Autism spectrum disorders: an overview on diagnosis and treatment

Pyroptosis; igniting neuropsychiatric disorders from mild depression to aging-related neurodegeneration

Neuropsychiatric disorders significantly impact global health and socioeconomic well-being, highlighting the urgent need for effective treatments. Chronic inflammation, often driven by the innate immune system, is a key feature of many neuropsychiatric conditions. NOD-like receptors (NLRs), which are intracellular sensors, detect danger signals and trigger inflammation. Among these, NLR protein (NLRP) inflammasomes play a crucial role by releasing pro-inflammatory cytokines and inducing a particular cell death process known as pyroptosis. Pyroptosis is defined as a proinflammatory form of programmed cell death executed by cysteine-aspartic proteases, also known as caspases. Currently, the role of pyroptotic flux has emerged as a critical factor in innate immunity and the pathogenesis of multiple diseases. Emerging evidence suggests that the induction of pyroptosis, primarily due to NLRP inflammasome activation, is involved in the pathophysiology of various neuropsychiatric disorders, including depression, stress-related issues, schizophrenia, autism spectrum disorders, and neurodegenerative diseases. Within this framework, the current review explores the complex relationship between pyroptosis and neuropsychiatric diseases, aiming to identify potential therapeutic targets for these challenging conditions.

Molecular Pathways, Neural Circuits and Emerging Therapies for Self-Injurious Behaviour

Nonsuicidal self-injurious behaviour (SIB) is a debilitating manifestation of physical aggression commonly observed across neurodevelopmental, psychiatric, and genetic disorders. This behaviour arises from a multifactorial aetiology involving genetic predispositions, epigenetic modifications, neurotransmitter dysregulation, and environmental stressors. Dysregulation in dopaminergic, serotonergic, glutamatergic, and GABAergic systems has been implicated in the pathophysiology of SIB, alongside structural and functional abnormalities within fronto-limbic-striatal circuits. These disruptions impair key processes, such as emotional regulation, reward processing, and behavioural inhibition, contributing to the emergence and reinforcement of SIB. Advances in preclinical research using genetic, lesion-based, pharmacological, and environmental animal models have been instrumental in elucidating the molecular and neurocircuitry underpinnings of SIB. Emerging neuromodulation therapies targeting critical nodes within the fronto-limbic-striatal network, particularly deep brain stimulation, have shown promise in treating severe, refractory SIB and improving quality of life. This review integrates current evidence from clinical studies, molecular research, and preclinical models to provide a comprehensive overview of the pathophysiology of SIB and therapeutic approaches. By focusing on the molecular mechanisms and neural circuits underlying SIB, we highlight the translational potential of emerging pharmacological and neuromodulatory therapies. A deeper understanding of these pathways will pave the way for precision-based interventions, bridging the gap between molecular research and clinical applications in SIB and related conditions.

Cerebellar Neuromodulation in Autism Spectrum Disorders and Social Cognition: Insights from Animal and Human Studies

Autism Spectrum Disorder (ASD) is a complex neurodevelopmental condition characterized by social atypicalities and repetitive behaviors. Growing evidence suggests that alterations in brain networks may contribute to ASD symptoms. The cerebellum, with its widespread connections to the cortex, has emerged as a potential key player in ASD. Non-invasive neuromodulation techniques, such as transcranial direct current stimulation (tDCS) or repetitive transcranial magnetic stimulation (rTMS) offer a promising avenue for modulating brain activity and potentially alleviating ASD symptoms. In addition, preclinical studies in rodents further emphasize the therapeutic effect of cerebellar stimulation to target autism-related symptoms. This article reviews both clinical and preclinical studies aiming to modulate cerebellar circuits to improve symptoms of ASD. We found ten relevant studies assessing the effect of cerebellar neuromodulation in human and preclinical models. Posterior cerebellar tDCS represented the most frequent neuromodulation method and suggested that cerebellar tDCS can lead to improvements in symptoms of ASD and restore cerebellar connectivity in individuals with ASD. In neurotypical participants, there is evidence that cerebellar tDCS can enhance social cognitive abilities. These results are in line with preclinical studies, suggesting that chemogenetic stimulation can modulate cerebellar circuits involved in ASD and improve related behaviors. Further research is needed to establish standardized protocols, assess long-term effects, and investigate the underlying mechanisms of cerebellar stimulation. We examine research questions that need to be addressed before launching large scale randomized clinical trials.

Neuropsychological profile of children with Autism Spectrum Disorder and children with Developmental Language Disorder and its relationship with social communication

OBJECTIVE

The objective of this study was to probe neuropsychological mechanisms of social communication in children with Autism Spectrum Disorders (ASD) and children with Developmental Language Disorders (DLD). Due to overlap of symptoms that include social dysfunction, diagnostic boundaries between these two developmental disorders remain unclear. This study hypothesizes that these two groups of children differ in the characteristics and in the underlying mechanisms of their social issues.

METHOD

This study examines a wide range of neuropsychological domains in search of a relationship with social communication. A total of 75 children with ASD and 26 children with DLD are included. A cross-battery assessment of neuropsychological functions is conducted, and social communication is evaluated using the Social Responsiveness Scale (SRS).

RESULTS

The neuropsychological profile for the ASD group differs from the DLD group, with the former demonstrating higher scores on Visual Processing and Comprehension, whereas the DLD group scores higher on Fluid Reasoning, Visual Processing and Processing Speed. Correlation analysis reveals that the association between neuropsychological domains and social communication differs between the groups.

DISCUSSION

Children with ASD and DLD clearly have distinctive neuropsychological profiles-their strengths and weaknesses are not equivalent. Such results motivate broad assessment of neuropsychological functions, as this assists in differentiating ASD from DLD for theragnostic purposes.

Enhancing ensemble classifiers utilizing gaze tracking data for autism spectrum disorder diagnosis

PROBLEM

Diagnosing Autism Spectrum Disorder (ASD) remains a significant challenge, especially in regions where access to specialists is limited. Computer-based approaches offer a promising solution to make diagnosis more accessible. Eye tracking has emerged as a valuable technique in aiding the diagnosis of ASD. Typically, individuals' gaze patterns are monitored while they view videos designed according to established paradigms. In a previous study, we developed a method to classify individuals as having ASD or Typical Development (TD) by processing eye-tracking data using Random Forest ensembles, with a focus on a paradigm known as joint attention.

AIM

This article aims to enhance our previous work by evaluating alternative algorithms and ensemble strategies, with a particular emphasis on the role of anticipation features in diagnosis.

METHODS

Utilizing stimuli based on joint attention and the concept of "floating regions of interest" from our earlier research, we identified features that indicate gaze anticipation or delay. We then tested seven class balancing strategies, applied seven dimensionality reduction algorithms, and combined them with five different classifier induction algorithms. Finally, we employed the stacking technique to construct an ensemble model.

RESULTS

Our findings showed a significant improvement, achieving an F1-score of 95.5%, compared to the 82% F1-score from our previous work, through the use of a heterogeneous stacking meta-classifier composed of diverse induction algorithms.

CONCLUSION

While there remains an opportunity to explore new algorithms and features, the approach proposed in this article has the potential to be applied in clinical practice, contributing to increased accessibility to ASD diagnosis.

Creation and Validation of an Educational Booklet on Autism Spectrum Disorder

OBJECTIVES

To develop and validate an educational booklet that contributes to alleviating the difficulties experienced by family members of children diagnosed as being on the Autism Spectrum.

METHODS

A descriptive exploratory study with a quali-quantitative approach. Ten families of children on the autism spectrum and twelve judges participated in the validation. Data collection took place through open interviews and data was analysed according to the procedures recommended by Bardin.

RESULTS

Difficulties identified included problems in children's verbal and non-verbal communication, daily care, school inclusion, late diagnosis due to the lack of specialists, and lack of psychological support for the family and for handling the child during an episode of crisis. Informational needs included early diagnosis, evolution and management of crises, children's ability to learn daily life activities, and information about their right to inclusion in formal education. Based on these difficulties and needs, the booklet was created and validated by eight experts and four family members. Comparing the average of positive reviews in each section, which were obtained in the first and second evaluations, there was a general improvement in the quality of the booklet.

CONCLUSIONS

The validation of educational materials on this topic can be essential to improve the quality of life of children, families, and educators.

Gasdermin D Mediated Mitochondrial Metabolism Orchestrate Neurogenesis Through LDHA During Embryonic Development

Regulatory cell death is an important way to eliminate the DNA damage that accompanies the rapid proliferation of neural stem cells during cortical development, including pyroptosis, apoptosis, and so on. Here, the study reports that the absence of GSDMD-mediated pyroptosis results in defective DNA damage sensor pathways accompanied by aberrant neurogenesis and autism-like behaviors in adult mice. Furthermore, GSDMD is involved in organizing the mitochondrial electron transport chain by regulating the AMPK/PGC-1α pathway to target Aifm3. This process promotes a switch from oxidative phosphorylation to glycolysis. The perturbation of metabolic homeostasis in neural progenitor cells increases lactate production which acts as a signaling molecule to regulate the p38MAPK pathway. And activates NF-𝜿B transcription to disrupt cortex development. This abnormal proliferation of neural progenitor cells can be rescued by inhibiting glycolysis and lactate production. Taken together, the study proposes a metabolic axis regulated by GSDMD that links pyroptosis with metabolic reprogramming. It provides a flexible perspective for the treatment of neurological disorders caused by genotoxic stress and neurodevelopmental disorders such as autism.

An Improved AlexNet Model and Cepstral Coefficient-Based Classification of Autism Using EEG

Autism is a neurodevelopmental disorder that cannot be completely cured, but early intervention during childhood can improve outcomes. Identifying autism spectrum disorder (ASD) has relied on subjective detection methods that involve questionnaires, medical professionals, and therapists and are subject to observer variability. The need for early diagnosis and the limitations of subjective detection methods has led researchers to explore machine learning-based approaches, such as Random Forests, K-Nearest Neighbors, Naive Bayes, and Support Vector Machines, to predict ASD meltdowns. In recent years, deep learning techniques have gained traction for early ASD detection. This study evaluates the performance of various deep learning networks, including AlexNet, VGG16, and ResNet50, using 5 cepstral coefficient features for ASD detection. The main contributions of this study are the utilization of Cepstral Coefficients in the processing stage to construct spectrograms and the modification of the AlexNet architecture for precise classification. Experimental observations indicate that the AlexNet with Linear Frequency Cepstral Coefficients (LFCC) yields the highest accuracy of 85.1%, while a customized AlexNet with LFCC achieves 90% accuracy.

Exploring Early Childhood Autism Spectrum Disorders: A Comprehensive Review of Diagnostic Approaches in Young Children

Autism spectrum disorders (ASD) encompass a diverse range of developmental disabilities characterized by pervasive deficiencies in socialization, communication, and the manifestation of behavioral issues. This review aims to clarify the diagnostic criteria for ASD, explore available diagnostic tools, evaluate biomedical examinations facilitating ASD diagnosis, and discuss the approach to screening assessments for ASD. ASDs are prevalent conditions, with a globally estimated prevalence of 7.6 cases per 100 (one in 132), based on a comprehensive review of epidemiological studies. The precise cause of autism and other ASDs remains unknown; however, genetic and environmental factors likely contribute. Common signs and symptoms shared among individuals with autism include restricted repetitive behaviors and learning disabilities. Standardized methods, such as the Diagnostic and Statistical Manual, Fifth Edition (DSM-5), diagnostic instruments, a thorough medical history, multiple physical examinations, laboratory investigations, neuroimaging, and screening tests, play a pivotal role in early autism diagnosis and intervention. ASD is a lifelong neurodevelopmental condition characterized by multiple deficits. Early detection is anticipated to have a positive impact on outcomes.

Region-Wise Brain Response Classification of ASD Children Using EEG and BiLSTM RNN

AbstractAutism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by impairment in sensory modulation. These sensory modulation deficits would ultimately lead them to difficulties in adaptive behavior and intellectual functioning. The purpose of this study was to observe changes in the nervous system with responses to auditory/visual and only audio stimuli in children with autism and typically developing (TD) through electroencephalography (EEG). In this study, 20 children with ASD and 20 children with TD were considered to investigate the difference in the neural dynamics. The neural dynamics could be understood by non-linear analysis of the EEG signal. In this research to reveal the underlying nonlinear EEG dynamics, recurrence quantification analysis (RQA) is applied. RQA measures were analyzed using various parameter changes in RQA computations. In this research, the cosine distance metric was considered due to its capability of information retrieval and the other distance metrics parameters are compared for identifying the best biomarker. Each computational combination of the RQA measure and the responding channel was analyzed and discussed. To classify ASD and TD, the resulting features from RQA were fed to the designed BiLSTM (bi-long short-term memory) network. The classification accuracy was tested channel-wise for each combination. T3 and T5 channels with neighborhood selection as FAN (fixed amount of nearest neighbors) and distance metric as cosine is considered as the best-suited combination to discriminate between ASD and TD with the classification accuracy of 91.86%, respectively.

Regional Dynamic Neuroimaging Changes of Adults with Autism Spectrum Disorder

Most neuroimaging studies investigating autism spectrum disorder (ASD) have focused on static brain function, but ignored the dynamic features of spontaneous brain activities in the temporal dimension. Research of dynamic brain regional activities might help to fully investigate the mechanisms of ASD patients. This study aimed to examine potential changes in the dynamic characteristics of regional neural activities in adult ASD patients and to detect whether the changes were associated with Autism Diagnostic Observation Schedule (ADOS) scores. Resting-state functional MRI was obtained on 77 adult ASD patients and 76 healthy controls. The dynamic regional homogeneity (dReHo) and dynamic amplitude of low-frequency fluctuations (dALFF) were compared between the two groups. Correlation analyses were also performed between dReHo and dALFF in areas showing group differences and ADOS scores. In ASD group, significant differences in dReHo were observed in the left middle temporal gyrus (MTG.L). Besides, we found increased dALFF in the left middle occipital gyrus (MOG.L), left superior parietal gyrus (SPG.L), left precuneus (PCUN.L), left inferior temporal gyrus (ITG.L), and right inferior frontal gyrus, orbital part (ORBinf.R). Furthermore, a significant positive correlation was found between dALFF in the PCUN.L and the ADOS_TOTAL scores, ADOS_SOCIAL scores; the dALFF in the ITG.L, SPG.L was positively associated with ADOS_SOCIAL scores. In conclusion, adults with ASD have a wide area of dynamic regional brain function abnormalities. These suggested that dynamic regional indexes might be used as a powerful measure to help us obtain a more comprehensive understanding of neural activity in adult ASD patients.

Jointly Composite Feature Learning and Autism Spectrum Disorder Classification Using Deep Multi-Output Takagi-Sugeno-Kang Fuzzy Inference Systems

Autism spectrum disorder (ASD) is characterized by poor social communication abilities and repetitive behaviors or restrictive interests, which has brought a heavy burden to families and society. In many attempts to understand ASD neurobiology, resting-state functional magnetic resonance imaging (rs-fMRI) has been an effective tool. However, current ASD diagnosis methods based on rs-fMRI have two major defects. First, the instability of rs-fMRI leads to functional connectivity (FC) uncertainty, affecting the performance of ASD diagnosis. Second, many FCs are involved in brain activity, making it difficult to determine effective features in ASD classification. In this study, we propose an interpretable ASD classifier DeepTSK, which combines a multi-output Takagi-Sugeno-Kang (MO-TSK) fuzzy inference system (FIS) for composite feature learning and a deep belief network (DBN) for ASD classification in a unified network. To avoid the suboptimal solution of DeepTSK, a joint optimization procedure is employed to simultaneously learn the parameters of MO-TSK and DBN. The proposed DeepTSK was evaluated on datasets collected from three sites of the Autism Brain Imaging Data Exchange (ABIDE) database. The experimental results showed the effectiveness of the proposed method, and the discriminant FCs are presented by analyzing the consequent parameters of Deep MO-TSK.

Profile of Service Use and Barriers to Access to Care among Brazilian Children and Adolescents with Autism Spectrum Disorders

Delayed diagnosis and a lack of adequate care for people with autism spectrum disorder (ASD) are related to worse outcomes and quality of life. This study aimed to identify the profile of service use, barriers to access care, and factors related to those barriers in Brazilian families with children with ASD. A total of 927 families with children with ASD (3–17 years) from five Brazilian regions completed an online version of the Caregivers Needs Survey. Results showed that the most used services were behavioral interventions and pharmacotherapy, while the most used professionals were neurologists, nutritionists, speech therapists, psychiatrists, psychologists, and pediatricians. The main barriers included waiting lists, costs, and the absence of services or treatment. Service use varied according to age, the region of residence, type of health care system used, and the parents/caregivers’ education. Access to behavioral interventions was more frequent among users of the private system/health insurance and families whose caregivers had higher education. The absence of specialized services/treatments was less frequent among residents of state capitals and families whose caregivers had higher levels of education. This study highlights how families with children/adolescents with ASD in Brazil face significant barriers to access care related to sociodemographic factors.

Psychotropic Medications Use among Children with Autism in Saudi Arabia

Psychotropic medication use is rising among children with autism spectrum disorders (ASD) in Saudi Arabia. Two hundred ninety-three parents of children diagnosed with ASD completed a parental concerns questionnaire (PCQ) online to examine children’s family socio-demographics, health conditions and comorbidities, and past and current exposure to psychotropic medication as prescribed by their primary doctor. Findings revealed that more than one-third of the parents (39.08%) reported that their children were using medications at the time of the survey; risperidone (53%), methylphenidate (30%), and valproic acid (9%) were the most commonly used. A smaller number of parents stated that their children had previously used medications (16.09%). The most often prescribed drugs among this group were risperidone (45%), followed by methylphenidate (32%) and valproic acid (17%). The variables that showed a statistically significant association with the current use of psychotropic drugs were the child’s age (OR = 1.25, 95% CI: 1.12, 1.40, p < 0.001), presence of comorbidities (OR = 7.75, 95% CI: 3.48, 17.24, p < 0.001), communication difficulties (OR = 1.79, 95% CI: 1.09, 2.95, p < 0.021), and anxiety symptoms (OR = 1.70, 95% CI: 1.00, 2.87, p < 0.049). Similarly, the child’s age (OR = 1.23, 95% CI: 1.08, 1.40, p < 0.002) and presence of comorbidities (OR = 2.83, 95% CI: 1.16, 6.29, p < 0.022) showed statistically significant associations with previous use.

TCHis mitigate oxidative stress and improve abnormal behavior in a prenatal valproic acid-exposed rat model of autism

Objective Troxerutin is known for its anti-inflammatory and antioxidative effects in nerve impairment. The purpose of this study is to investigate the effect of troxerutin and cerebroprotein hydrolysate injections (TCHis) on prenatal valproic acid (VPA)-exposed rats. Methods The VPA was administered to pregnant rats on gestational day 12.5 to induce a model of autism. The offsprings were given the treatment of TCHis on postnatal day (PND) 21-50. On PND 43-50, the behavioral analysis of offsprings was performed after the treatment of TCHis for 1 h. On PND 50, the offsprings were harvested and the brains were collected. The hippocampus and prefrontal cortex were isolated for relevant biochemical detections. Results The administration of TCHis increased the pain sensitivity and improved abnormal social behaviors in prenatal VPA-exposed rats. Prenatal expose of VPA induced neuronal loss and apoptosis, enhanced reactive oxygen species (ROS) production, and promoted oxidative stress in hippocampus and prefrontal cortex, while these effects were reversed by the postnatal treatment of TCHis. In addition, postnatal administration of TCHis ameliorated mitochondrial function in hippocampus and prefrontal cortex of prenatal VPA-exposed rats. Conclusion This study concluded that postnatal treatment of TCHis reduced oxidative stress and ameliorated abnormal behavior in a prenatal VPA-induced rat model of autism.

Challenges on Diagnoses and Assessments Related to Autism Spectrum Disorder in Brazil: A Systematic Review

Being a continental country, with over 210 million citizens, Brazil is similar to all of those who are part of the LAMIC (Low and middle income countries). It shows a big concentration of wealth, mainly in its south and southeast regions, as well as areas with immense poverty. In that sense, the health system also faces a huge amount of contrast. Inside University hospitals and facilities there are sophisticated tools and trained doctors prepared to assist in any kind of medical subject, including autism. But, unfortunately, at other times, the access to a good health system is made much harder. This results in many issues in the medical community, e.g., looking at the data regarding autism, there is a high average of the age of diagnosis. Another issue is the low number of professionals trained in ASD diagnosis and the few tools translated to Portuguese.

Habenula as a Neural Substrate for Aggressive Behavior

Over the past decades, an ever growing body of literature has explored the anatomy, connections, and functions of the habenula (Hb). It has been postulated that the Hb plays a central role in the control of the monoaminergic system, thus influencing a wide range of behavioral responses, and participating in the pathophysiology of a number of psychiatric disorders and neuropsychiatric symptoms, such as aggressive behaviors. Aggressive behaviors are frequently accompanied by restlessness and agitation, and are commonly observed in patients with psychiatric disorders, intellectual disabilities, and neurodegenerative diseases of aging. Recently, the Hb has been explored as a new target for neuromodulation therapies, such as deep brain stimulation, with promising results. Here we review the anatomical organization of the habenula and discuss several distinct mechanisms by which the Hb is involved in the modulation of aggressive behaviors, and propose new investigations for the development of novel treatments targeting the habenula to reduce aggressive behaviors.

Effect of Time Interval From Diagnosis to Treatment on Economic Burden in Families of Children With Autism Spectrum Disorder

The study aimed to investigate the economic costs in families of children with autism spectrum disorder (ASD) and explored how the time interval from diagnosis to treatment time interval from the date children first diagnosed with ASD to the date of first speech/behavior treatment influenced the economic costs. It was a cross-sectional study that recruited families with autistic children in Changsha, Hunan Province of China during March to November 2018. A self-designed questionnaire was applied to collect ASD-related economic costs in the two vital periods including the 12-month period after diagnosis and the most recent 12 months during the course of ASD. In total, 136 families with autistic children completed the interview. The results showed that 46.3% of children started intervention within 1 month. The median of total economic costs of these families in the 12-month period after diagnosis and the most recent 12 months was 26,502.26 RMB and 29,411.91 RMB, respectively. Compared with the time interval shorter than 1 month, time interval over 6 months was significantly associated with high direct economic costs (β SD = 0.308, 95% CI = 0.177, 1.254), inpatient/outpatient and drugs costs (β SD = 0.276, 95% CI = 0.104, 1.181), direct non-medical costs (β SD = 0.287, 95% CI = 0.140, 1.206), and total economic burden (β SD = 0.311, 95% CI = 0.186, 1.262); besides, time interval between 4 and 6 months was significantly related to large indirect costs (β SD = 0.230, 95% CI = 0.098, 1.363) in the 12-month period after diagnosis. Similarly, time interval between 1 and 3 months was significantly associated with high direct non-medical costs (β SD = 0.198, 95% CI = 0.004, 1.013) in the 12-month period after diagnosis. However, time interval from diagnosis to treatment was not correlated to economic costs in the recent 12 months. In the long term, shortening the time interval from diagnosis to treatment would reduce the economic burden on families, especially in the 12-month period after diagnosis.

Deep learning for neuroimaging-based diagnosis and rehabilitation of Autism Spectrum Disorder: A review

Accurate diagnosis of Autism Spectrum Disorder (ASD) followed by effective rehabilitation is essential for the management of this disorder. Artificial intelligence (AI) techniques can aid physicians to apply automatic diagnosis and rehabilitation procedures. AI techniques comprise traditional machine learning (ML) approaches and deep learning (DL) techniques. Conventional ML methods employ various feature extraction and classification techniques, but in DL, the process of feature extraction and classification is accomplished intelligently and integrally. DL methods for diagnosis of ASD have been focused on neuroimaging-based approaches. Neuroimaging techniques are non-invasive disease markers potentially useful for ASD diagnosis. Structural and functional neuroimaging techniques provide physicians substantial information about the structure (anatomy and structural connectivity) and function (activity and functional connectivity) of the brain. Due to the intricate structure and function of the brain, proposing optimum procedures for ASD diagnosis with neuroimaging data without exploiting powerful AI techniques like DL may be challenging. In this paper, studies conducted with the aid of DL networks to distinguish ASD are investigated. Rehabilitation tools provided for supporting ASD patients utilizing DL networks are also assessed. Finally, we will present important challenges in the automated detection and rehabilitation of ASD and propose some future works.

Involvement of the habenula in the pathophysiology of autism spectrum disorder

The habenula is a small epithalamic structure with widespread connections to multiple cortical, subcortical and brainstem regions. It has been identified as the central structure modulating the reward value of social interactions, behavioral adaptation, sensory integration and circadian rhythm. Autism spectrum disorder (ASD) is characterized by social communication deficits, restricted interests, repetitive behaviors, and is frequently associated with altered sensory perception and mood and sleep disorders. The habenula is implicated in all these behaviors and results of preclinical studies suggest a possible involvement of the habenula in the pathophysiology of this disorder. Using anatomical magnetic resonance imaging and automated segmentation we show that the habenula is significantly enlarged in ASD subjects compared to controls across the entire age range studied (6-30 years). No differences were observed between sexes. Furthermore, support-vector machine modeling classified ASD with 85% accuracy (model using habenula volume, age and sex) and 64% accuracy in cross validation. The Social Responsiveness Scale (SRS) significantly differed between groups, however, it was not related to individual habenula volume. The present study is the first to provide evidence in human subjects of an involvement of the habenula in the pathophysiology of ASD.

Directional Deep Brain Stimulation of the Posteromedial Hypothalamus for Refractory Intermittent Explosive Disorder: A Case Series Using a Novel Neurostimulation Device and Intraoperative Microdialysis

BACKGROUND

Intermittent explosive disorder (IED) is a psychiatric disorder characterized by recurrent outbursts of aggressive behavior. Deep brain stimulation (DBS) in the posteromedial nucleus of the hypothalamus (pHyp) is an alternative therapy for extreme cases and shows promising results. Intraoperative microdialysis can help elucidate the neurobiological mechanism of pHyp-DBS. We sought to evaluate efficacy and safety of pHyp-DBS using 8-contact directional leads in patients with refractory IED (rIED) and the accompanying changes in neurotransmitters.

METHODS

This was a prospective study in which patients with a diagnosis of rIED were treated with pHyp-DBS for symptom alleviation. Bilateral pHyp-DBS was performed with 8-contact directional electrodes. Follow-up was performed at 3, 6, and 12 months after surgery.

RESULTS

Four patients (3 men, mean age 27 ± 2.8 years) were included. All patients were diagnosed with rIED and severe intellectual disability. Two patients had congenital rubella, one had a co-diagnosis of infantile autism, and the fourth presented with drug-resistant epilepsy. There was a marked increase in the levels of gamma-aminobutyric acid and glycine during intraoperative stimulation. The average improvement in aggressive behavior in the last follow-up was 6 points (Δ: 50%, P = 0.003) while also documenting an important improvement of the Short Form Health Survey in all domains except bodily pain. No adverse events associated with pHyp-DBS were observed.

CONCLUSIONS

This is the first study to show the safety and beneficial effect of directional lead pHyp-DBS in patients with rIED and to demonstrate the corresponding mechanism of action through increases in gamma-aminobutyric acid and glycine concentration in the pHyp.

Bilateral Amygdala Radio-Frequency Ablation for Refractory Aggressive Behavior Alters Local Cortical Thickness to a Pattern Found in Non-refractory Patients

Aggressive behaviors comprise verbal and/or physical aggression directed toward oneself, others, or objects and are highly prevalent among psychiatric patients, especially patients diagnosed with autism spectrum disorder and severe intellectual disabilities. Some of these patients are considered refractory to treatment, and functional neurosurgery targeting the amygdala can result in widespread plastic brain changes that might reflect ceasing of some abnormal brain function, offering symptom alleviation. This study investigated cortical thickness changes in refractory aggressive behavior patients that were treated with bilateral amygdala ablation and compared to control patients presenting non-refractory aggressive behavior [three refractory and seven non-refractory patients, all males diagnosed with autism spectrum disorder (ASD) and intellectual disabilities]. The Overt Aggression Scale (OAS) was used to quantify behavior and magnetic resonance imaging was performed to investigate cortical thickness. Before surgery, both groups presented similar total OAS score, however refractory patients presented higher physical aggression against others. After surgery the refractory group showed 88% average reduction of aggressive behavior. Imaging analysis showed that while refractory patients present an overall reduction in cortical thickness compared to non-refractory patients across both timepoints, the local pattern of thickness difference found in areas of the neurocircuitry of aggressive behavior present before surgery is diminished and no longer detected after surgery. These results corroborate the hypotheses on induction of widespread neuronal plasticity following functional neurosurgical procedures resulting in modifications in brain morphology and improvement in behavior. Further studies are necessary to determine the underlying cause of these morphological changes and to better understand and improve treatment options.

Longitudinal Changes After Amygdala Surgery for Intractable Aggressive Behavior: Clinical, Imaging Genetics, and Deformation-Based Morphometry Study-A Case Series

BACKGROUND

Intractable aggressive behavior (iAB) is a devastating behavioral disorder that may affect psychiatric patients. These patients have reduced quality of life, are more challenging to treat as they impose a high caregiver burden and require specialized care. Neuromodulatory interventions targeting the amygdala, a key hub in the circuitry of aggressive behavior (AB), may provide symptom alleviation.

OBJECTIVE

To Report clinical and imaging findings from a case series of iAB patients treated with bilateral amygdala ablation.

METHODS

This series included 4 cases (3 males, 19-32 years old) who underwent bilateral amygdala radiofrequency ablation for iAB hallmarked by life-threatening self-injury and social aggression. Pre- and postassessments involved full clinical, psychiatric, and neurosurgical evaluations, including scales quantifying AB, general agitation, quality of life, and magnetic resonance imaging (MRI).

RESULTS

Postsurgery assessments revealed decreased aggression and agitation and improved quality of life. AB was correlated with testosterone levels and testosterone/cortisol ratio in males. No clinically significant side effects were observed. Imaging analyses showed preoperative amygdala volumes within normal populational range and confirmed lesion locations. The reductions in aggressive symptoms were accompanied by significant postsurgical volumetric reductions in brain areas classically associated with AB and increases in regions related to somatosensation. The local volumetric reductions are found in areas that in a normal brain show high expression levels of genes related to AB (eg, aminergic transmission) using gene expression data provided by the Allen brain atlas.

CONCLUSION

These findings provide new insight into the whole brain neurocircuitry of aggression and suggest a role of altered somatosensation and possible novel neuromodulation targets.

Role of CNTNAP2 in autism manifestation outlines the regulation of signaling between neurons at the synapse

Background

Autism is characterized by high heritability and a complex genetic mutational landscape with restricted social behavior and impaired social communication. Whole-exome sequencing is a reliable tool to pinpoint variants for unraveling the disease pathophysiology. The present meta-analysis was performed using 222 whole-exome sequences deposited by Simons Simplex Collection (SSC) at the European Nucleotide Archive. This sample cohort was used to identify causal mutations in autism-specific genes to create a mutational landscape focusing on the CNTNAP2 gene.

Results

The authors account for the identification of 15 high confidence genes with 24 variants for autism with Simons Foundation Autism Research Initiative (SFARI) gene scoring. These genes encompass critical autism pathways such as neuron development, synapse complexity, cytoskeleton, and microtubule activation. Among these 15 genes, overlapping variants were present across multiple samples: KMT2C in 167 cases, CNTNAP2 in 192 samples, CACNA1C in 152 cases, and SHANK3 in 124 cases. Pathway analysis identifies clustering and interplay of autism genes—WDFY3, SHANK2, CNTNAP2, HOMER1, SYNGAP1, and ANK2 with CNTNAP2. These genes coincide across autism-relevant pathways, namely abnormal social behavior and intellectual and cognitive impairment. Based on multiple layers of selection criteria, CNTNAP2 was chosen as the master gene for the study. It is an essential gene for autism with speech-language delays, a typical phenotype in most cases under study. It showcases nine variants across multiple samples with one damaging variant, T589P, with a GERP rank score range of 0.065–0.95. This unique variant was present across 86.5% of the samples impairing the epithelial growth factor (EGF) domain. Established microRNA (miRNA) genes hsa-mir-548aq and hsa-mir-548f were mutated within the CNTNAP2 region, adding to the severity. The mutated protein showed reduced stability by 0.25, increased solvent accessibility by 9%, and reduced depth by 0.2, which rendered the protein non-functional. Secondary physical interactors of CNTNAP2 through CNTN2 proteins were mutated in the samples, further intensifying the severity.

Conclusion

CNTNAP2 has been identified as a master gene in autism manifestation responsible for speech-language delay by impairing the EGF protein domain and downstream cascade. The decrease in EGF is correlated with vital autism symptoms, especially language disabilities.

What is autism?

The term "Autism spectrum disorder" (ASD), in vogue at present, has evolved after continual substantial developments taking place over more than a century. ASD is a heterogeneous, multi-factorial, developmental disability in which an unusual pattern of development takes place during infant and toddler years. As per DSM-5, Autism spectrum disorder is a combined phrase for a family of complex developmental disabilities inclusive of "Autistic Disorder, Pervasive Developmental Disorder not Otherwise Specified (PDD-NOS), and Asperger's Disorder". "ASD is characterized not only by persistent impairments in reciprocal social communication and social interactions, but is also manifested by restricted, repetitive patterns of behavior, interests, or activities". The classical clinical signs that exist in two major domains, viz. the 'social domain' and the 'behavioral domain' for the precise diagnosis of ASD have been tabulated and major differences between DSM-5 and DSM-4 are depicted with the help of a figure in this basic review article. A sharp rise in the incidence of ASD cases has been observed worldwide owing to various risk factors such as genetic predisposition coupled with adverse environmental conditions, gynecological interventions, etc. Two official manuals viz. the "Diagnostic and Statistical Manual of Mental Disorders" (DSM) (published by the American Psychiatric Association), and the "International Classification of Diseases" (ICD) (published by the World Health Organization) is being regularly updated to facilitate diagnosis of ASD. ICD-11 guidelines being prospectively implemented with effect from January 2022 have attracted global attention.

Improvement of brain functional connectivity in autism spectrum disorder: an exploratory study on the potential use of virtual reality

Patients with Autism Spectrum Disorder (ASD) need to be provided with behavioral, psychological, educational, or skill-building interventions as early as possible. Cognitive Behavior Therapy has proven useful to manage such problems. There is also growing evidence on the usefulness of Virtual Reality Therapy (VRT) in treating various functional deficits in ASD. This exploratory study is aimed at assessing the changes in cognitive functions in children with ASD, and the putative subtending neurophysiological mechanisms, following the provision of rehab training using an innovative VRT system. Twenty patients with ASD, aged 6-15 years, were provided with 24 sessions of VRT by using the pediatric module of the BTS NIRVANA System. Neuropsychological and EEG evaluations were carried out before and at the end of the training. After VRT, all patients showed a significant improvement in their cognitive-behavioral problems concerning attention processes, visuospatial cognition, and anxiety. These findings were paralleled by an evident reshape of frontoparietal connectivity in the alpha and theta frequency range. Our study suggests that VRT could be a useful and promising tool to improve ASD neurorehabilitation outcomes. This improvement is likely to occur through changes in frontoparietal network connectivity following VRT.

Stress and emotional wellbeing of parents due to change in routine for children with Autism Spectrum Disorder (ASD) at home during COVID-19 pandemic in Saudi Arabia

BACKGROUND

Parents of children with Autism Spectrum Disorder (ASD) experience considerable amounts of stress and impaired emotional well-being. Consequently, it is likely that these have been adversely impacted by COVID-19 outbreak due to disruptions to the schedules of children with ASD.

AIM

This study investigated the stress and emotional well-being of parents of children with ASD in Saudi Arabia during the COVID-19 pandemic.

METHOD

The study obtained quantitative data from 150 parents of children with ASD from different regions in Saudi Arabia using an online survey. The data collected included demographic data of the parents, ASD status of the family, ASD support during COVID-19 pandemic, severity of ASD behaviours in comparison to the pre- COVID-19 status eating behaviour of the child with ASD, Parental Stress, and emotional well-being. The PSI-short form (PSI-SF) (Abidin, 1995) scale was utilised to obtain data related to parental stress and the General Health Questionnaire (GHQ-12) (Goldberg, 1992) scale was utilised to obtain data related to parents' emotional well-being.

RESULTS

The study found that family ASD status (in particular, age and gender of child with ASD, and severity of his/her symptoms) had a significant impact on parental stress and emotional well-being. Moreover, parental stress and emotional well-being were negatively impacted by the frequency and usefulness of ASD support received during COVID-19 pandemic. These were also adversely impacted by the change in severity of ASD behaviours of the children with ASD. Finally, parental stress was found to have a negative impact on the emotional well-being of parents. Overall, the study found that the parental stress and emotional well-being of parents of children with ASD in Saudi Arabia had been unfavourably impacted by COVID-19 pandemic.

CONCLUSIONS

Overall, the study found that the parental stress and emotional well-being of parents with ASD in Saudi Arabia had been unfavourably impacted by COVID-19 pandemic. This study recommends the involvement of the Saudi Ministry of Health to establish and extend support services to support parents of children with ASD. Moreover, the provision of training programs to help parents deal with the characteristic behaviour of their children with ASD such as, the ability to maintain routines, aggressive or repetitive behaviour, is also recommended.

Complex Comorbid Presentations are Associated with Harmful Behavior Problems among Children and Adolescents with Cerebral Palsy

Aim: Frequency and relationship between gastrointestinal symptoms, sleep problems, internalizing and externalizing symptoms, behavior problems and autism spectrum disorder (ASD) symptoms, and predictors of behavior problems were examined in children and adolescents with Cerebral Palsy (CP). Method: Parents of 104 children and adolescents with CP completed the Gastrointestinal Symptom Inventory, Children's Sleep Habits Questionnaire, Child Behavior Checklist, Social Communication Questionnaire and the Behavior Problem Inventory-Short Form. Results: High frequency of behavior problems (88.5%), gastrointestinal symptoms (81.7%), sleep problems (81%) ASD symptoms (48%) and internalizing and externalizing symptoms (31.7%) were found. Relationships were found between gastrointestinal symptoms and sleep problems, and gastrointestinal symptoms and internalizing and externalizing symptoms. Relationships were found between sleep problems and behavior problems. Intellectual disability, sleep problems, internalizing and externalizing symptoms, and ASD symptoms predicted behavior problems. Conclusion: Findings highlights the frequency of comorbidities that exist in CP and how these comorbidities affect one another.

Early screening of autism spectrum disorder using cry features

The increase in the number of children with autism and the importance of early autism intervention has prompted researchers to perform automatic and early autism screening. Consequently, in the present paper, a cry-based screening approach for children with Autism Spectrum Disorder (ASD) is introduced which would provide both early and automatic screening. During the study, we realized that ASD specific features are not necessarily observable in all children with ASD and in all instances collected from each child. Therefore, we proposed a new classification approach to be able to determine such features and their corresponding instances. To test the proposed approach a set of data relating to children between 18 to 53 months which had been recorded using high-quality voice recording devices and typical smartphones at various locations such as homes and daycares was studied. Then, after preprocessing, the approach was used to train a classifier, using data for 10 boys with ASD and 10 Typically Developed (TD) boys. The trained classifier was tested on the data of 14 boys and 7 girls with ASD and 14 TD boys and 7 TD girls. The sensitivity, specificity, and precision of the proposed approach for boys were 85.71%, 100%, and 92.85%, respectively. These measures were 71.42%, 100%, and 85.71% for girls, respectively. It was shown that the proposed approach outperforms the common classification methods. Furthermore, it demonstrated better results than the studies which used voice features for screening ASD. To pilot the practicality of the proposed approach for early autism screening, the trained classifier was tested on 57 participants between 10 to 18 months. These 57 participants consisted of 28 boys and 29 girls and the results were very encouraging for the use of the approach in early ASD screening.

Refractoriness of aggressive behaviour to pharmacological treatment: cortical thickness analysis in autism spectrum disorder

Aggressive behaviour is a highly prevalent and devastating condition in autism spectrum disorder resulting in impoverished quality of life. Gold-standard therapies are ineffective in about 30% of patients leading to greater suffering. We investigated cortical thickness in individuals with autism spectrum disorder with pharmacological-treatment-refractory aggressive behaviour compared with those with non-refractory aggressive behaviour and observed a brain-wide pattern of local increased thickness in key areas related to emotional control and overall decreased cortical thickness in those with refractory aggressive behaviour, suggesting refractoriness could be related to specific morphological patterns. Elucidating the neurobiology of refractory aggressive behaviour is crucial to provide insights and potential avenues for new interventions.

Preliminary evidence of the validity process of the Autism Diagnostic Observation Schedule (ADOS): translation, cross-cultural adaptation and semantic equivalence of the Brazilian Portuguese version

OBJECTIVES

To translate and back-translate the Autism Diagnostic Observation Schedule (ADOS) into Brazilian Portuguese, to assess its cross-cultural semantic equivalence, and to verify indicators of quality of the final version by analyzing the inter-rater reliability of the ADOS scores.

METHODS

This study had three stages: 1) translation and back-translation; 2) semantic equivalence analysis; and 3) pre-test to verify the agreement between mental health specialists and an ADOS senior examiner regarding the scoring procedure. Authorization to translate and carry out the cultural adaptation of the instrument was first obtained from the Western Psychological Services, publishers of the instrument.

RESULTS

The main preliminary results pointed to good equivalence between the original English version and the final version and the Brazilian version following the cultural adaptation process. Some semantic differences were found between the original version and the back-translation into English, but they did not interfere with the first translation into Portuguese or into the final version. One of the limitations of the study was the small sample size; for that reason, the inter-rater reliability of the ADOS scores between the specialists and the senior examiner using the kappa coefficient was adequate for 7 out of 10 areas.

CONCLUSIONS

We conclude that the creation of an official Brazilian version of ADOS will help to strengthen clinical and scientific research into ASD, and deter the use of other unauthorized versions of ADOS in the country.

Amygdala and Hypothalamus: Historical Overview With Focus on Aggression

Aggressiveness has a high prevalence in psychiatric patients and is a major health problem. Two brain areas involved in the neural network of aggressive behavior are the amygdala and the hypothalamus. While pharmacological treatments are effective in most patients, some do not properly respond to conventional therapies and are considered medically refractory. In this population, surgical procedures (ie, stereotactic lesions and deep brain stimulation) have been performed in an attempt to improve symptomatology and quality of life. Clinical results obtained after surgery are difficult to interpret, and the mechanisms responsible for postoperative reductions in aggressive behavior are unknown. We review the rationale and neurobiological characteristics that may help to explain why functional neurosurgery has been proposed to control aggressive behavior.

Highly Selective Eating in Autism Spectrum Disorder Leading to Scurvy: A Series of Three Patients

BACKGROUND

Some children with autism spectrum disorder (ASD) have highly specific food selectivity and therefore are prone to nutritional deficiencies of different kinds.

PATIENTS

We document three children with ASD who presented with refusal to walk and gingivitis who underwent comprehensive evaluations before establishing the diagnosis of vitamin C deficiency (scurvy). The symptoms resolved after treatment with vitamin C.

CONCLUSIONS

Prevention of nutritional deficiencies in children with ASD is essential, and providing multivitamin supplementation whenever high food selectivity is noted may prevent significant morbidity.

Topological Properties of Resting-State fMRI Functional Networks Improve Machine Learning-Based Autism Classification

Automatic algorithms for disease diagnosis are being thoroughly researched for use in clinical settings. They usually rely on pre-identified biomarkers to highlight the existence of certain problems. However, finding such biomarkers for neurodevelopmental disorders such as Autism Spectrum Disorder (ASD) has challenged researchers for many years. With enough data and computational power, machine learning (ML) algorithms can be used to interpret the data and extract the best biomarkers from thousands of candidates. In this study, we used the fMRI data of 816 individuals enrolled in the Autism Brain Imaging Data Exchange (ABIDE) to introduce a new biomarker extraction pipeline for ASD that relies on the use of graph theoretical metrics of fMRI-based functional connectivity to inform a support vector machine (SVM). Furthermore, we split the dataset into 5 age groups to account for the effect of aging on functional connectivity. Our methodology achieved better results than most state-of-the-art investigations on this dataset with the best model for the >30 years age group achieving an accuracy, sensitivity, and specificity of 95, 97, and 95%, respectively. Our results suggest that measures of centrality provide the highest contribution to the classification power of the models.

A Experiência de Mães e Pais no Relacionamento com o Filho Diagnosticado com Autismo

Resumo Buscou-se compreender fenomenologicamente a experiência de mães e pais no relacionamento com o filho diagnosticado com autismo. A partir de encontros dialógicos com 11 participantes, narrativas foram construídas, considerando os principais elementos significativos da sua experiência. Os resultados principais foram: (a) o diagnóstico é desencadeador de uma nova compreensão sobre o filho; (b) as mães desenvolvem uma relação de exclusividade com o filho; (c) as mães descuidam de si para cuidarem bem do filho; (d) brincadeiras tornam o relacionamento mais gratificante; (e) a escola é percebida como uma parceira no cuidado do filho. Conclui-se que o relacionamento afetivo entre pais e filhos ultrapassa as limitações que a patologia impõe e pode ser potencializado pela atenção psicológica aos pais.

Leptin and camel milk abate oxidative stress status, genotoxicity induced in valproic acid rat model of autism

The aspect of treatment of autistic behaviour was investigated using valproic acid rat model of pregnant female rats. Two main groups (10 male rats/group) were treated for 6 days and then divided into six subgroups. The first group of normal rats was divided into three subgroups: (A) – control group, (B) – treated with camel milk (CAM; 2 mL/p.o) and (C) – treated with leptin (1000 µg/kg i.p) twice daily. The second group of autistic rats was randomly distributed into four subgroups as follows: (D) – positive control (autistics rats), (E) – treated with CAM, (F) – treated with a moderate dose of leptin and (G) – treated with a higher dose of leptin. Autistic behaviours of male offspring were checked by grooming and elevated pulz maze tests. Valproic acid (VPA)-induced autistic rats showed severe changes in oxidative stress markers, neurotransmitters and inflammatory cytokines, besides genotoxic manifestation of expression of tumour necrosis factor (TNF)-α, Bax and caspase-3. Leptin or CAM alone showed no signs of toxicity. CAM showed pronounced improvement in control rats than control itself. Leptin or CAM treatment of autistic animals showed a significant improvement of all measured parameters and genetic expression values. The improvement was pronounced in animals treated with CAM. These results suggest that CAM is a potential therapeutic candidate for autism via regulation of inflammatory and apoptotic pathways. Leptin plays an essential role in alleviation of autistic behaviour through antioxidant effects.

Oxytocin and Gynecomastia: Correlation or Causality?

Oxytocin has been administered to patients with autism spectrum disorder (ASD) in order to improve social skills, communication, and manage repetitive behaviors in the context of research trials. The majority of the studies focus on acute administration; thus, the effectiveness and potential side effects of chronic administration remain unknown. The main goal of this case report is to highlight the importance of the safety parameters for the chronic use of intranasal oxytocin administration. In a single case conducted in our outpatient clinic, one adolescent (15 years old) received intranasal oxytocin (24 IU) twice per day, in accordance with the recommended doses for this age group that varies from 8 - 25 IU twice per day. After three weeks of treatment, the patient presented with gynecomastia. While it is not certain that the gynecomastia was oxytocin-induced, this case highlights the importance of developing optimal regimens for chronic oxytocin administration, with a particular focus on safety parameters.

A Placebo-Controlled Crossover Trial of Gastrin-Releasing Peptide in Childhood Autism

OBJECTIVES

The aim of this study was to evaluate the efficacy, safety, and tolerability of gastrin-releasing peptide (GRP) compared with placebo in autism spectrum disorder symptoms.

METHODOLOGY

This is a randomized, double-blind, placebo-controlled crossover trial using GRP 160 pmol/kg for 4 consecutive days in 10 children with autism. Outcomes were measured by the Aberrant Behavior Checklist (ABC) scale.

RESULTS

All participants were boys, aged between 4 and 9 years. There was a reduction in the scores of the ABC range and its subscales after use GRP and placebo. The reduction was more prominent with GRP, particularly in the subscale "hyperactivity and noncompliance," but there was no statistical difference between the results (P = 0.334). After a week of infusion, 5 children showed improvement of 25% or greater in the total score of the ABC scale with GRP use and 2 with placebo use; however, there was no statistical difference (P = 0.375). There were no adverse effects, changes in vital signs, or laboratory abnormalities associated with the use of GRP.

CONCLUSIONS

The results of this study, despite the small sample size, reinforce previous data on the safety of the GRP in short-term use. There is a need for further research with other designs and a larger sample size to evaluate the efficacy and safety of GRP in children with autism.

Mitochondria as pharmacological targets in Down syndrome

Mitochondria play a pivotal role in cellular energy-generating processes and are considered master regulators of cell life and death fate. Mitochondrial function integrates signalling networks in several metabolic pathways controlling neurogenesis and neuroplasticity. Indeed, dysfunctional mitochondria and mitochondrial-dependent activation of intracellular stress cascades are critical initiating events in many human neurodegenerative or neurodevelopmental diseases including Down syndrome (DS). It is well established that trisomy of human chromosome 21 can cause DS. DS is associated with neurodevelopmental delay, intellectual disability and early neurodegeneration. Recently, molecular mechanisms responsible for mitochondrial damage and energy deficits have been identified and characterized in several DS-derived human cells and animal models of DS. Therefore, therapeutic strategies targeting mitochondria could have great potential for new treatment regimens in DS. The purpose of this review is to highlight recent studies concerning mitochondrial impairment in DS, focusing on alterations of the molecular pathways controlling mitochondrial function. We will also discuss the effects and molecular mechanisms of naturally occurring and chemically synthetized drugs that exert neuroprotective effects through modulation of mitochondrial function and attenuation of oxidative stress. These compounds might represent novel therapeutic tools for the modulation of energy deficits in DS.

Altered expression of histamine signaling genes in autism spectrum disorder

The histaminergic system (HS) has a critical role in cognition, sleep and other behaviors. Although not well studied in autism spectrum disorder (ASD), the HS is implicated in many neurological disorders, some of which share comorbidity with ASD, including Tourette syndrome (TS). Preliminary studies suggest that antagonism of histamine receptors 1-3 reduces symptoms and specific behaviors in ASD patients and relevant animal models. In addition, the HS mediates neuroinflammation, which may be heightened in ASD. Together, this suggests that the HS may also be altered in ASD. Using RNA sequencing (RNA-seq), we investigated genome-wide expression, as well as a focused gene set analysis of key HS genes (HDC, HNMT, HRH1, HRH2, HRH3 and HRH4) in postmortem dorsolateral prefrontal cortex (DLPFC) initially in 13 subjects with ASD and 39 matched controls. At the genome level, eight transcripts were differentially expressed (false discovery rate <0.05), six of which were small nucleolar RNAs (snoRNAs). There was no significant diagnosis effect on any of the individual HS genes but expression of the gene set of HNMT, HRH1, HRH2 and HRH3 was significantly altered. Curated HS gene sets were also significantly differentially expressed. Differential expression analysis of these gene sets in an independent RNA-seq ASD data set from DLPFC of 47 additional subjects confirmed these findings. Understanding the physiological relevance of an altered HS may suggest new therapeutic options for the treatment of ASD.

Procedures and compliance of a video modeling applied behavior analysis intervention for Brazilian parents of children with autism spectrum disorders

Video modeling using applied behavior analysis techniques is one of the most promising and cost-effective ways to improve social skills for parents with autism spectrum disorder children. The main objectives were: (1) To elaborate/describe videos to improve eye contact and joint attention, and to decrease disruptive behaviors of autism spectrum disorder children, (2) to describe a low-cost parental training intervention, and (3) to assess participant's compliance. This is a descriptive study of a clinical trial for autism spectrum disorder children. The parental training intervention was delivered over 22 weeks based on video modeling. Parents with at least 8 years of schooling with an autism spectrum disorder child between 3 and 6 years old with an IQ lower than 70 were invited to participate. A total of 67 parents fulfilled the study criteria and were randomized into two groups: 34 as the intervention and 33 as controls. In all, 14 videos were recorded covering management of disruptive behaviors, prompting hierarchy, preference assessment, and acquisition of better eye contact and joint attention. Compliance varied as follows: good 32.4%, reasonable 38.2%, low 5.9%, and 23.5% with no compliance. Video modeling parental training seems a promising, feasible, and low-cost way to deliver care for children with autism spectrum disorder, particularly for populations with scarce treatment resources.

Mismatch between diagnostic reports and special educational needs classification in a public educational system

OBJECTIVE

To assess the diagnostic status, the sociodemographic and health profiles for students with special educational needs (SEN) in a public educational system, and to map their use of educational/social services.

METHODS

The sample comprised 1,202 SEN students from a total of 59,344 students.

RESULTS

Only 792 students of the 1,202 had an established diagnosis. The most prevalent SEN condition was intellectual disability. There was a low percentage (29.4%) of use of specialized educational services or support. It was found that, for some neurodevelopmental disorders, prevalence data suggest an under-reporting in the school system.

CONCLUSION

Results suggest that there is a mismatch between the diagnostic reports and the SEN condition legally recognized according to Brazilian law, in addition to the under-reporting and under specialized service use of students with disabilities.

Low oxytocin and melatonin levels and their possible role in the diagnosis and prognosis in Iraqi autistic children

Objectives:

To test the possible association between oxytocin and melatonin levels with the severity of social and cognitive dysfunctions, and to study the correlation between these parameters in children with autism.

Methods:

A case-control study was carried out in the Department of Chemistry and Biochemistry, College of Medicine, Al-Nahrain University, Baghdad, Iraq. The study was performed on 60 male autistic patients recruited from the Pediatric Department of Al-Sader General Hospital, Baghdad, Iraq between November 2014 and April 2015. The levels of oxytocin and melatonin were measured in the serum of these autistic male patients, and categorized as mild, moderate, and severe (20 patients each), and was compared with 26 age- and gender-matched control subjects.

Results:

The data indicated that the levels of oxytocin (44.72 ± 36.1 µIU/mL) and melatonin in patients (23.08 ± 10.41 pg/mL) were significantly lower (p<0.05) than that of age-matched (102.1 ± 34.31 µIU/mL) and gender-matched controls (53.05 ± 38.38 pg/mL). These parameters were remarkably associated with the severity of the disease that was indicated by the significant decrease in the levels of oxytocin (47 ± 25.47 µIU/mL) and melatonin in moderate (20 ± 6.14 pg/mL), and patients with severe oxytocin (27.92 ± 10.23 µIU/mL) and patients with severe melatonin (21.69 ± 7.02 pg/mL) when compared with mild autistic patients with oxytocin (59.22 ± 27.32 µIU/mL) and melatonin (27.55 ± 14.71 pg/mL). These 2 parameters showed a significant positive correlation with each other in moderate (r=0.513; p=0.021), and severe patients (r=0.598; p=0.005).

Conclusion:

Receiver operating characteristic analysis revealed that oxytocin can be considered as a good diagnostic marker in severe autistic patients while melatonin can be considered as a good diagnostic marker in all autistic subgroups. This study proves the possibility of using oxytocin and melatonin in the diagnosis, and as markers of autism severity.

Effects of heterogeneous risk factors on psychological distress in adolescents with autism and victimization experiences in Taiwan

PURPOSE

To investigate the prevalence of various types of bullying victimization among adolescents with autism spectrum disorder (ASD) and examine the effects of victimization on the mental health of adolescents with ASD.

METHODS

The sample was collected from the Special Needs Education Longitudinal Study (SNELS) database released in 2011. Variables comprising seven psychological distress (PD) items and four types of bullying victimization and family-, school-, and peer-related factors were included in a multivariate regression analysis.

RESULTS

Exclusion and verbal bullying were most frequently reported, 72.4% of students with ASD experiencing exclusion bullying and 66% of them experiencing verbal bullying. Among the victims, delayed bedtime, use of medication, and conflicts with parents significantly increased PD. By contrast, good relationships with parents and friends and liking school environments relieved PD symptoms. Furthermore, delayed bedtime after 12 a.m. enhanced the effects of exclusion victimization on PD in the participants.

CONCLUSIONS

Our results indicated that bullying victimization among adolescents with ASD was a risk factor for their psychological well-being. Nevertheless, good parent-adolescent and interpeer relationships improved their mental health. Our results can serve as a reference in implementing strategies for motivating parents and teachers to pay more attention to the needs of adolescents with ASD. Implications for Rehabilitation More than 80% of adolescents with autism experience at least one type of bullying victimization. Bullying victimization attributes to a major factor influencing mental health of adolescents with autism. Good parent-adolescent and interpeer relationships can play beneficial roles in improving mental health of the adolescents.

Inappropriate sexual behaviour in adolescents with autism spectrum disorder: what education is recommended and why

AIM

Autism spectrum disorder (ASD) is a neurodevelopmental disorder impairing social skills and communication. Adolescents with ASD have sexual needs, but may not understand their physical and emotional development resulting in inappropriate sexual behaviour. The aim of this review is to describe the type of inappropriate behaviour that presents in these adolescents, explain why such behaviours occur, suggest what education is suitable and identify current gaps in research.

METHOD

The databases EMBASE, OVID MEDLINE and PSYCINFO were searched for relevant articles. In total, 5241 articles were found, with an additional 15 sources found via soft searches, of which 42 met inclusion criteria and were subsequently reviewed.

RESULTS

Sexual behaviours that occur in these adolescents with ASD include hypermasturbation, public masturbation, inappropriate romantic gestures, inappropriate arousal and exhibitionism. Such behaviours are thought to be caused via a lack of understanding of normal puberty, the absence of appropriate sex education, the severity of their ASD and other associated problems. It is suggested that individualized, repetitive education should be started from an early age in an accessible form. Social skills development is also important before more technical aspects of sex education are taught.

CONCLUSION

Despite being such a common problem for schools, institutions and families to manage, it is surprising how sparse literature is particularly regarding why inappropriate behaviour occurs and what education is effective.

Opioid peptides and gastrointestinal symptoms in autism spectrum disorders

Autism spectrum disorders (ASDs) are characterized by deficits in the individual's ability to socialize, communicate, and use the imagination, in addition to stereotyped behaviors. These disorders have a heterogenous phenotype, both in relation to symptoms and regarding severity. Organic problems related to the gastrointestinal tract are often associated with ASD, including dysbiosis, inflammatory bowel disease, exocrine pancreatic insufficiency, celiac disease, indigestion, malabsorption, food intolerance, and food allergies, leading to vitamin deficiencies and malnutrition. In an attempt to explain the pathophysiology involved in autism, a theory founded on opioid excess has been the focus of various investigations, since it partially explains the symptomatology of the disorder. Another hypothesis has been put forward whereby the probable triggers of ASDs would be related to the presence of bacteria in the bowel, oxidative stress, and intestinal permeability. The present update reviews these hypotheses.