Gender differences in psychosocial function and self-reported health status in late-diagnosed autistic adults: results from the FACE-ASD national cohort.

BACKGROUND: While adult outcome in autism spectrum disorder (ASD) is generally measured using socially valued roles, it could also be understood in terms of aspects related to health status - an approach that could inform on potential gender differences. METHODS: We investigated gender differences in two aspects of outcome related to health-status, i.e. general functioning and self-perceived health status, and co-occurring health conditions in a large multi-center sample of autistic adults. Three hundred and eighty-three participants were consecutively recruited from the FondaMental Advanced Centers of Expertise for ASD cohort (a French network of seven expert centers) between 2013 and 2020. Evaluation included a medical interview, standardized scales for autism diagnosis, clinical and functional outcomes, self-perceived health status and verbal ability. Psychosocial function was measured using the Global Assessment of Functioning scale. RESULTS: While autistic women in this study were more likely than men to have socially valued roles, female gender was associated with poorer physical and mental health (e.g. a 7-fold risk for having three or more co-occurring physical health conditions) and a poorer self-perceived health status. Psychosocial function was negatively associated with depression and impairment in social communication. Half of the sample had multiple co-occurring health conditions but more than 70% reported that their visit at the Expert Center was their first contact with mental health services. CONCLUSIONS: To improve objective and subjective aspects of health outcome, gender differences and a wide range of co-occurring health conditions should be taken into account when designing healthcare provision for autistic adults.

Is sustained attention deficit related to subclinical obsessive thoughts in children and adolescents with ADHD?

Background: Thought content and its impact on sustained attention in individuals with attention deficit hyperactivity disorder (ADHD) are topics of growing interest in literature.Objective: We hypothesised that subclinical obsessive thoughts may be correlated with attention lapses in individuals with ADHD.Method: Thirty children diagnosed with ADHD participated in the study and their level of subclinical obsessive thoughts, attention, and executive function were measured using Children Yale-Brown Obsessive Scale and Conners' Continuous Performance Test II.Results: No significant correlation between sustained attention impairment and the level of obsessive thoughts in patients with ADHD was found. Nevertheless, patients with ADHD with subclinical obsessive thoughts showed more commission errors than those without (W = 51.5; p = 0.02).Conclusion: The nature of thought content in individuals with ADHD should be linked to executive dysfunction rather than attentional impairment. This could be of importance in the therapeutic strategy choice, addressing the importance of executive function remediation in the specific context of subclinical obsessive thoughts.Key points Patients with ADHD, without OCD or ASD comorbidity, still present subclinical obsessive thoughts (36% of our sample). • Subclinical obsessive thoughts could be a part of thought content in patients with ADHD. • Subclinical obsessive thoughts as measured by the CPT-II are not correlated with attention function in patients with ADHD. • ADHD patients with subclinical obsessive symptoms present more impairment in response inhibition than the ones without. • Results on subclinical obsessive thoughts are similar to those on another type of thought content called 'mind wandering'. • A clinical improvement strategy for patients with ADHD could be using executive function remediation rather than classical attention function remediation, according to both to our and previous results.

Hippocampal subfields alterations in adolescents with post-traumatic stress disorder.

Reexperiencing symptoms in adolescent Post-Traumatic Stress Disorder (PTSD) are characterized by the apparition of vivid intrusive images of the traumatic event. The emergence of these intrusions is thought to be related to a deficiency in context processing and could then be related to hippocampal alterations. The hippocampus is a complex structure which can be divided into several subfields, namely, the Cornu Ammonis (CA1, CA2, and CA3), the subiculum, and the dentate gyrus (DG). As each subfield presents different histological characteristics and functions, it appears more relevant to consider hippocampal subfields, instead of only assessing the whole hippocampus, to understand the neurobiology of PTSD. Hence, this study presents the first investigation of structural alterations within hippocampal subfields and their links to reexperiencing symptoms in adolescent PTSD. Hippocampal subfields were manually delineated on high-resolution MRI images in 15 adolescents (13-18 years old) with PTSD and 24 age-matched healthy controls. The volume of the region CA2-3/DG region was significantly smaller in the PTSD group compared to controls in both hemispheres. No other significant difference was found for other subfields. Moreover, the volume of the left CA2-3/DG was negatively correlated with the intrusion score (as measured by the Impact of Events Scale-Revised) in the PTSD group. To conclude, an alteration in the hippocampal subregion CA2-3/DG, known to resolve interferences between new and similar stored memories, could participate in the apparition of intrusive trauma memories in adolescents with PTSD.

Functional brain alterations during self-reference processing in adolescents with sexual abuse-related post-traumatic stress disorder: A preliminary report.

We proposed to explore the functional brain changes during a self-reference processing (SRP) task in adolescents with sexual abuse-related post-traumatic stress disorder (N = 10), compared with healthy adolescents (N = 10). While patients showed no behavioral disturbances in (SRP), they exhibited changes in activity and connectivity in regions involved in emotional regulation (amygdala and dorsal prefrontal cortex) and semantic memory (temporal and ventrolateral prefrontal regions). These preliminary results suggest that these alterations may have an effect on self-esteem which may contribute to a possible retention and impairment of symptoms in adulthood.

[Preventing carer burnout]. / Prendre en compte l'épuisement des aidants.

The issue of the burnout of carers of disabled family members has been raising concern for several years. It is essential to identify the signs of suffering in the carer in order to put in place adapted support which will also be beneficial for the person being cared for. Autism, a disability which has a significant impact on the family circle, is an example of a condition for which providing support to carers is essential.

Neural Correlates of Self and Its Interaction With Memory in Healthy Adolescents.

Adolescence is marked by the development of personal identity and is associated with structural and functional changes in brain regions associated with Self processing. Yet, little is known about the neural correlates of self-reference processing and self-reference effect in adolescents. This functional magnetic resonance imaging study consists of a self-reference paradigm followed by a recognition test proposed to 30 healthy adolescents aged 13-18 years old. Results showed that the rostral anterior cingulate cortex is specifically involved in self-reference processing and that this specialization develops gradually from 13 to 18 years old. The self-reference effect is associated with increased brain activation changes during encoding, suggesting that the beneficial effect of Self on memory may occur at encoding of self-referential information, rather than at retrieval.

[Do families with multiple problems exist?]. / Les familles à problèmes multiples existent-elles ?

Families with multiple problems raise questions regarding society's responsibility in the marginalisation of some of its members. Withdrawn in themselves, these families seem only to be able to be helped through the intermediary of the child, by turns the whistle blower or the mediator between the family sphere and the outside world. Schools, hospitals, judiciary or educational institutions can help to identify the relational suffering of these families.

[Parenting problems, observation at home and support in a network]. / Troubles de la parentalité, observation à domicile et accompagnement en réseau.

Supporting parenthood in a family with multiple problems requires a strong network. In the case of difficulties in establishing the initial bonds between a couple and their baby, the perinatal psychiatric team, working with the mother and infant welfare protection service and the adult psychiatry service, can also put in place measures to support this family.

[Parenthood and the birth of the family]. / Parentalité et transmission, accompagner la naissance de la famille.

A project to start a family can be knocked off course by a couple's infertility. While medical intervention frequently leads to the birth of a baby, it is not always enough to ensure that the child is "born" psychologically. This article presents a clinical situation which highlights issues surrounding unattainable parenthood then the birth of the family, the impossible weaning from the mother's body and family transmission.

[Home monitoring of infants suffering from infantile anorexia]. / Suivi à domicile du nourrisson atteint d'anorexie mentale.

The construction of parenthood comes under pressure when an infant suffers from anorexia nervosa. Support at home for the family can be provided by the child health nurse using Esther Bick's infant observation method. Over the course of the visits, the intrafamily relationships are appeased to create an atmosphere which is favourable to the harmonious development of the child.

[Anorexia in adolescents, the experience of caregivers and team supervision]. / Anorexie de i'adolescente, vécu des soignants et supervision d'équipe.

The hospital treatment of anorexic adolescents is complex, multidisciplinary and often long.The psychopathological functioning of these young patients places the caregivers in a difficult position. The team of the adolescent crisis and hospitalisation unit at Caen general hospital benefits from the support of a psychologist from outside the unit.

[Consulting a child psychiatrist for sleep disorders]. / Une consultation de pédopsychiatrie pour les troubles du sommeil.

Sleep disorders in children and adolescents are frequent and can, in some cases, require psychiatric assessment and treatment.The consultation with a child psychiatrist assesses the characteristics of these problems in the newborn, infant and adolescent, to guide the practitioner towards suitable support.

[Therapeutic bonds for the treatment of eating disorders]. / Les liens thérapeutiques pour la prise en charge des troubles des conduites alimentaires.

Anorexia is the most common eating disorder. Aside from the weight loss and its effects on the body, this disease is characterised by relationship difficulties within the family. Institutional treatment aims to enable the teenager and her family to meet different professionals and, gradually, to create diverse bonds. The young patient thereby experiences difference and uncertainty in the relationship with others, while retaining the reassurance of an empathetic bond.

Intact memory storage but impaired retrieval in visual memory in autism: New insights from an electrophysiological study.

In a recent study on visual episodic memory (Desaunay, Clochon, et al., 2020), we have shown event-related potentials (ERPs) differences associated with priming (150-300 msec), familiarity (350-470 msec), and recollection (600-700 msec), in young people with autism spectrum disorders (ASD) compared with typical development (TD). To go further into the study of the processes of storage and retrieval of the memory trace, we re-analyzed Desaunay, Clochon, et al's data using time-frequency analysis, that is, event-related synchronization and desynchronization (ERS/ERD). This allows a decomposition of the spectral power within frequency bands associated with these ERPs. We focused both on the same time windows and the same regions of interest as previously published. We mainly identified, in ASD compared with TD, reduced ERS in low-frequencies (delta, theta) in early time-windows, and non-significant differences in ERD in higher frequencies (alpha, beta1) in all time-windows. Reduced ERS during recognition confirmed previously reported diminution of priming effects and difficulties in manipulation and retrieval of both semantic and episodic information. Conversely, preserved ERD corroborates a preservation of memory storage processes. These observations are consistent with a cognitive model of memory in ASD, that suggests difficulties in cognitive operations or executive demand at retrieval, subsequent to successful long-term storage of information. LAY SUMMARY: We assessed the EEG synchronization and desynchronization, during visual episodic recognition. We observed, in youth with Autism, reduced synchronization in low-frequencies (delta, theta), suggesting reduced access to and manipulation of long-term stored information. By contrast, non-significant differences in desynchronization at higher frequencies (alpha, beta frequency bands), that support long-term stored semantic and episodic information, suggested preserved memory traces.

Error disclosure in neonatal intensive care: a multicentre, prospective, observational study.

IMPORTANCE: Surveys based on hypothetical situations suggest that health-care providers agree that disclosure of errors and adverse events to patients and families is a professional obligation but do not always disclose them. Disclosure rates and reasons for the choice have not previously been studied. OBJECTIVE: To measure the proportion of errors disclosed by neonatal intensive care unit (NICU) professionals to parents and identify motives for and barriers to disclosure. DESIGN: Prospective, observational study nested in a randomised controlled trial (Study on Preventing Adverse Events in Neonates (SEPREVEN); ClinicalTrials.gov). Event disclosure was not intended to be related to the intervention tested. SETTING: 10 NICUs in France with a 20-month follow-up, starting November 2015. PARTICIPANTS: n=1019 patients with NICU stay ≥2 days with ≥1 error. EXPOSURE: Characteristics of errors (type, severity, timing of discovery), patients and professionals, self-reported motives for disclosure and non-disclosure. MAIN OUTCOME AND MEASURES: Rate of error disclosure reported anonymously and voluntarily by physicians and nurses; perceived parental reaction to disclosure. RESULTS: Among 1822 errors concerning 1019 patients (mean gestational age: 30.8±4.5 weeks), 752 (41.3%) were disclosed. Independent risk factors for non-disclosure were nighttime discovery of error (OR 2.40; 95% CI 1.75 to 3.30), milder consequence (for moderate consequence: OR 1.85; 95% CI 0.89 to 3.86; no consequence: OR 6.49; 95% CI 2.99 to 14.11), a shorter interval between admission and error, error type and fewer beds. The most frequent reported reasons for non-disclosure were parental absence at its discovery and a perceived lack of serious consequence. CONCLUSION AND RELEVANCE: In the particular context of the SEPREVEN randomised controlled trial of NICUs, staff did not disclose the majority of errors to parents, especially in the absence of moderate consequence for the infant. TRIAL REGISTRATION NUMBER: NCT02598609.

Maternal immune activation during pregnancy is associated with more difficulties in socio-adaptive behaviors in autism spectrum disorder.

Autism spectrum disorder (ASD) are neurodevelopmental conditions characterised by deficits in social communication and interaction and repetitive behaviours. Maternal immune activation (MIA) during the mid-pregnancy is a known risk factor for ASD. Although reported in 15% of affected individuals, little is known about the specificity of their clinical profiles. Adaptive skills represent a holistic approach to a person's competencies and reflect specifically in ASD, their strengths and difficulties. In this study, we hypothesised that ASD individual with a history of MIA (MIA+) could be more severely socio-adaptively impaired than those without MIA during pregnancy (MIA-). To answer this question, we considered two independent cohorts of individuals with ASD (PARIS study and FACE ASD) screened for pregnancy history, and used supervised and unsupervised machine learning algorithms. We included 295 mother-child dyads with 14% of them with MIA+. We found that ASD-MIA+ individuals displayed more severe maladaptive behaviors, specifically in their socialization abilities. MIA+ directly influenced individual's socio-adaptive skills, independent of other covariates, including ASD severity. Interestingly, MIA+ affect persistently the socio-adaptive behavioral trajectories of individuals with ASD. The current study has a retrospective design with possible recall bias regarding the MIA event and, even if pooled from two cohorts, has a relatively small population. In addition, we were limited by the number of covariables available potentially impacted socio-adaptive behaviors. Larger prospective study with additional dimensions related to ASD is needed to confirm our results. Specific pathophysiological pathways may explain these clinical peculiarities of ASD- MIA+ individuals, and may open the way to new perspectives in deciphering the phenotypic complexity of ASD and for the development of specific immunomodulatory strategies.

The French version of the Family Assessment Device.

OBJECTIVE: To validate a French version of the Family Assessment Device (FAD), a well-known self-report questionnaire assessing family functioning in clinical and research settings. METHODS: A French adaptation of the FAD was administered to 3 groups of subjects: a nonclinical group (n = 115), relatives of psychiatric patients (n = 102), and medical patients and their relatives (n = 106). Temporal stability was assessed by test-retest intraclass correlations. Internal consistency was measured by Cronbach alpha reliability coefficients. Discriminant validity was explored, comparing the scores of the 3 groups, using a covariance analysis (ANCOVA). The dimensional structure of the instrument was explored using a principal component analysis, with promax oblique rotation, on the entire sample. RESULTS: The French FAD showed good temporal stability and good discriminant validity across groups. Internal consistency was satisfactory only for the General Functioning (GF) subscale. Factor analysis yielded a 3-factor model. The GF subscale was highly correlated with all of the other subscales. CONCLUSIONS: The French version of the FAD provides a valuable tool for assessing family functioning. However, our study failed to identify the theoretical structure of the FAD and suggests that the GF subscale could be used as a better overall indicator of family functioning.

[Systemic approach to school phobia]. / Approche systémique de la phobie scolaire.

School refusal is described in very diverse psychopathological contexts. It involves at least two invariables: the child's refusal to go to school and the involvement of their family in their difficulties.The systemic description of the emergence of this symptom attempts to fix reference points and to offer treatment solutions.

ASD and ADHD Comorbidity: What Are We Talking About?

According to the scientific literature, 50 to 70% of individuals with autism spectrum disorder (ASD) also present with comorbid attention deficit hyperactivity disorder (ADHD). From a clinical perspective, this high rate of comorbidity is intriguing. What is the real significance of this dual diagnosis? Is ADHD in fact always present in such cases? Might the attentional impairment reported among our ASD patients actually be a distinct trait of their ASD-namely, impaired joint attention-rather than an ADHD attention deficit? Could their agitation be the consequence of this joint attention impairment or related to a physical restlessness etiologically very different from the agitation typical of ADHD? The neurobiological reality of ASD-ADHD comorbidity is a subject of debate, and amphetamine-based treatment can have paradoxical or undesirable effects in the ASD population. Consequently, does a dual diagnosis, notwithstanding its currency in the literature, prevent us from shedding sufficient light on major physiopathologic questions raised by the clinical picture of ASD?

EEG resting-state functional connectivity: evidence for an imbalance of external/internal information integration in autism.

BACKGROUND: Autism spectrum disorder (ASD) is associated with atypical neural activity in resting state. Most of the studies have focused on abnormalities in alpha frequency as a marker of ASD dysfunctions. However, few have explored alpha synchronization within a specific interest in resting-state networks, namely the default mode network (DMN), the sensorimotor network (SMN), and the dorsal attention network (DAN). These functional connectivity analyses provide relevant insight into the neurophysiological correlates of multimodal integration in ASD. METHODS: Using high temporal resolution EEG, the present study investigates the functional connectivity in the alpha band within and between the DMN, SMN, and the DAN. We examined eyes-closed EEG alpha lagged phase synchronization, using standardized low-resolution brain electromagnetic tomography (sLORETA) in 29 participants with ASD and 38 developing (TD) controls (age, sex, and IQ matched). RESULTS: We observed reduced functional connectivity in the ASD group relative to TD controls, within and between the DMN, the SMN, and the DAN. We identified three hubs of dysconnectivity in ASD: the posterior cingulate cortex, the precuneus, and the medial frontal gyrus. These three regions also presented decreased current source density in the alpha band. CONCLUSION: These results shed light on possible multimodal integration impairments affecting the communication between bottom-up and top-down information. The observed hypoconnectivity between the DMN, SMN, and DAN could also be related to difficulties in switching between externally oriented attention and internally oriented thoughts.