restreints (CRR) sont des domaines de symptômes diagnostiques de l'autisme. La gravité de la SC et du CRRpeut différer considérablement au sein et entre les individus et peut être étayée par différents circuits neuronaux et mécanismes génétiques.
La modélisation de l'équilibre SC-RRB pourrait aider à identifier comment les circuits neuronaux et les mécanismes génétiques correspondent à une telle hétérogénéité phénotypique. 

Ici, nous avons développé un modèle de stratification phénotypique qui permet des prédictions de sous-types SC = CRR, SC> CRR et CRR> SC très précises (97-99%) hors échantillon. En appliquant ce modèle aux données IRMf à l'état de repos de l'ensemble de données EU-AIMS LEAP (n = 509), nous constatons que si les sous-types phénotypiques partagent de nombreux points communs en termes de connectivité fonctionnelle intrinsèque, ils montrent également des différences réplicables au sein de certains réseaux par rapport à un groupe au développement typique (DT).
Plus précisément, le réseau somatomoteur est hypoconnecté avec les circuits périsylviens en SC> CRR et les circuits d'association visuelle en SC = CRR. Le sous-type SC = CRR montre une hyperconnectivité entre le moteur médial et les circuits de saillance antérieure.
Les gènes qui sont fortement exprimés dans ces réseaux montrent un modèle d'enrichissement différentiel avec des gènes connus associés à l'autisme, indiquant que ces circuits sont affectés par différents mécanismes génomiques associés à l'autisme. 

Ces résultats suggèrent que les sous-types de déséquilibre SC-CRR partagent de nombreux points communs, mais expriment également des différences subtiles dans les circuits neuronaux fonctionnels et les fondements génomiques derrière ces circuits. 

. 2021 May 14;4(1):574. doi: 10.1038/s42003-021-02015-2.

Imbalanced social-communicative and restricted repetitive behavior subtypes of autism spectrum disorder exhibit different neural circuitry

Natasha Bertelsen  ^{1   2} , Isotta Landi  ¹ , Richard A I Bethlehem  ³ , Jakob Seidlitz  ^{4   5} , Elena Maria Busuoli  ^{1   2} , Veronica Mandelli  ^{1   2} , Eleonora Satta  ¹ , Stavros Trakoshis  ^{1   6} , Bonnie Auyeung  ^{7   8} , Prantik Kundu  ⁹ , Eva Loth  ^{10   11} , Guillaume Dumas  ¹² , Sarah Baumeister  ¹³ , Christian F Beckmann  ¹⁴ , Sven Bölte  ^{15   16   17} , Thomas Bourgeron  ¹² , Tony Charman  ¹⁸ , Sarah Durston  ¹⁹ , Christine Ecker  ²⁰ , Rosemary J Holt  ⁸ , Mark H Johnson  ²¹ , Emily J H Jones  ²² , Luke Mason  ²² , Andreas Meyer-Lindenberg  ²³ , Carolin Moessnang  ²³ , Marianne Oldehinkel  ^{14   24} , Antonio M Persico  ^{25   26} , Julian Tillmann  ^{18   27} , Steve C R Williams  ²⁸ , Will Spooren  ²⁹ , Declan G M Murphy  ^{10   11} , Jan K Buitelaar  ¹⁴ , EU-AIMS LEAP group; Simon Baron-Cohen  ⁸ , Meng-Chuan Lai  ^{8   30   31   32   33} , Michael V Lombardo  ^{34   35}

Collaborators, Affiliations

• PMID: 33990680
• DOI: 10.1038/s42003-021-02015-2

Abstract

Social-communication (SC) and restricted repetitive behaviors (RRB) are autism diagnostic symptom domains. SC and RRB severity can markedly differ within and between individuals and may be underpinned by different neural circuitry and genetic mechanisms. Modeling SC-RRB balance could help identify how neural circuitry and genetic mechanisms map onto such phenotypic heterogeneity. Here, we developed a phenotypic stratification model that makes highly accurate (97-99%) out-of-sample SC = RRB, SC > RRB, and RRB > SC subtype predictions. Applying this model to resting state fMRI data from the EU-AIMS LEAP dataset (n = 509), we find that while the phenotypic subtypes share many commonalities in terms of intrinsic functional connectivity, they also show replicable differences within some networks compared to a typically-developing group (TD). Specifically, the somatomotor network is hypoconnected with perisylvian circuitry in SC > RRB and visual association circuitry in SC = RRB. The SC = RRB subtype show hyperconnectivity between medial motor and anterior salience circuitry. Genes that are highly expressed within these networks show a differential enrichment pattern with known autism-associated genes, indicating that such circuits are affected by differing autism-associated genomic mechanisms. These results suggest that SC-RRB imbalance subtypes share many commonalities, but also express subtle differences in functional neural circuitry and the genomic underpinnings behind such circuitry.

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