Role of Glutamate Receptor-related Biomarkers in the Etiopathogenesis of ADHD.

Objective: : Pathways associated with glutamate receptors are known to play a role in the pathophysiology of attention-deficit hyperactivity disorder (ADHD). However, cyclin-dependent kinase 5 (CDK5), microtubule-associated protein-2 (MAP2), guanylate kinase-associated protein (GKAP), and postsynaptic density 95 (PSD95), all of which are biomarkers involved in neurodevelopmental processes closely related to glutamatergic pathways, have not previously been studied in patients with ADHD. The main purpose of this study was to evaluate the plasma levels of CDK5, MAP2, GKAP, and PSD95 in children with ADHD and investigate whether these markers have a role in the etiology of ADHD. Methods: : Ninety-six children with ADHD between 6 and 15 years of age and 72 healthy controls were included in the study. Five milliliters of blood samples were taken from all participants. The samples were stored at -80°C until analyzed by the enzyme-linked immunosorbent assay method. Results: : Statistically significantly lower CDK5 levels were observed in children with ADHD than in healthy controls (p = 0.037). The MAP2, GKAP, and PSD95 levels were found to be statistically significantly higher in the ADHD group than in healthy controls (p = 0.012, p = 0.009, and p = 0.024, respectively). According to binary regression analysis, CDK5 and MAP2 levels were found to be predictors of ADHD. Conclusion: : In conclusion, we found that a close relationship existed between ADHD and glutamatergic pathways, and low levels of CDK5 and high levels of MAP2 and GKAP played a role in the etiopathogenesis of ADHD.

S100B and Neuron-Specific Enolase Levels as Brain Injury Biomarkers in Internet Addiction: Effect of Sleep.

BACKGROUND: Comorbidity of Internet addiction (IA) with sleep disruptions is common in adolescents. There is evidence that the levels of brain injury markers could be affected by sleep disruptions. In this study, we aimed to evaluate the relationship between sleep quality and these biomarkers within the framework of the relationship between IA and sleep disruptions. METHODS: A total of 65 drug-free adolescents with newly diagnosed IA, aged 12 to 18 years, were included in the study, and they were divided into two groups considering the comorbidities of attention-deficit/hyperactivity disorder (ADHD) and social anxiety. The control group consisted of 30 healthy children. The participants were asked to complete the Young Internet Addiction Scale, Pittsburgh Sleep Quality Index (PSQI), Morningness Eveningness Questionnaire, Beck's Depression Inventory, Beck's Anxiety Inventory, and Barratt Impulsiveness Scale-11. Blood samples were taken between 8 and 9 am to analyze S100 calcium-binding protein B (S100B) and neuron-specific enolase (NSE) levels with enzyme-linked immunosorbent assay. RESULTS: Plasma S100B and NSE levels were found to be statistically significantly higher in the IA with ADHD and the IA with anxiety groups than in healthy controls. NSE and S100B levels were found to be correlated with PSQI scores in both the IA groups. Also, there was a positive correlation between these biomarkers and IA severity. CONCLUSIONS: Decreased sleep quality and daily sleep duration in IA might cause brain injury, resulting in an increase in the severity of the addiction. Prospective studies with large samples are needed to better explain the IA-sleep-brain injury relationship.

functional outcome in late adolescence/early adulthood of patients with autism spectrum disorder and its relationships with parental burnout and depression: A preliminary multi-center, cross-sectional study.

The aim of this study is to determine the functioning of adults with autism spectrum disorders (ASDs) diagnosed in childhood and depression and burnout levels among their parents. A total of 261 adults with ASDs and their parents were recruited for the study. Both parents completed the Beck Depression and Maslach Burnout Inventories and reported the functioning of their adult offspring with ASDs. Only 5.4 % of our sample reported "good" or "very good" outcomes. The most common psychiatric comorbidities were intellectual disabilities and attention-deficit/hyperactivity disorder. Maternal burnout and depression scores were significantly elevated compared to those of fathers. There is an undeniable urgent need for more research to identify the needs of adults and families suffering from ASD. Modifications for those with ASD may have to be made for support in workplaces, achieving driving licenses, using public transportation and attendance at tertiary education.

Nerve growth factor and angiotensin converting enzyme 2 levels in children with neurodevelopmental disorders.

OBJECTIVE: Neurodevelopmental disorders (NDDs) are the most common psychiatric disorders in childhood, and there are many factors in their etiology. In recent years, many biomarkers have been studied to elucidate the etiology of these disorders. In this study, it was aimed to investigate the levels of nerve growth factor (NGF) and angiotensin converting enzyme 2 (ACE2) in attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and intellectual disability (ID). METHODS: The study included 74 children with NDDs (the number of patients in ADHD, ASD and ID groups were 24, 25 and 25 respectively) and 30 healthy controls (HCs). Serum NGF and ACE2 levels were studied with ELISA kits, also complete blood count (CBC), levels of fasting glucose and serum lipids were assessed. RESULTS: ACE2 levels were found to be lower in NDD group than HCs in girls. In boys with ASD, triglyceride levels were significantly higher than other groups. Also a positive correlation was found between ACE2 and NGF levels when all sample assessed together. CONCLUSIONS: This study is a premise for investigating ACE2 and NGF in NDDs. The role of these markers in ADHD, ASD, ID and other NDDs and their associations with gender should be assessed by studies in which both larger sample groups and more disorders.

The Role of BDNF and NPY Levels, Effects of Behavioral Systems and Emotion Regulation on Internet Addiction in Adolescents.

Internet addiction (IA), one of the behavioral addictions, is also related to impulsivity. Although studies on its etiology and risks continue, the number of studies is limited. In this study, we aimed to assess the roles of behavioral systems, emotional regulation (ER), and impulsivity in the development of IA in adolescents and also to assess the relationship between all these clinical parameters and brain-derived neurotrophic factor (BDNF) and neuropeptide Y (NPY). Forty-two adolescents with IA and 30 healthy controls (ages 12 -17) were included in the study. Self-reported measures included the Internet Addiction Scale. (IAS), Behavioral Activation and Behavioral Inhibition Scale (BAS/BIS), Barratt. Impulsiveness Scale-11 (BIS-11), and Difficulties in Emotion Regulation Scale-16 (DERS-16) were used for the assessment of the participants. The levels of plasma brain BDNF and NPY were evaluated with the ELISA method. BAS/BIS subscale scores, BIS-11, and DERS-16 scale total scores were found to be statistically significantly higher, while BDNF and NPY levels were found to be lower in adolescents with IA compared to the healthy controls. IA severity was not found to correlate with both BDNF and NPY. IA was found to be more related to BIS than to BAS. There is a need for further studies evaluating developmental features and possible diagnostic biomarkers that may be associated with IA in adolescents.

Using electrooculography with visual stimulus tracking test in diagnosing of ADHD: findings from machine learning algorithms.

BACKGROUND: Attention deficit hyperactivity disorder (ADHD), one of the most common neurodevelopmental disorders in childhood, is diagnosed clinically by assessing the symptoms of inattention, hyperactivity, and impulsivity. Also, there are limited objective assessment tools to support the diagnosis. Thus, in this study, a new electrooculography (EOG) based on visual stimulus tracking to support the diagnosis of ADHD was proposed. METHODS: Reference stimulus one-to-one tracking numbers (RSOT) and colour game detection (CGD) were applied to 53 medication-free children with ADHD and 36 healthy controls (HCs). Also, the test was applied six months after the treatment to children with ADHD. Parameters obtained during the visual stimulus tracking test were analyzed and Higuchi fractal dimension (HFD) and Hjorth parameters were calculated for all EOG records. RESULTS: The average test success rate was higher in HCs than in children with ADHD. Based on machine learning algorithms, the proposed system can distinguish drug-free ADHD patients from HCs with an 89.13% classification performance and also distinguish drug-free children from treated children with an 80.47% classification performance. DISCUSSION: The findings showed that the proposed system could be helpful to support the diagnosis of ADHD and the follow-up of the treatment.

A Different View on the Etiopathogenesis of Attention-deficit Hyperactivity Disorder from an Inflammation Perspective.

OBJECTIVE: Attention-deficit hyperactivity disorder (ADHD) has a complex etiology and genetic, environmental and biological factors are considered to play a role in the etiology of ADHD by mutually interacting. Recent studies have emphasized that inflammation may be present in the etiology of ADHD. This study aims to investigate the possible role of visfatin, IL-6, IL-1b and TNF-α molecules in the etiology of ADHD. METHODS: The study included 60 patients and 20 healthy controls between the ages of 6-18. Serum visfatin, IL-6, IL-1b and TNF-α levels were evaluated with enzyme-linked immunosorbent assay (ELISA) kits at a biochemistry laboratory. RESULTS: The study showed no statistically significant difference between children with ADHD and healthy controls in terms of visfatin, IL-6, IL-1b and TNF-α levels. When ADHD subgroups (combined and predominantly inattentive types) and the control group were compared in terms of visfatin, IL-6, IL-1b and TNF-α levels, no statistically significant difference was recorded. CONCLUSION: Data on the relationship between ADHD and IL-6, IL-1b and TNF-α in this study are in compliance with the literature. However, no study was found on visfatin in ADHD. This study is the first one evaluating the ADHD-Visfatin relationship.

Ghrelin and leptin levels in children with anxiety disorders.

Background Anxiety disorders are common psychiatric disorders in childhood and an important health problem that is associated with the risk of serious mental, educational and economical problems. Researchers have mentioned many different mechanisms in the etiopathology of anxiety disorders. This study aimed to investigate ghrelin and leptin levels in children with anxiety disorders and thus to contribute to the clarification of anxiety in children. Methods Forty-three children aged 6-12 years with a diagnosis of the Anxiety Disorder according to DSM 5 and 21 healthy children age- and gender-matched to the study group were included. All the subjects were assessed with Kiddie Schedule for Affective Disorders and Schizophrenia Present and Lifetime Version (K-SADS-PL) and State-Trait Anxiety Inventory for Children (STAI-C) scale. Blood samples were obtained in the morning and serum ghrelin and leptin levels were measured with enzyme-linked immunosorbent assay (ELISA) kits. Results In the anxiety group the ghrelin levels were higher than the control group (p = 0.037) but there was no significant difference between the leptin levels (p = 0.430). Also, when the girls in the anxiety group and the girls in the control group were compared, ghrelin levels were higher in the anxiety group (p < 0.01). Conclusions These findings suggest that ghrelin may play a significant role in the etiologic mechanisms of anxiety disorders. However, more detailed studies are needed to explain the linkage between anxiety disorders and neuropeptides.

Levels of Salivary Sialic Acid in Children with Autism Spectrum Disorder; Could It Be Related to Stereotypes and Hyperactivity?

OBJECTIVE: Sialic acid (Sia) is an essential nutrient for brain development, learning, memory and cognition and plays a role in neurodevelopment of infants. The aim of this study was to determine whether Sia levels are significantly associated with the autism spectrum disorder (ASD). METHODS: Forty-six ASD children and 30 typically developing children aged 3 to 10 years were included in the study. Behavioral symptoms in ASD children was assessed by the Autism Behavior Checklist (AuBC), the Childhood Autism Rating Scale, and the Aberrant Behavior Checklist (ABC). After the collection of saliva samples, the supernatant was separated. All the samples kept at -80°C until Sia analysis was done. RESULTS: Sia level was found to be significantly lower in the ASD group when compared to healthy controls ( p = 0.013). There was no correlation between severity of ASD and salivary Sia levels. We found a negative correlation between AuBC scores and Sia levels and a negative correlation in both ABC Stereotypic Behavior and Hyperactivity/Noncompliance subscales with Sia levels in ASD group. CONCLUSION: The obtained data indicate that Sia levels could have an effect on autism-like behaviors, particularly on stereotypes and hyperactivity.

Effects of Methylphenidate on Reaction Time in Children with Attention Deficit / Hyperactivity Disorder.

INTRODUCTION: Attention-deficit/hyperactivity disorder (ADHD) is associated with a broad range of neuropsychological impairments that are attenuated with methylphenidate (MPH) treatment. The aim of this study was to determine how MPH effects attentional functioning in terms of reaction time (RT) in ADHD. METHODS: Eighteen pre-medicated ADHD children (7 to 12 years old) and eighteen gender matched normal controls (7 to 12 years old) were included in the study. Participants performed an auditory attention task and the RT of participants to each target response was calculated automatically. The same test was repeated 3 months after OROS-MPH administration for ADHD group. RT, RT standard deviation (RTSD), and response errors (omission and commission errors) were compared between control and pre-MPH ADHD groups, and between Pre-MPH and post-MPH ADHD groups. RESULTS: Relative to control subjects, significantly longer RTs, higher RTSD and more errors of omission were observed in unmedicated ADHD children during auditory attention task. Analyses revealed significant effects of medication across all measures except commission errors. After treatment RTs were faster, RTSD values were lower, and errors of omission were attenuated compared to pre-medication condition in ADHD group. There were no significant differences in terms of commission errors between groups. CONCLUSION: In this study it was observed that MPH reduced RTs to stimuli, attenuated omission errors during the task in ADHD group and after 3 months of treatment ADHD children showed similar patterns in RT as compared to controls. Results suggest that when treating ADHD, it might help clinicians to evaluate objective and non-invasive cognitive outcomes such as RT, RTSD and response errors to evaluate the effects of treatment.

Evaluation of Two Types of Drug Treatment with QEEG in Children with ADHD.

AIMS: The aim of this study is to evalute the effects of methylphenidate and atomoxetine treatments on electroencephalography (EEG) signals in volunteer children diagnosed with Attention Deficit and Hyperactivity Disorder(ADHD). METHODS: The study contained 40 children all of whom were between the ages of 7 and 17. The participants were classified into two groups as ADHD (n=20), which was in itself divided into two groups as ADHD-MPH (ADHD- Metylphenidate treatment) (n=10) and as ADHD-ATX (ADHD-Atomoxetin treatment) (n=10), and one control group (n=20). Following the first EEG recordings of the ADHD group, long-acting methylphenidate dose was applied to one ADHD group and atomoxetine dose was applied to the other ADHD group. The effect of optimal dosage is about for 4-6 weeks in general. Therefore, the response or lack of response to the treatment was evaluated three months after the beginning of the treatment.After methylphenidate and atomoxetine drug treatment, in order to obtain mean and maximum power values for delta, theta, alpha and beta band, the EEG data were analyzed. RESULTS: The EEG power spectrum densities in all the bands yielded similar findings in both methylphenidate and atomoxetine. Although statistically significant frequency values of the electrodes were amplitude and maximally varied, in general, they appeared mostly at both frontal and temporal regions for methylphenidate and atomoxetine. CONCLUSION: Especially, after atomoxetine treatment, Quantitative Electroencephalography (QEEG) rates at frontal area electrodes were found statistically more significant than methylphenidate QEEG rates. What has been researched in this study is not only whether QEEG is likely to support the diagnosis, but whether changes on QEEG by treatment may be related to the severity of ADHD as well.

Prevalence of Childhood Affective disorders in Turkey: An epidemiological study.

AIM: To determine the prevalence of affective disorders in Turkey among a representative sample of Turkish population. METHODS: This study was conducted as a part of the "The Epidemiology of Childhood Psychopathology in Turkey" (EPICPAT-T) Study, which was designed by the Turkish Association of Child and Adolescent Mental Health. The inclusion criterion was being a student between the second and fourth grades in the schools assigned as study centers. The assessment tools used were the K-SADS-PL, and a sociodemographic form that was designed by the authors. Impairment was assessed via a 3 point-Likert type scale independently rated by a parent and a teacher. RESULTS: A total of 5842 participants were included in the analyses. The prevalence of affective disorders was 2.5 % without considering impairment and 1.6 % when impairment was taken into account. In our sample, the diagnosis of bipolar disorder was lacking, thus depressive disorders constituted all the cases. Among depressive disorders with impairment, major depressive disorder (MDD) (prevalence of 1.06%) was the most common, followed by dysthymia (prevalence of 0.2%), adjustment disorder with depressive features (prevalence of 0.17%), and depressive disorder-NOS (prevalence of 0.14%). There were no statistically significant gender differences for depression. Maternal psychopathology and paternal physical illness were predictors of affective disorders with pervasive impairment. CONCLUSION: MDD was the most common depressive disorder among Turkish children in this nationwide epidemiological study. This highlights the severe nature of depression and the importance of early interventions. Populations with maternal psychopathology and paternal physical illness may be the most appropriate targets for interventions to prevent and treat depression in children and adolescents.

Investigation of attention deficit hyperactivity disorder (ADHD) sub-types in children via EEG frequency domain analysis.

AIM OF THE STUDY: To investigate the frequency domain effects and changes in electroencephalography (EEG) signals in children diagnosed with attention deficit hyperactivity disorder (ADHD). PATIENTS AND METHODS: The study contains 40 children. All children were between the ages of 7 and 12 years. Participants were classified into four groups which were ADHD (n=20), ADHD-I (ADHD-Inattentive type) (n=10), ADHD-C (ADHD-Combined type) (n=10), and control (n=20) groups. In this study, the frequency domain of EEG signals for ADHD, subtypes and control groups were analyzed and compared using Matlab software. The mean age of the ADHD children's group was 8.7 years and the control group 9.1 years. RESULTS: Spectral analysis of mean power (µV2) and relative-mean power (%) was carried out for four different frequency bands: delta (0--4 Hz), theta (4--8 Hz), alpha (8--13 Hz) and beta (13--32 Hz). The ADHD and subtypes of ADHD-I, and ADHD-C groups had higher average power value of delta and theta band than that of control group. However, this is not the case for alpha and beta bands. Increases in delta/beta ratio and statistical significance were found only between ADHD-I and control group, and in delta/beta, theta/delta ratio statistical significance values were found to exist between ADHD-C and control group. CONCLUSION: EEG analyzes can be used as an alternative method when ADHD subgroups are identified.

The Relationship Between Parental Affective Temperament Traits and Disruptive Behavior Disorders Symptoms in Children With ADHD.

OBJECTIVE: This study investigated the relationship between parental affective temperaments and the oppositional defiant disorder (ODD) and conduct disorder (CD) symptoms of children with ADHD. METHOD: The sample consisted of 542 treatment-naive children with ADHD and their biological parents. Children were assessed via both parent- and teacher-rated behavioral disorder scales. Parental affective temperament and ADHD symptoms were measured by self-report inventories. The relationships between psychiatric variables were evaluated using structural equation modeling. RESULTS: According to parent-rated behavioral disorder scales, paternal cyclothymic and maternal irritable temperaments were associated with ODD scores, and maternal depressive temperament was associated with CD scores. In terms of teacher-rated behavioral disorder scales, maternal anxious temperament was associated with ODD scores, and paternal cyclothymic and maternal depressive temperaments were associated with CD scores. CONCLUSION: These results suggest that certain parental affective temperaments are related to an increase in symptoms of disruptive behavioral disorders in children with ADHD.

Default mode network activity and neuropsychological profile in male children and adolescents with attention deficit hyperactivity disorder and conduct disorder.

It is known that patients with Attention Deficit and Hyperactivity disorder (ADHD) and Conduct disorder (CD) commonly shows greater symptom severity than those with ADHD alone and worse outcomes. This study researches whether Default mode network (DMN) is altered in adolescents with ADHD + CD, relative to ADHD alone and controls or not. Ten medication-naïve boys with ADHD + CD, ten medication-naïve boys with ADHD and 10-age-matched typically developing (TD) controls underwent functional magnetic resonance imaging (fMRI) scans in the resting state and neuropsychological tasks such as the Wisconsin Card Sorting Test (WCST), Stroop Test TBAG Form (STP), Auditory Verbal learning Test (AVLT), Visual Auditory Digit Span B (VADS B) were applied to all the subjects included. fMRI scans can be used only nine patients in each groups. The findings revealed group differences between cingulate cortex and primary mortor cortex; cingulate cortex and somatosensory association cortex; angular gyrus (AG) and dorsal posterior cingulate cortex, in these networks increased activity was observed in participants with ADHD + CD compared with the ADHD. We found that lower resting state (rs)-activity was observed between left AG and dorsal posterior cingulate cortex, whereas higher rs-activity connectivity were detected between right AG and somatosensory association cortex in ADHD relative to the ones with ADHD + CD. In neuropsyhcological tasks, ADHD + CD group showed poor performance in WISC-R, WCST, Stroop, AVLT tasks compared to TDs. The ADHD + CD group displayed rs-functional abnormalities in DMN. Our results suggest that abnormalities in the intrinsic activity of resting state networks may contribute to the etiology of CD and poor prognosis of ADHD + CD.

Association of Reactive-Proactive Aggression and Anxiety Sensitivity with Internalizing and Externalizing Symptoms in Children with Attention-Deficit/Hyperactivity Disorder.

This study evaluates the associations among the symptoms of anxiety, depression, and disruptive behavioral disorders (DBD) in the context of their relationships with reactive-proactive aggression and anxiety sensitivity in children with attention-deficit/hyperactivity disorder (ADHD). The sample consisted of 342 treatment-naive children with ADHD. The severity of ADHD and DBD symptoms were assessed via parent- and teacher-rated inventories. Anxiety sensitivity, reactive-proactive aggression and severity of anxiety and depression symptoms of children were evaluated by self-report inventories. According to structural equation modeling, depression and anxiety scores had a relation with the DBD scores through reactive-proactive aggression. Results also showed a negative relation of the total scores of anxiety sensitivity on DBD scores, while conduct disorder scores had a positive relation with anxiety scores. This study suggests that examining the relations of reactive-proactive aggression and anxiety sensitivity with internalizing and externalizing disorders could be useful for understanding the link among these disorders in ADHD.

The relationship between aggression, empathy skills and serum oxytocin levels in male children and adolescents with attention deficit and hyperactivity disorder.

Although attention deficit and hyperactivity disorder (ADHD) are recognized as neurodevelopmental disorders characterized by impairment in executive functions, impairments in social functioning are often accompanied by ADHD. Oxytocin (OT) has been investigated in a number of psychiatric disorders owing to its effects on social interactions. The aim of this study was to determine the relationship between aggression, empathy and OT levels in children with ADHD. Forty male patients with ADHD, ranging in age from 7 to 18 years, and 40 healthy age-matched and sex-matched individuals were included in this study. The patients and healthy controls filled in the Buss-Perry Aggression Questionnaire and Bryant's Empathy Index for Children and Adolescents; the Reading the Mind in the Eyes test was then completed. Blood samples were collected for OT at the beginning of the study. Lower serum OT levels were observed in patients with ADHD compared with the healthy controls. Moreover, there was a negative correlation between serum OT level and aggression scores and a positive correlation between the serum OT level and empathy scores in patients with ADHD. We conclude that OT may play a role in aggression and empathy skills, affecting the social life of those with ADHD.

Relationship between Impulsivity and Serum Oxytocin in Male Children and Adolescents with Attention-Deficit and Hyperactivity Disorder: A Preliminary Study.

INTRODUCTION: Here we aimed to determine the relationship between oxytocin levels and impulsivity, which is an important aspect at Attention Deficit Hyperactivity Disorder (ADHD) clinics. METHODS: The study population comprised 40 ADHD patients diagnosed based on the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version, without other psychiatric disorders and chronic diseases aged between 8 and 15 years. The control group comprised 40 healthy, age-matched, male children and adolescents who voluntarily participated in the study. Patients and controls filled the Barratt impulsivity scale-11 (BIS-11). Ten cubic centimeters of blood was collected at 8 am for determining serum oxytocin levels. ELISA kits were used to measure serum oxytocin levels in a biochemistry laboratory. The obtained data were evaluated using appropriate statistical methods. RESULTS: In this study, compared with the control group, the impulsivity scores were significantly higher and serum oxytocin levels were lower in the ADHD group (52.5±18.1 and 37.62±9.0, respectively, p<0.001). Serum oxytocin levels showed a negative correlation with impulsivity and attention subscale scores of BIS-11 in the ADHD group. CONCLUSION: ADHD and impulsivity, which comprise an aspect of ADHD, may be associated with oxytocin. Serum oxytocin levels may contribute to inattention subtypes of impulsivity observed in ADHD.

Increased Serum Phthalates (MEHP, DEHP) and Bisphenol A Concentrations in Children With Autism Spectrum Disorder: The Role of Endocrine Disruptors in Autism Etiopathogenesis.

The aim of this study was to investigate the relationship between autism spectrum disorders development and exposure to mono-(2-ethylhexyl)-phthalate (MEHP), di-(2-ethylhexyl)-phthalate (DEHP), and bisphenol A (BPA), 1 of the endocrine disruptors, among phthalates. The study included 48 children with autism spectrum disorder (27 boys, 21 girls) and 41 healthy subjects (24 boys, 17 girls) as controls. Serum MEHP, DEHP, and BPA levels were measured by using high-performance liquid chromatography. Children with autism spectrum disorder had significantly increased serum MEHP, DEHP, and BPA concentrations (0.47 ± 0.14 µg/ml, 2.70 ± 0.90 µg/ml, 1.25 ± 0.30 ng/ml) compared to healthy control subjects (0.29 ± 0.05 µg/ml, 1.62 ± 0.56 µg/ml, 0.88 ± 0.18 ng/ml) respectively (P = .000). The fact that higher serum MEHP, DEHP, and BPA were found levels in the autism spectrum disorder group compared to healthy controls suggests that endocrine disruptors may have a role in the pathogenesis of autism spectrum disorders.

Different etiologies of acquired torticollis in childhood.

INTRODUCTION: Torticollis can be congenital or may be acquired in childhood. Acquired torticollis occurs because of another problem and usually presents in previously normal children. The causes of acquired torticollis include ligamentous, muscular, osseous, ocular, psychiatric, and neurologic disorders. OBJECTIVE: We performed this study to evaluate the underlying causes of torticollis in childhood. MATERIAL AND METHODS: Ten children presented with complaints of torticollis between April 2007 and April 2012 were enrolled in this study. The additional findings of physical examination included neck pain, twisted neck, walking disorder, imbalance, and vomiting The identified etiologies of the enrolled children was acute disseminated encephalomyelitis in a 2.5-year-old boy, posterior fossa tumor in a 10-month-old boy, spontaneous spinal epidural hematoma in a 5-year-old hemophiliac boy, cervical osteoblastoma in a 3-year-old boy, arachnoid cyst located at posterior fossa in a 16-month-old boy, aneurysm of the anterior communicating artery in a 6-year-old girl, pontine glioma in a 10-year-old girl, and a psychogenic torticollis in a 7-year-old boy were presented. CONCLUSION: There is a wide differential diagnosis for a patient with torticollis, not just neurological in etiology which should be considered in any patient with acquired torticollis. Moreover, early diagnosis of etiological disease will reduce mortality and morbidity. Therefore, clinicians managing children with torticollis must be vigilant about underlying neurological complications.