Quality of live among parents of children with autism spectrum disorders in Tunisia.

BACKGROUND: Studies on parents of children with autistic spectrum disorders' (ASD) quality of life (QOL) agree on its alteration and seek to identify risk factors in order to target interventions. AIMS: To study the QOL of a Tunisian population of parents of children with ASD and to look for risk factors specific to the Tunisian population. METHODS: We conducted a cross-sectional descriptive study of 50 parents of 50 children who met the DSM V criteria for autism spectrum disorder. A pre-established record was used to collect the biographical and clinical data. The severity of autism was determined using CARS. The SF-36, validated in Tunisia, made it possible to assess the QOL of the parents. RESULTS: The proportion of parents with impaired QOL was 64%. The average mental score was lower than the average physical summary score. Aggressiveness was the predominant factor that significantly altered parents' QOL at the total SF-36 score (p=0,03) and 5-dimensional levels (0.006

Cognitive deficits in children with autism spectrum disorders: Toward an integrative approach combining social and non-social cognition.

Autism spectrum disorder (ASD) is associated with neurocognitive impairment, including executive dysfunctioning and social cognition (SC) deficits. Cognitive remediation (CR) is a behavioral training-based intervention aiming to improve cognitive processes. Its first use in psychiatry interested patients with schizophrenia, in whom promising results have been shown. Integrated CR programs targeting both social and non-social cognition have demonstrated to be effective in improving both cognitive domains and functional outcomes. CR studies in children and adolescents with ASD are still new, those regarding CR approaches combining social and executive functioning remediation are scares. One study examining the efficacy of cognitive enhancement therapy (CET) for improving cognitive abilities in ADS adults, showed significant differential increases in neurocognitive function and large social-cognitive improvements. Therefore, taking into account the overlap between ASD and schizophrenia, and considering the close link between executive functions (EF) and SC, we suggest that integrative approach in ASD could result in better outcomes. The present perspective aimed to highlight cognitive remediation (CR) programs contributions in ASD (especially in children and adolescents), and to discuss the value of combining social and non-social programs.

Validation of the Tunisian Test for Facial Emotions Recognition: Study in Children From 7 to 12 Years Old.

Background: Facial expressions transmit information about emotional state, facilitating communication and regulation in interpersonal relationships. Their acute recognition is essential in social adaptation and lacks among children suffering from autism spectrum disorders. The aim of our study was to validate the "Recognition of Facial Emotions: Tunisian Test for Children" among Tunisian children in order to assess facial emotion recognition in children with autism spectrum disorders (ASD). Methods: We conducted a cross-sectional study among neurotypical children from the general population. The final version of or test consisted of a static subtest of 114 photographs and a dynamic subtest of 36 videos expressing the six basic emotions (happiness, anger, sadness, disgust, fear and surprise), presented by actors of different ages and genders. The test items were coded according to Ekman's "Facial Action Coding System" method. The validation study focused on the validity of the content, the validity of the construct and the reliability. Results: We included 116 neurotypical children, from 7 to 12 years old. Our population was made up of 54 boys and 62 girls. The reliability's study showed good internal consistency for each subtest: the Cronbach coefficient was 0.88 for the static subtest and 0.85 for the dynamic subtest. The study of the internal structure through the exploratory factor analysis of the items of emotions and those of intensity showed that the distribution of the items in sub-domains was similar to their theoretical distribution. Age was significantly correlated to the mean of the overall score for both subtests (p < 10-3). Gender was no significantly correlated to the overall score (p = 0.15). High intensity photographs were better recognized. The emotion of happiness was the most recognized in both subtests. A significant difference between the overall score of the static and dynamic subtest, in favor of the dynamic one, was identified (p < 10-3). Conclusion: This work provides clinicians with a reliable tool to assess recognition of facial emotions in typically developing children.

Bumetanide in the management of autism. Tunisian experience in Razi Hospital.

BACKGROUND: Autism is a multifactorial disease with multiple etiologic hypotheses. Some studies suggest changes in brain GABA mediated inhibition in autism, and a higher intracellular chlorine levels in autistic children. Given these data, clinical trials are conducted to test the efficacy of diuretics in improving clinical symptoms in autism. AIM: The aim of our study was to evaluate the effectiveness of Bumetanide in autistic children. METHODS: This is an experimental study of cross-type. We included children older than 5 years, with autistic disorder according to the diagnostic criteria of DSM- IV (Diagnostic and Statistical Manual of Mental Disorders, IV) and ADI-R (Autism Diagnostic Interview Revised), followed by the child psychiatry consultation Razi hospital. The subjects underwent assessment using the ADI-R, the behavioral scale CARS (Childhood autistic rating scale) and CGI (Clinical Global printing) prior to take diuretic (Bumetanide). In the protocol, the children received checks to day7, day14, day30, day60, day90 comprising: a clinical evaluation (weight gain, blood pressure, general examination for potential adverse effects); biological evaluation; and evaluations by scales (CARS and CGI) after every 3 months of evolution to objectively assess effectiveness. RESULTS: Twenty-nine children were included in our study. The average age was 7.9 years.Initiation of medication was carried out with a dose of    1 mg / day, in all children. The average duration of the protocol was 12 months. Sixteen children were excluded from the study for the following reasons: appearance of hypokalemia, poor tolerance of treatment, insufficient efficacy as estimated by parents. Measuring the effectiveness of diuretic, by studying correlations in the CARS showed an efficacy of this treatment at 3 months (p˂10-3), 6 months (p˂10-3), at 9 months (p = 0.010) and 12 months (p = 0.04), and this compared to the initial assessment. Significant improvement (p˂10-3) was found between the 3rd and 6th month. CONCLUSION: While our results seem to be promising. A larger sample and a medium and long-term evaluation after the end of treatment are needed.

Toward an integrative socio-cognitive approach in autism spectrum disorder: NEAR method adaptation-study protocol.

Background: The cognitive impairments exhibited by people with ASD, threaten the development of social skills that are essential for establishing and maintaining harmonious social relationships. Cognitive remediation and social skills training are now considered as crucial therapeutic approaches in the management of these disorders. Several programs have already been validated and have shown improvements in social skills or cognitive performance. However, the effects of these training methods seem to be difficult to generalize to other everyday life. The aim of our study is to alleviate cognitive and social deficiencies by using a socio-cognitive framework to adapt the Neuropsychological Educational Approach to Remediation (NEAR) method for adolescents with ASD. Methods/design: Adolescents meeting the DSM-5 criteria for ASD, older than 13 years, and following a regular school curriculum will be recruited from clinical population at the Child and Adolescent Psychiatry in Razi University Hospital-Manouba- Tunisia. Our study is an open and non-randomized controlled trial including 30 patients: NEAR group / control group. The NEAR method combines computerized cognitive exercises and bridging groups inspired from cognitive behavioral therapy. NEAR group will be divided into three groups of five patients each. The duration of the sessions will vary according to the capacities of the participants and the exchanges between them (about 60­120 min). In our study, bridging groups will be amended by adding other tasks including planning role plays and scenarios of problematic social situations in autism, taking into account cultural particularities in order to promote social skills. Computerized exercises will be enriched by adding other tasks aiming to improve the recognition and expression of facial emotions by using digital videos and photographs expressing the six basic emotions. The duration of the program will be about 6 months. All selected patients will have an assessment of cognitive function: social cognition, neurocognition and pragmatic skills, social skills, self-esteem and global functioning at baseline, 1 week after the end of the NEAR program and 6 months later. Conclusion: This adaptive program is a promising socio-cognitive intervention that create new perspectives for adolescents with autism spectrum disorder.