Childhood Autism Rating Scale Scores Research Articles

RoboCA3T: A Robot‐Inspired Computer‐Assisted adaptive autism therapy for improving joint attention and imitation skills through learning and computing innovations

AbstractBackgroundThis study presents a Robot‐Inspired Computer‐Assisted Adaptive Autism Therapy (RoboCA3T) focusing on improving joint attention and imitation skills of children with autism spectrum disorder (ASD). By harnessing the inherent affinity of children with ASD for robots and technology, RoboCA3T offers a therapeutic environment designed to maximise engagement and facilitate effective skill development. It harnesses the advantages of Robot‐Assisted Therapies (RATs) by employing robot avatars and integrating them with Computer‐Assisted Therapies (CATs) within a web‐based solution. The integration of automatic gaze and pose detection algorithms within RoboCA3T addresses the challenge posed by potential human error and observation bias in assessing the child's progress, thereby ensuring accurate results. This research responds to the need for more effective, technology driven therapies for autism, filling gaps in existing methods.ObjectivesThe primary goal of this research is to create a robot inspired computer assisted adaptive autism therapy that maximises engagement and enhances joint attention and imitation skills.MethodsThe study involves 11 ASD children with 30 sessions (divided into two halves) per module over eight months, comprising 660 experimental trials, 110 familiarizations, and 110 follow‐up sessions. The joint attention module evaluates the subject's gaze pattern using WebGazer for gaze detection in response to four least‐to‐most robot‐generated cues. The imitation module utilises robot‐generated pose for comparing subjects' imitated actions using Tensorflow Lite for pose estimation.Results and ConclusionsThe effectiveness of therapy was substantiated by comparing Childhood Autism Rating Scale (CARS) scores before and after intervention. Significant improvements were noted between the first and second therapy halves, validated by Wilcoxon signed‐rank tests (p < 0.01) and spearman's correlation analysis, reinforcing the observed improvements in joint attention and imitation skills.

Investigation of communicative behaviors and communication functions of Turkish individuals with autism spectrum disorder through Communication Matrix

Objectives This study investigates the communication functions and communicative behaviors of Turkish individuals with Autism Spectrum Disorder (ASD), using the Turkish adaptation of the Communication Matrix. Methods Thirty participants with ASD (24 males, six females; age 2;5–22;11) were assessed using the Turkish Communication Matrix, the Childhood Autism Rating Scale (CARS), and Denver-II Developmental Screening Test. Based on the CARS scores, the participants were categorized into mild-moderate and moderate-severe autism groups. Differences in Communication Matrix scores between the groups were analyzed using the Mann Whitney-U Test, while the relationship between Communication Matrix and CARS scores was examined through Spearman’s correlation. Results Mild-to-moderate autistic participants exhibited more often and diverse communication functions and communicative behaviors, especially in behavior regulation (refuse and obtain), social interaction, and information-seeking or information-providing behaviors than those with moderate-to-severe autism. Significant differences emerged in communicative behaviors for social interaction and information-seeking or information-providing behaviors. A significant negative correlation was observed between CARS scores and communicative behaviors for social interaction and information-seeking or information-providing behaviors. Conclusions Increased autism severity reduces the diversity and functionality of communicative behaviors. Social interaction and information-seeking or information-providing behaviors are the skills that are most impacted by autism severity.

Serum interleukin-17 A and homocysteine levels in children with autism

BackgroundAutism Spectrum Disorder (ASD) is a neurodevelopmental condition that typically emerges early in childhood. This study aimed to explore the potential link between serum levels of vitamin B12 and homocysteine (Hcy) and the severity of ASD symptoms in children.MethodsIn this study, 50 children diagnosed with ASD comprised the observation group, while 50 healthy children constituted the control group. Serum levels of IL-17 A, Hcy, folate, and vitamin B12 were compared between the study group and control group, as well as among children with different degrees of ASD severity. The correlation between the Childhood Autism Rating Scale (CARS) score and serum levels of IL-17 A, Hcy, folate, and vitamin B12 was examined. Additionally, the relationship between serum IL-17 A and Hcy levels and their association with the severity ASD were explored.ResultsCompared to the control group, the observation group demonstrated elevated serum Hcy and IL-17 A levels alongside decreased folate and vitamin B12 levels. Individuals with severe ASD exhibited higher Hcy and IL-17 A levels but lower folate and vitamin B12 levels compared to those with mild to moderate ASD. The CARS score showed negative correlations with serum folate and vitamin B12 levels and positive correlations with serum IL-17 A and Hcy levels in ASD patients. Additionally, serum Hcy and IL-17 A levels were correlated with ASD severity.ConclusionChildren diagnosed with ASD presented with reduced serum vitamin B12 levels and increased levels of Hcy, potentially contributing to the onset and severity of ASD.

A Comparison of Parent Reports, the Mental Synthesis Evaluation Checklist (MSEC) and the Autism Treatment Evaluation Checklist (ATEC), with the Childhood Autism Rating Scale (CARS).

This study compares two parent reports, the Mental Synthesis Evaluation Checklist (MSEC) and the Autism Treatment Evaluation Checklist (ATEC), with the Childhood Autism Rating Scale (CARS). The ATEC consists of four subscales, as follows: (1) expressive language, (2) sociability, (3) sensory awareness, and (4) health. The MSEC is complementary to the ATEC in measuring complex language comprehension. The parents of 143 autistic children, from 2 to 22 years of age (mean 6.7 ± 5.1 years), completed the MSEC and the ATEC questionnaires and a clinician assessed their CARS score. The CARS score correlated strongly with all parent reports, the complex language comprehension MSEC (r = 0.60, p < 0.0001), expressive language (r = 0.66, p < 0.0001), sociability (r = 0.58, p < 0.0001), sensory awareness (r = 0.71, p < 0.0001), and health (r = 0.53, p < 0.0001), as well as the total ATEC score (r = 0.75, p < 0.0001). The strongest correlation was between the CARS score and the composite of all five parent-reported scores (total ATEC + MSEC, r = 0.77, p < 0.0001). These results suggest a high fidelity of the MSEC and ATEC parent reports and especially of their composite score, total ATEC + MSEC.

Assessment of brain-derived neurotrophic factor levels in serum of children with autism spectrum disorders

BackgroundThe autism spectrum disorder (ASD) has no identified biomarker for early detection or for its severity. As for the brain-derived neurotrophic factor (BDNF), it is a crucial neurotropic factor that regulates the plasticity and maturing of neuronal synapses. Accordingly, it might influence how children with autism develop.MethodTo evaluate the BDNF serum levels in autistic children and their relationship with the illness severity as well as with the common drugs received by autistic patients, 60 patients with autism along with another 60 normally developing children were involved in the study. Using the Childhood Autism Rating Scale (CARS), the severity of autism was then evaluated. The ELISA method was used to measure the BDNF level.ResultsIt was seen that the BDNF concentrations were higher in autism patients (P < 0.001). There was also a highly strong positive association between the CARS score and the BDNF (P < 0.001). Using the cut-off value of > 2.8 of BDNF helped to distinguish between well-developing and autistic children, with the aspects of “sensitivity” and “specificity” being 88.3% and 80%, respectively. Moreover, children with autism who received omega-3 had statistically lower levels of BDNF than those who did not take any (P = 0.040).ConclusionThe serum BDNF concentration is higher in autism; this proposes that the BDNF may contribute to the onset or progress of autism. Therefore, it may be used as a noninvasive biomarker for the illness severity because of its greater occurrence in autistic children who have severe social impairment.

Altered intra- and inter-network brain functional connectivity associated with prolonged screen time in pre-school children with autism spectrum disorder.

Prolonged screen time (ST) has adverse effects on autistic characteristics and language development. However, the mechanisms underlying the effects of prolonged ST on the neurodevelopment of children with autism spectrum disorder (ASD) remain unclear. Neuroimaging technology may help to further explain the role of prolonged ST in individuals with ASD. This study included 164 cases, all cases were divided into low-dose ST exposure (LDE group 108 cases) and high-dose ST exposure (HDE group 56 cases) based on the average ST of all subjects. Spatial independent component analysis (ICA) was used to identify resting state networks (RSNs) and investigate intra- and inter-network alterations in ASD children with prolonged ST. We found that the total Childhood Autism Rating Scale (CARS) scores in the HDE group were significantly higher than those in the LDE group (36.2 ± 3.1 vs. 34.6 ± 3.9, p = 0.008). In addition, the developmental quotient (DQ) of hearing and language in the HDE group were significantly lower than those in the LDE group (31.5 ± 13.1 vs. 42.5 ± 18.5, p < 0.001). A total of 13 independent components (ICs) were identified. Between-group comparison revealed that the HDE group exhibited decreased functional connectivity (FC) in the left precuneus (PCUN) of the default mode network (DMN), the right middle temporal gyrus (MTG) of the executive control network (ECN), and the right median cingulate and paracingulate gyri (MCG) of the attention network (ATN), compared with the LDE group. Additionally, there was an increase in FC in the right orbital part of the middle frontal gyrus (ORBmid) of the salience network (SAN), compared with the LDE group. The inter-network analysis revealed increased FC between the visual network (VN) and basal ganglia (BG) and decreased FC between the sensorimotor network (SMN) and DMN, SMN and ATN, SMN and auditory network (AUN), and DMN and SAN in the HDE group, compared with the LDE group. There was a significant negative correlation between altered FC values in MTG and total CARS scores in subjects (r = - 0.18, p = 0.018). Conclusion: ASD children with prolonged ST often exhibit lower DQ of language development and more severe autistic characteristics. The alteration of intra- and inter-network FC may be a key neuroimaging feature of the effect of prolonged ST on neurodevelopment in ASD children. Clinical trial registration: ChiCTR2100051141. What is Known: • Prolonged ST has adverse effects on autistic characteristics and language development. • Neuroimaging technology may help to further explain the role of prolonged ST in ASD. What is New: • This is the first study to explore the impact of ST on intra- and inter-network FC in children with ASD. • ASD children with prolonged ST have atypical changes in intra- and inter-brain network FC.

Vitamin D profile in autism spectrum disorder children and its relation to the disease severity

BackgroundThe study aimed to investigate whether vitamin D deficiency is a common finding in autism spectrum disorder (ASD) children and whether such deficiency is related to ASD severity and language age or not.MethodsA cross-sectional observational study was conducted on ASD children aged 2-6 years. The participants were 80 Egyptian children with ASD. All participants were assessed using DSM-V, the Childhood Autism Rating Scale (CARS), language assessment, and assessment of serum vitamin D using ADVIA Centaur Vit D assay.ResultsAbout 63.8% of ASD children have vitamin D insufficiency, 28.8 % have vitamin D deficiency, and 7.4% have normal serum levels. No correlation was found between serum vitamin D and language age (r = -0.085, P = 0.451), DSM 5 severity levels (r = 0.015,P= 0.894), and CARS scores (r= 0.075, P= 0.511).ConclusionASD children have lower serum vitamin D levels, which may be one of the environmental factors contributing to ASD development in genetically susceptible individuals, and its correction may be helpful as adjuvant therapy for ASD.

The role of play therapy in the development of social skills in children with ASD

In pursuit of reducing the severity of autism spectrum disorder (ASD), the Intensive, Interactive, and Individual (3i) intervention method employs rigorous developmental play therapy. A retrospective analysis was conducted on 12 children engaged in the 3i approach over a 3-month period to evaluate alterations in ASD severity and identify potential influencing factors at follow-up. Systematic assessment of ASD severity using the childhood autism rating scale (CARS) and autism diagnosis interview-revised (ADI-R) was performed on 25 patients commencing 3i intervention between September and December of 2023. Of these, 12 patients (average age: 4) underwent a second evaluation at the second month of follow up. Statistical comparison via paired student’s t-tests revealed noteworthy reductions in CARS and ADI-R scores after 2 months of 3i intervention, showcasing declines of 10%, 21%, 22.5%, and 20% in interaction, communication, and repetitive behavior subscores, respectively. Approximately 34% and 40.7% of participants shifted to lower ASD severity categories based on CARS scale and ADI-R interview, respectively. Multiple linear regression models demonstrated that higher treatment intensity (exceeding 10 hours per week) correlated significantly with greater improvements in the ADI-R interaction score. Patients initially classified as verbal subjects displayed better outcomes in CARS, ADI-R interaction, and ADI-R communication scores. Additionally, older patients exhibited more substantial improvements in the ADI-R interaction score. Nevertheless, no substantial impact was observed concerning gender, ASD severity, or comorbidities at baseline. This study, involving 12 children, suggests that 3i therapy yields significant reductions in ASD severity while enhancing interaction, communication, and repetitive behaviors. Future investigations incorporating control groups are imperative to gauge the comparative efficacy of 3i play therapy against alternative interventions.

Serum brain-derived neurotrophic factor concentration is different between autism spectrum disorders and intellectual disability children and adolescents

PurposeRecent studies showed that mature brain-derived neurotrophic factor (mBDNF) and its precursor proBDNF are associated with autism spectrum disorders (ASD). Whether their levels are different between ASD and intellectual disability (ID) subjects is not clear. The aim of this study is to compare the serum mBDNF and proBDNF concentration, and mBNDF/proBDNF ratio in ASD and ID volunteers. MethodsChildren and adolescents with ASD or ID between the ages of 4 and 22 were recruited in Tianjin, China. Serum mBDNF and proBDNF level were tested and Wechsler Preschool and Primary Scale of Intelligence (WPPSI), Wechsler Intelligence Scale for Children (WISC), and Childhood Autism Rating Scale (CARS) evaluations were conducted. ResultsSerum mBDNF concentration and the ratio of mBDNF to proBDNF was higher in ASD subjects than that in ID subjects (P = 0.035 and P < 0.001, respectively), while serum proBDNF of ASD participants was lower compared to that of ID participants (P < 0.001). CARS score was positively correlated with serum mBDNF level (r = 0.33, P = 0.004) and m/p ratio (r = 0.39, P < 0.001), and negatively correlated with serum proBDNF level (r = −0.39, <0.001) after adjusting for age and IQ. The AUC of mBDNF, proBDNF, and m/p ratio were 0.741, 0.790, and 0.854, respectively, after adjusted for age and IQ. ConclusionSerum mBDNF, proBDNF and m/p ratio were different between ASD and ID group. The three biomarkers displayed good diagnostic values for classification of ASD and ID subjects.

Caregiver-child interaction as an effective tool for identifying autism spectrum disorder: evidence from EEG analysis

BackgroundAutism Spectrum Disorder (ASD) is a complex neurodevelopmental disorder that affects individuals across their lifespan. Early diagnosis and intervention are crucial for improving outcomes. However, current diagnostic methods are often time-consuming, and costly, making them inaccessible to many families. In the current study, we aim to test caregiver-child interaction as a potential tool for screening children with ASD in clinic.MethodsWe enrolled 85 preschool children (Mean age: 4.90 ± 0.65 years, 70.6% male), including ASD children with or without developmental delay (DD), and typical development (TD) children, along with their caregivers. ASD core symptoms were evaluated by Childhood Autism Rating Scale (CARS) and Autism Diagnostic Observation Schedule-Calibrated Severity Scores (ADOS-CSS). Behavioral indicators were derived from video encoding of caregiver-child interaction, including social involvement of children (SIC), interaction time (IT), response of children to social cues (RSC), time for caregiver initiated social interactions (GIS) and time for children initiated social interactions (CIS)). Power spectral density (PSD) values were calculated by EEG signals simultaneously recorded. Partial Pearson correlation analysis was used in both ASD groups to investigate the correlation among behavioral indicators scores and ASD symptom severity and PSD values. Receiver operating characteristic (ROC) analysis was used to describe the discrimination accuracy of behavioral indicators.ResultsCompared to TD group, both ASD groups demonstrated significant lower scores of SIC, IT, RSC, CIS (all p values < 0.05), and significant higher time for GIS (all p values < 0.01). SIC scores negatively correlated with CARS (p = 0.006) and ADOS-CSS (p = 0.023) in the ASD with DD group. Compared to TD group, PSD values elevated in ASD groups (all p values < 0.05), and was associated with SIC (theta band: p = 0.005; alpha band: p = 0.003) but not IQ levels. SIC was effective in identifying both ASD groups (sensitivity/specificity: ASD children with DD, 76.5%/66.7%; ASD children without DD, 82.6%/82.2%).ConclusionOur results verified the behavioral paradigm of caregiver-child interaction as an efficient tool for early ASD screening.

Reduction in Retinal Ganglion Cell Layer, Inner Plexiform Layer, and Choroidal Thickness in Children With Autism Spectrum Disorder.

The aim of this study was to evaluate the retinal nerve fiber layer (RNFL), choroidal layer, inner plexiform layer (IPL), and ganglion cell layer (GCL) in patients with autism spectrum disorder (ASD). In this study, we measured the thickness of the RNFL, GCL, IPL, and choroidal thickness using a spectral optical coherence tomography (OCT) device and we compared the results between the children diagnosed with ASD and healthy controls. Correlation between the Childhood Autism Rating Scale (CARS) and the OCT data was evaluated. Both ASD and control group consisted of 40 subjects (30 males and 10 females). Of the children in the ASD group, 29 had normal intelligence and 11 had mild intellectual disability (MID). The mean age of patients in the ASD group and control groups were 9.77 ± 3.37 years and 9.85 ± 3.97 years (p = 0.928). There was a statistically significant difference between the ASD group and the control group in the nasal and nasal-superior sectors of the RNFL layers in the left eye when all the lower layers of RNFL were assessed. In both eyes, the children with ASD had considerably lower mean choroidal thicknesses than the controls. When compared to the controls, the GCL and IPL volumes in the individuals with ASD were considerably lower in both eyes. Compared to the MID group, the left GCL volume of the nasal-inferior group was noticeably higher. A significant correlation was found between CARS scores and left GCL left IPL. In contrast to RNFL in the ASD group, significant reductions in IPL, GCL, and choroidal thickness were observed in both eyes. It is thought that GCL may be a much more important biomarker than RNFL in terms of representing the structural deterioration in the brain. In addition, these results may form the basis for a new perspective on the use of OCT for the diagnosis and clinical course of autism.

Effects of transcranial pulse stimulation on autism spectrum disorder: a double-blind, randomized, sham-controlled trial.

Transcranial pulse stimulation has been proven effective to improve cognition, memory and depressive symptoms of Alzheimer's disease, but supporting evidence on other neurological diseases or neuropsychiatric disorders remains limited. This study aimed to investigate the effects of transcranial pulse stimulation on the right temporoparietal junction, which is a key node for social cognition for autism spectrum disorder, and to examine the association between transcranial pulse stimulation and executive and social functions. This double-blinded, randomized, sham-controlled trial included 32 participants (27 males), aged 12-17 years with autism spectrum disorder. All eligible participants were randomized into either the verum or sham transcranial pulse stimulation group, on a 1:1 ratio, based on the Childhood Autism Rating Scale screening score. Sixteen participants received six verum transcranial pulse stimulation sessions (energy level: 0.2-0.25 mJ/mm2; pulse frequency: 2.5-4.0 Hz, 800 pulse/session) in 2 weeks on alternate days. The remaining 16 participants received sham transcranial pulse stimulation. The primary outcome measure included Childhood Autism Rating Scale score changes, evaluated by parents, from baseline to 3-month follow-ups. Secondary outcomes included a self-reported questionnaire responded to by parents and cognitive tests responded to by participants. A licensed mental health professional evaluated clinical global impression severity, improvement, efficacy and total score. Results revealed significant interactions in Childhood Autism Rating Scale and other secondary outcomes. Significant group and time effects were found in most secondary outcomes. Additionally, significant differences were found between the transcranial pulse stimulation and sham transcranial pulse stimulation groups in Childhood Autism Rating Scale and clinical global impression improvement and total score immediately after 2 weeks of transcranial pulse stimulation intervention (all P < 0.05), and effects were sustainable at 1- and 3-month follow-up, compared with baseline. The effect size of Childhood Autism Rating Scale (d = 0.83-0.95) and clinical global impression improvement (d = 4.12-4.37) were large to medium immediately after intervention and sustained at 1-month post-stimulation; however, the effects were reduced to small at 3-month post-stimulation (d = 2.31). These findings indicated that transcranial pulse stimulation over right temporoparietal junction was effective to reduce the core symptoms of autism spectrum disorder, as evidenced by a 24% reduction in the total Childhood Autism Rating Scale score in the verum transcranial pulse stimulation group. Additionally, the clinical global impression total score was reduced by 53.7% in the verum transcranial pulse stimulation group at a 3-month follow-up, compared with the baseline. Participants in the verum transcranial pulse stimulation group had shown substantial improvement at 1- and 3-month follow-ups, compared with baseline, although some of the neuropsychological test results were deemed statistically insignificant. Future replication of this study should include a larger sample derived from multi-nations to determine transcranial pulse stimulation as an alternative top-on treatment option in neuropsychiatry.

Quantitative Relaxometry Assessment of Brain Microstructural Abnormality of Preschool Children With Autism Spectrum Disorder With Synthetic Magnetic Resonance Imaging.

This study aimed to perform an assessment of brain microstructure in children with autism aged 2 to 5 years using relaxation times acquired by synthetic magnetic resonance imaging. Thirty-four children with autism spectrum disorder (ASD) (ASD group) and 17 children with global developmental delay (GDD) (GDD group) were enrolled, and synthetic magnetic resonance imaging was performed to obtain T1 and T2 relaxation times. The differences in brain relaxation times between the 2 groups of children were compared, and the correlation between significantly changed T1/T2 and clinical neuropsychological scores in the ASD group was analyzed. Compared with the GDD group, shortened T1 relaxation times in the ASD group were distributed in the genu of corpus callosum (GCC) ( P = 0.003), splenium of corpus callosum ( P = 0.002), and right thalamus (TH) ( P = 0.014), whereas shortened T2 relaxation times in the ASD group were distributed in GCC ( P = 0.011), left parietal white matter ( P = 0.035), and bilateral TH (right, P = 0.014; left, P = 0.016). In the ASD group, the T2 of the left parietal white matter is positively correlated with gross motor (developmental quotient [DQ] 2) and personal-social behavior (DQ5), respectively ( r = 0.377, P = 0.028; r = 0.392, P = 0.022); the T2 of the GCC was positively correlated with DQ5 ( r = 0.404, P = 0.018); and the T2 of the left TH is positively correlated with DQ2 and DQ5, respectively ( r = 0.433, P = 0.009; r = 0.377, P = 0.028). All significantly changed relaxation values were not significantly correlated with Childhood Autism Rating Scale scores. The shortened relaxometry times in the brain of children with ASD may be associated with the increased myelin content and decreased water content in the brain of children with ASD in comparison with GDD, contributing the understanding of the pathophysiology of ASD. Therefore, the T1 and T2 relaxometry may be used as promising imaging markers for ASD diagnosis.

Therapeutic Impacts of Hyperbaric Oxygen Therapy and Risperidone on Children with Autism: A Clinical Trial.

In this research, we investigated any possible effect of receiving hyperbaric oxygen therapy (HBOT) or risperidone on the core symptoms of autism in children diagnosed with autism spectrum disorder (ASD). This study was a randomized, controlled clinical trial in Minia and Assiut University hospitals in Egypt with three parallel groups. One hundred and eighty children with autism, aged 5-8 years were divided into three equal groups (n=60). Group 1 (G1) received 40 sessions of HBOT within two months, group 2 (G2) received risperidone (dose: 0.25 mg per day in children weighing less than 20 kg and 0.5 mg per day in cases weighing more) for six months, and group 3 (G3) as the control group, received a placebo for six months. The assessment was done using childhood autism rating scale (CARS) and autism treatment evaluation checklist (ATEC) at the beginning of the study (baseline) and after one year. The mean total CARS and ATEC scores significantly decreased (improved) by varying degrees in the three groups after a year of follow-up compared to the baseline scores, but the best results were found in G1, G2, and G3, respectively. Using HBOT or risperidone is effective in treating the core symptoms of autism in children diagnosed with autism spectrum disorder, but using HBOT gives better results than risperidone therapy. Non-pharmacologic therapy can be used for the treatment of the core symptoms of autism.Both hyperbaric oxygen therapy and risperidone reduce the core symptoms of autism.Hyperbaric oxygen therapy gives better effects than risperidone in reducing the core symptoms of autism. Since the long-term use of drug therapy in children with autism leads to the occurrence of side effects in addition to the difficulty in complying with the drugs for long-term use, efforts have begun to use non-traditional alternative treatments, such as hyperbaric oxygen therapy. The current study assessed the therapeutic effect of hyperbaric oxygen therapy and risperidone on the core symptoms of autism. The results revealed that both hyperbaric oxygen therapy and risperidone reduced the core symptoms of autism, but hyperbaric oxygen therapy gave better therapeutic results than risperidone.

Trastorno del espectro autista y función ejecutiva

Introducción: las alteraciones en la función ejecutiva, especialmente en flexibilidad cognoscitiva, planeación, control inhibitorio y memoria de trabajo constituyen un elemento cardinal dentro las manifestaciones del trastorno del espectro autista (TEA).&#x0D; Objetivo: el objetivo de este trabajo fue evaluar el desempeño de las pruebas de función ejecutiva en una población de pacientes con trastorno del espectro autista (TEA).&#x0D; Materiales y métodos: se realizó un estudio observacional en niños de una institución de rehabilitación. Se evaluó el desempeño en las subpruebas de la evaluación neuropsicológica infantil, el puntaje de CARS (Childhood Autism Rating Scale) y otras variables, mediante un análisis de correlación de Spearman. El estudio fue aprobado por el Comité de Ética en Investigación y se obtuvo consentimiento de los padres.&#x0D; Resultados: se evaluaron ocho niños con edad promedio de 8,9 años (6,1-13,7) y puntaje CARS entre 32 y 46. Se encontró mejor desempeño en habilidades gráficas y menor fluidez gráfica y verbal y de flexibilidad cognitiva. La edad tuvo correlación directa con el puntaje en memoria de trabajo y con la capacidad de planeación. Un puntaje de CARS alto se correlacionó con bajo rendimiento en flexibilidad cognitiva, memoria de trabajo y fluidez gráfica no semántica.&#x0D; Conclusión: los niños con TEA son susceptibles de presentar alteraciones significativas en tareas relacionadas con las funciones ejecutivas, lo que puede explicar la tendencia a la perseveración, incapacidad de cambio de criterio y conductas estereotipadas. Esta disfunción se correlaciona con la severidad del autismo y varía según la edad. Aunque esta alteración no es un fenómeno que se presente exclusivamente en el TEA, constituye un elemento a tener en cuenta al momento de evaluar estos niños.

Association of feeding patterns in infancy with later autism symptoms and neurodevelopment: a national multicentre survey

BackgroundWe aimed to compare differences in infant feeding patterns (breastfeeding and complementary food supplementation) between children with the autism spectrum disorder (ASD) and typically developing (TD) children through a multicentre study. The relationship between these patterns and later core symptoms and neurodevelopment in children with ASD was also investigated.MethodsWe analysed breastfeeding and complementary feeding patterns in 1389 children with ASD and 1190 TD children. The Children Neuropsychological and Behavior Scale-Revision 2016 (CNBS-R2016) was used to assess neurodevelopmental levels. The Autism Behavior Checklist (ABC), Social Responsiveness Scale (SRS), Childhood Autism Rating Scale (CARS), and ASD Warning Behavior Subscale of the CNBS-R2016 were used to assess ASD symptoms.ResultsChildren with ASD had a shorter breastfeeding duration in infancy (8 (3–12) months vs. 10 (6–14) months, P < 0.001), later introduction of complementary foods (P < 0.001), and poorer acceptance of complementary foods (P < 0.001) than TD children. Total ABC and CARS scores were lower in the group of children with ASD who had been breastfed for 12 months or more than in the group who had been breastfed for less than 6 months. Children with ASD who were given complementary food after 6 months had lower general quotient (GQ), adaptive ability, fine motor and language scores than those who were given complementary food within 4–6 months. Children with ASD with poor acceptance of complementary foods had higher ABC and SRS scores and lower gross motor scores than those who had good acceptance.ConclusionsChildren with ASD have a shorter duration of breastfeeding, a later introduction of complementary foods, and poorer acceptance of complementary foods than TD children. These feeding patterns may be related to the symptoms and growth of children with ASD. The research suggests that continued breastfeeding for longer than 12 months may be beneficial in reducing ASD symptoms and that infants who have difficulty introducing complementary foods should be followed up for neurodevelopment.Trial registrationThe ethics committee of the Children’s Hospital of Chongqing Medical University approved the study. Approval Number: (2018) IRB (STUDY) NO. 121, and registered in the Chinese Clinical Trial Registry (Registration number: ChiCTR2000031194, registered on 23/03/2020).

Toxoplasmosis and cytomegalovirus infection and their role in Egyptian autistic children

Autism is a neurodevelopmental disorder with a significantly increased incidence rate across the world over the past few years. Toxoplasmosis and cytomegalovirus (CMV) infection are globally prevalent and have been associated with diverse neurological and psychiatric disorders. A few studies have demonstrated the role of toxoplasmosis and CMV as potential etiological factors for autism. Accordingly, this study was performed to estimate the relationship between toxoplasmosis and CMV infection in children with autism as well as to assess their impact on the Childhood Autism Rating Scale (CARS) score. A total of 45 autistic children (6 girls, 39 boys) and 45 (21 girls, 24 boys) healthy control children were enrolled in our study. Their blood samples were collected and tested for the presence of Toxoplasma and CMV (IgG and IgM) antibodies and DNA by ELISA and real-time PCR (RT-PCR), respectively. Toxoplasmosis was detected in 11 (24.4%) autistic children through the ELISA [10 (22.2%) IgG + /IgM − and 1 (2.2%) IgG + /IgM +]; however, RT-PCR assay recorded only 1 positive case (2.2%), while it was detected in 10 (22.2%) control children through ELISA [9 (20%) IgG + /IgM − and 1 (2.2%) IgG + /IgM +] and 1 (2.2%) by RT-PCR. On the other hand, CMV infection was detected in all autistic children with 44 (97.8%) testing positive by ELISA [24 (53.3%) IgG + /IgM − , 18 (40%) IgG + /IgM + and 2 (4.4%) IgG − /IgM +] and 25 (55.6%) testing positive by RT-PCR assay. In addition, ELISA assay recorded 43 (95.6%) [19 (42.2%) IgG + /IgM + and 22 (48.9%) IgG + /IgM − and 2 (4.4%) IgG-/IgM +] and RT-PCR recorded 21 (46.7%) positive samples in control children with CMV. No significant difference was noted between autistic and control children for the overall prevalence of Toxoplasma or/and CMV infection. Similarly, the CARS score indicated a non-significant difference with Toxoplasma or/and CMV infection. Our data does not show an association between autism and toxoplasmosis or/and CMV infection. Nevertheless, considering that autistic children are at a high risk of contracting these infections, further studies with a larger sample size are recommended.

Risk factors for developmental quotients in ASD children: A cross-sectional study.

To analyze the risk factors for developmental quotients (DQs) of children with autism spectrum disorder (ASD) and to better understand the effects of screen time on neurodevelopment in children with ASD. We retrospectively analyzed the data of 382 children with ASD, including demographic profiles; socioeconomic status; score on the Chinese parent-child interaction scale (CPCIS); screen time questionnaire; ASD symptom rating scales, including the Autism Behavior Checklist (ABC), Childhood Autism Rating Scale (CARS), and Autism Diagnostic Observation Schedule Second Edition (ADOS-2); and DQs using Griffiths Development Scales-Chinese Edition. Univariate analysis was carried out to analyze the factors related to the DQs of children with ASD, and then the linear regression model was used to identify the independent influencing factors of the DQs of children with ASD. Vitamin D (β = 0.180, p = 0.002), age (β = -0.283, p = 0.000) and CARS score (β = -0.347, p = 0.000) are risk factors related to DQ of locomotor in children with ASD. Vitamin D (β = 0.108, p = 0.034), CARS score (β = -0.503, p = 0.000), ADOS-2 severity score (β = -0.109, p = 0.045) and CPCIS score (β = 0.198, p = 0.000) are risk factors related to DQ of personal social skill in children with ASD. Vitamin D (β = 0.130, p = 0.018), CARS score (β = -0.469, p = 0.000), and CPCIS score (β = 0.133, p = 0.022) are risk factors related to DQ of hearing-speech in children with ASD. Vitamin D (β = 0.163, p = 0.003) and CARS score (β = -0.471, p = 0.000) are risk factors related to DQ of eye-hand coordination in children with ASD. Age (β = -0.140, p = 0.020), CARS score (β = -0.342, p = 0.000), ADOS-2 severity score (β = -0.133, p = 0.034) and CPCIS score (β = 0.193, p = 0.002) are risk factors related to DQ of performance in children with ASD. Vitamin D (β = 0.801, p = 0.000) and CPCIS score (β = 0.394, p = 0.019) are risk factors related to DQ of practical reasoning in children with ASD. Vitamin D status, the severity of autistic symptoms and parent-child interaction are risk factors for developmental quotients in children with ASD. Screen exposure time is negatively associated with DQs in children with ASD but is not an independent risk factor for DQs.

Immunotherapy In Autism Spectrum Disorder; A Case Series

IntroductionResearches has shown that a subset of the autism spectrum disorder (ASD) population presents with immune dysregulation. Based upon the immunological abnormalities, various treatment modalities have been applied to children with ASD. One immunomodulatory treatment that has been studied in ASD is intravenous immunoglobulins (IVIG).ObjectivesThis report is based upon two hypotheses: autism etiology may be closely related to neuroinflammation; and, an effective treatment should restore the individual’s comminication skills. In this report, we present two cases who were diagnosed with ASD and received IVIG treatment.MethodsCase A is a 5-year-old female patient who was diagnosed with ASD at the age of 3. The second case, B is a 9 -year-old male patient who is a 7th grade student and was also diagnosed with ASD at the age of 3. The first patient’s autism symptoms was noticed by her family at the age of 2. Although she had the ability to coordinate eye contact, understood simple commands, she was observed to lose all her acquired developmental skills one by one at around 18-24 months. Towards the age of 3, stereotypical movements such as turning around and flapping wings, started. Similarly, the second patient’s acquired skills were lost around at the age of 2-3, after having recurrent infections. Based on deficits in social‐emotional reciprocity, deficits in nonverbal communicative behaviors used for social interaction and restricted/repetitive patterns of behavior, both patients were diagnosed with ASD. Considering that autoimmune mechanisms may have been affected in ASD, IVIG treatment was initiated at 1 g/kg/month. Case A received IVIG once in a month, total 5 infusions had been applied. Case B received total 12 infusions with the same protocol. Treatment response was assessed with the Childhood Autism Rating Scale (CARS).ResultsIn these two ASD cases which were treated with IVIG ,a subjective partial reduction in autism symptoms and an objective decrease in CARS scores were detected. Current evidence suggests that there are various factors contributing to the development of autism and different combinations of these aspects give rise to different variations of some ASD subtypes. Recent studies in this field indicate a possible connection between the immune system impairments and ASD. This report, therefore, provide support for the notion that at least a subset of children with ASD might have immune abnormalities and may respond to the immune modulating effect of IVIG therapy.ConclusionsAlthough, autoimmune or inflammatory etiologies may not explain the majority of cases of autism, it might at least be useful to understand some. Further studies with larger number of patients should be conducted about the use of IVIG in selected patients with ASD.Disclosure of InterestNone Declared

Assessment of Sonographic Carotid Parameters in Autism Spectrum Disorder: A Comparative Case Control Study

ABSTRACT Objective To compare carotid intima-media thickness (cIMT), systolic and diastolic diameters (D), intima-media thickness/diameter ratio (IDR) values in children with ASD, and control groups, and to analyze the correlation of these parameters with the Childhood Autism Rating Scale (CARS) scores. Methods This prospective case-control study included 37 children diagnosed with ASD and 38 individuals without ASD in the control group. Correlation assessments of sonographic measurements with CARS scores in the ASD group were also performed. Results Diastolic diameters of the right (median of ASD group:5.5 mm, control group:5.1 mm) and left (median of ASD group: 5.5 mm, in control group: 5.1 mm) side were higher in the ASD group (p = .015 and p = .032 respectively). A statistically significant correlation was detected between CARS score and left cIMT, right cIMT, right cIMT/systolic D, right cIMT/diastolic D, left cIMT/systolic D, and left cIMT/diastolic D (p < .05). Conclusion Vascular diameters, cIMT, and IDR values of children with ASD positively correlated with CARS scores, and these findings could be interpreted as a marker of early atherosclerosis in children with ASD.