Demanda de cuidado nutricional de crianças com transtorno do espectro autista em uma região de acesso remoto / Demandas de atención nutricional de niños con trastorno del espectro autista en una región de acceso remoto / Nutritional care demands of children with autism spectrum disorder in a remote access region

Introdução: O transtorno do espectro autista é uma condição neuropsiquiátrica que demanda atenção interdisciplinar e multiprofissional. A abordagem nutricional é necessária frente aos possíveis sintomas associados, como seletividade alimentar e alterações do hábito intestinal. Famílias residentes em locais de acesso limitado à serviços de saúde podem possuir dificuldades para o adequado acompanhamento. Objetivo: Relatar a experiência de atendimentos em nutrição realizados pela Liga Acadêmica de Nutrição e Saúde Coletiva a crianças com transtorno do espectro autista explorando as principais demandas identificadas e enfrentadas em uma região de acesso remoto. Metodologia: Abordagem descritiva, do tipo relato de experiência, de atendimentos realizados no município de Coari, interior do Amazonas. Os encontros foram realizados com vista a identificar demandas e refletir sobre a melhor maneira de auxiliar as crianças com essas comorbidades. Resultados: Foram atendidas 9 crianças, nem todas com o diagnóstico fechado. Seletividade alimentar, distúrbios gastrointestinais e excesso de peso foram desafios recorrentes. Nota-se a carência da percepção da importância do acompanhamento nutricional, em um cenário de relatos importantes sobre as dificuldades no acesso a medicações, por falta no município ou por ausência de recursos para aquisição, assim como terapias especializadas. Aspectos que se tornam ainda mais desafiadores frente à distância geográfica e carência de profissionais especializados e que realizem uma atenção multiprofissional. Conclusões: O acompanhamento nutricional adequado é essencial para atender às necessidades específicas e melhorar a qualidade de vida dessas crianças. Diante das limitações identificadas na região, são necessários esforços contínuos para desenvolver soluções que garantam uma assistência inclusiva e eficaz às crianças com transtorno do espectro autista no interior do Amazonas. A colaboração entre instituições, a conscientização da comunidade e o fortalecimento da rede de saúde local são cruciais para promover uma abordagem abrangente e de alta qualidade para essas crianças e suas famílias (AU).

Introduction: Autism spectrum disorder is a neuropsychiatric condition that demands interdisciplinary and multidisciplinary attention. Nutritional intervention is necessary in the face of possible associated symptoms, such as food selectivity and changes in bowel habits. Families living in places with limited access to health services may have difficulties in obtaining adequate support and follow-up.Objective: Reporting the experience of nutrition services provided by the Academic League of Nutrition and Public Health to children with autism spectrum disorder, exploring the main identified demands and challengesfaced in a remote access region. Methodology:Descriptive approach, experience of an report, of services provided in the municipality of Coari, in the interiorof Amazonas. The meetings were held with the aim identifying demands and reflecting on the best way to assistchildren with these comorbidities. Results: Ninechildren attended to, not all with a confirmed diagnosis. Food selectivity, gastrointestinal disorders and overweight were recurring challenges. There is a lack of perception of the importance of nutritional monitoring, in a scenario where there areimportant reportsofdifficulties in accessing medications, either due to lack of availability in the municipality or lack of resources for acquisition, as well as specialized therapies. Theseaspects become even more challenging given the geographical distance and scarcity of specialized professionals whocanprovide multidisciplinary care. Conclusions: Adequate nutritional monitoring is essential to meet the specific needs and improve the quality of life of these children. Given the limitations identified in the region, continuous efforts are needed to develop solutions that guarantee inclusive and effective assistance for children with autism spectrum disorder in the interior of Amazonas. Collaboration between institutions, community awareness, and strengthening the local health network are crucial to promoting a comprehensive, high-quality approach for these children and their families (AU).

Introducción: El trastorno del espectro autista es una condiciónneuropsiquiátrica que requiere atención interdisciplinaria y multidisciplinaria. El enfoque nutricionales frente a losposibles síntomas, como selectividad alimentaria y alteraciones delhábitosintestinales. Las familias que viven en lugares con accesolimitado a los servicios de salud pueden tener dificultades para recibir un seguimiento adecuado. Objetivo: Reportar la experiencia de los servicios de nutrición brindados por la Liga Académica de Nutrición y Salud Pública a niños con trastorno del espectro autista, explorando las principales demandas identificadas y enfrentadas en una región de acceso remoto.Metodología: Enfoque descriptivo, relato de experiencia, de los servicios prestados en Coari, en el interior de Amazonas. Los encuentros se realizaron con el objetivo de identificar demandas y reflexionar sobre la mejor manera de ayudar. Resultados:Se atendieron 9 niños, no todos con diagnóstico confirmado. Selectividad alimentaria, trastornos gastrointestinales y exceso de peso fueron desafíos recurrentes. Se observa una falta percepción de la importancia del seguimiento nutricional, en un escenario de informes importantes sobre las dificultades en el acceso a medicamentos, debido a lafaltade suministro en el municipio o a la falta de recursos para su adquisición, así como terapias especializadas. Estosaspectos que se vuelven aún más desafiantes dada la distancia geográfica y falta de profesionales especializados que brinden una atención multidisciplinaria.Conclusiones: Un adecuado seguimiento nutricional es fundamental para satisfacerlas necesidades específicas y mejorar la calidad de vida de estos niños. Antelas limitaciones identificadas, se necesitan esfuerzos continuos para desarrollar soluciones que garanticen una atención inclusiva y efectiva estosniños en el interior de Amazonas. Colaboración entre instituciones, concientización comunitaria y fortalecimiento de la red de salud local son cruciales para promover un enfoque integral y de alta calidad para estos niños com trastorno del espectro autista y sus familias (AU).

Disgust Processing and Potential Relationships with Behaviors in Autism.

PURPOSE OF REVIEW: While there are reports of differences in emotion processing in autism, it is less understood whether the emotion of disgust, in particular, plays a significant role in these effects. Here, we review literature on potential disgust processing differences in autism and its possible associations with autistic traits. RECENT FINDINGS: In autism, there is evidence for differences in physical disgust processing, pica behaviors, attention away from other's disgust facial expressions, and differences in neural activity related to disgust processing. In typically developing individuals, disgust processing is related to moral processing, but modulated by individual differences in interoception and alexithymia. Autistic individuals may experience atypical disgust, which may lead to difficulty avoiding contaminants and affect socio-emotional processing. In autism, such outcomes may lead to increased occurrences of illness, contribute to gastrointestinal issues, diminish vicarious learning of disgust expression and behaviors, and potentially contribute to differences in processes related to moral reasoning, though further research is needed.

[Autism and catatonia - Clinical aspects]. / Autismo y catatonía - Aspectos clínicos.

Autism is a neurodevelopmental disorder characterized by a qualitative alteration in social interaction and communication, associated with restricted interests and stereotyped behaviors. It can be associated with medical problems such as epilepsy, gastrointestinal dysfunction, sleep disorders, other neurodevelopmental disorders such as language impairment, intellectual disability, sensory dysfunction, ADH/D, motor clumsiness, and/or neuropsychiatric disorders such as anxiety, depression, catatonia, schizophrenia, obsessive-compulsive disorders, behavioral and impulsive disorders, among others. Catatonia is recognized as a neuropsychiatric syndrome identified in all major mood and psychotic disorders, due to general medical conditions or as a syndrome not otherwise specified; this allows catatonia to be coded in the context of other psychiatric or neurodevelopmental disorders, such as obsessive-compulsive disorder or autism. It is characterized by abnormal motor, vocal, and behavioral symptoms, with impaired volition and vegetative function. It is estimated that approximately 8-11% of autistic people suffer from catatonia. It is probable that there is an underreporting of catatonia, especially in people with autism, due to the lack of alertness about it, the clinical heterogeneity and the similarity of many of its symptoms with manifestations of autism. Many times it can even express itself as a late autistic regression from puberty to adult life. Its neurobiological bases are still not clear and the treatment is based on the administration of bensodiazepines and electroconvulsive therapy although there is still a long way to go to investigate these issues.

El autismo es un desorden del neurodesarrollo caracterizado por una alteración cualitativa en la interacción social y la comunicación, asociada a intereses restringidos y conductas estereotipadas. Puede asociarse a problemas médicos como epilepsia, disfunciones gastrointestinales, trastornos de sueño, otros trastornos del neurodesarrollo como deterioro del lenguaje, discapacidad intelectual, disfunciones sensoriales, TDA/H, torpeza motriz y/o trastornos neuropsiquiátricos como ansiedad, depresión, catatonia, esquizofrenia, trastornos obsesivo-compulsivo, trastornos de conducta e impulsividad, entre otros.La catatonía es reconocida como un síndrome neuropsiquiátrico identificado en todos los tra stornos psicóticos y del estado de ánimo mayor, debido a condiciones médicas generales o como un síndrome no especificado de otra manera; esto permite codificar la catatonia en el contexto de otros trastornos psiquiátricos o del neurodesarrollo, como el trastorno obsesivo compulsivo o el autismo. Se caracteriza por síntomas motores, vocales y conductuales anormales, con alteración de la volición y la función vegetativa. Se estima que aproximadamente entre el 8 y 11 % de las personas autistas padecen catatonia. Es probable que haya un subregistro de catatonía, en especial en personas con autismo, debido a la falta de alerta sobre la misma, la heterogenicidad clínica y la similitud de muchos de sus síntomas con manifestaciones del autismo. Incluso muchas veces puede expresarse como una regresión autista tardía desde la pubertad a la vida adulta. Sus bases neurobiológicas aún no son claras y el tratamiento se basa en la administración de bensodiazepinas y la terapia electroconvulsiva, aunque es mucho el camino que aún queda por investigar en estos temas.

"Amanhã você estará aqui?" O trabalho com objetos em uma instituição para crianças com dificuldades no laço social / « Est-ce que demain tu seras là? ¼ Le travail à partir des objets dans une institution pour enfants en difficulté au niveau du ien social / "Will you be here tomorrow?" The work with objects in an institution for children with social bond difficulties / "¿Estarás aquí mañana?"El trabajo con los objetos en una institución para niños con dificultades en el lazo social

Este artigo trata de uma experiência institucional de estágio no Institut Médico Pédagogique Notre Dame de la Sagesse, também conhecido como Le Courtil. O Courtil é uma instituição belga que acolhe crianças e jovens com impasses no laço social. A partir do caso clínico de uma garota de oito anos, discute-se a importância dos objetos para a invenção e o tratamento que o sujeito dá ao real. Demonstra-se que o tratamento é um trabalho singular realizado pelo sujeito em parceria com os interventores. A prática entre vários e a transferência são colocadas em evidência como dispositivos que favorecem esse trabalho

Cet article est à propos d'une expérience institutionnel de stage à l'Institut Médico Pédagogique Notre Dame de la Sagesse, connu comme Le Courtil. Le Courtil est une institution belge qui accueille des enfants et des jeunes en difficultéau niveau du lien social. À partir d'un cas clinique d'une fille de huit ans, on discute l'importance des objets pour l'invention et pour le traitement du réel donné par le sujet. On démontre que le traitement est un travail singulier réalisé par le sujet en partenariat avec des intervenants. La pratique à plusieurs et le transfert sont mis en avant comme dispositifs qui favorisent ce travail

This article is about an internship experience that took place at the Institut Médico Pédagogique Notre Dame de la Sagesse, known as Le Courtil. Le Courtil is a Belgian institution dedicated to the reception and treatment ofchildren and young people with social bond difficulties. Based on a clinical case of an eight-year-old girl, the importance of objects for the invention and treatment of the real given by the subject is discussed. It is shown that the treatment is a singular work carried out by the subject in partnership with intervening parties. The multi-person practice and the transfer are put forward as devices that favour this work

Este artículo trata de una experiencia de pasantía institucional en el Institut Médico Pédagogique Notre Dame de la Sagesse, también conocido como Le Courtil. Le Courtil es una institución belga que acoge a niños y jóvenes con impasses en el lazo social. A partir del caso clínico de una niña de ocho años, se discute la importancia de los objetos para la invención y el tratamiento que el sujeto hace de lo real. Se demuestra que el tratamiento es un trabajo único realizado por el sujeto en compañía de los interventores. La práctica entre varios y la transferencia se destacan como dispositivos que favorecen este trabajo

Affinity therapy, Novidade no tratamento do autismo / Affinity therapy, Nouveauté dans le traitement de l'autisme / Affinity therapy, Novelty in the treatment of autism

Es constante en el autismo una fijación o una ritualización, una obsesión o una pasión, un interés específico o una aptitud, en resumen, una particularidad, una afinidad. Este punto permite construir una dinámica subjetiva autista: una relación al mundo, al cuerpo, a los otros y al conocimiento. La alienación significante se correlaciona con un apoyo alienante al objeto como una compensación. Para Laurent, es un "órgano suplementario" a partir del cual el sujeto articula y desglosa todo su mundo. La defensa autística es el "regreso del goce sobre un borde". El sujeto procura el apoyo de un doble, en las variadas formas clínicas y con la intervención que resultará, un tratamiento de pulsiones y dinámica vital. Considerando esta defensa: ¿qué tratamiento sería posible con el autismo? ¿Qué apoyo institucional se puede ofrecer? ¿Cómo se podría acompañar al autista? La Affinity therapy nombra lo que sería un tratamiento del autista orientado por los objetos, los intereses específicos, los dobles, las particularidades de cada autista. El artículo muestra el interés de la Affinity therapy, explica la importancia y el peso de esta práctica en el tratamiento del autismo en un trabajo interdisciplinar orientada por el discurso analítico

É frequente no autismo uma fixação ou uma ritualização, uma obsessão ou uma paixão, um interesse ou uma atitude, em resumo, uma particularidade, uma afinidade. Este ponto permite construir uma dinâmica subjetiva autista: uma relação com o mundo, com o corpo, com os outros e com o conhecimento. A alienação significante é correlata de um apoio alienante no objeto como uma compensação. Para Laurent, é um "órgão suplementar" a partir do qual o sujeito articula e separa o seu mundo. A defesa autística é o "retorno do gozo sobre uma borda". O sujeito procura o apoio de um duplo, nas variadas formas clínicas e com a intervenção [do analista?] da qual resultará um tratamento das pulsões e uma dinâmica vital. Considerando esta defesa: qual o tratamento possível do autismo? Qual apoio institucional se pode oferecer? Como acompanhar o autista? A Affinity therapy nomeia o que seria o tratamento do autista orientado pelos objetos, pelos interesses específicos, pelos duplos, pelas particularidades de cada autista. O artigo mostra o interesse da Affinity therapy, explica a importância e o peso desta prática no tratamento do autismo num trabalho interdisciplinar orientada pelo discurso analítico.

Une fixation ou une ritualisation, une obsession ou une passion, un intérêt ou une attitude, bref, une particularité, une affinité, est fréquente. Ce point permet la construction d'une dynamique subjective autistique : un rapport au monde, au corps, aux autres et au savoir. L'aliénation significative est corrélée avec le soutien aliénant sur l'objet comme compensation. Pour Laurent, c'est un « organe supplémentaire ¼ à partir duquel le sujet articule et sépare son monde. La défense autistique est le «retour de la jouissance par-dessus bord ¼. Le sujet cherche l'appui d'un double, dans les différentes formes cliniques et avec l'intervention [de l'analyste ?] qui va déboucher sur un traitement des pulsions et une dynamique vitale. Considérant cette défense : quel est le traitement possible de l'autisme ? Quel soutien institutionnel peut être proposé ? Comment accompagner l'autiste ? L'Affinity therapy nomme ce que serait le traitement des autistes orienté par les objets, par les intérêts spécifiques, par les doubles, par les particularités de chaque autiste. L'article montre l'intérêt de la thérapie par affinité, explique l'importance et le poids de cette pratique dans la prise en charge de l'autisme dans un travail interdisciplinaire guidé par le discours analytique.

A fixation or a ritualization, an obsession or a passion, an interest or an attitude, in short, a particularity, an affinity, is frequent. This point allows the construction of an autistic subjective dynamic: a relationship with the world, with the body, with others and with knowledge. Meaningful alienation is correlated with alienating support on the object as compensation. For Laurent, it is a "supplementary organ" from which the subject articulates and separates his world. The autistic defense is the "return of jouissance over the edge". The subject seeks the support of a double, in the various clinical forms and with the intervention [of the analyst?] which will result in a treatment of the drives and a vital dynamic. Considering this defense: what is the possible treatment of autism? What institutional support can be offered? How to accompany the autistic? Affinity therapy names what would be the treatment of autistic people oriented by objects, by specific interests, by doubles, for the particularities of each autistic person. The article shows the interest of Affinity therapy, explains the importance and weight of this practice in the treatment of autism in an interdisciplinary work guided by analytical discourse.

Probiotics and prebiotics alleviate behavioral deficits, inflammatory response, and gut dysbiosis in prenatal VPA-induced rodent model of autism.

Autism spectrum disorders are neuropsychiatric conditions characterized by social interaction and communication disorders and repetitive stereotypical behaviors. These disorders are also accompanied by an inflammatory status. Bidirectional communication between microbiome, gut, and brain has been discovered as a major mechanism influencing core symptoms and biomarkers of autism. Therefore, the modulation of the gut microbiota in autism has recently attracted interest. In this study, probiotic- and prebiotic-mediated modulation of the gut microbiota was compared in terms of different symptoms and findings in an experimental autism model. Valproic acid (VPA) (500 mg/kg) was administered to Wistar rats (on prenatal day 12.5) to induce autistic-like behaviors. Based on the supply of probiotics and prebiotics, animals were grouped as control (saline), autistic-like (prenatal VPA), probiotic (prenatal VPA + 22.5 × 109 cfu/day probiotic), prebiotic (prenatal VPA + 100 mg/day prebiotic), and combined treatment (prenatal VPA + 22.5 × 109 cfu/day probiotic + 100 mg/day prebiotic). After the treatment process, behavioral tests (social behaviors, anxiety, stereotypical behavior, sensorimotor gating, and behavioral despair) and biochemical analyses (serum and brain tissue) were conducted, and the quantities of some phyla and genera were determined in stool samples. Significant positive effects of probiotic and combined treatments were observed on the sociability, social interaction, and anxiety parameters. In addition, all three treatments had positive effects on stereotypical behavior. However, the treatments did not affect sensorimotor gating deficits and behavioral despair. Further, probiotic treatment reversed the VPA-induced increase and decrease in serum IL-6 and IL-10 levels, respectively. Combined treatment also significantly increased the IL-10 levels. Prenatal VPA exposure decreased 5-hydroxytryptamine (5-HT) levels in the prefrontal cortex of the brain; however, combined treatment reversed this decrease. Prenatal VPA exposure also caused a decrease in Bacteroidetes/Firmicutes ratio in the gut microbiota, while the probiotic treatment significantly increased this ratio. These findings indicate that probiotic- and prebiotic-mediated microbial modulation may represent a new therapeutic approach to alleviate autistic-like symptoms.

Barriers to healthcare and self-reported adverse outcomes for autistic adults: a cross-sectional study.

OBJECTIVES: Autistic people experience poor physical and mental health along with reduced life expectancy compared with non-autistic people. Our aim was to identify self-reported barriers to primary care access by autistic adults compared with non-autistic adults and to link these barriers to self-reported adverse health consequences. DESIGN: Following consultation with the autistic community at an autistic conference, Autscape, we developed a self-report survey, which we administered online through social media platforms. SETTING: A 52-item, international, online survey. PARTICIPANTS: 507 autistic adults and 157 non-autistic adults. PRIMARY AND SECONDARY OUTCOME MEASURES: Self-reported barriers to accessing healthcare and associated adverse health outcomes. RESULTS: Eighty per cent of autistic adults and 37% of non-autistic respondents reported difficulty visiting a general practitioner (GP). The highest-rated barriers by autistic adults were deciding if symptoms warrant a GP visit (72%), difficulty making appointments by telephone (62%), not feeling understood (56%), difficulty communicating with their doctor (53%) and the waiting room environment (51%). Autistic adults reported a preference for online or text-based appointment booking, facility to email in advance the reason for consultation, the first or last clinic appointment and a quiet place to wait. Self-reported adverse health outcomes experienced by autistic adults were associated with barriers to accessing healthcare. Adverse outcomes included untreated physical and mental health conditions, not attending specialist referral or screening programmes, requiring more extensive treatment or surgery due to late presentations and untreated potentially life-threatening conditions. There were no significant differences in difficulty attending, barriers experienced or adverse outcomes between formally diagnosed and self-identified autistic respondents. CONCLUSIONS: Reduction of healthcare inequalities for autistic people requires that healthcare providers understand autistic perspectives, communication needs and sensory sensitivities. Adjustments for autism-specific needs are as necessary as ramps for wheelchair users.

Autism and chronic ill health: an observational study of symptoms and diagnoses of central sensitivity syndromes in autistic adults.

BACKGROUND: Autistic adults, particularly women, are more likely to experience chronic ill health than the general population. Central sensitivity syndromes (CSS) are a group of related conditions that are thought to include an underlying sensitisation of the central nervous system; heightened sensory sensitivity is a common feature. Anecdotal evidence suggests autistic adults may be more prone to developing a CSS. This study aimed to investigate the occurrence of CSS diagnoses and symptoms in autistic adults, and to explore whether CSS symptoms were related to autistic traits, mental health, sensory sensitivity, or gender. METHODS: The full sample of participants included 973 autistic adults (410 men, 563 women, mean age = 44.6) registered at the Netherlands Autism Register, who completed questionnaires assessing autistic traits, sensory sensitivity, CSS, physical and mental health symptoms. The reliability and validity of the Central Sensitization Inventory (CSI) in an autistic sample was established using exploratory and confirmatory factor analyses. Chi2 analyses, independent t-tests, hierarchical regression and path analysis were used to analyse relationships between CSS symptoms, autistic traits, measures of mental health and wellbeing, sensory sensitivity, age and gender. RESULTS: 21% of participants reported one or more CSS diagnosis, and 60% scored at or above the clinical cut-off for a CSS. Autistic women were more likely to report a CSS diagnosis and experienced more CSS symptoms than men. Sensory sensitivity, anxiety, age and gender were significant predictors of CSS symptoms, with sensory sensitivity and anxiety fully mediating the relationship between autistic traits and CSS symptoms. LIMITATIONS: Although this study included a large sample of autistic adults, we did not have a control group or a CSS only group. We also could not include a non-binary group due to lack of statistical power. CONCLUSIONS: CSS diagnoses and symptoms appear to be very common in the autistic population. Increased awareness of an association between autism and central sensitisation should inform clinicians and guide diagnostic practice, particularly for women where CSS are common and autism under recognised.

Autismo: história de um quadro e o quadro de uma história / Historia de um cuadro y cuadro de una historia / History of a framework and the framework of a story autism narratives

RESUMO. Com o crescente interesse público pela questão do autismo, assistimos a uma torção importante do debate que caracteriza esse tema. Inicialmente reduzida ao campo científico - em geral médico - a questão do autismo se viu progressivamente encampada por diferentes agentes, sobretudo pelos próprios autistas, cujas contribuições ampliaram muito o que podemos saber hoje sobre o autismo. Com o termo narrativas do autismo, tivemos como proposta neste artigo demonstrar a riqueza dos aportes desses novos saberes para o debate científico e político sobre a questão, bem como demonstrar o risco dela permanecer encapsulada e restrita ao campo estritamente científico. Para tanto, passamos pela história do conceito ressaltando como nela se pode ver o quanto o percurso científico vai sendo afetado, enriquecido por influência desses outros agentes e o valor de se tomar em consideração as diversas narrativas sobre o autismo. Situar a diversidade dessas narrativas não tem como objetivo apenas retomar uma posição plural e aberta contra outra exclusiva e restritiva, mas, antes, de colocar em curso o que pode acontecer ao debate científico quando ele não se fecha demasiadamente sobre a tendência objetivante própria a organização do discurso científico.

RESUMEN Con el creciente interés público por la cuestión del autismo, asistimos a una torcedura importante del debate que caracteriza ese tema. Al principio reducida al campo científico - engeneral médico - lacuestión del autismo se vio progresivamente encampada por distintos agentes, sobre todo por los propios autistas, cuyas contribuciones ampliaron mucho lo que podemos saber hoy sobre el autismo. Con el término narrativas del autismo buscamos en este artículo demostrar la riqueza de los aportes de estos nuevos saberes para el debate científico y político sobre la cuestión, así como demostrar su riesgo de permanecer encapsulada y restringida al campo estrictamente científico. Para ello, pasamos por la historia del concepto resaltando cómo en ella se puede ver cuánto el curso científico va siendo afectado, enriquecido por influencia de esos otros agentes y el valor de tomar en consideración las diversas narrativas sobre el autismo. Situar la diversidad de estas narrativas no tiene como objetivo sólo retomar una posición plural y abierta contra otra exclusiva y restrictiva, sino más bien de poner en marcha lo que puede suceder al debate científico cuando no se cierra demasiado sobre la tendencia objetiva propia de la organización del discurso científico.

ABSTRACT With the growing public interest in autism, we witness a critical twist in the debate that characterizes this subject. Initially reduced to the scientific field - generally medical - the issue of autism has been progressively taken over by different agents, especially by the autistic themselves, whose contributions have greatly expanded on what we may know about autism nowadays. With the term autism narratives, this article aims to demonstrate the richness of these new knowledge contributions to the scientific and political debate on the issue and demonstrate its risk of remaining encapsulated and restricted to the strictly scientific field. For this purpose, we go through the history of the concept, highlighting how it has been affected the scientific course enriched by these other agents' influence and the value of considering the various narratives about autism. Situating the diversity of these narratives is not only to retake a plural and open position against an exclusive and restrictive one but, instead, to put into action what may happen to the scientific debate when it does not close itself too much over the organization's objective tendency of scientific discourse.

Understanding the substance use of autistic adolescents and adults: a mixed-methods approach.

BACKGROUND: Autistic individuals might be more likely to misuse substances than non-autistic individuals. Better understanding of these patterns can help clinicians identify strategies to reduce substance use, protecting physical and mental health. The aim of this study was to compare the experiences of substance use between autistic and non-autistic adolescents and adults. METHODS: This study is a mixed-methods study, including both quantitative (closed-ended questions) and qualitative (one open-ended question) online assessments. Data were collected as part of a larger study, the Autism and Physical Health Survey, in which we administered an anonymised, online questionnaire to autistic and non-autistic individuals aged 16-90 years. In the present study, we investigated data on substance use or misuse, using two overlapping but separate samples from the survey (one sample with complete quantitative responses and one sample with complete qualitative responses). Binary measures of substance use were investigated using unadjusted and adjusted binomial logistic regression models. Content analysis was used to compare experiences of autistic and non-autistic adolescents and adults. We used Fisher's exact tests to assess differences in frequency of reporting particular qualitative themes and subthemes. FINDINGS: Survey recruitment was done between Feb 7, 2018, and Aug 26, 2019. At the end of the recruitment, 3657 individuals had accessed the survey. After excluding duplicates as well as participants with missing or incomplete responses, we had data from 2386 participants (1183 autistic and 1203 non-autistic participants; 1571 female and 815 male participants) for the quantitative analyses and data from 919 participants (429 autistic and 490 non-autistic participants; 569 female and 350 male participants) in the qualitative analyses. The samples for the quantitative and qualitative analyses were predominantly composed of female individuals, White individuals, UK residents, and those without intellectual disability. Autistic individuals were less likely than non-autistic individuals to report consuming alcohol regularly (16·0% of autistic individuals vs 22·2% of non-autistic individuals; adjusted model: odds ratio [OR] 0·69, 95% CI 0·55-0·86; p=0·0022) or binge-drinking (3·8% vs 8·2%; adjusted model: OR 0·38, 0·26-0·56; p<0·0001). Autistic male participants were less likely than non-autistic male participants to report ever having smoked (50·8% of autistic male participants vs 64·6% of non-autistic male participants; adjusted OR 0·50; 0·32-0·76; p=0·0022) or ever using drugs (35·4% vs 52·7%; adjusted OR 0·53; 0·35-0·80; p=0·0022). Regarding our qualitative analyses, among participants who reported a specific motivation for drug use, compared with non-autistic individuals, autistic individuals were nearly nine times more likely to report using recreational substances to manage behaviour (OR 8·89, 2·05-81·12; p=0·0017) and more likely to report using recreational substances to manage mental health symptoms (OR 3·08, 1·18-9·08; p=0·032). Autistic individuals were also more likely to report vulnerability associated with substance use (OR 4·16, 1·90-10·05; p=0·00027), including childhood use of drugs and being forced or tricked into using drugs. INTERPRETATION: Autistic individuals might be less likely than non-autistic individuals to report engaging in substance misuse. They also report using drugs to self-medicate. Clinicians should be aware of vulnerability linked to substance use among autistic patients and should work cooperatively with patients to effectively manage autistic and comorbid symptoms. FUNDING: Autism Research Trust, Rosetrees Trust, Cambridge and Peterborough NHS Foundation Trust.

Concurrent Validity of the Modified Checklist for Autism in Toddlers (M-CHAT): Socio-cognitive and Verbal Skills in 18-Month-Old Infants.

The Modified Checklist for Autism in Toddlers (M-CHAT) is a screening questionnaire for Autism Spectrum Disorder (ASD). Previous findings have confirmed the M-CHAT's sensitivity and specificity across several cultures, yet few studies have considered M-CHAT scores as a distributed trait in a sample of typical infants. The current study examined how the M-CHAT predicts concurrent word learning (experiment 1) as well as socio-emotional understanding (experiment 2) in 18-month-old infants. Results demonstrated that the number of items endorsed on the M-CHAT negatively correlated with the proportion of trials on which infants looked at a toy named by the experimenter as well as performance on the word learning task. In experiment 2, high scores on the M-CHAT correlated with less instrumental helping, less imitation, and a smaller productive vocabulary size.

Comparison of the Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F) Positive Predictive Value by Race.

The Modified Checklist for Autism in Toddlers, Revised, with Follow-Up (M-CHAT-R/F) is the most widely used screener for ASD. Despite the comparable rate of ASD in Black and White children, the M-CHAT-R/F was validated on a primarily White, Non-Hispanic sample. Few studies have assessed whether the screener performs adequately with racial minorities. This study compared the M-CHAT-R/F Positive Predictive Value (PPV), for ASD, and for any developmental condition, in Black and White children. We also examined M-CHAT-R/F item-level PPV by race. The PPVs for ASD and other developmental disorders were similar in both racial groups for total score and individual items. Therefore, our findings support the use of the M-CHAT-R/F with Black and White children.

A função constitutiva da voz e o poder da música no tratamento do autismo / La función constitutiva de la voz y el poder de la música en el tratamiento del autismo / The constitutive function of voice and the power of music in the treatment of autism

RESUMO. O artigo parte de uma experiência de pesquisa sobre o tratamento psicanalítico em grupo de crianças autistas, para refletir acerca da presença de mais de um analista no setting. A interação entre os analistas favorece uma abordagem não diretiva, permitindo à criança que ela se aproxime espontaneamente, sem ser forçada a um contato que pode ser sentido como extremamente angustiante pelo autista. Ademais, constatam-se os efeitos da voz como suporte para os próprios interventores, que dialogam, brincam e cantam entre eles, suscitando uma animação libidinal capaz de mobilizar a criança autista. A música que circula nas brincadeiras de roda veicula tanto aspectos simbólicos da cultura quanto o real do gozo de alíngua. Em um caso particular, a prosódia do canto mostrou-se uma forma imaginária específica de tratar a dimensão real da voz que invade o sujeito autista. Servindo-se de canções populares como objetos de mediação, foi possível orientar o tratamento a partir de uma solução que veio do próprio sujeito, que, antecipado neste ato, pode ouvir a invocação para advir. Evidencia-se assim, também no autismo, o papel do objeto pulsional voz para a constituição subjetiva.

RESUMEN. El artículo parte de una experiencia de investigación sobre el tratamiento psicoanalítico en grupo de niños autistas, para pensar se a propósito de la presencia de más de un analista en el setting. La interacción entre analistas favorece un abordaje no directivo, permitiendo que el niño se acerque espontáneamente, sin ser forzado a un contacto que puede ser extremadamente angustiante para el autista. Además, se constatan los efectos de la voz como soporte para los propios interventores, que dialogan, juegan y cantan entre sí, evocando una animación liminal capaz de movilizar el niño autista. La música que circula en las cirandas transmite tanto los aspectos simbólicos de la cultura cuanto el real del goce de la lengua. En un caso particular, la prosodia del canto se ha mostrado una forma imaginaria específica de tratar la dimensión real de la voz que invade el sujeto autista. Haciendo uso de canciones populares como objetos de mediación, fue posible guiar el tratamiento a partir de una solución proveniente del propio sujeto, que, anticipado en este acto, puede escuchar la invocación para venir a ser. Se evidencia así, también en el autismo, el papel del objeto pulsional voz para la constitución subjetiva.

ABSTRACT. Based on a research experience regarding the psychoanalytical group treatment of autistic children, the article reflects on the presence of more than one analyst in the setting. The interaction between analysts favors a non-directive approach, enabling the child to take action spontaneously, without being forced to a contact that can be extremely unsettling for the autist. Furthermore, one observes the effects of voice as a support for the caretakers, who talk, play and sing with each other, eliciting a libidinal excitement able to involve the autistic child. The music that reverberates through the circle games transmits both the symbolic aspects of culture and the real of la langue's jouissance. In a particular case, the singing prosody revealed itself to be a specific imaginary way to treat the real of voice which invades the autistic subject. Using folk songs as mediation objects, it was possible to conceive a treatment direction that took into account a solution that sprung from the subject, who, anticipated in this act, can hear the invocation to arise. Thus, one evidences, also in autism, the role of voice as pulsional object in the subjective constitution.

O uso de robôs como mediadores na prática clínica psicanalítica com crianças autistas / El uso de robots como mediadores en la práctica clínica psicoanalítica con niños autistas / The use of robots as mediators in psychoanalytical clinical practice with autistic children / L'utilisation de robots comme mediateurs dans la pratique clinique psychanalytique avec enfants autistes

Esta proposta, a partir da clínica psicanalítica, demonstra como o uso do robô, enquanto objeto tecnológico, poderá permitir à criança autista, no tratamento, maior interação e laço com o Outro. Faz-se uma aposta de que as intervenções mediadas pelo robô podem proporcionar um semblante das operações constitutivas do sujeito que não se realizaram. Considerando que os componentes da borda autística possibilitam ao sujeito enlaçar-se no meio social, destacam-se as possibilidades de "alargamento" dessa borda autística a partir de intervenções qualificadas como objeto. Assim, o uso do robô nas sessões torna as intervenções menos invasivas à criança, permitindo certa regulação pulsional, favorecendo um caminho privilegiado de comunicação e intervenção, e produzindo maior interação social

Nuestra propuesta en este artículo es demostrar, desde la clínica psicoanalítica, cómo el uso del robot, como objeto tecnológico, puede permitir al niño autista, en el tratamiento, una mayor interacción y lazo con el Otro. Apostamos a que las intervenciones mediadas por el robot pueden proporcionar un semblante de las operaciones constitutivas del sujeto que no se hicieron realidad.Considerando que los componentes del borde autístico le permiten al sujeto vincularse en el entorno social, se destacan las posibilidades de «dilatar¼ este borde autístico desde intervenciones calificadas con objeto. Así, el uso del robot en las sesiones hace con que las intervenciones sean menos invasivas para el niño, permitiendo una cierta regulación pulsional, favoreciendo un camino privilegiado de comunicación e intervención, produciendo una mayor interacción social

Our proposal, from the psychoanalytic clinic, is to demonstrate how the use of the robot, as a technological object, may allow the autistic child, in the treatment, greater interaction and bond with the Other. We place a bet that interventions mediated by the robot can provide a semblance of the subject's constitutive operations that have not taken place. Considering that the components of the autistic border allow the subject to bond in the social environment, the possibilities of 'widening' this autistic border are highlighted from qualified interventions with object. Thus, the use of the robot in the sessions makes the interventions less invasive to the child, allowing a certain drive regulation, favoring a privileged path of communication and intervention, producing greater social interaction

Notre proposition, à partir de la clinique psychanalytique, c'est de démontrer comme l'utilisation du robot, en tant qu'objet technologique, pourra permettre à l'enfant autiste, dans le traitement, des plus grands interaction et lien avec l'Autre. On parie que les interventions facilitées par le robot peuvent promouvoir un semblant des opérations constitutives du sujet qui n'ont pas été réalisées. En considérant que les composants de la borde autistique permettent au sujet de se lier au milieu social, on distingue les possibilités d''élargissement' de cette borde autistique à partir des interventions qualifiées avec objet. Ainsi, l'utilisation du robot dans les sessions rendent les interventions moins invasives pour l'enfant, en permettant une certaine régulation pulsionnelle qui favorise un chemin privilégié de communication et intervention, en ayant comme résultat une plus grande interaction sociale

O uso de objetos e filmagem no tratamento psicanalítico em grupo de crianças autistas / El uso de objetos y filmación en el tratamiento psicoanalítico en grupo de niños autistas / L'usage d'objets et du film dans le traitement psychanalytique de groupe d'enfants autistes / The use of objects and footage in psychoanalytic treatment in a group of autistic children

Resumo Este artigo visa apresentar os resultados de uma pesquisa sobre o uso de objetos no tratamento psicanalítico do autismo, que envolveu a realização de um atendimento em grupo de crianças com diagnóstico de Transtorno do Espectro Autista em uma instituição pública de saúde mental. O registro audiovisual dos atendimentos mostrou-se um componente indispensável desta abordagem, em especial nas reuniões com os pais e nas supervisões, convidando a uma reflexão acerca de seu estatuto. A questão da constituição subjetiva e o problema do diagnóstico na infância permearam as discussões aqui propostas.

Resumen Este artículo tiene como objetivo presentar los resultados de una investigación sobre el uso de objetos en el tratamiento psicoanalítico del autismo, que se realizó en una atención grupal a niños con trastorno del espectro autista en una institución pública de salud mental. El registro audiovisual demostró ser un componente indispensable de este enfoque -especialmente en reuniones con los padres y en las supervisiones- invitando a la reflexión sobre su status. El tema de la constitución subjetiva y el problema del diagnóstico en la infancia permearon las discusiones aquí propuestas.

Résumé Cet article présente les résultats d'une recherche sur l'usage d'objets dans le traitement psychanalytique de l'autisme. La recherche a compris un groupe d'enfants autistiques dans une institution publique de santé mentale. L'enregistrement audiovisuel des séances s'est avéré crucial dans cette approche - notamment dans les réunions avec les parents et dans les séances de contrôle -, invitant à une réflexion sur son statut. Les enjeux de la constitution subjective et du diagnostic pendant l'enfance se sont fait présentes tout au long de l'argumentation.

Abstract This article seeks to present the results of a research concerning the use of objects in the psychoanalytic treatment of autism, which involved attending a group of children diagnosed with Autism Spectrum Disorder at a public mental health institution. The audiovisual record of attendances proved to be an indispensable component of this approach, especially in meetings with parents and supervisors, inviting them to a reflection on their status. The issue of subjective constitution and the problem of diagnosis in childhood permeated the discussions proposed here.

Clínica e pesquisa do autismo: olhar ético para o sofrimento da família / Clínica e investigación del autismo: mirada ética al sufrimiento de la familia / Autism clinic and research: ethical look at family suffering

RESUMO: No presente artigo, temos como objetivo discutir, do ponto de vista da ética, alguns impactos que o autismo pode ter nas relações familiares. Para tanto, recorremos a uma revisão bibliográfica acerca de possíveis efeitos do autismo nas relações familiares e também à apresentação de recortes autobiográficos de famílias de crianças com Transtorno do Espectro do Autismo (TEA). A reflexão desenvolvida ao longo do artigo leva a pensar sobre como a criança com TEA, com suas singularidades, pode vir a impactar as relações familiares e sobre como a subjetividade da criança afeta a família ao mesmo tempo em que é afetada por ela. Dessa forma, esperamos alargar e aprofundar o horizonte das pesquisas que enfocam este tema e fornecer novos elementos para a escuta e cuidado dos pais e irmãos na clínica do autismo.

RESUMEN: En este artículo, nuestro objetivo es discutir, desde el punto de vista de la ética, algunos impactos que el autismo puede tener en las relaciones familiares. Para habilitar esta discusión, recurrimos a una revisión de la literatura sobre los posibles efectos del autismo en las relaciones familiares y también a la presentación de recortes autobiográficos de familias de niños con Trastorno del Espectro Autista (TEA). La reflexión desarrollada a lo largo del artículo lleva a pensar cómo el niño con TEA, con sus singularidades, puede impactar las relaciones familiares, reflexionando sobre cómo la subjetividad del niño afecta a la familia al mismo tiempo que se ve afectada por ella. De esta manera, esperamos ampliar y profundizar el horizonte de investigación sobre este tema y proporcionar nuevos elementos para la escucha y el cuidado con a los padres y hermanos en la clínica de autismo.

ABSTRACT: In this article, we aim to discuss, from a standpoint of the field of Ethics, some impacts that autism may have on the family. We made a literature review about possible effects of autism on family relationships and autobiographical texts of relatives of people with Autism Spectrum Disorder (ASD). We discuss how people with ASD, with their singularities, may impact family relationships, and how the person's subjectivity simultaneously impacts and is impacted by the family. In this way, we hope to broaden and deepen the horizon of researches that focus on such issues providing new elements for listening and caring for parents and siblings in autism-related treatment.

Um olhar psicanalítico acerca do autismo: revisão bibliográfica / Una mirada psicoanalítica sobre el autismo: revisión bibliográfica / A psychoanalytical view on autism: a literature review

O presente artigo é uma pesquisa de revisão de literatura, com o objetivo de identificar algumas das principais hipóteses explicativas sobre o autismo na psicanálise e as suas contribuições no que diz respeito ao seu tratamento. A busca foi realizada nas bibliotecas virtuais Pepsic e Scielo, sendo incluídos artigos escritos em língua portuguesa, publicados no período de 2012 a 2017. Vinte e três artigos foram selecionados e analisados, buscando- se identificar as hipóteses psicanalíticas sobre o autismo, propostas de tratamento, objetivos, métodos, principais resultados e conclusões. Constatamos que os autores mais citados foram Jacques Lacan, seguido por Jean-Claude Maleval, Marie Christine Laznik, Alfredo Jerusalinsky e Maria Cristina Kupfer, todos autores mais ou menos identificados ao referencial lacaniano. No que diz respeito às hipóteses explicativas, encontramos hipóteses sobre a existência de alguma falha ou de algo que não se completa na constituição psíquica do autista. Sobre o diagnóstico do autismo, destacamos os riscos dos diagnósticos precoces e normativos, considerando que a constituição psíquica da criança ainda está em formação. E, finalmente, sobre a possibilidade de tratamento, os artigos indicam a necessidade de respeitar a singularidade da pessoa autista e sua forma de estar no mundo, buscando uma aproximação delicada e não invasiva.

Este artículo es una investigación de revisión de literatura, con el objetivo de identificar algunas de las principales hipótesis explicativas sobre el autismo en psicoanálisis y sus contribuciones respecto a su tratamiento. La búsqueda fue realizada en las bibliotecas virtuales Pepsic y Scielo, incluyendo los artículos escritos en lengua portuguesa y publicados entre 2012 y 2017. Veintitrés artículos fueron seleccionados y analizados, buscando identificar las hipótesis psicoanalíticas sobre el autismo, propuestas de tratamiento, objetivos, métodos, principales resultados y conclusiones. Los resultados apuntan que los autores más citados fueron Jacques Lacan, seguido de Jean-Claude Maleval, Marie Christine Laznik, Alfredo Jerusalinsky y Maria Cristina Kupfer, todos ellos más o menos identificados con el referencial lacaniano. En lo que se refiere a las hipótesis explicativas, encontramos hipótesis sobre la existencia de alguna falla o algo incompleto en la constitución psíquica del autista. Sobre el diagnóstico de autismo, destacamos los riesgos de los diagnósticos tempranos y normativos, considerando que la constitución psíquica del niño todavía está en formación. Y, finalmente, sobre la posibilidad de tratamiento, los artículos indican la necesidad de respetar la singularidad de la persona autista y su forma de estar en el mundo, privilegiando un enfoque no invasivo.

This article is a research literature review aiming to identify some of the main explanatory hypotheses on autism in psychoanalysis and their contributions related to its treatment. The search was carried out in Pepsic and Scielo virtual libraries including articles written in Portuguese, published among 2012-2017 period. Twenty- three articles were selected and analyzed with the purpose of identifying the psychoanalytic hypotheses on autism, treatment proposals, objectives, methods, main results and conclusions. Results showed that the most cited authors were Jacques Lacan, followed by Jean-Claude Maleval, Marie Christine Laznik, Alfredo Jerusalinsky and Maria Cristina Kupfer, who are supported by the Lacanian framework. Regarding the explanatory hypotheses, assumptions about the existence of some failure or something that is not completed in the psychic constitution of the autistic were found, leading to highlight the risks of early and normative diagnoses. And, finally, about the possibility of treatment, the articles point out the need of respecting the uniqueness of the autistic person and his way of being in the world, in search of a delicate and non-invasive approach.

Down Syndrome Disintegrative Disorder: A Clinical Regression Syndrome of Increasing Importance.

Down syndrome disintegrative disorder (DSDD), a developmental regression in children with Down syndrome (DS), is a clinical entity that is characterized by a loss of previously acquired adaptive, cognitive, and social functioning in persons with DS usually in adolescence to early adulthood. Initially reported in 1946 as "catatonic psychosis," there has been an increasing interest among the DS community, primary care, and subspecialty providers in this clinical area over the past decade. This condition has a subacute onset and can include symptoms of mood lability, decreased participation in activities of daily living, new-onset insomnia, social withdrawal, autistic-like regression, mutism, and catatonia. The acute phase is followed by a chronic phase in which baseline functioning may not return. No strict criteria or definitive testing is currently available to diagnose DSDD, although a comprehensive psychosocial and medical evaluation is warranted for individuals presenting with such symptoms. The etiology of DSDD is unknown, but in several hypotheses for regression in this population, psychological stress, primary psychiatric disease, and autoimmunity are proposed as potential causes of DSDD. Both psychiatric therapy and immunotherapies have been described as DSDD treatments, with both revealing potential benefit in limited cohorts. In this article, we review the current data regarding clinical phenotypes, differential diagnosis, neurodiagnostic workup, and potential therapeutic options for this unique, most disturbing, and infrequently reported disorder.

Mental Health Clinicians' Screening and Intervention Practices to Reduce Suicide Risk in Autistic Adolescents and Adults.

Autistic individuals experience elevated risk for suicide ideation, attempts, and deaths. Little is known about how clinicians assess risk or intervene with suicidal autistic individuals. We surveyed 121 clinicians about use of suicide prevention practices with autistic and non-autistic clients. Clinicians reported greater self-efficacy in screening for suicide risk among non-autistic clients (p = 0.01). There were no statistically significant differences in whether they used standardized screening measures or in their reported normative pressure or attitudes towards screening. Clinicians reported similar rates of use of Safety Planning, an evidence-based suicide-prevention strategy, across groups, but greater acceptability for non-autistic clients (p < 0.001). These findings have implications for strategies to increase clinicians' adoption of these tools for autistic individuals.

Prominent autistic traits and subthreshold bipolar/mixed features of depression in severe anorexia nervosa

Objective: Autistic traits are associated with a burdensome clinical presentation of anorexia nervosa (AN), as is AN with concurrent depression. The aim of the present study was to explore the intertwined association between complex psychopathology combining autistic traits, subthreshold bipolarity, and mixed depression among people with AN. Method: Sixty patients with AN and concurrent major depressive episode (mean age, 22.2±7 years) were cross-sectionally assessed using the Autism-Spectrum Quotient test (AQ-test), the Hamilton depression scales for depression and anxiety, the Young Mania Rating Scale (YMRS), the Hypomania-Checklist-32 (HCL-32), second revision (for subthreshold bipolarity), the Brown Assessment and Beliefs Scale (BABS), the Yale-Brown-Cornell Eating Disorders Scale (YBC-EDS), and the Eating Disorder Examination Questionnaire (EDE-Q). Cases were split into two groups depending on body mass index (BMI): severe AN (AN+) if BMI < 16, not severe (AN-) if BMI ≥ 16. Results: The "subthreshold bipolarity with prominent autistic traits" pattern correctly classified 83.6% of AN patients (AN+ = 78.1%; AN- = 91.3%, Exp(B) = 1.391). AN+ cases showed higher rates of positive scores for YMRS items 2 (increased motor activity-energy) and 5 (irritability) compared to AN- cases. Conclusions: In our sample, depressed patients with severe AN had more pronounced autistic traits and subtly mixed bipolarity. Further studies with larger samples and prospective follow-up of treatment outcomes are warranted to replicate these findings.