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Teaching higher education staff to understand and support autistic students: evaluation of a novel training program. Front Psychiatry 2023; 14:1264895. [PMID: 38188057 PMCID: PMC10770249 DOI: 10.3389/fpsyt.2023.1264895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 11/29/2023] [Indexed: 01/09/2024] Open
Abstract
Background Autistic students are particularly vulnerable to stressors within a university environment and are more likely to experience poor mental health than their non-autistic peers. Students' experiences of stigma from staff and peers, and the masking behaviors they deploy to minimize it, can also result in worsening mental health. Despite these concerns, there is a lack of tailored support for autistic students at university. The current project assesses a co-created training course for university staff focused on debunking stereotypes, educating about the autistic experience at university, mental health presentation among autistic individuals, and practical strategies to improve interactions with autistic students. Methods The Autism Stigma and Knowledge Questionnaire [ASK-Q] was administered before and after the training, to examine changes in trainees' understanding and acceptance of autism and autistic people. Post-training interviews and surveys were also conducted with trainees, covering the impact the training has had on their perceptions of autism, the strategies they found beneficial, and how they will use the materials in future. Results There were no statistically significant differences between pre- and post-training scores on the ASK-Q, likely due to ceiling effects as pre-training scores were high. Thematic analysis of interviews identified five themes: value of lived experience; developing nuanced, in-depth knowledge of autism; training as acceptable and feasible; links to professional practice; and systemic barriers. Conclusion Although ceiling effects meant there were no changes to participant's knowledge about autism and autistic people statistically, the qualitative data reveals the extensive benefits they gained from taking part in the training programs. Scoring highly on the ASK-Q did not mean that people could not learn important new information and benefit from the course. This more nuanced understanding of autism led to practical changes in their practice. Listening to and learning from autistic people was seen as particularly important, highlighting the value of co-production. Our results also emphasize the need for varied approaches to evaluating training effectiveness, as reliance on quantitative data alone would have missed the subtler, but impactful, changes our participants experienced. This has important implications for professional practice, both within higher education and more broadly.
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Speech, language and communication needs and mental health: the experiences of speech and language therapists and mental health professionals. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2023; 58:52-66. [PMID: 36117337 PMCID: PMC10087343 DOI: 10.1111/1460-6984.12767] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 06/23/2022] [Indexed: 06/13/2023]
Abstract
BACKGROUND While the relationship between speech, language and communication needs (SLCN) and mental health difficulties has been recognized, speech and language therapists (SLTs), and mental health professionals face challenges in assessing and treating children with these co-occurring needs. There exists a gap in the evidence base for best practice for professionals working with children and young people (CYP) who experience difficulties in both areas. AIMS To explore the views of SLTs and mental health clinicians about their experiences of working with CYP exhibiting co-occurring SLCN and mental health difficulties. METHODS & PROCEDURES Semi-structured interviews were conducted with eight SLTs and six mental health professionals, including psychotherapists, clinical psychologists, play therapists and counsellors, with experience working with CYP with SLCN. Interviews were analysed using reflexive thematic analysis and themes were identified from the data. OUTCOMES & RESULTS Participants felt that SLCN and mental health difficulties frequently co-occur. Participants described how CYP with SLCN and mental health issues commonly experience difficulties across and between the domains of language and cognition, emotional well-being and challenging behaviour. Findings suggest that there are organizational limitations in the fields of SLT and mental health that have implications for the efficacy of assessment and treatment of CYP with SLCN and mental health difficulties. Traditional talking therapies were perceived to be inaccessible and ineffective for CYP with SLCN and mental health difficulties. Interventions blending behaviour and emotion programmes with language and communication interventions were considered potentially beneficial. CONCLUSIONS & IMPLICATIONS Future research should explore and evaluate current services and service set-up in SLT and mental health. The findings from this study have important implications for the efficacy of treatments provided to this population suggesting that more research needs to be done into effective diagnosis and interventions for this population. WHAT THIS PAPER ADDS What is already known on the subject Research suggests that CYP with SLCN, such as developmental language disorder (DLD), are likely to experience mental health difficulties including depression, anxiety and poor emotional well-being. CYP who experience difficulties with SLCN and poor mental health are not well understood and this area remains under-researched. This has implications for clinician knowledge and therefore the effective diagnosis and treatment of children and adolescents experiencing SLCN and mental health difficulties. In addition, little is known about the accessibility of talking therapies to CYP presenting with SLCN and mental health difficulties. What this paper adds to existing knowledge SLCN issues are understood by SLTs and mental health issues are understood by mental health professionals, but where these co-occur difficulties exist for the diagnostic process, with professionals perceiving that CYP in this category are often undiagnosed or misdiagnosed. Organizational boundaries between SLT and mental health were perceived to contribute to a lack of understanding of SLCN and mental health needs, which has implications for effective diagnosis and treatment. Traditional talking therapies were thought to be inaccessible for CYP with SLCN and mental health difficulties. Interventions used in both SLT and psychotherapy were perceived as clinically useful if combined. What are the potential or actual clinical implications of this work? This paper highlights implications for the accessibility and efficacy of the assessment and treatment provided to this population and to the organization of services currently treating this group of CYP. A direction for future research would be to undertake service evaluations and intervention-based studies.
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238 THE IMPACT OF COVID-19 ON ACUTE STROKE TREATMENT. Age Ageing 2022. [PMCID: PMC9620361 DOI: 10.1093/ageing/afac218.207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background Acute stroke management is time critical. Treatment options are dictated by time of symptom onset. 2019 Irish National Audit of Stroke (INAS) showed less than 50% stroke cases arrived in hospital within three hours of symptoms and national average rate of thrombolysis was 11%. The median time Door-To-Needle time (DTN) was 56 minutes, and to thrombectomy 93 and 240 minutes ‘direct to mothership’ / ‘drip and ship’ transfer to thrombectomy centre respectively. Methods Retrospective review of all stroke FAST calls on our acute stroke database in TUH from July 2019 -2021. Data was analysed pre (up until March 2020) and during COVID-19 pandemic. Results FAST protocol imaging was obtained in 78% of cases (464/594). Documented time of symptom onset to CT was 1:50:00 pre-Covid-19 and 2:26:00 during Covid (p<0.001). ED registration to CT was 28mins pre-Covid-19 and 30mins during Covid (p<0.001). The median DTN time was 41mins pre-Covid-19 (n=21), and 54mins during Covid-19 (n=37). Conclusion In contrast to INAS COVID-19 report, median DTN times and thrombolysis rates dis-improved at TUH. Trends observed probably reflect multiple factors; patient hesitation to attend ED; patient isolation from family; busier ambulance service; Infection control protocols. We observed small but significant change in door-to-CT time but a more significant increase in DTN. This may reflect time taken donning Personal Protective Equipment (PPE) or general increased ED activity. Understanding the impact of COVID-19 on acute stroke treatment metrics in addition to differences at sites may identify targets for national quality improvement in service delivery.
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Furthering the language hypothesis of alexithymia: An integrated review and meta-analysis. Neurosci Biobehav Rev 2022; 141:104864. [PMID: 36087760 DOI: 10.1016/j.neubiorev.2022.104864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 08/26/2022] [Accepted: 09/04/2022] [Indexed: 11/27/2022]
Abstract
Alexithymia, including the inability to identify and express one's own feelings, is a subclinical condition responsible for some of the socioemotional symptoms seen across a range of psychiatric conditions. The language hypothesis of alexithymia posits a language-mediated disruption in the development of discrete emotion concepts from ambiguous affective states, exacerbating the risk of developing alexithymia in language-impaired individuals. To provide a critical evaluation, a systematic review and meta-analysis of 29 empirical studies of language functioning in alexithymia was performed. A modest association was found between alexithymia and multi-domain language deficits (r = -0.14), including structural language, pragmatics, and propensity to use emotional language. A more theoretically-relevant subsample analysis comparing alexithymia levels in language-impaired and typical individuals revealed larger effects, but a limited number of studies adopted this approach. A synthesis of 11 emotional granularity studies also found an association between alexithymia and reduced emotional granularity (r = -0.10). Language impairments seem to increase the risk of alexithymia. Heterogeneous samples and methods suggest the need for studies with improved alexithymia assessments.
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Gender differences in interoceptive accuracy and emotional ability: An explanation for incompatible findings. Neurosci Biobehav Rev 2022; 141:104808. [PMID: 35932952 DOI: 10.1016/j.neubiorev.2022.104808] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 06/13/2022] [Accepted: 07/31/2022] [Indexed: 11/25/2022]
Abstract
Most theories of emotion describe a crucial role for interoceptive accuracy, the perception of the body's internal physiological signals, in emotional experience. Despite support for interoceptive accuracy's role in emotion, findings of gender differences in emotional and interoceptive processing are incompatible with theory; women typically show poorer interoceptive accuracy, but women often outperform men on measures of emotional processing and recognition. This suggests a need to re-evaluate the relationship between interoceptive accuracy and emotion considering sex and gender. Here we extend Pennebaker and Roberts' (1992) theory of gender differences in the use of interoceptive signals for emotional experience, proposing that language socialisation may result in gender differences in the propensity to label internal state changes as physiological or emotional, respectively. Despite outstanding questions concerning the fractionation of interoceptive and emotional domains, this theory provides a plausible explanation for seemingly incompatible findings of gender differences in interoceptive and emotional abilities.
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Opening up autism research: Bringing open research methods to our field. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 26:1011-1013. [PMID: 35899415 DOI: 10.1177/13623613221105385] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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1083 A REVIEW OF FAST DATA IN TALLAGHT UNIVERSITY HOSPITAL, AND THE IMPACT OF COVID ON TREATMENT. Age Ageing 2022. [DOI: 10.1093/ageing/afac126.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Stroke is a leading cause of morbidity. Current guidelines advise maximum of 4.5 hours post symptom onset for thrombolysis, and 24 hours for thrombectomy. (1) Delay between symptom onset and treatment is associated with an inferior outcome. Thrombolysis is available in 27 Irish centers. Average rate of thrombolysis is 11%. (3) Fewer than half of stroke patients arrived in hospital within three hours of symptom onset in 2019. (4) Median door-to-needle time is 48 minutes.
Method
FAST calls in Tallaght University Hospital, from 2/7/19–1/7/21, were included in this analysis (n = 594).
Results
160 FAST calls took place pre-Covid (20/month), and 434 post-Covid (27.12/month). Time of symptom onset was recorded in 390 cases. Time patients last seen well was known in 185 cases, unknown time of onset in 19. After review by the stroke clinician, FAST imaging was obtained in 78% of cases (n = 464). Of these, 34 cases of FAST imaging were performed for inpatients. Average time from registration to CT was 35:24 minutes pre covid, and 45:52 minutes post. 9.7% of patients were thrombolysed. The median door-to-needle time was 41 minutes pre-Covid(n = 21, 2.625/month), and 54 minutes after (n = 37, 2.3/month). Thrombectomy was performed in 46 cases. 222 patients were diagnosed with an ischaemic stroke, 50 had TIA and 48 had haemorrhagic strokes. Other diagnoses included migraine (6.7%, n = 40), seizures (6.7%, n = 40) and Bells Palsy (3.7%, n = 22). 55% (n = 330) of cases were registered to ED with FAST call between the hours of 9 am-5 pm. 27% (n = 161) of cases occurred during the night shift.
Conclusion
The median door-to-needle times were below national median pre-Covid, and longer post-pandemic, with an increase in the rate of presentation in the same time-frame. This report highlights the effect of the pandemic on time-critical patient interventions in stroke and the need to stratify services to respond to structural challenges.
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The Quest for Acceptance: A Blog-Based Study of Autistic Women's Experiences and Well-Being During Autism Identification and Diagnosis. AUTISM IN ADULTHOOD 2022; 4:42-51. [PMID: 36605564 PMCID: PMC8992923 DOI: 10.1089/aut.2021.0016] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background Although studies have found that autism is underdiagnosed in women and that autistic women have poorer well-being outcomes than men, less is known about autistic women's experiences with self-identification or diagnosis or how they feel such experiences affect their mental health. Methods We explored autistic women's experiences of coming to recognize and understand themselves as autistic. We used data collected from blogs written by autistic women about their diagnostic or self-identification experiences. We were particularly interested in well-being, and how this contributed to, was affected by, and interacted with the identification and diagnostic process. We used thematic analysis to explore and document experiences described in blogs from 20 blogsites (representing the views of 23 autistic women). Results Acceptance was a central issue. We developed themes of self-understanding and self-acceptance, being understood and accepted by others (including peers, clinicians, and others in the autism community), and the exhaustion resulting from trying to be accepted and be understood. These issues arose both when going through the diagnostic process, and after receiving a formal diagnosis. Conclusions Diagnosis and identification may have both positive and negative effects on autistic women's well-being, with women often describing difficulties after diagnosis as stemming from facing male stereotypes of autism. We consider the implications of our findings for clinicians, researchers, and those who work with autistic women.
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Autistic women's diagnostic experiences: Interactions with identity and impacts on well-being. WOMEN'S HEALTH (LONDON, ENGLAND) 2022; 18:17455057221137477. [PMID: 36377396 PMCID: PMC9666868 DOI: 10.1177/17455057221137477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 10/04/2022] [Accepted: 10/20/2022] [Indexed: 09/21/2023]
Abstract
OBJECTIVE There has been suggestion that current diagnostic instruments are not sufficient for detecting and diagnosing autism in women, and research suggests that a lack of diagnosis could negatively impact autistic women's well-being and identity. This study aimed to explore the well-being and identity of autistic women at three points of their diagnostic journey: self-identifying or awaiting assessment, currently undergoing assessment or recently diagnosed, and more than a year post-diagnosis. METHODS Mixed-methods were used to explore this with 96 women who identified as autistic and within one of these three groups. Participants completed an online questionnaire, and a sub-sample of 24 of these women participated in a semi-structured interview. RESULTS Well-being was found to differ significantly across groups in three domains: satisfaction with health, psychological health, and environmental health. Validation was found to be a central issue for all autistic women, which impacted their diagnosis, identity, and well-being. The subthemes of don't forget I'm autistic; what now?; having to be the professional; and no one saw me were also identified. CONCLUSION These results suggest that autistic women's well-being and identity differ in relation to their position on the diagnostic journey in a non-linear manner. We suggest that training on the presentation of autism in women for primary and secondary healthcare professionals, along with improved diagnostic and support pathways for autistic adult women could go some way to support well-being.
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Supporting the mental health of children with speech, language and communication needs: The views and experiences of parents. AUTISM & DEVELOPMENTAL LANGUAGE IMPAIRMENTS 2022; 7:23969415221101137. [PMID: 36124076 PMCID: PMC9479119 DOI: 10.1177/23969415221101137] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND AIMS A high rate of children in mental health services have poor language skills, but little evidence exists on how mental health support is delivered to and received by children with language needs. This study looked at parental experiences, asking parents of children with speech, language and communication needs (SLCN) about their experiences seeking help for their children's mental health. We were particularly interested on the experiences of parents of children with Developmental Language Disorder (DLD), a specific SLCN that remains relatively unknown to the general public. METHODS We conducted an online survey of 74 parents of children with speech, language and communication needs (SLCN). Survey respondents included parents of children with a range of difficulties, including DLD, autism, verbal dyspraxia, global intellectual delay, a history of hearing problems, and SLCN without a primary diagnosis. Survey respondents were asked what sources of support they had accessed for their child's mental health and to provide comments on what was good and what was not good about this support. We then conducted 9 semi-structured interviews of parents of children with DLD about their experiences. These were parents of children with DLD aged 7 to 17 years, from across a range of educational settings, and with a range of present mental health concerns. RESULTS Content analyses of the survey responses from parents of children with SLCN highlighted three broad factors of importance to parents' experiences: relational aspects of care, organisational aspects of care, and professionals' knowledge. Thematic analyses of the interviews of parents of children with DLD identified 5 themes: the effects of language problems on the presentation of distress; the role of the school environment; the role of key professionals; standard approaches to mental health support might not be appropriate; and the role and impact on parents. Parents expressed concerns that their children's mental health problems and need for support would not be recognised, and felt interventions were not accessible, or delivered in a manner that was not comfortable for their children due to high reliance on oral language skills. Some parents were left feeling that there was no provision suitable for their children. CONCLUSIONS Parents of children with SLCN face barriers accessing support for their children's mental health, including a lack of professional knowledge about their children's language needs. Parents argued that language and communication needs can significantly affect the delivery and success of psychological therapies and interventions. Systematic research is needed to understand how to successfully adapt services to make them accessible to children and young people with language needs, and to ensure that mental health problems are detected in children with language difficulties. Increased knowledge about language disorders such as DLD, and access to speech and language therapy expertise, is needed amongst professionals who work to support children's mental health.
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209 NEURO-MEDICAL COMPLICATIONS OF STROKE—TRENDS OVER THE DECADES IN AN ACUTE STROKE UNIT. Age Ageing 2021. [DOI: 10.1093/ageing/afab219.209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
Abstract
Background
Neuro-medical complications post-stroke are common and often serious [1]. We first described complications in our stroke cohort in 1998 and sought to assess whether the severity and the nature of neuro-medical complications may have changed over time due to changes in presentation and the processes of care [2].
Methods
Analysis of stroke service database, which captures all neuro-medical complications as part of its portal for the Irish National Audit of Stroke (INAS), was completed. The frequency of each of the 19 complications was expressed as the percentage of patients that developed each complication over a certain year and over 5 years. Historical comparison was made with dataset from 1998, which captured six complications.
Results
Data on 1,283 patients presenting over 5 years between 2015–2019 was collected. The median age of all patients was 71 years (Range 21–101). In all, 19 different post-stroke complications were recorded; 48% (n = 622) had post-stroke pain, while 23.85% (n = 306) had cognitive decline. Data on 100 patients from 1998 was compared for a number of common metrics including; 21.82% (n = 275) of patients developed an LRTI in the 2015–2019 cohort compared with 14%(n = 14) in the 1998 cohort (p = 0.09) while 16.29% (n = 209) of patients developed a swallow disorder compared to 21% (n = 21) in 1998 (p = 0.22).
Conclusion
There are high levels of neuro-medical complications in stroke patients. Twenty years has seen extensive investment in hyperacute stroke care yet post-acute care complications did not appear to reduce significantly between this time, albeit with low numbers. Direction of future funding may consider the full spectrum of stroke care.
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Editorial: Neuromodulatory Interventions for Pain. Front Neurosci 2021; 15:746328. [PMID: 34483836 PMCID: PMC8409571 DOI: 10.3389/fnins.2021.746328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 07/26/2021] [Indexed: 11/30/2022] Open
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Systematic review and meta-analysis of the relationship between the heartbeat-evoked potential and interoception. Neurosci Biobehav Rev 2021; 122:190-200. [PMID: 33450331 DOI: 10.1016/j.neubiorev.2020.12.012] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 12/11/2020] [Accepted: 12/13/2020] [Indexed: 02/07/2023]
Abstract
The Heartbeat Evoked Potential (HEP) has been proposed as a neurophysiological marker of interoceptive processing. Despite its use to validate interoceptive measures and to assess interoceptive functioning in clinical groups, the empirical evidence for a relationship between HEP amplitude and interoceptive processing, including measures of such processing, is scattered across several studies with varied designs. The aim of this systematic review and meta-analysis was to examine the body of HEP-interoception research, and consider the associations the HEP shows with various direct and indirect measures of interoception, and how it is affected by manipulations of interoceptive processing. Specifically, we assessed the effect on HEP amplitude of manipulating attention to the heartbeat; manipulating participants' arousal; the association between the HEP and behavioural measures of cardiac interoception; and comparisons between healthy and clinical groups. Following database searches and screening, 45 studies were included in the systematic review and 42 in the meta-analyses. We noted variations in the ways individual studies have attempted to address key confounds, particularly the cardiac field artefact. Meta-analytic summaries indicated there were moderate to large effects of attention, arousal, and clinical status on the HEP, and a moderate association between HEP amplitude and behavioural measures of interoception. Problematically, the reliability of the meta-analytic effects documented here remain unknown, given the lack of standardised protocols for measuring the HEP. Thus, it is possible effects are driven by confounds such as cardiac factors or somatosensory effects.
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Continuing to look in the mirror: A review of neuroscientific evidence for the broken mirror hypothesis, EP-M model and STORM model of autism spectrum conditions. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2020; 24:1945-1959. [PMID: 32668956 PMCID: PMC7539595 DOI: 10.1177/1362361320936945] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The mirror neuron system has been argued to be a key brain system responsible for action understanding and imitation. Subsequently, mirror neuron system dysfunction has therefore been proposed to explain the social deficits manifested within autism spectrum condition, an approach referred to as the broken mirror hypothesis. Despite excitement surrounding this hypothesis, extensive research has produced insufficient evidence to support the broken mirror hypothesis in its pure form, and instead two alternative models have been formulated: EP-M model and the social top-down response modulation (STORM) model. All models suggest some dysfunction regarding the mirror neuron system in autism spectrum condition, be that within the mirror neuron system itself or systems that regulate the mirror neuron system. This literature review compares these three models in regard to recent neuroscientific investigations. This review concludes that there is insufficient support for the broken mirror hypothesis, but converging evidence supports an integrated EP-M and STORM model.
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The association between communication impairments and acquired alexithymia in chronic stroke patients. J Clin Exp Neuropsychol 2020; 42:495-504. [PMID: 32576080 DOI: 10.1080/13803395.2020.1770703] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Language dysfunction has recently been suggested to be one route to alexithymia, an impairment in recognizing and communicating one's own emotions. Neuropsychological evidence is needed to investigate the possibility that acquired language problems could underlie acquired alexithymia. METHOD This project examined data from a large group of chronic stroke patients (N = 118) to test whether self-reported or behavioral measures of language and communication problems were associated with alexithymia. We also examined the impact of hemisphere of damage on alexithymia. RESULTS We found no differences in alexithymia levels for patients with observed language impairments on brief tests of picture naming, comprehension, and reading vs unimpaired patients. However, self-reported communication difficulties were found to be associated with higher scores of alexithymia, even after controlling for depression and anxiety. Patients with left- versus right-hemisphere damage did not differ in their alexithymia scores. CONCLUSIONS We found partial support for the language hypothesis of alexithymia. We discuss potential reasons for the discrepant findings between the self-report and objective language measures and suggest that self-report measures may be more sensitive to milder, more pragmatic language impairments, as opposed to the severe structural language impairments measured by the cognitive screening tests.
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Abstract
Alexithymia is characterized by difficulty identifying and describing one’s own emotion. Identifying and describing one’s emotion involves several cognitive processes, so alexithymia may result from a number of impairments. Here we propose the alexithymia language hypothesis—the hypothesis that language impairment can give rise to alexithymia—and critically review relevant evidence from healthy populations, developmental disorders, adult-onset illness, and acquired brain injury. We conclude that the available evidence is supportive of the alexithymia–language hypothesis, and therefore that language impairment may represent one of multiple routes to alexithymia. Where evidence is lacking, we outline which approaches will be useful in testing this hypothesis.
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High rates of language impairment in vulnerable populations: the case for improving cross-sector awareness of Developmental Language Disorder. Front Hum Neurosci 2019. [DOI: 10.3389/conf.fnhum.2019.229.00002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Is alexithymia characterised by impaired interoception? Further evidence, the importance of control variables, and the problems with the Heartbeat Counting Task. Biol Psychol 2018; 136:189-197. [DOI: 10.1016/j.biopsycho.2018.05.010] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 05/16/2018] [Accepted: 05/17/2018] [Indexed: 02/02/2023]
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Important methodological issues regarding the use of transcranial magnetic stimulation to investigate interoceptive processing: a Comment on Pollatos et al. (2016). Philos Trans R Soc Lond B Biol Sci 2018; 372:rstb.2016.0506. [PMID: 28396481 DOI: 10.1098/rstb.2016.0506] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2017] [Indexed: 11/12/2022] Open
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Language and alexithymia: Evidence for the role of the inferior frontal gyrus in acquired alexithymia. Neuropsychologia 2018; 111:229-240. [PMID: 29360519 PMCID: PMC8478116 DOI: 10.1016/j.neuropsychologia.2017.12.037] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 11/08/2017] [Accepted: 12/22/2017] [Indexed: 11/25/2022]
Abstract
The clinical relevance of alexithymia, a condition associated with difficulties identifying and describing one's own emotion, is becoming ever more apparent. Increased rates of alexithymia are observed in multiple psychiatric conditions, and also in neurological conditions resulting from both organic and traumatic brain injury. The presence of alexithymia in these conditions predicts poorer regulation of one's emotions, decreased treatment response, and increased burden on carers. While clinically important, the aetiology of alexithymia is still a matter of debate, with several authors arguing for multiple 'routes' to impaired understanding of one's own emotions, which may or may not result in distinct subtypes of alexithymia. While previous studies support the role of impaired interoception (perceiving bodily states) in the development of alexithymia, the current study assessed whether acquired language impairment following traumatic brain injury, and damage to language regions, may also be associated with an increased risk of alexithymia. Within a sample of 129 participants with penetrating brain injury and 33 healthy controls, neuropsychological testing revealed that deficits in a non-emotional language task, object naming, were associated with alexithymia, specifically with difficulty identifying one's own emotions. Both region-of-interest and whole-brain lesion analyses revealed that damage to language regions in the inferior frontal gyrus was associated with the presence of both this language impairment and alexithymia. These results are consistent with a framework for acquired alexithymia that incorporates both interoceptive and language processes, and support the idea that brain injury may result in alexithymia via impairment in any one of a number of more basic processes.
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Crossmodal Classification of Mu Rhythm Activity during Action Observation and Execution Suggests Specificity to Somatosensory Features of Actions. J Neurosci 2017; 37:5936-5947. [PMID: 28559380 PMCID: PMC6596509 DOI: 10.1523/jneurosci.3393-16.2017] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 05/05/2017] [Accepted: 05/11/2017] [Indexed: 11/21/2022] Open
Abstract
The alpha mu rhythm (8-13 Hz) has been considered to reflect mirror neuron activity because it is attenuated by both action observation and action execution. The putative link between mirror neuron system activity and the mu rhythm has been used to study the involvement of the mirror system in a wide range of socio-cognitive processes and clinical disorders. However, previous research has failed to convincingly demonstrate the specificity of the mu rhythm, meaning that it is unclear whether the mu rhythm reflects mirror neuron activity. It also remains unclear whether mu rhythm suppression during action observation reflects the processing of motor or tactile information. In an attempt to assess the validity of the mu rhythm as a measure of mirror neuron activity, we used crossmodal pattern classification to assess the specificity of EEG mu rhythm response to action varying in terms of action type (whole-hand or precision grip), concurrent tactile stimulation (stimulation or no stimulation), or object use (transitive or intransitive actions) in 20 human participants. The main results reveal that above-chance crossmodal classification of mu rhythm activity was obtained in the central channels for tactile stimulation and action transitivity but not for action type. Furthermore, traditional univariate analyses applied to the same data were insensitive to differences between conditions. By calling into question the relationship between mirror system activity and the mu rhythm, these results have important implications for the use and interpretation of mu rhythm activity.SIGNIFICANCE STATEMENT The central alpha mu rhythm oscillation is a widely used measure of the human mirror neuron system that has been used to make important claims concerning cognitive functioning in health and in disease. Here, we used a novel multivariate analytical approach to show that crossmodal EEG mu rhythm responses primarily index the somatosensory features of actions, suggesting that the mu rhythm is not a valid measure of mirror neuron activity. Results may lead to the revision of the conclusions of many previous studies using this measure, and to the transition toward a theory of mu rhythm function that is more consistent with current models of sensory processing in the self and in others.
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An evidence base to support the one concentration approach in fish bioconcentration studies for plant protection products and general chemicals. Toxicol Lett 2015. [DOI: 10.1016/j.toxlet.2015.08.921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Reducing the number of fish in bioconcentration studies for plant protection products by reducing the number of test concentrations. CHEMOSPHERE 2013; 90:1300-1304. [PMID: 23040052 DOI: 10.1016/j.chemosphere.2012.09.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Revised: 07/24/2012] [Accepted: 09/08/2012] [Indexed: 06/01/2023]
Abstract
Fish bioconcentration tests are time consuming, expensive, and use many animals. Alternative methods that replace, reduce or refine the use of fish for BCF testing would therefore be of value. Test guidelines generally require that bioconcentration factors (BCFs) are determined at two exposure concentrations. However, recent revisions to the OECD Test Guideline for BCF testing (TG 305) provide the option to use only one exposure concentration, when justification is provided, although two concentrations may still be required for some regulatory purposes. Analysis of 55 studies on plant protection products demonstrates that BCF values do not significantly differ between the two exposure concentrations. This analysis therefore provides evidence to support the revision of OECD TG 305, and in particular provides justification for using the one test concentration approach for plant protection product active substances.
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Abstract
Compounds previously identified as 5-HT1A antagonists have subsequently been demonstrated to possess partial agonistic properties in models assessing somatodendritic autoreceptor function. This study examined the influences of (+)-WAY-100135, claimed to be the first selective 5-HT1A antagonist, on offensive behaviour in male mice. Employing a resident-intruder paradigm, administration of (+)-WAY-100135 (1.0-10.0 mg/kg s.c.) enhanced elements of resident offensive behaviour at 2.5 and 5.0 mg/kg but reduced such behaviour at 10.0 mg/kg. In comparison, resident defensive postures remained unchanged except for a significant increase in defensive sideways behaviour at 10.0 mg/kg. These effects were accompanied by reduced rearing behaviour across the dose range tested. Attend/approach behaviour was significantly reduced at the lowest, but increased at the highest, doses tested. Such results may reflect response competition rather than concomitant motor impairment. Given the dynamic behavioural interactions occurring in this paradigm, the increased offensive behaviour of the resident mice leads to enhanced defence and counter-attack by the intruder conspecifics. The results are discussed with reference to the current literature concerning the behavioural effects of other 5-HT1A antagonists.
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5-HT1A receptor influences on rodent social and agonistic behavior: a review and empirical study. Neurosci Biobehav Rev 1994; 18:325-38. [PMID: 7984351 DOI: 10.1016/0149-7634(94)90046-9] [Citation(s) in RCA: 81] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Investigations examining the influence of 5-HT1A receptors in murine agonistic and social behavior have reported either specific or nonspecific attenuation of offensive behavior. To clarify this situation, the effects of three 5-HT1A agonists were examined on isolation-induced aggression and social behavior in male mice. 8-OH-DPAT (0.025-1.25 mg/kg) increased social behavior, rearing, and digging. Offensive behavior was reduced, without concomitant sedation. Ipsapirone (0.1-10.0 mg/kg) reduced naso-nasal behavior, whilst enhancing stretched-attend behavior, cage-exploration, and rearing. Offensive and defensive behaviors were attenuated, without reductions in activity. MDL 73005 EF (0.25-8.0 mg/kg) reduced social behaviors, cage-exploration and rearing while maintenance behavior was increased. Offensive and defensive behaviors showed attenuation. Current results corroborate previous findings with respect to 5-HT1A receptor involvement in murine agonistic behavior and anxiety. Data also connote that the behavioral specificity of 5-HT1A ligands should be interpreted in terms of response competition rather than solely concomitant sedation.
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Abstract
In view of conflicting results reported for 5-HT1A receptor involvement in murine social conflict, this study examined the effect of two compounds, SDZ 216-525 and (-)-pindolol, on agonistic and social behavior in male mice. In a resident-intruder paradigm, (-)-pindolol (1.0-20.0 mg/kg), a beta-adrenergic 5-HT1A/1B antagonist, significantly attenuated all agonistic behaviors across the dose range employed. Social behaviors showed significant decreases, while nonsocial cage exploration showed significant increases at all doses. Defensive evade was significantly attenuated at 20.0 mg/kg. SDZ 216-525 (0.025-1.0 mg/kg), a selective 5-HT1A antagonist, significantly attenuated offensive posturing and bite-attacks at 1.0 mg/kg, and all offensive behaviors nonsignificantly at the smaller doses tested. Rearing was significantly attenuated at 1.0 mg/kg, while cage exploration increased at this dose. Defensive and social behaviors remained largely unchanged. These results show that both compounds tested produced significant reductions in offensive behavior, with concomitant changes in defensive, social, and nonsocial behaviors. Results are discussed in relation to SDZ 216-525 and (-)-pindolol potential for the control of anxiety and agonistic behavior.
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Effects of pindobind 5-hydroxytryptamine1A (5-HT1A), a novel and potent 5-HT1A antagonist, on social and agonistic behaviour in male albino mice. Pharmacol Biochem Behav 1993; 46:67-72. [PMID: 8255924 DOI: 10.1016/0091-3057(93)90318-n] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
In view of inconsistent results reported for 5-hydroxytryptamine1A (5-HT1A) receptor involvement in murine social conflict, this study examined the effects of N1-(bromoacetyl)-N8-[3-(4-indolyloxy)-2- hydroxypropyl]-(Z)-1,8-diamino-p-menthane (pindobind) 5-HT1A, a novel 5-HT1A antagonist, on agonistic and social behaviour in mice. Employing a resident-intruder paradigm, administration of pindobind 5-HT1A (0.5-10 mg/kg) to resident animals produced a reduction in offensive sideways and chasing behaviour. Defensive postures were unchanged except for evasion, which was reduced. Within social behaviour, nonspecific social behaviour and following behaviour were reduced while stretch/attend behaviour was enhanced. Nonsocial behavioural changes included an increase in resident cage exploration and rearing. Intruder data indicated no significant change in offensive behaviours, an attenuation of defensive sideways posturing and evasion, decreases in attend behaviour, and increases in cage exploration, rearing, and digging. Results are discussed in relation to the effects of 5-HT1A receptor (ant)agonism on murine offensive behaviour.
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