Childhood Autism Rating Scale Research Articles

Evaluation of antineuronal antibodies and 8-OHdG in mothers of children with autism spectrum disorder: a case-control study

Objective The purpose of our study was to investigated the anti-Yo, anti-Hu, anti-Ri, anti-amphiphysin antibody levels and 8-OHdG in mothers of children with autism. Methods This study included 60 participants, 33 of whom were healthy mothers of 3–12-year-old children diagnosed with autism spectrum disorder (ASD) and the 27 others who constituted the control group, were healthy mothers with age-matched healthy children. Two groups were examined for plasma anti-Yo, anti-Hu, anti-amphiphysin and anti-Ri antibodies and, 8-OHdG levels. The participants were asked to accomplish a sociodemographic data form. The severity of ASD symptoms was evaluated according to the Childhood Autism Rating Scale (CARS). Results Anti-amphiphysin antibody levels and anti-Ri antibody positivity were significantly higher in the case group (p = 0.001; p = 0.027, respectively). The two groups did not significantly differ in terms of anti-Yo and anti-Hu antibody levels and in terms of 8-OHdG levels (p = 0.065; p = 0.099; p = 0.490, respectively). The two groups did not significantly differ in terms of sociodemographic data (p > 0.05). Conclusions According to the our study, maternal antineuronal antibodies, such as anti-amphiphysin and anti-Ri, may contribute to the risk of childhood autism. Studies with larger samples are needed. KEY POINTS Maternal factors associated with autism should be investigated in order to create early diagnosis and treatment opportunities for autism. Based on the importance of immunological and cerebellar pathologies in autism aetiology, we aimed to investigate antineuronal antibodies in mothers of children with autism. Maternal antineuronal antibodies, such as anti-amphiphysin and anti-Ri, may contribute to the risk of childhood autism. High anti-amphiphysin antibody levels in mothers of children with autism may also occur against the amphiphysin in the structure of the SrGAP3 gene, which is associated with autism.

Development of the Interactive Rehabilitation Game System for Children with Autism Based on Game Psychology

Autism is a widespread neurodevelopmental disorder. The cause of autism is still unclear. Once it occurs, it will be accompanied for life. Intervention treatment is currently recognized as an effective method. With the rise of somatosensory technology, Kinect has gradually been applied to the field of autism rehabilitation with its natural human-computer interaction and game rehabilitation psychology. Because there is a great demand for autism rehabilitation training resources in China and the existing somatosensory rehabilitation equipment has some shortcomings, this study designed a set of somatosensory rehabilitation system for autistic children based on Kinect and carried out its rehabilitation effect with experimental demonstration. The specific research work mainly includes the following contents: first, aiming at the rehabilitation needs of children with autism, this article combines mainstream intervention treatment methods, using C# programming language and Windows Presentation Foundation (WPF) development technology to develop Kinect-based somatosensory game modules. The somatosensory rehabilitation game involves the training of the language communication, behavioral movement, daily life, sensory integration, and other comprehensive abilities of children with autism, which improves the shortcomings of the previous rehabilitation training in the scope of intervention. A variety of game types and diversified game modes are designed to meet the individual needs of rehabilitation training for children with autism. Second, experiments were carried out to verify the rehabilitation effect of the system. Using the Childhood Autism Rating Scale (CARS) and Pediatric Evaluation of Disability Inventory (PEDI) scale as the rehabilitation effect evaluation tools of this system, the experimental subjects were divided into the experimental group and control group, and different comparative experiments were conducted, respectively. Through the analysis of the scoring data of the CARS, it is found that the comprehensive ability of the experimental group of children receiving somatosensory rehabilitation training is significantly improved. Through the analysis of the scoring data of the PEDI scale, it is found that the children’s language communication, behavioral activities, and daily life abilities of the experimental group have been significantly enhanced. This article focuses on the design of the somatosensory game module of the autistic somatosensory rehabilitation system and the analysis of the system’s rehabilitation effect. It satisfies the training and rehabilitation needs of children with autism and has strong practical significance.

Therapeutic Effect of Camel Milk in Children with Autism: Its Impact on Serum Levels of Vasoactive Intestinal Peptide

Background: Camel milk (CAM) regulates the inflammatory process, apoptotic pathways and oxidative stress. Thus, it is a therapeutic possibility for many autoimmune disorders, including autism. Vasoactive intestinal peptide (VIP) is an anti-inflammatory peptide that facilitates the immune regulatory functions by recruiting regulatory T cells to induce immune tolerance and prevent the occurrence of autoimmunity. This study aimed to investigate the effect of CAM consumption on both serum VIP levels and the severity of autism assessed by measuring the Childhood Autism Rating Scale (CARS). Mehods: Sixty-five autistic children, aged between 3-12 years, were studied. Forty-seven patients received 500 mL of CAM (either raw "24 patients" or boiled "23 patients") in their regular daily diet for two weeks. Eighteen patients received 500 mL of cow milk for two weeks. For all patients, CARS and serum VIP levels were assessed before and after milk consumption. Results: Although there was a decrease in CARS scores in patients who received raw CAM, this decrease was non-significant (P=0.070). Serum VIP levels were increased in patients who consumed CAM, either raw (P=0.076) or boiled (P=0.065), but this increase was non-significant. Conclusions: CAM consumption for 2 weeks neither significantly decreased the severity of autism nor increased serum anti-inflammatory VIP levels. The lack of a significant response to CAM in this study may be attributable to the short duration of CAM consumption. Further studies are required to investigate the effect of CAM consumption for a longer duration on serum VIP levels and the severity of autism.

Clinical outcomes of children with ASD - Preliminary findings from a 18 month follow up study.

Parent-mediated intervention for children with Autism Spectrum Disorder (ASD) is a critical component to deliver evidence-based interventions in resource-limited settings. There is a need for methodologically rigorous longitudinal and follow-up studies of children with ASD to understand clinical outcome and developmental trajectories. We report the clinical outcome at 18-month follow-up of children diagnosed with ASD who received parent-mediated intervention for a 3-month period as part of a feasibility study. The study participants were followed up for 18 months as part of Treatment As Usual (TAU). Symptom severity and adaptive functioning were assessed on Childhood Autism Rating Scale (CARS) and Vineland Social Maturity Scale (VSMS) respectively. All the study participants(n = 42), continued to show improvement between baseline and the two follow-up evaluations at 3 months and 18 months respectively, with reduction in symptom severity, improvement in core features of ASD and adaptive functioning. The maximum gains were attained during the first three months. Three subgroups were identified based on the trajectory of improvement: 1) Children with best possible outcomes, 2) Child with maintenance of gains, and 3) Children with minimal improvement. Seven participants (16.7 %) had the 'best possible' outcome at 18-month follow-up with CARS scores in the non-autistic range and they no longer qualified for a DSM-5 diagnosis of ASD. The intensity of early intervention is pivotal to positively alter the developmental trajectories in children with ASD. Parent-mediated intervention is the best possible mode of intervention delivery to initiate early intervention and address the prevailing challenges in resource-limited settings.

Neurodevelopmental Outcomes after Neonatal Mechanical Ventilation

Abstract Background A majority of extremely preterm infants are treated with mechanical ventilation, which is associated with an increased risk for future development of chronic lung disease, neonatal brain damage, and neurodevelopmental impairments. Objectives The aim of the current study was to evaluate the current and follow up neurodevelopmental status of an Egyptian sample of newly and previously discharged mechanically ventilated infants following them up for a period of 6 months for the earlier group and a year for the latter. Patients and Methods The current study was designed to be a descriptive study with retrospective (50 infants) and prospective (50 infants) domains. It was carried out on 100 neonates who were recruited from the Pediatric Neonatology Clinic, Children's Hospital and Neonatal Intensive Care Unit, Ain Shams University using clinical evaluation, Bayley Scales of Infant Development, and Childhood Autism Rating Scale (CARS).. Results There was statistically significant negative correlation between CARS score and Bayley Scale by using Composite Score (Cognitive, Language and Motor) on first assessment and follow up in the Prospective group while no correlation was found in the retrospective group. The study results showed that there was no statistical significant difference between two groups as regards gestational age, gender, residency, consanguinity, maternal disease, maturity, mode of delivery, respiratory distress, duration of stay in NICU, duration on mechanical ventilation, weight on admission, audiometry and fundus examination (P > 0.05). Conclusion Using a mechanical ventilator in the neonatal period for a prolonged duration increased the risk for ASD and neurodevelopmental delay. Future studies on large samples are recommended from multicenters to confirm the validity of such findings, Bayley scale is a predicative for neurodevelopmental delay in neonates with long duration stay at NICU especially preterms with low birth weight.

6.17 Transcranial Photobiomodulation (tPBM) Is a Noninvasive Form of Brain Stimulation That Can Improve Language and Social Skills Acquisition in Children With Autism Spectrum Disorder

The objective of this presentation is to demonstrate if transcranial photobiomodulation (tPBM) is an effective treatment modality to improve language and communication skills in children with autism spectrum disorder (ASD). In recent pilot studies, tPBM has been shown to be effective for stroke, traumatic brain injury (TBI), and depression. Furthermore, recently, 2 small pilot studies showed that tPBM can reduce symptoms of ASD. We hypothesized that children with ASD will demonstrate improvement in communication skills and language acquisition with this experimental treatment. Our study looked at the effect of tPBM modulation on symptoms of ASD in children aged 2 to 6 years. Currently, 14 out of 30 participants are enrolled in this randomized, placebo-controlled, double-blind study. Participants are wearing the tPBM device for 5 minutes, and 16-20 j are administered during each session. Each participant completes 16 sessions during an 8-week course of the study. Weekly behavioral data are collected from parents. Children's therapists are interviewed regarding any observed changes in the child's behavior. Before-and-after treatment scores of the Childhood Autism Rating Scale (CARS) are compared for placebo and experimental conditions. EEGs from the occipital and temporal areas are collected before and after each treatment. We demonstrated that tPBM could be an effective treatment for younger children with ASD and to contribute to improving language skills. Preliminary CARS results show an effect that is approaching statistical significance: experiment (before: 45.8 ± 5.5; after: 39.5 ± 9.5; change: –6.3 ± 5.9) and control (before: 38.9 ± 7.8; after: 42.3 ± 9.4; change: 3.4 ± 6.4) (t test p value: 1-sided p = 0.0106, 2-sided p = 0.0211). EEG changes show a decrease in delta and theta waves and an increase in alpha, beta, and gamma in a few patients associated with language skill improvement and faster language acquisition. The proportion of delta/theta/alpha/beta waves in T3 before treatment was 13.5%/41%/0.5%/45% respectively. After treatment, it was 3%/9,5%/0%/67% respectively. We demonstrated that tPBM is a safe and effective treatment modality for younger children with ASD. tPMB could contribute to language and communication skills improvement in children with ASD.

6.2 Evaluation of an Artificial Intelligence–Based Medical Device Designed to Aid in the Diagnosis of Autism Spectrum Disorder in the Primary Care Setting

The lack of diagnostic tools for autism spectrum disorder (ASD) in primary care settings and long waiting lists for specialist assessment contribute to an average delay of 3 years between first parental concern and diagnosis. This study examined the performance of an artificial intelligence–based device intended to aid primary care practitioners (PCPs) in the diagnosis of ASD. This was a prospective multisite pivotal study conducted in 6 states using a double-blind active comparator design with 425 completed subjects (36% female) ages 18 to 72 months with concern for developmental delay. Previous research developed, tuned, and tested a device that uses a gradient-boosted decision-tree machine learning algorithm that analyzes 64 behavioral features from 3 distinct inputs: 1) caregiver questionnaire; 2) 2 to 4 minutes of home videos analyzed by trained video analysts; and 3) PCP questionnaire. Device results were compared to diagnosis by independent agreement of specialist clinicians based on clinical assessment, including a modified Child Autism Rating Scale (CARS-2) and DSM-5 criteria. Specialists were child and adolescent psychiatrists, child psychologists, pediatric neurologists, and developmental behavioral pediatricians experienced in diagnosing ASD. Comparison of device results to specialist diagnosis found the following for subjects with determinate device results: positive predictive value (PPV) = 80.8% (95% CI, 70.3-88.8); negative predictive value (NPV) = 98.3% (90.6-100); sensitivity = 98.4% (91.6-100); and specificity = 78.9% (67.6-87.7). There was no evidence that device performance significantly varied when the PCP used the device remotely compared to in-person. Using this device, PCPs could efficiently, accurately, and equitably diagnose a subset of children aged 18 to 72 months old, thereby streamlining specialist referrals and facilitating earlier ASD diagnosis and interventions. The results further provide preliminary evidence that PCP evaluation of the child can be done via telemedicine or in-person with no degradation in device performance.

Correlation Between Serum Concentrations of Menaquinone-4 and Developmental Quotients in Children With Autism Spectrum Disorder.

Objective: The vitamin K family has a wide range of effects in the body, including the central nervous system. Menaquinone-4 (MK-4), a form of vitamin K2, is converted from phylloquinone (PK), which is the main source of dietary vitamin K and is the main form of vitamin K in the brain. We conducted this study to investigate the serum concentration of MK-4 and the correlations between MK-4 and developmental quotients in children with autism spectrum disorder (ASD).Methods: We selected 731 children with ASD who were diagnosed for the first time. During the same period, 332 neurotypical children who underwent regular physical examinations in our outpatient department were selected as the TD group. We investigated the general situation of children, including gender and age. Children in ASD group were assessed for autistic symptoms and development quotients, including Autism Behavior Checklist (ABC), Childhood Autism Rating Scale (CARS), ADOS-2, and Griffiths Development Scales-Chinese Language Edition (GDS-C). Both groups of children were tested for serum menaquinone-4. We compared serum menaquinone-4 levels of ASD group and TD group. We then conducted a correlation analysis between the level of menaquinone-4 and the developmental quotient of children with ASD.Results: The results of this study indicate that the serum concentration of MK-4 in children with ASD is lower than that in children with typical development (t = −2.702, P = 0.007). The serum concentration of MK-4 is related to the developmental quotients of several subscales in ASD children, and this correlation is more obvious in males.Conclusion: we conclude that MK-4 is present in lower concentrations in children with ASD, which may affect cognition and developmental quotients. The role of MK-4 in ASD needs to be further explored.

Investigating Developmental Profiles of Children with Autism Spectrum Disorders: Early Indicators and Directions for Intervention

The study describes the relationships between autistic symptomatology severity, developmental heterogeneity, and chronological age for a group of 62 Brazilian children with ASD (59 boys, 3 girls); average chronological age was 42 months and 8 days (SD = 17 months, 15 days). Assessments were carried out with the Social Cognitive Evaluation Battery (SCEB), a French psychological assessment tool currently being validated in Brazil, and the Childhood Autism Rating Scale (CARS). Results indicated a negative correlation between developmental levels and intensity of autistic symptoms; a negative correlation between heterogeneity indices and developmental levels; and a positive correlation between heterogeneity indices and autistic symptomatology intensity. When comparing the group of younger children (less than 33 months) to the older children in the sample, the study demonstrates that early socio-emotional heterogeneity is a developmental marker in young children with ASD, and this finding can lead to personalized intervention programs.

Effect of parental skills-based psychoeducation intervention on parental stress index and severity of children with autism spectrum disorders: A pilot study

ObjectiveAnalyzing the effect of psychoeducation on parental stress index and the severity of children with autism spectrum disorders. MethodsParticipants in the study consisted of autism spectrum disorder children and their parents who were divided into 2 groups (treatment = 15 and control group = 20). Participants were given psychoeducation as many as 6 sessions for 14 weeks (7 weeks for each group). Participants were measured for the value of the childhood autism rating scale (CARS) and autism parenting stress index (APSI) pre-post psychoeducation. ResultsThere were significant differences in the treatment group in terms of total CARS values (40.73 ± 7.17 vs −7.67 ± 4.91; p < 0.001), communications (5.60 ± 1.45 vs −4.73 ± 1.49; p = 0.001), social interactions (10.20 ± 2.18 vs 8.93 ± 2.66; p = 0.011), and psychomotor (18.33 ± 3.96 vs 14.27 ± 3.90; p < 0.001) before and after psychoeducation, whereas there were no significant differences in the control group (p > 0.05). In the treatment group, there were significant differences in total APSI values (17.33 ± 9.99 vs 12.20 ± 4.02; p = 0.001), social difficulties (8.73 ± 4.60 vs 6.00 ± 4.02; p = 0.002), and physical (4.13 ± 3.54 vs 2.27 ± 2.99; p = 0.013) before and after psychoeducation, while there were no significant differences in behavior (p = 0.443). There were no significant differences in the control group (p > 0.05). There was a significant influence between psychoeducation on parental stress index (p = 0.003) and the severity of children with autism spectrum disorders (p < 0.001). ConclusionThere is a decrease in parental stress index and severity of children with autism spectrum disorders after parental psychoeducation intervention.

Sex/Gender Differences in CARS2 and GARS-3 Item Scores: Evidence of Phenotypic Differences Between Males and Females with ASD.

Growing evidence suggests that autistic females are more likely to be diagnostically overlooked than males, perhaps due to differences in ASD presentations (van Wijngaarden-Cremers in JAMA 44:627-635, 2014). To investigate specific behaviours in which differences lie, we analysed profiles of 777 children using the Childhood Autism Rating Scale (Scholper in JAMA 29:489-493, 2010) or Gilliam Autism Rating Scale (Gilliam, 2014). Males demonstrated greater difficulty in six CARS2-ST items and seven behaviours on the GARS-3, mostly reflecting restricted and repetitive behaviours. Across all instruments, the only area in which females showed greater difficulty was fear or nervousness (CARS2-ST). No meaningful differences emerged from the CARS2-HF analysis. Where males showed greater difficulty, females were more likely to present with developmentally typical behaviour.

Overconnectivity of the right Heschl's and inferior temporal gyrus correlates with symptom severity in preschoolers with autism spectrum disorder.

Previous studies have reported varying findings regarding the association of brain connectivity in autism spectrum disorder (ASD) with overconnectivity, underconnectivity, or both. Despite the emerging understanding that ASD is a developmental disconnection syndrome, very little is known about structural brain networks in preschool‐aged children with low‐functioning ASD. We aimed to investigate the structural brain connectivity of low‐functioning ASD using diffusion magnetic resonance imaging and graph theory to examine alterations in different brain network topologies and identify any correlations with the clinical severity of ASD in preschool‐aged children. Fifty‐two preschool‐aged children (28 with ASD and 24 with typical development) were included in the analysis. Graph‐based network analysis was performed to examine the global and local structural brain networks. Nodal network measures exhibited increased nodal strength in the right Heschl's gyrus, which was positively associated with all autistic clinical symptoms (Autism Diagnostic Observation Schedule and Childhood Autism Rating Scale [CARS]). The nodal strength of the right inferior temporal gyrus showed a moderate correlation with the CARS score. Using network‐based statistics, we identified a subnetwork with increased connections encompassing the right Heschl's gyrus and the right inferior temporal gyrus in preschool‐aged children with ASD. The asymmetric value in the inferior temporal gyrus exhibited right dominance of nodal strength in children with ASD compared to that in typically developing children. Our findings support the theory of aberrant brain growth and overconnectivity as the underlying mechanism of ASD and provides new insights into potential regional biomarkers that can detect low‐functioning ASD in preschool‐aged children.Lay SummaryThis study supports the theory of aberrant brain growth and overconnectivity as an explanation for ASD. Measuring the right HG and inferior temporal gyrus provides new insights of potential regional biomarkers underpinning ASD in preschool‐aged children.

Serum Zonulin Levels Are Higher Among Children with Autism Spectrum Disorders and Correlated with Social Impairment.

Zonulin is a protein that affects the integrity of intercellular connections in the intestines. It has been emphasized that autoimmune diseases as well as neurodevelopmental disorders, for example autism spectrum disorder (ASD), may occur through alterations in intestinal permeability and blood-brain barrier. We aimed to investigate the gastrointestinal permeability of individuals with ASD by determining serum zonulin levels and their relationship to symptom severity. Twenty-five ASD patients and 19 controls were included. Serum zonulin levels were measured by enzyme-linked immunosorbent assay kits. Clinical severity was assessed by the Childhood Autism Rating Scale (CARS), and social skills of the control group were evaluated by the Conners' Parents and Teacher's Rating Scales-Revised/Long Forms (CPRS-CTRS). Mean zonulin levels were significantly higher in the ASD group and positively correlated with CARS scores. After regression analysis, serum zonulin levels predicted CARS total scores. We could not find any significant correlation between zonulin levels and CPRS-CTRS sociability subscale scores in the control group. The positive correlation between serum zonulin levels and ASD severity may require precaution for impaired intestinal permeability in clinical practice, especially for the cases in which sociability is severely impaired. However, it is too early to state that intestinal permeability has a role in the etiology of ASD. Further studies involving specific autism subgroups, and samples with certain dietary differences are needed.

Specifics in Children's Drawings with Autism

Background: The peculiarities of sensory perception and perception of one's own body in children with autism are the basis for understanding their cognitive and social development difficulties.&#x0D; Objective: The study aims to structure different categories of drawings of children with autism and compare them with the severity of autism measured by CARS2. Methods: 120 children aged 3 to 9 years were studied (X= 6.26, SD = 3.16). Drawings of autistic children. The children have a white sheet, pencils, a children's drawing table, and the experimenter asks them to draw a person. The children were studied with CARS. 2. Clinical method: includes observation, direct work with the child on each of the topics of the methodology used, interview with parents, diagnostic discussion with the clinical team. Psychodiagnostic method: includes an examination of children with mental developmental stairs, assessment of cognitive, communication, socioemotional and sensorimotor functions. CARS 2 Childhood Autism Rating Scale | Second Edition Statistical.&#x0D; Method: includes data processing using the SPSS programme. Descriptive statistics, correlation analysis, a frequency distribution of data are used for data analysis.&#x0D; Results: The results show eight main categories of drawings in autistic children: 1. circles, water; 2. patches of colour covering the human figure or representing a human figure without an external boundary; 3. figures and letters; 4. human figures fenced as a bubble, a human figure composed of parts of objects (the elements are not connected); 5. objects with geometric shapes (buildings, roads with markings, apartment blocks, strange shells; 6. road signs, logos.&#x0D; Conclusions: There is no statistical dependence between the severity of autistic symptomatology and the types of drawings. We can draw some conclusions about how a child with autism perceives his own body from the presented results. Because we see that in mild and moderate degrees of autism CARS 2, the whole variety of drawing categories was evaluated, while in severe and very severe degrees of expression of the disorder circles, colourful spots with vague boundaries predominate. Children with autism often identify with non-living objects, street signs, eccentric houses and towers.

Retinol-binding protein 4 in combination with lipids to predict the regression phenomenon of autism spectrum disorders

BackgroundAbout 20–40 % of autistic people experience a phenomenon of regression. Retinol binding protein 4 (RBP4) plays an important role as an inflammatory neurotrophic adipokine and is a promising mediator of the fat-brain axis. Abnormal fatty acid metabolism and lipid mediators have been reported to be related to the etiological mechanism in autism, and amelioration of impaired lipid metabolism can be recognized as a treatment strategy for autism. The purpose of this study is to explore the relationship between RBP4, lipids, and the autistic regression phenomenon, and to discuss their potentials as biomarkers for the autistic regression phenomenon.MethodsA total of 60 autistic individuals (18 with regression phenomenon, 42 without regression phenomenon) (ASD group) and 36 healthy controls were enrolled in this case-control study. The levels of RBP4, total cholesterol (TC), high-density lipoprotein (HDLC), low–density lipoprotein (LDLC), and triglyceride (TG) were measured. Childhood Autism Rating Scale (CARS) is used to assess the severity of autism. Ethical measures were performed in compliance with the current Declaration of Helsinki and written informed consent was obtained from the parents before enrollment of the children and adolescents.ResultsCompared with control subjects, autistic individuals had lower levels of TC (P = 0.007), RBP4 (P = 0.001), and HDLC (P = 0.027). The levels of RBP4 in ASD group were positively correlated with TG (r = 0.355, P = 0.005), HDLC (r = 0.257, P = 0.047), TG/TC (r = 0.376, P = 0.003) and TG/LDLC (r = 0.363, P = 0.004), and were negatively correlated with CARS (r=-0.296, P = 0.003). Further logistic regression demonstrated that decreased RBP4 concentration was associated with the presentation of the autistic regression phenomenon even after the adjustment of the potential confounding factors.ConclusionsSerum RBP4 is associated with the autistic regression phenomenon and the severity of ASD. Further studies are needed to expound whether decreased RBP4 participates in the development of the autistic regression phenomenon.

An Experimental Trial: Multi-Robot Therapy for Categorization of Autism Level Using Hidden Markov Model

Several robot-mediated therapies have been implemented for diagnosis and improvement of communication skills in children with Autism Spectrum Disorder. The proposed research uses an existing model i.e., Multi-robot-mediated Intervention System (MRIS) in combination with Hidden Markov Model (HMM) to develop an infrastructure for categorizing the severity of autism in children. The observable states are joint attention type (low, delayed, and immediate) and imitation type (partial, moderate, and full) whereas the non-observable states are (level of autism i.e., (minimal, and mild). The research has been conducted on 12 subjects in which 8 children were in the training session with 72 experiments over 9 weeks, and the remaining 4 subjects were in the prediction test with 25 experiments for 6 weeks. The predicted category was compared with the actual category of autism assessed by the therapist using Childhood Autism Rating Scale. The accuracy of the proposed model is 76%. Further, a statistically significantly moderate Kappa measure of agreement between Childhood Autism Rating Scale and our proposed model has been performed in which n = 25, k = 0.52, and p = 0.009. This research contributes towards the usefulness of Hidden Markov Model integrated with joint attention and imitation modules for categorizing the level of autism using multi-robot therapies.

Sleep problems in children with autism spectrum disorder: a\xa0multicenter\xa0survey

BackgroundHigh prevalence of sleep problems have been reported in children with Autism Spectrum Disorder (ASD). This study aims to investigate the sleep conditions of ASD children in China, and explore the relationship between the common sleep problems and core symptoms and developmental levels.MethodsUsing a cross-sectional design, we included 2 to 7-year-old children from 13 cities in China: 1310 with ASD and 1158 with typically-developing (TD) children. The neurodevelopmental level was evaluated with the revised Children Neuropsychological and Behavior Scale (CNBS-R2016). ASD were diagnosed with DSM-5 and Child Autism Rating Scale (CARS). the Social Responsiveness Scale (SRS), the Autism Behavior Checklist (ABC) and the communication warning behavior sub-scale in CNBS-R2016 valued autism behaviors. The children’ s sleep habits questionnaire (CSHQ) assessed sleep conditions.ResultsThe prevalence of sleep disorders in ASD children was significantly higher than that in TD (67.4% vs. 51%, p < 0.01), and among them the four dimensions with the highest prevalence of sleep problems were bedtime resistance (25.6%), sleep anxiety (22.7%), sleep onset delay (17.9%) and daytime sleepiness (14.7%). ASD children with sleep onset delay or sleep anxiety had higher ABC, SRS scores and higher scores on communication warning behavior with sleep anxiety, with daytime sleepiness had higher ABC, SRS and CARS scores, and with bedtime resistance had higher SRS total scores. Differences in the neurodevelopmental level were not significant.ConclusionChildren with ASD have a higher prevalence of sleep problems. Bedtime resistance, anxiety, sleep onset delay and daytime sleepiness may be related to the core symptoms, but not be related to the developmental level in ASD children. In the clinic, sleep assessment should be included in the routine of ASD visits, and during the intervention, sleep hygiene education is as important as the treatment of biological factors.Trial registrationThe study was approved by the ethics committee of the Children’s Hospital of Chongqing Medical University, Approval Number: (2018) IRB (STUDY) NO. 121, and registered in the Chinese Clinical Trial Registry (Registration number: ChiCTR2000031194).

Screen Time and Autism: Current Situation and Risk Factors for Screen Time Among Pre-school Children With ASD.

Objective: To investigate the current status of screen time in children with ASD, its correlation with autistic symptoms and developmental quotient (DQ), and the factors affecting screen time.Method: One hundred ninety-three Chinese children with ASD were recruited. We collected the demographic and screen time data using a questionnaire. The ASD core symptoms and developmental quotient (DQ) were measured by the Autism Behavior Checklist (ABC), Childhood Autism Rating Scale (CARS), Autism Diagnostic Observation Schedule-Second Edition (ADOS-2), Griffiths Development Scales-Chinese Language Edition (GDS-C), and Chinese Children's Parent-Child Relationship Questionnaire (CPCIS). Then, we analyzed the correlations between the screen time of children with ASD and the ABC, CARS, ADOS, GDS-C DQs, and CPCIS scores. Linear regression was used to analyze the risk factors that affect screen time.Results: The children's average daily screen time was 2.64 ± 2.24 h. Forty eight percent children were exposed to two or more types of electronic devices. Their favorite activity of screen time was watching cartoons. Only 34% children spent screen time accompanied by parents and with communication. 50.26% children had no screen time before sleeping. The screen time of children with ASD had a negative correlation with the GDS-C CQ (r = −0.234, P = 0.001) and the CPCIS score (r = −0.180, P = 0.012) and a positive correlation with the CARS score (r = 0.192, P = 0.009). A low father's education level (P = 0.010), less restriction of the child's screen time by the guardian (P = 0.001), greater caregiver screen time (P < 0.001), the use of the screen as a tool for child rearing (P = 0.001), and the child's ownership of independent electronic equipment (P = 0.027) are risk factors for long screen time in children with ASD.Conclusion: The screen time of children with ASD in China is higher than the recommended standard, and the current situation is serious. The screen time of ASD children is related to their autism symptoms, DQ and parent-child interaction. Low paternal education levels, less restriction of children's screen time by guardians, greater guardian screen time, the use of screens in child rearing, and children's ownership of independent electronic equipment can lead to an increase in children's screen time. These findings may have implications for family intervention strategies.

Cochlear implantation in children with Autism Spectrum Disorder (ASD): Outcomes and implant fitting characteristics

BackgroundLittle is known regarding fitting parameters and receptive and expressive language development in cochlear-implanted children (CCI) with profound sensorineural hearing loss (SHL) who are diagnosed with Autism Spectrum Disorder (ASD). The aim of the study was to evaluate a group of ASD CCI users in order to describe their ASD clinical features and CCI outcomes; report on the average electrical charge requirements; and evaluate the possible correlations between electrical and psychophysical outcomes with ASD characteristics. Materials and methodsA multicentre observational study of 22 ASD children implanted in four cochlear implant (CI) centers. Data concerning profound SHL diagnosis, ASD diagnosis, CI timing and CI compliance were collected. Sound Field (SF) was assessed through repeated behavioural measurements. Categories of Auditory Perception (CAP) and Categories of Language (CL) were used to evaluate speech perception and language skills at short (≤2 yrs), medium (5 yrs) and long term (>10 yrs) follow-up. Fitting parameters such as comfortable thresholds, pulse-width (pw, μsec) and clinical units converted into units of charge/phase were collected. The diagnosis of ASD was acquired by the referral neuropsychiatric department and severity was assessed through the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) and the Childhood Autism Rating Scale (CARS). ResultsAt the final follow-up session the median SF threshold for CI outcomes was 30 dB HL (min 15 – max 60). CAP score was extremely variable: 45.5% showed no improvement over time and only 22% of children reached CAP scores of 5–7. CL 45.5% showed no improvement over time and score was 1–2 in the majority of ASD children (72.7%), while only 18.2% reached the highest level of language skills. There were no statistically significant differences at each follow-up between subjects with or without comorbidities. CAP and CL were inversely correlated with DSM-V A and B domains, corresponding to lower speech and language scores in children with more severe ASD symptoms, and maintained their correlation at mid and long follow-ups whilst controlling for age at CI. Electrical charge requirements did not correlate with SF or age at implant but did inversely correlate with ASD severity. With regards to CI compliance: only 13.6% children (3) with severe DSM-V A/B levels and CARS score were partial/intermittent users. ConclusionThe present study is a targeted contribution to the current literature to support clinical procedures for CI fitting and audiological follow-up in children with ASD. The findings indicate that the outcomes of CI use and the fitting procedures are both influenced by the severity of the ASD symptoms rather than the demographic variables or associated disorders.

Measurement invariance of the Childhood Autism Rating Scale (CARS) across six countries.

The Childhood Autism Rating Scale (CARS) is a simple and inexpensive tool for Autism spectrum disorder (ASD) assessments, with evidenced psychometric data from different countries. However, it is still unclear whether ASD symptoms are measured the same way across different societies and world regions with this tool, since data on its cross-cultural validity are lacking. This study evaluated the cross-cultural measurement invariance of the CARS among children with ASD from six countries, for whom data were aggregated from previous studies in India (n=101), Jamaica (n=139), Mexico (n=72), Spain (n=99), Turkey (n=150), and the United States of America (n=186). We analyzed the approximate measurement invariance based on Bayesian structural equation modeling. The model did not fit the data and its measurement invariance did not hold, with all items found non-invariant across the countries. Items related to social communication and interaction (i.e., relating to people, imitation, emotional response, and verbal and nonverbal communication) displayed lower levels of cross-country non-invariance compared to items about stereotyped behaviors/sensory sensitivity (i.e., body and object use, adaptation to change, or taste, smell, and touch response). This study found that the CARS may not provide cross-culturally valid ASD assessments. Thus, cross-cultural comparisons with the CARS should consider first which items operate differently across samples of interest, since its cross-cultural measurement non-invariance could be a source of cross-cultural variability in ASD presentations. Additional studies are needed before drawing valid recommendations in relation to the cultural sensitivity of particular items.