Trouble du sommeil familial et "trouble du spectre de l'autisme": une étude d'actigraphie pilote sur la qualité du sommeil, la qualité de vie et la détresse psychologique

Aperçu: G.M.

Objectifs:
Les problèmes de sommeil sont courants chez les enfants avec un diagnostic de "trouble du spectre de l'autisme (dTSA) et peuvent avoir un impact négatif sur le comportement et le fonctionnement de l'enfant pendant la journée. L'étude pilote actuelle a examiné des mesures objectives du sommeil des enfants et des parents en tant que facteurs associés au stress, à l'anxiété, aux symptômes dépressifs, au soutien social et à la qualité de vie des parents d'enfants avec un dTSA. 

Méthodes:
Les participants étaient neuf enfants avec un dTSA et leurs parents (neuf mères et trois pères). Les participants ont porté un actigraphe pendant 7 jours et nuits consécutifs. Des mesures des habitudes et de la qualité du sommeil ont été utilisées pour vérifier le sommeil des enfants et des parents. Des mesures du stress parental, de l'anxiété, des symptômes dépressifs, de la qualité de vie et du soutien social ont été rassemblées. 

Résultats:
Les résultats ont indiqué l'émergence d'un stress parental élevé, d'anxiété et de symptômes dépressifs. Des corrélations significatives ont été observées entre les symptômes dépressifs des parents et la qualité subjective du sommeil et les perturbations du sommeil des enfants. 

Conclusions:
La présente étude a révélé que le bien-être des parents est affecté par les problèmes de sommeil des enfants.

• 2021 May 11;1-11.  doi: 10.1017/ipm.2021.24. 

Familial sleep and autism spectrum disorder: a pilot actigraphy study of sleep quality, quality of life and psychological distress

Geraldine Leader  ¹ , Carmel Glynn  ¹ , Bernadette Kirkpatrick  ² , June L Chen  ³ , Páraic S O'Súilleabháin  ^{4   5} , Arlene Mannion  ¹

Affiliations

• PMID: 33973508
• DOI: 10.1017/ipm.2021.24

Abstract

Objectives: Sleep problems are common among children with autism spectrum disorder (ASD) and can have a negative impact on the child's behaviour and daytime functioning. The current pilot study examined objective measurements of child and parent sleep as factors associated with the stress, anxiety, depressive symptoms, social support and quality of life of parents of children with ASD.

Methods: Participants were nine children with ASD and their parents (nine mothers and three fathers). Participants wore an actigraph for 7 consecutive days and nights. Measures of sleep habits and quality were used to ascertain child and parent sleep. Measures of parenting stress, anxiety, depressive symptoms, quality of life and social support were collated.

Results: Results indicated the emergence of high parental stress, anxiety and depressive symptoms. Significant correlations were observed between parent depressive symptoms, and both subjective sleep quality and child sleep disruptions.

Conclusions: The present study found that parental well-being is affected by child sleep problems.

Keywords: Autism spectrum disorder; actigraphy; parents; quality of life; sleep problems.

Comorbidités médicales de l'autisme

 Aperçu: G.M.

Les comorbidités médicales sont plus fréquentes chez les enfants avec un diagnostic de "troubles du spectre de l'autisme" (dTSA) que dans la population générale. Certains troubles génétiques sont plus fréquents chez les enfants atteints de TSA, tels que le syndrome du X fragile, le syndrome de Down, la dystrophie musculaire de Duchenne, la neurofibromatose de type I et le complexe de la sclérose tubéreuse.
Les enfants autistes sont également plus sujets à divers troubles neurologiques, notamment l'épilepsie, la macrocéphalie, l'hydrocéphalie, la paralysie cérébrale, la migraine / maux de tête et les anomalies congénitales du système nerveux.
En outre, les troubles du sommeil sont un problème important chez les personnes autistes, survenant chez environ 80% d'entre eux.
Les troubles gastro-intestinaux (GI) sont significativement plus fréquents chez les enfants avec un dTSA; ils surviennent chez 46% à 84% d'entre eux. Les problèmes gastro-intestinaux les plus courants observés chez les enfants avec un dTSA sont la constipation chronique, la diarrhée chronique, le reflux et / ou la maladie gastro-œsophagienne, les nausées et / ou vomissements, les flatulences, les ballonnements chroniques, l'inconfort abdominal, les ulcères, la colite, les maladies inflammatoires de l'intestin, l'intolérance alimentaire et / ou retard staturopondéral..
Plusieurs catégories d'erreurs innées du métabolisme ont été observées chez certains patients autistes, y compris des troubles mitochondriaux, des troubles du métabolisme de la créatine, des troubles des acides aminés sélectionnés, des troubles du métabolisme du folate ou de la B12 et certains troubles du stockage lysosomal.
Une proportion significative d'enfants avec un dTSA présente des signes de neuroinflammation persistante, des réponses inflammatoires modifiées et des anomalies immunitaires. Les anticorps anti-cérébraux peuvent jouer un important mécanisme pathoplastique dans l'autisme. Les troubles allergiques sont significativement plus fréquents chez les personnes avec un dTSA de tous les groupes d'âge. Ils influencent le développement et la gravité des symptômes. Ils pourraient provoquer des comportements problématiques chez au moins un sous-ensemble significatif d'enfants affectés.
Par conséquent, il est important de considérer l'enfant autiste dans son ensemble et de ne pas négliger les symptômes possibles dans le cadre de l'autisme. Le médecin doit exclure la présence d'une condition médicale avant de passer à d'autres interventions ou thérapies. Les enfants en bonne santé ont de meilleures chances d'apprendre. Cela peut s'appliquer à tous les enfants, y compris ceux qui sont autistes.

• 2021 May 9;10(3):15-28.

doi: 10.5409/wjcp.v10.i3.15.

Autism medical comorbidities

Mohammed Al-Beltagi  ¹

Affiliations

• PMID: 33972922
• PMCID: PMC8085719
• DOI: 10.5409/wjcp.v10.i3.15

Abstract

Medical comorbidities are more common in children with autism spectrum disorders (ASD) than in the general population. Some genetic disorders are more common in children with ASD such as Fragile X syndrome, Down syndrome, Duchenne muscular dystrophy, neurofibromatosis type I, and tuberous sclerosis complex. Children with autism are also more prone to a variety of neurological disorders, including epilepsy, macrocephaly, hydrocephalus, cerebral palsy, migraine/headaches, and congenital abnormalities of the nervous system. Besides, sleep disorders are a significant problem in individuals with autism, occurring in about 80% of them. Gastrointestinal (GI) disorders are significantly more common in children with ASD; they occur in 46% to 84% of them. The most common GI problems observed in children with ASD are chronic constipation, chronic diarrhoea, gastroesophageal reflux and/or disease, nausea and/or vomiting, flatulence, chronic bloating, abdominal discomfort, ulcers, colitis, inflammatory bowel disease, food intolerance, and/or failure to thrive. Several categories of inborn-errors of metabolism have been observed in some patients with autism including mitochondrial disorders, disorders of creatine metabolism, selected amino acid disorders, disorders of folate or B12 metabolism, and selected lysosomal storage disorders. A significant proportion of children with ASD have evidence of persistent neuroinflammation, altered inflammatory responses, and immune abnormalities. Anti-brain antibodies may play an important pathoplastic mechanism in autism. Allergic disorders are significantly more common in individuals with ASD from all age groups. They influence the development and severity of symptoms. They could cause problematic behaviours in at least a significant subset of affected children. Therefore, it is important to consider the child with autism as a whole and not overlook possible symptoms as part of autism. The physician should rule out the presence of a medical condition before moving on to other interventions or therapies. Children who enjoy good health have a better chance of learning. This can apply to all children including those with autism.

Keywords: Allergy; Autism; Children; Epilepsy; Gastrointestinal diseases; Medical comorbidity; Sleep disorders.

 

Le savant inattendu: une nouvelle forme de capacités extraordinaires

Aperçu: G.M.

Introduction:
Le syndrome de Savant était auparavant caractérisé comme congénital ou acquis. Ce rapport décrit le syndrome du savant inattendu dans lequel des personnes neurotypiques ont l'émergence soudaine de compétences savantes sans handicap sous-jacent ni lésion cérébrale et sans intérêt ou capacité préalable dans les domaines de compétences nouvellement émergés. 

Présentation de cas:
Onze cas sont décrits dans lesquels des capacités de savant sont apparues soudainement et de manière inattendue chez des personnes neurotypiques sans intérêt ou capacité préalable particulier pour les nouvelles compétences, accompagnées d'un intérêt obsessionnel et d'un besoin compulsif d'afficher les nouvelles capacités. Tous les participants ont répondu à un sondage en ligne pour enregistrer leurs caractéristiques démographiques et leurs compétences. 

Discussion:
Le savant acquis, et maintenant le savant inattendu, soulèvent des questions sur le potentiel dormant de ces compétences enfouies chez chacun. Le défi est de pouvoir exploiter ces capacités latentes sans traumatisme crânien ou autres événements précipitants. 

Conclusion:
Cet article documente 11 cas de syndrome du savant inattendu, qui est une forme nouvelle et supplémentaire de capacités de savant apparaissant chez des personnes neurotypiques sans troubles du développement (tels que l'autisme) ou traumatisme crânien ou autre (syndrome du savant acquis). Cela ouvre de nouvelles voies d'enquête pour l'exploration de capacités extraordinaires peut-être chez tout le monde.

. 2021 Apr;120(1):69-73.

The Sudden Savant: A New Form of Extraordinary Abilities

Darold A Treffert  ¹ , Darold A Treffert  ²

Affiliations

• PMID: 33974770

Abstract

Introduction: Savant Syndrome previously has been characterized as either congenital or acquired. This report describes sudden savant syndrome in which neurotypical persons have the sudden emergence of savant skills without underlying disability or brain injury and without prior interest or ability in the newly emerged skill areas.

Case presentation: Eleven cases are described in which savant abilities suddenly and unexpectedly surfaced in neurotypical persons with no special prior interest or ability in the new skills, accompanied by an obsessive interest with and compulsive need to display the new abilities. All participants completed an online survey to record their demographics and skill characteristics.

Discussion: The acquired savant, and now the sudden savant, raise questions about the dormant potential for such buried skills in everyone. The challenge is to be able to tap such latent abilities without head injury or other precipitating events.

Conclusion: This paper documents 11 cases of sudden savant syndrome, which is a new and additional form of savant abilities surfacing in neurotypical persons without developmental disabilities (such as autism) or head or other brain injury (acquired savant syndrome). It opens new paths of inquiry for exploration of extraordinary abilities perhaps within everyone.

Polypharmacie psychotrope chez les enfants et les jeunes autistes: une revue systématique

Aperçu: G.M.

Objectifs:
La majorité des jeunes autistes prennent simultanément au moins deux médicaments (psychotropes ou non psychotropes), également connus sous le nom de polypharmacie (Wink et al.). Pourtant, l'efficacité et les résultats potentiels de la polypharmacie dans cette population sont largement inconnus. Cette revue systématique de la littérature décrit les tendances de la polypharmacie chez les jeunes autistes et identifie les facteurs associés à la polypharmacie. 

Méthodes:
Seize études ont été incluses, englobant plus de 300 000 jeunes autistes. 

Résultats:
Les taux de polypharmacie variaient considérablement d'une étude à l'autre, allant de 6,8% à 87% des jeunes autistes. Avoir des comorbidités psychiatriques, des comportements d'automutilation et une agression physique, ainsi que le fait d'être de sexe masculin et plus âgé, étaient associés à des taux plus élevés de polypharmacie. 

Conclusion:
Les résultats soulignent l'importance de recherches supplémentaires pour déterminer les pratiques appropriées liées à la surveillance des effets secondaires indésirables et l'impact à long terme de la polypharmacie chez les jeunes autistes.

• 2021 May 7. doi: 10.1089/cap.2020.0110. 

Psychotropic Polypharmacy Among Children and Youth with Autism: A Systematic Review

Chantel Ritter  ¹ , Katherine Hewitt  ^{2   3} , Carly A McMorris  ^{2   3}

Affiliations

• PMID: 33970024
• DOI: 10.1089/cap.2020.0110

Abstract

Objectives: Majority of youth with autism are taking two or more medications (psychotropic or nonpsychotropic) simultaneously, also known as polypharmacy (Wink et al.). Yet the efficacy and the potential outcomes of polypharmacy in this population are widely unknown. This systematic literature review described the trends of polypharmacy among autistic youth, and identified factors associated with polypharmacy. Methods: Sixteen studies were included, encompassing over 300,000 youth with autism. Results: Rates of polypharmacy varied quite substantially across studies, ranging from 6.8% to 87% of autistic youth. Having psychiatric comorbidities, self-injurious behaviors, and physical aggression, as well as being male and older, were associated with higher rates of polypharmacy. Conclusion: Findings emphasize the importance of further research to determine appropriate practices related to the monitoring of adverse side effects, and the long-term impact of polypharmacy among autistic youth.

Keywords: autism; children; mental health; multiple medications; polypharmacy; psychotropic medications; youth.

Le profil de la mémoire épisodique dans les "troubles du spectre de l'autisme": une méta-analyse bayésienne

Aperçu: G.M.

Bien que les "troubles du spectre de l'autisme" (TSA) soient généralement caractérisés par une mémoire épisodique diminuée, la littérature dans ce domaine est mitigée.
Nous abordons ces résultats inconsistants en utilisant une méta-analyse bayésienne à plusieurs niveaux pour quantifier les différences de mémoire épisodiques entre les personnes avec un diagnostic de TSA et les témoins au développement typique (TD).
Nous avons utilisé la méta-régression pour évaluer les effets de la modalité de test (par exemple, liste de mots, rappel d'histoire), de l'intervalle de retard (immédiat vs retardé), des demandes de récupération (reconnaissance vs rappel) et de la modalité sensorielle (auditive vs visuelle) sur la mémoire épisodique dans les TSA.
Un total de 338 tailles d'effet provenant de 113 articles empiriques, dont 5 632 participants uniques (TSA = 2 777, DT = 2 855), ont été inclus. 

Les résultats montrent que les déficits de mémoire associés aux TSA étaient plus importants pour le rappel (g = -0,52, se = 0,04, 95% CrI [-0,60, -0,43]) par rapport à la reconnaissance (g = -0,25, se = 0,05, 95% CrI [-0,35, -0,14]) et différaient en fonction de la modalité de test.
Par exemple, les tailles d'effet étaient les plus petites pour les mots (g = -0,28, se = 0,05, 95% CrI [-0,38, -0,18]), les images (g = -0,38, se = 0,07, 95% CrI [-0,52, - 0,24]) et la reproduction de la figure (g = -0,49, se = 0,11, 95% CrI [-0,70, -0,27]).
Cependant, les tailles d'effet pour les phrases (g = -0,59, se = 0,20, 95% CrI [-1,00, -0,21]), les histoires (Hedges 'g = -0,54, se = 0,08, 95% CrI [-0,69, -0,38 ]) et les événements par étapes (g = -0,75, se = 0,10, 95% CrI [-0,95, -0,55]) étaient beaucoup plus importants. 

Ces résultats suggèrent que le TSA est associé à une réduction faible à moyenne des scores aux tests de mémoire épisodique par rapport aux témoins TD.

. 2021 May 5. doi: 10.1007/s11065-021-09493-5. 

The Episodic Memory Profile in Autism Spectrum Disorder: A Bayesian Meta-Analysis

Jason W Griffin  ¹ , Russell Bauer  ² , Brandon E Gavett  ³

Affiliations

• PMID: 33954915
• DOI: 10.1007/s11065-021-09493-5

Abstract

Although autism spectrum disorders (ASD) are commonly characterized by diminished episodic memory, the literature in this area is mixed. We address these inconsistent findings by employing multilevel Bayesian meta-analysis to quantify episodic memory differences between individuals with ASD and typically developing (TD) controls. We used meta-regression to evaluate the effects of test modality (e.g., word list, story recall), delay interval (immediate vs. delayed), retrieval demands (recognition vs. recall), and sensory modality (auditory vs. visual) on episodic memory in ASD. A total of 338 effect sizes from 113 empirical articles, including 5,632 unique participants (ASD = 2,777, TD = 2,855), were included. Results show that the memory deficits associated with ASD were larger for recall (g = -0.52, se = 0.04, 95% CrI [-0.60, -0.43]) compared to recognition (g = -0.25, se = 0.05, 95% CrI [-0.35, -0.14]) and differed based on the testing modality. For example, effect sizes were smallest for words (g = -0.28, se = 0.05, 95% CrI [-0.38, -0.18]), pictures (g = -0.38, se = 0.07, 95% CrI [-0.52, -0.24]), and figure reproduction (g = -0.49, se = 0.11, 95% CrI [-0.70, -0.27]). However, effect sizes for sentences (g = -0.59, se = 0.20, 95% CrI [-1.00, -0.21]), stories (Hedges' g = -0.54, se = 0.08, 95% CrI [-0.69, -0.38]) and staged events (g = -0.75, se = 0.10, 95% CrI [-0.95, -0.55]) were much larger. These findings suggest that ASD is associated with a small to medium reduction in scores on episodic memory tests relative to TD controls.

Keywords: ASD; Neuropsychological tests; Recall; Recognition; Systematic review.

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