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1.
Nutrients ; 14(13)2022 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-35807909

RESUMO

We examined the relationship between maternal intake of established dietary patterns and child autism-related outcomes in two prospective cohorts in the United States. Participants were drawn from the Early Autism Risk Longitudinal Investigation (EARLI, n = 154) and the Nurses' Health Study II (NHSII, n = 727). Dietary information was collected via food frequency questionnaires (FFQs) and used to calculate the empirical dietary inflammatory pattern (EDIP), Alternative Healthy Eating Index (AHEI), Western and Prudent dietary patterns, and the alternative Mediterranean Diet (aMED) score. Primary analyses examined associations with continuous autism-related traits as measured by the Social Responsiveness Scale (SRS), and secondary analyses with autism spectrum disorder (ASD) diagnosis. We used crude and multivariable quantile regression fixed at the 50th percentile to examine associations between quartiles of dietary patterns and SRS scores, and logistic regression to examine associations with ASD diagnosis. There was suggestion of a positive association with the Western diet (Q4 vs. Q1, ß = 11.19, 95% CI: 3.30, 19.90) in EARLI, though the association was attenuated with adjustment for total energy intake, and no clear associations were observed with other dietary patterns and ASD diagnosis or SRS scores. Further work is needed to better understand the role of maternal dietary patterns in ASD and related outcomes.


Assuntos
Transtorno do Espectro Autista , Transtorno Autístico , Dieta Mediterrânea , Transtorno do Espectro Autista/epidemiologia , Transtorno do Espectro Autista/etiologia , Criança , Feminino , Humanos , Gravidez , Estudos Prospectivos , Fatores de Risco , Estados Unidos/epidemiologia
2.
Indian J Public Health ; 66(2): 166-170, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35859499

RESUMO

Background: Despite steady decline in the age of diagnosis (AOD) at the global level, it has not declined uniformly, and marked disparities are documented by income, education, race, and access to health care. Objectives: The objectives of the study are to examine the urban/rural disparities in the initial age of autism diagnosis and to understand the interplay of the underlying demographic and social factors. Methods: A retrospective case record review of all children who received their initial diagnosis of autism at the Pediatric Psychology Clinic (1997-2018) of a tertiary advanced pediatric center at Chandigarh was conducted. A structured abstraction data form was used to extract demographic, socioeconomic, and clinical information from the files maintained at the clinic. Results: A total of 1321 case records were examined. The mean AOD was 4.62 years (standard deviation = 2.38) and children from rural communities were diagnosed at 4.87 years, nearly 0.35 years later than urban children (t = 2.47, P = 0.013). Results indicated that 31.1% of the variance in the AOD for children from rural areas was predicted by two variables, namely the number of children in the family and total Childhood Autism Rating Scale (CARS) score (F = 13.62, P = 0.001). For the urban sample, three variables emerged as significant predictors including the number of children in the family, total CARS score, and maternal education and these together explained 20.2% of the variance in the AOD (F = 19.60, P = 0.001). Conclusion: The public health system must be sensitized to the unmet needs of the marginalized socioeconomic groups to access diagnostic and management services in a timely manner.


Assuntos
Transtorno do Espectro Autista , Transtorno Autístico , Transtorno do Espectro Autista/diagnóstico , Transtorno do Espectro Autista/epidemiologia , Criança , Humanos , Índia/epidemiologia , Estudos Retrospectivos , População Rural , Fatores Socioeconômicos
3.
Res Dev Disabil ; 128: 104299, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35820265

RESUMO

BACKGROUND: Sleep problems are common in children with autism spectrum disorder (autism). There is sparse research to date to examine whether insomnia in people with autism is related to autism genetics or insomnia genetics. Moreover, there is a lack of research examining whether circadian-rhythm related genes share potential pathways with autism. AIMS: To address this research gap, we tested whether polygenic scores of insomnia or autism are related to risk of insomnia in people with autism, and whether the circadian genes are associated with insomnia in people with autism. METHODS AND PROCEDURES: We tested these questions using the phenotypically and genotypically rich MSSNG dataset (N = 1049) as well as incorporating in the analyses data from the Vanderbilt University Biobank (BioVU) (N = 349). OUTCOMES AND RESULTS: In our meta-analyzed sample, there was no evidence of associations between the polygenic scores (PGS) for insomnia and a clinical diagnosis of insomnia, or between the PGS of autism and insomnia. We also did not find evidence of a greater burden of rare and disruptive variation in the melatonin and circadian genes in individuals with autism and insomnia compared to individuals with autism without insomnia. CONCLUSIONS AND IMPLICATIONS: Overall, we did not find evidence for strong effects of genetic scores influencing sleep in people with autism, however, we cannot rule out the possibility that smaller genetic effects may play a role in sleep problems. Our study indicated the need for a larger collection of data on sleep problems and sleep quality among people with autism.


Assuntos
Transtorno do Espectro Autista , Melatonina , Distúrbios do Início e da Manutenção do Sono , Transtornos do Sono-Vigília , Transtorno do Espectro Autista/complicações , Transtorno do Espectro Autista/epidemiologia , Transtorno do Espectro Autista/genética , Criança , Ritmo Circadiano/genética , Humanos , Sono , Distúrbios do Início e da Manutenção do Sono/complicações , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Distúrbios do Início e da Manutenção do Sono/genética , Transtornos do Sono-Vigília/complicações
4.
Autism Res ; 15(8): 1447-1456, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35809003

RESUMO

Survey-based research with recruitment through online channels is a convenient way to obtain large samples and has recently been increasingly used in autism research. However, sampling from online channels may be associated with a high risk of sampling bias causing findings not to be generalizable to the autism population. Here we examined autism studies that have sampled on social media for markers of sampling bias. Most samples showed one or more indicators of sampling bias, in the form of reversed sex ratio, higher employment rates, higher education level, lower fraction of individuals with intellectual disability, and later age of diagnosis than would be expected when comparing with for example population study results from published research. Findings from many of the included studies are therefore difficult to generalize to the broader autism population. Suggestions for how research strategies may be adapted to address some of the problems are discussed. LAY SUMMARY: Online surveys offer a convenient way to recruit large numbers of participants for autism research. However, the resulting samples may not fully reflect the autism population. Here we investigated the samples of 36 autism studies that recruited participants online and found that the demographic composition tended to deviate from what has been reported about the autism population in previous research. The results may thus not be generalizable to autism in general.


Assuntos
Transtorno do Espectro Autista , Transtorno Autístico , Deficiência Intelectual , Mídias Sociais , Transtorno do Espectro Autista/epidemiologia , Humanos , Deficiência Intelectual/epidemiologia , Inquéritos e Questionários
5.
Autism Res ; 15(8): 1482-1494, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35790084

RESUMO

Previous research has indicated that autistic adults experience higher rates of co-occurring mental health difficulties and poorer quality of life (QoL) than their non-autistic peers. Little is known, however, about these aspects in older age or whether younger and older autistic adults experience similar patterns This cross-sectional study investigated potential age-related effects on autism symptoms, self-reported mental health, and QoL in younger and older autistic adults (n = 79, aged 19-71 years) compared to a non-autistic control group (n = 57) matched for gender, age and IQ. Results showed that autistic adults had higher levels of self-reported autism symptoms and poorer QoL than controls. There were no significant age effects on autism symptoms or on most self-rated mental health symptoms. However, significantly more autistic adults in the younger versus older group scored above the clinical threshold for anxiety, somatoform disorders and eating disorders. Older autistic adults rated social QoL as significantly better than younger autistic adults; there was no significant age difference in the control group. Self-reported QoL was best predicted by self-ratings of severity of depressive symptoms in both groups. Further research is needed to track autism and co-occurring mental health symptomatology across the lifespan, so that service provision can be tailored accordingly. LAY SUMMARY: Young autistic adults have reported more psychological difficulties and poorer quality of life (QoL) than the general population. We investigated whether these difficulties continue into older age. Autism symptoms and mental health problems were common in autistic adults, with no difference between age groups, except for anxiety, physical and eating problems. Although QoL was poorer in both younger and older autistic compared to non-autistic adults, older autistic adults reported better social QoL than those who were younger.


Assuntos
Transtorno do Espectro Autista , Transtorno Autístico , Adulto , Envelhecimento , Transtorno do Espectro Autista/complicações , Transtorno do Espectro Autista/epidemiologia , Transtorno do Espectro Autista/psicologia , Transtorno Autístico/complicações , Transtorno Autístico/epidemiologia , Transtorno Autístico/psicologia , Estudos Transversais , Humanos , Saúde Mental , Qualidade de Vida/psicologia
6.
AMIA Annu Symp Proc ; 2022: 456-465, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35854759

RESUMO

Autism is among the most common neurodevelopmental conditions. Timely diagnosis and access to therapeutic resources are essential for positive prognoses, yet long queues and unevenly dispersed resources leave many untreated. Without granular estimates of autism prevalence by geographic area, it is difficult to identify unmet needs and mechanisms to address them. Mining a dataset of 53M children using meaningful geographic regions, we computed autism prevalence across the country. We then performed comparative analysis against 50,000 resources to identify the type and extent of gaps in access to autism services. We find a steady increase in autism diagnoses from K-5, supporting delayed diagnosis of autism, and consistent under-diagnosis of females. We find a significant inverse relationship between prevalence and availability of resources (p < 0.001). While more work is needed to characterize additional trends including racial and ethnicity-based disparities, the identification of resource gaps can direct and prioritize new innovations.


Assuntos
Transtorno do Espectro Autista , Transtorno Autístico , Transtorno do Espectro Autista/diagnóstico , Transtorno do Espectro Autista/epidemiologia , Transtorno do Espectro Autista/terapia , Transtorno Autístico/diagnóstico , Transtorno Autístico/epidemiologia , Transtorno Autístico/terapia , Criança , Atenção à Saúde , Etnicidade , Feminino , Humanos , Informática , Prevalência , Estados Unidos/epidemiologia
7.
Nutrients ; 14(14)2022 Jul 14.
Artigo em Inglês | MEDLINE | ID: mdl-35889852

RESUMO

Autism spectrum disorder (ASD) is a developmental disorder of variable severity, characterized by difficulties in social interaction, communication, and restricted or repetitive patterns of thought and behavior. In 2018, the incidence of ASD was 2.4 times higher than estimated in 2000. Behavior and brain development abnormalities are present in the complex disorder of ASD. Nutritional status plays a key role in the incidence and severity of the core symptoms of ASD. The aim of this study was to review the available peer-reviewed studies that evaluated the relationship between amino acids, choline, B vitamins, and ASD incidence and/or severity of symptoms. Through examining plasma profiles, urine samples, and dietary intake, researchers found that low choline, abnormal amino acid, and low B vitamin levels were present in children with ASD compared to those without ASD. The evidence supports the need for future research that implements simultaneous supplementation of all essential nutrients in individuals with ASD and among prenatal mothers. Future evidence could lead to scientific breakthroughs, ultimately reducing the rates of ASD incidence and severity of symptoms by applying nutritional interventions in at-risk populations.


Assuntos
Transtorno do Espectro Autista , Complexo Vitamínico B , Aminoácidos , Transtorno do Espectro Autista/diagnóstico , Transtorno do Espectro Autista/epidemiologia , Criança , Colina , Suplementos Nutricionais , Feminino , Humanos , Incidência , Gravidez
8.
Transl Psychiatry ; 12(1): 270, 2022 07 09.
Artigo em Inglês | MEDLINE | ID: mdl-35810183

RESUMO

Alterations in tryptophan and serotonin have been implicated in various mental disorders; but studies are limited on child neurodevelopmental disabilities such as autism spectrum disorder (ASD) and attention-deficit hyperactivity disorder (ADHD). This prospective cohort study examined the associations between levels of tryptophan and select metabolites (5-methoxytryptophol (5-MTX), 5-hydroxytryptophan (5-HTP), serotonin, N-acetyltrytophan) in cord plasma (collected at birth) and physician-diagnosed ASD, ADHD and other developmental disabilities (DD) in childhood. The study sample (n = 996) derived from the Boston Birth Cohort, which included 326 neurotypical children, 87 ASD, 269 ADHD, and 314 other DD children (mutually exclusive). These participants were enrolled at birth and followed-up prospectively (from October 1, 1998 to June 30, 2018) at the Boston Medical Center. Higher levels of cord 5-MTX was associated with a lower risk of ASD (aOR: 0.56, 95% CI: 0.41, 0.77) and ADHD (aOR: 0.79, 95% CI: 0.65, 0.96) per Z-score increase, after adjusting for potential confounders. Similarly, children with cord 5-MTX ≥ 25th percentile (vs. <25th percentile) had a reduction in ASD (aOR: 0.27, 95% CI: 0.14, 0.49) and ADHD risks (aOR: 0.45, 95% CI: 0.29, 0.70). In contrast, higher levels of cord tryptophan, 5-HTP and N-acetyltryptophan were associated with higher risk of ADHD, with aOR: 1.25, 95% CI: 1.03, 1.51; aOR: 1.32, 95% CI: 1.08, 1.61; and aOR: 1.27, 95% CI: 1.05, 1.53, respectively, but not with ASD and other DD. Cord serotonin was not associated with ASD, ADHD, and other DD. Most findings remained statistically significant in the sensitivity and subgroup analyses.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade , Transtorno do Espectro Autista , 5-Hidroxitriptofano/química , 5-Hidroxitriptofano/metabolismo , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Transtorno do Espectro Autista/diagnóstico , Transtorno do Espectro Autista/epidemiologia , Criança , Sangue Fetal , Humanos , Recém-Nascido , Estudos Prospectivos , Triptofano/química , Triptofano/metabolismo
9.
Rev Paul Pediatr ; 41: e2021220, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35830161

RESUMO

OBJECTIVE: To assess the association between peripartum events and autism spectrum disorder (ASD) development in children and adolescents. METHODS: The current research is a case-control study in northern Minas Gerais state, Brazil. The inclusion criteria in the case group included individuals whose medical records reported an autistic disorder diagnosis, individuals had this diagnosis further confirmed by Northern Minas Autistic Support Association and specialized clinics, and their mothers had to answer positively to the question: "Was your child diagnosed with autism spectrum disorder?" in the data collection instrument. Thus, the case group included 253 mothers of children/adolescents of 2-15 years old diagnosed with autism. The inclusion criteria in the control group included 852 individuals belonging to the same age group and enrolled in the same schools as the case group. A semi-structured questionnaire was applied for mothers of children/adolescents, and the multiple logistic regression model was adopted for data analysis. Gross and adjusted Odds Ratios (ORa) were used to estimate the magnitude of the associations. RESULTS: Autistic disorder was associated with the presence of meconium in amniotic fluid (AF) (ORa 1.67; 95% confidence interval [95%CI] 1.06-2.65) and cesarean delivery type (ORa 1.65; 95%CI 1.17-2.32). Emergency cesarean section increased autistic disorder development likelihood (ORa 2.38; 95%CI 1.61-3.51). Children and adolescents with ASD were more likely to have been exposed to two or more unfavorable peripartum events and obstetric complications than control groups (ORa 1.59; 95%CI 1.01-2.51). CONCLUSIONS: Meconium stained amniotic fluid, delivery by cesarean, and two or more unfavorable peripartum events are variables that should be considered in studies about ASD etiology.


Assuntos
Transtorno do Espectro Autista , Transtorno Autístico , Adolescente , Transtorno do Espectro Autista/epidemiologia , Transtorno do Espectro Autista/etiologia , Transtorno Autístico/complicações , Estudos de Casos e Controles , Cesárea , Criança , Pré-Escolar , Feminino , Humanos , Período Periparto , Gravidez
10.
Rev Paul Pediatr ; 41: e2021262, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35830165

RESUMO

OBJECTIVE: To translate and validate the Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F) from English to Brazilian Portuguese, taking transcultural differences into account. METHODS: Permission for the translation was obtained from the author of the scale. Translation and back-translation were performed, and the document was then assessed for reference and general equivalence. Specialists in childhood autism evaluated the scale. A preliminary version was prepared and pre-tested in a sample population, and a final version was validated with the target population. RESULTS: Only one question had issues relating to referential equivalence. The 10 individuals questioned in the pre-test all understood most of the instrument, although some suggested substituting certain terms to improve comprehension. The final version was reached following inclusion of pertinent suggestions and was submitted to validation with the target population, indicating a sensitivity of 88.2% for a cutoff point greater than 2 points. CONCLUSIONS: A Brazilian version of the M-CHAT-R/F scale, approved by specialists and understandable by the target audience, is now available for use.


Assuntos
Transtorno do Espectro Autista , Transtorno Autístico , Transtorno do Espectro Autista/diagnóstico , Transtorno do Espectro Autista/epidemiologia , Brasil , Lista de Checagem , Humanos , Programas de Rastreamento , Inquéritos e Questionários
11.
Mymensingh Med J ; 31(3): 758-766, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35780361

RESUMO

Sleep problems are commonly seen in children with Autism Spectrum Disorder (ASD). According to previous research, sensory problems and anxiety may be related to the development and maintenance of sleep problems in children with ASD. To determine pattern and severity sleep disturbance in children with autism spectrum disorder. This descriptive cross sectional study was done in Institute of Paediatric Neuro-disorder and Autism (IPNA) and Department of Paediatric Neurology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from October 2017 to September 2018. A total of 59 children aged 3 to 15 year who were diagnosed as ASD according to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) were enrolled in this study. Sleep disturbances were recorded in the standard questionnaire. The mean age was 49.78±20.69 months and male to female ratio was almost 4:1. More than two third (69.2%) patients had sleep awakening in mild, 7(36.8%) in moderate autism spectrum disorder. The difference was statistically significant (p<0.05) among three groups. More than half (56.4%) patients had sleep starting 12 am to 2 am in mild, 3(15.8%) in moderate autism spectrum disorder. The difference was statistically significant (p<0.05) among three groups. Sleep awakening and sleep starting time were significantly associated with autism spectrum disorder.


Assuntos
Transtorno do Espectro Autista , Transtornos do Sono-Vigília , Transtorno do Espectro Autista/complicações , Transtorno do Espectro Autista/diagnóstico , Transtorno do Espectro Autista/epidemiologia , Bangladesh/epidemiologia , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Masculino , Sono , Transtornos do Sono-Vigília/complicações , Transtornos do Sono-Vigília/etiologia
12.
Artigo em Inglês | MEDLINE | ID: mdl-35830739

RESUMO

Objective: Despite scientific evidence to the contrary, parental concerns with respect to the association between vaccination and development of autism spectrum disorder persist. The objective of this study was to assess the vaccination uptake and its associated factors in siblings of children with developmental delay.Methods: This cross-sectional study was conducted from December 2017 to February 2018. The families of children with developmental delay, according to evaluation by a psychiatrist per ICD-10 criteria, were recruited from 3 child development centers. The data were collected using a semistructured questionnaire.Results: 189 families with children with developmental delay were recruited into the study. In total, these children had 114 typically developing elder siblings and 50 typically developing younger siblings. The proportions of overall complete vaccination among the children with developmental delay group and the younger sibling group were significantly lower than the older sibling group (P < .01). The proportions of MMR (mumps, measles, and rubella) vaccination among the children with developmental delay group and the younger sibling group were significantly lower than the older sibling group (P < .001).Conclusions: Findings from this study suggest that reduced vaccination uptake is a general trend in families of children with developmental delay. Such a significant decline in the vaccination rate in this group of children will make them vulnerable if outbreaks occur. Therefore, public health strategies targeted to improve vaccination rates in families of children with developmental delay are needed.


Assuntos
Transtorno do Espectro Autista , Irmãos , Idoso , Transtorno do Espectro Autista/epidemiologia , Criança , Estudos Transversais , Humanos , Índia , Vacinação
13.
Indian Pediatr ; 59(7): 581-582, 2022 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-35869879

RESUMO

We reviewed the medical records of our pediatric ophthalmology and strabismus clinic of our hospitals for the period 1 January, 2009 to 31 December, 2018, to identify children with autism spectrum disorder (ASD). We found that refractive errors (62%) and strabismus (63%) were the most common ocular manifestations in children with ASD. With timely management, amblyopia and strabismus could have favorable outcome. As amblyopia was significantly associated with intellectual disability (P=0.02), early ophthalmic monitoring via multidisciplinary approach is warranted.


Assuntos
Transtorno do Espectro Autista , Ambliopia/epidemiologia , Ambliopia/terapia , Transtorno do Espectro Autista/complicações , Transtorno do Espectro Autista/epidemiologia , Criança , Humanos , Erros de Refração/epidemiologia , Estudos Retrospectivos , Estrabismo/epidemiologia , Estrabismo/terapia
14.
Ital J Pediatr ; 48(1): 112, 2022 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-35804408

RESUMO

BACKGROUND: Autism spectrum disorder (ASD) is one of the serious developmental disorders that is usually diagnosed below the age of three years. Although the severity of the disease's symptoms varies from patient to patient, the ability to communicate with others is affected in all forms of ASD. This study aimed to determine the prevalence of ASD in high-risk groups by continent. METHODS: The present study was conducted by systematic review and meta-analysis from 2008 to July 2021. Databases such as Science Direct, PubMed, Scopus, SID, Magiran, Web of Science (WoS), and Google Scholar from 2008 to July 2021 were searched to find related studies. Data were analysed using Comprehensive Meta-Analysis software (Version 2). RESULTS: A total of 74 studies with 30,212,757 participants were included in this study. The prevalence of ASD in the world was 0.6% (95% confidence interval: 0.4-1%). Subgroup analyses indicated that the prevalence of ASD in Asia, America, Europe, Africa and Australia was 0.4% (95% CI: 0.1-1), 1% (95% CI: 0.8-1.1), 0.5% (95% CI: 0.2-1), 1% (95% CI: 0.3-3.1), 1.7% (95% CI: 0.5-6.1) respectively. CONCLUSION: ASD imposes a heavy health burden on communities around the world. Early detection of ASD can reduce the incidence of developmental disorders and improve patients' communication skills. Therefore, health policymakers need to be aware of the prevalence and increasing trend of ASD to implement appropriate planning and interventions to reduce its consequences.


Assuntos
Transtorno do Espectro Autista , Transtorno do Espectro Autista/diagnóstico , Transtorno do Espectro Autista/epidemiologia , Transtorno do Espectro Autista/etiologia , Pré-Escolar , Europa (Continente) , Humanos , Prevalência
15.
Autism Res ; 15(8): 1560-1564, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35670304

RESUMO

Due to uncertainties associated with the COVID-19 public health crisis, several clinical trials had to be withdrawn or postponed. Our investigation aimed to assess the rate of discontinuation of clinical trials focusing on Autism Spectrum Disorder. Of the 197 registered trials included in our systematic review, 15 (7.6%) were discontinued, with nearly half of these explicitly citing COVID-19 as their reason for discontinuation. Pharmacological trials were six times more likely to be discontinued during the pandemic than non-pharmacological studies. The difference between the likelihood of discontinuation was statistically significant (OR: 6.13; 95% CI: 1.22-30.71). There was no evidence of association between funding source and reasons for discontinuation. Limitations, along with implications for future trials are discussed. LAY SUMMARY: We investigated the impact of the COVID-19 pandemic on the discontinuation rate of autism clinical trials. We found that drug trials were six times more likely to be discontinued during the pandemic compared to behavioral, diagnostic, and nutritional trials. The overall discontinuation rate was notably lower in autism clinical trials than in other areas of medical research. We recommend an examination of the methodology of the continued autism trials to assess their applicability in other fields.


Assuntos
Transtorno do Espectro Autista , Transtorno Autístico , COVID-19 , Transtorno do Espectro Autista/epidemiologia , Transtorno Autístico/epidemiologia , Estudos Transversais , Humanos , Pandemias
16.
J Clin Psychiatry ; 83(3)2022 05 30.
Artigo em Inglês | MEDLINE | ID: mdl-35649168

RESUMO

Between 0.3%-4.6% of women use antipsychotic (AP) drugs during pregnancy. Two large, retrospective, population-based cohort studies, conducted in Nordic countries and in the US, examined the risk of neurodevelopmental disorders (NDDs) following gestational exposure to APs. The Nordic study found that, in unadjusted analyses, exposure to APs during pregnancy was associated with increased risk of attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) in offspring; that the risk all but disappeared after adjusting for covariates; and that the risk appeared to be related to maternal major mental illness rather than to gestational exposure to APs. The US study also found that, in unadjusted analyses, gestational exposure to APs was associated with an increased risk of almost all of the study-specified NDDs in offspring; however, after adjusting for covariates, the risks were no longer meaningfully increased and, importantly, were no longer statistically significant for ADHD and ASD. Thus, these 2 studies suggest that gestational exposure to APs is a marker of NDD risk in offspring rather than a potential cause. Whereas a small but significantly increased risk was identified for aripiprazole in the US study, the signal was inconsistent across analyses, and confounding due to maternal mental illness was not ruled out. Previous studies have suggested that the use of APs during pregnancy is not associated with an increased risk of major congenital malformations and other adverse gestational outcomes. Considering the potential harm and suffering associated with major mental illness and the very low risks associated with AP use during pregnancy, initiation or continuation of APs appears to carry a favorable risk-benefit ratio in pregnant women who need these drugs; however, decision-making should be shared between patients, their caregivers, and the treating team.


Assuntos
Antipsicóticos , Transtorno do Deficit de Atenção com Hiperatividade , Transtorno do Espectro Autista , Efeitos Tardios da Exposição Pré-Natal , Antipsicóticos/efeitos adversos , Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Transtorno do Deficit de Atenção com Hiperatividade/etiologia , Transtorno do Espectro Autista/induzido quimicamente , Transtorno do Espectro Autista/complicações , Transtorno do Espectro Autista/epidemiologia , Feminino , Humanos , Gravidez , Resultado da Gravidez/epidemiologia , Efeitos Tardios da Exposição Pré-Natal/induzido quimicamente , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Estudos Retrospectivos
17.
Child Adolesc Psychiatr Clin N Am ; 31(3): 449-468, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35697395

RESUMO

Attention-deficit/hyperactivity disorder (ADHD) is the most frequent comorbid disorder that is observed at a higher rate and with greater morbidity in higher intellectually functioning populations with autism. Up to 85% of the populations with autism and 15% of individuals with ADHD suffer from a reciprocal comorbidity that is highly under-recognized in intellectually capable populations. Limited empirical evidence is available on the response of anti-ADHD agents in autism populations with ADHD. In autism spectrum disorder (ASD) populations, response to methylphenidate for the treatment of hyperactivity is worse than typically expected in the presence of the intellectual disability. The anti-ADHD response to atomoxetine in autism populations is worse than typically expected although tolerability is similar to that observed in the typicals. The hyperactivity response to guanfacine treatment in predominantly intellectually impaired populations with ASD is as robust as observed in the typicals although tolerability was worse than typically expected. Further trials are warranted to document the extent of atypical anti-ADHD response in intellectually capable populations with autism.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade , Transtorno do Espectro Autista , Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Transtorno do Espectro Autista/epidemiologia , Comorbidade , Humanos , Deficiência Intelectual/epidemiologia
18.
Front Public Health ; 10: 917563, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35712277

RESUMO

Previous studies indicate a role of immune disturbances during early development in the etiology of autism spectrum disorders (ASD). Any potential disturbances during fetal development are best addressed by prospective evaluation of maternal markers of inflammation. Previous studies have investigated maternal cytokines, a group of powerful effectors of the immune system, with inconsistent results. In this study, we aimed to clarify the relationship between maternal cytokines and ASD by evaluating levels of 17 cytokines in first trimester maternal serum samples, from 318 mothers to ASD-cases and 429 mothers to ASD-unaffected controls, nested within the register-based Stockholm Youth Cohort. Overall, we observed no consistent associations between levels of maternal cytokines and ASD. While we observed a number of individual associations, the patterns varied across the diagnostic sub-groups. Levels above the 90th percentile of IL-1ß (OR = 2.31, 95% CI 1.16-4.60), IL-7 (OR = 2.28, 95% CI 1.20-4.33), IL-13 (OR = 2.42, 95% CI 1.29-4.55), and MCP-1 (OR = 2.09, 95% CI 1.03-4.24) were associated with increased odds of ASD with co-occurring intellectual disability (ID), whereas GMCSF (OR = 2.06, 95% CI 1.03-4.11) and TNF-α (OR = 2.31, 95% CI 1.18-4.50) were associated with increased odds of ASD with ADHD but none survived correction for multiple comparisons. Also, none of the measured maternal cytokines were associated with ASD without co-occurring ID or ADHD. Implementing a data-driven approach using machine learning (Random Forest's Variable Importance measurement), we found no evidence to suggest that adding these cytokines and other markers of maternal immunity, to register-based maternal factors (e.g., psychiatric history) improves prediction of ASD. In summary, we found no robust evidence of an association between maternal immune markers during early pregnancy and ASD.


Assuntos
Transtorno do Espectro Autista , Deficiência Intelectual , Adolescente , Transtorno do Espectro Autista/epidemiologia , Biomarcadores , Estudos de Coortes , Citocinas , Feminino , Humanos , Deficiência Intelectual/complicações , Mães , Gravidez
19.
Sci Rep ; 12(1): 10914, 2022 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-35764687

RESUMO

Anxiety in children with autism spectrum disorder (ASD) negatively affects their social interactions, and quality of life. It is necessary to identify early risk factors for anxiety to tailor prevention and interventions. We aimed to examine the clinical level of anxiety in children with ASD from 5 to 10 years of age and identify potential early risk factors 3 years earlier. Participants were ASD children included in ELENA, a French prospective cohort. In this study, we used the collection of data at Time 1-T1 (at baseline) and Time 2-T2 (3 years after T1). Two groups were identified at T2 according to the threshold for anxiety on the CBCL: ASD-only group and ASD + anxiety group. Our results showed that half of the children in our sample had a clinical level of anxiety at T2. Regression analysis showed that greater ASD severity and lower sensory processing difficulties predicted lower anxiety, whereas higher levels of restricted and repetitive behaviours tended to predict higher levels of anxiety. The high prevalence of clinical-level anxiety in our sample suggests the need for specific assessment and targeted treatment of anxiety on a routine basis.


Assuntos
Transtorno do Espectro Autista , Transtornos de Ansiedade/epidemiologia , Transtorno do Espectro Autista/complicações , Transtorno do Espectro Autista/epidemiologia , Criança , Humanos , Estudos Prospectivos , Qualidade de Vida , Fatores de Risco
20.
Sci Rep ; 12(1): 9737, 2022 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-35697905

RESUMO

Adults with autism spectrum disorder (ASD) are at risk for excess bodyweight and hypertension, yet the prevalence of and clinical predictors for these health conditions remain unknown. The objective of this study was to assess the prevalence of overweight, obesity, and hypertension in a large clinical sample of adults with a confirmed diagnosis of ASD and to examine potential clinical predictors. This retrospective chart review study included adult subjects (≥ 20 years) with ASD who had been seen within the past 5 years at a multidisciplinary developmental disorders clinic. Data collected from the electronic health record included age, sex, race and ethnicity, cognitive ability, language ability, body mass index (BMI), hypertension, and use of second generation antipsychotic medications (SGAs). Of 622 adults with a confirmed diagnosis of ASD potentially eligible for the study, 483 (78%) had one or more notes in their records from the past 5 years. Those with recent notes were 23% female, 89% White, and had a mean (SD) age of 28.1 (7.1) years. Overall prevalence estimates for adults represented by this predominantly male, White, and young clinical sample were 28% (95% CI 24%, 32%) for overweight (BMI 25-29.9 kg/m2), 35% (95% CI 31%, 40%) for obesity (≥ 30 kg/m2), and 11% (95% CI 9%, 15%) for hypertension. Controlling for age and sex, intellectual disability (ID) was significantly associated with BMI (p = 0.003) but not hypertension (p = 0.69); those with moderate or more severe ID had a mean BMI that was 2.26 kg/m2 (95% CI 0.96, 3.57) lower than those with no ID. Controlling for age and sex, neither language ability, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) subtype of autism, nor past or current use of SGAs were significantly associated with BMI or hypertension. The study identified a high prevalence of overweight and obesity in adults with ASD consistent with the prevalence of these medical comorbidities in the U.S. population.


Assuntos
Transtorno do Espectro Autista , Hipertensão , Deficiência Intelectual , Adulto , Transtorno do Espectro Autista/epidemiologia , Feminino , Humanos , Hipertensão/epidemiologia , Deficiência Intelectual/epidemiologia , Masculino , Obesidade/complicações , Obesidade/epidemiologia , Sobrepeso/complicações , Sobrepeso/epidemiologia , Prevalência , Estudos Retrospectivos
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