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1.
Occup Ther Int ; 2022: 9693648, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36110198

RESUMO

This paper presents a research design for an integrated intervention using sensory integration training fused with social sports games for the treatment of children with autism. This study used a multiple baseline cross-subject design in a single-subject experiment, with structured play as the independent variable and expressive language skills of children with autism spectrum disorders as the dependent variable, with three phases of intervention: baseline, intervention period, and maintenance period. The expressive language ability was examined in terms of both oral expression and gestural expression, where the intervention effect of the oral expression was analyzed in terms of four components: the total number of words, the total number of sentences, average sentence length, and vocabulary complexity of oral expression, and the intervention effect of the gestural expression was analyzed in terms of changes in the frequency of children's gestural expression behaviors. For the categories classified by sensory integration ability, there are corresponding specific training programs that combine various physical exercises and play equipment to train the various abnormal functions of children with autism. Stereotyped behavior is a repetitive, self-imposed, and purposeless physical action, usually in the form of continuous and repetitive movements, sounds, and so on. 4 times a week, 25 minutes each time, the activity of recognizing pictures and familiar objects is carried out first, and then the children choose the structured game model and the initiative to build and take turns with the researchers to build. Stereotypic behaviors cause a great deal of distress in the lives of children with autism, and it is necessary to explore how to implement positive and effective interventions. Subjects' play abilities developed after receiving effective critical response training. The subjects' practice and symbolic play showed good immediate and maintenance intervention effectiveness; their associative and functional play showed no significant intervention effectiveness. The enhancement of the sensory integration skills of children with autism through sensory integration training resulted in a relative reduction of stereotypic behavior about the stimulus-seeking function, which had a positive effect on the intervention of stereotypic behavior.


Assuntos
Transtorno do Espectro Autista , Transtorno Autístico , Terapia Ocupacional , Transtorno do Espectro Autista/terapia , Transtorno Autístico/terapia , Criança , Humanos , Idioma , Terapia Ocupacional/métodos
2.
Ugeskr Laeger ; 184(33)2022 08 15.
Artigo em Dinamarquês | MEDLINE | ID: mdl-36065878

RESUMO

Autism spectrum disorder (ASD) is a neurodevelopmental disorder with a global prevalence of approximately 1%. This review summarises new evidence of association between bipolar disorder (BD) and ASD. The mood episodes of BD can present atypically in people with ASD, potentially leading to misdiagnosis. Anamnesis regarding family history of affective disorders as well as previous mood episode is important among people with ASD to capture the BD diagnosis. Precaution with SSRI-treatment among people with ASD is crucial as the treatment can potentially trigger a mood episode of an underlying BD.


Assuntos
Transtorno do Espectro Autista , Transtorno Bipolar , Transtorno do Espectro Autista/complicações , Transtorno do Espectro Autista/diagnóstico , Transtorno do Espectro Autista/terapia , Transtorno Bipolar/complicações , Transtorno Bipolar/diagnóstico , Transtorno Bipolar/tratamento farmacológico , Humanos , Transtornos do Humor/complicações , Transtornos do Humor/diagnóstico
3.
Zhonghua Wei Chang Wai Ke Za Zhi ; 25(9): 798-803, 2022 Sep 25.
Artigo em Chinês | MEDLINE | ID: mdl-36117371

RESUMO

Objective: To evaluate the efficacy and safety of fecal microbiota transplantation (FMT) in the treatment of autism spectrum disorder (ASD). Methods: A longitudinal study was conducted. Clinical data from ASD patients with gastrointestinal symptoms and who underwent FMT in the Tenth People's Hospital affiliated to Tongji University or Jinling Hospital between May 2012 to May 2021 were retrospectively collected. Scores derived from the autism behavior checklist (ABC), the childhood autism rating scale (CARS), the Bristol stool form scale (BSFS), and the gastrointestinal symptom rating scale (GSRS) were analyzed at baseline and at the 1st, 3rd, 6th, 12th, 24th, 36th, 48th and 60th month after FMT. Records of any adverse reactions were collected. Generalized estimating equations were used for analysis of data on time points before and after FMT. Results: A total of 328 patients met the inclusion criteria for this study. Their mean age was 6.1±3.4 years old. The cohort included 271 boys and 57 girls. The percentage of patients remaining in the study for post-treatment follow-up at the 1st, 3rd, 12th, 24th, 36th, 48th and 60th month were as follows: 303 (92.4%), 284 (86.7%), 213 (64.9%), 190 (57.9%), 143 (43.6%), 79 (24.1%), 46 (14.0%), 31 (9.5%). After FMT, the average ABC score was significantly improved in the first 36 months and remained improved at the 48th month. However, the average score was not significantly different from baseline by the 60th month (1st-36th month, P<0.001; 48th month, P=0.008; 60th month, P=0.108). The average CARS score improved significantly during the first 48 months and remained improved at the 60th month (1st-48th month, P<0.001; 60th month, P=0.010). The average BSFS score was also significantly improved in the first 36 months (with an accompanying stool morphology that resembled type 4). This improvement was maintained at the 48th month. However, the average score was similar to baseline at the 60th month (1st-36th month, P<0.001; 48th month, P=0.008; 60th month, P=0.109). The average GSRS score was significantly improved during the first 24 months, but not afterwards (1st-24th month, P<0.001; 36th month, P=0.209; 48th month, P=0.996; 60th month, P=0.668). The adverse events recorded during treatment included abdominal distension in 21 cases (6.4%), nausea in 14 cases (4.3%), vomiting in 9 cases (2.7%), abdominal pain in 15 cases (4.6%), diarrhea in 18 cases (5.5%), fever in 13 cases (4.0%), and excitement in 24 cases (7.3%). All adverse reactions were mild to moderate and improved immediately after suspension of FMT or on treatment of symptoms. No serious adverse reactions occurred. Conclusion: FMT has satisfactory long-term efficacy and safety for the treatment of ASD with gastrointestinal symptoms.


Assuntos
Transtorno do Espectro Autista , Gastroenteropatias , Transtorno do Espectro Autista/etiologia , Transtorno do Espectro Autista/terapia , Criança , Pré-Escolar , Transplante de Microbiota Fecal/efeitos adversos , Fezes , Feminino , Humanos , Estudos Longitudinais , Masculino , Estudos Retrospectivos
4.
J Nutr Educ Behav ; 54(9): 853-862, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36087955

RESUMO

OBJECTIVE: Examine the impact of a virtual nutrition education program, Bringing Adolescent Learners with Autism Nutrition and Culinary Education (BALANCE), on dietary intake and psychosocial determinants of healthy eating in adolescents and young adults (AYA) with autism spectrum disorder (ASD). METHODS: A sample of AYA with ASD aged 12-21 years (n = 27; 6 groups of 2-7 adolescents) participated in BALANCE, a Social Cognitive Theory-based intervention, for eight 30-45-minute lessons. Outcomes were compared using a pre-post design and included dietary intake (assessed using a food frequency questionnaire) and psychosocial determinants of healthy eating (assessed by a validated survey). Wilcoxon signed-rank tests compared preintervention and postintervention medians with an alpha level of 0.05. RESULTS: Mean added sugar intake (P = 0.026) decreased, and behavioral strategies (P = 0.010), self-efficacy (P < 0.001), and outcome expectations (P = 0.009) improved. There was no difference in fruit or vegetable intake or other psychosocial determinants. CONCLUSIONS AND IMPLICATIONS: The BALANCE intervention may improve psychosocial determinants and dietary behaviors in AYA with ASD. Future virtual programs may incorporate more assistance and support to be accessible for AYA with ASD of varying severity levels.


Assuntos
Transtorno do Espectro Autista , Adolescente , Transtorno do Espectro Autista/terapia , Frutas , Educação em Saúde , Humanos , Projetos Piloto , Autoeficácia , Adulto Jovem
5.
BMC Health Serv Res ; 22(1): 1137, 2022 Sep 08.
Artigo em Inglês | MEDLINE | ID: mdl-36076224

RESUMO

BACKGROUND: The economic burden of autism is substantial and includes a range of costs, including healthcare, education, productivity losses, informal care and respite care, among others. In India, approximately, 2 million children aged 2-9 years have autism. Given the likely substantial burden of illness and the need to identify effective and cost-effective interventions, this research aimed to produce a comprehensive cost of illness inventory (COII) suitable for children with autism in South Asia (India) to support future research. METHODS: A structured and iterative design process was followed to create the COII, including literature reviews, interviews with caregivers, pilot testing and translation. Across the development of the COII, thirty-two families were involved in the design and piloting of the tool. The COII was forward translated (from English to Hindi) and back translated. Each stage of the process of development of the COII resulted in the further refinement of the tool. RESULTS: Domains covered in the final COII include education, childcare, relocation, healthcare contacts (outpatient, inpatient, medical emergencies, investigations and medication), religious retreats and rituals, specialist equipment, workshops and training, special diet, support and care, certification, occupational adjustments and government rebates/schemes. Administration and completion of the COII determined it to be feasible to complete in 35 minutes by qualified and trained researchers. The final COII is hosted by REDCap Cloud and is a bilingual instrument (Hindi and English). CONCLUSIONS: The COII was developed using experiences gathered from an iterative process in a metropolitan area within the context of one low- and middle-income country (LMIC) setting, India. Compared to COII tools used for children with autism in high-income country settings, additional domains were required, such as complimentary medication (e.g. religious retreats and homeopathy). The COII will allow future research to quantify the cost of illness of autism in India from a broad perspective and will support relevant economic evaluations. Understanding the process of developing the questionnaire will help researchers working in LMICs needing to adapt the current COII or developing similar questionnaires.


Assuntos
Transtorno do Espectro Autista , Transtorno Autístico , Transtorno do Espectro Autista/diagnóstico , Transtorno do Espectro Autista/terapia , Criança , Efeitos Psicossociais da Doença , Humanos , Índia , Inquéritos e Questionários
6.
Medicina (B Aires) ; 82 Suppl 3: 67-70, 2022 Aug 30.
Artigo em Espanhol | MEDLINE | ID: mdl-36054861

RESUMO

The coexistence of autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) definitely poses new challenges, such as making an early diagnosis, considering that the former is usually diagnosed 2 years later in children with ADHD comorbid with autism compared to those with ASD alone; this is a problem at a personal, family and social level, since they must receive timely intervention. This coexistence raises questions about the efficacy of treatment in ADHD in people with autism, genetic, anatomical and functional concordances, among others; these are the challenges that are currently posed. In this review, we present some responses to the challenges posed by such coexistence, and we highlight some pending issues to be solved, being these of great importance for their better understanding and management. In all patients with ADHD or ASD, a coexistence between them should be sought. There are shared functional brain alterations in both disorders identified by functional brain magnetic resonance imaging; the treatment established for ADHD is also effective in this comorbidity.


La coexistencia del trastorno del espectro autista (TEA) y trastorno por déficit de atención con hiperactividad (TDAH) definitivamente plantea nuevos desafíos, como la realización de un diagnóstico temprano teniendo en cuenta que el primero generalmente es diagnosticado 2 años después en los niños con TDAH comórbidos; esto es un problema a nivel personal, familiar y social, ya que deben recibir intervención oportuna. Esta coexistencia genera interrogantes sobre la eficacia del tratamiento en TDAH en personas con autismo, concordancias genéticas, anatómicas y funcionales entre otros; y son los retos que se plantean en la actualidad. En la presente revisión exponemos algunas respuestas a los desafíos dados por tal coexistencia y resaltamos algunos temas pendientes a resolver, siendo estos de gran importancia para su mejor entendimiento y manejo. En todos los pacientes con TDAH o TEA se debe buscar una coexistencia entre ellos. Existen alteraciones funcionales cerebrales compartidas en ambos trastornos identificadas por resonancia magnética funcional cerebral; el tratamiento establecido para el TDAH es también eficaz en esta comorbilidad.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade , Transtorno do Espectro Autista , Transtorno Autístico , Transtorno do Deficit de Atenção com Hiperatividade/complicações , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Transtorno do Deficit de Atenção com Hiperatividade/terapia , Transtorno do Espectro Autista/complicações , Transtorno do Espectro Autista/diagnóstico , Transtorno do Espectro Autista/terapia , Encéfalo , Criança , Comorbidade , Humanos
7.
Artigo em Inglês | MEDLINE | ID: mdl-36078696

RESUMO

BACKGROUND AND AIMS: With remote work becoming more common across industries, employees with autism may experience different work support needs from neurotypical peers. However, the specific remote work needs of this group of employees are underexplored in the literature. We aim to propose ways to assess workplace digital adaptation needs for individuals with autism and a framework for communicating these needs to employers. METHODS: This qualitative study included interviews with 13 Polish business professionals, including coworkers and/or supervisors of employees with autism (n = 9) and female employees with autism (n = 4), about their remote work support needs. Participants responded to semi-structured interview questions identifying advantages and risk factors associated with remote work for this specific group of employees. RESULTS: Participants reported advantages of remote work, such as limiting sensory overload and intensive interpersonal contacts, indirect interpersonal communications, flexible work hours, and eliminating the need to travel to work. Participants also reported challenges of remote work, such as reducing wanted or helpful social contacts, engaging in direct electronic communications, limiting opportunities to learn from other employees, and managing work-life balance. CONCLUSION: These findings suggest a need for an autism-inclusive digitalized remote work design customized to the unique needs of employees on the autism spectrum. Business managers would be key partners in the design of autism-inclusive digitalized remote work systems. Additional research is needed with larger and more diverse samples of employees with autism.


Assuntos
Transtorno do Espectro Autista , Transtorno Autístico , Transtorno do Espectro Autista/terapia , Transtorno Autístico/terapia , Feminino , Humanos , Polônia , Pesquisa Qualitativa , Local de Trabalho
8.
BMJ Paediatr Open ; 6(1)2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-36053590

RESUMO

OBJECTIVE: This review aims to identify the mhealth apps delivering early intervention to support parents of children with autism spectrum disorders (ASD). We aim to explore the concept, context and methodology of implementation that is, theoretical framework, feasibility, quality of evidence, for such apps. BACKGROUND: To improve outcomes for children with autism, early intervention has been found to be promising. Parental training, parent psychoeducation and parent-mediated intervention are regarded as the gold standard, to achieve early childhood development goals. Digital health technologies like tele-health, web-based services, have been used to deliver this at a reduced cost. There is little evidence about their use and efficacy in empowering parents of children with ASD. INCLUSION CRITERIA: The studies reporting the use of mhealth apps to support parents of children with ASD, in community settings, school settings, special schools, clinics, hospitals or child development centres. There will be no exclusion based on region, gender or sociocultural factors. The types of studies included will be quantitative, qualitative, mixed-methods study designs, case reports, grey literature, systematic reviews, clinical trials and studies reporting feasibility of digital mhealth applications. METHOD: Using the NICE Healthcare Databases Advanced Search, we will search the following databases: MEDLINE, PUBMED, CINAHL, EMBASE, PsycINFO, Cochrane Library, EbscoHost, Sabinet, SAGE Journals, Directory of Open Access Journals, BioMed Central, Scopus, ScienceDirect. Furthermore, grey literature will be searched through Google Scholar, ShodhGanga, JSTOR, CORE, EBSCO, DOAJ, BASE. The searches will be limited to the age range of children between 2 and 6 years with ASD, and the date range is from the inception of the database to the current date. The terms for the ASD will be combined with terms for parent, early intervention and digital mhealth to identify eligible studies.


Assuntos
Transtorno do Espectro Autista , Transtorno Autístico , Telemedicina , Transtorno do Espectro Autista/terapia , Criança , Pré-Escolar , Intervenção Educacional Precoce/métodos , Humanos , Pais/educação , Literatura de Revisão como Assunto , Telemedicina/métodos
9.
S Afr J Commun Disord ; 69(2): e1-e12, 2022 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-36073081

RESUMO

BACKGROUND:  There has been an increased emergence of the use of telerehabilitation by speech-language therapists (SLTs) in South Africa since the COVID-19 pandemic in 2020. OBJECTIVES:  To explore the criteria that SLTs use when recommending telerehabilitation for children with autism spectrum disorder (ASD), the technical skills required, strategies used by SLTs, the restrictions encountered when conducting telerehabilitation and the views of SLTs on telerehabilitation in comparison to face-to-face therapy for children with ASD. METHOD:  A descriptive, phenomenological, qualitative study design was utilised. Purposive and snowball sampling techniques were employed. Six SLTs from the private sector, who had experience providing telerehabilitation to children with ASD, were recruited from three provinces in South Africa. Data were gathered via semistructured online interviews and analysed using thematic analysis. RESULTS:  Two out of five themes that emerged from this study are presented in this paper, i.e. approaches to telerehabilitation and the benefits of telerehabilitation. Results revealed that telerehabilitation was used to provide assessment and therapy during the COVID-19 pandemic lockdowns as an alternative method of service delivery. Assessment and treatment strategies included synchronous and asynchronous methods, family collaboration, social stories, frequent breaks and interactive sessions. Telerehabilitation reduced the client's and SLT's travel costs and increased caregiver and clinician satisfaction. Client progress and increased awareness of SLT were viewed as further benefits. CONCLUSION:  Telerehabilitation was found to be beneficial to most children with ASD, and in most cases, the benefits far outweighed the challenges encountered. Clinical implications included the need for caregiver support in facilitating effective carryover, an increase in SLTs' knowledge and the opportunity to provide services to a broader geographical range. Limitations of the study are included.


Assuntos
Transtorno do Espectro Autista , COVID-19 , Telerreabilitação , Transtorno do Espectro Autista/terapia , Criança , Controle de Doenças Transmissíveis , Humanos , Pandemias , Fala , Fonoterapia/métodos
10.
J Neuroeng Rehabil ; 19(1): 91, 2022 08 18.
Artigo em Inglês | MEDLINE | ID: mdl-35982460

RESUMO

INTRODUCTION: Emerging virtual technologies and cognitive rehabilitation methods are two new treatment approaches that can be used to strengthen cognitive functions in Autism Spectrum Disorder (ASD). The main aim of this study was to examine the effect of using virtual reality-based approaches on cognitive disorders of children and adults with ASD. METHODS: This systematic review was conducted on scientific papers to determine the effects of virtual reality-based technologies on the cognitive functions of children and adults with ASD. We identified 688 studies related to this topic and filtered them down to 17 articles, and then extracted the effects of interventions on cognitive outcomes. RESULTS: A total of 17 studies met the inclusion criteria, in which 226 persons with ASD had taken place. The sample size in the selected studies ranged from 1 to 56 participants (Median: 8, Q1: 3.5, Q3: 15.5). Four of the studies were case-control studies, ten were pre-test/post-test studies, and three were Randomized Control Trials (RCTs). Results of 16 studies showed significant progress in various cognitive indexes, such as task learning, attention, executive functioning, and daily skills in people with ASD. In most studies, virtual technologies had beneficial effects on reducing cognitive problems, but existing limitations could reduce their effectiveness. These limitations included the cost of virtual reality devices, inappropriate size of software, the weight of devices, potential addiction, intolerance of wearing glasses or headsets by people with autism (especially in children), and the possibility of eye injury. CONCLUSION: Applying appropriate virtual-based approaches could improve cognitive indexes in people with ASD. However, further studies are needed to investigate the real effects of these technologies in the long run.


Assuntos
Transtorno do Espectro Autista , Transtorno Autístico , Realidade Virtual , Transtorno do Espectro Autista/psicologia , Transtorno do Espectro Autista/terapia , Criança , Cognição , Humanos , Aprendizagem
11.
PLoS One ; 17(8): e0271406, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35921352

RESUMO

OBJECTIVES: This questionnaire-based validation study investigated if the dental examination of children and adolescents with autism spectrum disorder is viewed by dentists with key expertise in paediatric dentistry as a challenge or a threat in terms of transactional stress theory. The Stress Appraisal Measure (SAM) was used for this purpose and it's feasibility and validity was examined as a first part of a multi-stage process for validation in dentistry with a sample of German dentists. It has hardly been investigated how the treatment of children and adolescents with a disorder from the autism spectrum is perceived by dentists. METHODS: An online-based survey (39 questions) plus the SAM as an add-on as well as a preceding short story of imagination on the topic (appointment for a dental check-up in a special school) were developed. Via e-mail members of the German Society of Paediatric Dentistry (DGKiZ) received a link which enabled interested members to participate. The majority of the members of the DGKiZ have additional qualifications in the treatment of children and adolescents and further training in the area of special needs care in dentistry. The data analysis was based on the SAM and its subscales. RESULTS: Out of the 1.725 members of DGKiZ 92 participants (11 male, 81 female) fully completed the questionnaire and the SAM. All in all the dentists rated their own psychological and physical stress in course of treating children and adolescents with a disorder from the autism spectrum between less and partly stressful. Although the structure of the SAM could not be fully mapped by means of a factor analysis, the different ratings "challenge" or "threat" could be comprehensibly evaluated after reading the story. The participants rated the situation from the story in general as challenging but not as threatening. Intercorrelations between the subscales of the SAM (e.g threat and centrality) of r = .56 showed that the scales are not clearly independent of one another. According to the transactional stress model, the SAM bases on, stress (perceived stressfulness) arises from appraisal processes (e.g. threat, controllable-by-self) that bring about a comparison between the requirements for the described situation and one's own possibilities in terms of a person-environment-fit. In the hierarchical regression a variance of R2 = .48 could be explained with all six subscales (appraisal processes) to predict perceived stressfulness of the SAM within a sample of dentists. CONCLUSIONS: Due to the response rate the results of the SAM are not representative for all German dentists, but it offers an insight into topics of special needs dentistry in Germany that have not yet been examined. Overall, the feasibility and validity of the SAM in the context of mapping cognitive appraisal processes and stress could be confirmed. Taking into account the result that the treatment of children and adolescents with autism spectrum disorder is seen as a challenge, it is concluded that there is a need to improve the education of dental students and graduated dentists in Germany in the field of special needs dentistry.


Assuntos
Transtorno do Espectro Autista , Odontopediatria , Adolescente , Transtorno do Espectro Autista/terapia , Criança , Odontólogos/psicologia , Feminino , Alemanha , Humanos , Masculino , Odontopediatria/educação , Inquéritos e Questionários
12.
Pediatr Clin North Am ; 69(4): 645-656, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35934491

RESUMO

The rising prevalence of autism spectrum disorder (ASD) calls for clear referral and treatment guidelines for children with ASD and their caregivers. Caregiver involvement in intervention is a standard practice of care and research suggests that teaching intervention strategies to caregivers can improve child outcomes and increase caregiver efficacy. Caregiver-mediated interventions that are naturalistic, developmental, and behavioral are effective in improving social and communication skills for children with ASD. Caregiver training models that use behavioral strategies are effective in reducing challenging behaviors. Finally, reducing caregiver barriers to treatment implementation, including stress and strain, are becoming critical components for improving the well-being and care of children with ASD and their families.


Assuntos
Transtorno do Espectro Autista , Transtorno do Espectro Autista/terapia , Cuidadores , Criança , Família , Humanos , Pais
13.
Nurs Clin North Am ; 57(3): 489-499, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-35985735

RESUMO

Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder characterized by difficulties with social interaction and communication and the presence of restrictive and repetitive behavior. Individuals with ASD, particularly those from diverse racial and ethnic backgrounds, are at higher risk of certain health conditions and mortality over the lifespan. Disparities in timing of diagnosis, access to services, and quality of care have a significant impact on the trajectory of individuals on the autism spectrum. Health care providers and law enforcement officers often interact with individuals with ASD and need adequate preparation to provide person-centered care to this vulnerable population.


Assuntos
Transtorno do Espectro Autista , Transtorno do Espectro Autista/epidemiologia , Transtorno do Espectro Autista/terapia , Etnicidade , Humanos , Grupos Raciais
14.
Ir J Psychol Med ; 39(3): 312-318, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-35965060

RESUMO

Autistic spectrum disorder (ASD) is a neuro-developmental disability with multi-systemic impacts. Individuals with ASD without intellectual impairment (DSM-V) or Aspergers (DSM-IV) are often particularly vulnerable to mental health problems such as anxiety disorders including social phobia and generalised anxiety disorder, depressive disorders and psychosis. Adults with ASD without intellectual impairment suffer higher rates of physical and psychiatric morbidity, display a poorer ability to engage with treatment and have a lower chance of recovery compared with the general population. It is widely acknowledged that adults with suspected ASD without intellectual impairment and co-morbid mental health problems are often not best supported through adult mental health services and often require more tailored supports. This review seeks to (a) increase awareness in the area of undiagnosed cases of ASD without intellectual impairment in adult mental health settings and (b) highlights the importance of identifying this population more efficiently by referring to best practice guidelines. The value of future research to examine the benefit of having a team of specialist staff within adult mental health teams who have received ASD training and who are supported to work with the 'core difficulties' of ASD is discussed and a model for the same is proposed. It is proposed that a specialist team could form a 'hub' for the development of expertise in ASD, which when adequately resourced and funded could reach across an entire region, offering consultancy and diagnostic assessments and interventions.


Assuntos
Transtorno do Espectro Autista , Serviços de Saúde Mental , Adulto , Transtornos de Ansiedade , Transtorno do Espectro Autista/complicações , Transtorno do Espectro Autista/terapia , Manual Diagnóstico e Estatístico de Transtornos Mentais , Humanos , Inquéritos e Questionários
15.
Ir J Psychol Med ; 39(3): 237-239, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-35965061

RESUMO

This edition of Irish Journal of Psychological Medicine is a Special Themed Issue on Autism Spectrum Disorders (ASD). Mental health services are not currently meeting the needs of autistic people across the lifespan. We have limited evidence based treatments for core symptoms and comorbidities and there is lack of awareness and under-recognition of ASD, particularly in adults and certain groups of individuals. The key themes in this edition focus on challenges with recognition and diagnosis and address these from both clinical and research perspectives. Co-occurring conditions also feature, which are also under-recognised and can contribute to less optimal outcomes. New and existing research developments in stratification for clinical trials and neuroimaging are also discussed. We hope this Issue highlights relevant current issues in ASD, and provides insights which can help address the challenges in providing evidence based pathways to better meet the needs of autistic people into the future.


Assuntos
Transtorno do Espectro Autista , Transtorno Autístico , Serviços de Saúde Mental , Adulto , Transtorno do Espectro Autista/psicologia , Transtorno do Espectro Autista/terapia , Comorbidade , Previsões , Humanos
16.
Brain Behav ; 12(9): e2724, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35938945

RESUMO

OBJECTIVE: Among the target groups in child and adolescent psychiatry, transcranial direct current stimulation (tDCS) has been more applied in neurodevelopmental disorders specifically, attention-deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and dyslexia. This systematic review aims to provide the latest update on published randomized-controlled trials applying tDCS in these disorders for evaluating its efficacy and safety. METHODS: Based on a pre-registered protocol (PROSPERO: CRD42022321430) and using the PRISMA approach, a literature search identified 35 randomized controlled trials investigating the effects of tDCS on children and adolescents with ADHD (n = 17), ASD (n = 11), and dyslexia (n = 7). RESULTS: In ADHD, prefrontal anodal tDCS is reported more effective compared to stimulation of the right inferior frontal gyrus. Similarly in ASD, prefrontal anodal tDCS was found effective for improving behavioral problems. In dyslexia, stimulating temporoparietal regions was the most common and effective protocol. In ASD and dyslexia, all tDCS studies found an improvement in at least one of the outcome variables while 64.7% of studies (11 of 17) in ADHD found a similar effect. About 88% of all tDCS studies with a multi-session design in 3 disorders (16 of 18) reported a significant improvement in one or all outcome variables after the intervention. Randomized, double-blind, controlled trials consisted of around 70.5%, 36.3%, and 57.1% of tDCS studies in ADHD, ASD, and dyslexia, respectively. tDCS was found safe with no reported serious side effects in 6587 sessions conducted on 745 children and adolescents across 35 studies. CONCLUSION: tDCS was found safe and partially effective. For evaluation of clinical utility, larger randomized controlled trials with a double-blind design and follow-up measurements are required. Titration studies that systematically evaluate different stimulation intensities, duration, and electrode placement are lacking.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade , Transtorno do Espectro Autista , Transtorno Autístico , Dislexia , Estimulação Transcraniana por Corrente Contínua , Adolescente , Transtorno do Deficit de Atenção com Hiperatividade/terapia , Transtorno do Espectro Autista/terapia , Criança , Dislexia/terapia , Humanos , Córtex Pré-Frontal/fisiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Estimulação Transcraniana por Corrente Contínua/efeitos adversos , Estimulação Transcraniana por Corrente Contínua/métodos
17.
Biomed J ; 45(4): 567-572, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35944870

RESUMO

In this issue of the Biomedical Journal the reader is provided with an insight into the latest observations and advances in acute kidney injury as well as chronic kidney disease. The current SARS-CoV-2 variants are reviewed, and the role of long non-coding RNA in HIV therapy is explored. Furthermore, the potential of metabolomics as means to diagnose multiple sclerosis as well as tuberculosis is presented. Other topics of this issue include the restoration of the spermatogonial stem cell niche; atherosclerosis and the use of improved ultrasound images; and the effect of transcranial magnetic stimulation in patients with autism spectrum disorder. Finally, it is shown how continuous passive motion can be used as supportive therapeutic approach in children with cerebral palsy, and minimally invasive surgery is presented as valid alternative in cases of spine metastasis.


Assuntos
Transtorno do Espectro Autista , COVID-19 , RNA Longo não Codificante , Transtorno do Espectro Autista/terapia , Criança , Humanos , Rim , SARS-CoV-2
18.
JAMA Psychiatry ; 79(9): 847-856, 2022 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-35921102

RESUMO

Importance: Transcranial direct current stimulation (tDCS) may improve symptoms of inattention in adults with attention-deficit/hyperactivity disorder (ADHD). However, previous trials are characterized by small sample sizes, heterogeneous methodologies, and short treatment periods using clinic-based tDCS. Objective: To determine the efficacy and safety of home-based tDCS in treating inattention symptoms in adult patients with ADHD. Design, Setting, and Participants: Randomized, double-blind, parallel, sham-controlled clinical trial (tDCS for the Treatment of Inattention Symptoms in Adult Patients With ADHD [TUNED]), conducted from July 2019 through July 2021 in a single-center outpatient academic setting. Of 277 potential participants screened by phone, 150 were assessed for eligibility on site, and 64 were included. Participants were adults with ADHD, inattentive or combined subtype. Exclusion criteria included current stimulant drug treatment, current moderate to severe symptoms of depression or anxiety, diagnosis of bipolar disorder with a manic or depressive episode in the last year, diagnosis of schizophrenia or another psychotic disorder, and diagnosis of autism spectrum disorder; 55 of participants completed follow-up after 4 weeks. Interventions: Thirty-minute daily sessions of home-based tDCS for 4 weeks, 2 mA anodal-right and cathodal-left prefrontal stimulation with 35-cm2 carbon electrodes. Main Outcomes and Measures: Inattentive scores in the clinician-administered version of the Adult ADHD Self-report Scale version 1.1 (CASRS-I). Results: Included in this trial were 64 participants with ADHD (31 [48%] inattentive presentation and 33 [52%] combined presentation), with a mean (SD) age of 38.3 (9.6) years. Thirty participants (47%) were women and 34 (53%) were men. Fifty-five finished the trial. At week 4, the mean (SD) inattention score, as measured with CASRS-I, was 18.88 (5.79) in the active tDCS group and 23.63 (3.97) in the sham tDCS group. Linear mixed-effects models revealed a statistically significant treatment by time interaction for CASRS-I (ßinteraction = -3.18; 95% CI, -4.60 to -1.75; P < .001), showing decreased symptoms of inattention in the active tDCS group over the 3 assessments compared to the sham tDCS group. Mild adverse events were more frequent in the active tDCS group, particularly skin redness, headache, and scalp burn. Conclusions and Relevance: In this randomized clinical trial, daily treatment with a home-based tDCS device over 4 weeks improved attention in adult patients with ADHD who were not taking stimulant medication. Home-based tDCS could be a nonpharmacological alternative for patients with ADHD. Trial Registration: ClinicalTrials.gov Identifier: NCT04003740.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade , Transtorno do Espectro Autista , Transtorno Bipolar , Estimulação Transcraniana por Corrente Contínua , Adulto , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Transtorno do Deficit de Atenção com Hiperatividade/terapia , Transtorno do Espectro Autista/terapia , Transtorno Bipolar/terapia , Método Duplo-Cego , Feminino , Humanos , Masculino , Estimulação Transcraniana por Corrente Contínua/métodos , Resultado do Tratamento
19.
Am J Speech Lang Pathol ; 31(5): 2248-2267, 2022 Sep 07.
Artigo em Inglês | MEDLINE | ID: mdl-35969850

RESUMO

PURPOSE: This scoping review aimed to map the literature on the effects of interventions involving speech output technologies on communication outcomes for individuals with developmental disabilities other than autism spectrum disorder. METHOD: A scoping review methodology was used to limit bias in searching, selecting, coding, and synthesizing relevant intervention studies. This involved a multifaceted search for studies conducted between 1991 and March 2021 using various electronic databases, ancestry searches, and forward citation searches from selected articles. Studies had to meet stringent inclusion criteria. Each study was summarized in terms of authors, purpose, participants, design, speech output, outcomes, effectiveness, and quality appraisal. RESULTS: Twenty-five single-case experimental design studies (88 participants) and one group design studies (62 participants) qualified for inclusion. Most of the participants had multiple diagnoses followed by a diagnosis of cerebral palsy and Down syndrome. Most studies focused on requesting behaviors and to a much lesser extent on syntactic structure and word identification. A dearth of high-quality studies was identified. CONCLUSIONS: Overall, there is a paucity of high-quality research investigating the effects of speech output technologies for children with developmental disabilities. Additionally, several directions for future research are posited. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.20468928.


Assuntos
Transtorno do Espectro Autista , Auxiliares de Comunicação para Pessoas com Deficiência , Transtorno do Espectro Autista/diagnóstico , Transtorno do Espectro Autista/terapia , Criança , Comunicação , Deficiências do Desenvolvimento/diagnóstico , Deficiências do Desenvolvimento/terapia , Humanos , Fala
20.
BMC Psychiatry ; 22(1): 556, 2022 08 19.
Artigo em Inglês | MEDLINE | ID: mdl-35986348

RESUMO

BACKGROUND: Autism spectrum disorder (ASD) in adulthood is associated with severe impairments in functioning and poor health, while ASD is also affecting close relations. Accessible first-line interventions addressing the complex clinical needs and care coordination are lacking. METHODS: This study investigated the feasibility and preliminary effects of a new psychoeducational intervention (Prisma) developed for intellectually able adults with ASD and their close relations in an outpatient setting. The manualized Prisma intervention consist of four weekly group sessions guided by trained group leaders and providing information about autism, support, and services. Feasibility was examined through treatment completion rate and group-level comparisons between intervention completers and non-completers (Student's t-test, Fisher's exact test, and Pearson's chi-squared test). Perceived treatment credibility was investigated by within-group comparisons of participant's self-ratings from pre-intervention to post-intervention, as well as by group leaders' ratings using an adjusted questionnaire. Treatment satisfaction was examined quantitatively regarding the session evaluations (Student's t-tests), as well as by a qualitative thematic analysis of participants' feedback. Preliminary efficacy was studied using paired t-tests (pre- and post-intervention). RESULTS: Completion rate was 77% (n = 71 of the 92 adults with ASD) and 73% (n = 69 of the 94 close relations), respectively. Participants considered Prisma to be an acceptable intervention indicated by increases in treatment credibility and expectations from pre- to post-intervention. The group leaders reported treatment credibility in the same range as the participants. Both autistic adults and their close relations reported good treatment satisfaction for each session, while the qualitative thematic analysis indicated that Prisma could be improved by enhancing active participation. This participant feedback will be used to further improve the intervention for an upcoming RCT. Preliminary analyses of effects showed promising results with an increase in knowledge of ASD and some indications for improvements in relationship quality, mental health, quality of life, acceptance of diagnosis and burden of care. CONCLUSIONS: Overall, results indicate that the Prisma is a feasible and acceptable first-line intervention in outpatient services. Randomized controlled trials are needed to further corroborate the evidence base of this novel intervention. TRIAL REGISTRATION: Clinicaltrials.org NCT0446097, retrospectively registered July 8th 2020.


Assuntos
Transtorno do Espectro Autista , Transtorno Autístico , Adulto , Transtorno do Espectro Autista/terapia , Transtorno Autístico/terapia , Estudos de Viabilidade , Glicosaminoglicanos , Humanos , Qualidade de Vida
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