[Sleep in neurodevelopmental disorders]. / Sueño en los trastornos del neurodesarrollo.

INTRODUCTION: Sleep disorders can affect daytime functioning in a variety of neurodevelopmental disabilities as autism, attention deficit hyperactivity disorder and Asperger syndrome. DEVELOPMENT: Researchers using behavioural and/or electrophysiological measures have identified differences in sleep architecture among people with autism, attention deficit hyperactivity disorder and other developmental disorders. Children with neurodevelopmental disabilities have significant sleep problems, most commonly disorders of initiating and maintaining sleep. Studies of sleep disturbance in children with academic and behavioural problems have underscored the role that primary sleep disorders play in the clinical presentation of symptoms of inattention and behavioural dysregulation. CONCLUSIONS: Identification and treatment of sleep disorders in children with neurodevelopmental disabilities may improve daytime behaviour in this patients. When establishing a treatment plan, it is imperative to understand the underlying etiology of the sleep problem, which in many cases is multifactorial.

[Auditory processing in specific language disorder]. / Procesamiento auditivo en el trastorno especifico del lenguaje.

INTRODUCTION: Specific language impairment (SLI) is diagnosed when a child has difficulty in producing or understanding spoken language for no apparent reason. The diagnosis in made when language development is out of keeping with other aspects of development, and possible explanatory causes have been excluded. DEVELOPMENT: During the last years neurosciences have approached to the study of SLI. The ability to process two or more rapidly presented, successive, auditory stimuli is believed to underlie successful language acquisition. It has been proposed that SLI is the consequence of low-level abnormalities in auditory perception. Too, children with SLI show a specific deficit in automatic discrimination of syllables. Electrophysiological methods may reveal underlying immaturity or other abnormality of auditory processing even when behavioural thresholds look normal. CONCLUSIONS: There is much controversy about the role of such deficits in causing their language problems, and it has been difficult to establish solid, replicable findings in this area because of the heterogeneity in the population and because insufficient attention has been paid to maturational aspects of auditory processing.

[Cognitive processing in autism spectrum disorders]. / Procesamiento cognitivo en los trastornos del espectro autista.

INTRODUCTION: Autism involves a basic impairment in social cognition. Abnormalities in social behavior coexist with aberrant attention and deficient language. In the attentional domain, attention to people and socially relevant stimuli is impaired. Also children with autism spectrum disorders (ASD) are characterized by impairments in face recognition and decreased attention to faces. AIM: To review neurofunctional deficits underlying ASD by using event related potentials. CONCLUSIONS: Event related potentials demonstrate that auditory orienting deficits in autism cannot be explained by sensory deficits and that the orienting deficit in autism might be speech-sound specific, suggesting deficits particularly in social orienting. In addition, children with ASD have a disordered pattern of brain responses to faces and objects at an early age.

[Good practice guidelines for the treatment of autistic spectrum disorders]. / Guia de buena practica para el tratamiento de los trastornos del espectro autista.

INTRODUCTION: Due to the inexistence of an aetiology-based intervention for autistic spectrum disorders (ASD) families and professionals are exposed to diverse and sometimes conflictive recommendations when they have to decide the most adequate alternative for treatment. AIM: To elaborate treatment guidelines agreed by consensus at the ASD Study Group of the (National) Institute of Health Carlos III. DEVELOPMENT: Information about treatment of ASD was searched and gathered through available evidence based medical (EBM) databases. The data generated was complemented with practice parameters published elsewhere, reports from prestigious international institutions, focus oriented searches in PubMed and, finally, the opinion and experience of a multidisciplinary Study Group with extensive experience in treating ASD in Spain. Most popular treatment methods were reviewed as well as the common elements to be considered in successful support programs. CONCLUSION: No simple treatment algorithm can be produced at this time, and the level of available evidence based recommendations are in the weaker degrees of EBM classifications. Nevertheless, there is widespread agreement to stress that education, with special incidence in the development of communication and social competence, with the addition of community support are the main means of treatment. They can be complemented, depending on individual needs, with medication, behavioural approaches and cognitive-behavioural therapy for associated psychological problems in persons with higher cognitive level. Support to families and community empowerment are essential elements for the quality of life of persons with ASD.

[Best practice guidelines for the diagnosis of autistic spectrum disorders]. / Guía de buena práctica para el diagnóstico de los trastornos del espectro autista.

INTRODUCTION: The autism spectrum disorder (ASD) diagnostic process requires expertise both in the knowledge of autism as in teamwork strategies with different professionals, often working in different clinic services, and with parents. AIM: To recommend a consensus diagnostic procedure for ASD, that has been designed by the Study Group of the Instituto de Salud Carlos III. DEVELOPMENT: The reports emphasize the need to obtain a complete clinical history, covering personal, family and psychosocial antecedents; detailing the basic areas affected in ASD--social interaction, communication and restricted patterns of behaviour, activities and interests. Diagnostic tests to be used as a routine in all cases are described and analysed--including both psychoeducational and biomedical tests. Also, tests indicated in cases with suspected identifiable physical disorders are covered, as well as those medical tests to be used for research purposes only. CONCLUSION: The diagnostic procedure requires the implementation of a coordinated interdisciplinary assessment strategy, that needs to ensure the participation of professionals from very different fields in active collaboration with the family. Their role culminates in the preparation and delivery of a personalized report. Every diagnostic procedure needs to be accompanied by an action plan that includes immediate support to the person with ASD, as well as information to the family on resources and community initiatives in their living area.

[Best practice guidelines for research in autistic spectrum disorders]. / Guía de buena práctica para la investigación de los trastornos del espectro autista.

INTRODUCTION: Achieving a better knowledge of autism and other pervasive developmental disorders known as autistic spectrum disorders (ASD), poses a major scientific challenge. These disorders are some of the earliest and most severe psychopathological disorders in infancy; they include an heterogeneous group of conditions; its prevalence rate seems to be continually increasing and they generate a significant social impact. AIMS AND DEVELOPMENT: Nowadays, there is a current international agreement on the general requirements to be fulfilled by research projects and the priority areas to be considered when developing ASD high quality research. In Spain, although there are some established research groups with broad experience and expertise in these disorders, public funding opportunities and research development are still scarce. For this reason, the Study Group of the Instituto de Salud Carlos III has generated by consensus some Good Practice Guidelines for Research in ASD. CONCLUSIONS: After comparing priorities and recommendations from international reference documents with the results obtained after having carried out an exhaustive bibliographic revision of articles published in autism in the last 30 years by Spanish authors, methodological and ethical recommendations are established. Finally, structural deficiencies to be corrected and emerging research initiatives to be supported are identified.