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Shrader SH, Mellen N, Cai J, Barnes GN, Song ZH. Cannabidiol is a behavioral modulator in BTBR mouse model of idiopathic autism. Front Neurosci 2024; 18:1359810. [PMID: 38784096 PMCID: PMC11112039 DOI: 10.3389/fnins.2024.1359810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 04/29/2024] [Indexed: 05/25/2024] Open
Abstract
Introduction The prevalence of Autism Spectrum Disorder (ASD) has drastically risen over the last two decades and is currently estimated to affect 1 in 36 children in the U.S., according to the center for disease control (CDC). This heterogenous neurodevelopmental disorder is characterized by impaired social interactions, communication deficits, and repetitive behaviors plus restricted interest. Autistic individuals also commonly present with a myriad of comorbidities, such as attention deficit hyperactivity disorder, anxiety, and seizures. To date, a pharmacological intervention for the treatment of core autistic symptoms has not been identified. Cannabidiol (CBD), the major nonpsychoactive constituent of Cannabis sativa, is suggested to have multiple therapeutic applications, but its effect(s) on idiopathic autism is unknown. We hypothesized that CBD will effectively attenuate the autism-like behaviors and autism-associated comorbid behaviors in BTBR T+Itpr3tf/J (BTBR) mice, an established mouse model of idiopathic ASD. Methods Male BTBR mice were injected intraperitoneally with either vehicle, 20 mg/kg CBD or 50 mg/kg CBD daily for two weeks beginning at postnatal day 21 ± 3. On the final treatment day, a battery of behavioral assays were used to evaluate the effects of CBD on the BTBR mice, as compared to age-matched, vehicle-treated C57BL/6 J mice. Results High dose (50 mg/kg) CBD treatment attenuated the elevated repetitive self-grooming behavior and hyperlocomotion in BTBR mice. The social deficits exhibited by the control BTBR mice were rescued by the 20 mg/kg CBD treatment. Discussion Our data indicate that different doses for CBD are needed for treating specific ASD-like behaviors. Together, our results suggest that CBD may be an effective drug to ameliorate repetitive/restricted behaviors, social deficits, and autism-associated hyperactivity.
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Affiliation(s)
- Sarah H. Shrader
- Department of Pharmacology and Toxicology, University of Louisville School of Medicine, Louisville, KY, United States
| | - Nicholas Mellen
- Departments of Neurology and Autism Center, Pediatric Research Institute, University of Louisville School of Medicine, Louisville, KY, United States
| | - Jun Cai
- Department of Pharmacology and Toxicology, University of Louisville School of Medicine, Louisville, KY, United States
- Department of Pediatrics, Pediatric Research Institute, University of Louisville School of Medicine, Louisville, KY, United States
| | - Gregory N. Barnes
- Department of Pharmacology and Toxicology, University of Louisville School of Medicine, Louisville, KY, United States
- Departments of Neurology and Autism Center, Pediatric Research Institute, University of Louisville School of Medicine, Louisville, KY, United States
- Department of Pediatrics, Pediatric Research Institute, University of Louisville School of Medicine, Louisville, KY, United States
| | - Zhao-Hui Song
- Department of Pharmacology and Toxicology, University of Louisville School of Medicine, Louisville, KY, United States
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Adelson RP, Ciobanu M, Garikipati A, Castell NJ, Singh NP, Barnes G, Rumph JK, Mao Q, Roane HS, Vaish A, Das R. Family-Centric Applied Behavior Analysis Facilitates Improved Treatment Utilization and Outcomes. J Clin Med 2024; 13:2409. [PMID: 38673682 PMCID: PMC11051390 DOI: 10.3390/jcm13082409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/15/2024] [Accepted: 04/19/2024] [Indexed: 04/28/2024] Open
Abstract
Background/Objective: Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized by lifelong impacts on functional social and daily living skills, and restricted, repetitive behaviors (RRBs). Applied behavior analysis (ABA), the gold-standard treatment for ASD, has been extensively validated. ABA access is hindered by limited availability of qualified professionals and logistical and financial barriers. Scientifically validated, parent-led ABA can fill the accessibility gap by overcoming treatment barriers. This retrospective cohort study examines how our ABA treatment model, utilizing parent behavior technicians (pBTs) to deliver ABA, impacts adaptive behaviors and interfering behaviors (IBs) in a cohort of children on the autism spectrum with varying ASD severity levels, and with or without clinically significant IBs. Methods: Clinical outcomes of 36 patients ages 3-15 years were assessed using longitudinal changes in Vineland-3 after 3+ months of pBT-delivered ABA treatment. Results: Within the pBT model, our patients demonstrated clinically significant improvements in Vineland-3 Composite, domain, and subdomain scores, and utilization was higher in severe ASD. pBTs utilized more prescribed ABA when children initiated treatment with clinically significant IBs, and these children also showed greater gains in their Composite scores. Study limitations include sample size, inter-rater reliability, potential assessment metric bias and schedule variability, and confounding intrinsic or extrinsic factors. Conclusion: Overall, our pBT model facilitated high treatment utilization and showed robust effectiveness, achieving improved adaptive behaviors and reduced IBs when compared to conventional ABA delivery. The pBT model is a strong contender to fill the widening treatment accessibility gap and represents a powerful tool for addressing systemic problems in ABA treatment delivery.
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Affiliation(s)
- Robert P. Adelson
- Montera, Inc., dba Forta, Research and Development, 548 Market St., PMB 89605, San Francisco, CA 94104-5401, USA; (R.P.A.); (M.C.); (A.G.); (N.J.C.); (N.P.S.); (G.B.); (A.V.); (R.D.)
| | - Madalina Ciobanu
- Montera, Inc., dba Forta, Research and Development, 548 Market St., PMB 89605, San Francisco, CA 94104-5401, USA; (R.P.A.); (M.C.); (A.G.); (N.J.C.); (N.P.S.); (G.B.); (A.V.); (R.D.)
| | - Anurag Garikipati
- Montera, Inc., dba Forta, Research and Development, 548 Market St., PMB 89605, San Francisco, CA 94104-5401, USA; (R.P.A.); (M.C.); (A.G.); (N.J.C.); (N.P.S.); (G.B.); (A.V.); (R.D.)
| | - Natalie J. Castell
- Montera, Inc., dba Forta, Research and Development, 548 Market St., PMB 89605, San Francisco, CA 94104-5401, USA; (R.P.A.); (M.C.); (A.G.); (N.J.C.); (N.P.S.); (G.B.); (A.V.); (R.D.)
| | - Navan Preet Singh
- Montera, Inc., dba Forta, Research and Development, 548 Market St., PMB 89605, San Francisco, CA 94104-5401, USA; (R.P.A.); (M.C.); (A.G.); (N.J.C.); (N.P.S.); (G.B.); (A.V.); (R.D.)
| | - Gina Barnes
- Montera, Inc., dba Forta, Research and Development, 548 Market St., PMB 89605, San Francisco, CA 94104-5401, USA; (R.P.A.); (M.C.); (A.G.); (N.J.C.); (N.P.S.); (G.B.); (A.V.); (R.D.)
| | - Jodi Kim Rumph
- Montera, Inc., dba Forta, Research and Development, 548 Market St., PMB 89605, San Francisco, CA 94104-5401, USA; (R.P.A.); (M.C.); (A.G.); (N.J.C.); (N.P.S.); (G.B.); (A.V.); (R.D.)
| | - Qingqing Mao
- Montera, Inc., dba Forta, Research and Development, 548 Market St., PMB 89605, San Francisco, CA 94104-5401, USA; (R.P.A.); (M.C.); (A.G.); (N.J.C.); (N.P.S.); (G.B.); (A.V.); (R.D.)
| | - Henry S. Roane
- Madison-Irving Medical Center, Upstate Medical University, 475 Irving Avenue, Syracuse, NY 13210-1756, USA;
| | - Anshu Vaish
- Montera, Inc., dba Forta, Research and Development, 548 Market St., PMB 89605, San Francisco, CA 94104-5401, USA; (R.P.A.); (M.C.); (A.G.); (N.J.C.); (N.P.S.); (G.B.); (A.V.); (R.D.)
| | - Ritankar Das
- Montera, Inc., dba Forta, Research and Development, 548 Market St., PMB 89605, San Francisco, CA 94104-5401, USA; (R.P.A.); (M.C.); (A.G.); (N.J.C.); (N.P.S.); (G.B.); (A.V.); (R.D.)
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3
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Ford CL, McDonough AA, Horie K, Young LJ. Melanocortin agonism in a social context selectively activates nucleus accumbens in an oxytocin-dependent manner. Neuropharmacology 2024; 247:109848. [PMID: 38253222 PMCID: PMC10923148 DOI: 10.1016/j.neuropharm.2024.109848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 10/18/2023] [Accepted: 01/13/2024] [Indexed: 01/24/2024]
Abstract
Social deficits are debilitating features of many psychiatric disorders, including autism. While time-intensive behavioral therapy is moderately effective, there are no pharmacological interventions for social deficits in autism. Many studies have attempted to treat social deficits using the neuropeptide oxytocin for its powerful neuromodulatory abilities and influence on social behaviors and cognition. However, clinical trials utilizing supplementation paradigms in which exogenous oxytocin is chronically administered independent of context have failed. An alternative treatment paradigm suggests pharmacologically activating the endogenous oxytocin system during behavioral therapy to enhance the efficacy of therapy by facilitating social learning. To this end, melanocortin receptor agonists like Melanotan II (MTII), which induces central oxytocin release and accelerates formation of partner preference, a form of social learning, in prairie voles, are promising pharmacological tools. To model pharmacological activation of the endogenous oxytocin system during behavioral therapy, we administered MTII prior to social interactions between male and female voles. We assessed its effect on oxytocin-dependent activity in brain regions subserving social learning using Fos expression as a proxy for neuronal activation. In non-social contexts, MTII only activated hypothalamic paraventricular nucleus, a primary site of oxytocin synthesis. However, during social interactions, MTII selectively increased oxytocin-dependent activation of nucleus accumbens, a site critical for social learning. These results suggest a mechanism for the MTII-induced acceleration of partner preference formation observed in previous studies. Moreover, they are consistent with the hypothesis that pharmacologically activating the endogenous oxytocin system with a melanocortin agonist during behavioral therapy has potential to facilitate social learning.
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Affiliation(s)
- Charles L Ford
- Center for Translational Social Neuroscience, Silvio O. Conte Center for Oxytocin and Social Cognition, Emory National Primate Research Center, Atlanta, GA, 30329, USA.
| | - Anna A McDonough
- Center for Translational Social Neuroscience, Silvio O. Conte Center for Oxytocin and Social Cognition, Emory National Primate Research Center, Atlanta, GA, 30329, USA
| | - Kengo Horie
- Center for Translational Social Neuroscience, Silvio O. Conte Center for Oxytocin and Social Cognition, Emory National Primate Research Center, Atlanta, GA, 30329, USA
| | - Larry J Young
- Center for Translational Social Neuroscience, Silvio O. Conte Center for Oxytocin and Social Cognition, Emory National Primate Research Center, Atlanta, GA, 30329, USA; Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, 30322, USA.
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4
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Cox DJ, Jennings AM. The Promises and Possibilities of Artificial Intelligence in the Delivery of Behavior Analytic Services. Behav Anal Pract 2024; 17:123-136. [PMID: 38405282 PMCID: PMC10890993 DOI: 10.1007/s40617-023-00864-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2023] [Indexed: 02/27/2024] Open
Abstract
Artificial intelligence (AI) has begun to affect nearly every aspect of our daily lives and nearly every industry and profession. Many readers of this journal likely work in one or more areas of behavioral health. For readers who work in behavioral health and who are interested in AI, the purpose of this article is to highlight the pervasiveness of AI research being conducted around many facets of behavioral health service delivery. To do this, we first provide a brief overview of some of the areas within AI and the types of problems each area of AI attempts to solve. We then outline the prototypical client journey in behavioral healthcare beginning with diagnosis/assessment and ending with intervention withdrawal or ongoing monitoring. Next, for each stage in the client journey, we highlight several areas that parallel existing behavior analytic practice where researchers have begun to use AI, often to improve the efficiency of service delivery or to learn new things that improve the effectiveness of behavioral health services. Finally, for those whose appetite has been whet for getting involved with AI, we close by describing three roles they might consider trying out and that parallel the three main domains of behavior analysis. These three roles are an AI tool designer (akin to EAB), AI tool implementer (akin to ABA), or AI tool supporter (akin to practice).
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Affiliation(s)
- David J. Cox
- Department of Applied Behavior Analysis, Endicott College, Beverly, MA USA
| | - Adrienne M. Jennings
- Department of Behavioral Science, Daemen University, 4380 Main Street, Amherst, NY USA
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Bordini D, Moya AC, Asevedo GRDC, Paula CS, Brunoni D, Brentani H, Caetano SC, Mari JDJ, Bagaiolo L. Exploring the Acquisition of Social Communication Skills in Children with Autism: Preliminary Findings from Applied Behavior Analysis (ABA), Parent Training, and Video Modeling. Brain Sci 2024; 14:172. [PMID: 38391746 PMCID: PMC10886593 DOI: 10.3390/brainsci14020172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 02/01/2024] [Accepted: 02/03/2024] [Indexed: 02/24/2024] Open
Abstract
Social communication skills, especially eye contact and joint attention, are frequently impaired in autism spectrum disorder (ASD) and predict functional outcomes. Applied behavior analysis is one of the most common evidence-based treatments for ASD, but it is not accessible to most families in low- and middle-income countries (LMICs) as it is an expensive and intensive treatment and needs to be delivered by highly specialized professionals. Parental training has emerged as an effective alternative. This is an exploratory study to assess a parental intervention group via video modeling to acquire eye contact and joint attention. Four graded measures of eye contact and joint attention (full physical prompt, partial physical prompt, gestural prompt, and independent) were assessed in 34 children with ASD and intellectual disability (ID). There was a progressive reduction in the level of prompting required over time to acquire eye contact and joint attention, as well as a positive correlation between the time of exposure to the intervention and the acquisition of abilities. This kind of parent training using video modeling to teach eye contact and joint attention skills to children with ASD and ID is a low-cost intervention that can be applied in low-resource settings.
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Affiliation(s)
- Daniela Bordini
- Department of Psychiatry, Federal University of Sao Paulo (UNIFESP), Sao Paulo 04017-030, SP, Brazil
| | - Ana Cláudia Moya
- Department of Psychiatry, Federal University of Sao Paulo (UNIFESP), Sao Paulo 04017-030, SP, Brazil
| | | | - Cristiane Silvestre Paula
- Human Development Sciences Program, Mackenzie Presbyterian University (UPM), Sao Paulo 01302-907, SP, Brazil
| | - Décio Brunoni
- Human Development Sciences Program, Mackenzie Presbyterian University (UPM), Sao Paulo 01302-907, SP, Brazil
| | - Helena Brentani
- Psychiatry Institute, University of São Paulo (USP), Sao Paulo 01246-904, SP, Brazil
| | - Sheila Cavalcante Caetano
- Department of Psychiatry, Federal University of Sao Paulo (UNIFESP), Sao Paulo 04017-030, SP, Brazil
| | - Jair de Jesus Mari
- Department of Psychiatry, Federal University of Sao Paulo (UNIFESP), Sao Paulo 04017-030, SP, Brazil
| | - Leila Bagaiolo
- Department of Psychiatry, Federal University of Sao Paulo (UNIFESP), Sao Paulo 04017-030, SP, Brazil
- Gradual-Behavioral Intervention Group, Sao Paulo 05458-000, SP, Brazil
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6
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Peterson T, Dodson J, Strale F. Predicting Behavioral Target Mastery With Age, Intensity and Duration, Open Targets, and Maintenance Failure With Applied Behavior Analysis in Individuals With Autism. Cureus 2024; 16:e53964. [PMID: 38469009 PMCID: PMC10925972 DOI: 10.7759/cureus.53964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/08/2024] [Indexed: 03/13/2024] Open
Abstract
Background Researchers have studied the effects of age, treatment intensity, and treatment duration with applied behavior analysis (ABA) outcomes in autistic individuals. This study's primary objective was to evaluate the predictive capabilities of age, intensity, and duration of treatment, open behavioral targets, and behavior maintenance failure on behavioral target mastery. Methods A retrospective cohort of 100 autistic individuals treated with ABA with functional analysis and discrete trial training, mass trials, and naturalistic training were treated and analyzed. Target behavioral mastery data was collected via a retrospective chart review contained within the "Catalyst" tracking software. ABA treatment was administered for three months between March 19, 2023, and June 11, 2023. Multiple linear regression was performed using the percentage of behavioral targets mastered as the dependent variable. The independent variables were age, average trials to behavioral mastery, average teaching days to behavioral mastery, and percentage of behavioral targets that failed in maintenance. Results The multiple linear regression model was statistically significant (R=0.443, R²=0.196, adjusted R2=0.150, F(5, 87)=4.239, p=0.002). The average teaching days to mastery (β=0.416, p=0.019) and percentage of targets failed in maintenance (β=0.201, p=0.047) significantly predicted the percentage of behavioral targets mastered. However, age (β=0.079, p=0.419), average trials to mastery (β=-0.271, p=0.114), and open targets (β=0.184, p=0.081) did not significantly predict the percentage of behavioral targets mastered. The analysis of variance (ANOVA) resulted in non-significant (p>0.05) age group differences between the above variables. Conclusions The predictor variables average teaching days to mastery (intensity and duration) and percentage of targets failed in maintenance had a statistically significant effect on the percentage of behavioral targets mastered. The predictor variables age, average trials to behavioral mastery (intensity and duration), and open behavioral targets had a non-significant influence on the percentage of behavioral targets mastered. A non-significant difference between age groups was found in all study variables.
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Affiliation(s)
| | - Jessica Dodson
- Applied Behavior Analysis, The Oxford Center, Brighton, USA
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Iannone A, Giansanti D. Breaking Barriers-The Intersection of AI and Assistive Technology in Autism Care: A Narrative Review. J Pers Med 2023; 14:41. [PMID: 38248742 PMCID: PMC10817661 DOI: 10.3390/jpm14010041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 12/18/2023] [Accepted: 12/23/2023] [Indexed: 01/23/2024] Open
Abstract
(Background) Autism increasingly requires a multidisciplinary approach that can effectively harmonize the realms of diagnosis and therapy, tailoring both to the individual. Assistive technologies (ATs) play an important role in this context and hold significant potential when integrated with artificial intelligence (AI). (Objective) The objective of this study is to analyze the state of integration of AI with ATs in autism through a review. (Methods) A review was conducted on PubMed and Scopus, applying a standard checklist and a qualification process. The outcome reported 22 studies, including 7 reviews. (Key Content and Findings) The results reveal an early yet promising interest in integrating AI into autism assistive technologies. Exciting developments are currently underway at the intersection of AI and robotics, as well as in the creation of wearable automated devices like smart glasses. These innovations offer substantial potential for enhancing communication, interaction, and social engagement for individuals with autism. Presently, researchers are prioritizing innovation over establishing a solid presence within the healthcare domain, where issues such as regulation and acceptance demand increased attention. (Conclusions) As the field continues to evolve, it becomes increasingly clear that AI will play a pivotal role in bridging various domains, and integrated ATs with AI are positioned to act as crucial connectors.
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Affiliation(s)
- Antonio Iannone
- CREA, Italian National Research Body, Via Ardeatina, 546, 00178 Roma, Italy
| | - Daniele Giansanti
- Centro Nazionale TISP, Istituto Superiore di Sanità; Viale Regina Elena 299, 00161 Roma, Italy
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Bahry S, Gerhardt PF, Weiss MJ, Leaf JB, Putnam RF, Bondy A. The Ethics of Actually Helping People: Targeting Skill Acquisition Goals That Promote Meaningful Outcomes for Individuals with Autism Spectrum Disorder. Behav Anal Pract 2023; 16:672-695. [PMID: 37680332 PMCID: PMC10480108 DOI: 10.1007/s40617-022-00757-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2022] [Indexed: 12/14/2022] Open
Abstract
As a field that predominately supports individuals with autism spectrum disorder (ASD), we have an ethical duty as behavior analysts to ensure that the goals we write and interventions we prescribe promote best outcomes across the lifespan. This is critical, given that as it stands now, outcomes in adulthood for individuals with ASD are poor in every area assessed. The Ethics Code for Behavior Analysts can be interpreted to provide support for teaching the right goals, the right way, with respect to inherent rights of those we serve, in order to help affect positive changes in these outcomes. The present article highlights ethical themes that are relevant in order to affect these changes that are supported by the Code, as well as actionable steps to take next. The aim is to provide a resource for practitioners to use in clinical practice and in making ethical decisions that will help to improve outcomes for individuals with autism in adulthood. In addition, recommendations are made about integrating these values and approaches in terms of training, supervision, advocacy, and research.
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Affiliation(s)
- Shanna Bahry
- Endicott College, Beverly, MA USA
- Meaningful HOPE, East Providence, RI USA
| | | | | | - Justin B. Leaf
- Endicott College, Beverly, MA USA
- Autism Partnership Foundation, Seal Beach, CA USA
| | - Robert F. Putnam
- Endicott College, Beverly, MA USA
- May Institute, Randolph, MA USA
| | - Andy Bondy
- Pyramid Educational Consultants, New Castle, DE USA
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Constantino JN, Abbacchi AM, May BK, Klaiman C, Zhang Y, Lowe JK, Marrus N, Klin A, Geschwind DH. Prospects for Leveling the Playing Field for Black Children With Autism. J Am Acad Child Adolesc Psychiatry 2023; 62:949-952. [PMID: 37196781 PMCID: PMC10948275 DOI: 10.1016/j.jaac.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 03/04/2023] [Accepted: 05/08/2023] [Indexed: 05/19/2023]
Abstract
Among the many race-based health disparities that have persistently plagued the US population,1 the disproportionate burden of adverse neurodevelopmental outcomes to Black children affected by autism spectrum disorder (ASD) is particularly devastating given its major lifelong consequences. Recently, in 3 successive reports from the Autism and Developmental Disabilities Monitoring (ADDM) program of the US Centers for Disease Control and Prevention (CDC) (birth cohort years 2014, 2016, and 2018), we and our collaborators reported that although the prevalence of community-diagnosed ASD had equalized for Black and non-Hispanic White (NHW) children in the United States, there has persisted a pronounced racial disparity in the proportion of ASD-affected children with comorbid intellectual disability (ID), on the order of 50% for Black children with ASD vs 20% for White children with ASD.2 Here, we provide data to support the following: much earlier diagnosis is possible; early diagnosis alone is not likely to close the ID comorbidity disparity; and judicious efforts over care as usual are necessary to ensure that Black children have access to timely implementation of developmental therapy, for which we observed promising associations with improved cognitive and adaptive outcomes in our sample.
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Affiliation(s)
| | - Anna M Abbacchi
- Washington University School of Medicine, St. Louis, Missouri
| | - Brandon K May
- Washington University School of Medicine, St. Louis, Missouri
| | - Cheryl Klaiman
- Marcus Autism Center, School of Medicine, Emory University, Atlanta, Georgia
| | - Yi Zhang
- Washington University School of Medicine, St. Louis, Missouri
| | - Jennifer K Lowe
- David Geffen School of Medicine, University of California, Los Angeles, California
| | - Natasha Marrus
- Washington University School of Medicine, St. Louis, Missouri
| | - Ami Klin
- Marcus Autism Center, School of Medicine, Emory University, Atlanta, Georgia
| | - Daniel H Geschwind
- David Geffen School of Medicine, University of California, Los Angeles, California
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Alper M, Christiansen E, Allen AA, Mello S. Pediatric Media Guidance for Parents of Children on the Autism Spectrum: A Thematic Analysis. Health Commun 2023; 38:1572-1580. [PMID: 34963394 DOI: 10.1080/10410236.2021.2020982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Very little is known about pediatric media guidance, or the one-on-onse advice that medical and clinical professionals (MCPs) communicate to parents about their children's recreational media and technology (RMT) use. One population that stands to benefit from a closer examination is children on the autism spectrum due to their behavior and communication challenges. We surveyed one group of pediatric autism MCPs, applied behavioral analysis (ABA) providers (N = 234), due to their proximity to families and conducted an applied thematic analysis of RMT advice they deliver. Providers reported primarily suggesting that caregivers employ restrictive parental mediation with their autistic child, that RMT should primarily be limited to use as a reward or reinforcement, and that parents should set time limits. Our findings offer new insights into the intersections of health communication theory and practice, while highlighting the need for greater research into RMT guidance for children with and without disabilities.
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Affiliation(s)
- Meryl Alper
- Department of Communication Studies, College of Arts, Media, and Design, Northeastern University
| | - Erika Christiansen
- Department of Communication Studies, College of Arts, Media, and Design, Northeastern University
| | | | - Susan Mello
- Department of Communication Studies, College of Arts, Media, and Design, Northeastern University
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11
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Garikipati A, Ciobanu M, Singh NP, Barnes G, Decurzio J, Mao Q, Das R. Clinical Outcomes of a Hybrid Model Approach to Applied Behavioral Analysis Treatment. Cureus 2023; 15:e36727. [PMID: 36998917 PMCID: PMC10047423 DOI: 10.7759/cureus.36727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2023] [Indexed: 03/29/2023] Open
Abstract
Objective This study examines the implementation of a hybrid applied behavioral analysis (ABA) treatment model to determine its impact on autism spectrum disorder (ASD) patient outcomes. Methods Retrospective data were collected for 25 pediatric patients to measure progress before and after the implementation of a hybrid ABA treatment model under which therapists consistently captured session notes electronically regarding goals and patient progress. ABA treatment was streamlined for consistent delivery, with improved software utilization for tracking scheduling and progress. Eleven goals within three domains (behavioral, social, and communication) were examined. Results After the implementation of the hybrid model, the goal success rate improved by 9.7% compared to the baseline; 41.8% of goals showed improvement, 38.4% showed a flat trend, and 19.8% showed deterioration. Multiple goals trended upwards in 76% of the patients. Conclusion This pilot study demonstrated that enhancing the consistency with which ABA treatment is monitored/delivered can improve patient outcomes as seen through improved attainment of goals.
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Maharjan J, Garikipati A, Dinenno FA, Ciobanu M, Barnes G, Browning E, DeCurzio J, Mao Q, Das R. Machine learning determination of applied behavioral analysis treatment plan type. Brain Inform 2023; 10:7. [PMID: 36862316 PMCID: PMC9981822 DOI: 10.1186/s40708-023-00186-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 02/06/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Applied behavioral analysis (ABA) is regarded as the gold standard treatment for autism spectrum disorder (ASD) and has the potential to improve outcomes for patients with ASD. It can be delivered at different intensities, which are classified as comprehensive or focused treatment approaches. Comprehensive ABA targets multiple developmental domains and involves 20-40 h/week of treatment. Focused ABA targets individual behaviors and typically involves 10-20 h/week of treatment. Determining the appropriate treatment intensity involves patient assessment by trained therapists, however, the final determination is highly subjective and lacks a standardized approach. In our study, we examined the ability of a machine learning (ML) prediction model to classify which treatment intensity would be most suited individually for patients with ASD who are undergoing ABA treatment. METHODS Retrospective data from 359 patients diagnosed with ASD were analyzed and included in the training and testing of an ML model for predicting comprehensive or focused treatment for individuals undergoing ABA treatment. Data inputs included demographics, schooling, behavior, skills, and patient goals. A gradient-boosted tree ensemble method, XGBoost, was used to develop the prediction model, which was then compared against a standard of care comparator encompassing features specified by the Behavior Analyst Certification Board treatment guidelines. Prediction model performance was assessed via area under the receiver-operating characteristic curve (AUROC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). RESULTS The prediction model achieved excellent performance for classifying patients in the comprehensive versus focused treatment groups (AUROC: 0.895; 95% CI 0.811-0.962) and outperformed the standard of care comparator (AUROC 0.767; 95% CI 0.629-0.891). The prediction model also achieved sensitivity of 0.789, specificity of 0.808, PPV of 0.6, and NPV of 0.913. Out of 71 patients whose data were employed to test the prediction model, only 14 misclassifications occurred. A majority of misclassifications (n = 10) indicated comprehensive ABA treatment for patients that had focused ABA treatment as the ground truth, therefore still providing a therapeutic benefit. The three most important features contributing to the model's predictions were bathing ability, age, and hours per week of past ABA treatment. CONCLUSION This research demonstrates that the ML prediction model performs well to classify appropriate ABA treatment plan intensity using readily available patient data. This may aid with standardizing the process for determining appropriate ABA treatments, which can facilitate initiation of the most appropriate treatment intensity for patients with ASD and improve resource allocation.
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Affiliation(s)
- Jenish Maharjan
- Montera Inc. dba Forta, 548 Market St, San Francisco, CA PMB 89605 USA
| | - Anurag Garikipati
- Montera Inc. dba Forta, 548 Market St, San Francisco, CA PMB 89605 USA
| | - Frank A. Dinenno
- Montera Inc. dba Forta, 548 Market St, San Francisco, CA PMB 89605 USA
| | - Madalina Ciobanu
- Montera Inc. dba Forta, 548 Market St, San Francisco, CA PMB 89605 USA
| | - Gina Barnes
- Montera Inc. dba Forta, 548 Market St, San Francisco, CA PMB 89605 USA
| | - Ella Browning
- Montera Inc. dba Forta, 548 Market St, San Francisco, CA PMB 89605 USA
| | - Jenna DeCurzio
- Montera Inc. dba Forta, 548 Market St, San Francisco, CA PMB 89605 USA
| | - Qingqing Mao
- Montera Inc. dba Forta, 548 Market St, San Francisco, CA, PMB 89605, USA.
| | - Ritankar Das
- Montera Inc. dba Forta, 548 Market St, San Francisco, CA PMB 89605 USA
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13
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Préfontaine I, Morizot J, Lanovaz MJ, Rivard M. Changes in Autistic Symptoms and Adaptive Functioning of Children Receiving Early Behavioral Intervention in a Community Setting: A Latent Growth Curve Analysis. J Autism Dev Disord 2023; 53:901-17. [PMID: 34813033 DOI: 10.1007/s10803-021-05373-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2021] [Indexed: 10/19/2022]
Abstract
Despite showing effects in well-controlled studies, the extent to which early intensive behavioral intervention (EBI) produces positive changes in community-based settings remains uncertain. Thus, our study examined changes in autistic symptoms and adaptive functioning in 233 children with autism receiving EBI in a community setting. The results revealed nonlinear changes in adaptive functioning characterized by significant improvements during the intervention and a small linear decrease in autistic symptoms from baseline to follow-up. The intensity of intervention, initial age, IQ and autistic symptoms were associated either with progress during the intervention or maintenance during the follow-up. The next step to extend this line of research involves collecting detailed data about intervention strategies and implementation fidelity to produce concrete recommendations for practitioners.
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Ilan M, Faroy M, Zachor D, Manelis L, Waissengreen D, Michaelovski A, Avni I, Menashe I, Koller J, Dinstein I, Meiri G. Children with autism exhibit similar longitudinal changes in core symptoms when placed in special or mainstream education settings. Autism 2023:13623613221142394. [PMID: 36632654 PMCID: PMC10375002 DOI: 10.1177/13623613221142394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
LAY ABSTRACT Today, children with autism spectrum disorder (ASD) are placed in mainstream or special education settings somewhat arbitrarily with no clear clinical recommendations. Here, we compared changes in core ASD symptoms, as measured by the Autism Diagnostic Observation Schedule, 2nd edition (ADOS-2) clinical assessment, across ASD preschool children placed in special or mainstream education. Longitudinal changes in ADOS-2 scores did not differ significantly across settings over a 1- to 2-year period. While some children improved in core ASD symptoms, others deteriorated in both settings. This highlights the need to identify specific criteria for establishing meaningful placement recommendations.
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Affiliation(s)
- Michal Ilan
- Ben-Gurion University of the Negev, Israel.,Soroka University Medical Center, Israel
| | - Michal Faroy
- Ben-Gurion University of the Negev, Israel.,Soroka University Medical Center, Israel.,The Academic College of Tel Aviv-Yaffo, Israel
| | | | - Liora Manelis
- Ben-Gurion University of the Negev, Israel.,Soroka University Medical Center, Israel
| | - Danel Waissengreen
- Ben-Gurion University of the Negev, Israel.,Soroka University Medical Center, Israel
| | | | - Inbar Avni
- Ben-Gurion University of the Negev, Israel
| | | | | | | | - Gal Meiri
- Ben-Gurion University of the Negev, Israel.,Soroka University Medical Center, Israel
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15
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Ostrovsky A, Willa M, Cho T, Strandberg M, Howard S, Davitian C. Data-driven, client-centric applied behavior analysis treatment-dose optimization improves functional outcomes. World J Pediatr 2022:10.1007/s12519-022-00643-0. [PMID: 36394715 PMCID: PMC9672611 DOI: 10.1007/s12519-022-00643-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 10/16/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND With increasing numbers of individuals diagnosed with autism spectrum disorder (ASD) and with affirmation of applied behavior analysis (ABA) as an evidence-based standard of care for ASD, there has been a proliferation of agencies offering ABA services over the last several decades. Disagreement exists among ABA providers and health plans that reimburse those providers on the optimal number of hours of ABA services that should be reimbursed. This study aims to understand whether children who receive more hours of ABA therapy achieve better outcomes and to evaluate the impact of the COVID-19-induced shift to telehealth clinical supervision on outcomes. METHODS A retrospective cohort analysis was performed using data from the Vineland 3 Comprehensive Interview Form to assess function throughout ABA treatment. Paired sample t tests, independent sample t tests, Cohen's D, and Pearson correlations were used to determine relationships between Vineland scores and input variables including hours of service and modality of supervision (in-person vs. telehealth). RESULTS While statistically and clinically significant improvements in function were observed, children appear to have improved outcomes independent of the number of hours of service received. There were also no significant associations between modality of supervision and Vineland standard scores. CONCLUSIONS These findings challenge prior research that demonstrated a linear dose-response relationship. By tailoring treatment dosage to the individual client's needs, providers may be able to better maximize functional progress of the client, to preserve family time, and to utilize health plan dollars more efficiently.
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Affiliation(s)
| | | | - Ted Cho
- UCSF Benioff Children’s Hospital, San Francisco, CA USA
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16
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Dănciulescu T, Zaharia A. Piano with a Twist: A Pilot Study Exploring the Preliminary Effects of a Piano Therapy Program for Children with Autism Spectrum Disorder. The Arts in Psychotherapy 2022. [DOI: 10.1016/j.aip.2022.101987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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17
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Kohli M, Kar AK, Bangalore A, AP P. Machine learning-based ABA treatment recommendation and personalization for autism spectrum disorder: an exploratory study. Brain Inform 2022; 9:16. [PMID: 35879626 PMCID: PMC9311349 DOI: 10.1186/s40708-022-00164-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 06/25/2022] [Indexed: 12/27/2022] Open
Abstract
Autism spectrum is a brain development condition that impairs an individual's capacity to communicate socially and manifests through strict routines and obsessive-compulsive behavior. Applied behavior analysis (ABA) is the gold-standard treatment for autism spectrum disorder (ASD). However, as the number of ASD cases increases, there is a substantial shortage of licensed ABA practitioners, limiting the timely formulation, revision, and implementation of treatment plans and goals. Additionally, the subjectivity of the clinician and a lack of data-driven decision-making affect treatment quality. We address these obstacles by applying two machine learning algorithms to recommend and personalize ABA treatment goals for 29 study participants with ASD. The patient similarity and collaborative filtering methods predicted ABA treatment with an average accuracy of 81-84%, with a normalized discounted cumulative gain of 79-81% (NDCG) compared to clinician-prepared ABA treatment recommendations. Additionally, we assess the two models' treatment efficacy (TE) by measuring the percentage of recommended treatment goals mastered by the study participants. The proposed treatment recommendation and personalization strategy are generalizable to other intervention methods in addition to ABA and for other brain disorders. This study was registered as a clinical trial on November 5, 2020 with trial registration number CTRI/2020/11/028933.
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Affiliation(s)
- Manu Kohli
- Indian Institute of Technology-Delhi, Department of Management Studies, IV Floor, Vishwakarma Bhavan, Shaheed Jeet Singh Marg, Hauz Khas, New Delhi, 110016 India
| | - Arpan Kumar Kar
- Indian Institute of Technology-Delhi, Department of Management Studies, IV Floor, Vishwakarma Bhavan, Shaheed Jeet Singh Marg, Hauz Khas, New Delhi, 110016 India
| | - Anjali Bangalore
- ICON Centre, K. M. Chavan chawk, Shivajinagar Road, Garkheda, Aurangabad, 431005 India
| | - Prathosh AP
- Indian Institute of Science, CV Raman Rd, Bengaluru, 560012 Karnataka India
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18
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Choi KR, Lotfizadah AD, Bhakta B, Pompa-Craven P, Coleman KJ. Concordance between patient-centered and adaptive behavior outcome measures after applied behavior analysis for autism. BMC Pediatr 2022; 22:314. [PMID: 35624439 PMCID: PMC9137129 DOI: 10.1186/s12887-022-03383-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 05/23/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Applied behavior analysis (ABA) is an evidence-based approach to autism spectrum disorder that has been shown in clinical trials to improve child functional status. There is substantial focus in ABA on setting and tracking individualized goals that are patient-centered, but limited research on how to measure progress on such patient-centered outcomes. PURPOSE The purpose of this investigation was to assess concordance between patient-centered and standard outcome measures of treatment progress in a real-world clinical sample of children receiving ABA for autism spectrum disorder. METHODS This observational study used a clinical sample of children ages 3 to 16 years (N = 154) who received 24 months of ABA from an integrated health system. Concordance between three outcome measures after ABA was assessed using a correlation matrix: (1) patient-centered measures of progress on individualized treatment goals, (2) caregiver-centered measure of progress on treatment participation goals, and (3) the Vineland Adaptive Behavior Scales adaptive behavior composite. RESULTS There was limited concordance among measures at both 12 and 24 months of ABA. None of the patient-centered measures showed significant positive correlation with adaptive behavior composite difference scores at either 12 or 24 months, nor did the caregiver measure. The percentage of children achieving clinically meaningful gain on patient-centered goal measures increased between 12 and 24 months of ABA, while the percentage of children achieving clinically meaningful gains in adaptive behavior declined during the same time period. CONCLUSIONS In a health system implementation of ABA, there was limited concordance between patient-centered and standard measures of clinically meaningful treatment progress for children with ASD. Clinicians should have ongoing dialogue with patients and parents/caregivers to ensure that interventions for ASD are resulting in progress towards outcomes that are meaningful to patients and families.
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Affiliation(s)
- Kristen R Choi
- UCLA School of Nursing, 700 Tiverton Ave, Los Angeles, CA, 90049, USA.
- Department of Health Policy and Management, UCLA Fielding School of Public Health, 650 Charles E Young Dr S, Los Angeles, CA, 90095, USA.
- Department of Research & Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles, Pasadena, CA, 91101, USA.
| | - Amin D Lotfizadah
- Easterseals Southern California, 1063 McGaw Avenue, Suite 100, Irvine, CA, 92614, USA
| | - Bhumi Bhakta
- Department of Research & Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles, Pasadena, CA, 91101, USA
| | - Paula Pompa-Craven
- Easterseals Southern California, 1063 McGaw Avenue, Suite 100, Irvine, CA, 92614, USA
| | - Karen J Coleman
- Department of Research & Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles, Pasadena, CA, 91101, USA
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Kim YH. Maternal Responsive Parenting Trajectories From Birth to Age 3 and Children's Self-Esteem at First Grade. Front Psychol 2022; 13:870669. [PMID: 35572234 PMCID: PMC9096869 DOI: 10.3389/fpsyg.2022.870669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/05/2022] [Indexed: 11/27/2022] Open
Abstract
This paper examines the quality and stability of the responsive parenting practices of mothers with infants and the longitudinal links between these practices and children’s self-esteem. Using data presented by the Panel Study on Korean Children, this study identified Korean mothers’ responsive parenting trajectories from birth to age three and examined their associations with children’s self-esteem at first grade. Korean mothers developed one of three responsive parenting patterns from birth to age three: low (19.0%), moderate (66.0%), or high (15.0%). Children’s self-esteem differed according to their mother’s responsive parenting trajectory. First-graders with mothers displaying the low responsive parenting trajectory were more likely to have lower self-esteem than children of mothers with the moderate responsive parenting trajectory and children of mothers with the high responsive parenting trajectory. The longitudinal link between mother-reported responsive parenting patterns during infancy and child-reported self-esteem at first grade was verified. This finding highlights the significance of early responsive parenting from mothers as a predictor of the self-esteem of children in later developmental stages.
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Affiliation(s)
- Yeon Ha Kim
- Department of Child and Family Studies, Kyung Hee University, Seoul, South Korea
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20
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Chisholm AK, Lami F, Haebich KM, Ure A, Brignell A, Maloof T, Pride NA, Walsh KS, Maier A, Rouel M, Granader Y, Barton B, Darke H, Fuelscher I, Dabscheck G, Anderson VA, Williams K, North KN, Payne JM. Sex- and age-related differences in autistic behaviours in children with neurofibromatosis type 1. J Autism Dev Disord 2022. [PMID: 35445370 DOI: 10.1007/s10803-022-05571-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2022] [Indexed: 10/18/2022]
Abstract
This study investigated sex and age differences in autistic behaviours in children with neurofibromatosis type 1 (NF1) who scored within the clinical range on the Social Responsiveness Scale - Second Edition (T score ≥ 60). Thirty-four males and 28 females (3-16 years) were assessed with the Autism Diagnostic Observation Schedule - Second Edition and Autism Diagnostic Interview - Revised. Across both measures, males exhibited greater social communication deficits relative to females. Age-related abatement of social communication difficulties was observed for males but not females. Conversely, no sex differences were found for restricted/repetitive behaviours, which were stable over time for both males and females. The findings are discussed within the context of broader neurodevelopmental considerations that are common in NF1.
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21
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Virues-Ortega J, McKay NS, McCormack JC, Lopez N, Liu R, Kirk I. A callosal biomarker of behavioral intervention outcomes for autism spectrum disorder? A case-control feasibility study with diffusion tensor imaging. PLoS One 2022; 17:e0262563. [PMID: 35113904 PMCID: PMC8812884 DOI: 10.1371/journal.pone.0262563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 12/30/2021] [Indexed: 11/18/2022] Open
Abstract
Tentative results from feasibility analyses are critical for planning future randomized control trials (RCTs) in the emerging field of neural biomarkers of behavioral interventions. The current feasibility study used MRI-derived diffusion imaging data to investigate whether it would be possible to identify neural biomarkers of a behavioral intervention among people diagnosed with autism spectrum disorder (ASD). The corpus callosum has been linked to cognitive processing and callosal abnormalities have been previously found in people diagnosed with ASD. We used a case-control design to evaluate the association between the type of intervention people diagnosed with ASD had previously received and their current white matter integrity in the corpus callosum. Twenty-six children and adolescents with ASD, with and without a history of parent-managed behavioral intervention, underwent an MRI scan with a diffusion data acquisition sequence. We conducted tract-based spatial statistics and a region of interest analysis. The fractional anisotropy values (believed to indicate white matter integrity) in the posterior corpus callosum was significantly different across cases (exposed to parent-managed behavioral intervention) and controls (not exposed to parent-managed behavioral intervention). The effect was modulated by the intensity of the behavioral intervention according to a dose-response relationship. The current feasibility case-control study provides the basis for estimating the statistical power required for future RCTs in this field. In addition, the study demonstrated the effectiveness of purposely-developed motion control protocols and helped to identify regions of interest candidates. Potential clinical applications of diffusion tensor imaging in the evaluation of treatment outcomes in ASD are discussed.
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Affiliation(s)
- Javier Virues-Ortega
- School of Psychology, The University of Auckland, Auckland, New Zealand
- Facultad de Psychology, Universidad Autónoma de Madrid, Madrid, Spain
- * E-mail:
| | - Nicole S. McKay
- Department of Neurology, Washington University, St Louis, Missouri, United States of America
| | - Jessica C. McCormack
- National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Nerea Lopez
- Facultad de Psicología, Universidad Nacional de Educación a Distancia, Madrid, Spain
| | - Rosalie Liu
- School of Psychology, The University of Auckland, Auckland, New Zealand
| | - Ian Kirk
- School of Psychology, The University of Auckland, Auckland, New Zealand
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22
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Rosales R, Leon A, Serna RW, Maslin M, Arevalo A, Curtin C. A First Look at Applied Behavior Analysis Service Delivery to Latino American Families Raising a Child With Autism Spectrum Disorder. Behav Anal Pract 2021; 14:974-83. [PMID: 34868810 DOI: 10.1007/s40617-021-00572-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2021] [Indexed: 12/25/2022] Open
Abstract
Recent statistics indicate children of Latino background are diagnosed with autism spectrum disorder (ASD) at a much later age than their non-Latino White counterparts. Once a diagnosis is made, it is critically important that families get access to evidence-based interventions, including applied behavior analysis (ABA) services. However, disadvantaging factors such as a lack of awareness of available services, poor health care access and health literacy, and language barriers may impact these families' ability to access and maintain ABA services. The purpose of this pilot study was to obtain preliminary information on the experiences of accessing and maintaining ABA services for a sample of Latino American families living in Massachusetts. We conducted structured interviews with 28 families that had a child with ASD aged 8 years or younger. Questions in the interview were related to the background and diagnostic experiences of the child; difficulties in accessing ABA services; and for those children receiving ABA services, parents' perceptions of the services. Results of the interviews are summarized, and implications for future research and service delivery are discussed.
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Abstract
CASE SECTION Zoe is a 25-month-old girl who presented to developmental-behavioral pediatrics with her parents for follow-up after receiving a diagnosis of autism spectrum disorder with global developmental delay and language impairment 3 months ago. Zoe was born by spontaneous vaginal delivery at term after an uncomplicated pregnancy, labor, and delivery. She had a routine newborn course and was discharged home with her parents 2 days after her birth.At 7 months, Zoe was not able to sit independently, had poor weight gain, and had hypertonia on physical examination. Her parents described her to tense her arms and have hand tremors when she held her bottle during feedings and reported that she had resisted their attempts to introduce pureed or other age-appropriate table foods into her diet. The Bayley Scales of Infant and Toddler Development Screening Test was administered and found a cognitive composite score of 70, language composite score of 65, and motor composite score of 67. Chromosomal microarray analysis, testing for fragile X syndrome, laboratory studies for metabolic disorders, magnetic resonance imaging of the brain, and an audiologic examination were normal. Zoe was referred to and received early intervention services including physical therapy, feeding therapy, and infant stimulation services. By 16 months, Zoe was walking independently and was gaining weight well but continued to have sensory aversions to some foods.At 22 months, Zoe was evaluated by a multidisciplinary team because of ongoing developmental concerns and concerning results on standardized screening for autism spectrum disorder completed at her 18-month preventive care visit. Her parents also reported concern about the possibility of autism spectrum disorder (ASD) because they both were diagnosed with ASD as young children. Both parents completed college and were employed full-time. Zoe's mother seemed to be somewhat anxious during the visit and provided fleeting eye contact throughout the evaluation. Zoe's father was assertive, but polite, and was the primary historian regarding parental concerns during the evaluation.Zoe was noted to have occasional hand flapping and squealing vocalizations while she roamed the examination area grabbing various objects and casting them to the floor while watching the trajectory of their movements. She did not use a single-finger point to indicate her wants or needs and did not initiate or follow joint attention. She met criteria for ASD. In discussing the diagnosis with Zoe's parents, they shared that they were not surprised by the diagnosis. They expressed feeling that Zoe was social and playful, although delayed in her language. Hence, they were more concerned about her disinterest in eating. They were not keen on behavioral intervention because they did not want Zoe to be "trained to be neurotypical." Although the mother did not receive applied behavior analysis (ABA), the father had received ABA for 3 years beginning at age 5 years. He believed that ABA negatively changed his personality, and he did not want the same for Zoe.How would you assist Zoe's parents in identification of priorities for her developmental care while ensuring respect for their perspective of neurodiversity?
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Affiliation(s)
- Kek K Loo
- Department of Pediatrics, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA
| | | | - Jeffrey H Yang
- Department of Pediatrics, Kaiser Permanente Los Angeles Medical Center, Keck School of Medicine of USC, Pasadena, CA
| | - David B McAdam
- Division of Behavioral and Developmental Pediatrics, University of Rochester, Warner School of Education and Human Development, Rochester, NY
| | - Sarah S Nyp
- Developmental-Behavioral Pediatrician, Division of Developmental and Behavioral Health, Children's Mercy Kansas City, UMKC School of Medicine, Kansas City, MO
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25
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McFayden TC, Gatto AJ, Dahiya AV, Antezana L, Miyazaki Y, Cooper LD. Integrating Measurement-Based Care into Treatment for Autism Spectrum Disorder: Insights from a Community Clinic. J Autism Dev Disord 2021; 51:3651-3661. [PMID: 33387241 DOI: 10.1007/s10803-020-04824-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2020] [Indexed: 12/28/2022]
Abstract
Measurement-based care (MBC), an evidence-based approach that has demonstrated efficacy for improving treatment outcomes, has yet to be investigated in clients with Autism Spectrum Disorder. The current paper investigates the use of MBC in autistic (n = 20) and non-autistic (n = 20) clients matched on age, sex, and presenting problem. Results of change score analysis indicated that utilizing routine symptom monitoring can enhance treatment evaluation. Autistic clients participated in significantly more sessions, made significantly less progress, and were less compliant with MBC than non-autistic clients. Though hierarchical linear modeling demonstrated no significant differences in treatment slope, results indicated moderate effect size. These results inform the use of MBC in community clinics, highlighting policy implications and need for targeted measurement.
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Affiliation(s)
- Tyler C McFayden
- Department of Psychology, Virginia Tech, 460 Turner Street NW, Suite 207, Blacksburg, VA, 24060, USA.
| | - Alyssa J Gatto
- Department of Psychology, Virginia Tech, 460 Turner Street NW, Suite 207, Blacksburg, VA, 24060, USA
| | - Angela V Dahiya
- Department of Psychology, Virginia Tech, 460 Turner Street NW, Suite 207, Blacksburg, VA, 24060, USA
| | - Ligia Antezana
- Department of Psychology, Virginia Tech, 460 Turner Street NW, Suite 207, Blacksburg, VA, 24060, USA
| | - Yasuo Miyazaki
- Department of Education Research and Evaluation, Virginia Tech, Blacksburg, VA, USA
| | - Lee D Cooper
- Department of Psychology, Virginia Tech, 460 Turner Street NW, Suite 207, Blacksburg, VA, 24060, USA
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Aithal S, Karkou V, Makris S, Karaminis T, Powell J. A Dance Movement Psychotherapy Intervention for the Wellbeing of Children With an Autism Spectrum Disorder: A Pilot Intervention Study. Front Psychol 2021; 12:588418. [PMID: 34349692 PMCID: PMC8326518 DOI: 10.3389/fpsyg.2021.588418] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 06/09/2021] [Indexed: 12/13/2022] Open
Abstract
Background Sustaining the wellbeing for children with an autism spectrum disorder (ASD) can be highly demanding. Dance Movement Psychotherapy (DMP), a form of psychotherapy with a non-verbal character, may present as a relevant intervention option for this group of children. Methods A protocol-based group DMP intervention was developed and implemented in two special educational needs schools in the North West of England. We aimed to investigate the effects of DMP on children with ASD using the Social Communication Questionnaire (SCQ) and Strengths and Difficulties Questionnaire (SDQ). Twenty-six children aged between 8 and 13 years (mean age = 10.65 years) with ASD were randomly allocated to DMP and a control group with standard care, following a crossover research design. Results Results showed no significant carryover or period effects for either the SCQ or SDQ (p > 0.05). A significant intervention effect was found only for SCQ (p = 0.005) but not for SDQ (p > 0.05). ANCOVAs were performed on the data before the crossover to test for differences in SCQ and SDQ scores between the DMP intervention and control groups while controlling for pre-intervention scores. Those in the DMP intervention group presented significantly lower SCQ scores following the intervention period than those in the control group (p = 0.001). No significant differences in post-intervention SDQ scores were found between DMP intervention and control groups (p = 0.2). However, minimal clinically important differences (MCID) were reached for both SCQ and SDQ measures before crossover for those in the DMP intervention group. Moreover, repeated measures ANOVAs performed on SCQ and SDQ measures following crossover were significant, with the change in both SCQ (p = 0.001) and SDQ (p = 0.009) pre-and post-intervention being significantly greater for those in the DMP intervention than the control group. Conclusion The pilot DMP intervention has shown promising results on the social and emotional wellbeing of children with ASD irrespective of whether they preferred verbal or non-verbal mode of communication. Limitations and appropriateness of the research methods implemented in this study for their use in a large RCT are discussed in detail. Overall, our findings highlight the value of creative therapies for improving the lives of young vulnerable groups.
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Affiliation(s)
- Supritha Aithal
- Research Centre for Arts and Wellbeing, School of Applied Health and Social Care, Edge Hill University, Ormskirk, United Kingdom
| | - Vicky Karkou
- Research Centre for Arts and Wellbeing, School of Applied Health and Social Care, Edge Hill University, Ormskirk, United Kingdom
| | - Stergios Makris
- Research Centre for Arts and Wellbeing, Department of Psychology, Edge Hill University, Ormskirk, United Kingdom
| | - Themis Karaminis
- Research Centre for Arts and Wellbeing, Department of Psychology, Edge Hill University, Ormskirk, United Kingdom
| | - Joanne Powell
- Research Centre for Arts and Wellbeing, Department of Psychology, Edge Hill University, Ormskirk, United Kingdom
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27
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Levitskiy D, Confair A, Wagner KE, DeVita S, Shea N, McKernan EP, Kopec J, Russo N, Middleton FA, Hicks SD. Longitudinal stability of salivary microRNA biomarkers in children and adolescents with autism spectrum disorder. Res Autism Spectr Disord 2021; 85:101788. [PMID: 34025747 PMCID: PMC8139124 DOI: 10.1016/j.rasd.2021.101788] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
BACKGROUND Autism spectrum disorder (ASD) is a complex neurological condition with increasing prevalence. Few tools accurately predict the developmental trajectory of children with ASD. Such tools would allow clinicians to provide accurate prognoses and track the efficacy of therapeutic interventions. Salivary RNAs that reflect the genetic-environmental interactions underlying ASD may provide objective measures of symptom severity and developmental outcomes. This study investigated whether salivary RNAs previously identified in childhood ASD remain perturbed in older children. We also explored whether RNA candidates changed with therapeutic intervention. METHOD A case-control design was used to characterize levels of 78 saliva RNA candidates among 96 children (48 ASD, 48 non-ASD, mean age: 11 years). Thirty-one children (22 ASD, 9 non-ASD developmental delay, mean age: 4 years) were followed longitudinally to explore changes of RNA candidates during early intervention. Saliva RNA and standardized behavioral assessments were collected for each participant. Associations between candidate RNAs and behavioral scores were determined in both groups via Spearman Correlation. Changes in candidate RNAs across two time-points were assessed in the younger cohort via Wilcoxon rank-sum test. RESULTS Seven RNAs were associated with VABS-II and BASC scores in the older group ([R] >0.25, FDR< 0.15). Within the younger cohort, 12 RNAs displayed significant changes over time (FDR< 0.05). Three microRNAs were associated with behavioral scores and changed over time (miR-182-5p, miR-146b-5p, miR-374a-5p). CONCLUSION Several salivary RNAs are strongly associated with autistic behaviors in older individuals with ASD and change as early as three months after therapy initiation in younger children. These molecules could be used to track treatment effectiveness and provide prognoses. Further validation is necessary.
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Affiliation(s)
- David Levitskiy
- Quadrant Biosciences Inc., 505 Irving Ave, Suite 3100 AB, Syracuse, NY 13210
| | - Alexandra Confair
- Penn State College of Medicine, Department of Pediatrics, Hershey PA, 17033
| | - Kayla E. Wagner
- Quadrant Biosciences Inc., 505 Irving Ave, Suite 3100 AB, Syracuse, NY 13210
| | - Samantha DeVita
- Quadrant Biosciences Inc., 505 Irving Ave, Suite 3100 AB, Syracuse, NY 13210
| | - Nicole Shea
- Syracuse University, Department of Psychology, Syracuse NY13210
| | | | - Justin Kopec
- Syracuse University, Department of Psychology, Syracuse NY13210
| | - Natalie Russo
- Syracuse University, Department of Psychology, Syracuse NY13210
| | - Frank A. Middleton
- SUNY Upstate Medical University, Department of Neuroscience and Physiology, Syracuse, NY 13210
| | - Steven D. Hicks
- Penn State College of Medicine, Department of Pediatrics, Hershey PA, 17033
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28
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Gardner-Hoag J, Novack M, Parlett-Pelleriti C, Stevens E, Dixon D, Linstead E. Unsupervised Machine Learning for Identifying Challenging Behavior Profiles to Explore Cluster-Based Treatment Efficacy in Children With Autism Spectrum Disorder: Retrospective Data Analysis Study. JMIR Med Inform 2021; 9:e27793. [PMID: 34076577 PMCID: PMC8209527 DOI: 10.2196/27793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 04/23/2021] [Accepted: 04/29/2021] [Indexed: 11/13/2022] Open
Abstract
Background Challenging behaviors are prevalent among individuals with autism spectrum disorder; however, research exploring the impact of challenging behaviors on treatment response is lacking. Objective The purpose of this study was to identify types of autism spectrum disorder based on engagement in different challenging behaviors and evaluate differences in treatment response between groups. Methods Retrospective data on challenging behaviors and treatment progress for 854 children with autism spectrum disorder were analyzed. Participants were clustered based on 8 observed challenging behaviors using k means, and multiple linear regression was performed to test interactions between skill mastery and treatment hours, cluster assignment, and gender. Results Seven clusters were identified, which demonstrated a single dominant challenging behavior. For some clusters, significant differences in treatment response were found. Specifically, a cluster characterized by low levels of stereotypy was found to have significantly higher levels of skill mastery than clusters characterized by self-injurious behavior and aggression (P<.003). Conclusions These findings have implications on the treatment of individuals with autism spectrum disorder. Self-injurious behavior and aggression were prevalent among participants with the worst treatment response, thus interventions targeting these challenging behaviors may be worth prioritizing. Furthermore, the use of unsupervised machine learning models to identify types of autism spectrum disorder shows promise.
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Affiliation(s)
- Julie Gardner-Hoag
- Schmid College of Science and Technology, Chapman University, Orange, CA, United States
| | - Marlena Novack
- Center for Autism and Related Disorders, Woodland Hills, CA, United States
| | | | - Elizabeth Stevens
- Fowler School of Engineering, Chapman University, Orange, CA, United States
| | - Dennis Dixon
- Center for Autism and Related Disorders, Woodland Hills, CA, United States
| | - Erik Linstead
- Fowler School of Engineering, Chapman University, Orange, CA, United States
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29
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Rogers SJ, Yoder P, Estes A, Warren Z, McEachin J, Munson J, Rocha M, Greenson J, Wallace L, Gardner E, Dawson G, Sugar CA, Hellemann G, Whelan F. A Multisite Randomized Controlled Trial Comparing the Effects of Intervention Intensity and Intervention Style on Outcomes for Young Children With Autism. J Am Acad Child Adolesc Psychiatry 2021; 60:710-722. [PMID: 32853704 PMCID: PMC8057785 DOI: 10.1016/j.jaac.2020.06.013] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 04/30/2020] [Accepted: 08/17/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVE This randomized, multisite, intent-to-treat study tested the effects of 2 levels of treatment intensity (number of hours) and 2 treatment styles on the progress of young children with autism spectrum disorder (ASD). We predicted that initial severity of developmental delay or autism symptoms would moderate the effects of intensity and style on progress in 4 domains: autism symptom severity, expressive communication, receptive language, and nonverbal ability. METHOD A total of 87 children with ASD, mean age 23.4 months, were assigned to 1 of 2 intervention styles (naturalistic developmental/behavioral or discrete trial teaching), each delivered for either 15 or 25 hours per week of 1:1 intervention for 12 months by trained research staff. All caregivers received coaching twice monthly. Children were assessed at 4 timepoints. Examiners and coders were naive to treatment assignment. RESULTS Neither style nor intensity had main effects on the 4 outcome variables. In terms of moderating the effects of initial severity of developmental delay and of autism symptom severity, neither moderated the effects of treatment style on progress in any of the 4 domains. In terms of treatment intensity, initial severity moderated effect of treatment intensity on only 1 domain, namely, change in autism symptom severity; in a secondary analysis, this effect was found in only 1 site. CONCLUSION Neither treatment style nor intensity had overall effects on child outcomes in the 4 domains examined. Initial severity did not predict better response to 1 intervention style than to another. We found very limited evidence that initial severity predicted better response to 25 vs 15 hours per week of intervention in the domains studied. CLINICAL TRIAL REGISTRATION INFORMATION Intervention Effects of Intensity and Delivery Style for Toddlers With Autism: https://clinicaltrials.gov/; NCT02272192.
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Affiliation(s)
| | - Paul Yoder
- Vanderbilt University, Nashville, Tennessee
| | | | | | | | | | - Marie Rocha
- University of California, Davis MIND Institute, Davis
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30
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van Hoogdalem LE, Feijs HME, Bramer WM, Ismail SY, van Dongen JDM. The Effectiveness of Neurofeedback Therapy as an Alternative Treatment for Autism Spectrum Disorders in Children. J PSYCHOPHYSIOL 2021. [DOI: 10.1027/0269-8803/a000265] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Abstract. Findings for the effectiveness of neurofeedback in autism spectrum disorder are found to be inconsistent. Therefore, this review comprehensively and systematically reviewed literature on the effectiveness of neurofeedback for the treatment of autism spectrum disorders in children. A systematic search of Embase, Medline, Web of Science, PsycINFO, Cochrane, and Google Scholar was carried out in October 2017 to find relevant papers. We selected full journal articles that reported neurofeedback as a treatment for autism in children (0–17 years). The search yielded 587 articles and we included 20 references with a total of 443 participants. Ninety-four percent of nonrandomized controlled and experimental trials concerning neurofeedback for autism spectrum disorders found positive results. The evidence for effectiveness of neurofeedback therapy was even more robust when only randomized controlled studies were considered. Although there are only a few randomized controlled studies, results support effectiveness of neurofeedback for autism spectrum disorder, including long-term positive effects. In the future, optimal treatment protocols have to be developed to guide clinicians in their neurofeedback treatment. In conclusion, neurofeedback seems to be an alternative treatment for autism spectrum disorders, with space for improvement.
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Affiliation(s)
- Lothar E. van Hoogdalem
- Department of Psychiatry, Section Medical Psychology and Psychotherapy, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | | | - Wichor M. Bramer
- Medical Library, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - Sohal Y. Ismail
- Department of Psychiatry, Section Medical Psychology and Psychotherapy, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - Josanne D. M. van Dongen
- Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, The Netherlands
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31
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Robain F, Franchini M, Kojovic N, Wood de Wilde H, Schaer M. Predictors of Treatment Outcome in Preschoolers with Autism Spectrum Disorder: An Observational Study in the Greater Geneva Area, Switzerland. J Autism Dev Disord 2021; 50:3815-3830. [PMID: 32166526 DOI: 10.1007/s10803-020-04430-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This study aims to identify predictors of treatment outcome in young children with ASD within a European context, where service provision of intervention remains sporadic. We investigated whether a child's age at baseline, intensity of the intervention provided, type of intervention, child's level of social orienting and cognitive skills at baseline predicted changes in autistic symptoms and cognitive development after 1 year of intervention, in a sample of 60 children with ASD. Our results strongly support early and intensive intervention. We also observed that lower cognitive skills at baseline were related to greater cognitive gains. Finally, we show that a child's interest in social stimuli may contribute to intervention outcome.
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Affiliation(s)
- François Robain
- Office Médico-Pédagogique, Department of Psychiatry, University of Geneva School of Medicine, Geneva, Switzerland.
| | - Martina Franchini
- Office Médico-Pédagogique, Department of Psychiatry, University of Geneva School of Medicine, Geneva, Switzerland.,Department of Pediatrics, IWK Hospital, Autism Research Centre, Halifax, Canada
| | - Nada Kojovic
- Office Médico-Pédagogique, Department of Psychiatry, University of Geneva School of Medicine, Geneva, Switzerland
| | - Hilary Wood de Wilde
- Office Médico-Pédagogique, Department of Psychiatry, University of Geneva School of Medicine, Geneva, Switzerland
| | - Marie Schaer
- Office Médico-Pédagogique, Department of Psychiatry, University of Geneva School of Medicine, Geneva, Switzerland
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32
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Klinger LG, Cook ML, Dudley KM. Predictors and Moderators of Treatment Efficacy in Children and Adolescents with Autism Spectrum Disorder. Journal of Clinical Child & Adolescent Psychology 2020; 50:517-524. [DOI: 10.1080/15374416.2020.1833735] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Laura Grofer Klinger
- Department of Psychiatry, TEACCH Autism Program, University of North Carolina at Chapel Hill
| | - Michal L. Cook
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill
| | - Katerina M. Dudley
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill
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33
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Constantino JN, Abbacchi AM, Saulnier C, Klaiman C, Mandell DS, Zhang Y, Hawks Z, Bates J, Klin A, Shattuck P, Molholm S, Fitzgerald R, Roux A, Lowe JK, Geschwind DH. Timing of the Diagnosis of Autism in African American Children. Pediatrics 2020; 146:peds.2019-3629. [PMID: 32839243 PMCID: PMC7461218 DOI: 10.1542/peds.2019-3629] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/29/2020] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES African American (AA) children affected by autism spectrum disorder (ASD) experience delays in diagnosis and obstacles to service access, as well as a disproportionate burden of intellectual disability (ID) as documented in surveillance data recently published by the US Centers for Disease Control and Prevention. Our objective in this study was to analyze data from the largest-available repository of diagnostic and phenotypic information on AA children with ASD, and to explore the wide variation in outcome within the cohort as a function of sociodemographic risk and specific obstacles to service access for the purpose of informing a national approach to resolution of these disparities. METHODS Parents of 584 AA children with autism consecutively enrolled in the Autism Genetic Resource Exchange across 4 US data collection sites completed event history calendar interviews of the diagnostic odysseys for their children with ASD. These data were examined in relation to developmental outcomes of the children with autism and their unaffected siblings. RESULTS The average age of ASD diagnosis was 64.9 months (±49.6), on average 42.3 months (±45.1) after parents' first concerns about their children's development. The relationship between timing of diagnosis and ASD severity was complex, and ID comorbidity was not predicted in a straightforward manner by familial factors associated with cognitive variation in the general population. CONCLUSIONS These findings document significant opportunity to expedite diagnosis, the need to further understand causes of ID comorbidity, and the necessity to identify effective approaches to the resolution of disparities in severity-of-outcome for AA children with autism.
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Affiliation(s)
- John N. Constantino
- Department of Psychiatry, School of Medicine,
Washington University, St Louis, Missouri;,Contributed equally as co-first authors
| | - Anna M. Abbacchi
- Department of Psychiatry, School of Medicine,
Washington University, St Louis, Missouri;,Contributed equally as co-first authors
| | - Celine Saulnier
- Marcus Autism Center, School of Medicine, Emory
University, Atlanta, Georgia;,Neurodevelopmental Assessment and Consulting
Services, Atlanta, Georgia
| | - Cheryl Klaiman
- Marcus Autism Center, School of Medicine, Emory
University, Atlanta, Georgia
| | - David S. Mandell
- Department of Psychiatry, Perelman School of
Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Yi Zhang
- Department of Psychiatry, School of Medicine,
Washington University, St Louis, Missouri
| | - Zoe Hawks
- Department of Psychiatry, School of Medicine,
Washington University, St Louis, Missouri
| | - Julianna Bates
- Departments of Pediatrics, Neuroscience, and
Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx,
New York
| | - Ami Klin
- Marcus Autism Center, School of Medicine, Emory
University, Atlanta, Georgia
| | - Paul Shattuck
- Drexel Autism Institute, Drexel University,
Philadelphia, Pennsylvania; and
| | - Sophie Molholm
- Departments of Pediatrics, Neuroscience, and
Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx,
New York
| | - Robert Fitzgerald
- Department of Psychiatry, School of Medicine,
Washington University, St Louis, Missouri
| | - Anne Roux
- Drexel Autism Institute, Drexel University,
Philadelphia, Pennsylvania; and
| | - Jennifer K. Lowe
- Departments of Neurology, Psychiatry, and Human
Genetics, David Geffen School of Medicine, University of California, Los
Angeles, California
| | - Daniel H. Geschwind
- Departments of Neurology, Psychiatry, and Human
Genetics, David Geffen School of Medicine, University of California, Los
Angeles, California
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34
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Allen C, Fehr KK, Nyp SS. Maintaining Safety and Planning for the Future. J Dev Behav Pediatr 2020; 40:651-653. [PMID: 31626073 DOI: 10.1097/dbp.0000000000000729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CASE Kevin is a 12-year-old boy with autism spectrum disorder, intellectual disability (nonverbal IQ scores in mid-40s), and attention-deficit/hyperactivity disorder who has been followed up by a developmental-behavioral pediatrician (DBP) and a child psychologist for medication and behavioral management since he was 4 years old. Kevin was placed in the care of his great-great-aunt shortly after he turned 2 years of age because of concerns of neglect. She is now his legal guardian.Kevin is predominately nonverbal but does use a few single words to make requests or label items. He attends a public school and receives full-time special education support. He has a personal care assistant (PCA) who provides in-home support 5 to 6 days/wk for 3 to 4 hours at a time. The PCA is working on toilet training, using a "clock-training" approach, and also takes Kevin outdoors to play or on short outings during her visits. In his free time, Kevin prefers to watch cooking shows on television.Over the past year, Kevin's behaviors have become more concerning. There have been several episodes of Kevin waking up during the early morning hours and going to the kitchen to "cook." After one of these episodes, his guardian was not aware that Kevin had woken up until the next morning when she found a concoction of corn starch, coffee grounds, cottage cheese, and powdered drink mix in the blender. Kevin had also woken up during the night and ventured out of the house into the back yard. His guardian had woken up immediately as the alarm system sounded when he opened the outer door from the house to the yard.A door alarm was added to Kevin's bedroom door so that his guardian would be alerted when he leaves his bedroom; however, the alarm is not used consistently because there are times when the alarm cannot be found at bedtime. Kevin's guardian was able to obtain a GPS device for him to wear on his shoe from the local police department. He wears this without resistance every day.Kevin's guardian is in her mid-70s, and she has had several health issues over the past 2 to 3 years. There are no other family members who are willing or able to care for Kevin if his guardian were no longer able to. The DBP and child psychologist have encouraged Kevin's guardian to explore long-term residential care options with the state agency that provides support for individuals with intellectual disabilities and with Kevin's insurance provider, but the guardian is very reluctant to do this. She fears that Kevin will be removed from her care or placed in a "home" where someone will "do bad things to him."What else would you recommend or actions would you take to support Kevin's guardian in ensuring Kevin's safety and planning for his future care?
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35
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Ocanto R, Levi-Minzi MA, Chung J, Sheehan T, Padilla O, Brimlow D. The development and implementation of a training program for pediatric dentistry residents working with patients diagnosed with ASD in a special needs dental clinic. J Dent Educ 2020; 84:397-408. [PMID: 32053257 DOI: 10.1002/jdd.12049] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 11/11/2019] [Accepted: 12/17/2019] [Indexed: 11/08/2022]
Abstract
Oral health care is the most prevalent unmet health care need among all U.S. children age 17 and under in the U.S., and this includes those with special health care needs (SHCN). Children with SHCN experience unique barriers to receiving oral care including challenging behaviors, inadequate insurance coverage, and a lack of trained dentists. Despite the need for specialized training to successfully provide dental care to children with SHCN, few dental programs offer the necessary educational preparation. The Nova Southeastern University College of Dentistry was funded by the Health Resources and Services Administration to prepare pediatric and Advanced Education in General Dentistry (AEGD) dental residents in the care of children, adolescents, and adults with SHCN. The purpose of this paper is to describe the didactic and clinical training program and to provide data on the program's impact.
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Affiliation(s)
- Romer Ocanto
- Department of Pediatric Dentistry, College of Dental Medicine, Nova Southeastern University, Fort Lauderdale, Florida, USA
| | - Maria A Levi-Minzi
- Center for Applied Research on Substance Use and Health Disparities, Nova Southeastern University, Fort Lauderdale, Florida, USA
| | - Jennifer Chung
- Pediatric Dental Clinic, Mailman Segal Center for Human Development, Nova Southeastern University, Davie, Florida, USA
| | - Tara Sheehan
- Unicorn Children's Foundation Clinic, Mailman Segal Center for Human Development, Davie, Florida, USA
| | - Oscar Padilla
- Department of Pediatric Dentistry, College of Dental Medicine, Nova Southeastern University, Fort Lauderdale, Florida, USA
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36
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Yazdani S, Capuano A, Ghaziuddin M, Colombi C. Exclusion Criteria Used in Early Behavioral Intervention Studies for Young Children with Autism Spectrum Disorder. Brain Sci 2020; 10:E99. [PMID: 32069875 PMCID: PMC7071598 DOI: 10.3390/brainsci10020099] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 02/10/2020] [Accepted: 02/11/2020] [Indexed: 12/24/2022] Open
Abstract
This literature review evaluated early behavioral intervention studies of Autism Spectrum disorder (ASD) based on their participant exclusion criteria. The studies included were found through searching PsycINFO and PubMed databases, and discussed behavioral interventions for children up to 5 years of age with ASD and utilized a group research design. Studies reviewed were categorized into three groups: Restrictive exclusion criteria, loosely defined exclusion criteria, and exclusion criteria not defined. Results indicated that studies that used restrictive exclusion criteria demonstrated greater differences in terms of outcomes between experimental and control groups in comparison to studies that used loosely defined exclusion criteria and/or did not define any exclusion criteria. We discussed implications for the generalizability of the studies' outcomes in relationship to exclusion criteria.
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Affiliation(s)
- Sahr Yazdani
- Stritch School of Medicine, Loyola University, Maywood, IL 60153, USA;
| | - Angela Capuano
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, USA; (A.C.); (M.G.)
| | - Mohammad Ghaziuddin
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, USA; (A.C.); (M.G.)
| | - Costanza Colombi
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, USA; (A.C.); (M.G.)
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37
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Abstract
Autism spectrum disorder (ASD) is characterized by impairment in behavior, communication, and social interaction. Thus, accurate identification, regular behavioral and other nonmedical interventions would improve the diagnosis, management, and treatment of this condition.In this chapter, we investigate the importance of diagnosing and identifying comorbid psychiatric disorders that occur with ASD as these conditions can often complicate treatment, and failure to recognize them can result in deficits that can persist into adolescence and adulthood. In addition, we explore the impact of comprehensive psychological intervention in ASD patients with comorbid psychiatric disorders with the ultimate goal of improving overall quality of life.
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Affiliation(s)
- Eman Shaltout
- Medical Research Center, Hamad Medical Corporation (HMC), Doha, Qatar.,Department of Psychology, Kingston University London, Kingston upon Thames, UK
| | - Nader Al-Dewik
- Clinical and Metabolic Genetics, Pediatrics Department, Hamad General Hospital (HGH), Hamad Medical Corporation (HMC), Doha, Qatar.,College of Health and Life Sciences, Hamad Bin Khalifa University (HBKU), Doha, Qatar
| | - Muthanna Samara
- Department of Psychology, Kingston University London, Kingston upon Thames, UK.
| | - Hisham Morsi
- Department of Psychology, Kingston University London, Kingston upon Thames, UK.,Quality of Life Unit, National Center for Cancer Care and Research, (NCCCR), Hamad Medical Corporation (HMC), Doha, Qatar
| | - Azhar Khattab
- Qatar Rehabilitation Institute, Pediatric Rehabilitation, Hamad Medical Corporation (HMC), Doha, Qatar
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38
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Manohar H, Kandasamy P, Chandrasekaran V, Rajkumar RP. Brief Parent-Mediated Intervention for Children with Autism Spectrum Disorder: A Feasibility Study from South India. J Autism Dev Disord 2019; 49:3146-3158. [PMID: 31053990 DOI: 10.1007/s10803-019-04032-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The study assesses the acceptability and feasibility of a brief parent-mediated home-based intervention for children with autism spectrum disorder (ASD), deliverable in resource-limited settings, with an emphasis on addressing parental stress from a socio-cultural perspective. 50 children (2-6 years), with a DSM 5 diagnosis of ASD were randomized to intervention (n = 26) or active control group (n = 24). The intervention based on naturalistic developmental behavioral approach, focusing on joint attention, imitation, social and adaptive skills was structured to be delivered in five outpatient sessions over 12 weeks. All children were followed up at 4, 8 and 12 weeks. Parents of children randomized to the intervention group reported more improvements across parental stress and child outcome measures compared to those in the control group. The intervention was found to be acceptable and feasible, with high fidelity measures and retention rates.
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Affiliation(s)
- Harshini Manohar
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605 006, India
| | - Preeti Kandasamy
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605 006, India.
| | - Venkatesh Chandrasekaran
- Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605 006, India
| | - Ravi Philip Rajkumar
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605 006, India
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39
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Magaña S, Lopez K, Salkas K, Iland E, Morales MA, Garcia Torres M, Zeng W, Machalicek W. A Randomized Waitlist-Control Group Study of a Culturally Tailored Parent Education Intervention for Latino Parents of Children with ASD. J Autism Dev Disord 2019; 50:250-262. [PMID: 31606887 DOI: 10.1007/s10803-019-04252-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
This two-site randomized waitlist-control study (n = 96 mother-child dyads) examined the efficacy of a psychoeducation program as compared to usual care to empower Latina mothers and improve their confidence in and use of evidence-based practices (EBPs) for their children with ASD. A secondary aim was to improve child outcomes. Compared to control group, we found significant positive changes in the treatment group in maternal confidence of and frequency in use of EBPs, child social communication and the number of EB services the child received. We found no significant differences for the treatment group in family empowerment or in child challenging behaviors. This RCT presents evidence of an efficacious intervention for Latino children with ASD and their mothers in California and Illinois.
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Affiliation(s)
- Sandy Magaña
- Steve Hicks School of Social Work, University of Texas at Austin, 1925 San Jacinto Blvd., Austin, TX, 78712, USA.
| | - Kristina Lopez
- School of Social Work, Arizona State University, Pheonix, AZ, USA
| | - Kristen Salkas
- Department of Disability and Human Development, University of Illinois at Chicago, Chicago, IL, USA
| | - Emily Iland
- Department of Education, California State University, Northridge, Northridge, CA, USA
| | - Miguel Angel Morales
- Department of Disability and Human Development, University of Illinois at Chicago, Chicago, IL, USA
| | - Mariana Garcia Torres
- Department of Disability and Human Development, University of Illinois at Chicago, Chicago, IL, USA
| | - Weiwen Zeng
- Steve Hicks School of Social Work, University of Texas at Austin, 1925 San Jacinto Blvd., Austin, TX, 78712, USA
| | - Wendy Machalicek
- Department of Special Education and Clinical Sciences, University of Oregon, Eugene, OR, USA
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40
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Cariveau T, Shillingsburg MA, Alamoudi A, Thompson T, Bartlett B, Gillespie S, Scahill L. Brief Report: Feasibility and Preliminary Efficacy of a Behavioral Intervention for Minimally Verbal Girls with Autism Spectrum Disorder. J Autism Dev Disord 2019; 49:2203-2209. [DOI: 10.1007/s10803-018-03872-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
A SCERTS model-based intervention with different durations (5-month vs. 10-month) was provided to 122 children with autism spectrum disorder (ASD) (age = 53.43 ± 9.05 months) in Hong Kong. Before and after the intervention, the children were assessed with the Chinese Psychoeducational Profile-Third Edition (CPEP-3) and the Developmental Assessment Chart (DAC). Educators and parents expressed their views toward the intervention in focus groups. Results showed that participating children improved significantly in their social communication and emotional behavior after the intervention, as measured by DAC and CPEP-3. Likewise, educators and parents had positive views toward the intervention and noted the children's improvement. The results suggest that a SCERTS model-based intervention can improve social communication, emotional regulation, and other skills in children with ASD.
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Affiliation(s)
- Lu Yu
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hunghom, Hong Kong, People's Republic of China.
| | - Xiaoqin Zhu
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hunghom, Hong Kong, People's Republic of China
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43
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Leaf JB, Ross RK, Cihon JH, Weiss MJ. Evaluating Kupferstein’s claims of the relationship of behavioral intervention to PTSS for individuals with autism. AIA 2018; 4:122-9. [DOI: 10.1108/aia-02-2018-0007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Kupferstein (2018) surveyed 460 respondents and found that 46 percent of respondents met the diagnostic threshold for posttraumatic stress disorder after exposure to applied-behavior-analysis-based intervention. The purpose of this paper is to provide an evaluation a critical analysis of Kupferstein (2018) including the experimental methods and discussion of the results.
Design/methodology/approach
The authors evaluated the Kupferstein’s methodological rigor with respect to the use of hypothesis testing, use of indirect measures, selection of respondents, ambiguity in definitions, measurement system, and framing of the experimental question when conducting the correlational analysis in addition to Kupferstein’s analysis and discussion of the results.
Findings
Based upon the analysis, Kupferstein’s results should be viewed with extreme caution due to several methodological and conceptual flaws including, but not limited to, leading questions used within a non-validated survey, failure to confirm diagnosis, and incomplete description of interventions.
Originality/value
It is the authors’ hope that this analysis provides caregivers, clinicians, and service providers with a scientific lens which will useful in viewing the limitations and methodological flaws of Kupferstein.
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Pujol CN, Pellissier LP, Clément C, Becker JAJ, Le Merrer J. Back-translating behavioral intervention for autism spectrum disorders to mice with blunted reward restores social abilities. Transl Psychiatry 2018; 8:197. [PMID: 30242222 PMCID: PMC6155047 DOI: 10.1038/s41398-018-0247-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 07/31/2018] [Accepted: 08/05/2018] [Indexed: 12/12/2022] Open
Abstract
The mu opioid receptor (MOR) plays a critical role in modulating social behavior in humans and animals. Accordingly, MOR null mice display severe alterations in their social repertoire as well as multiple other behavioral deficits, recapitulating core and secondary symptoms of autism spectrum disorder (ASD). Such behavioral profile suggests that MOR dysfunction, and beyond this, altered reward processes may contribute to ASD etiopathology. Interestingly, the only treatments that proved efficacy in relieving core symptoms of ASD, early behavioral intervention programs, rely principally on positive reinforcement to ameliorate behavior. The neurobiological underpinnings of their beneficial effects, however, remain poorly understood. Here we back-translated applied behavior analysis (ABA)-based behavioral interventions to mice lacking the MOR (Oprm1-/-), as a model of autism with blunted reward processing. By associating a positive reinforcement, palatable food reward, to daily encounter with a wild-type congener, we were able to rescue durably social interaction and preference in Oprm1-/- mice. Along with behavioral improvements, the expression of marker genes of neuronal activity and plasticity as well as genes of the oxytocin/vasopressin system were remarkably normalized in the reward/social circuitry. Our study provides further evidence for a critical involvement of reward processes in driving social behavior and opens new perspectives regarding therapeutic intervention in ASD.
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Affiliation(s)
- Camille N. Pujol
- 0000 0001 2157 9291grid.11843.3fMédecine Translationelle et Neurogénétique, Institut de Génétique et de Biologie Moléculaire et Cellulaire, Inserm U-964, CNRS UMR-7104, Université de Strasbourg, Illkirch, France ,0000 0004 0383 2080grid.461890.2Present Address: Département de Neurosciences, Institut de Génomique fonctionnelle, Inserm U-661, CNRS UMR 5203, 34094 Montpellier, France
| | - Lucie P. Pellissier
- 0000 0001 2182 6141grid.12366.30Physiologie de la Reproduction et des Comportements, INRA UMR-0085, CNRS UMR-7247, IFCE, Université de Tours, Inserm, Nouzilly, France ,0000 0004 0383 2080grid.461890.2Present Address: Département de Neurosciences, Institut de Génomique fonctionnelle, Inserm U-661, CNRS UMR 5203, 34094 Montpellier, France
| | - Céline Clément
- 0000 0001 2157 9291grid.11843.3fLaboratoire Interuniversitaire en Sciences de l’Education et de la Communication, EA 2310, Université de Strasbourg, Strasbourg, France
| | - Jérôme A. J. Becker
- 0000 0001 2157 9291grid.11843.3fMédecine Translationelle et Neurogénétique, Institut de Génétique et de Biologie Moléculaire et Cellulaire, Inserm U-964, CNRS UMR-7104, Université de Strasbourg, Illkirch, France ,0000 0001 2182 6141grid.12366.30Physiologie de la Reproduction et des Comportements, INRA UMR-0085, CNRS UMR-7247, IFCE, Université de Tours, Inserm, Nouzilly, France ,0000 0004 0383 2080grid.461890.2Present Address: Département de Neurosciences, Institut de Génomique fonctionnelle, Inserm U-661, CNRS UMR 5203, 34094 Montpellier, France
| | - Julie Le Merrer
- Médecine Translationelle et Neurogénétique, Institut de Génétique et de Biologie Moléculaire et Cellulaire, Inserm U-964, CNRS UMR-7104, Université de Strasbourg, Illkirch, France. .,Physiologie de la Reproduction et des Comportements, INRA UMR-0085, CNRS UMR-7247, IFCE, Université de Tours, Inserm, Nouzilly, France.
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