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1.
PLoS One ; 16(3): e0249237, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33765076

RESUMEN

Advances in digital health have enabled clinicians to move away from a reliance on face to face consultation methods towards making use of modern video and web-based conferencing technology. In the context of the COVID-19 pandemic, remote telecommunication methods have become much more common place in mental health settings. The current study sought to investigate whether remote telecommunication methods are preferable to face to face consultations for adults referred to an Autism and ADHD Service during the COVID-19 pandemic. Also, whether there are any differences in preferred consultation methods between adults who were referred for an assessment of Autism as opposed to ADHD. 117 service users who undertook assessment by the ADHD and Autism Service at South West Yorkshire NHS Partnership Foundation Trust from April to September 2020 completed an adapted version of the Telehealth Usability Questionnaire (TUQ). Results demonstrated that service users found remote telecommunication to be useful, effective, reliable and satisfactory. Despite this, almost half of service users stated a general preference for face to face consultations. There was no difference in the choice of methods of contact between Autism and ADHD pathways. Remote telecommunication methods were found to be an acceptable medium of contact for adults who undertook an assessment of Autism and ADHD at an NHS Service during the COVID-19 pandemic.


Asunto(s)
Trastorno por Déficit de Atención con Hiperactividad/psicología , Trastorno Autístico/psicología , Satisfacción Personal , Telemedicina , Adolescente , Adulto , Anciano , Trastorno por Déficit de Atención con Hiperactividad/diagnóstico , Trastorno por Déficit de Atención con Hiperactividad/patología , Trastorno Autístico/diagnóstico , Trastorno Autístico/patología , /virología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Consulta Remota , Encuestas y Cuestionarios , Adulto Joven
2.
Mol Autism ; 12(1): 21, 2021 03 03.
Artículo en Inglés | MEDLINE | ID: mdl-33658046

RESUMEN

BACKGROUND: Previous studies have reported a negative psychological and mental health impact of the COVID-19 pandemic. This impact is likely to be stronger for people with autism as they are at heightened risk of mental health problems and because the pandemic directly affects social functioning and everyday routines. We therefore examined COVID-19 pandemic-related changes in mental health, the impact of the pandemic on their social life and routines, satisfaction with pandemic-related information and tips, and participants' wishes for guidance. METHODS: We used a mixed-method approach, collecting quantitative and qualitative survey data from adults with and without autism across three European countries: Belgium, the Netherlands, and the UK (N = 1044). RESULTS: We found an increase in depression and anxiety symptoms in response to the pandemic for both the non-autism and the autism group, which was greater for adults with autism. Furthermore, adults with autism showed a greater increase in worries about their pets, work, getting medication and food, and their own safety/security. They felt more relieved from social stress, yet experienced the loss of social contact as difficult. Adults with autism also felt more stressed about the loss of routines. Pleasant changes noted by adults with autism were the increase in solidarity and reduced sensory and social overload. Adults with autism frequently reported problems with cancellation of guidance due to the pandemic and expressed their wish for (more) autism-specific information and advice. LIMITATIONS: Our sample is likely to reflect some degree of selection bias, and longitudinal studies are needed to determine long-term effects. CONCLUSIONS: Results highlight the psychological burden of the pandemic on adults with autism and shed light on how to support them during this COVID-19 pandemic, which is especially important now that the pandemic is likely to have a prolonged course. There is a need for accessible, affordable (continued) support from health services. Guidance may focus on the maintenance of a social network, and adjusting routines to the rapid ongoing changes. Finally, we may learn from the COVID-19 pandemic-related changes experienced as pleasant by adults with autism to build a more autism-friendly society post-pandemic.


Asunto(s)
Ansiedad/epidemiología , Trastorno Autístico/psicología , Depresión/epidemiología , Estrés Psicológico/epidemiología , Adolescente , Adulto , Anciano , Bélgica/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Países Bajos/epidemiología , Encuestas y Cuestionarios , Reino Unido/epidemiología , Adulto Joven
3.
Int J Mol Sci ; 22(3)2021 Jan 25.
Artículo en Inglés | MEDLINE | ID: mdl-33503967

RESUMEN

BACKGROUND: Environmental Enrichment (EE) has been suggested as a possible therapeutic intervention for neurodevelopmental disorders such as autism. Although the benefits of this therapeutic method have been reported in some animal models and human studies, the unknown pathophysiology of autism as well as number of conflicting results, urge for further examination of the therapeutic potential of EE in autism. Therefore, the aim of this study was to examine the effects of environmental enrichment on autism-related behaviors which were induced in the maternal separation (MS) animal model. MATERIAL AND METHODS: Maternally separated (post-natal day (PND) 1-14, 3h/day) and control male rats were at weaning (PND21) age equally divided into rats housed in enriched environment and normal environment. At adolescence (PND42-50), the four groups were behaviorally tested for direct social interaction, sociability, repetitive behaviors, anxiety behavior, and locomotion. Following completion of the behavioral tests, the blood and brain tissue samples were harvested in order to assess plasma level of brain derived neurotrophic factor (BDNF) and structural plasticity of brain using ELISA and stereological methods respectively. RESULTS: We found that environmental enrichment reduced repetitive behaviors but failed to improve the impaired sociability and anxiety behaviors which were induced by maternal separation. Indeed, EE exacerbated anxiety and social behaviors deficits in association with increased plasma BDNF level, larger volume of the hippocampus and infra-limbic region and higher number of neurons in the infra-limbic area (p < 0.05). Conclusion: We conclude that environmental enrichment has a significant improvement effect on the repetitive behavior as one of the core autistic-like behaviors induced by maternal separation but has negative effect on the anxiety and social behaviors which might have been modulated by BDNF.


Asunto(s)
Trastorno Autístico/etiología , Trastorno Autístico/psicología , Privación Materna , Animales , Animales Recién Nacidos , Ansiedad , Trastorno Autístico/terapia , Conducta Animal , Biomarcadores , Encéfalo/metabolismo , Encéfalo/fisiopatología , Factor Neurotrófico Derivado del Encéfalo/sangre , Factor Neurotrófico Derivado del Encéfalo/metabolismo , Terapia Combinada , Manejo de la Enfermedad , Modelos Animales de Enfermedad , Masculino , Oxitocina/farmacología , Ratas , Conducta Social
4.
Interv. psicosoc. (Internet) ; 30(1): 57-66, ene. 2021. tab
Artículo en Inglés | IBECS | ID: ibc-197953

RESUMEN

There are no systematic reviews of the use of parent-child interaction measures employed within studies examining the effects of parent-mediated intervention on toddlers with autism. Best practices recommend using parent-child interaction measures to assess whether interventions aimed at strengthening parent-child interactions are functioning as intended. A systematic review of parent-mediated early intervention studies of toddlers with autism was conducted. The purpose was to examine the use of parent-child interaction measures to assess parent positive support of toddler social communication and report feasibility characteristics for early interventionist practitioners. Experimental parent-mediated intervention studies of social communication among children with autism younger than 36 months were identified. Measurement approaches to parent support of social communication were quantified. Of 25 studies, only 7 studies reported parent and child outcomes using an instrument designed to measure the construct of parent support of child social communication during observed parent-child interaction. Measures reported are of limited relevance for early intervention practitioners due to administration burden and lack of feasibility for repeated measurement of progress toward increasing parent support of toddler social communication. This study highlights the need for feasible practitioner tools for monitoring progress of parent support of social communication for toddlers with autism


No hay revisiones sistemáticas acerca de las medidas de interacción padres-hijo que se utilizan en los estudios que analizan los efectos de la intervención en niños autistas mediada por los padres. Las mejores prácticas recomiendan controlar la medición de las intervenciones mediadas por los padres, las cuales han sido diseñadas para mejorar las habilidades de comunicación social de los niños con el fin de saber si dichas intervenciones funcionan según lo previsto. El propósito de este artículo es presentar los resultados de una revisión sistemática de la literatura que examina específicamente la medición de la interacción entre padres e hijos en estudios de intervención mediada por padres de niños pequeños con autismo. Se utilizó un enfoque PRISMA para identificar estudios experimentales de intervención mediada por padres, enfocados en la comunicación social de niños pequeños con autismo. Las formas utilizadas para medir el apoyo de los padres de la comunicación social en cada uno de estos estudios fueron cuantificadas. De 25 estudios solo 7 incluyeron una medida de observación directa de la interacción entre padres e hijos en la que se presentaron los índices de comportamiento de padres e hijos. Los métodos de evaluación utilizados para medir la interacción entre padres e hijos en los estudios experimentales publicados tienden a buscar profesionales altamente capacitados y especializados, que además requiere bastante tiempo para codificar. En consecuencia, estas herramientas de medición tienen una utilidad limitada para los profesionales que precisan de herramientas breves y confiables que además tengan una base psicométrica para medir la interacción entre padres e hijos para tomar decisiones basadas en datos sobre si sus intervenciones están teniendo los efectos previstos. El estudio destaca la necesidad de contar con instrumentos de medición con base psicométrica que permitan seguir de manera accesible el progreso del apoyo sobre comunicación social para padres de niños pequeños con autismo


Asunto(s)
Humanos , Masculino , Femenino , Niño , Adulto , Trastorno Autístico/epidemiología , Trastorno Autístico/psicología , Habilidades Sociales , Discapacidades del Desarrollo/psicología , Psicometría , Comunicación Social , Conducta Infantil/psicología
5.
PLoS One ; 15(12): e0243298, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33320901

RESUMEN

The network approach to psychological phenomena advances our understanding of the interrelations between autism and well-being. We use the Perceived Causal Relations methodology in order to (i) identify perceived causal pathways in the well-being system, (ii) validate networks based on self-report data, and (iii) quantify and integrate clinical expertise in autism research. Trained clinicians served as raters (N = 29) completing 374 cause-effects ratings of 34 variables on well-being and symptomatology. A subgroup (N = 16) of raters chose intervention targets in the resulting network which we found to match the respective centrality of nodes. Clinicians' perception of causal relations was similar to the interrelatedness found in self-reported client data (N = 323). We present a useful tool for translating clinical expertise into quantitative information enabling future research to integrate this in scientific studies.


Asunto(s)
Trastorno Autístico/psicología , Felicidad , Adolescente , Adulto , Anciano , Trastorno Autístico/terapia , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Autoinforme
6.
Medicine (Baltimore) ; 99(36): e21651, 2020 Sep 04.
Artículo en Inglés | MEDLINE | ID: mdl-32898998

RESUMEN

BACKGROUND/OBJECTIVE: Teaching has been found to be 1 of the most stressful occupations worldwide. Stress associated with teaching is more critical among teachers teaching children with special needs in general and those with autism specifically, partly due to the heterogeneous nature of the disorders. The purpose of this study was to investigate the effectiveness of Rational Emotive Occupational Health Coaching (REOHC) in minimizing job stress in teachers of children with autism (CWA). METHODS: A group-randomized waitlist control-trial design was adopted. A sample of 87 teachers of CWA who participated in the study was randomized into the immediate intervention group (IIG) and waitlist group (WLG). Participants were evaluated on 3 occasions: pretest, post-test and follow-up. Three instruments (Occupational Stress Index, Perceived Occupational Stress Scale and Stress Symptom Scale) were used to measure dimensions of job stress. After the pretest exercise, the IIG participated in a 2-hour REOHC programme weekly for a period of 12 weeks. Post- and follow-up evaluations were conducted respectively at 2 weeks and 3 months after the REOHC programme. Those in WLG were exposed to the REOHC after the follow-up assessment. Data collected were analysed using t-test statistics, repeated measures analysis of variance and bar charts. RESULTS: Results revealed that the perceived stress and stress symptoms of the REOHC group reduced significantly over WLG at post-test, and follow-up assessments. Changes in the occupational stress index scores across pre-, post- and follow-up measurements were minimal and could not account for a significant difference between the IIG and WLG. CONCLUSION: It was concluded that REOHC is effective in reducing subjective feelings and physiological symptoms of job stress, even when the objective stressors remain constant among teachers of CWA and other employees who work in stressful occupational environments.


Asunto(s)
Terapia Conductista/métodos , Estrés Laboral/prevención & control , Maestros/psicología , Adulto , Trastorno Autístico/psicología , Niño , Preescolar , Niños con Discapacidad/educación , Femenino , Humanos , Masculino , Encuestas y Cuestionarios
7.
Nat Protoc ; 15(10): 3464-3477, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-32895524

RESUMEN

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by social communication deficits and other behavioral abnormalities. The three-chamber social preference test is often used to assess social deficits in mouse models of ASD. However, varying and often contradicting phenotypic descriptions of ASD mouse models can be found in the scientific literature, and the substantial variability in the methods used by researchers to assess social deficits in mice could be a contributing factor. Here we describe a standardized three-chamber social preference protocol, which is sensitive and reliable at detecting social preference deficits in several mouse models of ASD. This protocol comprises three phases that can all be completed within 1 d. The test mouse is first habituated to the apparatus containing two empty cups in the side chambers, followed by the pre-test phase in which the mouse can interact with two identical inanimate objects placed in the cups. During the test phase, the mouse is allowed to interact with a social stimulus (an unfamiliar wild-type (WT) mouse) contained in one cup and a novel non-social stimulus contained in the other cup. The protocol is thus designed to assess preference between social and non-social stimuli under conditions of equal salience. The broad implementation of the three-chamber social preference protocol presented here should improve the accuracy and consistency of assessments for social preference deficits associated with ASD and other psychiatric disorders.


Asunto(s)
Análisis Aplicado de la Conducta/métodos , Trastorno Autístico/psicología , Modelos Animales de Enfermedad , Animales , Trastorno del Espectro Autista/fisiopatología , Trastorno del Espectro Autista/psicología , Trastorno Autístico/fisiopatología , Conducta Animal/fisiología , Ratones , Proteínas de Microfilamentos/metabolismo , Proteínas del Tejido Nervioso/metabolismo , Conducta Social , Trastorno de la Conducta Social/fisiopatología
8.
Nat Commun ; 11(1): 3959, 2020 08 07.
Artículo en Inglés | MEDLINE | ID: mdl-32770077

RESUMEN

It is unclear whether transgender and gender-diverse individuals have elevated rates of autism diagnosis or traits related to autism compared to cisgender individuals in large non-clinic-based cohorts. To investigate this, we use five independently recruited cross-sectional datasets consisting of 641,860 individuals who completed information on gender, neurodevelopmental and psychiatric diagnoses including autism, and measures of traits related to autism (self-report measures of autistic traits, empathy, systemizing, and sensory sensitivity). Compared to cisgender individuals, transgender and gender-diverse individuals have, on average, higher rates of autism, other neurodevelopmental and psychiatric diagnoses. For both autistic and non-autistic individuals, transgender and gender-diverse individuals score, on average, higher on self-report measures of autistic traits, systemizing, and sensory sensitivity, and, on average, lower on self-report measures of empathy. The results may have clinical implications for improving access to mental health care and tailoring adequate support for transgender and gender-diverse individuals.


Asunto(s)
Trastorno Autístico/diagnóstico , Trastorno Autístico/psicología , Personas Transgénero/psicología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Intervalos de Confianza , Femenino , Humanos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Autoinforme , Adulto Joven
9.
Nature ; 584(7820): 252-256, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32760004

RESUMEN

A fundamental challenge in developing treatments for autism spectrum disorders is the heterogeneity of the condition. More than one hundred genetic mutations confer high risk for autism, with each individual mutation accounting for only a small fraction of cases1-3. Subsets of risk genes can be grouped into functionally related pathways, most prominently those involving synaptic proteins, translational regulation, and chromatin modifications. To attempt to minimize this genetic complexity, recent therapeutic strategies have focused on the neuropeptides oxytocin and vasopressin4-6, which regulate aspects of social behaviour in mammals7. However, it is unclear whether genetic risk factors predispose individuals to autism as a result of modifications to oxytocinergic signalling. Here we report that an autism-associated mutation in the synaptic adhesion molecule Nlgn3 results in impaired oxytocin signalling in dopaminergic neurons and in altered behavioural responses to social novelty tests in mice. Notably, loss of Nlgn3 is accompanied by a disruption of translation homeostasis in the ventral tegmental area. Treatment of Nlgn3-knockout mice with a new, highly specific, brain-penetrant inhibitor of MAP kinase-interacting kinases resets the translation of mRNA and restores oxytocin signalling and social novelty responses. Thus, this work identifies a convergence between the genetic autism risk factor Nlgn3, regulation of translation, and oxytocinergic signalling. Focusing on such common core plasticity elements might provide a pragmatic approach to overcoming the heterogeneity of autism. Ultimately, this would enable mechanism-based stratification of patient populations to increase the success of therapeutic interventions.


Asunto(s)
Trastorno Autístico/metabolismo , Trastorno Autístico/psicología , Modelos Animales de Enfermedad , Oxitocina/metabolismo , Conducta Social , Animales , Moléculas de Adhesión Celular Neuronal/deficiencia , Moléculas de Adhesión Celular Neuronal/genética , Factor 4E Eucariótico de Iniciación/metabolismo , Masculino , Proteínas de la Membrana/deficiencia , Proteínas de la Membrana/genética , Ratones , Ratones Endogámicos C57BL , Ratones Noqueados , Proteínas Quinasas Activadas por Mitógenos/metabolismo , Proteínas del Tejido Nervioso/deficiencia , Proteínas del Tejido Nervioso/genética , Neuronas/efectos de los fármacos , Neuronas/metabolismo , Fosforilación/efectos de los fármacos , Biosíntesis de Proteínas/efectos de los fármacos , ARN Mensajero/genética , ARN Mensajero/metabolismo , Transducción de Señal/efectos de los fármacos , Área Tegmental Ventral/citología , Área Tegmental Ventral/efectos de los fármacos
10.
Mol Autism ; 11(1): 61, 2020 07 22.
Artículo en Inglés | MEDLINE | ID: mdl-32698850

RESUMEN

The new coronavirus disease (COVID-19) pandemic is changing how society operates. Environmental changes, disrupted routines, and reduced access to services and social networks will have a unique impact on autistic individuals and their families and will contribute to significant deterioration in some. Access to support is crucial to address vulnerability factors, guide adjustments in home environments, and apply mitigation strategies to improve coping. The current crisis highlights that our regular care systems are not sufficient to meet the needs of the autism communities. In many parts of the world, people have shifted to online school and increased use of remote delivery of healthcare and autism supports. Access to these services needs to be increased to mitigate the negative impact of COVID-19 and future epidemics/pandemics. The rapid expansion in the use of telehealth platforms can have a positive impact on both care and research. It can help to address key priorities for the autism communities including long waitlists for assessment and care, access to services in remote locations, and restricted hours of service. However, system-level changes are urgently needed to ensure equitable access and flexible care models, especially for families and individuals who are socioeconomically disadvantaged. COVID-19 mandates the use of technology to support a broader range of care options and better meet the diverse needs of autistic people and their families. It behooves us to use this crisis as an opportunity to foster resilience not only for a given individual or their family, but also the system: to drive enduring and autism-friendly changes in healthcare, social systems, and the broader socio-ecological contexts.


Asunto(s)
Adaptación Psicológica , Trastorno Autístico/psicología , Infecciones por Coronavirus/terapia , Neumonía Viral/terapia , Resiliencia Psicológica , Poblaciones Vulnerables/psicología , Accesibilidad a los Servicios de Salud , Humanos , Redes Sociales en Línea , Pandemias , Factores Socioeconómicos , Telemedicina/estadística & datos numéricos
11.
Pediatr. aten. prim ; 22(86): e81-e104, abr.-jun. 2020. tab
Artículo en Español | IBECS | ID: ibc-198540

RESUMEN

Los trastornos del neurodesarrollo, como el autismo, aunque presentes principalmente en la infancia, son una afección de por vida. Uno de los principales retos en el campo de los trastornos del neurodesarrollo es que estas entidades se hagan visibles. Y un terreno esencial para trabajar por su visualización son los medios de comunicación, siendo el cine un recurso esencial. El proyecto Cine y Pediatría apuesta por el objetivo de mejorar la humanización de nuestra práctica clínica a través de la prescripción de películas. Y en este artículo proponemos 22 películas sobre trastornos del neurodesarrollo en la infancia y adolescencia para vivir las emociones y reflexiones que nos devuelven sus protagonistas y familias. Estas son las películas prescritas que abordan el trastorno del espectro autista: Mater amatísima, Rain Man, Paraíso oceánico, Un viaje inesperado, Mozart y la ballena, Ben-X, El niño de Marte, Mary and Max, María y yo, Mi nombre es Khan, Tan fuerte, tan cerca, La sonrisa verdadera, Especiales. Y estas son las películas prescritas que versan sobre otros trastornos del neurodesarrollo: El milagro de Anna Sullivan, Forrest Gump, Estrellas en la Tierra, El primero de la clase, Gabrielle, Cromosoma 5, La historia de Marie Heurtin, Línea de meta, Dora y la revolución sexual. La observación narrativa de estas películas argumentales nos permitirá acercarnos a este apasionante mundo, pero sobre todo a las extraordinarias personas y familias que hay detrás del frío nombre de cada entidad médica. Y aunque hemos "prescrito" 22 historias "de cine", seguro que en los trastornos del neurodesarrollo quedan muchos guiones por escribir


Neurodevelopmental disorders such as autism spectrum disorder, although most commonly present in childhood, can be lifelong conditions. One of the main challenges in the field of neurodevelopmental disorders is that these entities become visible. For that purpose, media is playing a relevant role in order to achieve such a challenge, and cinema is one of the essentials. Cine y Pediatría project aims to improve the humanization of our clinical practice through the prescription of films. In this article we propose 22 films whose protagonists are children or adolescents with neurodevelopment disorders, essential to experience the emotions and reflections that their heroes and families give us back. These are the prescribed movies regarding autism spectrum disorder: Mater amatísima, Rain Man, Ocean Heaven, Miracle Run, Mozart and the Whale, Ben-X, Martian Child, Mary and Max, María y yo, My name is Khan, Extremely Loud and Incredibly Closer, La sonrisa verdadera and Hors normes. And these are the prescribed movies regarding other neurodevelopmental disorders: The Miracle Worker, Forrest Gump, Taare Zameen Par, Front of the class, Gabrielle, Cromosoma 5, Marie Heurtin, Línea de meta and Dora or The Sexual Neuroses of Our Parents. The narrative observation of these main plot films will allow us to approach this exciting world, but above all the extraordinary people and families behind the cold name of each medical entity. And although we have "prescribed" 22 "cinema" stories, surely in neurodevelopmental disorders there are many scripts to write


Asunto(s)
Humanos , Trastornos del Neurodesarrollo/psicología , Educación en Salud/métodos , Películas Cinematográficas/clasificación , Trastorno Autístico/psicología , Discapacidades del Desarrollo/psicología , Discapacidad Intelectual/psicología
13.
Medicina (Kaunas) ; 56(5)2020 May 13.
Artículo en Inglés | MEDLINE | ID: mdl-32413984

RESUMEN

In a special issue that focuses on complex presentations related to Autism, we ask the question in this editorial whether an Autism Spectrum Condition without complexity is a disorder, or whether it represents human diversity? Much research into Autism Spectrum Conditions (ASCs) over the years has focused on comparisons between neuro-typical people and people with Autism Spectrum Conditions. These comparisons have tended to draw attention to 'deficits' in cognitive abilities and descriptions of behaviours that are characterised as unwanted. Not surprisingly, this is reflected in the classification systems from the World Health Organisation and the American Psychiatric Association. Public opinion about ASC may be influenced by presentations in the media of those with ASC who also have intellectual disability. Given that diagnostic systems are intended to help us better understand conditions in order to seek improved outcomes, we propose a more constructive approach to descriptions that uses more positive language, and balances descriptions of deficits with research finding of strengths and differences. We propose that this will be more helpful to individuals on the Autism Spectrum, both in terms of individual self-view, but also in terms of how society views Autism Spectrum Conditions more positively. Commentary has also been made on guidance that has been adjusted for people with ASC in relation to the current COVID-19 pandemic.


Asunto(s)
Trastorno Autístico , Opinión Pública , Trastorno del Espectro Autista , Trastorno Autístico/complicaciones , Trastorno Autístico/diagnóstico , Trastorno Autístico/psicología , Betacoronavirus , Infecciones por Coronavirus , Personas con Discapacidad , Humanos , Medios de Comunicación de Masas , Pandemias , Neumonía Viral , Autoimagen
14.
Pediatrics ; 145(6)2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-32471843

RESUMEN

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.


Asunto(s)
Actividades Cotidianas/psicología , Trastorno Autístico/epidemiología , Trastorno Autístico/psicología , Síndrome de Down/epidemiología , Síndrome de Down/psicología , Adolescente , Trastorno Autístico/diagnóstico , Catatonia/diagnóstico , Catatonia/epidemiología , Catatonia/psicología , Niño , Discapacidades del Desarrollo/diagnóstico , Discapacidades del Desarrollo/epidemiología , Discapacidades del Desarrollo/psicología , Síndrome de Down/diagnóstico , Femenino , Humanos , Masculino , Trastornos del Humor/diagnóstico , Trastornos del Humor/epidemiología , Trastornos del Humor/psicología , Trastornos Psicóticos/diagnóstico , Trastornos Psicóticos/epidemiología , Trastornos Psicóticos/psicología , Literatura de Revisión como Asunto
16.
Encephale ; 46(3S): S99-S106, 2020 Jun.
Artículo en Francés | MEDLINE | ID: mdl-32405083

RESUMEN

COVID-19 is a multi-organ disease due to an infection with the SARS-CoV2 virus. It has become a pandemic in early 2020. The disease appears less devastating in children and adolescents. However, stress, quarantine and eventually mourning have major impacts on development. It is difficult to describe what this pandemic implies for a child psychiatrist, other than by giving a first-hand account. I propose to go through the main ethical questions that have arisen; to describe how my hospital team has reorganized itself to meet the new demands and questions, in particular by opening a unit dedicated to people with autism and challenging behaviors affected by COVID-19; and to address, in a context of national discussion, how the discipline has sought to understand the conditions of a certain well-being during quarantine. Finally, I will try to conclude with more speculative reflections on re-opening.


Asunto(s)
Psiquiatría del Adolescente , Actitud del Personal de Salud , Trastorno Autístico/terapia , Betacoronavirus , Psiquiatría Infantil , Infecciones por Coronavirus , Pandemias , Neumonía Viral , Psiquiatría , Adolescente , Conducta del Adolescente , Psiquiatría del Adolescente/ética , Trastorno Autístico/complicaciones , Trastorno Autístico/psicología , Niño , Conducta Infantil , Psiquiatría Infantil/ética , Control de Enfermedades Transmisibles/métodos , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Infecciones por Coronavirus/psicología , Infecciones por Coronavirus/transmisión , Infección Hospitalaria/complicaciones , Infección Hospitalaria/psicología , Infección Hospitalaria/terapia , Exposición a Riesgos Ambientales , Francia , Accesibilidad a los Servicios de Salud , Reestructuración Hospitalaria , Unidades Hospitalarias/organización & administración , Humanos , Control de Infecciones/métodos , Servicios de Salud Mental/ética , Servicios de Salud Mental/organización & administración , Trastornos del Olfato/etiología , Trastornos del Olfato/psicología , Pandemias/prevención & control , Aceptación de la Atención de Salud , Grupo de Atención al Paciente , Aislamiento de Pacientes/psicología , Ludoterapia , Neumonía Viral/complicaciones , Neumonía Viral/prevención & control , Neumonía Viral/psicología , Neumonía Viral/transmisión , Práctica Profesional/ética , Equipos de Seguridad , Factores de Riesgo , Estrés Psicológico/etiología
17.
Psychiatry Res ; 288: 112937, 2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-32315876

RESUMEN

Most children with autism have ADHD, and children with ADHD-Combined and children with autism have high rates of irritable, oppositional, and aggressive behavior. Despite similar symptoms, prescribing practices may differ between autism and ADHD, which has not been examined in a single study. 1407 children with autism and 1036 with ADHD without autism, 2-17 years, were compared with 186 typical peers. Symptom scores were maternal Pediatric Behavior Scale ratings in eight areas (ADHD, oppositional/aggressive, irritable/angry, anxious, depressed, and social, writing, and learning problems). Psychotropics were prescribed to 38.0% with ADHD-Combined, 33.3% with autism, and 20.2% with ADHD-Inattentive, most often an ADHD medication (22.1% stimulant, 2.3% atomoxetine), antipsychotic (7.8%), SSRI (5.5%), and alpha agonist (4.9%). ADHD medications were more often prescribed than other medications in all diagnostic groups. Compared to autism, children with ADHD-Combined were more likely to be prescribed an ADHD medication, whereas antipsychotics and SSRIs were more likely to be prescribed in autism than in ADHD-Combined. Children with ADHD-Inattentive were least impaired and least likely to be medicated. More severely impaired children were more often medicated regardless of diagnosis. Symptom scores were far worse for treated and untreated children with ADHD and with autism than for typical peers.


Asunto(s)
Trastorno por Déficit de Atención con Hiperactividad/diagnóstico , Trastorno por Déficit de Atención con Hiperactividad/tratamiento farmacológico , Trastorno Autístico/diagnóstico , Trastorno Autístico/tratamiento farmacológico , Psicotrópicos/uso terapéutico , Adolescente , Antipsicóticos/uso terapéutico , Clorhidrato de Atomoxetina/uso terapéutico , Trastorno por Déficit de Atención con Hiperactividad/psicología , Trastorno Autístico/psicología , Estimulantes del Sistema Nervioso Central/uso terapéutico , Niño , Preescolar , Femenino , Humanos , Masculino
18.
BMC Psychiatry ; 20(1): 127, 2020 03 17.
Artículo en Inglés | MEDLINE | ID: mdl-32183793

RESUMEN

BACKGROUND: Many persons with autism spectrum disorder (ASD) are treated in long-term specialised care. In this population, suicidal behaviour troubles patients, families, and specialists in the field because it is difficult to treat. At present, there is no documented effective therapy for suicidal behaviour in ASD (Autism Research 7:507-521, 2014; Crisis 35:301-309, 2014). Dialectical Behaviour Therapy (DBT) is an efficacious treatment programme for chronically suicidal and/or self-harm behaviour in patients with Borderline Personality Disorder (J Psychiatry 166:1365-1374, 2014; Linehan MM. Cognitive behavioural therapy of borderline personality disorder. 1993). This study will evaluate the efficacy of DBT in persons with ASD and suicidal/ self- destructive behaviour in a multicentre randomised controlled clinical trial. METHOD: One hundred twenty-eight persons with autism and suicidal and/or self-harming behaviour will be recruited from specialised mental healthcare services and randomised into two conditions: 1) the DBT condition in which the participants have weekly individual cognitive behavioural therapy sessions and a 2.5 h skills training group session twice per week during 6 months, and 2) the treatment as usual condition which consists of weekly individual therapy sessions of 30-45 min with a psychotherapist or social worker. Assessments will take place at baseline, at post-treatment (6 months), and after a follow-up period of 12 months. The mediators will also be assessed at 3 months. The primary outcome is the level of suicidal ideation and behaviour. The secondary outcomes are anxiety and social performance, depression, core symptoms of ASD, quality of life, and cost-utility. Emotion regulation and therapeutic alliance are hypothesised to mediate the effects on the primary outcome. DISCUSSION: The results from this study will provide an evaluation of the efficacy of DBT treatment in persons with ASD on suicidal and self-harming behaviour. The study is conducted in routine mental health services which enhances the generalisability of the study results to clinical practice. TRIAL REGISTRATION: ISRCTN96632579. Registered 1 May 2019. Retrospectively registered.


Asunto(s)
Trastorno del Espectro Autista , Trastorno Autístico , Trastorno de Personalidad Limítrofe , Terapia Conductual Dialéctica , Conducta Autodestructiva , Suicidio , Trastorno del Espectro Autista/psicología , Trastorno del Espectro Autista/terapia , Trastorno Autístico/psicología , Trastorno Autístico/terapia , Terapia Conductista , Femenino , Humanos , Masculino , Calidad de Vida , Conducta Autodestructiva/terapia , Método Simple Ciego , Suicidio/prevención & control , Resultado del Tratamiento
19.
PLoS Comput Biol ; 16(3): e1007700, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-32176684

RESUMEN

Autism is still diagnosed on the basis of subjective assessments of elusive notions such as interpersonal contact and social reciprocity. We propose to decompose reciprocal social interactions in their basic computational constituents. Specifically, we test the assumption that autistic individuals disregard information regarding the stakes of social interactions when adapting to others. We compared 24 adult autistic participants to 24 neurotypical (NT) participants engaging in a repeated dyadic competitive game against artificial agents with calibrated reciprocal adaptation capabilities. Critically, participants were framed to believe either that they were competing against somebody else or that they were playing a gambling game. Only the NT participants did alter their adaptation strategy when they held information regarding others' competitive incentives, in which case they outperformed the AS group. Computational analyses of trial-by-trial choice sequences show that the behavioural repertoire of autistic people exhibits subnormal flexibility and mentalizing sophistication, especially when information regarding opponents' incentives was available. These two computational phenotypes yield 79% diagnosis classification accuracy and explain 62% of the severity of social symptoms in autistic participants. Such computational decomposition of the autistic social phenotype may prove relevant for drawing novel diagnostic boundaries and guiding individualized clinical interventions in autism.


Asunto(s)
Adaptación Psicológica/fisiología , Trastorno Autístico/fisiopatología , Trastorno Autístico/psicología , Conducta Social , Adulto , Biología Computacional , Simulación por Computador , Femenino , Humanos , Relaciones Interpersonales , Masculino , Recompensa , Análisis y Desempeño de Tareas , Adulto Joven
20.
Medicina (B Aires) ; 80 Suppl 2: 17-20, 2020.
Artículo en Español | MEDLINE | ID: mdl-32150707

RESUMEN

We start from the evidence that confirms a greater vulnerability to anxiety in people with autism and to wonder to what extent the intolerance to the uncertainty mediates in that anxiety. In addition, the alterations of the predictive abilities in autism could explain the coherence between greater intolerance to uncertainty and some peculiarities inherent in autism such as patterns of restrictive and stereotyped behaviors, interests and activities, and particularities in the processing of sensory information. This information will allow us to develop interventions specifically focused on this construct for the prevention and improvement of anxiety symptoms in autism in cases that the severity of intolerance to uncertainty constitutes a significant risk factor.


Asunto(s)
Trastornos de Ansiedad/psicología , Trastorno Autístico/psicología , Incertidumbre , Trastornos de Ansiedad/terapia , Trastorno Autístico/terapia , Humanos , Factores de Riesgo , Trastornos de la Sensación/psicología , Conducta Estereotipada
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