Towards system redesign: An exploratory analysis of neurodivergent traits in a childhood population referred for autism assessment.

BACKGROUND: Children's health services in many countries are moving from single condition diagnostic silo assessments to considering neurodevelopment in a more holistic sense. There has been increasing recognition of the importance of clinical overlap and co-occurrence of different neurotypes when assessing neurodivergent children. Using a cross-sectional service evaluation design, we investigated the overlap of neurodivergences in a cohort of children referred for autism assessment, focusing on motor, learning, and attention/activity level domains. We aimed to determine what proportion of children in a cohort referred for an autism assessment showed traits of additional neurodivergences, and what proportion were further investigated. METHODS: We evaluated anonymised medical records of children aged between two and 17 years referred for autism assessment. We used validated questionnaires to assess for neurodivergent traits. A weighted scoring system was developed to determine traits in each neurodevelopmental domain and a score above the median was considered to indicate a neurodivergent trait. Evidence of further investigations were recorded. We then examined the relationships between autism traits and traits of additional neurodivergence. RESULTS: 114 participants were included for evaluation. 62.3% (n = 71) had completed questionnaires for analysis. Of these, 71.8% (n = 51) scored greater than the median for at least one additional neurotype, indicating the presence of other neurodivergent traits, and 88.7% (n = 64) attracted a diagnosis of autism. Only 26.3% of children with evidence of additional neurotypes were further investigated beyond their autism assessment. CONCLUSIONS: Our results demonstrate the extensive overlap between additional neurodivergent traits in a population of children referred with suspected autism and show that only a small proportion were further investigated. The use of standardised questionnaires to uncover additional neurodivergences may have utility in improving the holistic nature of neurodevelopmental assessments.

A comprehensive analysis towards exploring the promises of AI-related approaches in autism research.

Autism Spectrum Disorder (ASD) is a neurodevelopmental condition that presents challenges in communication, social interaction, repetitive behaviour, and limited interests. Detecting ASD at an early stage is crucial for timely interventions and an improved quality of life. In recent times, Artificial Intelligence (AI) has been increasingly used in ASD research. The rise in ASD diagnoses is due to the growing number of ASD cases and the recognition of the importance of early detection, which leads to better symptom management. This study explores the potential of AI in identifying early indicators of autism, aligning with the United Nations Sustainable Development Goals (SDGs) of Good Health and Well-being (Goal 3) and Peace, Justice, and Strong Institutions (Goal 16). The paper aims to provide a comprehensive overview of the current state-of-the-art AI-based autism classification by reviewing recent publications from the last decade. It covers various modalities such as Eye gaze, Facial Expression, Motor skill, MRI/fMRI, and EEG, and multi-modal approaches primarily grouped into behavioural and biological markers. The paper presents a timeline spanning from the history of ASD to recent developments in the field of AI. Additionally, the paper provides a category-wise detailed analysis of the AI-based application in ASD with a diagrammatic summarization to convey a holistic summary of different modalities. It also reports on the successes and challenges of applying AI for ASD detection while providing publicly available datasets. The paper paves the way for future scope and directions, providing a complete and systematic overview for researchers in the field of ASD.

What Makes the Detection of Movement Different Within the Autistic Traits Spectrum? Evidence From the Audiovisual Depth Paradigm.

Atypical sensory processing is now considered a diagnostic feature of autism. Although multisensory integration (MSI) may have cascading effects on the development of higher-level skills such as socio-communicative functioning, there is a clear lack of understanding of how autistic individuals integrate multiple sensory inputs. Multisensory dynamic information is a more ecological construct than static stimuli, reflecting naturalistic sensory experiences given that our environment involves moving stimulation of more than one sensory modality at a time. In particular, depth movement informs about crucial social (approaching to interact) and non-social (avoiding threats/collisions) information. As autistic characteristics are distributed on a spectrum over clinical and general populations, our work aimed to explore the multisensory integration of depth cues in the autistic personality spectrum, using a go/no-go detection task. The autistic profile of 38 participants from the general population was assessed using questionnaires extensively used in the literature. Participants performed a detection task of auditory and/or visual depth moving stimuli compared to static stimuli. We found that subjects with high-autistic traits overreacted to depth movement and exhibited faster reaction times to audiovisual cues, particularly when the audiovisual stimuli were looming and/or were presented at a fast speed. These results provide evidence of sensory particularities in people with high-autistic traits and suggest that low-level stages of multisensory integration could operate differently all along the autistic personality spectrum.

The Relationship Between Augmentative and Alternative Communication Use by Pediatric Psychiatric Inpatients With Autism Spectrum Disorder and Interfering Behaviors.

PURPOSE: Previous research conducted by Williams et al. (2018) using data from the Autism Inpatient Collection (AIC) found a weak and inconsistent association between verbal ability and the severity of interfering behaviors; however, adapting/coping scores were significantly associated with self-injury, stereotypy, and irritability (including aggression and tantrums). The previous study did not account for access to or use of alternative forms of communication in their sample population. This study uses retrospective data to investigate the association between verbal ability and augmentative and alternative communication (AAC) use and the presence of interfering behaviors in individuals with autism who have complex behavioral profiles. METHOD: The sample included 260 autistic inpatients, ages 4-20 years, from six psychiatric facilities, enrolled during the second phase of the AIC when detailed information about AAC use was collected. Measures included AAC use, method, and function; comprehension and production of language; receptive vocabulary; nonverbal IQ; severity of interfering behaviors; and the presence and severity of repetitive behaviors. RESULTS: Lower language/communication abilities were related to increased repetitive behaviors and stereotypies. More specifically, these interfering behaviors appeared to be related to communication in those individuals who were candidates for AAC but who were not reported to have access to it. Although the use of AAC did not predict a decrease in interfering behaviors, receptive vocabulary scores-as measured by the Peabody Picture Vocabulary Test-Fourth Edition-were positively correlated with the presence of interfering behaviors in participants with the most complex communication needs. CONCLUSIONS: The communication needs of some individuals with autism may be unmet, prompting the use of interfering behaviors as a form of communication. Further investigation of the functions of interfering behaviors and the related functions of communication skills may provide greater support for an increased focus on the provision of AAC to prevent and ameliorate interfering behaviors in individuals with autism.

Relations Between the McGurk Effect, Social and Communication Skill, and Autistic Features in Children with and without Autism.

Children with autism show alterations in multisensory integration that have been theoretically and empirically linked with the core and related features of autism. It is unclear, however, to what extent multisensory integration maps onto features of autism within children with and without autism. This study, thus, evaluates relations between audiovisual integration and core and related autism features across children with and without autism. Thirty-six children reported perceptions of the McGurk illusion during a psychophysical task. Parents reported on participants' autistic features. Increased report of illusory percepts tended to covary with reduced autistic features and greater communication skill. Some relations, though, were moderated by group. This work suggests that associations between multisensory integration and higher-order skills are present, but in some instances vary according to diagnostic group.

Cannabinoid treatment for autism: a proof-of-concept randomized trial.

BACKGROUND: Endocannabinoid dysfunction in animal models of autism spectrum disorder (ASD) and accumulating, albeit anecdotal, evidence for efficacy in humans motivated this placebo-controlled double-blind comparison of two oral cannabinoid solutions in 150 participants (age 5-21 years) with ASD. METHODS: We tested (1) BOL-DP-O-01-W, a whole-plant cannabis extract containing cannabidiol and Δ9-tetrahydrocannabinol at a 20:1 ratio and (2) BOL-DP-O-01, purified cannabidiol and Δ9-tetrahydrocannabinol at the same ratio. Participants (N = 150) received either placebo or cannabinoids for 12-weeks (testing efficacy) followed by a 4-week washout and predetermined cross-over for another 12 weeks to further assess tolerability. Registered primary efficacy outcome measures were improvement in behavioral problems (differences between whole-plant extract and placebo) on the Home Situation Questionnaire-ASD (HSQ-ASD) and the Clinical Global Impression-Improvement scale with disruptive behavior anchor points (CGI-I). Secondary measures were Social Responsiveness Scale (SRS-2) and Autism Parenting Stress Index (APSI). RESULTS: Changes in Total Scores of HSQ-ASD (primary-outcome) and APSI (secondary-outcome) did not differ among groups. Disruptive behavior on the CGI-I (co-primary outcome) was either much or very much improved in 49% on whole-plant extract (n = 45) versus 21% on placebo (n = 47; p = 0.005). Median SRS Total Score (secondary-outcome) improved by 14.9 on whole-plant extract (n = 34) versus 3.6 points after placebo (n = 36); p = 0.009). There were no treatment-related serious adverse events. Common adverse events included somnolence and decreased appetite, reported for 28% and 25% on whole-plant extract, respectively (n = 95); 23% and 21% on pure-cannabinoids (n = 93), and 8% and 15% on placebo (n = 94). Limitations Lack of pharmacokinetic data and a wide range of ages and functional levels among participants warrant caution when interpreting the results. CONCLUSIONS: This interventional study provides evidence that BOL-DP-O-01-W and BOL-DP-O-01, administrated for 3 months, are well tolerated. Evidence for efficacy of these interventions are mixed and insufficient. Further testing of cannabinoids in ASD is recommended. Trial registration ClinicalTrials.gov: NCT02956226. Registered 06 November 2016, https://clinicaltrials.gov/ct2/show/NCT02956226.

Autistic traits in mentalization-based treatment for concurrent borderline personality disorder and substance use disorder: Secondary analyses of a randomized controlled feasibility study.

Autism is suggested to be a dimensional construct and often represents a comorbid state. However, research on the clinical implications of the presence of autistic traits is scarce. This study aimed to investigate the impact of subclinical autistic traits in mentalization-based treatment (MBT) for concurrent borderline personality disorder (BPD) and substance use disorder (SUD). Based on the data of a randomized controlled feasibility study by Philips, Wennberg, Konradsson, and Franck (2018), secondary analyses were conducted. It was tested, if patients' (N = 46) levels of autistic traits were associated with treatment outcome measured in the course of and after treatment using interviews and self-report measures. Participants' autistic traits were not associated with the change in the severity of BPD throughout and at the end of the treatment. However, results showed associations between autistic traits and the change in patients' consumption of alcohol in the course of MBT. Furthermore, there was an association between autistic traits and the change in mentalizing capacity at the end of MBT, indicating that elevated autistic traits were associated with an improvement in mentalizing capacity. Autistic traits on a subclinical level do not appear to be a complicating factor in MBT for concurrent BPD and SUD. On the contrary, in terms of mentalizing capacity autistic traits might be associated with a larger potential for improvement or facilitate treatment outcome. Further research is needed to explore the role of higher autistic traits in treatment of this special patient group.

Improving autism perinatal risk factors: A systematic review.

BACKGROUND: Current understanding of the etiology of autism is based on the interaction of multiple genes with each other and with environmental factors, leading to a neurodevelopmental process that results in the expression of autism spectrum disorder (ASD) in the child. This suggests that it might be possible to strengthen resilience to environmental stressors during the perinatal period to improve outcomes and possibly prevent the development of ASD. METHODS: We searched the MEDLINE database for multiple perinatal factors associated with the development of ASD published between January 1, 2005 and July 1, 2018. The search terms used were "autism" crossed with either "perinatal," "prenatal," "gestational," or "pregnancy," and crossed again with each perinatal risk factor highlighted in this review including topics on parental health, infections, medications, and environmental stressors. We then searched interventions that may improve neurodevelopmental outcome before and during pregnancy, including supplements, breastfeeding, and postpartum stress reduction. We identified recent or unique metanalyses and systematic reviews of the identified focus and on randomized controlled trials and summarized these using the most recent and comprehensive reviews. RESULTS: Folate, omega-3, vitamin D3, environmental toxin avoidance, correcting deficiencies, immune boosting, and prolonged breast feeding are all reported to be linked to the possible reduction of adverse pregnancy outcomes including ASD. CONCLUSIONS: Studies of individual components for improving pregnancy outcomes and several uncontrolled preconception to infancy medical practices suggest that multiple interventions might improve the outcomes of pregnancies where there is risk for developing ASD.

Developmental social vulnerability as the intrinsic origin of psychopathology: A paradigm shift from disease entities to psychiatric derivatives within human diversity.

How a social episode is perceived by a person and how the experience affects her/his subsequent behaviors will inevitably and sometimes accidentally vary in each case on the developmental trajectory from the birth of consciousness to death. Both the preceding developmental conditions and the social impact of the episode become a starting point for the following states of human complex conditions, creating the extraordinary diversity that characterizes our complex society. In this evolutionarily carved landscape, genetic factors including stochastic epistasis, environmental modification, and gene-environment interactions are all active. In these processes, interactions between developmental social vulnerability and environmental influences can lead to the emergence and persistence of some derivative states with social maladaptation. In our model, every psychiatric condition including aberrant paranoid-hallucinatory states is classified as a derivative state. The probability distribution curve for these derivative states has a non-linear relationship with the liability in the population, and there is none with probability 1.0 or zero. Individuals with trivial social vulnerability or high resilience may develop the derivative states in tremendously stressful circumstances, and individuals with huge social vulnerability may not necessarily develop the derivative states in the presence of adequate social supports. Social skillfulness/unskillfulness and behavioral flexibility/inflexibility form the core of the vulnerability-related dimensions. The clinical picture of a derivative manifestation is profiled depending on the individual trait levels in the derivative-related dimensions. Each derivative state has a requisite lineup of dimensions and each dimension can contribute to multiple psychiatric conditions. For example, aberrant paranoid-hallucinatory states and bipolar condition may share some developmental conditions as the derivative-related dimensions. Therefore, multiple derivative states can co-occur or be sequentially comorbid. Although the 'learned strategies' can ostensibly mask the clinical manifestation of developmental deviations, the change of the true dimensional position to the socially skillful direction is efficiently obtained through social experiences in a supportive environment. The liability-probability model makes it impossible to discriminate individuals with psychiatric diagnosis from individuals without the diagnosis and allows all of us to reside in the same human complex diversity.

Impacto da suplementação de ácidos graxos ômega-3 nos transtornos do espectro autista: revisão sistemática baseada em ensaios clínicos randomizados e controlados / Impact of omega-3 fatty acids supplementation on autism spectrum disorders: systematic review based on randomized controlled clinical trials

Os transtornos do espectro autista (TEAs) são disfunções do desenvolvimento neurológico associadas à alteração de diversos sintomas comportamentais, nos quais se destacam a redução de interações sociais e a execução de atividades repetitivas. Atualmente, o tratamento farmacológico é limitado e parece contribuir para o desenvolvimento de morbidades cardiovasculares. Associado a esse perfil, o restrito e seletivo padrão alimentar, promove o desenvolvimento de diversas deficiências nutricionais, entre as quais, os ácidos graxos essenciais como o ômega-3 (ω-3). Nesta revisão sistemática, baseada em estudos randomizados e controlados, foram selecionados estudos realizados nos últimos 10 anos. Os resultados mostram que a heterogeneidade das populações estudadas com grande variação na dose e tipo de ω-3 administrados em tempos distintos de seguimento dificultam a avaliação precisa da eficácia da intervenção baseada no uso de ω-3. Desta forma, o uso de ω-3 como terapia adjuvante no tratamento de TEA não deve ser recomendado rotineiramente na prática clínica, apesar de sua essencialidade para o adequado desenvolvimento neurológico

Autism spectrum disorders (ASDs) are neurodevelopmental dysfunctions associated with a number of altered behavioral symptoms, including reduced social interactions and the performance of repetitive activities. Pharmacological treatment is currently limited, and appears to contribute to the development of cardiovascular morbidity. Associated with this profile, a restricted and selective dietary pattern promotes the development of several nutritional deficiencies, including essential fatty acids, such as omega-3 (ω-3). In this systematic review, based on randomized controlled trials, studies performed in the last 10 years were selected. The results show that the heterogeneity of the populations studied, with wide variation in the dose and type of ω-3 administered at different times during follow-up, hinder more precise assessment of the effectiveness of the intervention based on the use of ω-3. Thus, the use of ω-3 as adjuvant therapy in the treatment of ASDs should not be routinely recommended in clinical practice, even though it is essential for proper neurological development

Experiências de professores com o autismo: impacto no diagnóstico precoce e na inclusão escolar / Teachers' experiences with autism: impact on early diagnosis and school inclusion

Objetivou-se compreender como a experiência com o autismo pode impactar na identificação de traços autísticos em alunos pelos professores da Educação Infantil, sob a perspectiva do diagnóstico precoce e da inclusão escolar. A abordagem metodológica foi de cunho qualitativo. Participaram do estudo dez professores de dez Centros Municipais de Educação Infantil de Foz do Iguaçu, Paraná, Brasil. Os dados foram coletados por meio de entrevistas semiestruturadas e analisados segundo análise de conteúdo, modalidade temática. Evidenciaram-se dois núcleos temáticos: "Conhecimentos, experiências e percepções sobre o Transtorno do Espectro do Autismo" e "O professor frente ao aluno com Transtorno do Espectro do Autismo e os investimentos para a detecção e inclusão". Concluiu-se que os professores são capazes de identificar sinais de autismo, contribuindo para o diagnóstico precoce e que experiências positivas cooperaram para a acurácia na detecção e para a inclusão escolar. Ações intersetoriais e interprofissionais necessitam ser ampliadas a fim de oportunizar o acolhimento e o cuidado integral.

The objective was to understand how the experience with autism can impact on early childhood teachers' identification of autistic traits in students from the perspective of early diagnosis and school inclusion. The methodological approach was qualitative. Ten teachers from ten Municipal Centers of Early Childhood Education located in Foz do Iguaçu, Paraná, Brazil participated in the study. Data were collected through semi-structured interviews and analyzed according to content analysis, thematic modality. Two thematic nuclei emerged: "Knowledge, experiences and perceptions about Autism Spectrum Disorder" and "The teacher before the student with Autism Spectrum Disorder and investments for detection and inclusion". The conclusion was that teachers could identify signs of autism and contribute to early diagnosis, and positive experiences cooperated for accuracy in detection and school inclusion. Intersectoral and interprofessional actions should be expanded in order to provide the opportunity for user embracement and comprehensive care.

Role of inter-trial phase coherence in atypical auditory evoked potentials to speech and nonspeech stimuli in children with autism.

OBJECTIVE: This autism study investigated how inter-trial phase coherence (ITPC) drives abnormalities in auditory evoked potential (AEP) responses for speech and nonspeech stimuli. METHODS: Auditory P1-N2 responses and ITPCs in the theta band (4-7 Hz) for pure tones and words were assessed with EEG data from 15 school-age children with autism and 16 age-matched typically developing (TD) controls. RESULTS: The autism group showed enhanced P1 and reduced N2 for both speech and nonspeech stimuli in comparison with the TD group. Group differences were also found with enhanced theta ITPC for P1 followed by ITPC reduction for N2 in the autism group. The ITPC values were significant predictors of P1 and N2 amplitudes in both groups. CONCLUSIONS: Abnormal trial-to-trial phase synchrony plays an important role in AEP atypicalities in children with autism. ITPC-driven enhancement as well as attenuation in different AEP components may coexist, depending on the stage of information processing. SIGNIFICANCE: It is necessary to examine the time course of auditory evoked potentials and the corresponding inter-trial coherence of neural oscillatory activities to better understand hyper- and hypo- sensitive responses in autism, which has important implications for sensory based treatment.

Illustrating a Supports-Based Approach Toward Friendship With Autistic Students.

Purpose: The present clinical focus article describes and illustrates 3 key elements of a supports-based approach to enhancing friendship with autistic students. Method: In comparison to the predominant skills-based approach, we highlight 3 key elements of a supports-based approach to social interaction for autistic children and youth. We then offer descriptive details of the activity-based music program as an illustrative example of a program that integrated all 3 elements of a supports-based approach. Specifically, we designed an activity-based music program to enhance social interaction among a 7-year-old autistic student and 4 of his nonautistic peers. Results: We focused on 3 key elements of a supports-based approach for enhancing peer interaction: (a) focusing on participation in a shared activity, (b) encouraging flexible use of multiple communicative resources, and (c) supporting egalitarian interaction. Conclusion: A supports-based approach presents a theoretically distinct and viable alternative to a skills-based approach in the design of social supports for autistic students and their peers.

Effects of l-Carnosine Supplementation on Sleep Disorders and Disease Severity in Autistic Children: A Randomized, Controlled Clinical Trial.

Sleep disorders are frequently reported in autistic patients. Evidences suggest that increased oxidative stress and reduced antioxidants may play a major role in the pathogenesis of these disorders. Carnosine acts as an antioxidant, antitoxic and neuroprotective agent. The aim of this trial study was to examine the effects of carnosine supplementation on the sleep disorders and severity of autism core symptoms in autistic patients. In this double-blind, randomized clinical trial, 43 autistic patients (31 boys and 12 girls; aged 4 to 16 years) were divided into two groups of carnosine and control that received 500 mg of carnosine and 500 mg of placebo per day for 2 months, respectively. Sleep disorders were measured using Children's Sleep Habits Questionnaires. Gilliam Autism Rating Scale 2 was used to assess the effects of carnosine supplementation on the autism severity. Carnosine supplementation did not change anthropometric indices (p > 0.05) and showed no effect on autism severity (p > 0.05), whereas it significantly reduced sleep duration (p = 0.04), parasomnias (p = 0.02) and total sleep disorders score by 7.59% (p = 0.006) when compared with the control group. The results suggest that carnosine supplementation could be effective in improving sleep disturbances, in particular sleep duration and parasomnias subscales.

NREM sleep EEG activity and procedural memory: A comparison between young neurotypical and autistic adults without sleep complaints.

Delta EEG activity (0.75-3.75 Hz) during non-Rapid eye movement (NREM) sleep reflects the thalamo-cortical system contribution to memory consolidation. The functional integrity of this system is thought to be compromised in the Autism spectrum disorder (ASD). This lead us to investigate the topography of NREM sleep Delta EEG activity in young adults with ASD and typically-developed individuals (TYP). The relationship between Delta EEG activity and sensory-motor procedural information was also examined using a rotary pursuit task. Two dependent variables were computed: a learning index (performance increase across trials) and a performance index (average performance for all trials). The ASD group showed less Delta EEG activity during NREM sleep over the parieto-occipital recording sites compared to the TYP group. Delta EEG activity dropped more abruptly from frontal to posterior regions in the ASD group. Both groups of participants learned the task at a similar rate but the ASD group performed less well in terms of contact time with the target. Delta EEG activity during NREM sleep, especially during stage 2, correlated positively with the learning index for electrodes located all over the cortex in the TYP group, but only in the frontal region in the ASD group. Delta EEG activity, especially during stage 2, correlated positively with the performance index, but in the ASD group only. These results reveal an atypical thalamo-cortical functioning over the parieto-occipital region in ASD. They also point toward an atypical relationship between the frontal area and the encoding of sensory-motor procedural memory in ASD. Autism Res 2018, 11: 613-623. © 2018 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Slow EEG waves recorded from the scalp during sleep are thought to facilitate learning and memory during daytime. We compared these EEG waves in young autistic adults to typically-developing young adults. We found less slow EEG waves in the ASD group and the pattern of relationship with memory differed between groups. This suggests atypicalities in the way sleep mechanisms are associated with learning and performance in a sensory-motor procedural memory task in ASD individuals.

Mismatch Negativity and P3a in Adolescents and Young Adults with Autism Spectrum Disorders: Behavioral Correlates and Clinical Implications.

In a sample of 37 adolescents and young adults with autism spectrum disorder (ASD) and 35 typically-developing controls (TDC), we investigated sensory symptoms by clinical measures, and Mismatch Negativity and P3a component at Fz with the frequency and duration oddball paradigms of event-related potentials. Results showed that compared to TDC, ASD participants reported more sensory symptoms, and presented a shorter P3a peak latency in the duration paradigm, which was correlated with more social awareness deficits. In the frequency paradigm, P3a parameters were correlated with sensation avoiding and attention characteristics of ASD. Our findings suggest that sensory abnormality in ASD may extend into adolescence and young adulthood. P3a latency might be a potential neurophysiological marker for ASD.

Prescription Trends of Psychotropics in Children and Adolescents with Autism Based on Nationwide Health Insurance Data.

Children with autism are often medicated to manage emotional and behavioral symptoms; yet, data on such pharmacotherapy is insufficient. In this study, we investigated the Korean National Health Insurance Claims Database (NHICD) information related to autism incidence and psychotropic medication use. From the 2010-2012 NHICD, we selected a total of 31,919,732 subjects under 19 years old. To examine the diagnostic incidence, we selected patients who had at least one medical claim containing an 10th revision of International Statistical Classification of Diseases and Related Health Problems (ICD-10) code for pervasive developmental disorder, F84, not diagnosed in the previous 360 days. Psychotropics were categorized into seven classes. Then, we analyzed the data to determine the mean annual diagnostic incidence and psychotropic prescription trends. Diagnostic incidence was 17,606 for the 3 years, with a mean annual incidence per 10,000 population of 5.52. Among them, 5,348 patients were prescribed psychotropics. Atypical antipsychotics were the most commonly used, followed by antidepressants. An older age, male sex, and the availability of medical aid were associated with a higher rate of prescription than observed for a younger age, female sex, and the availability of health insurance. Psychotropic drugs were used for less than one-third of patients newly diagnosed with autism, and prescription differed by sex and age. Increased diagnostic incidence is associated with an increased prescription of psychotropic drugs. Therefore, medication-related safety data and policies for psychotropic drugs in autism should be prepared.

Autism and Equine-Assisted Interventions: A Systematic Mapping Review.

This systematic mapping review mapped current knowledge of equine-assisted interventions for people with autism to help guide future practice and research. Thirty-three studies including children and adolescents with autism, 3 of which confirmed diagnoses, were reviewed. Five types of equine-assisted activities were identified across 25 studies, with reported improvements in behavior, social interaction, and communication. Four types of equine-assisted therapies were identified across 8 studies, with reported improvements in motor control and self-care. Different approaches to therapeutic riding and hippotherapy, the most studied interventions, were evident. While this literature reflected early scientific development, it offered broad proof of concept that equine-assisted interventions can benefit children and adolescents with autism. Promising outcomes support continued investigation focused on standardization, appropriateness, and efficacy.

How Children with Autism Reason about Other's Intentions: False-Belief and Counterfactual Inferences.

We examine false belief and counterfactual reasoning in children with autism with a new change-of-intentions task. Children listened to stories, for example, Anne is picking up toys and John hears her say she wants to find her ball. John goes away and the reason for Anne's action changes-Anne's mother tells her to tidy her bedroom. We asked, 'What will John believe is the reason that Anne is picking up toys?' which requires a false-belief inference, and 'If Anne's mother hadn't asked Anne to tidy her room, what would have been the reason she was picking up toys?' which requires a counterfactual inference. We tested children aged 6, 8 and 10 years. Children with autism made fewer correct inferences than typically developing children at 8 years, but by 10 years there was no difference. Children with autism made fewer correct false-belief than counterfactual inferences, just like typically developing children.

Evolución de la sintomatología autista de los 2 a los 4 años: un estudio de seguimiento / Evolution of autistic symptoms from two to four years: a follow-up study / Evolució de la simptomatologiaautistadels dos als quatre anys: un estudi de seguiment

La detección e intervención temprana en el trastorno del espectro autista (TEA) es de gran relevancia para su pronóstico y su evolución. El principal objetivo de este estudio es analizar y detectar qué síntomas destacan como más significativos y cuáles son los que se mantienen en el tiempo. Se ha realizado un estudio longitudinal de tres años con una muestra clínica de 15 niños, de 24 a 47 meses de edad. Los síntomas han sido evaluados mediante los instrumentos ATA y ADI-R. Los resultados indican que las dimensiones detectadas en la escala ATA manipulación del ambiente, lenguaje y comunicación, hiper e hipoactividad, son las que presentan mayor estabilidad temporal. Las dimensiones restantes presentan menor estabilidad

Early detection and intervention in autism spectrum disorder (ASD) is of great importance for prognosis and evolution. The article aims to highlight the importance of detection and early intervention. Specifically in children with autism spectrum disorders (ASD), difficulty in detection involves a delay in the onset of therapeutic intervention, and therefore affects their prognosis and devolution. The aim of the study to analyze and detect the symptoms that stand out as especially significant and determine which are maintained over time. We performed a three-year longitudinal study with a clinical sample of 15 children, aged from 24 to 47 months. ATA-scales and ADI-R were used to evaluate symptoms. The results indicate that of the dimensions measured on the ATA scale, the manipulation of the environment, difficulties in language and communication and hyper and hypoactivity are those that display the greatest degree of stability over time. The other symptoms show lesser stability

La detecció i interven­ció primerenca en el trastorn de l’espectre autista (TEA) és de gran rellevància pel seu pronòstic i evolució. El principal objectiu d’aquest estudi és analitzar i detectar quins símptomes destaquen com a més significatius i quins són els que es mantenen en el temps. S’ha realitzat un estudi longitudinal de tres anys amb una mostra clínica de 15 nens, de 24 a 47 mesos d’edat. Els símptomes han estat avaluats mitjançant els instruments ATA i ADI-R. Els resultats indiquen que les dimensions detectades a l’escala ATA manipulació de l’ambient, llenguatge i comunicació, hiper i hipoactivitat són les que presenten més estabilitat temporal. La resta de dimensions presenten menys estabilitat