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Rogerson-Wood L, Goldsbury CS, Sawatari A, Leamey CA. An early enriched experience drives targeted microglial engulfment of miswired neural circuitry during a restricted postnatal period. Glia 2024; 72:1217-1235. [PMID: 38511347 DOI: 10.1002/glia.24522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 02/17/2024] [Accepted: 02/27/2024] [Indexed: 03/22/2024]
Abstract
Brain function is critically dependent on correct circuit assembly. Microglia are well-known for their important roles in immunological defense and neural plasticity, but whether they can also mediate experience-induced correction of miswired circuitry is unclear. Ten-m3 knockout (KO) mice display a pronounced and stereotyped visuotopic mismapping of ipsilateral retinal inputs in their visual thalamus, providing a useful model to probe circuit correction mechanisms. Environmental enrichment (EE) commenced around birth, but not later in life, can drive a partial correction of the most mismapped retinal inputs in Ten-m3 KO mice. Here, we assess whether enrichment unlocks the capacity for microglia to selectively engulf and remove miswired circuitry, and the timing of this effect. Expression of the microglial-associated lysosomal protein CD68 showed a clear enrichment-driven, spatially restricted change which had not commenced at postnatal day (P)18, was evident at P21, more robust at P25, and had ceased by P30. This was observed specifically at the corrective pruning site and was absent at a control site. An engulfment assay at the corrective pruning site in P25 mice showed EE-driven microglial-uptake of the mismapped axon terminals. This was temporally and spatially specific, as no enrichment-driven microglial engulfment was seen in P18 KO mice, nor the control locus. The timecourse of the EE-driven corrective pruning as determined anatomically, aligned with this pattern of microglia reactivity and engulfment. Collectively, these findings show experience can drive targeted microglial engulfment of miswired neural circuitry during a restricted postnatal window. This may have important therapeutic implications for neurodevelopmental conditions involving aberrant neural connectivity.
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Affiliation(s)
- Lara Rogerson-Wood
- School of Medical Sciences (Neuroscience theme), Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Claire S Goldsbury
- School of Medical Sciences (Neuroscience theme), Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Atomu Sawatari
- School of Medical Sciences (Neuroscience theme), Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Catherine A Leamey
- School of Medical Sciences (Neuroscience theme), Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
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2
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Boulton KA, Lee D, Honan I, Phillips NL, Morgan C, Crowle C, Novak I, Badawi N, Guastella AJ. Exploring early life social and executive function development in infants and risk for autism: a prospective cohort study protocol of NICU graduates and infants at risk for cerebral palsy. BMC Psychiatry 2024; 24:359. [PMID: 38745143 PMCID: PMC11092236 DOI: 10.1186/s12888-024-05779-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 04/19/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Delays in early social and executive function are predictive of later developmental delays and eventual neurodevelopmental diagnoses. There is limited research examining such markers in the first year of life. High-risk infant groups commonly present with a range of neurodevelopmental challenges, including social and executive function delays, and show higher rates of autism diagnoses later in life. For example, it has been estimated that up to 30% of infants diagnosed with cerebral palsy (CP) will go on to be diagnosed with autism later in life. METHODS This article presents a protocol of a prospective longitudinal study. The primary aim of this study is to identify early life markers of delay in social and executive function in high-risk infants at the earliest point in time, and to explore how these markers may relate to the increased risk for social and executive delay, and risk of autism, later in life. High-risk infants will include Neonatal Intensive Care Unit (NICU) graduates, who are most commonly admitted for premature birth and/or cardiovascular problems. In addition, we will include infants with, or at risk for, CP. This prospective study will recruit 100 high-risk infants at the age of 3-12 months old and will track social and executive function across the first 2 years of their life, when infants are 3-7, 8-12, 18 and 24 months old. A multi-modal approach will be adopted by tracking the early development of social and executive function using behavioural, neurobiological, and caregiver-reported everyday functioning markers. Data will be analysed to assess the relationship between the early markers, measured from as early as 3-7 months of age, and the social and executive function as well as the autism outcomes measured at 24 months. DISCUSSION This study has the potential to promote the earliest detection and intervention opportunities for social and executive function difficulties as well as risk for autism in NICU graduates and/or infants with, or at risk for, CP. The findings of this study will also expand our understanding of the early emergence of autism across a wider range of at-risk groups.
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Affiliation(s)
- Kelsie A Boulton
- Clinic for Autism and Neurodevelopmental (CAN) research, Brain and Mind Centre, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Child Neurodevelopment and Mental Health Team, Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Dabin Lee
- Clinic for Autism and Neurodevelopmental (CAN) research, Brain and Mind Centre, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Child Neurodevelopment and Mental Health Team, Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Ingrid Honan
- Cerebral Palsy Alliance Institute, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, Australia
| | - Natalie L Phillips
- Clinic for Autism and Neurodevelopmental (CAN) research, Brain and Mind Centre, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Child Neurodevelopment and Mental Health Team, Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Catherine Morgan
- Cerebral Palsy Alliance Institute, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, Australia
| | - Cathryn Crowle
- Grace Centre for Newborn Intensive Care, Sydney Children's Hospital Network, Sydney, Australia
| | - Iona Novak
- Cerebral Palsy Alliance Institute, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, Australia
| | - Nadia Badawi
- Child Neurodevelopment and Mental Health Team, Brain and Mind Centre, University of Sydney, Sydney, Australia
- Cerebral Palsy Alliance Institute, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, Australia
- Grace Centre for Newborn Intensive Care, Sydney Children's Hospital Network, Sydney, Australia
| | - Adam J Guastella
- Clinic for Autism and Neurodevelopmental (CAN) research, Brain and Mind Centre, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
- Child Neurodevelopment and Mental Health Team, Brain and Mind Centre, University of Sydney, Sydney, Australia.
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3
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Bowe AK, Lightbody G, O'Boyle DS, Staines A, Murray DM. Predicting low cognitive ability at age 5 years using perinatal data and machine learning. Pediatr Res 2024; 95:1634-1643. [PMID: 38177251 PMCID: PMC11126385 DOI: 10.1038/s41390-023-02914-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 10/06/2023] [Accepted: 11/03/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND There are no early, accurate, scalable methods for identifying infants at high risk of poor cognitive outcomes in childhood. We aim to develop an explainable predictive model, using machine learning and population-based cohort data, for this purpose. METHODS Data were from 8858 participants in the Growing Up in Ireland cohort, a nationally representative study of infants and their primary caregivers (PCGs). Maternal, infant, and socioeconomic characteristics were collected at 9-months and cognitive ability measured at age 5 years. Data preprocessing, synthetic minority oversampling, and feature selection were performed prior to training a variety of machine learning models using ten-fold cross validated grid search to tune hyperparameters. Final models were tested on an unseen test set. RESULTS A random forest (RF) model containing 15 participant-reported features in the first year of infant life, achieved an area under the receiver operating characteristic curve (AUROC) of 0.77 for predicting low cognitive ability at age 5. This model could detect 72% of infants with low cognitive ability, with a specificity of 66%. CONCLUSIONS Model performance would need to be improved before consideration as a population-level screening tool. However, this is a first step towards early, individual, risk stratification to allow targeted childhood screening. IMPACT This study is among the first to investigate whether machine learning methods can be used at a population-level to predict which infants are at high risk of low cognitive ability in childhood. A random forest model using 15 features which could be easily collected in the perinatal period achieved an AUROC of 0.77 for predicting low cognitive ability. Improved predictive performance would be required to implement this model at a population level but this may be a first step towards early, individual, risk stratification.
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Affiliation(s)
- Andrea K Bowe
- INFANT Research Centre, University College Cork, Cork, Ireland.
| | - Gordon Lightbody
- INFANT Research Centre, University College Cork, Cork, Ireland
- Department of Electrical and Electronic Engineering, University College Cork, Cork, Ireland
| | | | - Anthony Staines
- School of Nursing, Psychotherapy, and Community Health, Dublin City University, Dublin, Ireland
| | - Deirdre M Murray
- INFANT Research Centre, University College Cork, Cork, Ireland
- Department of Paediatrics, Cork University Hospital, Cork, Ireland
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4
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Cleary DB, Maybery MT, Waddington H, Macaskill E, Whitehouse AJO. Investigating Parental Observations of Early Autism Development in Simplex and Multiplex Families. J Autism Dev Disord 2024:10.1007/s10803-024-06262-0. [PMID: 38642179 DOI: 10.1007/s10803-024-06262-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2024] [Indexed: 04/22/2024]
Abstract
Past research has highlighted the importance of early identification of developmental differences to improve targeted access to early interventions or supports. As such, it is of particular importance in the context of children at elevated likelihood of autism (such as where an older sibling has a diagnosis of autism), to better understand when and which early concerns are important as predictors of which children will benefit from pre-diagnostic supports. This study explored the number and frequency of retrospective parent reported concerns within the first year of life for children diagnosed with autism, both those who had an older sibling diagnosed with autism and those who did not, as well as for undiagnosed siblings. We found that at both 0-6 and 7-12 months, the only factor related to the presence or absence of early parent reported concerns was child diagnostic status, with the presence of reported early concerns more likely for children with a diagnosis of autism. These findings suggest that for children at elevated likelihood of autism, parents' concerns are driven primarily by developmental differences, with child's birth order and sibling diagnostic status not impacting on parent early concerns.
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Affiliation(s)
- Dominique B Cleary
- Telethon Kids Institute, University of Western Australia, Subiaco, Australia.
- School of Psychological Science, The University of Western Australia, Crawley, Australia.
| | - Murray T Maybery
- School of Psychological Science, The University of Western Australia, Crawley, Australia
| | | | - Ella Macaskill
- Victoria University of Wellington, Wellington, New Zealand
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Chung WK, Kanne SM, Hu Z. An Opportunity to Fill a Gap for Newborn Screening of Neurodevelopmental Disorders. Int J Neonatal Screen 2024; 10:33. [PMID: 38651398 PMCID: PMC11036277 DOI: 10.3390/ijns10020033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 03/27/2024] [Accepted: 04/11/2024] [Indexed: 04/25/2024] Open
Abstract
Screening newborns using genome sequencing is being explored due to its potential to expand the list of conditions that can be screened. Previously, we proposed the need for large-scale pilot studies to assess the feasibility of screening highly penetrant genetic neurodevelopmental disorders. Here, we discuss the initial experience from the GUARDIAN study and the systemic gaps in clinical services that were identified in the early stages of the pilot study.
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Affiliation(s)
- Wendy K. Chung
- Department of Pediatrics, Boston Children’s Hospital, Boston, MA 02115, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Stephen M. Kanne
- Department of Psychiatry, Weill Cornell Medical College, New York, NY 10065, USA;
| | - Zhanzhi Hu
- Department of Systems Biology, Columbia University Irving Medical Center, New York, NY 10032, USA;
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Gale-Grant O, Chew A, Falconer S, França LGS, Fenn-Moltu S, Hadaya L, Harper N, Ciarrusta J, Charman T, Murphy D, Arichi T, McAlonan G, Nosarti C, Edwards AD, Batalle D. Clinical, socio-demographic, and parental correlates of early autism traits in a community cohort of toddlers. Sci Rep 2024; 14:8393. [PMID: 38600134 PMCID: PMC11006842 DOI: 10.1038/s41598-024-58907-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 04/04/2024] [Indexed: 04/12/2024] Open
Abstract
Identifying factors linked to autism traits in the general population may improve our understanding of the mechanisms underlying divergent neurodevelopment. In this study we assess whether factors increasing the likelihood of childhood autism are related to early autistic trait emergence, or if other exposures are more important. We used data from 536 toddlers from London (UK), collected at birth (gestational age at birth, sex, maternal body mass index, age, parental education, parental language, parental history of neurodevelopmental conditions) and at 18 months (parents cohabiting, measures of socio-economic deprivation, measures of maternal parenting style, and a measure of maternal depression). Autism traits were assessed using the Quantitative Checklist for Autism in Toddlers (Q-CHAT) at 18 months. A multivariable model explained 20% of Q-CHAT variance, with four individually significant variables (two measures of parenting style and two measures of socio-economic deprivation). In order to address variable collinearity we used principal component analysis, finding that a component which was positively correlated with Q-CHAT was also correlated to measures of parenting style and socio-economic deprivation. Our results show that parenting style and socio-economic deprivation correlate with the emergence of autism traits at age 18 months as measured with the Q-CHAT in a community sample.
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Affiliation(s)
- Oliver Gale-Grant
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16, De Crespigny Park, London, SE5 8AF, UK.
- Centre for the Developing Brain, School of Imaging Sciences & Biomedical Engineering, King's College London, London, UK.
- MRC Centre for Neurodevelopmental Disorders, King's College London, London, UK.
| | - Andrew Chew
- Centre for the Developing Brain, School of Imaging Sciences & Biomedical Engineering, King's College London, London, UK
| | - Shona Falconer
- Centre for the Developing Brain, School of Imaging Sciences & Biomedical Engineering, King's College London, London, UK
| | - Lucas G S França
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16, De Crespigny Park, London, SE5 8AF, UK
- Centre for the Developing Brain, School of Imaging Sciences & Biomedical Engineering, King's College London, London, UK
- Department of Computer and Information Sciences, Faculty of Engineering and Environment, Northumbria University, Newcastle Upon Tyne, UK
| | - Sunniva Fenn-Moltu
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16, De Crespigny Park, London, SE5 8AF, UK
- Centre for the Developing Brain, School of Imaging Sciences & Biomedical Engineering, King's College London, London, UK
| | - Laila Hadaya
- Centre for the Developing Brain, School of Imaging Sciences & Biomedical Engineering, King's College London, London, UK
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Nicholas Harper
- Centre for the Developing Brain, School of Imaging Sciences & Biomedical Engineering, King's College London, London, UK
| | - Judit Ciarrusta
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16, De Crespigny Park, London, SE5 8AF, UK
| | - Tony Charman
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Declan Murphy
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16, De Crespigny Park, London, SE5 8AF, UK
- MRC Centre for Neurodevelopmental Disorders, King's College London, London, UK
| | - Tomoki Arichi
- Centre for the Developing Brain, School of Imaging Sciences & Biomedical Engineering, King's College London, London, UK
- MRC Centre for Neurodevelopmental Disorders, King's College London, London, UK
- Department of Paediatric Neurosciences, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Department of Bioengineering, Imperial College London, London, UK
| | - Grainne McAlonan
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16, De Crespigny Park, London, SE5 8AF, UK
- MRC Centre for Neurodevelopmental Disorders, King's College London, London, UK
| | - Chiara Nosarti
- Centre for the Developing Brain, School of Imaging Sciences & Biomedical Engineering, King's College London, London, UK
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - A David Edwards
- Centre for the Developing Brain, School of Imaging Sciences & Biomedical Engineering, King's College London, London, UK
- MRC Centre for Neurodevelopmental Disorders, King's College London, London, UK
| | - Dafnis Batalle
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16, De Crespigny Park, London, SE5 8AF, UK
- Centre for the Developing Brain, School of Imaging Sciences & Biomedical Engineering, King's College London, London, UK
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Chetcuti L, Varcin KJ, Boutrus M, Smith J, Bent CA, Whitehouse AJO, Hudry K. Feasibility of a 2-minute eye-tracking protocol to support the early identification of autism. Sci Rep 2024; 14:5117. [PMID: 38429348 PMCID: PMC10907367 DOI: 10.1038/s41598-024-55643-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 02/26/2024] [Indexed: 03/03/2024] Open
Abstract
We tested the potential for Gazefinder eye-tracking to support early autism identification, including feasible use with infants, and preliminary concurrent validity of trial-level gaze data against clinical assessment scores. We embedded the ~ 2-min 'Scene 1S4' protocol within a comprehensive clinical assessment for 54 consecutively-referred, clinically-indicated infants (prematurity-corrected age 9-14 months). Alongside % tracking rate as a broad indicator of feasible assessment/data capture, we report infant gaze data to pre-specified regions of interest (ROI) across four trial types and associations with scores on established clinical/behavioural tools. Most infants tolerated Gazefinder eye-tracking well, returning high overall % tracking rate. As a group, infants directed more gaze towards social vs. non-social (or more vs. less socially-salient) ROIs within trials. Behavioural autism features were correlated with increased gaze towards non-social/geometry (vs. social/people) scenes. No associations were found for gaze directed to ROIs within other stimulus types. Notably, there were no associations between developmental/cognitive ability or adaptive behaviour with gaze towards any ROI. Gazefinder assessment seems highly feasible with clinically-indicated infants, and the people vs. geometry stimuli show concurrent predictive validity for behavioural autism features. Aggregating data across the ~ 2-min autism identification protocol might plausibly offer greater utility than stimulus-level analysis alone.
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Affiliation(s)
- Lacey Chetcuti
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Kandice J Varcin
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
- Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Maryam Boutrus
- Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Jodie Smith
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, Australia
| | - Catherine A Bent
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | | | - Kristelle Hudry
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia.
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Carruthers S, Pickles A, Charman T, McConachie H, Le Couteur A, Slonims V, Howlin P, Collum R, Salomone E, Tobin H, Gammer I, Maxwell J, Aldred C, Parr J, Leadbitter K, Green J. Mediation of 6-year mid-childhood follow-up outcomes after pre-school social communication (PACT) therapy for autistic children: randomised controlled trial. J Child Psychol Psychiatry 2024; 65:233-244. [PMID: 37095645 PMCID: PMC10953331 DOI: 10.1111/jcpp.13798] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/22/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND There are very few mechanistic studies of the long-term impact of psychosocial interventions in childhood. The parent-mediated Paediatric Autism Communication Therapy (PACT) RCT showed sustained effects on autistic child outcomes from pre-school to mid-childhood. We investigated the mechanism by which the PACT intervention achieved these effects. METHODS Of 152 children randomised to receive PACT or treatment as usual between 2 and 5 years of age, 121 (79.6%) were followed 5-6 years after the endpoint at a mean age of 10.5 years. Assessors, blind to the intervention group, measured Autism Diagnostic Observation Scale Calibrated Severity Score (ADOS CSS) for child autistic behaviours and Teacher Vineland (TVABS) for adaptive behaviour in school. Hypothesised mediators were child communication initiations with caregivers in a standard play observation (Dyadic Communication Measure for Autism, DCMA). Hypothesised moderators of mediation were baseline child non-verbal age equivalent scores (AE), communication and symbolic development (CSBS) and 'insistence on sameness' (IS). Structural equation modelling was used in a repeated measures mediation design. RESULTS Good model fits were obtained. The treatment effect on child dyadic initiation with the caregiver was sustained through the follow-up period. Increased child initiation at treatment midpoint mediated the majority (73%) of the treatment effect on follow-up ADOS CSS. A combination of partial mediation from midpoint child initiations and the direct effect of treatment also contributed to a near-significant total effect on follow-up TVABS. No moderation of this mediation was found for AE, CSBS or IS. CONCLUSIONS Early sustained increase in an autistic child's communication initiation with their caregiver is largely responsible for the long-term effects from PACT therapy on autistic and adaptive behaviour outcomes. This supports the theoretical logic model of PACT therapy but also illuminates fundamental causal processes of social and adaptive development in autism over time: early social engagement in autism can be improved and this can have long-term generalised outcome effects.
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Affiliation(s)
- Sophie Carruthers
- Department of PsychologyInstitute of Psychiatry, Psychology & Neuroscience, King's College LondonLondonUK
| | - Andrew Pickles
- Department of Biostatistics and Health InformaticsInstitute of Psychiatry, Psychology & Neuroscience, King's College LondonLondonUK
| | - Tony Charman
- Department of PsychologyInstitute of Psychiatry, Psychology & Neuroscience, King's College LondonLondonUK
| | - Helen McConachie
- Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Ann Le Couteur
- Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Vicky Slonims
- Department of PsychologyInstitute of Psychiatry, Psychology & Neuroscience, King's College LondonLondonUK
- Evelina London Children's HospitalLondonUK
| | - Patricia Howlin
- Department of PsychologyInstitute of Psychiatry, Psychology & Neuroscience, King's College LondonLondonUK
| | - Rachel Collum
- Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Erica Salomone
- Department of PsychologyInstitute of Psychiatry, Psychology & Neuroscience, King's College LondonLondonUK
- Department of PsychologyUniversity of Milano‐BicoccaMilanItaly
| | | | - Isobel Gammer
- Department of PsychologyInstitute of Psychiatry, Psychology & Neuroscience, King's College LondonLondonUK
| | - Jessica Maxwell
- Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneUK
| | | | - Jeremy Parr
- Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneUK
| | | | - Jonathan Green
- Manchester Academic Health Sciences Centre, Royal Manchester Children's HospitalUniversity of ManchesterManchesterUK
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9
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Fletcher-Watson S. What's in a name? The costs and benefits of a formal autism diagnosis. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:257-262. [PMID: 37997793 DOI: 10.1177/13623613231213300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
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10
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Mottron L, Gagnon D. Debate: How far can we modify the expression of autism by modifying the environment? Child Adolesc Ment Health 2024; 29:101-103. [PMID: 38049933 DOI: 10.1111/camh.12686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/01/2023] [Indexed: 12/06/2023]
Abstract
Following Green (Child and Adolescent Mental Health, 2023, 28, 438) the emergence of a manifest autistic phenotype, during preschool years, represents a discontinuity from preclinical or subclinical states. We propose that this discontinuity suggests that autistic children experience superior interest for, and processing of non-social information, whereas children without autism favor social information processing. This is produced by perceptual over-functioning, still allowing self-taught non-social language learning in a substantial fraction of prototypical autistic children. A new set of rigorous intervention studies using Pediatric Autism Communication Therapy (PACT), based on the synchrony principle, brought autistic children below the ADOS diagnostic threshold (Whitehouse et al., JAMA Pediatrics, 2021, 175, e213298). We now know that adaptation of the child's social environment can produce changes in the manifestations of autism in the pre-school period and later. However, the limitation of these changes, combine with evidence of non-social learning of language suggests that clinicians should combine lateral tutorship (the parallel, unsynchronous exposure of information) with the synchrony (early dyadic communication and engagement) principle to create a new generation of strength-based interventions.
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Affiliation(s)
- Laurent Mottron
- CIUSSS du Nord-de-l'Ile-de-Montréal, Hôpital Rivière des-Prairies, Montréal, QC, Canada
- Département de psychiatrie et d'addictologie, Université de Montréal, Montréal, QC, Canada
| | - David Gagnon
- Département de psychiatrie et d'addictologie, Université de Montréal, Montréal, QC, Canada
- Centre de Recherche du CIUSSS-NIM, Hôpital Rivière-des-Prairies, Université de Montréal, Montréal, QC, Canada
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11
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Sun YJ, Sahakian BJ, Langley C, Yang A, Jiang Y, Kang J, Zhao X, Li C, Cheng W, Feng J. Early-initiated childhood reading for pleasure: associations with better cognitive performance, mental well-being and brain structure in young adolescence. Psychol Med 2024; 54:359-373. [PMID: 37376848 DOI: 10.1017/s0033291723001381] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
BACKGROUND Childhood is a crucial neurodevelopmental period. We investigated whether childhood reading for pleasure (RfP) was related to young adolescent assessments of cognition, mental health, and brain structure. METHODS We conducted a cross-sectional and longitudinal study in a large-scale US national cohort (10 000 + young adolescents), using the well-established linear mixed model and structural equation methods for twin study, longitudinal and mediation analyses. A 2-sample Mendelian randomization (MR) analysis for potential causal inference was also performed. Important factors including socio-economic status were controlled. RESULTS Early-initiated long-standing childhood RfP (early RfP) was highly positively correlated with performance on cognitive tests and significantly negatively correlated with mental health problem scores of young adolescents. These participants with higher early RfP scores exhibited moderately larger total brain cortical areas and volumes, with increased regions including the temporal, frontal, insula, supramarginal; left angular, para-hippocampal; right middle-occipital, anterior-cingulate, orbital areas; and subcortical ventral-diencephalon and thalamus. These brain structures were significantly related to their cognitive and mental health scores, and displayed significant mediation effects. Early RfP was longitudinally associated with higher crystallized cognition and lower attention symptoms at follow-up. Approximately 12 h/week of youth regular RfP was cognitively optimal. We further observed a moderately significant heritability of early RfP, with considerable contribution from environments. MR analysis revealed beneficial causal associations of early RfP with adult cognitive performance and left superior temporal structure. CONCLUSIONS These findings, for the first time, revealed the important relationships of early RfP with subsequent brain and cognitive development and mental well-being.
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Affiliation(s)
- Yun-Jun Sun
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
- Key Laboratory of Computational Neuroscience and Brain Inspired Intelligence (Fudan University), Ministry of Education, Shanghai, China
- MOE Frontiers Center for Brain Science, Fudan University, Shanghai, China
| | - Barbara J Sahakian
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
- Key Laboratory of Computational Neuroscience and Brain Inspired Intelligence (Fudan University), Ministry of Education, Shanghai, China
- MOE Frontiers Center for Brain Science, Fudan University, Shanghai, China
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
| | - Christelle Langley
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
- Key Laboratory of Computational Neuroscience and Brain Inspired Intelligence (Fudan University), Ministry of Education, Shanghai, China
- MOE Frontiers Center for Brain Science, Fudan University, Shanghai, China
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
| | - Anyi Yang
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
- Key Laboratory of Computational Neuroscience and Brain Inspired Intelligence (Fudan University), Ministry of Education, Shanghai, China
- MOE Frontiers Center for Brain Science, Fudan University, Shanghai, China
| | - Yuchao Jiang
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
- Key Laboratory of Computational Neuroscience and Brain Inspired Intelligence (Fudan University), Ministry of Education, Shanghai, China
- MOE Frontiers Center for Brain Science, Fudan University, Shanghai, China
| | - Jujiao Kang
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
- Key Laboratory of Computational Neuroscience and Brain Inspired Intelligence (Fudan University), Ministry of Education, Shanghai, China
- MOE Frontiers Center for Brain Science, Fudan University, Shanghai, China
| | - Xingming Zhao
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
- Key Laboratory of Computational Neuroscience and Brain Inspired Intelligence (Fudan University), Ministry of Education, Shanghai, China
- MOE Frontiers Center for Brain Science, Fudan University, Shanghai, China
- Zhangjiang Fudan International Innovation Center, Shanghai, China
| | - Chunhe Li
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
- Key Laboratory of Computational Neuroscience and Brain Inspired Intelligence (Fudan University), Ministry of Education, Shanghai, China
- MOE Frontiers Center for Brain Science, Fudan University, Shanghai, China
| | - Wei Cheng
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
- Key Laboratory of Computational Neuroscience and Brain Inspired Intelligence (Fudan University), Ministry of Education, Shanghai, China
- MOE Frontiers Center for Brain Science, Fudan University, Shanghai, China
- Department of Computer Science, University of Warwick, Coventry CV4 7AL, UK
| | - Jianfeng Feng
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
- Key Laboratory of Computational Neuroscience and Brain Inspired Intelligence (Fudan University), Ministry of Education, Shanghai, China
- MOE Frontiers Center for Brain Science, Fudan University, Shanghai, China
- Department of Computer Science, University of Warwick, Coventry CV4 7AL, UK
- Zhangjiang Fudan International Innovation Center, Shanghai, China
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12
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Hodge A, Sutherland R, Ong N, Chan E, Barnett D, Bennett B, Boulton K, Francis D, Guastella A, Papanicolaou A, Tomsic G, Williamsz M, Silove N. Telehealth assessment of autism in preschoolers using the TELE-ASD-PEDS: A pilot clinical investigation. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023:1-17. [PMID: 38105699 DOI: 10.1080/17549507.2023.2270187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
PURPOSE Appropriate early intervention is beneficial but dependent on accurate and timely diagnoses. This has been affected by long waiting lists for face-to-face clinical services, in part due to pandemic lockdowns, with telehealth introduced in many services to continue clinical services. This pilot clinical study investigated the feasibility of integrating a specially-designed telepractice autism assessment tool into a tertiary diagnostic service. METHOD Eighteen boys (2;4-5;1) participated in the study. Assessment was undertaken as per standard practice (parent interview, questionnaires, review of reports), with an additional telepractice assessment, included in place of face-to-face assessment, to provide clinicians with an observation of the children's communication, behaviours, and interests. Ten parents provided feedback via semi-structured interviews. RESULT The TELE-ASD-PEDS was a feasible assessment tool in terms of administration, clinical experience, and information gained through the assessment process. Parents reported mostly positive experiences of the TELE-ASD-PEDS and made suggestions for improvements for future use of this tool. CONCLUSION It is possible to obtain useful information about a child's autism-specific behaviours using the activities in the TELE-ASD-PEDS. This information can be combined with clinical history from parents using the DSM-5 framework to provide a gold standard assessment for autism.
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Affiliation(s)
- Antoinette Hodge
- Child Development Unit, The Children's Hospital at Westmead, Westmead, Australia
| | - Rebecca Sutherland
- Discipline of Speech Pathology, Faculty of Medicine and Health, Univeristy of Sydney, Sydney, Australia
| | - Natalie Ong
- Child Development Unit, The Children's Hospital at Westmead, Westmead, Australia
- Discipline of Speech Pathology, Faculty of Medicine and Health, Univeristy of Sydney, Sydney, Australia
- The School of Women's and Children's Health, University of New South Wales, Sydney, Australia
| | - Esther Chan
- Child Development Unit, The Children's Hospital at Westmead, Westmead, Australia
| | - Diana Barnett
- Child Development Unit, The Children's Hospital at Westmead, Westmead, Australia
| | - Beverley Bennett
- Child Development Unit, The Children's Hospital at Westmead, Westmead, Australia
| | - Kelsie Boulton
- Discipline of Speech Pathology, Faculty of Medicine and Health, Univeristy of Sydney, Sydney, Australia
| | - Deanna Francis
- Child Development Unit, The Children's Hospital at Westmead, Westmead, Australia
- Black Dog Institute, University of New South Wales, Sydney, Australia, and
- School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Adam Guastella
- Discipline of Speech Pathology, Faculty of Medicine and Health, Univeristy of Sydney, Sydney, Australia
| | - Angela Papanicolaou
- Child Development Unit, The Children's Hospital at Westmead, Westmead, Australia
| | - Gail Tomsic
- Child Development Unit, The Children's Hospital at Westmead, Westmead, Australia
| | - Marcia Williamsz
- Child Development Unit, The Children's Hospital at Westmead, Westmead, Australia
| | - Natalie Silove
- Child Development Unit, The Children's Hospital at Westmead, Westmead, Australia
- Discipline of Speech Pathology, Faculty of Medicine and Health, Univeristy of Sydney, Sydney, Australia
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13
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An S, Zhen Z, Wang S, Sang M, Zhang S. Intestinal Microbiota Is a Key Target for Load Swimming to Improve Anxiety Behavior and Muscle Strength in Shank 3 -/- Rats. Mol Neurobiol 2023:10.1007/s12035-023-03670-8. [PMID: 37966684 DOI: 10.1007/s12035-023-03670-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 09/20/2023] [Indexed: 11/16/2023]
Abstract
Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by social disorder and stereotypical behavior, and its incidence rate is increasing yearly. It is considered that acritical period for the prognosis of young children with ASD exists, thus early treatment is crucial. Swimming, due to its comforting effect, is often used to induce enthusiasm in young children for completing activities and has a good effect in the treatment of ASD, but the effective path of swimming has yet to be reported. The intestinal microbiota of ASD patients and animal models has been reported to be different from that of healthy controls, and these changes may affect the brain environment. Therefore, whether the intestinal microbiota is involved in the treatment of ASD by early swimming is our concern. In this study, we used 8-day old Shank3 gene knockout rats with 8 weeks of early load swimming training and conducted behavioral, small intestine morphology, and intestinal content sequencing after training. The results showed that early load swimming significantly reduced the stereotyped and anxious behaviors of Shank3-/- rats, increased their muscle strength, increased the length of intestinal villi and the width of the muscular layer after Shank3 knockout, and affected the abundance of intestinal microorganisms. The abundances with statistical significance were Lactobacillus, Lachnospiraceae, and Alloprevotella. To further confirm the role of intestinal microorganisms in it, we designed a 14-day intestinal stool transplantation experiment. Fecal microbiota transplantation demonstrated that load swimming can significantly reduce the anxiety behavior of Shank3 rats, increase their muscle strength, change the structure of the small intestine, and affect the abundance of intestinal contents. The abundance of Epsilonbateraeota, Prevotella, and Bacteroides significantly changed after transplantation. Our findings confirm the possibility of early load swimming therapy for individuals with ASD and explain that the intestinal microbiota is a key pathway for early exercise therapy for patients with ASD.
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Affiliation(s)
- Shasha An
- College of Physical Education and Sports, Beijing Normal University, Beijing, 100875, China
| | - Zhiping Zhen
- College of Physical Education and Sports, Beijing Normal University, Beijing, 100875, China.
| | - Shijiao Wang
- College of Physical Education and Sports, Beijing Normal University, Beijing, 100875, China
| | - Mingze Sang
- College of Physical Education and Sports, Beijing Normal University, Beijing, 100875, China
| | - Shuai Zhang
- College of Physical Education and Sports, Beijing Normal University, Beijing, 100875, China
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14
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Smith J, Sulek R, Van Der Wert K, Cincotta-Lee O, Green CC, Bent CA, Chetcuti L, Hudry K. Parental Imitations and Expansions of Child Language Predict Later Language Outcomes of Autistic Preschoolers. J Autism Dev Disord 2023; 53:4107-4120. [PMID: 35976507 PMCID: PMC9382601 DOI: 10.1007/s10803-022-05706-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2022] [Indexed: 11/26/2022]
Abstract
Both the amount and responsiveness of adult language input contribute to the language development of autistic and non-autistic children. From parent-child interaction footage, we measured the amount of adult language input, overall parent responsiveness, and six discrete parent responsive behaviours (imitations, expansions, open-ended questions, yes/no questions, comments and acknowledgements) to explore which types of responsiveness predicted autistic preschoolers' language five months later, after controlling for adult language input. We found expansions and particularly imitations to be more important for later language than overall responsiveness. This study emphasises the need to capture what exactly about parent language input influences child language acquisition, and adds to the evidence that imitating and expanding early language might be particularly beneficial for autistic preschoolers.
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Affiliation(s)
- Jodie Smith
- School of Allied Health, Human Services and Sport, La Trobe University, Plenty Road and Kingsbury Drive Bundoora, Melbourne, 3086, Australia.
- Department of Psychology, Counselling and Therapy, La Trobe University, Plenty Road and Kingsbury Drive Bundoora, Melbourne, 3086, Australia.
| | - Rhylee Sulek
- School of Allied Health Sciences, Griffith University, Parklands Drive, Southport, QLD, 4222, Australia
| | - Kailia Van Der Wert
- Department of Psychology, Counselling and Therapy, La Trobe University, Plenty Road and Kingsbury Drive Bundoora, Melbourne, 3086, Australia
| | - Olivia Cincotta-Lee
- Department of Psychology, Counselling and Therapy, La Trobe University, Plenty Road and Kingsbury Drive Bundoora, Melbourne, 3086, Australia
| | - Cherie C Green
- Department of Psychology, Counselling and Therapy, La Trobe University, Plenty Road and Kingsbury Drive Bundoora, Melbourne, 3086, Australia
| | - Catherine A Bent
- Department of Psychology, Counselling and Therapy, La Trobe University, Plenty Road and Kingsbury Drive Bundoora, Melbourne, 3086, Australia
| | - Lacey Chetcuti
- Department of Psychology, Counselling and Therapy, La Trobe University, Plenty Road and Kingsbury Drive Bundoora, Melbourne, 3086, Australia
- School of Psychology, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia
| | - Kristelle Hudry
- Department of Psychology, Counselling and Therapy, La Trobe University, Plenty Road and Kingsbury Drive Bundoora, Melbourne, 3086, Australia
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Grzadzinski R, Jatkar A, Donovan K, Truong K, Holbrook A, Lord C, Kim SH. Examining Treatment Outcomes Across Contexts: How Do Child Baseline Characteristics Impact Measurement of Treatment Response? J Autism Dev Disord 2023; 53:4121-4131. [PMID: 35969334 PMCID: PMC9969996 DOI: 10.1007/s10803-022-05655-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2022] [Indexed: 10/15/2022]
Abstract
The evaluation of the overlap between the ADOS BOSCC and Standard BOSCC as well as the exploration of child characteristics that may predict change are important steps in consolidating data-driven definitions of "improvement". Participants were seen between 2 and 5 times with Standard BOSCC and ADOS BOSCC observations over the course of early intervention trials (Grzadzinski et al. in J Autism Dev Disord 46:2464, 2016; Kim et al. in Autism 23:5, 2019). Results showed consistency between the Standard BOSCC and ADOS BOSCC, highlighting the utility of both as metrics of change and treatment outcome across contexts. Baseline characteristics may play a role in the tailoring of early intervention to maximize treatment outcome and may offer guidance when determining which outcome measures to use.
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Affiliation(s)
- Rebecca Grzadzinski
- Carolina Institute for Developmental Disabilities, University of North Carolina, Chapel Hill, NC, USA
- Program for Early Autism Research Leadership and Service (PEARLS), University of North Carolina, Chapel Hill, NC, USA
| | - Alapika Jatkar
- Carolina Institute for Developmental Disabilities, University of North Carolina, Chapel Hill, NC, USA
| | - Kevin Donovan
- Penn Statistics in Imaging and Visualization Endeavor (PennSIVE), Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Kinh Truong
- Gillings School of Global Public Health, Department of Biostatistics, Chapel Hill, USA
| | | | - Catherine Lord
- Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles, Los Angeles, USA
| | - So Hyun Kim
- School of Psychology, Korea University, Seoul, South Korea.
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16
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Cleary DB, Maybery MT, Green C, Whitehouse AJO. The first six months of life: A systematic review of early markers associated with later autism. Neurosci Biobehav Rev 2023; 152:105304. [PMID: 37406749 DOI: 10.1016/j.neubiorev.2023.105304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 06/02/2023] [Accepted: 07/02/2023] [Indexed: 07/07/2023]
Abstract
There is now good evidence that behavioural signs of autism spectrum conditions (autism) emerge over the first two years of life. Identifying clear developmental differences early in life may facilitate earlier identification and intervention that can promote longer-term quality of life. Here we present a systematic review of studies investigating behavioural markers of later autism diagnosis or symptomology taken at 0-6 months. The following databases were searched for articles published between 01/01/2000 and 15/03/2022: Embase, Medline, Scopus, PubMed, PsycINFO, CINAHL, Web of Science and Proquest. Twenty-five studies met inclusion criteria: assessment of behaviour at 0-6 months and later assessment of autism symptomology or diagnosis. Studies examined behaviours of attention, early social and communication behaviours, and motor behaviours, as well as composite measures. Findings indicated some evidence of measures of general attention, attention to social stimuli, and motor behaviours associated with later autism diagnosis or symptomology. Findings were inconsistent regarding social and communication behaviours, with a lack of repeated or validated measures limiting drawing firm conclusions. We discuss implications of the findings and suggest recommendations for future research.
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Affiliation(s)
- Dominique B Cleary
- Telethon Kids Institute, The University of Western Australia, Australia; School of Psychological Science, The University of Western Australia, Australia.
| | - Murray T Maybery
- School of Psychological Science, The University of Western Australia, Australia
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17
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Highman C, Overby M, Leitão S, Abbiati C, Velleman S. Update on Identification and Treatment of Infants and Toddlers With Suspected Childhood Apraxia of Speech. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023:1-21. [PMID: 37441847 DOI: 10.1044/2023_jslhr-22-00639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Abstract
PURPOSE The purpose of this tutorial is to (a) provide an updated review of the literature pertaining to proposed early features of childhood apraxia of speech (CAS), (b) discuss the findings of recent treatment studies of infants and toddlers with suspected CAS (sCAS), and (c) present evidence-based strategies and tools that can be used for the identification of and intervention for infants and toddlers with sCAS or at high risk for the disorder. METHOD Since Davis and Velleman's (2000) seminal work on assessment and intervention in infants and toddlers with sCAS, limited research has guided clinicians in the complex task of identifying and treating early speech motor difficulties prior to a definitive diagnosis of CAS. Following the structure of Davis and Velleman, we explore the proposed early characteristics of CAS with reference to contemporary research. Next, we describe the limited treatment studies that have investigated intervention for infants and toddlers at risk of or suspected of having CAS. Finally, we present practical suggestions for integrating this knowledge into clinical practice. CONCLUSIONS Many of the originally proposed correlates of CAS in infants and toddlers now have research supporting their presence. However, questions remain about the developmental trajectory of the disorder. Although limited in number and restricted by lack of experimental control, emerging treatment studies can help guide clinicians in providing appropriate intervention to infants and toddlers with sCAS who need not wait for a definitive diagnosis to initiate intervention.
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Affiliation(s)
- Chantelle Highman
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Megan Overby
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Suze Leitão
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Claudia Abbiati
- Department of Communication Sciences and Disorders, University of Vermont, Burlington
| | - Shelley Velleman
- Department of Communication Sciences and Disorders, University of Vermont, Burlington
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Abstract
We are at a time of unparalleled flux in our understanding of what autism is and now to respond to it, including our understanding of the role of clinical services. For any clinician working in the context of child development and child mental health services, the majority experience is probably of overwhelming demand, and then perhaps confusion. Referrals for neurodevelopmental conditions, and particularly autism, have become an increasing proportion of UK CAMHS referrals in recent years-with the consequent lengthening of wait times extending to years, sometimes equivalent to the whole length of a child's life up until that point. Services are struggling to develop response strategies to meet user frustration, a task not helped by the fact that most interventions in current use have no good evidence of effectiveness. Consequently, a plethora of local approaches and initiatives have developed. In this article I address these clinical and related issues. I discuss current different uses of the term autism, the relation to intellectual disability, and introduce a conceptualisation of autism as emergent and transactional, which is consistent with current developmental and intervention science. This could bridge between neurodiversity and clinical perspectives and implies a framing of early intervention support that has strong clinical trials evidence and provides the basis for a rational and pre-emptive evidenced care pathway, which I describe.
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Affiliation(s)
- Jonathan Green
- University of Manchester, Royal Manchester Children's Hospital, and Manchester Academic Health Sciences Centre, Manchester, UK
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19
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McGlade A, Whittingham K, Barfoot J, Taylor L, Boyd RN. Efficacy of very early interventions on neurodevelopmental outcomes for infants and toddlers at increased likelihood of or diagnosed with autism: A systematic review and meta-analysis. Autism Res 2023; 16:1145-1160. [PMID: 37036800 PMCID: PMC10946707 DOI: 10.1002/aur.2924] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 03/18/2023] [Indexed: 04/11/2023]
Abstract
The aim of this systematic review was to determine the efficacy of very early interventions for infants and toddlers at increased likelihood of or diagnosed with autism for autism symptomatology, developmental outcomes and/or neurocognitive markers. Eight databases were searched (14 April 2022) with inclusion criteria: (i) RCTs with care as usual (CAU) comparison group, (ii) participants at increased likelihood of or diagnosed with autism and aged <24 months corrected age (CA), (iii) parent-mediated and/or clinician directed interventions, and (iv) outcome measures were autism symptomatology, cognition, language, adaptive skills, or neurocognitive assessments (EEG and eye tracking). Quality was assessed using Risk of Bias 2 and GRADE. Nineteen publications from 12 studies reported on 715 infants and toddlers. There was low to moderate certainty evidence that clinician-assessed outcomes did not show significant treatment effects for: autism symptomatology (ADOS CSS: MD -0.08, 95% CI -0.61, 0.44, p = 0.75), cognitive outcome (Mullen Scales of Early Learning-Early Learning Composite (MSEL-ELC): SMD 0.05, 95% CI -0.19, 0.29, p = 0.67), receptive language (MSEL-Receptive Language: SMD 0.04, 95% CI -0.21, 0.3, p = 0.74) or expressive language (MSEL-Expressive Language: SMD 0.06, 95% CI -0.1, 0.23, p = 0.45). Neurocognitive outcomes (EEG and eye tracking) were heterogeneous, with inconsistent findings. There is low to moderate certainty evidence that very early interventions have limited impact on neurodevelopmental outcomes by age 3 years.
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Affiliation(s)
- Andrea McGlade
- Faculty of MedicineThe University of Queensland, Queensland Cerebral Palsy and Rehabilitation Research CentreBrisbaneQueenslandAustralia
| | - Koa Whittingham
- Faculty of MedicineThe University of Queensland, Queensland Cerebral Palsy and Rehabilitation Research CentreBrisbaneQueenslandAustralia
| | - Jacqui Barfoot
- Faculty of MedicineThe University of Queensland, Queensland Cerebral Palsy and Rehabilitation Research CentreBrisbaneQueenslandAustralia
| | - Leisa Taylor
- Department of Humanities EducationUniversity of New EnglandArmidaleNew South WalesAustralia
| | - Roslyn N. Boyd
- Faculty of MedicineThe University of Queensland, Queensland Cerebral Palsy and Rehabilitation Research CentreBrisbaneQueenslandAustralia
- Queensland Paediatric Rehabilitation ServiceQueensland Children's HospitalBrisbaneQueenslandAustralia
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20
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Bao XH, Chen BF, Liu J, Tan YH, Chen S, Zhang F, Lu HS, Li JC. Olink proteomics profiling platform reveals non-invasive inflammatory related protein biomarkers in autism spectrum disorder. Front Mol Neurosci 2023; 16:1185021. [PMID: 37293545 PMCID: PMC10244537 DOI: 10.3389/fnmol.2023.1185021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 04/28/2023] [Indexed: 06/10/2023] Open
Abstract
Background Owing to the lack of valid biomarkers, the diagnosis of autism spectrum disorder (ASD) diagnosis relies solely on the behavioral phenotypes of children. Several researchers have suggested an association between ASD and inflammation; however, the complex relationship between the two is unelucidated to date. Therefore, the current study aims to comprehensively identify novel circulating ASD inflammatory biomarkers. Methods Olink proteomics was applied to compare the plasma inflammation-related protein changes in a group of the healthy children (HC, n = 33) and another with ASD (n = 31). The areas under the receiver operating characteristic curves (AUCs) of the differentially expressed proteins (DEPs) were calculated. The functional analysis of the DEPs was performed using Gene Ontology and Kyoto Encyclopedia Genes and Genomes. Pearson correlation tests were used employed to analyze the correlation between the DEPs and clinical features. Results A total of 13 DEPs were significantly up-regulated in the ASD group compared with the HC group. The four proteins, namely, STAMBP, ST1A1, SIRT2, and MMP-10 demonstrated good diagnostic accuracy with the corresponding AUCs (95% confidence interval, CI) of 0.7218 (0.5946-0.8489), 0.7107 (0.5827-0.8387), 0.7016 (0.5713-0.8319), and 0.7006 (0.568-0.8332). Each panel of STAMBP and any other differential protein demonstrated a better classification performance [AUC values from 0.7147 (0.5858-0.8436, STAMBP/AXIN1) to 0.7681 (0.6496-0.8867, STAMBP/MMP-10)]. These DEP profiles were enriched in immune and inflammatory response pathways, including TNF and NOD-like receptor signaling pathways. The interaction between STAMBP and SIRT2 (R = 0.97, p = 8.52 × 10-39) was found to be the most significant. In addition, several DEPs related to clinical features in patients with ASD, particularly AXIN1 (R = 0.36, p = 0.006), SIRT2 (R = 0.34, p = 0.010) and STAMBP (R = 0.34, p = 0.010), were positively correlated with age and parity, indicating that older age and higher parity may be the inflammation-related clinical factors in ASD. Conclusion Inflammation plays a crucial role in ASD, and the up-regulated inflammatory proteins may serve as potential early diagnostic biomarkers for ASD.
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Affiliation(s)
- Xiao-Hong Bao
- Precision Medicine Center and Department of Cardiothoracic Surgery, Taizhou Central Hospital (Taizhou University Hospital), Taizhou University, Taizhou, China
| | - Bao-Fu Chen
- Precision Medicine Center and Department of Cardiothoracic Surgery, Taizhou Central Hospital (Taizhou University Hospital), Taizhou University, Taizhou, China
| | - Jun Liu
- Medical Research Center, Yue Bei People's Hospital, Shantou University Medical College, Shaoguan, China
| | - Yu-Hua Tan
- Department of Children Rehabilitation, Shaoguan Maternal and Child Health Hospital, Shaoguan, China
| | - Shu Chen
- Department of Children Rehabilitation, Shaoguan Maternal and Child Health Hospital, Shaoguan, China
| | - Fan Zhang
- Medical Research Center, Yue Bei People's Hospital, Shantou University Medical College, Shaoguan, China
| | - Hong-Sheng Lu
- Precision Medicine Center and Department of Cardiothoracic Surgery, Taizhou Central Hospital (Taizhou University Hospital), Taizhou University, Taizhou, China
| | - Ji-Cheng Li
- Precision Medicine Center and Department of Cardiothoracic Surgery, Taizhou Central Hospital (Taizhou University Hospital), Taizhou University, Taizhou, China
- Medical Research Center, Yue Bei People's Hospital, Shantou University Medical College, Shaoguan, China
- Department of Histology and Embryology, School of Basic Medical Sciences, Henan University, Kaifeng, China
- Institute of Cell Biology, Zhejiang University Medical School, Hangzhou, China
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Loncarevic A, Maybery MT, Barbaro J, Dissanayake C, Green J, Hudry K, Iacono T, Slonims V, Varcin KJ, Wan MW, Wray J, Whitehouse AJO. Parent-Child Interactions May Help to Explain Relations Between Parent Characteristics and Clinically Observed Child Autistic Behaviours. J Autism Dev Disord 2023:10.1007/s10803-023-05914-x. [PMID: 37209200 DOI: 10.1007/s10803-023-05914-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2023] [Indexed: 05/22/2023]
Abstract
The importance of supporting parent-child interactions has been noted in the context of prodromal autism, but little consideration has been given to the possible contributing role of parental characteristics, such as psychological distress. This cross-sectional study tested models in which parent-child interaction variables mediated relations between parent characteristics and child autistic behaviour in a sample of families whose infant demonstrated early signs of autism (N = 103). The findings suggest that associations between parent characteristics (psychological distress; aloofness) and child autistic behaviours may be mediated by the child's inattentiveness or negative affect during interactions. These findings have important implications in developing and implementing interventions in infancy which target the synchrony of parent-child interaction with the goal to support children's social communication development.
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Affiliation(s)
- Antonina Loncarevic
- CliniKids, Telethon Kids Institute, Nedlands, WA, Australia.
- School of Psychological Science, University of Western Australia, Crawley, WA, Australia.
| | - Murray T Maybery
- School of Psychological Science, University of Western Australia, Crawley, WA, Australia
| | - Josephine Barbaro
- Cooperative Research Centre for Living with Autism, Long Pocket, Indooroopilly, QLD, Australia
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Bundoora, VIC, Australia
| | - Cheryl Dissanayake
- Cooperative Research Centre for Living with Autism, Long Pocket, Indooroopilly, QLD, Australia
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Bundoora, VIC, Australia
| | - Jonathan Green
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Greater Manchester Mental Health NHS Trust, Manchester, UK
| | - Kristelle Hudry
- Cooperative Research Centre for Living with Autism, Long Pocket, Indooroopilly, QLD, Australia
- Department of Psychology and Counselling, School of Psychology and Public Health, La Trobe University, Bundoora, VIC, Australia
| | - Teresa Iacono
- Living with Disability Research Centre, College of Science, Health, and Engineering, Victoria, Australia
| | - Vicky Slonims
- Children's Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, Evelina London Children's Hospital, Kings College London, London, UK
| | - Kandice J Varcin
- CliniKids, Telethon Kids Institute, Nedlands, WA, Australia
- School of Allied Health Sciences, Griffith University, Gold Coast, Brisbane, QLD, Australia
| | - Ming Wai Wan
- Perinatal Mental Health and Parenting Research Unit, Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - John Wray
- Child and Adolescent Health Service, Child Development Service, West Perth, WA, Australia
| | - Andrew J O Whitehouse
- CliniKids, Telethon Kids Institute, Nedlands, WA, Australia
- Cooperative Research Centre for Living with Autism, Long Pocket, Indooroopilly, QLD, Australia
- University of Western Australia, Crawley, WA, Australia
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22
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Mottron L, Gagnon D. Prototypical autism: New diagnostic criteria and asymmetrical bifurcation model. Acta Psychol (Amst) 2023; 237:103938. [PMID: 37187094 DOI: 10.1016/j.actpsy.2023.103938] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 05/04/2023] [Accepted: 05/11/2023] [Indexed: 05/17/2023] Open
Abstract
The current "autism spectrum" DSM 5 diagnostic criteria and autism standardized diagnostic instruments promote considerable heterogeneity or clinical indecision and may be detrimental to the advancement of fundamental research on autism mechanisms. To increase clinical specificity and reorient research towards core autistic presentations, we propose new diagnostic criteria for prototypical autism during the age of 2- to 5-years. We include autism within other non-dominant, familiarly aggregated phenomena sharing asymmetrical developmental bifurcations, such as twin pregnancy, left handedness, and breech presentation/delivery. Following this model, nature, trajectory, and positive/negative signs structure of autism would result from the polarized problem of whether or not language and information is processed in a socially biased manner. Prototypical autism would follow a canonical developmental trajectory by which a gradual decline in social bias in the processing of incoming information, overtly beginning at the end of the first year, bifurcates into a prototypical autistic presentation in the second half of the second year of life. This bifurcation event is followed by a plateau, in which these atypicalities show maximal stringency and distinctiveness, and then ultimately, in most cases, by partial normalization. During the plateau period, the orientation towards, and processing of, information is considerably modified, with an absence of bias for social information, contrasting with a high level of interest in complex, unbiased information, independently of its social or non-social nature. Integrating autism into asymmetrical developmental bifurcations would explain the absence of deleterious neurological and genetic markers and the presence of familial transmission in canonical autistic presentations.
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Affiliation(s)
- Laurent Mottron
- Department of Psychiatry and Addictology, University of Montreal, 2900 blvd Edouard-Montpetit, Montreal, Qc H3T 1J4, Canada; CIUSSS-NIM Research Center, Riviere-des-Prairies Hospital, 7070, blvd Perras, Montreal, QC H1E 1A4, Canada.
| | - David Gagnon
- Department of Psychiatry and Addictology, University of Montreal, 2900 blvd Edouard-Montpetit, Montreal, Qc H3T 1J4, Canada; CIUSSS-NIM Research Center, Riviere-des-Prairies Hospital, 7070, blvd Perras, Montreal, QC H1E 1A4, Canada
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23
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Segal L, Green J, Twizeyemariya A, Hudry K, Wan MW, Barbaro J, Iacono T, Varcin KJ, Pillar S, Cooper MN, Billingham W, Upson G, Whitehouse AJO. Estimated Therapy Costs and Downstream Cost Consequences of iBASIS-Video Interaction to Promote Positive Parenting Intervention vs Usual Care Among Children Displaying Early Behavioral Signs of Autism in Australia. JAMA Netw Open 2023; 6:e235847. [PMID: 37017966 PMCID: PMC10077097 DOI: 10.1001/jamanetworkopen.2023.5847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 02/07/2023] [Indexed: 04/06/2023] Open
Abstract
Importance The growing global prevalence of autism spectrum disorder (ASD) is associated with increasing costs for support services. Ascertaining the effects of a successful preemptive intervention for infants showing early behavioral signs of autism on human services budgets is highly policy relevant. Objective To estimate the net cost impact of the iBASIS-Video Interaction to Promote Positive Parenting (iBASIS-VIPP) intervention on the Australian government. Design, Setting, and Participants Infants (aged 12 months) showing early behavioral indicators of autism were recruited through community settings into the multicenter Australian iBASIS-VIPP randomized clinical trial (RCT), a 5- to 6-month preemptive parent-mediated intervention, between June 9, 2016, and March 30, 2018, and were followed up for 18 months to age 3 years. This economic evaluation, including cost analysis (intervention and cost consequences) and cost-effectiveness analyses of iBASIS-VIPP compared with usual care (treatment as usual [TAU]), modeled outcomes observed at age 3 through to 12 years (13th birthday) and was conducted from April 1, 2021, to January 30, 2023. Data analysis was conducted from July 1, 2021, to January 29, 2023. Exposures iBASIS-VIPP intervention. Main Outcomes and Measures To project the diagnostic trajectory and associated disability support costs drawing on the Australian National Disability Insurance Scheme (NDIS), the main outcome was the differential treatment cost of iBASIS-VIPP plus TAU vs TAU and disability-related government costs modeled to age 12 years, using a clinical diagnosis of ASD and developmental delay (with autism traits) at 3 years. Costs were calculated in Australian dollars and converted to US dollars. Economic performance was measured through the following: (1) differential net present value (NPV) cost (iBASIS-VIPP less TAU), (2) investment return (dollars saved for each dollar invested, taking a third-party payer perspective), (3) break-even age when treatment cost was offset by downstream cost savings, and (4) cost-effectiveness in terms of the differential treatment cost per differential ASD diagnosis at age 3 years. Alternate values of key parameters were modeled in 1-way and probabilistic sensitivity analysis, the latter identifying the likelihood of an NPV cost savings. Results Of the 103 infants enrolled in the iBASIS-VIPP RCT, 70 (68.0%) were boys. Follow-up data at age 3 years were available for 89 children who received TAU (44 [49.4%]) or iBASIS-VIPP (45 [50.6%]) and were included in this analysis. The estimated mean differential treatment cost was A $5131 (US $3607) per child for iBASIS-VIPP less TAU. The best estimate of NPV cost savings was A $10 695 (US $7519) per child (discounted at 3% per annum). For each dollar invested in treatment, a savings of A $3.08 (US $3.08) was estimated; the break-even cost occurred at age 5.3 years (approximately 4 years after intervention delivery). The mean differential treatment cost per lower incident case of ASD was A $37 181 (US $26 138). We estimated that there was an 88.9% chance that iBASIS-VIPP would deliver a cost savings for the NDIS, the dominant third-party payer. Conclusions and Relevance The results of this study suggest that iBASIS-VIPP represents a likely good-value societal investment for supporting neurodivergent children. The estimated net cost savings were considered conservative, as they covered only third-party payer costs incurred by the NDIS and outcomes were modeled to just age 12 years. These findings further suggest that preemptive interventions may be a feasible, effective, and efficient new clinical pathway for ASD, reducing disability and the costs of support services. Long-term follow-up of children receiving preemptive intervention is needed to confirm the modeled results.
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Affiliation(s)
- Leonie Segal
- Health Economics and Social Policy Group, Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Jonathan Green
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, United Kingdom
| | - Asterie Twizeyemariya
- Health Economics and Social Policy Group, Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Kristelle Hudry
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Ming Wai Wan
- Division of Psychology and Mental Health, University of Manchester, Manchester, United Kingdom
| | - Josephine Barbaro
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Teresa Iacono
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
- La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Kandice J. Varcin
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Telethon Kids Institute, University of Western Australia, Nedlands, Australia
| | - Sarah Pillar
- Telethon Kids Institute, University of Western Australia, Nedlands, Australia
| | - Matthew N. Cooper
- Telethon Kids Institute, University of Western Australia, Nedlands, Australia
| | - Wesley Billingham
- Telethon Kids Institute, University of Western Australia, Nedlands, Australia
| | - Gemma Upson
- Telethon Kids Institute, University of Western Australia, Nedlands, Australia
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24
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Hudry K, Smith J, Pillar S, Varcin KJ, Bent CA, Boutrus M, Chetcuti L, Clark A, Dissanayake C, Iacono T, Kennedy L, Lant A, Robinson Lake J, Segal L, Slonims V, Taylor C, Wan MW, Green J, Whitehouse AJO. The Utility of Natural Language Samples for Assessing Communication and Language in Infants Referred with Early Signs of Autism. Res Child Adolesc Psychopathol 2023; 51:529-539. [PMID: 36602626 DOI: 10.1007/s10802-022-01010-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2022] [Indexed: 01/06/2023]
Abstract
Natural Language Sampling (NLS) offers clear potential for communication and language assessment, where other data might be difficult to interpret. We leveraged existing primary data for 18-month-olds showing early signs of autism, to examine the reliability and concurrent construct validity of NLS-derived measures coded from video-of child language, parent linguistic input, and dyadic balance of communicative interaction-against standardised assessment scores. Using Systematic Analysis of Language Transcripts (SALT) software and coding conventions, masked coders achieved good-to-excellent inter-rater agreement across all measures. Associations across concurrent measures of analogous constructs suggested strong validity of NLS applied to 6-min video clips. NLS offers benefits of feasibility and adaptability for validly quantifying emerging skills, and potential for standardisation for clinical use and rigorous research design.
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Affiliation(s)
- Kristelle Hudry
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, 3086, Australia.
| | - Jodie Smith
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, 3086, Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, 3086, Australia
| | - Sarah Pillar
- Telethon Kids Institute, The University of Western Australia, Perth, WA, 6009, Australia
| | - Kandice J Varcin
- Telethon Kids Institute, The University of Western Australia, Perth, WA, 6009, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, 4222, Australia
| | - Catherine A Bent
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, 3086, Australia
| | - Maryam Boutrus
- Telethon Kids Institute, The University of Western Australia, Perth, WA, 6009, Australia
- Cooperative Research Centre for Living With Autism, Brisbane, QLD, 4068, Australia
| | - Lacey Chetcuti
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, 3086, Australia
- Cooperative Research Centre for Living With Autism, Brisbane, QLD, 4068, Australia
| | - Alena Clark
- Telethon Kids Institute, The University of Western Australia, Perth, WA, 6009, Australia
| | - Cheryl Dissanayake
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, 3086, Australia
| | - Teresa Iacono
- Living with Disability Research Centre, La Trobe University, Bendigo, VIC, 3550, Australia
| | - Lyndel Kennedy
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, 3086, Australia
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, 3086, Australia
| | - Alicia Lant
- Telethon Kids Institute, The University of Western Australia, Perth, WA, 6009, Australia
| | - Jemima Robinson Lake
- Telethon Kids Institute, The University of Western Australia, Perth, WA, 6009, Australia
| | - Leonie Segal
- Australian Centre for Precision Health Sciences, School of Health Sciences, University of South Australia, Adelaide, SA, 5001, Australia
| | - Vicky Slonims
- Children's Neurosciences, Evelina London Children's Hospital, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, SE5 8AF, UK
| | - Carol Taylor
- Division of Neuroscience & Experimental Psychology, School of Biological Sciences, University of Manchester, Manchester, M13 PL9, UK
| | - Ming Wai Wan
- Division of Neuroscience & Experimental Psychology, School of Biological Sciences, University of Manchester, Manchester, M13 PL9, UK
| | - Jonathan Green
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, M13 PL9, UK
- Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Greater Manchester Mental Health NHS Foundation Trust, Manchester, M25 3BL, UK
| | - Andrew J O Whitehouse
- Telethon Kids Institute, The University of Western Australia, Perth, WA, 6009, Australia
- Cooperative Research Centre for Living With Autism, Brisbane, QLD, 4068, Australia
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25
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Bertamini G, Perzolli S, Bentenuto A, Paolizzi E, Furlanello C, Venuti P. Child-therapist interaction features impact Autism treatment response trajectories. RESEARCH IN DEVELOPMENTAL DISABILITIES 2023; 135:104452. [PMID: 36796270 DOI: 10.1016/j.ridd.2023.104452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/18/2023] [Accepted: 02/01/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Identifying mechanisms of change in Autism treatment may help explain response variability and maximize efficacy. For this, the child-therapist interaction could have a key role as stressed by developmental models of intervention, but still remains under-investigated. AIMS The longitudinal study of treatment response trajectories considering both baseline and child-therapist interaction features by means of predictive modeling. METHODS AND PROCEDURES N = 25 preschool children were monitored for one year during Naturalistic Developmental Behavioral Intervention. N = 100 video-recorded sessions were annotated with an observational coding system at four time points, to extract quantitative interaction features. OUTCOMES AND RESULTS Baseline and interaction variables were combined to predict response trajectories at one year, and achieved the best predictive performance. The baseline developmental gap, therapist's efficacy in child engagement, respecting children's timing after fast behavioral synchronization, and modulating the interplay to prevent child withdrawal emerged as key factors. Further, changes in interaction patterns in the early phase of the intervention were predictive of the overall response to treatment. CONCLUSIONS AND IMPLICATIONS Clinical implications are discussed, stressing the importance of promoting emotional self-regulation during intervention and the possible relevance of the first period of intervention for later response.
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Affiliation(s)
- Giulio Bertamini
- Laboratory of Observation, Diagnosis, and Education (ODFLab), Department of Psychology and Cognitive Science, University of Trento, 38068 Rovereto, Italy; Department of Child and Adolescent Psychiatry, Pitie-Salpetriere University Hospital, Sorbonne University, 75013 Paris, France; Data Science for Health (DSH), Bruno Kessler Foundation, 38123 Trento, Italy; Institute for Ingelligent Systems and Robotics (ISIR), Sorbonne University, 75005 Paris, France.
| | - Silvia Perzolli
- Laboratory of Observation, Diagnosis, and Education (ODFLab), Department of Psychology and Cognitive Science, University of Trento, 38068 Rovereto, Italy
| | - Arianna Bentenuto
- Laboratory of Observation, Diagnosis, and Education (ODFLab), Department of Psychology and Cognitive Science, University of Trento, 38068 Rovereto, Italy
| | - Eleonora Paolizzi
- Laboratory of Observation, Diagnosis, and Education (ODFLab), Department of Psychology and Cognitive Science, University of Trento, 38068 Rovereto, Italy
| | - Cesare Furlanello
- Orobix Life Sciences, 24121 Bergamo, Italy; HK3Lab, 38068 Rovereto, Italy
| | - Paola Venuti
- Laboratory of Observation, Diagnosis, and Education (ODFLab), Department of Psychology and Cognitive Science, University of Trento, 38068 Rovereto, Italy
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26
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Trembath D, Varcin K, Waddington H, Sulek R, Bent C, Ashburner J, Eapen V, Goodall E, Hudry K, Roberts J, Silove N, Whitehouse A. Non-pharmacological interventions for autistic children: An umbrella review. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:275-295. [PMID: 36081343 DOI: 10.1177/13623613221119368] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
LAY ABSTRACT What is already known about the topic?The delivery of evidence-based interventions is an important part of the clinical pathway for many autistic children and their families. However, parents, practitioners, and policymakers face challenges making evidence informed decisions, due to the wide variety of interventions available and the large, and often inconsistent, body of evidence regarding their effectiveness.What this paper adds?This is a comprehensive umbrella review, also known as a 'review of reviews', which examined the range of interventions available, the evidence for their effectiveness, and whether effects were influenced by factors relating to individual children (e.g. chronological age, core autism characteristics, and related skills) or the ways interventions were delivered (by whom and in what setting, format, mode, and amount). There was evidence for positive therapeutic effects for some, but not all, interventions. No single intervention had a positive effect for all child and family outcomes of interest. The influence of child and delivery characteristics on effects was unclear.Implications for practice, research, and policyThe findings provide parents, practitioners, and policymakers with a synthesis of the research evidence to inform decision-making and highlight the importance of individualised approaches in the absence of clear and consistent evidence. The findings also highlight the need to improve consistency and completeness in reporting of research studies, so that the same questions may be answered more comprehensively in the future.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Andrew Whitehouse
- Telethon Kids Institute and The University of Western Australia, Australia
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27
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Finding the Proportion of Females with Autistic Spectrum Disorder Who Develop Anorexia Nervosa, the True Prevalence of Female ASD and Its Clinical Significance. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020272. [PMID: 36832401 PMCID: PMC9955974 DOI: 10.3390/children10020272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/24/2023] [Accepted: 01/27/2023] [Indexed: 02/04/2023]
Abstract
It appears that up to 80% of females with autistic spectrum disorder (ASD) have not been diagnosed by the age of 18. This translates to a prevalence of about 5-6%, and if true, has serious implications for female mental health. One way of finding the true value is to use Bayes' Theorem with a comorbid condition as a more easily recognizable flag. An obvious choice is anorexia nervosa (AN), but it transpires that the proportion of women with ASD who develop AN is unknown. This study uses published data in novel ways to provide two methods of estimating a range for this variable, and gives a median value of 8.3% for AN in ASD and, with four other methods, a median prevalence of 6% for female ASD. The clinical implications of the diagnosis and management of ASD and its comorbidities are discussed and, as an example, a solution is provided for the rate of ASD in symptomatic generalized joint hypermobility. It is probable that one in six women with a mental health condition is autistic.
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28
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Bowe AK, Lightbody G, Staines A, Murray DM. Big data, machine learning, and population health: predicting cognitive outcomes in childhood. Pediatr Res 2023; 93:300-307. [PMID: 35681091 PMCID: PMC7614199 DOI: 10.1038/s41390-022-02137-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 05/05/2022] [Accepted: 05/17/2022] [Indexed: 11/09/2022]
Abstract
The application of machine learning (ML) to address population health challenges has received much less attention than its application in the clinical setting. One such challenge is addressing disparities in early childhood cognitive development-a complex public health issue rooted in the social determinants of health, exacerbated by inequity, characterised by intergenerational transmission, and which will continue unabated without novel approaches to address it. Early life, the period of optimal neuroplasticity, presents a window of opportunity for early intervention to improve cognitive development. Unfortunately for many, this window will be missed, and intervention may never occur or occur only when overt signs of cognitive delay manifest. In this review, we explore the potential value of ML and big data analysis in the early identification of children at risk for poor cognitive outcome, an area where there is an apparent dearth of research. We compare and contrast traditional statistical methods with ML approaches, provide examples of how ML has been used to date in the field of neurodevelopmental disorders, and present a discussion of the opportunities and risks associated with its use at a population level. The review concludes by highlighting potential directions for future research in this area. IMPACT: To date, the application of machine learning to address population health challenges in paediatrics lags behind other clinical applications. This review provides an overview of the public health challenge we face in addressing disparities in childhood cognitive development and focuses on the cornerstone of early intervention. Recent advances in our ability to collect large volumes of data, and in analytic capabilities, provide a potential opportunity to improve current practices in this field. This review explores the potential role of machine learning and big data analysis in the early identification of children at risk for poor cognitive outcomes.
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Affiliation(s)
- Andrea K. Bowe
- grid.7872.a0000000123318773INFANT Research Centre, University College Cork, Cork, Ireland
| | - Gordon Lightbody
- grid.7872.a0000000123318773INFANT Research Centre, University College Cork, Cork, Ireland ,grid.7872.a0000000123318773Department of Electrical and Electronic Engineering, University College Cork, Cork, Ireland
| | - Anthony Staines
- grid.15596.3e0000000102380260School of Nursing, Psychotherapy, and Community Health, Dublin City University, Dublin, Ireland
| | - Deirdre M. Murray
- grid.7872.a0000000123318773INFANT Research Centre, University College Cork, Cork, Ireland
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29
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Loth E. Does the current state of biomarker discovery in autism reflect the limits of reductionism in precision medicine? Suggestions for an integrative approach that considers dynamic mechanisms between brain, body, and the social environment. Front Psychiatry 2023; 14:1085445. [PMID: 36911126 PMCID: PMC9992810 DOI: 10.3389/fpsyt.2023.1085445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 01/23/2023] [Indexed: 02/24/2023] Open
Abstract
Over the past decade, precision medicine has become one of the most influential approaches in biomedical research to improve early detection, diagnosis, and prognosis of clinical conditions and develop mechanism-based therapies tailored to individual characteristics using biomarkers. This perspective article first reviews the origins and concept of precision medicine approaches to autism and summarises recent findings from the first "generation" of biomarker studies. Multi-disciplinary research initiatives created substantially larger, comprehensively characterised cohorts, shifted the focus from group-comparisons to individual variability and subgroups, increased methodological rigour and advanced analytic innovations. However, although several candidate markers with probabilistic value have been identified, separate efforts to divide autism by molecular, brain structural/functional or cognitive markers have not identified a validated diagnostic subgroup. Conversely, studies of specific monogenic subgroups revealed substantial variability in biology and behaviour. The second part discusses both conceptual and methodological factors in these findings. It is argued that the predominant reductionist approach, which seeks to parse complex issues into simpler, more tractable units, let us to neglect the interactions between brain and body, and divorce individuals from their social environment. The third part draws on insights from systems biology, developmental psychology and neurodiversity approaches to outline an integrative approach that considers the dynamic interaction between biological (brain, body) and social mechanisms (stress, stigma) to understanding the origins of autistic features in particular conditions and contexts. This requires 1) closer collaboration with autistic people to increase face validity of concepts and methodologies; (2) development of measures/technologies that enable repeat assessment of social and biological factors in different (naturalistic) conditions and contexts, (3) new analytic methods to study (simulate) these interactions (including emergent properties), and (4) cross-condition designs to understand which mechanisms are transdiagnostic or specific for particular autistic sub-populations. Tailored support may entail both creating more favourable conditions in the social environment and interventions for some autistic people to increase well-being.
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Affiliation(s)
- Eva Loth
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
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30
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Ouss L, Beauquier Maccotta B, Hervé MJ, Bompard C, Desvignes C, Velasquez P, Rusconi Serpa S, Quirot B. Interventions précoces chez les enfants avec autisme : place du vidéo feedback. Des interventions comportementales, à une approche centrée sur les interactions précoces et la sensibilité parentale. ANNALES MÉDICO-PSYCHOLOGIQUES, REVUE PSYCHIATRIQUE 2023. [DOI: 10.1016/j.amp.2022.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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31
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Colombi C, Chericoni N, Bargagna S, Costanzo V, Devescovi R, Lecciso F, Pierotti C, Prosperi M, Contaldo A. Case report: Preemptive intervention for an infant with early signs of autism spectrum disorder during the first year of life. Front Psychiatry 2023; 14:1105253. [PMID: 37205979 PMCID: PMC10189150 DOI: 10.3389/fpsyt.2023.1105253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 04/07/2023] [Indexed: 05/21/2023] Open
Abstract
Autism spectrum disorder (ASD) includes neurodevelopmental conditions traditionally considered to bring life long disabilities, severely impacting individuals and their families. Very early identification and intervention during the very first phases of life have shown to significantly diminish symptom severity and disability, and improve developmental trajectories. Here we report the case of a young child showing early behavioral signs of ASD during the first months of life, including diminished eye contact, reduced social reciprocity, repetitive movements. The child received a pre-emptive parent mediated intervention based on the Infant Start, an adaptation of the Early Start Denver Model (ESDM), specifically developed for children with ASD signs during the first year of life. The child here described received intervention from 6 to 32 months of age, in combination with educational services. Diagnostic evaluations performed at several time points (8, 14, 19, and 32 months) showed progressive improvements in his developmental level and ASD symptoms. Our case study supports the possibility of identifying ASD symptoms and providing services as soon as concerns emerge even during the first year of life. Our report, in combination with recent infant identification and intervention studies, suggests the need for very early screening and preemptive intervention to promote optimal outcomes.
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Affiliation(s)
- Costanza Colombi
- Stella Maris Foundation (IRCCS), Calambrone, Italy
- *Correspondence: Costanza Colombi,
| | | | | | | | - Raffaella Devescovi
- Institute for Maternal and Child Health Burlo Garofolo (IRCCS), Trieste, Friuli-Venezia Giulia, Italy
| | - Flavia Lecciso
- Department of History, Society and Human Studies, University of Salento, Lecce, Apulia, Italy
| | | | - Margherita Prosperi
- UFSMIA Valdera-Alta Val di Cecina, Azienda USL Toscana Nord Ovest, Pisa, Tuscany, Italy
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An Early Enriched Experience Drives an Activated Microglial Profile at Site of Corrective Neuroplasticity in Ten-m3 Knock-Out Mice. eNeuro 2023; 10:ENEURO.0162-22.2022. [PMID: 36635245 PMCID: PMC9831145 DOI: 10.1523/eneuro.0162-22.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 09/29/2022] [Accepted: 10/09/2022] [Indexed: 12/15/2022] Open
Abstract
Environmental enrichment (EE) is beneficial for brain development and function, but our understanding of its capacity to drive circuit repair, the underlying mechanisms, and how this might vary with age remains limited. Ten-m3 knock-out (KO) mice exhibit a dramatic and stereotyped mistargeting of ipsilateral retinal inputs to the thalamus, resulting in visual deficits. We have recently shown a previously unexpected capacity for EE during early postnatal life (from birth for six weeks) to drive the partial elimination of miswired axonal projections, along with a recovery of visually mediated behavior, but the timeline of this repair was unclear. Here, we reveal that with just 3.5 weeks of EE from birth, Ten-m3 KOs exhibit a partial behavioral rescue, accompanied by pruning of the most profoundly miswired retinogeniculate terminals. Analysis suggests that the pruning is underway at this time point, providing an ideal opportunity to probe potential mechanisms. With the shorter EE-period, we found a localized increase in microglial density and activation profile within the identified geniculate region where corrective pruning was observed. No comparable response to EE was found in age-matched wild-type (WT) mice. These findings identify microglia as a potential mechanistic link through which EE drives the elimination of miswired neural circuits during early postnatal development. Activity driven, atypical recruitment of microglia to prune aberrant connectivity and restore function may have important therapeutic implications for neurodevelopmental disorders such as autistic spectrum disorder.
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Franchini M, Smith IM, Sacrey L, Duku E, Brian J, Bryson SE, Vaillancourt T, Armstrong V, Szatmari P, Roberts W, Roncadin C, Zwaigenbaum L. Continuity of trajectories of autism symptom severity from infancy to childhood. J Child Psychol Psychiatry 2022; 64:895-906. [PMID: 36562606 DOI: 10.1111/jcpp.13744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/30/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Behavioral symptom trajectories are informative of the development of young children at increased likelihood for autism spectrum disorder (ASD). METHODS Developmental trajectories of early signs were examined in a cohort of siblings of children diagnosed with ASD (n = 502) from 6 to 18 months using the Autism Observation Scale for Infants (AOSI), and from 18 months to 5-7 years using the Autism Diagnostic Observation Schedule (ADOS). Diagnostic outcomes for ASD at age 3 confirmed diagnosis for 137 children. We further analyzed the conditional probability of a switch from a trajectory measured with the AOSI to a trajectory measured with the ADOS as well as predictors from age 6 months. RESULTS We derived three early trajectories of behavioral signs ("Low," "Intermediate," and "Increasing") from 6 to 18 months using the AOSI. We then derived three similar, distinct trajectories for the evolution of symptom severity between 18 and 60-84 months of age (Low, Intermediate, Increasing) using the ADOS. Globally, the Low trajectory included children showing fewer ASD signs or symptoms and the Increasing trajectory included children showing more severe symptoms. We also found that most children in the Low AOSI trajectory stayed in the corresponding ADOS trajectory, whereas children in an Increasing AOSI trajectory tended to transition to an Intermediate or Increasing ADOS trajectory. Developmental measures taken at 6 months (early signs of ASD, Fine Motor, and Visual Reception skills) were predictive of trajectory membership. CONCLUSIONS Results confirm substantial heterogeneity in the early emergence of ASD signs in children at increased likelihood for ASD. Moreover, we showed that the way those early behavioral signs emerge in infants is predictive of later symptomatology. Results yield clear clinical implications, supporting the need to repeatedly assess infants at increased likelihood for ASD as this can be highly indicative of their later development and behavior.
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Affiliation(s)
- Martina Franchini
- Fondation Pôle Autisme and Faculty of Educational Psychology and Sciences, University of Geneva, Geneva, Switzerland
| | - Isabel M Smith
- Autism Research Centre, IWK Health Centre, Halifax, Canada.,Departments of Pediatrics and Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
| | - Lori Sacrey
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Eric Duku
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Jessica Brian
- Bloorview Research Institute and Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Susan E Bryson
- Autism Research Centre, IWK Health Centre, Halifax, Canada.,Departments of Pediatrics and Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
| | - Tracy Vaillancourt
- Counselling Psychology, Faculty of Education, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Peter Szatmari
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Hospital for Sick Children, Toronto, ON, Canada
| | - Wendy Roberts
- Integrated Services for Autism and Neurodevelopmental Disorders, Toronto, ON, Canada
| | - Caroline Roncadin
- McMaster Children's Hospital Autism Program, Hamilton Health Sciences, Hamilton, Canada
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Smith J, Chetcuti L, Kennedy L, Varcin KJ, Slonims V, Bent CA, Green J, Iacono T, Pillar S, Taylor C, Wan MW, Whitehouse AJO, Hudry K. Caregiver sensitivity predicts infant language use, and infant language complexity predicts caregiver language complexity, in the context of possible emerging autism. Autism Res 2022; 16:745-756. [PMID: 36563289 DOI: 10.1002/aur.2879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 12/01/2022] [Indexed: 12/24/2022]
Abstract
While theory supports bidirectional effects between caregiver sensitivity and language use, and infant language acquisition-both caregiver-to-infant and also infant-to-caregiver effects-empirical research has chiefly explored the former unidirectional path. In the context of infants showing early signs of autism, we investigated prospective bidirectional associations with 6-min free-play interaction samples collected for 103 caregivers and their infants (mean age 12-months; and followed up 6-months later). We anticipated that measures of caregiver sensitivity/language input and infant language would show within-domain temporal stability/continuity, but also that there would be predictive associations from earlier caregiver input to subsequent child language, and vice versa. Caregiver sensitive responsiveness (from the Manchester Assessment of Caregiver-Infant interaction [MACI]) predicted subsequent infant word tokens (i.e., amount of language, coded following the Systematic Analysis of Language Transcripts [SALT]). Further, earlier infant Mean Length of Utterance (MLU; reflecting language complexity, also derived from SALT coding) predicted later caregiver MLU, even when controlling for variability in infant ages and clear within-domain temporal stability/continuity in key measures (i.e., caregiver sensitive responsiveness and infant word tokens; and infant and caregiver MLU). These data add empirical support to theorization on how caregiver input can be both supportive of, and potentially influenced by, infant capacities, when infants have social-communication differences and/or communication/language delays suggestive of possible emerging autism.
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Affiliation(s)
- Jodie Smith
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Lacey Chetcuti
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
- Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia
| | - Lyndel Kennedy
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Kandice J Varcin
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Vicky Slonims
- Children's Neurosciences, Evelina London Children's Hospital, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, UK
| | - Catherine A Bent
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Jonathan Green
- School of Biological Sciences, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Teresa Iacono
- Living with Disability Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Sarah Pillar
- School of Biological Sciences, University of Manchester, Manchester, UK
| | - Carol Taylor
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Ming Wai Wan
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Andrew J O Whitehouse
- Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Kristelle Hudry
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
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Robain F, Godel M, Kojovic N, Franchini M, Journal F, Schaer M. Measuring social orienting in preschoolers with autism spectrum disorder using cartoons stimuli. J Psychiatr Res 2022; 156:398-405. [PMID: 36323142 DOI: 10.1016/j.jpsychires.2022.10.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 09/27/2022] [Accepted: 10/17/2022] [Indexed: 11/21/2022]
Abstract
Altered social orienting (SO) was proposed as the primary source of socio-communicative difficulties in autism spectrum disorder (ASD). Eye-tracking studies generally confirm a decreased SO in ASD population. However, SO has been scarcely investigated using minimally social stimuli such as cartoons. The extent to which SO might be decreased when watching cartoons is therefore unknown. Yet, it could allow for malleable and child-friendly paradigms that could be sensitive to early atypical visual preference. In this study, 90 preschoolers with ASD (age = 3.19 ± 0 .88) and 20 TD (age = 2.95 ± 1.26) watched two eye-tracking preference tasks. One Realistic task, displaying children dancing versus geometric shapes moving repetitively and a Cartoon task, displaying social and non-social cartoon stimuli with similar movements. We measured SO percentage along with refined visual exploration parameters and compared those of ASD children to TDs. In addition, we investigated their relations with behavioral measures such as symptom severity, developmental and adaptive levels. We evidenced a decreased SO percentage in ASD compared to TD children when watching the Realistic task but not the Cartoon task. We did not identify any other between groups differences. However, we identified several correlations between eye-tracking measures and developmental as well as adaptive measures within the Cartoon task. Together, our results support a preferential orientation of children with autism towards repetitively moving shapes but no decreased SO when measured with minimally social stimuli. Nonetheless, when investigating finer visual exploration parameters, even socially simple stimuli elicited atypical gaze patterns related to early developmental delay.
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Affiliation(s)
- François Robain
- Department of Psychiatry, University of Geneva, Faculty of Medicine, Geneva, Switzerland.
| | - Michel Godel
- Department of Psychiatry, University of Geneva, Faculty of Medicine, Geneva, Switzerland; Fondation Pôle Autisme, Unité de Recherche, 4 place du Cirque, 1204, Geneva, Switzerland
| | - Nada Kojovic
- Department of Psychiatry, University of Geneva, Faculty of Medicine, Geneva, Switzerland
| | - Martina Franchini
- Department of Psychiatry, University of Geneva, Faculty of Medicine, Geneva, Switzerland; Fondation Pôle Autisme, Unité de Recherche, 4 place du Cirque, 1204, Geneva, Switzerland
| | - Fiona Journal
- Department of Psychiatry, University of Geneva, Faculty of Medicine, Geneva, Switzerland; Fondation Pôle Autisme, Unité de Recherche, 4 place du Cirque, 1204, Geneva, Switzerland
| | - Marie Schaer
- Department of Psychiatry, University of Geneva, Faculty of Medicine, Geneva, Switzerland; Fondation Pôle Autisme, Unité de Recherche, 4 place du Cirque, 1204, Geneva, Switzerland
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Ravi S, Bradshaw A, Abdi H, Meera SS, Parish-Morris J, Yankowitz L, Paterson S, Dager SR, Burrows CA, Chappell C, St.John T, Estes AM, Piven J, Swanson MR. Are early social communication skills a harbinger for language development in infants later diagnosed autistic?-A longitudinal study using a standardized social communication assessment. FRONTIERS IN COMMUNICATION 2022; 7:977724. [PMID: 37168581 PMCID: PMC10167971 DOI: 10.3389/fcomm.2022.977724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
The early emergence of social communication challenges and their impact on language in infants later diagnosed with autism has sparked many early intervention programs that target social communication skills. While research has consistently shown lower scores on social communication assessments in the first year of life, there is limited research at 12-months exploring associations between different dimensions of social communication and later language. Understanding associations between early social communication skills and language would enhance our ability to choose high priority intervention goals that will impact downstream language skills. The current study used a standardized assessment to profile social communication skills across 516 infants with a high (HL) or low likelihood (LL-Neg) for autism (84% White, 60% Male), based on the presence of a sibling with autism in the family. The primary aim of the study was to profile social communication skill development in the second year of life and to evaluate associations between social communication skills and later language. HL infants who met criteria for autism (HL-ASD, N = 81) demonstrated widespread reductions in social communication skills at 12-months compared to HL infants who did not meet criteria for autism (HL-Neg, N = 277) and LL-Neg (N = 158) infants. Across all infants in the study, those with better social communication skills at 12-months had better language at 24-months. However, within group analyses indicated that infants who met criteria for autism did not show this developmental coupling until 24-months-of-age at which point social communication was positively associated with downstream language skills. The cascading pattern of reduced social communication skills as well as overall significant positive associations with later language provide further evidence for the need to support developing social communication skills prior to formal autism diagnosis, a goal that could possibly be reached through pre-emptive interventions.
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Affiliation(s)
- Shruthi Ravi
- Department of Psychology, The University of Texas at Dallas, Richardson, TX, United States
| | - Allison Bradshaw
- Department of Psychology, The University of Texas at Dallas, Richardson, TX, United States
| | - Hervé Abdi
- Department of Psychology, The University of Texas at Dallas, Richardson, TX, United States
| | - Shoba Sreenath Meera
- Department of Speech Pathology & Audiology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Julia Parish-Morris
- Center for Autism Research, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Lisa Yankowitz
- Boston Children’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Sarah Paterson
- The James S. McDonnell Foundation, St. Louis, MO, United States
| | - Stephen R. Dager
- Department of Radiology, University of Washington, Seattle, WA, United States
| | - Catherine A. Burrows
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, United States
| | - Chad Chappell
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, United States
| | - Tanya St.John
- Department of Radiology, University of Washington, Seattle, WA, United States
| | - Annette M. Estes
- Department of Radiology, University of Washington, Seattle, WA, United States
| | - Joseph Piven
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, United States
| | - Meghan R. Swanson
- Department of Psychology, The University of Texas at Dallas, Richardson, TX, United States
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Azzano A, Vause T, Ward R, Feldman MA. Telehealth parent training for a young child at risk for autism spectrum disorder. BEHAVIORAL INTERVENTIONS 2022. [DOI: 10.1002/bin.1917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Horien C, Floris DL, Greene AS, Noble S, Rolison M, Tejavibulya L, O'Connor D, McPartland JC, Scheinost D, Chawarska K, Lake EMR, Constable RT. Functional Connectome-Based Predictive Modeling in Autism. Biol Psychiatry 2022; 92:626-642. [PMID: 35690495 PMCID: PMC10948028 DOI: 10.1016/j.biopsych.2022.04.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 04/14/2022] [Accepted: 04/17/2022] [Indexed: 01/08/2023]
Abstract
Autism is a heterogeneous neurodevelopmental condition, and functional magnetic resonance imaging-based studies have helped advance our understanding of its effects on brain network activity. We review how predictive modeling, using measures of functional connectivity and symptoms, has helped reveal key insights into this condition. We discuss how different prediction frameworks can further our understanding of the brain-based features that underlie complex autism symptomatology and consider how predictive models may be used in clinical settings. Throughout, we highlight aspects of study interpretation, such as data decay and sampling biases, that require consideration within the context of this condition. We close by suggesting exciting future directions for predictive modeling in autism.
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Affiliation(s)
- Corey Horien
- Interdepartmental Neuroscience Program, Yale School of Medicine, New Haven, Connecticut; MD-PhD Program, Yale School of Medicine, New Haven, Connecticut.
| | - Dorothea L Floris
- Methods of Plasticity Research, Department of Psychology, University of Zürich, Zurich, Switzerland; Donders Center for Brain, Cognition and Behavior, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Abigail S Greene
- Interdepartmental Neuroscience Program, Yale School of Medicine, New Haven, Connecticut; MD-PhD Program, Yale School of Medicine, New Haven, Connecticut
| | - Stephanie Noble
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - Max Rolison
- Yale Child Study Center, New Haven, Connecticut
| | - Link Tejavibulya
- Interdepartmental Neuroscience Program, Yale School of Medicine, New Haven, Connecticut
| | - David O'Connor
- Department of Biomedical Engineering, Yale University, New Haven, Connecticut
| | - James C McPartland
- Department of Psychology, Yale University, New Haven, Connecticut; Yale Child Study Center, New Haven, Connecticut
| | - Dustin Scheinost
- Interdepartmental Neuroscience Program, Yale School of Medicine, New Haven, Connecticut; Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut; Department of Biomedical Engineering, Yale University, New Haven, Connecticut; Department of Statistics and Data Science, Yale University, New Haven, Connecticut; Yale Child Study Center, New Haven, Connecticut
| | - Katarzyna Chawarska
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut; Department of Statistics and Data Science, Yale University, New Haven, Connecticut; Yale Child Study Center, New Haven, Connecticut
| | - Evelyn M R Lake
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - R Todd Constable
- Interdepartmental Neuroscience Program, Yale School of Medicine, New Haven, Connecticut; Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut; Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut; Department of Biomedical Engineering, Yale University, New Haven, Connecticut.
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Song C, Wu L, Hong Y, Chen X, Zhu Z. Factors affecting knowledge of autism spectrum disorder among pediatric residents in eastern China: a cross-sectional study. BMC MEDICAL EDUCATION 2022; 22:699. [PMID: 36192723 PMCID: PMC9528050 DOI: 10.1186/s12909-022-03770-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 09/04/2022] [Accepted: 09/26/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND There is a global increase in the prevalence of autism spectrum disorder (ASD). Early identification of ASD in children and intervention are key aspects in the management of ASD. However, early identification is partly dependent on knowledge on ASD among pediatricians. This study analyzed the extent of ASD knowledge and its underlying factors among pediatric residents in eastern China, to provide a reference for medical education reforms. METHODS The study employed the Knowledge about Childhood Autism among Health Workers questionnaire. A total of 138 pediatric residents participated in the survey. Descriptive statistics were used to describe demographic characteristics and the four domains of the questionnaire. Univariate analysis was employed to assess impacts of the demographic characteristics on the questionnaire scores. On the other hand, multivariate regression analysis was used to analyze the correlation between the participants' demographic characteristics and the questionnaire scores. RESULTS The average ASD cognitive score of 138 respondents was 13.38 ± 4.48. The ASD cognitive scores in female pediatric residents were higher compared to that in males (p < 0.05). Residents who had obtained professional doctor qualification certificate were more than those without professional doctor qualification certificate (p < 0.05). The ASD knowledge in the group which did not have rotation in both departments was lower than in the group which had rotation in both departments (p < 0.05) as well as the group that had rotation in developmental and behavioral pediatrics department only (p < 0.05). Our multivariate linear regression model demonstrated significant statistical differences (p < 0.05), and showed that gender and systematic exposure to ASD knowledge had significant effects on cognitive scores (p < 0.05). CONCLUSION Most participants had relatively low levels of awareness and knowledge about ASD, especially on ASD comorbidities and age of onset. Women, systematic learning of ASD knowledge in medical school, successful passing of the physician examination, and rotation in the developmental and behavioral pediatrics (DBP) department significantly influence the levels of ASD awareness and knowledge. It is, therefore, important to strengthen ASD education in medical students at the university level and make rotation in the DBP department a requisite for pediatric trainees.
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Affiliation(s)
- Chao Song
- Department of Developmental and behavioral Pediatrics, the Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Centre for Child Health, Hangzhou, China.
| | - Lingling Wu
- Department of Developmental and behavioral Pediatrics, the Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Centre for Child Health, Hangzhou, China
| | - Yunxia Hong
- Education Office, the Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Centre for Child Health, Hangzhou, China.
| | - Xiaoyang Chen
- Department of Developmental and behavioral Pediatrics, the Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Centre for Child Health, Hangzhou, China
| | - Zhiwei Zhu
- Department of Developmental and behavioral Pediatrics, the Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Centre for Child Health, Hangzhou, China
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Sanchez VA, Arnold ML, Moore DR, Clavier O, Abrams HB. Speech-in-noise testing: Innovative applications for pediatric patients, underrepresented populations, fitness for duty, clinical trials, and remote services. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2022; 152:2336. [PMID: 36319253 PMCID: PMC9722269 DOI: 10.1121/10.0014418] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 08/24/2022] [Accepted: 09/15/2022] [Indexed: 06/16/2023]
Abstract
Speech perception testing, defined as providing standardized speech stimuli and requiring a listener to provide a behavioral and scored response, has been an integral part of the audiologic test battery since the beginning of the audiology profession. Over the past several decades, limitations in the diagnostic and prognostic validity of standard speech perception testing as routinely administered in the clinic have been noted, and the promotion of speech-in-noise testing has been highlighted. This review will summarize emerging and innovative approaches to speech-in-noise testing with a focus on five applications: (1) pediatric considerations promoting the measurement of sensory and cognitive components separately; (2) appropriately serving underrepresented populations with special attention to racial, ethnic, and linguistic minorities, as well as considering biological sex and/or gender differences as variables of interest; (3) binaural fitness for duty assessments of functional hearing for occupational settings that demand the ability to detect, recognize, and localize sounds; (4) utilization of speech-in-noise tests in pharmacotherapeutic clinical trials with considerations to the drug mechanistic action, the patient populations, and the study design; and (5) online and mobile applications of hearing assessment that increase accessibility and the direct-to-consumer market.
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Affiliation(s)
- Victoria A Sanchez
- Department of Otolaryngology-Head and Neck Surgery, University of South Florida, 12901 Bruce B. Downs Boulevard, MDC 73, Tampa, Florida 33612, USA
| | - Michelle L Arnold
- Department of Communication Sciences and Disorders, University of South Florida, Tampa, Florida 33612, USA
| | - David R Moore
- Communication Sciences Research Center, Cincinnati Children's Hospital, Cincinnati, Ohio 45229, USA
| | | | - Harvey B Abrams
- Department of Communication Sciences and Disorders, University of South Florida, Tampa, Florida 33612, USA
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Godoy PBG, Shephard E, Argeu A, Silveira LR, Salomone E, Aldred C, Green J, Polanczyk GV, Matijasevich A. Social communication therapy for children at risk for neurodevelopmental difficulties: Protocol for a clinical trial. Ann N Y Acad Sci 2022; 1514:104-115. [PMID: 35506888 DOI: 10.1111/nyas.14784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Exposure to adverse environments are risk factors for neurodevelopmental problems in childhood. Children exposed to such environments may benefit from interventions that target social communication abilities, since these are protective factors for healthy neurodevelopment. This randomized controlled trial will test the efficacy of Paediatric Autism Communication Therapy (PACT) in improving social communication development in young children at risk for neurodevelopmental difficulties living in poverty in Brazil. Participants will be 160 children aged 2-4 years with lower-than-average social communication abilities and their primary caregivers. Child-caregiver dyads will be recruited from public childhood education centers in impoverished urban regions of the city of São Paulo, Brazil. Lower-than-average social communication abilities will be defined by standard scores (≤84) on the socialization and/or communication domains of the Vineland Adaptive Behavior Scales. Child-caregiver dyads will be randomized to receive 12 sessions of the PACT intervention (n = 80) or 5 months of community support as usual plus psychoeducation (n = 80). The primary outcome (parent-child interaction) and secondary outcomes (parent-reported social communication abilities and neurophysiological activity during a live social interaction) will be measured pre- and postintervention. This study may lead to new interventions for vulnerable young children in Brazil and better understanding of the neural mechanisms of PACT.
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Affiliation(s)
- Priscilla B G Godoy
- Department of Psychiatry, Faculdade de Medicina FMUSP, University of São Paulo, São Paulo, Brazil
| | - Elizabeth Shephard
- Department of Psychiatry, Faculdade de Medicina FMUSP, University of São Paulo, São Paulo, Brazil
- Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, UK
| | - Adriana Argeu
- Department of Psychiatry, Faculdade de Medicina FMUSP, University of São Paulo, São Paulo, Brazil
| | - Leticia R Silveira
- Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Erica Salomone
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Catherine Aldred
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | - Jonathan Green
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | - Guilherme V Polanczyk
- Department of Psychiatry, Faculdade de Medicina FMUSP, University of São Paulo, São Paulo, Brazil
| | - Alicia Matijasevich
- Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
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Jones J, Reinke SN, Mousavi-Derazmahalleh M, Palmer DJ, Christophersen CT. Changes to the Gut Microbiome in Young Children Showing Early Behavioral Signs of Autism. Front Microbiol 2022; 13:905901. [PMID: 35966698 PMCID: PMC9371947 DOI: 10.3389/fmicb.2022.905901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 06/22/2022] [Indexed: 11/13/2022] Open
Abstract
The human gut microbiome has increasingly been associated with autism spectrum disorder (ASD), which is a neurological developmental disorder, characterized by impairments to social interaction. The ability of the gut microbiota to signal across the gut-brain-microbiota axis with metabolites, including short-chain fatty acids, impacts brain health and has been identified to play a role in the gastrointestinal and developmental symptoms affecting autistic children. The fecal microbiome of older children with ASD has repeatedly shown particular shifts in the bacterial and fungal microbial community, which are significantly different from age-matched neurotypical controls, but it is still unclear whether these characteristic shifts are detectable before diagnosis. Early microbial colonization patterns can have long-lasting effects on human health, and pre-emptive intervention may be an important mediator to more severe autism. In this study, we characterized both the microbiome and short-chain fatty acid concentrations of fecal samples from young children between 21 and 40 months who were showing early behavioral signs of ASD. The fungal richness and acetic acid concentrations were observed to be higher with increasing autism severity, and the abundance of several bacterial taxa also changed due to the severity of ASD. Bacterial diversity and SCFA concentrations were also associated with stool form, and some bacterial families were found with differential abundance according to stool firmness. An exploratory analysis of the microbiome associated with pre-emptive treatment also showed significant differences at multiple taxonomic levels. These differences may impact the microbial signaling across the gut-brain-microbiota axis and the neurological development of the children.
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Affiliation(s)
- Jacquelyn Jones
- Trace and Environmental DNA Laboratory, School of Molecular and Life Sciences, Curtin University, Bentley, WA, Australia
- The Western Australian Human Microbiome Collaboration Centre, Curtin University, Bentley, WA, Australia
- *Correspondence: Jacquelyn Jones
| | - Stacey N. Reinke
- Centre for Integrative Metabolomics and Computational Biology, School of Science, Edith Cowan University, Joondalup, WA, Australia
| | - Mahsa Mousavi-Derazmahalleh
- Trace and Environmental DNA Laboratory, School of Molecular and Life Sciences, Curtin University, Bentley, WA, Australia
- The Western Australian Human Microbiome Collaboration Centre, Curtin University, Bentley, WA, Australia
| | - Debra J. Palmer
- Telethon Kids Institute, University of Western Australia, Nedlands, WA, Australia
- School of Medicine, University of Western Australia, Crawley, WA, Australia
| | - Claus T. Christophersen
- Trace and Environmental DNA Laboratory, School of Molecular and Life Sciences, Curtin University, Bentley, WA, Australia
- The Western Australian Human Microbiome Collaboration Centre, Curtin University, Bentley, WA, Australia
- Centre for Integrative Metabolomics and Computational Biology, School of Science, Edith Cowan University, Joondalup, WA, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
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43
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Yankowitz LD, Petrulla V, Plate S, Tunc B, Guthrie W, Meera SS, Tena K, Pandey J, Swanson MR, Pruett JR, Cola M, Russell A, Marrus N, Hazlett HC, Botteron K, Constantino JN, Dager SR, Estes A, Zwaigenbaum L, Piven J, Schultz RT, Parish-Morris J. Infants later diagnosed with autism have lower canonical babbling ratios in the first year of life. Mol Autism 2022; 13:28. [PMID: 35761377 PMCID: PMC9235227 DOI: 10.1186/s13229-022-00503-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 05/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Canonical babbling-producing syllables with a mature consonant, full vowel, and smooth transition-is an important developmental milestone that typically occurs in the first year of life. Some studies indicate delayed or reduced canonical babbling in infants at high familial likelihood for autism spectrum disorder (ASD) or who later receive an ASD diagnosis, but evidence is mixed. More refined characterization of babbling in the first year of life in infants with high likelihood for ASD is needed. METHODS Vocalizations produced at 6 and 12 months by infants (n = 267) taking part in a longitudinal study were coded for canonical and non-canonical syllables. Infants were categorized as low familial likelihood (LL), high familial likelihood diagnosed with ASD at 24 months (HL-ASD) or not diagnosed (HL-Neg). Language delay was assessed based on 24-month expressive and receptive language scores. Canonical babble ratio (CBR) was calculated by dividing the number of canonical syllables by the number of total syllables. Generalized linear (mixed) models were used to assess the relationship between group membership and CBR, controlling for site, sex, and maternal education. Logistic regression was used to assess whether canonical babbling ratios at 6 and 12 months predict 24-month diagnostic outcome. RESULTS No diagnostic group differences in CBR were detected at 6 months, but HL-ASD infants produced significantly lower CBR than both the HL-Neg and LL groups at 12 months. HL-Neg infants with language delay also showed reduced CBR at 12 months. Neither 6- nor 12-month CBR was significant predictors of 24-month diagnostic outcome (ASD versus no ASD) in logistic regression. LIMITATIONS Small numbers of vocalizations produced by infants at 6 months may limit the reliability of CBR estimates. It is not known if results generalize to infants who are not at high familial likelihood, or infants from more diverse racial and socioeconomic backgrounds. CONCLUSIONS Lower canonical babbling ratios are apparent by the end of the first year of life in ASD regardless of later language delay, but are also observed for infants with later language delay without ASD. Canonical babbling may lack specificity as an early marker when used on its own.
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Affiliation(s)
- L D Yankowitz
- Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA.
| | - V Petrulla
- Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - S Plate
- Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - B Tunc
- Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - W Guthrie
- Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - S S Meera
- National Institute of Mental Health and Neurosciences, Bangalore, India
| | - K Tena
- Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - J Pandey
- Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - M R Swanson
- Department of Psychology, University of Texas at Dallas, Richardson, TX, USA
| | - J R Pruett
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - M Cola
- Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - A Russell
- Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - N Marrus
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - H C Hazlett
- University of North Carolina, Chapel Hill, NC, USA
| | - K Botteron
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - J N Constantino
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - S R Dager
- University of Washington, Seattle, WA, USA
| | - A Estes
- University of Washington, Seattle, WA, USA
| | - L Zwaigenbaum
- Department of Pediatrics, University of Alberta, Edmonton, Canada
| | - J Piven
- University of North Carolina, Chapel Hill, NC, USA
| | - R T Schultz
- Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - J Parish-Morris
- Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Dwivedi AK. How to write statistical analysis section in medical research. J Investig Med 2022; 70:1759-1770. [PMID: 35710142 DOI: 10.1136/jim-2022-002479] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2022] [Indexed: 12/15/2022]
Abstract
Reporting of statistical analysis is essential in any clinical and translational research study. However, medical research studies sometimes report statistical analysis that is either inappropriate or insufficient to attest to the accuracy and validity of findings and conclusions. Published works involving inaccurate statistical analyses and insufficient reporting influence the conduct of future scientific studies, including meta-analyses and medical decisions. Although the biostatistical practice has been improved over the years due to the involvement of statistical reviewers and collaborators in research studies, there remain areas of improvement for transparent reporting of the statistical analysis section in a study. Evidence-based biostatistics practice throughout the research is useful for generating reliable data and translating meaningful data to meaningful interpretation and decisions in medical research. Most existing research reporting guidelines do not provide guidance for reporting methods in the statistical analysis section that helps in evaluating the quality of findings and data interpretation. In this report, we highlight the global and critical steps to be reported in the statistical analysis of grants and research articles. We provide clarity and the importance of understanding study objective types, data generation process, effect size use, evidence-based biostatistical methods use, and development of statistical models through several thematic frameworks. We also provide published examples of adherence or non-adherence to methodological standards related to each step in the statistical analysis and their implications. We believe the suggestions provided in this report can have far-reaching implications for education and strengthening the quality of statistical reporting and biostatistical practice in medical research.
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Affiliation(s)
- Alok Kumar Dwivedi
- Department of Molecular and Translational Medicine, Division of Biostatistics and Epidemiology, Texas Tech University Health Sciences Center El Paso, El Paso, Texas, USA
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45
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Cleary DB, Bunney A, Henry L, Renton M, Granich J, Green J, Maybery MT, Whitehouse AJO. A Parent-Mediated Intervention for Newborns at Familial Likelihood of Autism: Initial Feasibility Study in the General Population. ADVANCES IN NEURODEVELOPMENTAL DISORDERS 2022; 6:494-505. [PMID: 35698574 PMCID: PMC9178338 DOI: 10.1007/s41252-022-00262-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/11/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Developmental theory and previous studies support the potential value of prodromal interventions for infants at elevated likelihood of developing autism. Past research has supported the efficacy of parent-mediated prodromal therapies with infants from as early as 7 months. We outline the rationale for implementing interventions following this model from even earlier in development and report on the feasibility of a novel intervention developed following this model of parent-mediated infant interventions. METHODS We report a feasibility study (n = 13) of a parent-mediated, video-aided intervention, beginning during pregnancy, focussed on parent-infant interactions. The study evaluated the feasibility of this intervention initially with a general population sample. Feasibility was assessed across four domains (acceptability, implementation, practicality and integration) using self-report questionnaire, semi-structured interviews with parents and therapists, attendance and assessment completion. RESULTS Feasibility assessment shows that the intervention was acceptable, with all participants reporting that they had benefited from the program, with perceived positive benefits to their understanding of and communication with their infant, and that they had integrated program teachings into everyday life. The intervention was implemented as planned with 100% attendance for the core sessions. Changes to minimise the number of antenatal sessions was suggested to improve practicality. CONCLUSIONS This study found initial feasibility for this intervention in a general population sample. This suggests parent-mediated video feedback interventions are a promising format to be implemented within the perinatal developmental time period.
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Affiliation(s)
- Dominique B. Cleary
- Telethon Kids Institute, The University of Western Australia, 100 Roberts Road, Subiaco, Western Australia 6008 Australia
- School of Psychological Science, The University of Western Australia, Perth, Australia
| | - Angela Bunney
- Telethon Kids Institute, The University of Western Australia, 100 Roberts Road, Subiaco, Western Australia 6008 Australia
| | - Lindy Henry
- Telethon Kids Institute, The University of Western Australia, 100 Roberts Road, Subiaco, Western Australia 6008 Australia
| | - Michelle Renton
- Telethon Kids Institute, The University of Western Australia, 100 Roberts Road, Subiaco, Western Australia 6008 Australia
| | - Joanna Granich
- Telethon Kids Institute, The University of Western Australia, 100 Roberts Road, Subiaco, Western Australia 6008 Australia
| | - Jonathan Green
- Division of Neuroscience & Experimental Psychology, School of Biological Sciences, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Greater Manchester Mental Health NHS Trust, Manchester, UK
| | - Murray T. Maybery
- School of Psychological Science, The University of Western Australia, Perth, Australia
| | - Andrew J. O. Whitehouse
- Telethon Kids Institute, The University of Western Australia, 100 Roberts Road, Subiaco, Western Australia 6008 Australia
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46
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Chung WK, Berg JS, Botkin JR, Brenner SE, Brosco JP, Brothers KB, Currier RJ, Gaviglio A, Kowtoniuk WE, Olson C, Lloyd-Puryear M, Saarinen A, Sahin M, Shen Y, Sherr EH, Watson MS, Hu Z. Newborn screening for neurodevelopmental diseases: Are we there yet? AMERICAN JOURNAL OF MEDICAL GENETICS. PART C, SEMINARS IN MEDICAL GENETICS 2022; 190:222-230. [PMID: 35838066 PMCID: PMC9796120 DOI: 10.1002/ajmg.c.31988] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 06/13/2022] [Accepted: 06/30/2022] [Indexed: 01/01/2023]
Abstract
In the US, newborn screening (NBS) is a unique health program that supports health equity and screens virtually every baby after birth, and has brought timely treatments to babies since the 1960's. With the decreasing cost of sequencing and the improving methods to interpret genetic data, there is an opportunity to add DNA sequencing as a screening method to facilitate the identification of babies with treatable conditions that cannot be identified in any other scalable way, including highly penetrant genetic neurodevelopmental disorders (NDD). However, the lack of effective dietary or drug-based treatments has made it nearly impossible to consider NDDs in the current NBS framework, yet it is anticipated that any treatment will be maximally effective if started early. Hence there is a critical need for large scale pilot studies to assess if and how NDDs can be effectively screened at birth, if parents desire that information, and what impact early diagnosis may have. Here we attempt to provide an overview of the recent advances in NDD treatments, explore the possible framework of setting up a pilot study to genetically screen for NDDs, highlight key technical, practical, and ethical considerations and challenges, and examine the policy and health system implications.
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Affiliation(s)
- Wendy K Chung
- Department of Pediatrics and Medicine, Columbia University, New York, New York, USA
| | - Jonathan S Berg
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jeffrey R Botkin
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Steven E Brenner
- Department of Plant and Microbial Biology, University of California, Berkeley, California, USA
| | - Jeffrey P Brosco
- Institute for Bioethics and Health Policy, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Kyle B Brothers
- Department of Pediatrics, University of Louisville, Louisville, Kentucky, USA
| | - Robert J Currier
- School of Medicine, University of California, San Francisco, California, USA
| | - Amy Gaviglio
- Connetics Consulting, Minneapolis, Minnesota, USA
| | | | - Colleen Olson
- Steinhardt Graduate School of Education, New York University, New York, New York, USA
| | | | | | - Mustafa Sahin
- Rosamund Stone Zander Translational Neuroscience Center, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Yufeng Shen
- Department of Systems Biology, Columbia University, New York, New York, USA.,Department of Biomedical Informatics, Columbia University, New York, New York, USA
| | - Elliott H Sherr
- Department of Neurology, Weill Institute of Neurosciences, University of California, San Francisco, California, USA
| | - Michael S Watson
- Department of Pediatrics, School of Medicine, Washington University (Adjunct), St. Louis, Missouri, USA
| | - Zhanzhi Hu
- Department of Systems Biology, Columbia University, New York, New York, USA.,Department of Biomedical Informatics, Columbia University, New York, New York, USA
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Daniel S, Wimpory D, Delafield-Butt JT, Malloch S, Holck U, Geretsegger M, Tortora S, Osborne N, Schögler B, Koch S, Elias-Masiques J, Howorth MC, Dunbar P, Swan K, Rochat MJ, Schlochtermeier R, Forster K, Amos P. Rhythmic Relating: Bidirectional Support for Social Timing in Autism Therapies. Front Psychol 2022; 13:793258. [PMID: 35693509 PMCID: PMC9186469 DOI: 10.3389/fpsyg.2022.793258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 03/23/2022] [Indexed: 11/13/2022] Open
Abstract
We propose Rhythmic Relating for autism: a system of supports for friends, therapists, parents, and educators; a system which aims to augment bidirectional communication and complement existing therapeutic approaches. We begin by summarizing the developmental significance of social timing and the social-motor-synchrony challenges observed in early autism. Meta-analyses conclude the early primacy of such challenges, yet cite the lack of focused therapies. We identify core relational parameters in support of social-motor-synchrony and systematize these using the communicative musicality constructs: pulse; quality; and narrative. Rhythmic Relating aims to augment the clarity, contiguity, and pulse-beat of spontaneous behavior by recruiting rhythmic supports (cues, accents, turbulence) and relatable vitality; facilitating the predictive flow and just-ahead-in-time planning needed for good-enough social timing. From here, we describe possibilities for playful therapeutic interaction, small-step co-regulation, and layered sensorimotor integration. Lastly, we include several clinical case examples demonstrating the use of Rhythmic Relating within four different therapeutic approaches (Dance Movement Therapy, Improvisational Music Therapy, Play Therapy, and Musical Interaction Therapy). These clinical case examples are introduced here and several more are included in the Supplementary Material (Examples of Rhythmic Relating in Practice). A suite of pilot intervention studies is proposed to assess the efficacy of combining Rhythmic Relating with different therapeutic approaches in playful work with individuals with autism. Further experimental hypotheses are outlined, designed to clarify the significance of certain key features of the Rhythmic Relating approach.
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Affiliation(s)
- Stuart Daniel
- British Association of Play Therapists, London, United Kingdom
| | - Dawn Wimpory
- BCU Health Board (NHS), Bangor, United Kingdom
- School of Human and Behavioural Sciences, Bangor University, Bangor, United Kingdom
| | - Jonathan T. Delafield-Butt
- Laboratory for Innovation in Autism, University of Strathclyde, Glasgow, United Kingdom
- School of Education, University of Strathclyde, Glasgow, United Kingdom
| | - Stephen Malloch
- Westmead Psychotherapy Program, School of Medicine, University of Sydney, Sydney, NSW, Australia
- MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Sydney, NSW, Australia
| | - Ulla Holck
- Music Therapy, Department of Communication and Psychology, Aalborg University, Aalborg, Denmark
| | - Monika Geretsegger
- The Grieg Academy Music Therapy Research Centre, NORCE Norwegian Research Centre, Bergen, Norway
| | - Suzi Tortora
- Dancing Dialogue, LCAT, New York, NY, United States
| | - Nigel Osborne
- Department of Music, University of Edinburgh, Edinburgh, United Kingdom
| | - Benjaman Schögler
- Perception Movement Action Research Consortium, University of Edinburgh, Edinburgh, United Kingdom
| | - Sabine Koch
- Research Institute for Creative Arts Therapies, Alanus University, Alfter, Germany
- School of Therapy Sciences, Creative Arts Therapies, SRH University Heidelberg, Heidelberg, Germany
| | - Judit Elias-Masiques
- BCU Health Board (NHS), Bangor, United Kingdom
- School of Human and Behavioural Sciences, Bangor University, Bangor, United Kingdom
| | | | | | - Karrie Swan
- Department of Counseling, Leadership, and Special Education, Missouri State University, Springfield, MO, United States
| | - Magali J. Rochat
- Functional and Molecular Neuroimaging Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | | | - Katharine Forster
- BCU Health Board (NHS), Bangor, United Kingdom
- School of Human and Behavioural Sciences, Bangor University, Bangor, United Kingdom
| | - Pat Amos
- Independent Researcher, Ardmore, PA, United States
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Ou W, Zeng W, Gao W, He J, Meng Y, Fang X, Nie J. Movie Events Detecting Reveals Inter-Subject Synchrony Difference of Functional Brain Activity in Autism Spectrum Disorder. Front Comput Neurosci 2022; 16:877204. [PMID: 35591883 PMCID: PMC9110681 DOI: 10.3389/fncom.2022.877204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 03/25/2022] [Indexed: 11/13/2022] Open
Abstract
Recently, movie-watching fMRI has been recognized as a novel method to explore brain working patterns. Previous researchers correlated natural stimuli with brain responses to explore brain functional specialization by “reverse correlation” methods, which were based on within-group analysis. However, what external stimuli drove significantly different brain responses in two groups of different subjects were still unknown. To address this, sliding time windows technique combined with inter-Subject functional correlation (ISFC) was proposed to detect movie events with significant group differences between autism spectrum disorder (ASD) and typical development (TD) subjects. Then, using inter-Subject correlation (ISC) and ISFC analysis, we found that in three movie events involving character emotions, the ASD group showed significantly lower ISC in the middle temporal gyrus, temporal pole, cerebellum, caudate, precuneus, and showed decreased functional connectivity between large scale networks than that in TD. Under the movie event focusing on objects and scenes shot, the dorsal and ventral attentional networks of ASD had a strong synchronous response. Meanwhile, ASD also displayed increased functional connectivity between the frontoparietal network (FPN) and dorsal attention network (DAN), FPN, and sensorimotor network (SMN) than TD. ASD has its own unique synchronous response rather than being “unresponsive” in natural movie-watching. Our findings provide a new method and valuable insight for exploring the inconsistency of the brain “tick collectively” to same natural stimuli. This analytic approach has the potential to explore pathological mechanisms and promote training methods of ASD.
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Affiliation(s)
- Wenfei Ou
- Guangdong Key Laboratory of Mental Health and Cognitive Science, Center for Studies of Psychological Application, School of Psychology, South China Normal University, Guangzhou, China
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, South China Normal University, Guangzhou, China
| | - Wenxiu Zeng
- Guangdong Key Laboratory of Mental Health and Cognitive Science, Center for Studies of Psychological Application, School of Psychology, South China Normal University, Guangzhou, China
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, South China Normal University, Guangzhou, China
- Dongcheng Central Primary School, Dongguan, China
| | - Wenjian Gao
- Guangdong Key Laboratory of Mental Health and Cognitive Science, Center for Studies of Psychological Application, School of Psychology, South China Normal University, Guangzhou, China
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, South China Normal University, Guangzhou, China
| | - Juan He
- Guangdong Key Laboratory of Mental Health and Cognitive Science, Center for Studies of Psychological Application, School of Psychology, South China Normal University, Guangzhou, China
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, South China Normal University, Guangzhou, China
| | - Yufei Meng
- Guangdong Key Laboratory of Mental Health and Cognitive Science, Center for Studies of Psychological Application, School of Psychology, South China Normal University, Guangzhou, China
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, South China Normal University, Guangzhou, China
| | - Xiaowen Fang
- Guangdong Key Laboratory of Mental Health and Cognitive Science, Center for Studies of Psychological Application, School of Psychology, South China Normal University, Guangzhou, China
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, South China Normal University, Guangzhou, China
| | - Jingxin Nie
- Guangdong Key Laboratory of Mental Health and Cognitive Science, Center for Studies of Psychological Application, School of Psychology, South China Normal University, Guangzhou, China
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, South China Normal University, Guangzhou, China
- *Correspondence: Jingxin Nie,
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Green J, Leadbitter K, Ainsworth J, Bucci S. An integrated early care pathway for autism. THE LANCET. CHILD & ADOLESCENT HEALTH 2022; 6:335-344. [PMID: 35303486 DOI: 10.1016/s2352-4642(22)00037-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/25/2022] [Accepted: 01/27/2022] [Indexed: 01/17/2023]
Abstract
In this Viewpoint, we argue for the need to reconceptualise an integrated early-care provision for autistic children in the light of their enduring support needs and relevant new findings from developmental and intervention research. This model goes beyond short-term reactive care to outline an early proactive, evidenced, developmentally phased, and scalable programme of support for autistic children and their families from the earliest opportunity, with timely access to later step-up care when needed. We also integrate this model with emerging opportunities from data science and digital health technologies as a potential facilitator of such a pathway. Building on this work, we argue that the best current autism intervention evidence can be integrated with concepts and evidence gained in the management of other enduring health conditions to support an autistic child and their family through their early development. The aim is to improve those children's social communication abilities, expand their range and flexibility of interests, and mitigate any negative impacts of sensory difficulties and restricted, repetitive behaviours on the child and their family wellbeing. The pathway solutions described could also be adapted for older adolescents and adults and could be used within the health systems of different countries, including within low-income and middle-income contexts.
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Affiliation(s)
- Jonathan Green
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Manchester, UK; Department of Child and Adolescent Mental Health, Manchester Royal Children's Hospital, Manchester, UK.
| | - Kathy Leadbitter
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Manchester, UK
| | - John Ainsworth
- Division of Imaging, Informatics and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine, and Health, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine, and Health, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK; Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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50
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Green J, Leadbitter K, Ellis C, Taylor L, Moore HL, Carruthers S, James K, Taylor C, Balabanovska M, Langhorne S, Aldred C, Slonims V, Grahame V, Parr J, Humphrey N, Howlin P, McConachie H, Couteur AL, Charman T, Emsley R, Pickles A. Combined social communication therapy at home and in education for young autistic children in England (PACT-G): a parallel, single-blind, randomised controlled trial. Lancet Psychiatry 2022; 9:307-320. [PMID: 35305746 PMCID: PMC9630149 DOI: 10.1016/s2215-0366(22)00029-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 01/20/2022] [Accepted: 01/20/2022] [Indexed: 12/22/2022]
Abstract
BACKGROUND Autistic children can have difficulty generalising treatment effects beyond the immediate treatment context. Paediatric Autism Communication Therapy (PACT) has been successful when delivered in the clinic. Here we tested the Paediatric Autism Communication Therapy-Generalised (PACT-G) intervention combined between home and education settings for its overall effect and mechanistic transmission of effect across contexts. METHODS In this parallel, single-blind, randomised, controlled trial, we recruited autistic children aged 2-11 years in urban or semi-urban areas in Manchester, Newcastle, and London, England. Children needed to meet core autism criteria on Autism Diagnostic Observation Schedule-second edition (ADOS-2) and parent-rated Social Communication Questionnaire (SCQ-lifetime), and children older than 5 years were included if they had intentional communication but expressive language equivalent of age 4 years or younger. Eligible children were randomly assigned (1:1), using block randomisation (random block sizes of 2 and 4) and stratified for site, age (2-4 years vs 5-11 years), and gender, to either PACT-G plus treatment as usual or treatment as usual alone. Research assessors were masked to treatment allocation. The PACT-G intervention was delivered by a therapist in parallel to the child's parents at home and to learning-support assistants (LSA) at their place of education, using both in-person and remote sessions over a 6 month period, to optimise adult-child social interaction. Treatment as usual included any health support or intervention from education or local community services. The primary outcome was autism symptom severity using the ADOS-2, as measured by researchers, at 12 months versus baseline. Secondary outcomes were Brief Observation of Social Communication Change (BOSCC) and dyadic social interaction between child and adult across contexts, both at 12 months. Other secondary outcome measures were assessed using the following composites: language, anxiety, repetitive behaviour, adaptive behaviour, parental wellbeing, child health-related quality of life, and disruptive behaviour. Assessments were done at baseline, 7 months, and 12 months. We used an intention-to-treat (ITT) analysis of covariance for the efficacy outcome measures. Adverse events were assessed by researchers for all trial families at each contact and by therapists in the PACT-G group at each visit. This study is registered with the ISRCTN Registry, ISRCTN 25378536. FINDINGS Between Jan 18, 2017, and April 19, 2018, 555 children were referred and 249 were eligible, agreed to participate, and were randomly assigned to either PACT-G (n=122) or treatment as usual (n=127). One child in the PACT-G group withdrew and requested their data be removed from the study, giving an ITT population of 248 children. 51 (21%) of 248 children were female, 197 (79%) were male, 149 (60%) were White, and the mean age was 4·0 years (SD 0·6). The groups were well balanced for demographic and clinical characteristics. In the PACT-G group, parents of children received a median of 10 (IQR 8-12) home sessions and LSAs received a median of 8 (IQR 5-10) education sessions over 6 months. We found no treatment effect on the ADOS-2 primary outcome compared with treatment as usual (effect size 0·04 [95% CI -0·19 to 0·26]; p=0·74), or researcher-assessed BOSCC (0·03 [-0·25 to 0·31]), language composite (-0·03 [-0·15 to 0·10]), repetitive behaviour composite (0·00 [-0·35 to 0·35]), adaptive behaviour composite (0·01 [-0·15 to 0·18]), or child wellbeing (0·09 [-0·15 to 0·34]). PACT-G treatment improved synchronous response in both parent (0·50 [0·36 to 0·65]) and LSA (0·33 [0·16 to 0·50]), mediating increased child communication with parent (0·26 [0·12 to 0·40]) and LSA (0·20 [0·06 to 0·34]). Child dyadic communication change mediated outcome symptom alteration on BOSCC at home (indirect effect -0·78 [SE 0·34; 95% CI -1·44 to -0·11]; p=0·022) although not in education (indirect effect -0·67 [SE 0·37; 95% CI -1·40 to 0·06]; p=0·073); such an effect was not seen on ADOS-2. Treatment with PACT-G also improved the parental wellbeing composite (0·44 [0·08 to 0·79]) and the child disruptive behaviour composite in home and education (0·29 [0·01 to 0·57]). Adverse events on child behaviour and wellbeing were recorded in 13 (10%) of 127 children in the treatment as usual group (of whom four [31%] were girls) and 11 (9%) of 122 in the PACT-G group (of whom three [33%] were girls). One serious adverse event on parental mental health was recorded in the PACT-G group and was possibly study related. INTERPRETATION Although we found no effect on the primary outcome compared with treatment as usual, adaptation of the 12-month PACT intervention into briefer multicomponent delivery across home and education preserved the positive proximal outcomes, although smaller in effect size, and the original pattern of treatment mediation seen in clinic-delivered therapy, as well as improving parental wellbeing and child disruptive behaviours across home and school. Reasons for this reduced efficacy might be the reduced dose of each component, the effect of remote delivery, and the challenges of the delivery contexts. Caution is needed in assuming that changing delivery methods and context will preserve an original intervention efficacy for autistic children. FUNDING National Institute for Health Research and Medical Research Council Efficacy and Mechanism Evaluation Award.
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Affiliation(s)
- Jonathan Green
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK; Manchester Royal Children's Hospital, Manchester Academic Health Sciences Centre, Manchester, UK.
| | - Kathy Leadbitter
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | - Ceri Ellis
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | - Lauren Taylor
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Heather L Moore
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK; Sir James Spence Institute, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Sophie Carruthers
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Kirsty James
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Carol Taylor
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | - Matea Balabanovska
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | - Sophie Langhorne
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | - Catherine Aldred
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | - Vicky Slonims
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK; Evelina London Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Victoria Grahame
- Complex Neurodevelopmental Disorders Service (CNDS), Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Jeremy Parr
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK; Complex Neurodevelopmental Disorders Service (CNDS), Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK; Great North Children's Hospital, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Neil Humphrey
- Institute of Education, University of Manchester, Manchester, UK
| | - Patricia Howlin
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Helen McConachie
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK; Sir James Spence Institute, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Ann Le Couteur
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK; Sir James Spence Institute, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Tony Charman
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Richard Emsley
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Andrew Pickles
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
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