01 novembre 2022

Déficiences motrices chez les tout-petits chinois avec un diagostic de troubles du spectre de l'autisme et leur relation avec les compétences de communication sociale

Aperçu: G.M.

Objectif
Les déficiences motrices sont prévalentes chez les enfants avec un diagnostic de trouble du spectre de l'autisme (dTSA) et persistent à travers l'âge. Notre étude actuelle a été conçue pour étudier les déficits moteurs chez les tout-petits chinois avec un dTSA et pour explorer les relations entre les déficits moteurs et les compétences de communication sociale. 

Méthodes
Pour cette étude transversale, nous avons recruté un total de 210 tout-petits chinois avec un dTSA âgés de 18 à 36 mois dans l'étude de décembre 2017 à décembre 2020. Griffiths Developmental Scales-Chinese (GDS-C), Autism Diagnostic Observation Schedule -Second Edition (ADOS-2) et Communication and Symbolic Behavior Scales Developmental Profile-Infant-Toddler Checklist (CSBS-DP-ITC) ont été administrés à ces tout-petits pour évaluer leur développement, leurs compétences de communication sociale et la gravité de l'autisme. Nous avons comparé les profils de développement et de communication sociale des tout-petits TSA dans différents sous-groupes de motricité globale et fine, et exploré les facteurs associés potentiels. Le modèle linéaire généralisé univarié a testé la relation entre la motricité fine et globale et les compétences de communication sociale. 

Résultats
La prévalence des déficits moteurs globaux et fins était de 59,5 et 82,5 %, respectivement, ce qui est presque équivalent chez les garçons et les filles. Les déficiences motrices ont tendance à être plus sévères avec l'âge chez les tout-petits. Après ajustement pour l'âge, le sexe, le quotient de développement non verbal (QD) et les comportements restreints et répétitifs, les déficiences motrices globales plus graves étaient significativement liées à un score de comparaison plus élevé d'ADOS-2 et à un score composite social plus élevé de CSBS-DP-ITC, sans interactions avec d'autres variables. Pendant ce temps, une motricité fine inférieure était associée à davantage de déficits de communication sociale et à une sévérité plus élevée des TSA, également en fonction du QD non verbal. Dans le sous-groupe QD non verbal inférieur, les déficits de motricité fine et les comportements répétitifs restreints (RRB) pourraient avoir des effets sur les symptômes de l'autisme. 

Conclusion
Les déficiences motrices sont courantes chez les tout-petits chinois avec un dTSA. Les tout-petits dont les habiletés motrices globales et fines sont plus faibles ont des déficits plus importants dans les habiletés de communication sociale. La déficience motrice globale pourrait être un prédicteur indépendant de la gravité de l'autisme et des compétences de communication sociale, tandis que l'effet des déficits de motricité fine pourrait être affecté par le QD et les RRB non verbaux des tout-petits avec un dTSA. Nous fournissons une justification supplémentaire pour l'inclusion des déficiences motrices dans l'intervention précoce pour les tout-petits avec un dTSA.

. 2022 Oct 14;13:938047.
doi: 10.3389/fpsyt.2022.938047. eCollection 2022.

Motor impairments in Chinese toddlers with autism spectrum disorder and its relationship with social communicative skills

Bingrui Zhou  1 , Qiong Xu  1 , Huiping Li  1 , Ying Zhang  1 , Dongyun Li  1 , Ping Dong  1 , Yi Wang  1 , Ping Lu  1 , Ye Zhu  1 , Xiu Xu  1
Affiliations

Abstract

Objective: Motor impairments are prevalent in children with autism spectrum disorder (ASD) and persistent across age. Our current study was designed to investigate motor deficits in Chinese toddlers with ASD and to explore the relationships between motor deficits and social communication skills.

Methods: For this cross-sectional study, we recruited a total of 210 Chinese toddlers with ASD aged between 18 and 36 months in the study during December 2017 to December 2020. Griffiths Developmental Scales-Chinese (GDS-C), Autism Diagnostic Observation Schedule-Second Edition (ADOS-2) and Communication and Symbolic Behavior Scales Developmental Profile-Infant-Toddler Checklist (CSBS-DP-ITC) were administered in these toddlers to evaluate their development, social communicative skills, and autism severity. We compared the developmental and social communicational profiles of ASD toddlers in different gross and fine motor subgroups, and explored potential associated factors. The univariate generalized linear model tested the relationship of fine and gross motor skills and social communicative skills.

Results: The prevalence of gross and fine motor deficits were 59.5 and 82.5%, respectively, which are almost equivalent in boys and girls. The motor impairments tended to be more severe with age in toddlers. After adjusting for age, sex, non-verbal development quotient (DQ) and restricted, repetitive behaviors, severer gross motor impairments were significantly related to higher comparison score of ADOS-2 and higher social composite score of CSBS-DP-ITC, without interactions with other variables. Meanwhile, lower fine motor skills were associated with more deficits of social communication and higher severity of ASD, also depending on non-verbal DQ. In the lower non-verbal DQ subgroup, both fine motor deficits and restricted repetitive behaviors (RRBs) might have effects on autism symptomology.

Conclusion: Motor impairments are common in Chinese toddlers with ASD. Toddlers with weaker gross and fine motor skills have greater deficits in social communicative skills. Gross motor impairment might be an independent predictor of the severity of autism and social communication skills, while the effect of fine motor deficits might be affected by non-verbal DQ and RRBs of toddlers with ASD. We provide further justification for the inclusion of motor impairments in the early intervention for toddlers with ASD.

Keywords: autism severity; autism spectrum disorder; communication; motor impairment; social interaction.

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De nouveaux traitements dans les "troubles du spectre de l'autisme"

Aperçu: G.M.

Objet de la revue :
Il n'existe actuellement aucun médicament approuvé pour les principaux symptômes des "troubles du spectre de l'autisme" (TSA), et seulement des données limitées sur la gestion des symptômes concomitants de santé mentale et de comportement. Le but de cette revue est de synthétiser les essais récents sur les nouveaux traitements des TSA, en mettant l'accent sur les tendances de la recherche au cours des 2 dernières années. 

Découvertes récentes :
Aucun nouvel agent pharmacologique n'a reçu l'approbation réglementaire pour une utilisation dans les TSA. Plusieurs grands essais contrôlés randomisés (ECR) ont donné des résultats négatifs ou ambigus (par exemple, fluoxétine, ocytocine). Un ECR croisé d'un cannabinoïde oral a suggéré des avantages possibles pour les comportements perturbateurs. Deux essais multicentriques à grande échelle sur le bumétanide ont été interrompus prématurément faute d'efficacité. Des essais multicentriques utilisant la stimulation magnétique transcrânienne répétitive sont en cours. Des méta-analyses récentes indiquent que des interventions comportementales et psychologiques spécifiques peuvent favoriser la communication sociale et traiter l'anxiété. De nombreuses nouvelles cibles de traitement fondées sur des mécanismes biologiques sont à l'étude. 

Résumé :
Des données récentes appuient l'utilisation d'interventions comportementales et psychologiques pour la communication sociale et l'anxiété dans les TSA ; les données sont plus limitées concernant la pharmacothérapie des symptômes principaux et associés. Les prochaines étapes comprennent la réplication des premiers résultats, des essais de nouvelles cibles moléculaires et l'identification de nouveaux biomarqueurs, y compris des prédicteurs génétiques, de la réponse au traitement.

. 2022 Mar 1;35(2):101-110.
doi: 10.1097/YCO.0000000000000775.

Novel treatments in autism spectrum disorder

Danielle Baribeau  1   2   3 , Jacob Vorstman  1   2 , Evdokia Anagnostou  1   2   3
Affiliations

Abstract

Purpose of review: There are currently no approved medications for the core symptoms of autism spectrum disorder (ASD), and only limited data on the management of co-occurring mental health and behavioural symptoms. The purpose of this review is to synthesize recent trials on novel treatments in ASD, with a focus on research trends in the past 2 years.

Recent findings: No new pharmacologic agents received regulatory approval for use in ASD. Several large randomized controlled trials (RCTs) had negative or ambiguous results (e.g. fluoxetine, oxytocin). A cross-over RCT of an oral cannabinoid suggested possible benefits for disruptive behaviours. Two large-scale multicentre trials of bumetanide were terminated early for lack of efficacy. Multicenter trials using repetitive transcranial magnetic stimulation are underway. Recent meta-analyses indicate that specific behavioural and psychological interventions can support social communication and treat anxiety. Numerous novel treatment targets informed by biological mechanisms are under investigation.

Summary: Recent data support the use of behavioural and psychological interventions for social communication and anxiety in ASD; data are more limited regarding pharmacotherapy for core and associated symptoms. Next steps include replication of early findings, trials of new molecular targets, and the identification of novel biomarkers, including genetic predictors, of treatment response.

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Analyse comportementale basée sur smartphone pour les comportements difficiles dans les déficiences intellectuelles et développementales et les troubles du spectre de l'autisme- Protocole d'étude pour l'essai ProVIA

Aperçu: G.M.

Résumé 

Contexte
Les comportements difficiles (CD) comprennent diverses formes de comportements agressifs et problématiques survenant fréquemment chez les enfants ayant une déficience intellectuelle et développementale (DID) ou un trouble du spectre de l'autisme (TSA). Le CD découle souvent d'une altération des capacités de communication ou de résolution de problèmes. Il est souvent rencontré avec une mesure coercitive en raison d'un manque de stratégies alternatives de la part du soignant, alors qu'il a également un impact sur les soignants en raison de l'exposition à des dommages physiques et à des niveaux élevés de stress. Dans le cadre du projet ProVIA, nous avons développé un outil basé sur un smartphone pour les soignants d'enfants avec une DID et/ou de TSA afin de prévenir et de modifier le CD. L'application ProVIA aide systématiquement les soignants à identifier les causes spécifiques de CD et fournit des conseils pratiques individualisés pour prévenir le CD et les mesures coercitives consécutives, visant ainsi à améliorer la santé et le bien-être des enfants et des soignants. 

Méthodes
Dans cet essai ouvert non contrôlé, nous recruterons N = 25 soignants d'enfants âgés de 3 à 11 ans avec un diagnostic de DID et/ou de TSA. Les participants utiliseront l'application ProVIA-Kids pendant 8 semaines. Pendant la phase d'intervention, les participants effectueront des analyses de comportement après chaque cas de CD. L'application résumera les causes putatives identifiées pour le CB dans chaque situation et fournira des recommandations concernant la manipulation et la prévention du CB. De plus, l'application regroupera les données de toutes les analyses de comportement disponibles et identifiera les facteurs de risque les plus pertinents (c'est-à-dire les plus fréquemment signalés). Les points de mesure sont au départ (T0), après l'intervention (T1) et 12 semaines après la fin de l'intervention (suivi ; T2). 

Résultat
Le résultat principal est le changement absolu du stress parental (échelle totale EBI) entre T0 et T1. D'autres aspects d'intérêt sont les changements dans la gravité et la fréquence des CD, l'humeur du soignant, la satisfaction à l'égard du rôle parental (échelle totale EFB-K) et la compétence parentale expérimentée (échelle totale FKE). Les comparaisons pré-post seront analysées avec des tests t d'échantillons appariés. 

Discussion
ProVIA est un pionnier de l'analyse comportementale structurée via smartphone, évaluant les causes prédéfinies de CB et fournissant des commentaires et des recommandations. Si cette approche s'avère fructueuse, l'application ProVIA-Kids sera un outil précieux pour les soignants afin de prévenir le CB et d'améliorer leur propre qualité de vie ainsi que celle des enfants.  

Enregistrement de l'essai : l'étude est enregistrée sur 

https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_IDDRKS00029039 (enregistré le 31 mai 2022). 

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. 2022 Oct 13;16:984618.
doi: 10.3389/fnins.2022.984618. eCollection 2022.

Smartphone-based behaviour analysis for challenging behaviour in intellectual and developmental disabilities and autism spectrum disorder - Study protocol for the ProVIA trial

Julia Geissler  1 , Hanna Buchholz  1 , Rinat Meerson  1 , Klaus Kammerer  2 , Manuel Göster  2 , Johannes Schobel  3 , Christoph Ratz  4   5 , Regina Taurines  1 , Rüdiger Pryss  2 , Marcel Romanos  1   5
Affiliations

Abstract

Background: Challenging behaviour (CB) comprises various forms of aggressive and problematic behaviours frequently occurring in children with intellectual and developmental disability (IDD) or autism spectrum disorder (ASD). CB often arises from impaired communication or problem solving skills. It is often met with coercive measure due to a lack of alternative strategies on the part of the caregiver, while it also impacts on the caregivers due to the exposure to physical harm and high levels of stress. Within the ProVIA project we developed a smartphone-based tool for caregivers of children with IDD and/or ASD to prevent and modify CB. The ProVIA app systematically helps caregivers to identify specific causes of CB and provides individualised practical guidance to prevent CB and consecutive coercive measures, thus aiming to improve the health and well-being of the children and caregivers.

Methods: In this uncontrolled open trial we will enrol N = 25 caregivers of children aged 3-11 years with a diagnosis of IDD and/or ASD. Participants will use the ProVIA-Kids app for 8 weeks. During the intervention phase, participants will conduct behaviour analyses after each instance of CB. The app will summarise the identified putative causes for the CB in each situation, and provide recommendations regarding the handling and prevention of CB. Furthermore, the app will aggregate data from all available behaviour analyses and identify the most relevant (i.e., most frequently reported) risk factors. Measurement points are at baseline (T0), after the intervention (T1) and 12 weeks after the end of the intervention (follow-up; T2). The primary outcome is the absolute change in parental stress (EBI total scale) between T0 and T1. Further aspects of interest are changes in CB severity and frequency, caregiver mood, satisfaction with the parenting role (EFB-K total scale) and experienced parenting competence (FKE total scale). Pre-post comparisons will be analysed with paired sample t-tests.

Discussion: ProVIA is pioneering structured behaviour analysis via smartphone, assessing predefined causes of CB and providing feedback and recommendations. If this approach proves successful, the ProVIA-Kids app will be a valuable tool for caregivers to prevent CB and improve their own as well as the children's quality of life.

Trial registration: The study is registered at https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_IDDRKS00029039 (registered May 31, 2022).

Keywords: autism spectrum disorder; behaviour analysis; challenging behaviour; cognitive behaviour therapy; intellectual disability; mental health application; parent training; parental stress.

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Évaluation d'un programme de formation des parents par télésanté au Japon : collaboration avec des parents pour enseigner de nouvelles compétences de demande aux enfants diagnostiqués avec un trouble du spectre de l'autisme

Aperçu: G.M.

Cette étude a développé un programme de formation des parents en télésanté pour enseigner aux parents d'enfants avec un diagnostic de troubles du spectre de l'autisme (dTDA) le processus de mise en œuvre de la formation mand au Japon et pour favoriser la diffusion internationale de stratégies de formation fondées sur des preuves.
Les sessions de formation des parents étaient basées sur un modèle de formation aux compétences comportementales (BST), combiné à des commentaires graphiques et vidéo hebdomadaires. Les séances ont été menées par un analyste-doctorant en comportement certifié résidant au Japon.
Quatre parents d'enfants avec un dTDA ont participé à cette étude. 

Les résultats confirment provisoirement l'efficacité et la validité sociale du programme.
Cette étude prolonge les recherches antérieures sur la formation des parents menées au Japon en comprenant toutes les caractéristiques suivantes :

  1. conception de programmes en ligne ;
  2. la formation des mandants ;
  3. Modèle BST ;
  4. des données session par session sur les changements de comportement des enfants et l'intégrité procédurale ;
  5. conception expérimentale intra-sujet; et
  6. évaluation de la validité sociale.
. 2022 Oct 24;1-12.
doi: 10.1007/s40617-022-007

Evaluation of a Telehealth Parent-Training Program in Japan: Collaboration with Parents to Teach Novel Mand Skills to Children Diagnosed with Autism Spectrum Disorder

Kohei Togashi  1   2 , Yasuyo Minagawa  3 , Masahiro Hata  1 , Junichi Yamamoto  3
Affiliations

Abstract

This study developed a telehealth parent-training program to teach parents of children with autism spectrum disorder the process of mand-training implementation in Japan, and to further the international dissemination of evidence-based training strategies. Parent-training sessions were based on a behavioral skills training (BST) model, combined with weekly graphic and video feedback. The sessions were conducted by a board-certified behavior analyst-doctoral residing in Japan. Four parents with children with autism spectrum disorder participated in this study. The results preliminarily support the effectiveness and social validity of the program. This study extends previous parent-training research conducted in Japan by comprising all of the following features: (1) online program design; (2) mand training; (3) BST model; (4) session-by-session data on children's behavioral changes and procedural integrity; (5) within-subject experimental design; and (6) social validity evaluation.

Keywords: Autism spectrum disorder; Behavioral skills training; International dissemination; Mand training; Parent training; Telehealth.

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Libellés : , ,

31 octobre 2022

Stimulation du nerf vague comme traitement de la peur et de l'anxiété chez les personnes avec un diagnostic de troubles du spectre de l'autisme

Aperçu: G.M.

Les troubles anxieux touchent un grand pourcentage de personnes avec un diagnostic de trouble du spectre de l'autisme (dTSA). Chez les enfants avec un dTSA, une anxiété excessive est également liée à des problèmes gastro-intestinaux, à des comportements d'automutilation et à des symptômes dépressifs. Les thérapies cognitivo-comportementales basées sur l'exposition sont des traitements efficaces pour les troubles anxieux chez les enfants avec un dTSA, mais des taux de rechute élevés indiquent la nécessité de stratégies de traitement supplémentaires. 

Cette perspective discute des preuves issues de la recherche préclinique, qui indiquent que la stimulation du nerf vague (SNV) associée à l'exposition à des stimuli et à des situations provoquant la peur pourrait offrir des avantages en tant que traitement adjuvant des troubles anxieux qui coexistent avec les TSA. 

La stimulation du nerf vague est approuvée pour une utilisation dans le traitement de l'épilepsie, de la dépression et, plus récemment, comme adjuvant dans l'entraînement de réadaptation après un AVC. 

Dans les modèles précliniques, la SNV semble prometteuse pour améliorer simultanément la consolidation des souvenirs d'extinction et réduire l'anxiété. Dans cette revue, nous présenterons les mécanismes potentiels par lesquels la SNV pourrait traiter la peur et l'anxiété dans les TSA. 

Nous discutons également des utilisations potentielles de la SNV pour traiter la dépression et l'épilepsie dans le contexte des TSA, et des méthodes non invasives pour stimuler le nerf vague.

 

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. 2022;7(4):e220007.
doi: 10.20900/jpbs.20220007. Epub 2022 Sep 23.

Vagus Nerve Stimulation as a Treatment for Fear and Anxiety in Individuals with Autism Spectrum Disorder

Tanushree Shivaswamy  1 , Rimenez R Souza  1 , Crystal T Engineer  1 , Christa K McIntyre  1
Affiliations

Abstract

Anxiety disorders affect a large percentage of individuals who have an autism spectrum disorder (ASD). In children with ASD, excessive anxiety is also linked to gastrointestinal problems, self-injurious behaviors, and depressive symptoms. Exposure-based cognitive behavioral therapies are effective treatments for anxiety disorders in children with ASD, but high relapse rates indicate the need for additional treatment strategies. This perspective discusses evidence from preclinical research, which indicates that vagus nerve stimulation (VNS) paired with exposure to fear-provoking stimuli and situations could offer benefits as an adjuvant treatment for anxiety disorders that coexist with ASD. Vagus nerve stimulation is approved for use in the treatment of epilepsy, depression, and more recently as an adjuvant in rehabilitative training following stroke. In preclinical models, VNS shows promise in simultaneously enhancing consolidation of extinction memories and reducing anxiety. In this review, we will present potential mechanisms by which VNS could treat fear and anxiety in ASD. We also discuss potential uses of VNS to treat depression and epilepsy in the context of ASD, and noninvasive methods to stimulate the vagus nerve.

Keywords: behavioral therapy; exposure therapy; neurodevelopmental disorders; neuromodulation; rehabilitation.

Conflict of interest statement

CONFLICTS OF INTEREST CT Engineer is married to an employee of MicroTransponder, Inc. CK McIntyre is an author of a patent entitled “Methods for Enhancing Exposure Therapy using Vagus Nerve Stimulation”.

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