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1.
Medicina (B Aires) ; 80 Suppl 2: 41-46, 2020.
Artigo em Espanhol | MEDLINE | ID: mdl-32150712

RESUMO

This article briefly presents the theoretical and practical background of Ayres Sensory Integration (ASI) and its application in autism spectrum disorder (ASD). Historical criticisms on the evidence of ASI as a therapeutic intervention are reviewed and contemporary evidence is presented. According to standards established by the Council for Exceptional Children (CEC), an international organization that develops criteria for categorizing evidence-based practices, ASI is an evidence-based practice.


Assuntos
Transtorno do Espectro Autista/psicologia , Transtorno do Espectro Autista/terapia , Terapia Ocupacional/métodos , Criança , Medicina Baseada em Evidências , Humanos , Plasticidade Neuronal/fisiologia , Reprodutibilidade dos Testes , Resultado do Tratamento
2.
Adv Neurobiol ; 24: 97-141, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32006358

RESUMO

Autism spectrum disorder (ASD) is a complex heterogeneous consortium of pervasive development disorders (PDD) which ranges from atypical autism, autism, and Asperger syndrome affecting brain in the developmental stage. This debilitating neurodevelopmental disorder results in both core as well as associated symptoms. Core symptoms observed in autistic patients are lack of social interaction, pervasive, stereotyped, and restricted behavior while the associated symptoms include irritability, anxiety, aggression, and several comorbid disorders.ASD is a polygenic disorder and is multifactorial in origin. Copy number variations (CNVs) of several genes that regulate the synaptogenesis and signaling pathways are one of the major factors responsible for the pathogenesis of autism. The complex integration of various CNVs cause mutations in the genes which code for molecules involved in cell adhesion, voltage-gated ion-channels, scaffolding proteins as well as signaling pathways (PTEN and mTOR pathways). These mutated genes are responsible for affecting synaptic transmission by causing plasticity dysfunction responsible, in turn, for the expression of ASD.Epigenetic modifications affecting DNA transcription and various pre-natal and post-natal exposure to a variety of environmental factors are also precipitating factors for the occurrence of ASD. All of these together cause dysregulation of glutamatergic signaling as well as imbalance in excitatory: inhibitory pathways resulting in glial cell activation and release of inflammatory mediators responsible for the aberrant social behavior which is observed in autistic patients.In this chapter we review and provide insight into the intricate integration of various genetic, epigenetic, and environmental factors which play a major role in the pathogenesis of this disorder and the mechanistic approach behind this integration.


Assuntos
Transtorno do Espectro Autista/genética , Transtorno do Espectro Autista/fisiopatologia , Epigênese Genética , Interação Gene-Ambiente , Transtorno do Espectro Autista/psicologia , Transtorno Autístico/genética , Transtorno Autístico/fisiopatologia , Transtorno Autístico/psicologia , Variações do Número de Cópias de DNA , Humanos
3.
Adv Neurobiol ; 24: 163-191, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32006360

RESUMO

Autism spectrum disorder (ASD) is characterized by impairment in behavior, communication, and social interaction. Thus, accurate identification, regular behavioral and other nonmedical interventions would improve the diagnosis, management, and treatment of this condition.In this chapter, we investigate the importance of diagnosing and identifying comorbid psychiatric disorders that occur with ASD as these conditions can often complicate treatment, and failure to recognize them can result in deficits that can persist into adolescence and adulthood. In addition, we explore the impact of comprehensive psychological intervention in ASD patients with comorbid psychiatric disorders with the ultimate goal of improving overall quality of life.


Assuntos
Transtorno do Espectro Autista/epidemiologia , Transtorno do Espectro Autista/psicologia , Transtornos Mentais/epidemiologia , Comorbidade , Humanos , Transtornos Mentais/psicologia
4.
Adv Neurobiol ; 24: 207-222, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32006362

RESUMO

Autism spectrum disorder (ASD) encompasses a cluster of neurodevelopmental and genetic disorders that has been characterized mainly by social withdrawal, repetitive behavior, restricted interests, and deficits in language processing mainly in children. ASD has been known to severely impair behavioral patterns and cognitive functions including learning and memory due to defects in neuroplasticity. The biology of the ASD appears to be highly complex and heterogeneous, and thus, finding a therapeutic target for autism remains obscure. There has been no complete prevention or disease-modifying cure for this disorder. Recently, individuals with autism have been characterized by reactive neurogenesis, obstructions in axonal growth, heterotopia, resulting from dysplasia of neuroblasts in different brain regions. Therefore, it can be assumed that the aforementioned neuropathological correlates seen in the autistic individuals might originate from the defects mainly in the regulation of neuroblasts in the developing as well as adult brain. Nutrient deficiencies during early brain development and intake of certain allergic foods have been proposed as main reasons for the development of ASD. However, the integrated understanding of neurodevelopment and functional aspects of neuroplasticity working through neurogenesis in ASD is highly limited. Moreover, neurogenesis at the level of neuroblasts can be regulated by nutrition. Hence, defects in neuroblastosis underlying the severity of autism potentially could be rectified by appropriate implementation of nutraceuticals.


Assuntos
Transtorno do Espectro Autista/dietoterapia , Transtorno do Espectro Autista/patologia , Suplementos Nutricionais , Plasticidade Neuronal/efeitos dos fármacos , Transtorno do Espectro Autista/fisiopatologia , Transtorno do Espectro Autista/psicologia , Encéfalo/efeitos dos fármacos , Encéfalo/patologia , Humanos
5.
Adv Neurobiol ; 24: 469-479, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32006368

RESUMO

Autism spectrum disorder (ASD) is an inherited neurodevelopmental disorder of social communication and restricted, repetitive behaviors. Much remains unknown about their mechanisms of action and physiological effects. In recent years, there has been a growing interest in nutritional diets, which can be used as a form of therapeutic intervention for ASD with a recent increase in the research being carried out in this field. Selective nutrition therapy for ASD and brain function shows improvement in behavioral changes and reduction in malnutrition seemingly associated with the allergies or food intolerances to gluten. Therefore, a gluten-free diet has yielded positive outcomes giving hope in developing therapy for ASD.


Assuntos
Transtorno do Espectro Autista/dietoterapia , Transtorno do Espectro Autista/imunologia , Dieta Livre de Glúten , Glutens/efeitos adversos , Glutens/imunologia , Transtorno do Espectro Autista/fisiopatologia , Transtorno do Espectro Autista/psicologia , Glutens/metabolismo , Humanos , Hipersensibilidade a Trigo/imunologia , Hipersensibilidade a Trigo/metabolismo
6.
Adv Neurobiol ; 24: 481-504, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32006369

RESUMO

Autism has been increasing dramatically since its description by Leo Kanner in 1943. The Centers for Disease Control and Prevention (CDC) in 2018 has identified 1 in 59 children (1 in 37 boys and 1 in 151 girls) has autism spectrum disorder (ASD). Autistic spectrum disorders and ADHD are complex conditions in which nutritional and environmental factors play major roles. It is important to understand how food can have an impact on their current and future health. Appealing food colors stimulate the consumption of different food products. Since 2011, it is evident that dyes are linked to harmful effects in children. Artificial dyes have neurotoxic chemicals that aggravate mental health problems. Many families with autistic children avoid food dyes in their diet in order to avoid behavioral issues. A study reported that there is a correlation between yellow dye and sleep disturbance. Food colors Blue 1 and 2, Green 3, Red 3, Yellow 5 and 6, Citrus Red 2, and Red 40 can trigger many behaviors in most kids. Artificial food color usually contains petroleum and is manufactured in a chemical process that includes formaldehyde, aniline, hydroxides, and sulfuric acids. Most impurities in the food color are in the form of salts or acids. Sometimes lead, arsenic, and mercury may be present as impurities. The U.S. FDA is yet to study the effects of synthetic dyes on behavior in children. A study conducted at Southampton University in England found a link between food dyes and hyperactive behavior in children. The research does not prove that food coloring actually causes autism spectrum disorder, but there seems to be a link. This chapter attempts to provide a broad review of the available literature on food color and the epidemiology, etiology, prevention, and treatment of autistic spectrum disorder.


Assuntos
Transtorno do Espectro Autista/induzido quimicamente , Transtorno do Espectro Autista/epidemiologia , Dieta/efeitos adversos , Corantes de Alimentos/efeitos adversos , Transtorno do Deficit de Atenção com Hiperatividade/induzido quimicamente , Transtorno do Deficit de Atenção com Hiperatividade/dietoterapia , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Transtorno do Espectro Autista/dietoterapia , Transtorno do Espectro Autista/psicologia , Criança , Dieta/estatística & dados numéricos , Feminino , Humanos , Masculino
7.
Adv Neurobiol ; 24: 505-523, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32006370

RESUMO

BACKGROUND: Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by core deficits in social interactions, verbal/nonverbal communication, and restricted, repetitive, and stereotyped behaviors. Children with ASD are known to have several feeding problems that are believed to affect their nutritional and health status. AIM: The present study was designed to assess the food preferences in Omani children diagnosed with ASD compared with controls. METHODS: A case-control study was conducted in which 375 children (males and females) aged between 4 and 13 years were recruited. The sample consisted of 163 children with ASD and a control group of 212 typically developing (TD) children. For each participant, demographic, anthropometric, and medical information and information regarding dietary intakes were gathered using the food frequency questionnaire (FFQ) to assess their food preferences. RESULTS: The sociodemographic characteristics of caregivers were similar in the two groups, while their perceptions based on several nutritional parameters were different. Children's age and body mass index (BMI) were similar in both groups, while the number of male children was higher in ASD group (P < 0.001). Problematic behaviors including food refusal and selectivity were significantly higher in ASD children than in TD children. Despite that, the children with ASD were found to consume mostly traditional Omani dishes. CONCLUSION: This is the first study that provides information on the eating habits and nutritional intake of Omani children diagnosed with ASD. The overall findings are promising and may contribute to further understanding of food preferences in children with ASD in Oman. Such information is highly valuable for the prevention and management of nutritional deficiencies among Omani children with autism by improving their diet quality.


Assuntos
Transtorno do Espectro Autista/epidemiologia , Transtorno do Espectro Autista/psicologia , Dieta/estatística & dados numéricos , Preferências Alimentares , Inquéritos Nutricionais , Adolescente , Estudos de Casos e Controles , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Omã/epidemiologia
8.
Adv Neurobiol ; 24: 535-545, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32006372

RESUMO

Along with the issues of inflated social and financial burden associated with autism spectrum disorder (ASD), specific treatment for this disorder has also not been developed. Having a thorough look at previous trials done to treat autism, we find that nutrition intervention had been used frequently as a complementary form of therapy. Indeed, an early diagnosis of nutrition deficiency and metabolic disorders done concomitantly with accurate therapeutic interventions can be a cornerstone for improving cognitive and behavioral aptitudes of people with autism. Several studies have showed that increasing the intake of specific nutrients can reduce the symptoms and comorbidities associated with autism. Consequently, nutrition intervention and appropriate supplementation can be crucial in managing and treating autism. This paper will discuss recent literature on the significance of metabolic aspects in autistic disorder and highlight the influence of nutrition intervention on the symptoms of autism.


Assuntos
Transtorno do Espectro Autista/dietoterapia , Transtorno do Espectro Autista/psicologia , Transtorno Autístico/dietoterapia , Transtorno Autístico/psicologia , Humanos
9.
Adv Neurobiol ; 24: 615-646, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32006377

RESUMO

Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder with symptoms ranging from lack of social interaction and communication deficits to rigid, repetitive, and stereotypic behavior. It has also been associated with comorbidities such as anxiety, aggression, epilepsy, deficit in sensory processing, as well as ADHD (attention deficit hyperactivity disorder). Apart from several behavioral and cognitive complications arising as a result of central nervous system dysfunction, there are various physiological comorbidities such as immune system deregulation, neuroinflammation, oxidative stress, mitochondrial dysfunction, and gastrointestinal complications which can worsen existing behavioral complications. There are no available treatments for these physiological comorbidities. The prevalence of gastrointestinal complications in ASD ranges from 9% to 70% and it correlates with behaviors consistent with the autistic endophenotype indicating that these are one of the major comorbidities associated with ASD. A strong connection of gut-brain cross talk occurs as a result of gut dysbiosis responsible for excessive production of short-chain fatty acids such as propanoic acid (PPA) by abnormal gut flora in ASD patients. This worsens behavioral, neurochemical, and mitochondrial dysfunction occurring in ASD. These physiological comorbidities are responsible for the generation of free radical species that cause immune system dysfunction leading to synthesis of various pro-inflammatory cytokines and chemokines. This in turn causes activation of microglia. Dietary phytochemicals are thought to be safer and useful as an alternative neurotherapeutic moiety. These compounds provide neuroprotection by modulating signaling pathways such as Nrf2, NF-κB, MAPK pathway or Sirtuin-FoxO pathway. There has been recent evidence in scientific literature regarding the modulation of gut-brain cross talk responsible for behavioral, biochemical, and mitochondrial dysfunction as well as cellular and behavioral sensory alterations by dietary phytochemicals such as curcumin, resveratrol, naringenin, and sulforaphane. These dietary phytochemicals can be formulated in novel brain-targeted delivery systems which overcome their limitation of low oral bioavailability and short half-life leading to prolonged action. Till date, not much work has been done on the development of brain-targeted neurotherapeutics for ASD. In this chapter we discuss plausible mechanisms and evidence from our own and other scientific research for the utilization of curcumin, resveratrol, naringenin, and sulforaphane as neurotherapeutics for ASD.


Assuntos
Transtorno do Espectro Autista/dietoterapia , Transtorno do Espectro Autista/fisiopatologia , Compostos Fitoquímicos/administração & dosagem , Compostos Fitoquímicos/uso terapêutico , Transtorno do Espectro Autista/complicações , Transtorno do Espectro Autista/psicologia , Encéfalo/efeitos dos fármacos , Encéfalo/fisiopatologia , Trato Gastrointestinal/efeitos dos fármacos , Trato Gastrointestinal/fisiopatologia , Humanos
10.
Adv Neurobiol ; 24: 679-693, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32006380

RESUMO

Food selectivity by children with autism spectrum disorder (ASD) is relatively high as compared to typical children and consequently puts them at risk of nutritional inadequacies. Thus, there is a need to educate children with ASD on food types and their benefits in a simple and interesting manner that will encourage food acceptance and enable a move toward healthy living. The use of technological intervention has proven to be an effective tool for educating children with ASD in maintaining attention and mastering new skills as compared to traditional methods. Some of the popularly used technologies are computer-based intervention and robotics which do not support ecological validity (i.e., mimicking natural scenario). Consideration of natural factors is essential for better learning outcomes and generalized skills which can easily be incorporated into reality-based technologies such as virtual reality, augmented reality, and mixed reality. These technologies provide evidence-based support for ecological validation of intervention and sustaining the attention of children with ASD. The main objective of this study is to review existing reality-based technology intervention for children with ASD and investigate the following: (1) commonly used reality-based technology, (2) types of intervention targeted with reality-based technology, and (3) what subjects' inclusion types are used in the reality-based interventions. These objective statements have guided our recommendation of reality-based technology that can support ecological validity of food intake intervention.


Assuntos
Transtorno do Espectro Autista/dietoterapia , Transtorno do Espectro Autista/psicologia , Ingestão de Alimentos/psicologia , Preferências Alimentares , Realidade Virtual , Criança , Humanos , Aprendizagem , Robótica
11.
Rev Med Suisse ; 16(681): 310-313, 2020 Feb 12.
Artigo em Francês | MEDLINE | ID: mdl-32049452

RESUMO

For the purpose of improving the management of somatic disorders among patients suffering from severe intellectual development and autism spectrum disorders, a specific admissions mechanism has been implemented at Geneva University Hospitals (HUG). The Adult Psychiatric Hospital Unit (UPHA), a complex intervention unit, collaborates with HUG's Disability Program. From May 2018 to May 2019, 29 requests for hospitalizations were accepted. These requests primarily originated from private practice physicians (42 %). In some cases, immediate admissions were urgently organized, and in others a 13-day waiting period was imposed. Hospitalizations were adapted to the patient: more often than not, these were short (48 %), with 6 hospitalizations extended for an average 103-day period. A clinical case illustrates the healthcare management provided.


Assuntos
Transtorno do Espectro Autista/psicologia , Transtorno do Espectro Autista/terapia , Deficiência Intelectual/psicologia , Deficiência Intelectual/terapia , Adulto , Pessoas com Deficiência/psicologia , Hospitalização , Humanos , Suíça
12.
Dev Neurorehabil ; 23(1): 31-38, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31684786

RESUMO

Background: Childhood overweight and obesity, in addition to weight stigma, can result in numerous physical and psychosocial conditions. Children with Autism Spectrum Disorder (ASD) are at a higher risk of developing overweight/obesity than their typically developing peers, yet we know little about what matters to them with regards to weight and their bodies.Methods: Eight semi-structured interviews were conducted with youth with ASD. Interviews were transcribed and analyzed using a phenomenological approach within an interpretive paradigm.Results: Participants mostly showed little concern about their weight. Participants highly valued moving their bodies and reported feeling good about their bodies.Discussion: Findings suggest that children with ASD may be more engaged in healthcare discussions focusing on growth and health rather than size and weight. This approach can also reduce stigmatizing discussions.


Assuntos
Atitude , Transtorno do Espectro Autista/psicologia , Obesidade Pediátrica/psicologia , Adolescente , Criança , Exercício , Feminino , Humanos , Masculino
13.
Artigo em Inglês | MEDLINE | ID: mdl-31847476

RESUMO

Autism spectrum disorder (ASD) is a neurodevelopmental disorder that is characterized by impaired social interaction, communication and restricted and repetitive behavior. Few studies have focused on the effect of facial emotion recognition on bullying involvement among individuals with ASD. The aim of this study was to examine the association between facial emotion recognition and different types of bullying involvement in adolescents with high-functioning ASD. We recruited 138 adolescents aged 11 to 18 years with high-functioning ASD. The adolescents' experiences of bullying involvement were measured using the Chinese version of the School Bullying Experience Questionnaire. Their facial emotion recognition was measured using the Facial Emotion Recognition Task (which measures six emotional expressions and four degrees of emotional intensity). Logistic regression analysis was used to examine the association between facial emotion recognition and different types of bullying involvement. After controlling for the effects of age, gender, depression, anxiety, inattention, hyperactivity/impulsivity and opposition, we observed that bullying perpetrators performed significantly better on rating the intensity of emotion in the Facial Emotion Recognition Task; bullying victims performed significantly worse on ranking the intensity of facial emotion. The results of this study support the different deficits of facial emotion recognition in various types of bullying involvement among adolescents with high-functioning ASD. The different directions of association between bully involvement and facial emotion recognition must be considered when developing prevention and intervention programs.


Assuntos
Transtorno do Espectro Autista/psicologia , Bullying , Emoções , Reconhecimento Facial , Adolescente , Criança , Feminino , Humanos , Masculino , Inquéritos e Questionários
14.
Yakugaku Zasshi ; 139(11): 1391-1396, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-31685735

RESUMO

Over the last decade there has been an increase in the prevalence of autism spectrum disorder (ASD); however, its pathogenic mechanisms remain unclear. To date, no effective drug has been developed to treat the core symptoms of ASD, especially social interaction deficits. Previous studies have mainly focused on the glutamatergic, GABAergic, and serotonergic signaling pathways; however, a growing number of studies have reported abnormalities in the dopaminergic pathway, such as mutations and functional alterations of dopamine-related molecules, in ASD patients. Furthermore, atypical antipsychotic drugs risperidone and aripiprazole are prescribed for the treatment of non-core symptoms, such as irritability, in patients with ASD. These observations suggest that the dopaminergic pathway is involved in the pathogenesis of ASD. Previously, we have established a mouse model of ASD based on clinical research, which shows that exposure to valproic acid, an antiepileptic drug, during pregnancy causes an increase in the risk of developing ASD in children. This review summarizes our recent studies, which have assessed alterations in the prefrontal dopaminergic pathway. In addition, we discuss the effects of treatment with attention deficit/hyperactivity disorder drugs and atypical antipsychotic drugs, which activate the prefrontal dopaminergic pathway, on ASD-like behavioral abnormalities in the valproic acid exposure mouse model of ASD.


Assuntos
Anticonvulsivantes/efeitos adversos , Transtorno do Espectro Autista/etiologia , Transtorno do Espectro Autista/psicologia , Comportamento , Dopamina/metabolismo , Dopamina/fisiologia , Vias Neurais/fisiologia , Efeitos Tardios da Exposição Pré-Natal , Ácido Valproico/efeitos adversos , Animais , Antipsicóticos/farmacologia , Antipsicóticos/uso terapêutico , Transtorno do Espectro Autista/tratamento farmacológico , Modelos Animais de Doenças , Feminino , Humanos , Masculino , Camundongos , Vias Neurais/efeitos dos fármacos , Córtex Pré-Frontal/metabolismo , Gravidez , Risco
16.
BMC Psychol ; 7(1): 74, 2019 Nov 27.
Artigo em Inglês | MEDLINE | ID: mdl-31775887

RESUMO

BACKGROUND: Prioritization of the processing of threatening stimuli induces deleterious effects on task performance. However, emotion evoked by viewing images of snakes exerts a facilitating effect upon making judgments of their color in neurotypical adults and schoolchildren. We attempted to confirm this in school and preschool children with and without Autism Spectrum Disorder (ASD). METHODS: Forty French children participated and corresponded to two age groups: a group of schoolchildren and a group of preschool children, each group including 10 children with typical development and 10 children with ASD. Each participant was exposed to 120 trials composed of 20 photographs of snakes and 20 photographs of flowers, each of which appeared 3 times (in red, green and blue). Participants were asked to indicate the color of each image as quickly as possible via key-press. A three-way analysis of variance test for reaction time (RT) considering image type (IMAGE), participant group (PARTICIPANT), and age (AGE) as main effects and its interaction terms was performed for each subject. RESULTS: When the reaction time required to respond to presented stimuli was measured, schoolchildren tended to respond faster when stimuli were snake images than when stimuli were flower images whether the children had or did not have ASD. For the 5-to-6-year-old preschool participants, the difference between reaction time for the color-naming of snake images and flower images was ambiguous overall. CONCLUSIONS: There were possible odd color-specific effects in children with ASD when images were presented to the children in green. Implications of the findings are argued with respect to active avoidance or attraction as one of the behavioral characteristics commonly noted in children with ASD.


Assuntos
Transtorno do Espectro Autista/psicologia , Cognição/fisiologia , Medo/psicologia , Serpentes , Análise e Desempenho de Tarefas , Animais , Criança , Pré-Escolar , Emoções , Feminino , França , Humanos , Masculino , Tempo de Reação/fisiologia , Percepção Visual
18.
JAMA ; 322(16): 1561-1569, 2019 10 22.
Artigo em Inglês | MEDLINE | ID: mdl-31638682

RESUMO

Importance: Selective serotonin receptor inhibitors are prescribed to reduce the severity of core behaviors of autism spectrum disorders, but their efficacy remains uncertain. Objective: To determine the efficacy of fluoxetine for reducing the frequency and severity of obsessive-compulsive behaviors in autism spectrum disorders. Design, Setting, and Participants: Multicenter, randomized, placebo-controlled clinical trial. Participants aged 7.5-18 years with autism spectrum disorders and a total score of 6 or higher on the Children's Yale-Brown Obsessive Compulsive Scale, modified for pervasive developmental disorder (CYBOCS-PDD) were recruited from 3 tertiary health centers across Australia. Enrollment began November 2010 and ended April 2017. Follow-up ended August 2017. Interventions: Participants were randomized to receive fluoxetine (n = 75) or placebo (n = 71). Study medication was commenced at 4 or 8 mg/d for the first week, depending on weight, and then titrated to a maximum dose of 20 or 30 mg/d over 4 weeks. Treatment duration was 16 weeks. Main Outcomes and Measures: The primary outcome was the total score on the CYBOCS-PDD (scores range from 0-20; higher scores indicate higher levels of maladaptive behaviors; minimal clinically important difference, 2 points) at 16 weeks postrandomization, analyzed with a linear regression model adjusted for stratification factors (site, age at baseline, and intellectual disability), with an additional prespecified model that included additional adjustment for baseline score, sex, communication level, and imbalanced baseline and demographic variables. Results: Among the 146 participants who were randomized (85% males; mean age, 11.2 years), 109 completed the trial; 31 in the fluoxetine group and 21 in the placebo group dropped out or did not complete treatment. The mean CYBOCS-PDD score from baseline to 16 weeks decreased in the fluoxetine group from 12.80 to 9.02 points (3.72-point decrease; 95% CI, -4.85 to -2.60) and in the placebo group from 13.13 to 10.89 points (2.53-point decrease; 95% CI, -3.86 to -1.19). The between-group mean difference at 16 weeks was -2.01 (95% CI, -3.77 to -0.25; P = .03) (adjusted for stratification factors), and in the prespecified model with further adjustment, it was -1.17 (95% CI, -3.01 to 0.67; P = .21). Conclusions and Relevance: In this preliminary study of children and adolescents with autism spectrum disorders, treatment with fluoxetine compared with placebo resulted in significantly lower scores for obsessive-compulsive behaviors at 16 weeks. Interpretation is limited by the high dropout rate, null findings of prespecified analyses that accounted for potentially confounding factors and baseline imbalances, and CIs for the treatment effect that included the minimal clinically important difference. Trial Registration: anzctr.org.au Identifier: ACTRN12608000173392.


Assuntos
Transtorno do Espectro Autista/tratamento farmacológico , Fluoxetina/uso terapêutico , Transtorno Obsessivo-Compulsivo/tratamento farmacológico , Inibidores de Captação de Serotonina/uso terapêutico , Adolescente , Ansiedade/diagnóstico , Transtorno do Espectro Autista/psicologia , Criança , Feminino , Fluoxetina/efeitos adversos , Humanos , Masculino , Transtorno Obsessivo-Compulsivo/classificação , Gravidade do Paciente , Inibidores de Captação de Serotonina/efeitos adversos , Transtorno de Movimento Estereotipado/tratamento farmacológico , Resultado do Tratamento
19.
Psychiatr Danub ; 31(3): 333-339, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31596826

RESUMO

BACKGROUND: Early intervention for Autism Spectrum Disorder (ASD) in France is heterogeneous and poorly evaluated to date. Early Start Denver Model (ESDM) is a developmental and behavioral model of intervention for toddlers with ASD which has already shown very interesting outcomes on the development of children with ASD in various studies with different settings. However, it is not possible with the current research to agree on the best setting. Thus, we implemented an ESDM program according to our context where children are often pre-schooling early from 30 months old. This therapy was applied by a multidisciplinary team working in close collaboration with parents and other partners. SUBJECTS AND METHODS: A prospective observational study including 19 toddlers with ASD was conducted. We evaluated improvement on the cognitive level of toddlers with ASD receiving therapist-delivered ESDM intervention for 12 hours per week. RESULTS: Significant improvements in verbal and nonverbal cognitive skills at the Mullen Scale of Early Learning were obtained after 10 months of intervention in our sample. The largest improvement was in receptive language development quotient with a mean improvement of 19.6 points. We also observed promising outcomes in daily adaptive behavior, with a slight improvement in communication at the Vineland Adaptive Behavioral Scale. These outcomes, when compared to the conclusions of previous studies, are leading us to the need for a therapy duration beyond 10 months. CONCLUSIONS: Our outcomes were very encouraging even with low cognitive and nonverbal children. These outcomes may be confirmed in a multicenter randomized controlled trial that is ongoing.


Assuntos
Transtorno do Espectro Autista/psicologia , Transtorno do Espectro Autista/terapia , Pré-Escolar , Estudos de Viabilidade , Humanos , Estudos Multicêntricos como Assunto , Pais/psicologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Tempo
20.
Cogn Behav Neurol ; 32(3): 139-163, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31517698

RESUMO

There is face validity to the expectation that adults with level 3 autism spectrum disorder (ASD-3) will benefit from a range of psychoeducational interventions. This paper reviews the empirical evidence supporting the effectiveness of these interventions, many of which are currently used in clinical settings. We reviewed 56 peer-reviewed studies of psychoeducational interventions for adults with ASD-3, written in English and since 1968, that met our criteria. The reviewing team included educators, clinicians, researchers, and a biostatistician. The available literature was limited, and most, if not all, of the studies presented some significant methodological limitations. When using Cochrane's criteria to assess seven key outcome domains-activities of daily living, aggressive/destructive behaviors, emotional functioning, language/communication skills, self-injurious behaviors, stereotypy/mannerisms, and vocational skills-we found only moderately reliable evidence to support the effectiveness of interventions designed to improve emotional functioning in adults with ASD-3. The reliability of evidence relevant to the six other outcome domains was rated as low or very low. Based on this review, we suggest directions for future study of interventions for adults with ASD-3, including topics, subpopulations, and approaches that should be explored. We also propose some crucial changes in how future studies regarding this population should be designed, analyzed, and documented, while balancing clinical considerations with scientific/educational utility.


Assuntos
Transtorno do Espectro Autista/psicologia , Transtorno do Espectro Autista/terapia , Adulto , Feminino , Humanos , Masculino , Fatores de Tempo
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