LF-rTMS ameliorates social dysfunction of FMR1-/- mice via modulating Akt/GSK-3ß signaling.

Autism spectrum disorders (ASD) are a group of neurological disorders which affect approximately 1% of children around the world. Social dysfunction is one of the two core syndromes of ASD, and still lacks effective treatment. Transcranial magnetic stimulation (TMS) is a noninvasive and safe procedure that uses magnetic fields to modulate neural activity. Whether it were effective in modulating social function remains unclear. By using 3-chamber test, ultrasonic vocalization recording and Western-blotting, we demonstrated that FMR1 (fragile X mental retardation protein) mutant mice, a model of ASD, exhibited obvious defects in social preference and ultrasonic communication. In addition, we detected increase of p-Akt (S473) and p-GSK-3ß (S9), and decrease of p-PSD-95 (T19) in the anterior cingulate cortex (ACC) of FMR1-/- mice. Treating FMR1-/- mice with 1 Hz repetitive TMS (rTMS) exerted a long lasting effect in improving both the ultrasonic communication and social preference, as well as restoring the levels of Akt/GSK-3ß activity and spine density in the FMR1-/-ACC. Our data, for the first time, demonstrated a beneficial effect of low frequency rTMS (LF-rTMS) on the social function of FMR1-/- mice and an involvement of Akt/GSK-3ß signaling in this process, indicating LF-rTMS as a potential therapeutic strategy for ASD patients.

Biocognitive Classification of Antisocial Individuals Without Explanatory Reductionism.

Effective and specifically targeted social and therapeutic responses for antisocial personality disorders and psychopathy are scarce. Some authors maintain that this scarcity should be overcome by revising current syndrome-based classifications of these conditions and devising better biocognitive classifications of antisocial individuals. The inspiration for the latter classifications has been embedded in the Research Domain Criteria (RDoC) approach. RDoC-type approaches to psychiatric research aim at transforming diagnosis, provide valid measures of disorders, aid clinical practice, and improve health outcomes by integrating the data on the genetic, neural, cognitive, and affective systems underlying psychiatric conditions. In the first part of the article, we discuss the benefits of such approaches compared with the dominant syndrome-based approaches and review recent attempts at building biocognitive classifications of antisocial individuals. Other researchers, however, have objected that biocognitive approaches in psychiatry are committed to an untenable form of explanatory reductionism. Explanatory reductionism is the view that psychological disorders can be exclusively categorized and explained in terms of their biological causes. In the second part of the article, we argue that RDoC-like approaches need not be associated with explanatory reductionism. Moreover, we argue how this is the case for a specific biocognitive approach to classifying antisocial individuals.

The Effects of Social Skills Interventions for Students With EBD and ASD: A Single-Case Meta-Analysis.

Social skills interventions are critical for promoting social, emotional, and behavioral competence for students with or at risk of emotional and behavioral disorders (EBD) and autism spectrum disorders (ASD). This single-case meta-analysis examined the effects of social skills interventions (SSIs) for students with EBD and ASD. Effect sizes were calculated for 78 cases across 25 included studies using a nonparametric effect size, Baseline Corrected Tau. The overall weighted mean effect size of 0.54 suggested a moderate effect across the 25 studies. The overall weighted mean effects for studies reporting maintenance and generalization data were 0.68 and 0.37, respectively. Potential moderators examined (disability, intervention design, intervention delivery, methodological quality) were not significant. As such, they did not moderate the outcomes for participants. We conducted a post hoc analysis and hypothesized that between-study differences may be more meaningful than the similarities shared by participants in the same moderator groups. Implications are discussed on using SSIs to address the social, emotional, and behavioral challenges of students with or at risk of EBD and ASD.

Microbiota and the social brain.

Sociability can facilitate mutually beneficial outcomes such as division of labor, cooperative care, and increased immunity, but sociability can also promote negative outcomes, including aggression and coercion. Accumulating evidence suggests that symbiotic microorganisms, specifically the microbiota that reside within the gastrointestinal system, may influence neurodevelopment and programming of social behaviors across diverse animal species. This relationship between host and microbes hints that host-microbiota interactions may have influenced the evolution of social behaviors. Indeed, the gastrointestinal microbiota is used by certain species as a means to facilitate communication among conspecifics. Further understanding of how microbiota influence the brain in nature may be helpful for elucidating the causal mechanisms underlying sociability and for generating new therapeutic strategies for social disorders in humans, such as autism spectrum disorders (ASDs).

A systematic review of the impact of social cognitive deficits on psychosocial functioning in major depressive disorder and opportunities for therapeutic intervention.

Social cognition is the ability to identify, perceive and interpret socially relevant information from the external world. It is an important adaptive trait, but is frequently affected in major depressive disorder by a mood-congruent interpretive bias. The present review examined the existing body of literature to determine (i) the impact social cognitive deficits in depression have on psychosocial functioning; and (ii) the utility of psychotropic, psychological and procedural interventions employed to target these deficits. A total of 107 studies met inclusion criteria for review. Social cognitive performance was found to adversely impact depressed patients' psychosocial functioning across the key domains of general cognitive functioning and quality of life. Secondly, many current therapies were found to have a normalising effect on the social cognitive abilities of subjects with major depressive disorder, both at a neural and functional level. In particular, certain anti-depressant medications corrected facial affect recognition deficits, while several psychotherapeutic approaches improved impairments in theory of mind and negative interpretive bias.

Mechanisms Underlying Microbial-Mediated Changes in Social Behavior in Mouse Models of Autism Spectrum Disorder.

Currently, there are no medications that effectively treat the core symptoms of Autism Spectrum Disorder (ASD). We recently found that the bacterial species Lactobacillus (L.) reuteri reverses social deficits in maternal high-fat-diet offspring. However, whether the effect of L. reuteri on social behavior is generalizable to other ASD models and its mechanism(s) of action remains unknown. Here, we found that treatment with L. reuteri selectively rescues social deficits in genetic, environmental, and idiopathic ASD models. Interestingly, the effects of L. reuteri on social behavior are not mediated by restoring the composition of the host's gut microbiome, which is altered in all of these ASD models. Instead, L. reuteri acts in a vagus nerve-dependent manner and rescues social interaction-induced synaptic plasticity in the ventral tegmental area of ASD mice, but not in oxytocin receptor-deficient mice. Collectively, treatment with L. reuteri emerges as promising non-invasive microbial-based avenue to combat ASD-related social dysfunction.

Interventions and social functioning in youth at risk of psychosis: A systematic review and meta-analysis.

AIM: Youth at clinical high risk (CHR) for psychosis often exhibit difficulties in social functioning and poorer social functioning may be predictive of transition to a psychotic disorder. Therefore, the primary objective of this systematic review was to summarize the impact of all interventions on social functioning in CHR samples. METHOD: Electronic databases PsycINFO, CINAHL, Embase, EBM, and MEDLINE were searched from 1951 to June 2017. Studies were selected if they included any intervention that reported changes in social functioning in youth at CHR. Data were evaluated using random effects pairwise meta-analyses, stratified by time, and reported as the standardized mean difference (SMD). RESULTS: Nineteen studies met our inclusion criteria, including a total of 1513 CHR participants. The mean age was 20.5 years and 47% were male. Cognitive behavioural therapy (4 studies) did not significantly improve social functioning at 6 months (SMD = 0.06; 95% confidence interval [CI] = -0.35, 0.46), 12 months (SMD = -0.15; 95% CI = -0.38, 0.08) and 18 months (SMD = 0.20; 95% CI = -0.10, 0.50). Omega-3 (2 studies) did not significantly improve social functioning at 6 months (SMD = 0.01; 95% CI = -0.21, 0.24) and 12 months (SMD = -0.08; 95% CI = -0.33, 0.17). Lastly, cognitive remediation (3 studies) did not significantly improve social functioning at 2- to 3-month follow-up (SMD = 0.13, 95% CI = -0.18, 0.43). CONCLUSIONS: This systematic review and meta-analysis demonstrated that no treatment significantly improved social functioning in youth at CHR. Future randomized control trials are required that are designed to target and improve social functioning in youth at CHR for psychosis.

Team-based parent training by child specialists helps maltreated children.

BACKGROUND: This study assessed the effects of the parent training (PT) technique, in which child specialists (CS) such as preschool and school teachers promote secure attachment in children with aberrant social behavior following maltreatment, using a team approach. METHODS: Child specialists confirmed the presence of child abuse, according to Japanese Ministry of Health, Labour and Welfare criteria. CS such as homeroom, special education-related, student guidance-related, nursing teachers and co-workers received a PT course conducted by the authors. A homeroom teacher provided classroom management to model good examples of social life for the target child. A nursing teacher and assistant offered individualized instruction to foster the formation of secure attachments by the target child. RESULT: Behavioral abnormalities in both school and home resolved in seven out of 12 cases. These subjects received the intervention for 2-4 years. In the other cases, behavioral abnormalities disappeared or decreased at school, but continued at home. Almost all children met the alternative criteria of attachment disorder proposed by Boris and Zeanah. One child met the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) criteria for reactive attachment disorder. This intervention is significantly more effective for children who have yet to begin elementary school than those in elementary school. CONCLUSIONS: The PT technique as applied by CS using a team approach may be a useful intervention for fostering secure attachment in children with maltreatment who exhibit behavioral abnormalities. Early detection and intervention are necessary to successfully address the behavioral abnormalities of children with maltreatment.

A randomized controlled trial evaluating the Hebrew adaptation of the PEERS® intervention: Behavioral and questionnaire-based outcomes.

Social interaction deficits form a core characteristic of ASD that is commonly targeted through social-skill groups. The Program for the Education and Enrichment of Relational Skills (PEERS® ) is a well-established parent-assisted intervention for adolescents, which addresses key areas of social functioning. PEERS® has been mainly studied in North-America and its evaluations were mostly questionnaire based. The aim of the current study was to test the effectiveness of the adapted and translated Hebrew version of the PEERS® intervention in a randomized controlled trial, using behavioral measures of peer interaction, in addition to self, parent, and teacher reports. Forty-one participants with ASD and no intellectual impairment, aged 12-17 years, were randomly assigned to an immediate intervention or a delayed-intervention group. All participants were assessed before and after the immediate intervention, and again at follow up, after the delayed intervention took place. Results revealed intervention-related behavioral improvements on adolescents' engagement, question-asking, and physical arousal. Parental reports indicated improved social skills, and reduced ASD symptoms. Adolescents reported on more social encounters, greater empathy, and scored higher on social-skill knowledge. Most of these effects maintained at a 16-week follow-up. Teacher reports' yielded effects only on pre-post intervention analysis. Adolescents' improvement on behavioral engagement predicted parent-reported social skills improvement. Our findings support the effectiveness of the adapted Hebrew version of PEERS® for adolescents with ASD, through significant behavioral and questionnaire-based outcomes, which maintained at follow-up. Autism Res 2018, 11: 1187-1200. © 2018 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Social-skills groups, which facilitate key social deficits characteristic of ASD, are a popular intervention for adolescents with ASD. Indeed, many treatment protocols have been published, and some have also been research validated. However, there have been inconsistent findings regarding the effectiveness of different protocols, in addition to limited findings of improvement beyond questionnaire reports. This study evaluated the Hebrew adaptation of the PEERS® intervention, a 16-weeks long program, which involves the parents as their adolescents' social coaches. Following the intervention, adolescents improved their social-skills, participated more in social encounters, reported greater empathy, and demonstrated higher social-skill knowledge. A live play-role assessment with an unfamiliar peer indicated that adolescents showed greater involvement, asked more questions and were more physically relaxed during the conversation. Improvements maintained 16 weeks after the intervention was completed.

Social Skills Deficits in Autism Spectrum Disorder: Potential Biological Origins and Progress in Developing Therapeutic Agents.

Autism spectrum disorder is defined by two core symptoms: a deficit in social communication and the presence of repetitive behaviors and/or restricted interests. Currently, there is no US Food and Drug Administration-approved drug for these core symptoms. This article reviews the biological origins of the social function deficit associated with autism spectrum disorder and the drug therapies with the potential to treat this deficit. A review of the history of autism demonstrates that a deficit in social interaction has been the defining feature of the concept of autism from its conception. Abnormalities identified in early social skill development and an overview of the pathophysiology abnormalities associated with autism spectrum disorder are discussed as are the abnormalities in brain circuits associated with the social function deficit. Previous and ongoing clinical trials examining agents that have the potential to improve social deficits associated with autism spectrum disorder are discussed in detail. This discussion reveals that agents such as oxytocin and propranolol are particularly promising and undergoing active investigation, while other agents such as vasopressin agonists and antagonists are being activity investigated but have limited published evidence at this time. In addition, agents such as bumetanide and manipulation of the enteric microbiome using microbiota transfer therapy appear to have promising effects on core autism spectrum disorder symptoms including social function. Other pertinent issues associated with developing treatments in autism spectrum disorder, such as disease heterogeneity, high placebo response rates, trial design, and the most appropriate way of assessing effects on social skills (outcome measures), are also discussed.

Cognitive behavioural therapy for aggression among individuals with moderate to severe acquired brain injury: a systematic review and meta-analysis.

BACKGROUND: Aggression is common after an acquired brain injury (ABI). Cognitive behavioural therapy (CBT) is a form of psychotherapy, in which therapists help patients to identify their maladaptive behaviours. OBJECTIVE: The objective of this systematic review and meta-analysis was to evaluate the effectiveness of CBT interventions in treating aggression in an ABI population. METHODS: A systematic literature search was conducted using: PubMed/MEDLINE, CINAHL, EMBASE and PsycINFO from database inception to August 2016. English articles were included if: at least 50% of the study sample had a moderate to severe ABI, there were at least three adult human participants, and use of a CBT intervention for the treatment of aggression. RESULTS: Seven articles met inclusion criteria: one RCT, an RCT crossover and five pre-post trials. Of these, four articles were included in a pre-post meta-analysis for treatment efficacy on subscales of the State Trait Anger Expression Inventory (STAXI) and STAXI-2 outcome measures. The meta-analysis found CBT was effective in moderating the external behaviours of aggression, but not internal anger. CONCLUSION: The differences in outcomes may be related to the differential management of anger expression and anger suppression. CBT shows promise, but further studies with comparator groups are needed before conclusions about its efficacy can be made.

A haven of green space: learning from a pilot pre-post evaluation of a school-based social and therapeutic horticulture intervention with children.

BACKGROUND: Research suggests outdoor activity in green spaces is important for children's mental, emotional and social wellbeing. A recognised green space intervention is "Social and Therapeutic Horticulture" (STH). We discuss findings from a pilot STH intervention, "A Haven of Green Space" conducted in North West England. The target group were school children aged 9-15 years experiencing behavioural, emotional and social difficulties. This exploratory study aims to assess the mental wellbeing of the children pre- and post-intervention, and assess the value of the evaluation methods and "Five Ways to Wellbeing" evaluation framework. METHODS: The intervention involved 6 monthly sessions with two horticulturists and a psychotherapist. Sessions were participatory with the development of selected greenspaces at each school directed by the children. Evaluation was situated in the "Five Ways to Wellbeing" framework, using a mixed-methods pre- post-evaluation design. Existing public mental health evaluation methodologies were adapted for use with school children: Mental Well Being Impact Assessment (MWIA) and Wellbeing Check Cards. The MWIA was analysed qualitatively identifying over-arching themes. The quantitative wellbeing check cards were analysed by mean score comparison. RESULTS: Results were collected from 36 children across the three participating schools, and suggest that the Haven Green Space intervention was associated with improved mental wellbeing. MWIA factors relating to mental wellbeing ("emotional wellbeing" and "self-help") were positively impacted in all three schools. However, findings from the wellbeing check cards challenge this, with worsening scores across many domains. CONCLUSIONS: A key study limitation is the pilot nature of the intervention and challenges in adapting evaluation methods to context and age-range. However, results indicate that group based socially interactive horticulture activities facilitated by trained therapists are associated with positive impacts upon the mental and emotional wellbeing of children experiencing behavioural, emotional and social difficulties. Further research is needed to verify this, and to support using the "Five Ways" in intervention development and evaluation. Finally, we recommend continued efforts to develop age-appropriate evaluation methods.

Dementia Care Competence Among Care Professionals and Reduced Challenging Behavior of Home-Dwelling Persons with Dementia: A Pre- and Post-Intervention Data Analysis.

BACKGROUND: We developed a psychosocial dementia care program to help care managers and professional caregivers manage challenging behavior in home-dwelling persons with dementia in Japan. The program consists of a web-based tool for ongoing monitoring and assessment for challenging behavior, and multi-agency discussion meetings. Results of a cluster-randomized controlled trial indicate a reduction in challenging behavior through this program. OBJECTIVES: The present study aimed to identify a key component of the developed program that is associated with a reduction in challenging behavior. METHODS: We used consecutive data of the intervention and examined the association between challenging behavior in home-dwelling persons with dementia, professionals' competence, and the frequency of revision of action plans. Challenging behavior was assessed using the total score of the Neuropsychiatric Inventory. A baseline and follow-up questionnaire was completed by care professionals using a Japanese version of the Sense of Competence in Dementia Care Staff scale. RESULTS: A total of 86 care professionals completed a 6-month intervention with 219 persons with dementia. The 86 care professionals significantly improved in their dementia care competence. Challenging behavior was significantly reduced among the 219 persons with dementia at follow-up regardless of the level of professionals' competence or the frequency of revision of action plans. Less pain was significantly related to the lower levels of challenging behavior. CONCLUSION: The ongoing multi-agency discussion meetings, with a focus on challenging behavior, may have been the key component in the psychosocial dementia care program. Pain management should be emphasized in action plans for challenging behavior.

Potentially Reversible Social Deficits Among Transgender Youth.

Recently, there has been increased attention to a putative relationship between Autism Spectrum Disorder (ASD) and gender dysphoria, the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) diagnosis for those whose gender assigned at birth does not match their gender identity. Studies have shown an over-representation of ASD symptoms among transgender youth. These studies, however, have used scales that are non-specific for ASD. These ASD symptoms may represent social deficits that are secondary to social stress and deprivation, as transgender youth suffer high rates of peer and family rejection. These social deficits may not represent true ASD and may be reversible as patients are affirmed in their gender identities and social stress is reduced.

Course of Disinhibited Social Engagement Disorder From Early Childhood to Early Adolescence.

OBJECTIVE: Disinhibited social engagement disorder (DSED) is poorly understood beyond early childhood. The course of DSED signs in a sample of children who experienced severe, early deprivation from early childhood to early adolescence was examined using variable-centered (linear mixed modeling) and person-centered (growth mixture modeling) approaches. METHOD: The study included 124 children with a history of institutional care from a randomized controlled trial of foster care as an alternative to institutional care and 69 community comparison children matched by age and sex. DSED signs were assessed at baseline (mean age 22 months), 30, 42, and 54 months of age, and 8 and 12 years of age using a validated caregiver report of disturbed attachment behavior. RESULTS: Variable-centered analyses based on intent-to-treat groups indicated that signs of DSED decreased sharply for children randomized to foster care and decreased slightly but remained high for children randomized to care as usual. Person-centered analyses showed 4 profiles (i.e., elevated, persistent modest, early decreasing, and minimal). Elevated and persistent modest courses were associated with greater placement disruptions (F3,99 = 4.29, p = .007, partial eta-squared [η2] = 0.12), older age at placement into foster care (F3,56 = 3.41, p < .05, partial η2 = 0.16), and more time in institutional care (F3,115 = 11.91, p < .001, partial η2 = 0.24) compared with decreasing and minimal courses. CONCLUSION: Early and sustained placement into families after deprivation is associated with minimal or decreasing signs of DSED across development. Shortening the amount of time children spend in institutions and preserving placements could help decrease signs of DSED into early adolescence in previously institutionalized children.

Evaluación del Abordaje Terapéutico en un Centro de Justicia Juvenil / Evaluation of the therapeutic approach in Juvenile Justice Center / Avaluació de l'abordatge terapéutic en un centre de justícia juvenil

El objeto del estudio es evaluar la intervención en un Centro de Justicia Juvenil mediante el contraste del estado clínico en 18 episodios de ingreso realizados por 16 adolescentes. La intervención se basa en la Psicoterapia de Vinculación Emocional Validante. Es un enfoque integrador de tiempo limitado centrado en generar conciencia de problema, adherencia al tratamiento, remisión de la sintomatología aguda y experiencias emocionales correctoras con el objetivo, en última instancia, de poder beneficiarse de un tratamiento en la comunidad. Los resultados muestran un perfil diferencial del grupo de menores infractores. Asimismo se constata un cambio estadísticamente significativo en este grupo tras la intervención. Finalmente, se discuten aspectos relevantes de la evaluación y medidas terapéuticas a aplicar en esta población

The aim of this study is to evaluate the effectiveness of the intervention in a Juvenile Justice Center contrasting the clinical status of 18 hospitalizations in 16 teenagers. The intervention is based on the Validative Emotional Bonding Psychotherapy. It is a limited time integrative-approach to make patients become aware of the problem, of the treatment adherence, of the remission of severe symptoms and the corrective emotional experiences in order to take advantage from the treatment in the community. The results show a differential profile of the group of juvenile offenders and a statistically significant change after the treatment. Finally, we discuss about the important aspects of the assessment and the therapeutic measures applied in this population

L'objecte de l'estudi és el d'avaluar la in-tervenció en un centre de justícia juvenil mitjançant el contrast de l'estat clínic en 18 episodis d'ingrés realitzats per 16 adolescents. La intervenció es basa en la Psicoterápia de Vinculació Emocional Validant. És un enfoc in-tegrador de temps limitat centrat en generar consciéncia del problema, adheréncia al tractament, remissió de la simptomatologia aguda I experiéncies emocionals correctores amb l'objectiu, en última instància, de poder beneficiar-se d'un tractament en la comunitat. Els resultats mostren un perfil diferencial del grup de menors infractors. Al mateix temps, es constata un canvi estadísticament significatiu en aquest grup després de la inter-venció. Finalment, es discuteixen aspectes rellevants en l'avaluació I mesures terapéutiques a aplicar en aquesta població