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Kaufmann WE, Raspa M, Bann CM, Gable JM, Harris HK, Budimirovic DB, Lozano R. Latent Class Analysis Identifies Distinctive Behavioral Subtypes in Children with Fragile X Syndrome. J Autism Dev Disord 2024; 54:725-737. [PMID: 36441429 PMCID: PMC10258834 DOI: 10.1007/s10803-022-05821-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Accepted: 11/07/2022] [Indexed: 11/29/2022]
Abstract
Fragile X syndrome (FXS) is characterized by variable neurobehavioral abnormalities, which leads to difficulties in developing and evaluating treatments and in determining accurate prognosis. We employed a pediatric cross-sectional sample (1,072 males, 338 females) from FORWARD, a clinic-based natural history study, to identify behavioral subtypes by latent class analysis. Input included co-occurring behavioral conditions, sleep and sensory problems, autistic behavior scales (SCQ, SRS-2), and the Aberrant Behavior Checklist revised for FXS (ABCFX). A 5-class solution yielded the most clinically meaningful, pharmacotherapy independent behavioral groups with distinctive SCQ, SRS-2, and ABCFX profiles, and adequate non-overlap (≥ 71%): "Mild" (31%), "Moderate without Social Impairment" (32%), "Moderate with Social Impairment" (7%), "Moderate with Disruptive Behavior" (20%), and "Severe" (9%). Our findings support FXS subtyping, for improving clinical management and therapeutic development.
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Affiliation(s)
- Walter E Kaufmann
- Department of Human Genetics, Emory University School of Medicine, 615 Michael Street, Atlanta, GA, 30322, USA.
| | - Melissa Raspa
- RTI International, 3040 Cornwallis Road, Research Triangle Park, NC, 27709, USA
| | - Carla M Bann
- RTI International, 3040 Cornwallis Road, Research Triangle Park, NC, 27709, USA
| | - Julia M Gable
- RTI International, 3040 Cornwallis Road, Research Triangle Park, NC, 27709, USA
| | - Holly K Harris
- Texas Children's Hospital, 8080 North Stadium Drive, Houston, TX, 77054, USA
| | | | - Reymundo Lozano
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY, 10029, USA
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Page SD, Souders MC, Aryal S, Pinto-Martin JA, Deatrick JA. A Comparison of Family Management Between Families of Children With Autism Spectrum Disorder and Families of Children With Down Syndrome. J Pediatr Health Care 2024; 38:61-73. [PMID: 37725028 DOI: 10.1016/j.pedhc.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 07/25/2023] [Accepted: 08/29/2023] [Indexed: 09/21/2023]
Abstract
INTRODUCTION This cross-sectional study aimed to (1) compare family management between families of children with autism spectrum disorder (ASD) or Down syndrome and (2) evaluate the contribution of the child (ASD behaviors, feeding difficulties, sleep disturbances), caregiver (mental health) and family (social support) factors to the caregiver's perceived condition management ability and effort. METHOD Eighty-five caregivers (56 ASD, 29 Down syndrome) completed quantitative instruments online. Data analysis included independent samples t-tests and multiple linear regression. RESULTS There were no significant differences in the dimensions of family management between groups. More ASD behaviors were associated with lower condition management ability and higher condition management effort. Lower perceived social support and higher caregiver age were associated with lower condition management ability. DISCUSSION Integrating care into family life may be more challenging when the child has more social differences and behavioral rigidity. Nursing care should include an assessment of family social support.
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Baumer NT, Capone G. Psychopharmacological treatments in Down syndrome and autism spectrum disorder: State of the research and practical considerations. Am J Med Genet C Semin Med Genet 2023; 193:e32069. [PMID: 37870763 DOI: 10.1002/ajmg.c.32069] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/20/2023] [Accepted: 09/30/2023] [Indexed: 10/24/2023]
Abstract
Individuals with Down syndrome (DS) or Autism Spectrum Disorder (ASD), and especially those with both DS and co-occurring ASD (DS + ASD) commonly display behavioral and psychiatric symptoms that can impact quality of life and places increased burden on caregivers. While the mainstay of treatment in DS and ASD is focused on educational and behavioral therapies, pharmacological treatments can be used to reduce symptom burden. There is a paucity of evidence and limited clinical trials in DS and DS + ASD. Some scientific evidence is available, primarily in open label studies and case series that can guide treatment choices. Additionally, clinical decisions are often extrapolated from evidence and experience from those with ASD, or intellectual disability in those without DS. This article reviews current research in pharmacological treatment in DS, ASD, and DS + ASD, reviews co-occurring neurodevelopmental and mental health diagnoses in individuals with DS + ASD across the lifespan, and describes practical approaches to psychopharmacological management.
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Affiliation(s)
- Nicole T Baumer
- Division of Developmental Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - George Capone
- Department of Pediatrics, Johns Hopkins Medicine, Baltimore, Maryland, USA
- Kennedy Krieger Institute, Baltimore, Maryland, USA
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Fidler DJ, Van Deusen K, Prince MA, Schworer EK, Lee NR, Edgin JO, Patel LR, Daunhauer LA. Longitudinal Predictors of Neurodevelopmental Outcomes in Children with Down Syndrome. Dev Neuropsychol 2023; 48:280-298. [PMID: 37555433 PMCID: PMC10530357 DOI: 10.1080/87565641.2023.2239401] [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: 01/10/2023] [Revised: 06/24/2023] [Accepted: 07/17/2023] [Indexed: 08/10/2023]
Abstract
This study examined longitudinal predictors of neurodevelopmental outcomes in children with Down syndrome (DS). Participants were assessed at Wave 1 during infancy on measures of looking behavior and caregivers provided infant sensory ratings. At Wave 2, child-age participants completed a developmental assessment and caregivers provided ratings of executive function, ADHD symptoms, and autism symptoms. Longer looking durations and greater sensory dysregulation during infancy were predictive of higher ADHD symptom ratings and other neurodevelopmental outcomes during childhood. The findings suggest that early indicators of neurodevelopmental dysregulation may be detectable during infancy in DS.
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Affiliation(s)
- Deborah J Fidler
- Department of Human Development and Family Studies, Colorado State University, Fort Collins, Colorado, USA
| | - Kaylyn Van Deusen
- Department of Human Development and Family Studies, Colorado State University, Fort Collins, Colorado, USA
| | - Mark A Prince
- Department of Psychology, Colorado State University, Fort Collins, Colorado, USA
| | - Emily K Schworer
- Waisman Center, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Nancy R Lee
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, Pennsylvania, USA
| | - Jamie O Edgin
- Department of Psychology, University of Arizona, Tucson, Arizona, USA
| | - Lina R Patel
- Department of Psychiatry, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Lisa A Daunhauer
- Department of Human Development and Family Studies, Colorado State University, Fort Collins, Colorado, USA
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Abbeduto L, Del Hoyo Soriano L, Berry-Kravis E, Sterling A, Edgin JO, Abdelnur N, Drayton A, Hoffmann A, Hamilton D, Harvey DJ, Thurman AJ. Expressive language sampling and outcome measures for treatment trials in fragile X and down syndromes: composite scores and psychometric properties. Sci Rep 2023; 13:9267. [PMID: 37286643 PMCID: PMC10247708 DOI: 10.1038/s41598-023-36087-3] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 05/29/2023] [Indexed: 06/09/2023] Open
Abstract
The lack of psychometrically sound outcome measures has been a barrier to evaluating the efficacy of treatments proposed for core symptoms of intellectual disability (ID). Research on Expressive Language Sampling (ELS) procedures suggest it is a promising approach to measuring treatment efficacy. ELS entails collecting samples of a participant's talk in interactions with an examiner that are naturalistic but sufficiently structured to ensure consistency and limit examiner effects on the language produced. In this study, we extended previous research on ELS by analyzing an existing dataset to determine whether psychometrically adequate composite scores reflecting multiple dimensions of language can be derived from ELS procedures administered to 6- to 23-year-olds with fragile X syndrome (n = 80) or Down syndrome (n = 78). Data came from ELS conversation and narration procedures administered twice in a 4-week test-retest interval. We found that several composites emerged from variables indexing syntax, vocabulary, planning processes, speech articulation, and talkativeness, although there were some differences in the composites for the two syndromes. Evidence of strong test-retest reliability and construct validity of two of three composites were obtained for each syndrome. Situations in which the composite scores would be useful in evaluating treatment efficacy are outlined.
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Affiliation(s)
- Leonard Abbeduto
- MIND Institute and Department of Psychiatry and Behavioral Sciences, University of California Davis Health, 2828 50Th St., Sacramento, CA, 95817, USA.
| | - Laura Del Hoyo Soriano
- MIND Institute and Department of Psychiatry and Behavioral Sciences, University of California Davis Health, 2828 50Th St., Sacramento, CA, 95817, USA
| | | | - Audra Sterling
- Waisman Center and Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, WI, USA
| | - Jamie O Edgin
- Department of Psychology, Sonoran UCEDD, UA Family and Community Medicine, University of Arizona, Phoenix, AZ, USA
| | - Nadia Abdelnur
- MIND Institute and Department of Psychiatry and Behavioral Sciences, University of California Davis Health, 2828 50Th St., Sacramento, CA, 95817, USA
| | - Andrea Drayton
- MIND Institute and Department of Psychiatry and Behavioral Sciences, University of California Davis Health, 2828 50Th St., Sacramento, CA, 95817, USA
| | - Anne Hoffmann
- Department of Communication Disorders and Sciences, Rush University, Chicago, IL, USA
- Department of Pediatrics, Rush University, Chicago, IL, USA
| | - Debra Hamilton
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA
| | - Danielle J Harvey
- Department of Public Health Sciences, University of California, Davis, USA
| | - Angela John Thurman
- MIND Institute and Department of Psychiatry and Behavioral Sciences, University of California Davis Health, 2828 50Th St., Sacramento, CA, 95817, USA
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Jenner L, Richards C, Howard R, Moss J. Heterogeneity of Autism Characteristics in Genetic Syndromes: Key Considerations for Assessment and Support. Curr Dev Disord Rep 2023; 10:132-146. [PMID: 37193200 PMCID: PMC10169182 DOI: 10.1007/s40474-023-00276-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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] [Accepted: 04/12/2023] [Indexed: 05/18/2023]
Abstract
Purpose of Review Elevated prevalence of autism characteristics is reported in genetic syndromes associated with intellectual disability. This review summarises recent evidence on the behavioural heterogeneity of autism in the following syndromes: Fragile X, Cornelia de Lange, Williams, Prader-Willi, Angelman, Down, Smith-Magenis, and tuberous sclerosis complex. Key considerations for assessment and support are discussed. Recent Findings The profile and developmental trajectory of autism-related behaviour in these syndromes indicate some degree of syndrome specificity which may interact with broader behavioural phenotypes (e.g. hypersociability), intellectual disability, and mental health (e.g. anxiety). Genetic subtype and co-occurring epilepsy within syndromes contribute to increased significance of autism characteristics. Autism-related strengths and challenges are likely to be overlooked or misunderstood using existing screening/diagnostic tools and criteria, which lack sensitivity and specificity within these populations. Summary Autism characteristics are highly heterogeneous across genetic syndromes and often distinguishable from non-syndromic autism. Autism diagnostic assessment practices in this population should be tailored to specific syndromes. Service provisions must begin to prioritise needs-led support.
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Affiliation(s)
- Lauren Jenner
- School of Psychology, University of Surrey, Guildford, England
| | | | - Rachel Howard
- School of Psychology, University of Surrey, Guildford, England
| | - Joanna Moss
- School of Psychology, University of Surrey, Guildford, England
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Guerreiro S, Maciel P. Transition from Animal-Based to Human Induced Pluripotent Stem Cells (iPSCs)-Based Models of Neurodevelopmental Disorders: Opportunities and Challenges. Cells 2023; 12. [PMID: 36831205 DOI: 10.3390/cells12040538] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/25/2023] [Accepted: 02/02/2023] [Indexed: 02/11/2023] Open
Abstract
Neurodevelopmental disorders (NDDs) arise from the disruption of highly coordinated mechanisms underlying brain development, which results in impaired sensory, motor and/or cognitive functions. Although rodent models have offered very relevant insights to the field, the translation of findings to clinics, particularly regarding therapeutic approaches for these diseases, remains challenging. Part of the explanation for this failure may be the genetic differences-some targets not being conserved between species-and, most importantly, the differences in regulation of gene expression. This prompts the use of human-derived models to study NDDS. The generation of human induced pluripotent stem cells (hIPSCs) added a new suitable alternative to overcome species limitations, allowing for the study of human neuronal development while maintaining the genetic background of the donor patient. Several hIPSC models of NDDs already proved their worth by mimicking several pathological phenotypes found in humans. In this review, we highlight the utility of hIPSCs to pave new paths for NDD research and development of new therapeutic tools, summarize the challenges and advances of hIPSC-culture and neuronal differentiation protocols and discuss the best way to take advantage of these models, illustrating this with examples of success for some NDDs.
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Van Deusen K, Prince MA, Esbensen AJ, Edgin JO, Schworer EK, Thurman AJ, Patel LR, Daunhauer LA, Fidler DJ. Profiles of Caregiver-Reported Executive Function in Children with Down Syndrome. Brain Sci 2022; 12:1333. [PMID: 36291267 PMCID: PMC9599143 DOI: 10.3390/brainsci12101333] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/14/2022] [Accepted: 09/22/2022] [Indexed: 11/16/2022] Open
Abstract
Children with Down syndrome (DS) are at risk for challenges with aspects of executive function (EF). The current study explores whether heterogeneity in EF profiles can be detected within a sample of children with DS. Participants were 69 children with DS, ages 3-10 years (M = 6.23, SD = 1.91). T-scores from a caregiver-report measure of executive function were modeled using latent profile analysis, and auxiliary analyses examined the association between demographic and biomedical factors and probability of profile membership. The two-profile solution was the best fit for the sample, with a profile that involved elevated scores in working memory only ("Working Memory Only" profile; 43% of sample) and a "Multi-Domain" profile that involved elevated scores in planning, inhibition, and working memory (57%). The presence of congenital heart defects was associated with a higher probability of assignment to the Multi-Domain profile. Findings from this study contribute to the characterization of heterogeneous outcomes associated with DS.
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Affiliation(s)
- Kaylyn Van Deusen
- Human Development and Family Studies, Colorado State University, Fort Collins, CO 80523, USA
| | - Mark A. Prince
- Department of Psychology, Colorado State University, Fort Collins, CO 80523, USA
| | - Anna J. Esbensen
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
- College of Medicine, University of Cincinnati, Cincinnati, OH 45229, USA
| | - Jamie O. Edgin
- Sonoran University Center for Excellence in Developmental Disabilities, University of Arizona, Tucson, AZ 85721, USA
| | - Emily K. Schworer
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
- Waisman Center, University of Wisconsin—Madison, Madison, WI 53705, USA
| | - Angela John Thurman
- Department of Psychiatry, MIND Institute, University of California Davis Health, Sacramento, CA 95817, USA
| | - Lina R. Patel
- Department of Psychiatry, University of Colorado-Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Lisa A. Daunhauer
- Human Development and Family Studies, Colorado State University, Fort Collins, CO 80523, USA
| | - Deborah J. Fidler
- Human Development and Family Studies, Colorado State University, Fort Collins, CO 80523, USA
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