Bumetanide, a Diuretic That Can Help Children with Autism Spectrum Disorder.

BACKGROUND: Autism Spectrum Disorder (ASD) is a common child neurodevelopmental disorder, whose pathogenesis is not completely understood. Until now, there is no proven treatment for the core symptoms of ASD. However, some evidence indicates a crucial link between this disorder and GABAergic signals which are altered in ASD. Bumetanide is a diuretic that reduces chloride, shifts gamma-amino-butyric acid (GABA) from excitation to inhibition, and may play a significant role in the treatment of ASD. OBJECTIVE: The objective of this study is to assess the safety and efficacy of bumetanide as a treatment for ASD. METHODS: Eighty children, aged 3-12 years, with ASD diagnosed by Childhood Autism Rating Scale (CARS), ⩾ 30 were included in this double-blind, randomized, and controlled study. Group 1 received Bumetanide, Group 2 received a placebo for 6 months. Follow-up by CARS rating scale was performed before and after 1, 3, and 6 months of treatment. RESULTS: The use of bumetanide in group 1 improved the core symptoms of ASD in a shorter time with minimal and tolerable adverse effects. There was a statistically significant decrease in CARS and most of its fifteen items in group 1 versus group 2 after 6 months of treatment (p-value <0.001). CONCLUSION: Bumetanide has an important role in the treatment of core symptoms of ASD.

Different autism measures targeting different severity levels in children with autism spectrum disorder.

The Childhood Autism Rating Scale™, Second Edition (CARS™-2) and Social Responsiveness Scale™, Second Edition (SRS™-2) are two measures for identifying autism symptoms. The CARS™-2 has two versions: Standard (CARS-ST) and High-Functioning (CARS-HF). To better understand their properties, this study aimed to investigate: (1) the associations among the CARS-ST, CARS-HF and the SRS™-2, and (2) the severity consistency between the CARS-ST and the CARS-HF. A sample of 125 children with autism spectrum disorder was recruited (mean age: 80.98 months, SD = 16.08). Based on Verbal Comprehension Index (VCI), children were divided into two groups: low severity level of autism spectrum disorder (LSL-ASD: VCI ≥ 80) and high severity level of autism spectrum disorder (HSL-ASD: VCI < 80). All children were evaluated with the CARS-ST and the SRS™-2, and the HF group, with the CARS-HF as well. In the LSL group, the CARS-ST and the CARS-HF had high correlation (r = 0.852, p < .001). Both versions had small to moderate correlations with the SRS™-2 (r = 0.130-0.491). In the HSL group, no significant correlations were found between the CARS-ST and SRS™-2 (p > .05). The CARS-HF and the CARS-ST had low severity consistency (Kappa = 0.376, p < .01). The CARS-ST and the CARS-HF had high correlations but low severity consistency. Different correlation patterns were found between the CARS™-2 and the SRS™-2 in the LSL and HSL groups. The results should help clinicians better understand the properties of the measures and choose appropriate measures when assessing autism symptoms.

Therapeutic Impacts of Hyperbaric Oxygen Therapy and Risperidone on Children with Autism: A Clinical Trial.

Introduction: In this research, we investigated any possible effect of receiving hyperbaric oxygen therapy (HBOT) or risperidone on the core symptoms of autism in children diagnosed with autism spectrum disorder (ASD). Methods: This study was a randomized, controlled clinical trial in Minia and Assiut University hospitals in Egypt with three parallel groups. One hundred and eighty children with autism, aged 5-8 years were divided into three equal groups (n=60). Group 1 (G1) received 40 sessions of HBOT within two months, group 2 (G2) received risperidone (dose: 0.25 mg per day in children weighing less than 20 kg and 0.5 mg per day in cases weighing more) for six months, and group 3 (G3) as the control group, received a placebo for six months. The assessment was done using childhood autism rating scale (CARS) and autism treatment evaluation checklist (ATEC) at the beginning of the study (baseline) and after one year. Results: The mean total CARS and ATEC scores significantly decreased (improved) by varying degrees in the three groups after a year of follow-up compared to the baseline scores, but the best results were found in G1, G2, and G3, respectively. Conclusion: Using HBOT or risperidone is effective in treating the core symptoms of autism in children diagnosed with autism spectrum disorder, but using HBOT gives better results than risperidone therapy. Highlights: Non-pharmacologic therapy can be used for the treatment of the core symptoms of autism.Both hyperbaric oxygen therapy and risperidone reduce the core symptoms of autism.Hyperbaric oxygen therapy gives better effects than risperidone in reducing the core symptoms of autism. Plain Language Summary: Since the long-term use of drug therapy in children with autism leads to the occurrence of side effects in addition to the difficulty in complying with the drugs for long-term use, efforts have begun to use non-traditional alternative treatments, such as hyperbaric oxygen therapy. The current study assessed the therapeutic effect of hyperbaric oxygen therapy and risperidone on the core symptoms of autism. The results revealed that both hyperbaric oxygen therapy and risperidone reduced the core symptoms of autism, but hyperbaric oxygen therapy gave better therapeutic results than risperidone.

Influence of Auditory Integrative Training on Casein Kinase 2 and Its Impact on Behavioral and Social Interaction in Children with Autism Spectrum Disorder.

Considerable disturbances in post-translational protein phosphorylation have recently been discovered in multiple neurological disorders. Casein kinase-2 (CK2) is a tetrameric Ser/Thr protein kinase that phosphorylates a large number of substrates and contributes in several cellular physiological and pathological processes. CK2 is highly expressed in the mammalian brain and catalyzes the phosphorylation of a large number of substrates that are crucial in neuronal or glial homeostasis and inflammatory signaling processes across synapses. In this study, we investigated the impact of auditory integration therapy (AIT) for the treatment of sensory processing abnormalities in autism on plasma CK2 levels. A total of 25 ASD children, aged between 5 and 12 years, were enrolled and participated in the present research study. AIT was performed for two weeks, for a period of 30 min, twice a day, with a 3 h interval between sessions. Before and after AIT, the Childhood Autism Rating Scale (CARS), Social Responsiveness Scale (SRS), and Short Sensory Profile (SSP) scores were calculated, and plasma CK2 levels were assayed using an ELISA test. The CARS and SRS indices of autism severity improved as a result of AIT, which could be related to the decreased level of plasma CK2. However, the mean value of the SSP scores was not significantly increased after AIT. The relationship between CK2 downregulation and glutamate excitotoxicity, neuro-inflammation, and leaky gut, as etiological mechanisms in ASD, was proposed and discussed. Further research, conducted on a larger scale and with a longer study duration, are required to assess whether the cognitive improvement in ASD children after AIT is related to the downregulation of CK2.

[Re-evaluation of systematic reviews of acupuncture and moxibustion for childhood autism].

OBJECTIVE: To re-evaluate the systematic review/Meta-analysis of acupuncture and moxibustion for childhood autism (CA), aiming to provide decision-making basis for clinical diagnosis and treatment. METHODS: The systematic review and/or Meta-analysis of acupuncture and moxibustion for CA were searched in PubMed, EMbase, Cochrane Library, SinoMed, CNKI and Wanfang databases. The retrieval time was from the database establishment to May 5th, 2022. PRISMA (preferred reporting items for systematic reviews and Meta-analyses) was used to evaluate the report quality, and AMSTAR 2 (a measurement tool to assess systematic reviews 2) was used to evaluate the methodological quality, bubble map was used to construct the evidence map and GRADE was used to evaluate the quality of evidence. RESULTS: A total of 9 systematic reviews were included. The PRISMA scores ranged from 13 to 26. The report quality was low, and there was a serious lack in the aspects of program and registration, search, other analysis and funding. The main problems in methodology included not making prespecified protocol, incomplete retrieval strategy, not providing a list of excluded literatures, and incomplete explanation on heterogeneity analysis and bias risk. The evidence map showed that 6 conclusions were valid, 2 conclusions were possible valid and 1 conclusion was uncertain valid. The overall quality of evidence was low, and the main factors leading to the downgrade were limitations, followed by inconsistency, imprecision and publication bias. CONCLUSION: Acupuncture and moxibustion has a certain effect for CA, but the quality of reporting, methodology and evidence in included literature need to be improved. It is suggested to perform high-quality and standardized research in the future to provide evidence-based basis.

Sialic acid and anti-ganglioside M1 antibodies are invaluable biomarkers correlated with the severity of autism spectrum disorder.

BACKGROUND: Autism spectrum disorders (ASD) are devastating neurodevelopmental disorders that showed global increased prevalence. They are characterized by impairment of social communication and stereotyped patterns. OBJECTIVE: This study aimed at measuring the levels of total sialic acid (SA) and anti-ganglioside M1 (anti- GM1) IgG antibodies as essential biomarkers in a cohort of children with ASD to identify their diagnostic yield as well as their correlation with the severity of autistic behaviors. METHODS: The demographic characteristics, anthropometric measurements, and clinical data were recorded. The levels of total plasma SA and serum anti-GM1 IgG antibodies levels were measured in 100 children with ASD and 100 healthy controls. The severity of ASD-related symptoms was assessed by using the Childhood Autism Rating Scale (CARS). RESULTS: Children with ASD had significantly higher levels of both SA and anti-GM1 antibodies than healthy controls (p < 0.001). SA showed a statistically significant moderate diagnostic performance while anti-GM1 antibody showed a statistically significant high diagnostic in differentiating severe from mild to moderate autism. Moreover, both SA and anti-GM1 antibodies levels were significantly correlated to the severity of ASD symptoms (p < 0.001). CONCLUSION: The significantly increased levels of SA and anti-GM1 antibodies in children with ASD and their correlation with autism-related symptoms suggest their possible etiopathogenic role in autism as one of the pediatric autoimmune neuropsychiatric disorders. However, further large-scale studies are still needed to explore their possible bidirectional relationship as biomarkers for autism.

The importance of low IQ to early diagnosis of autism.

Some individuals can flexibly adapt to life's changing demands while others, in particular those with Autism Spectrum Disorder (ASD), find it challenging. The origin of early individual differences in cognitive abilities, the putative tools with which to navigate novel information in life, including in infants later diagnosed with ASD remains unexplored. Moreover, the role of intelligence quotient (IQ) vis-à-vis core features of autism remains debated. We systematically investigate the contribution of early IQ in future autism outcomes in an extremely large, population-based study of 8000 newborns, infants, and toddlers from the US between 2 and 68 months with over 15,000 cross-sectional and longitudinal assessments, and for whom autism outcomes are ascertained or ruled out by about 2-4 years. This population is representative of subjects involved in the National Institutes of Health (NIH)-funded research, mainly on atypical development, in the US. Analyses using predetermined age bins showed that IQ scores are consistently lower in ASD relative to typically developing (TD) children at all ages (p < 0.001), and IQ significantly correlates with social, non-social, and total Calibrated Severity Scores (CSS) on the Autism Diagnostic Observation Schedule (ADOS) (p<0.01). Lower IQ is associated with greater autistic impairments. Note, verbal IQ (VIQ) is no better than the full-scale IQ to predict ASD cases. These findings raise new, compelling questions about potential atypical brain circuitry affecting performance in both verbal and nonverbal abilities and preceding an ASD diagnosis. This study is the first to establish prospectively that low early IQ is a major feature of ASD in early childhood. LAY SUMMARY: The role of IQ scores in autism remains debated. We systematically investigate the contribution of early IQ in an extremely large study of 8,000 children between 2 and 68 months with autism outcomes by about 2-4 years. We show that IQ scores are consistently lower in ASD relative to TD children. This study is the first to establish prospectively that low early IQ is a predictor for ASD diagnosis in early childhood.

Re-evaluation of systematic reviews of acupuncture and moxibustion for childhood autism / 中国针灸

OBJECTIVE@#To re-evaluate the systematic review/Meta-analysis of acupuncture and moxibustion for childhood autism (CA), aiming to provide decision-making basis for clinical diagnosis and treatment.@*METHODS@#The systematic review and/or Meta-analysis of acupuncture and moxibustion for CA were searched in PubMed, EMbase, Cochrane Library, SinoMed, CNKI and Wanfang databases. The retrieval time was from the database establishment to May 5th, 2022. PRISMA (preferred reporting items for systematic reviews and Meta-analyses) was used to evaluate the report quality, and AMSTAR 2 (a measurement tool to assess systematic reviews 2) was used to evaluate the methodological quality, bubble map was used to construct the evidence map and GRADE was used to evaluate the quality of evidence.@*RESULTS@#A total of 9 systematic reviews were included. The PRISMA scores ranged from 13 to 26. The report quality was low, and there was a serious lack in the aspects of program and registration, search, other analysis and funding. The main problems in methodology included not making prespecified protocol, incomplete retrieval strategy, not providing a list of excluded literatures, and incomplete explanation on heterogeneity analysis and bias risk. The evidence map showed that 6 conclusions were valid, 2 conclusions were possible valid and 1 conclusion was uncertain valid. The overall quality of evidence was low, and the main factors leading to the downgrade were limitations, followed by inconsistency, imprecision and publication bias.@*CONCLUSION@#Acupuncture and moxibustion has a certain effect for CA, but the quality of reporting, methodology and evidence in included literature need to be improved. It is suggested to perform high-quality and standardized research in the future to provide evidence-based basis.

Relationships Between Mental Health, Emotion Regulation, and Meaning in Life of Frontline Nurses During the COVID-19 Outbreak.

Background: The sporadic outbreak of COVID-19 and the constant mutation of the virus have put the public in panic. Frontline nurses' appropriate emotional regulation and mental health are the key to win the victory of fighting against the epidemic. The relationships between these variables directly influence the availability of human resources to combat COVID-19. Objective: To investigate the relationship between meaning in life, emotional regulation, and mental health of frontline nurses during the Delta virus epidemic. Methods: A cross-sectional survey was conducted in August 2021 among 105 nurses from the Second Xiangya Hospital, Central South University, Changsha, China, who were deployed at the COVID-19 units in Zhangjiajie People's Hospital. The Chinese Meaning in Life Questionnaire, Emotion Regulation Questionnaire, and Psychological Questionnaire for Emergent Events of Public Health were used to evaluate their meaning in life, emotion regulation, and mental health. Their correlation and the moderating effect of emotion regulation were conducted. Results: In total, 105 (100%) nurses responded. There were 14 men and 91 women and the mean age was (30.295 ± 4.653) years. The average score of meaning in life and mental health of frontline nurses was 49.971 ± 6.386 and 2.755 ± 2.580, respectively. The meaning in life of frontline nurses was positively correlated with cognitive reappraisal and negatively correlated with expressive suppression and mental health. Mental health was negatively correlated with cognitive reappraisal and positively correlated with expressive suppression. The emotional regulation of frontline nurses has a moderating effect between meaning in life and mental health. Conclusion: Meaning in life and emotion regulation of frontline nurses were significantly correlated with mental health under the effects of the COVID-19 pandemic. Changing the emotion regulation of frontline nurses, strengthening cognitive reappraisal, and weakening expressive suppression could reduce the predictive effect of meaning in life on mental health.

Marginal, conditional, and pseudo likelihood ratio approaches for biomarker combination to predict a binary disease outcome.

It is a common practice in public health research that multiple biomarkers are collected to diagnose or predict a disease outcome. A natural question is how to combine multiple biomarkers to improve the diagnostic accuracy. It has been shown by Neyman-Pearson lemma that the likelihood ratio statistic achieves the optimal AUC in theory. However, practical difficulty often lies in the estimation of the multivariate density functions. We propose three novel methods for the biomarker combination, with the idea of breaking down the joint densities to a series of univariate densities. The marginal likelihood ratio approach only assumes the marginal distribution of each biomarker. While the conditional likelihood ratio (CLR) and pseudo likelihood ratio (PLR) approaches assume the conditional distributions of a marker given others, and hence make use of the correlation structure to estimate the combination rules. The proposed methods make it much easier to assume and validate the univariate distributions of a biomarker than making multivariate distributional assumptions. Extensive simulation studies demonstrate that the CLR and the PLR approaches outperform many existing methods, and are therefore recommended for practical use. The proposed methods are motivated by and applied to a biomarker study to diagnose childhood autism/autism spectrum disorder.

Comparison of diagnostic validity of two autism rating scales for suspected autism in a large Chinese sample.

BACKGROUND: Autism is the most common clinical developmental disorder in children. The childhood autism rating scale (CARS) and autistic autism behavior checklist (ABC) are the most commonly used assessment scales for diagnosing autism. However, the diagnostic validations and the corresponding cutoffs for CARS and ABC in individuals with suspected autism spectrum disorder (ASD) remain unclear. Furthermore, for suspected ASD in China, it remains unclear whether CARS is a better diagnostic tool than ABC. Also unclear is whether the current cutoff points for ABC and CARS are suitable for the accurate diagnosis of ASD. AIM: To investigate the diagnostic validity of CARS and ABC based on a large Chinese sample. METHODS: A total of 591 outpatient children from the ASD Unit at Beijing Children's Hospital between June and November 2019 were identified. First, the Clancy autism behavior scale (CABS) was used to screen out suspected autism from these children. Then, each suspected ASD was evaluated by CARS and ABC. Receiver operating characteristic (ROC) curve analysis was used to compare diagnostic validations. We also calculated the area under the curve (AUC) for both CARS and ABC. RESULTS: We found that the Cronbach alpha coefficients of CARS and ABC were 0.772 and 0.426, respectively. Therefore, the reliability of the CARS was higher than that of the ABC. In addition, we found that the correlation between CARS and CABS was 0.732. Next, we performed ROC curve analysis for CARS and ABC, which yielded AUC values of 0.846 and 0.768, respectively. The cutoff value, which is associated with the maximum Youden index, is usually applied as a decision threshold. We found that the cutoff values of CARS and ABC were 34 and 67, respectively. CONCLUSION: This result indicated that CARS is superior to ABC in the Chinese population with suspected ASD.

Potential protein markers in children with Autistic Spectrum Disorder (ASD) revealed by salivary proteomics.

The lack of specific pharmacological therapy for Autistic Spectrum Disorder (ASD) and its clinical heterogeneity demand efforts directed toward the identification of biomarkers to aid in diagnosis. Proteomics offers a new perspective for studying the altered proteins associated with autism spectrum disorders (ASD) and we have saliva as an easy-to-collect biological fluid with important biomolecules for investigating biomarkers in various diseases. In this sense, saliva could be used to identify potential biomarkers of ASD. In the current work, saliva samples were collected from children with different degrees of ASD and healthy children and proteomics approaches were applied to generate data on differentially expressed proteins between groups which will serve as a basis for future validation studies as protein markers. Data are available via ProteomeXchange with identifier PXD030065. As results, 132 proteins were present in 80% of the saliva pools of all analyzed groups. Twenty-five proteins were identified as overexpressed in the group of severe and mild/moderate ASD carriers, among which, eight were identified as potential biomarkers for ASD.

CTRP3 as a novel biomarker in the plasma of Saudi children with autism.

BACKGROUND: C1q/tumor necrosis factor-related protein-3 (CTRP3) has diverse functions: anti-inflammation, metabolic regulation, and protection against endothelial dysfunction. METHODS: The plasma level of CTRP3 in autistic patients (n = 32) was compared to that in controls (n = 37) using ELISA. RESULTS: CTRP3 was higher (24.7% with P < 0.05) in autistic patients than in controls. No association was observed between CTRP3 and the severity of the disorder using the Childhood Autism Rating Scale (CARS). A positive correlation between CARs and the age of patients was reported. Receiver operating characteristic (ROC) analysis demonstrated a low area under the curve (AUC) for all patients (0.636). Low AUCs were also found in the case of severe patients (0.659) compared to controls, but both values were statistically significant (P ≤ 0.05). Despite the small sample size, we are the first to find an association between CTRP3 and autism spectrum disorder (ASD).

Os impasses ao acesso à intersubjetividade: observações clínicas de um bebê com risco de evolução autística / Impases en el accesoa la intersubjetividad: observaciones clínicas de un bebé con riesgo de evolución autista / Challenge in accessing intersubjectivity: clinical observations of a baby with a risk of autism / Les impasses à l'accès à l'intersubjectivité: observations cliniques d'un bébé à risque d'autisme

O artigo aborda os impasses vividos por um bebê com risco de autismo em seu processo de subjetivação. Estudos afirmam que há bebês que, muito precocemente, recusam-se a estabelecer trocas com o objeto materno, impossibilitando que a mãe entre em um estado de identificação com seu bebê, o que colocaria em pauta que o autismo infantil não se limitaria apenas a uma falha materna, mas se trataria de uma patologia multifatorial. Quais intervenções clínicas seriam necessárias para que a mãe e o bebê possam juntos (re)escrever uma nova narrativa psíquica? Haveria um tipo de intervenção e de manejo clínico específico nos casos de bebês com risco de autismo? E como a psicanálise contemporânea, fundamentada pela leitura da intersubjetividade, nos ajudaria na compreensão da clínica da intervenção precoce?

Este artículo se propone abordar los impases experimentados por un bebé con riesgo autista en su proceso de subjetivación. Existen estudios sobre bebés que precozmente se niegan a establecer intercambios con el objeto materno, imposibilitando que la madre entre en identificación con él, poniendo sobre la mesa que el autismo infantil no se limitaría a una falla materna, sino que se trataría de una patología multifactorial. Se plantea, cuáles intervenciones clínicas son necesarias para que madre y bebé puedan (re)escribir una nueva narrativa psíquica, que posibilite un verdadero encuentro diádico. ¿Habría un tipo específico de intervención y manejo clínico en los bebés con riesgo de autismo? ¿Cómo el psicoanálisis contemporáneo, basado en la lectura de la intersubjetividad y de lo intrapsíquico, ayudaría a entender la clínica de la intervención precoz?

This article addresses the failures of a baby with a risk of autism to develop his subjectivation process. Recent studies show that some babies are not able to develop exchanges with their maternal object, which would show that children autism would not be limited to a failure of the mother to enter into a state of identification with her baby, but would be associated to a multifactorial pathology. In that respect, which clinical interventions would be necessary so that mother and baby can (re)write a new psychic narrative, enabling them to develop a genuine capability to meet together? Is there a type of clinical handling for babies with a risk of autism? How can contemporary psychoanalysis, with focus on intersubjectivity and inter-psychism, could help us to understand early intervention clinic?

Cet article aborde les entraves d'un bébé à risque autistique à développer son processus de subjectivation. Des études récentes montrent que certains bébés ne sont pas capables de développer des échanges avec leur objet maternel, ce qui montrerait que l'autisme infantile ne se limiterait pas seulement à un échec de la mère d'entrer dans un état d'identification avec son bébé, mais qu'il s'agirait d'une pathologie multifactorielle. Ainsi, quelles interventions cliniques seraient nécessaires pour que mère et bébé puissent (ré)écrire ensemble un nouveau récit psychique, qui leur permettrait de développer une véritable capacité à se rencontrer ? Y aurait-il un type de prise en charge clinique spécifique aux bébés à risque d'autisme? Comment la psychanalyse contemporaine, centrée sur l'intersubjectivité et l'inter-psychisme, peut nous aider à comprendre la clinique d'intervention précoce?

Knowledge about childhood autism among nurses in Turkey: A cross-sectional descriptive study.

PURPOSE: The aim of this study was to determine the level of knowledge that nurses possess about childhood autism. DESIGN AND METHODS: This cross-sectional descriptive study was conducted among 278 nurses. A personal information form, which was created by the present researchers, and Knowledge about Childhood Autism among Health Workers questionnaire were used to collect data. FINDINGS: The mean knowledge level was 12.29 ± 3.19. There was a significant difference in total scale scores as a function of participation in a training program on childhood autism and acquaintance with a person with autism. PRACTICE IMPLICATIONS: Nurses play an important role in the early diagnosis of childhood autism. Therefore, they should be educated about childhood autism.

Alteration of TRIM33 Expression at Transcriptional and Translational Levels is Correlated with Autism Symptoms.

As a complex neurodevelopmental disorder, autism affects children in three major cognitive domains including social interactions, language learning and repetitive stereotyped behaviors. Abnormal regulation of cell proliferation in the brain during the embryonic period via the TGF-ß signaling pathway and TRIM33 gene that encodes a protein with a corepressor and regulatory role in this pathway has been considered as an etiology for autism. Here, we investigated the association of a variation of TRIM33 with autism symptoms at levels of mRNA and protein expression. We used Autism Diagnostic Interview-Revised (ADI-R) and Childhood Autism Rating Scale (CARS) as behavioral diagnostic tools. Normal and autistic children were genotyped for a TRIM33 polymorphism (rs11102807), and then expression was assessed at transcriptional and translational levels. Results demonstrated that the frequency of the homozygous A allele (AA genotype of rs11102807) was significantly higher in children with autism (P < 0.001), whereas carriers of the G allele were mostly among healthy individuals. Children homozygous for the rs11102807 A allele were associated with an increase in CARS and ADI-R scores, indicating a significant correlation with autism symptoms. TRIM33 gene expression at both mRNA (P < 0.01) and protein (P < 0.001) levels was significantly higher in controls compared to autistic children. A remarkable association between higher TRIM33 gene expression at the transcriptional level and lower scores for both CARS and ADI-R was observed in non-autistic children. It seems that rs11102807 modulates the function and expression of the TRIM33 gene, implying that the A allele may increase the risk of autism in children by reducing gene expression and altering the TGF-ß signaling pathway.

[Classification metamorphoses of autism in child psychiatry]. / Klassifikatsionnye metamorfozy autizma v detskoi psikhiatrii.

The article analyzes the evolution of scientific views on autism in children and milestone changes in the international classification. The main issues related to conceptual, terminological and classification aspects are reflected. The reasons for the increase in the prevalence of autism spectrum disorders, terminological inconsistencies, and deviations from etiopathogenetic views on autism are discussed. The question is raised about the need to adapt the introduced ICD-11 practice or working practice for everyday practice and scientific research in Russia.

A Sleeping rs-fMRI Study of Preschool Children with Autism Spectrum Disorders.

OBJECTIVES: The brain functional network of autism spectrum disorders (ASDs) in the earlier stages of life has been almost unknown due to difficulties in obtaining a resting-state functional magnetic resonance imaging (rs-fMRI). This study aimed to perform rs-MRI under a sedated sleep state and reveal possible alterations in the brain functional network. METHODS: Rs-fMRI was performed in a group of preschool children (aged 2-6 years, 53 with ASD, 63 as controls) under a sedated sleeping state. Based on graph theoretical analysis, global and local topological metrics were calculated to investigate alterations in brain functional networks. Besides, correlation analyses were conducted between the abnormal attribute values and the Childhood Autism Rating Scale (CARS) scores. RESULTS: The graph theoretical analysis showed that the nodal degree of the right medial frontal gyrus and the nodal efficiency of the right lingual gyrus in the ASD group were higher than those in the control group (P<0.05). There was a statistically significant positive correlation (R=0.318, P<0.05) between the right midfrontal gyrus nodal degree values and CARS scores in the ASD patients. CONCLUSION: Alterations of some nodal attributes in the brain network occurred in preschool autistic children which could serve as potential imaging biomarkers for evaluating ASD in earlier stages.

Adaptation of the Knowledge about Childhood Autism among Health Workers (KCAHW) Questionnaire: Turkish version.

OBJECTIVE: Many checklists and scales have been developed to diagnose the autism spectrum disorder in childhood. However, self-applied questionnaires/scales that can be filled out by health professionals for assessing their knowledge and consciousness of this disorder are still limited. The Knowledge about Childhood Autism among Health Workers self-administered survey was developed by Bakare et al. in 2008. This survey was recruited by many study groups in developing countries. In these countries, knowledge regarding childhood autism is inadequate within community healthcare professionals. METHODS: In our study, the agreed-upon Turkish version of the questionnaire was distributed to the 61 primary care physicians working in Maltepe District of Istanbul Province for the adaptation and validation. RESULTS: The internal consistency coefficient (Kuder-Richarson coefficient of reliability-KR20) of the measurements attained from the Turkish version of the questionnaire was 0.70. The split- half reliability analysis demonstrated that the Guttman Split-half value was 0.84. According to the principal factor analysis of the tetrachoric correlation matrix, the three factors with the highest Eigenvalues were associated with (i) Relatively easy clinical observations, (ii) the signs which require a longer observation time and detailed anamnesis, and (iii) the signs, which require detailed examination and observation. The factors explained cumulatively 65.98% of the total variance. CONCLUSION: The findings obtained in this study showed that the adapted questionnaire addressed in the scope of this study is a valid measure for Turkish society.

Knowledge Gaps about Autism Spectrum Disorders and its Clinical Management among Child and Adolescent Health Care Workers in Uganda: A Cross-Sectional Study.

BACKGROUND: There is limited literature on the knowledge about Autism Spectrum Disorder (ASD) among child and adolescent health professionals from resource limited settings. METHODS: 40 child and adolescent health professionals were purposively sampled from the two national referral hospitals in Uganda. Participants completed a standardized questionnaire that collected data on socio-demographic characteristics, the Knowledge about Childhood Autism among Health Workers (KCAHW) and the challenges related to diagnosing and managing ASD. General linear model with the Poisson regression was used to evaluate bivariate and multivariate factors associated with limited knowledge about ASD. RESULTS: The study participation rate was 90% with the majority being females (N = 21, 58%). Also, most (N = 20, 55.6%) were mental health professionals working at the Butabika pediatric out-patient clinic while (N = 16, 44.4%) were pediatric health professionals working at the Mulago mental and neurological pediatric clinics. The mean score on KCAHW was 11.8 (SD = 3.75). The participants (36.1%) who scored below the mean score were regarded as having limited knowledge about ASD. Health workers with limited knowledge about ASD (KCAHW score < 11.8) were less likely to have a degree [adjusted Prevalence rate ratio (aPRR) = 0.26, 95%CI = 0.08 to 0.78, p-value = 0.018. Mental health and Non-mental health workers had comparable KCAHW mean scores. Clinical Psychologists, Psychiatrists, psychiatry residents and pediatric nurses had the highest KCAHW scores while psychiatric nurses and medical social workers had the lowest scores. CONCLUSION: The proportion of child and adolescent health professionals with limited knowledge about ASD is substantial. There is urgent need to increase focus on training in autism spectrum disorders especially among non-specialist health workers.