Childhood Autism Rating Scale Research Articles

Preliminary analysis of a clinical trial of children with autism spectrum disorder treated with DHA-rich marine Schizochytrium sp. oil and multi-vitamin/mineral complex

BackgroundAutism spectrum disorder (ASD) is a syndrome characterized by alterations in social interaction and communication, frequently associated with stereotyped patterns, such as repetitive behavior. Inflammation and oxidative stress are frequently observed in patients, and natural products that control these aspects can be an alternative for ASD treatment.Method:In this prospective case series study, we administered in 2–12 years-old children (n = 12) with severe ASD a commercial extract of marine Schizochytrium sp. oil, composed by 200 mg DHA and 2 mg eicosapentaenoic acid, associated to a multi-vitamin/mineral complex, daily for 12 weeks. Patients were evaluated by Childhood Autism Rating Scale (CARS) and Adaptive Behavior Assessment System Third Edition (ABAS-3) scales before and after the treatment, and had the urine analyzed.Results:Values obtained from CARS, general adaptive composite and social domains from ABAS-3 were statistically different after treatment. Although not statistically significant, conceptual and practical domains from ABAS-3 had the score increased in several patients after the intervention. Among these domains, communication and visual contact improved in all patients, and vocabulary, interaction, feeding, and food selectivity were enhanced in some of them. The total antioxidant capacity in urine increased after treatment, as well as some metabolites, like amino acids, which were exclusive in all patient’s urine after the administration of the product.Conclusions:These preliminary data show that the continuous use of marine Schizochytrium sp. oil and multi-vitamin/mineral complex can help control characteristic symptoms of ASD in children.

Neuroinflammation Process as a Key Etiopathogenetic Factor in the Evolution of Autism Spectrum Disorders in Child Patients

Background: the prevalence of autism spectrum disorders (ASD) is increasing every year, however, diagnostic and therapeutic options are still limited. Aim: identification the patterns of the neuroinflammation process in the etiopathogenesis of ASD of child patients. Patients and methods: clinical, anamnestic and laboratory data of 85 child patients with a confirmed ASD diagnosis. Each patient was assessed for the level of neurospecific proteins (neuron-specific enolase (NSE), S100b protein), the indices of the “Neuro-immuno-test” panel (leukocyte elastase (LE) and α1-proteinase inhibitor (α1-PI) activity, autoantibodies to S100b protein and myelin basic protein) in the blood before and after a standardized three-month-course of treatment. The reference interval of the laboratory was taken as normal values. The clinical picture was assessed according to the Childhood Autism Rating Scale (CARS). The correlation calculations were carried out in the MS Excel program. Results: in this work we describe the dynamics of the neuroinflammation process parameters in children with autism-like syndrome and psycho-speech development delay on the basis of complex anti-inflammatory therapy. The results of the research prove the increase in NSE and S100b protein quantity among 85% of patients before the treatment. More than 60% of patients had the increase of the parameters of the Neuro-test panel. The severity levels of symptoms among patients according to the scales used specified moderate and severe autism. The quantity of neurospecific proteins and immunological parameters correlated with CARS scale scores. Positive dynamics of clinical symptoms and studied parameters decrease were observed while therapy. The use of the parameters allows to evaluate objectively the severity levels of the patient’s immunomitochondrial status and shows a congruent change on the basis of etiopathogenetic therapy.

Psychoeducational Profile-Revised, Korean Wechsler Preschool and Primary Scale of Intelligence, Fourth Edition, and the Vineland Adaptive Behavior Scale, Second Edition: Comparison of Utility for Developmental Disabilities in Preschool Children.

This study aimed to compare the utility of the Psychoeducational Profile-Revised (PEP-R), Korean Wechsler Preschool and Primary Scale of Intelligence, Fourth Edition (K-WPPSI-IV), and Vineland Adaptive Behavior Scale, Second Edition (VABS-II) for evaluating developmental disabilities (DD) in preschool children. Additionally, we examined the correlations between the PEP-R, KWPPSI- IV, and VABS-II. A total of 164 children aged 37-84 months were assessed. Children's development was evaluated using the PEP-R, K-WPPSIIV, VABS-II, Preschool Receptive-Expressive Language Scale, and Korean Childhood Autism Rating Scale, Second Edition. Of the 164 children, 103 had typical development (TD) and 61 had DD. The mean of the PEP-R Developmental Quotient (DQ), K-WPPSI-IV Full-Scale Intelligence Quotient (FSIQ), and VABS-II Adaptive Behavior Composite (ABC) scores were significantly higher in the TD group than in the DD group (p<0.001). The estimated area under the curve of the PEP-R DQ, K-WPPSI-IV FSIQ, and VABS-II ABC scores was 0.953 (95% confidence interval [CI]=0.915-0.992), 0.955 (95% CI=0.914-0.996), and 0.961 (95% CI=0.932- 0.991), respectively, which did not indicate a statistically significant difference. The PEP-R DQ scores were positively correlated with the K-WPPSI-IV FSIQ (r=0.90, p<0.001) and VABS-II ABC scores (r=0.84, p<0.001). A strong correlation was observed between the KWPPSI- IV FSIQ and VABS-II ABC scores (r=0.89, p<0.001). This study found that the PEP-R, K-WPPSI-IV, and VABS-II effectively distinguished DD from TD in preschool children, and no significant differences in utility were observed between them.

Leukocyte cytokine expression is associated with severity of autism in children

Autism Spectrum Disorder (ASD) is a complex neurodevelopmental disorder with unknown etiology, high clinical heterogeneity and marked aberrations of the immune system. Evidence for an association between immune dysfunction and behavioral traits highlights the need for a study of the immune cell functional activity in order to search for pathogenesis mechanisms and potential targets for therapy at ASD. The purpose: to determine the expression levels of IL-1β, IL-2, IL-4, IL-6, IL-10, IL-18, IFNγ and TNFα in peripheral blood leukocytes of children with mild and severe ASD. The study included 81 children with ASD (77.8% boys) and 45 children with typical neurodevelopment (TDC, 71.1% boys). According to the Childhood Autism Rating Scale, 51 children (63.0%) had mild autistic symptoms (CARS score 32.0±1,5) and 30 children had severe ASD symptoms (CARS score 39.0±3,4). Cytokines expression in leukocytes was determined by quantitative PCR with SYBRGreen. The data were transformed using Box–Cox transformation. The differences between groups were assessed by one-way ANOVA and Dunn’s test for multiple comparisons. In leukocytes of children with ASD, regardless of the severity, the expression of IL-1β, IL-18 and IL-2, was significantly reduced compared to TDC. Moreover, in children with mild ASD, low expression of TNFα, compared with TDC was found. In children with severe ASD, the expression of the main cytokine of Th1 – IFNγ, was significantly increased, without an increased expression of an important cytokine of Treg – IL-10. Activation of the Th1 adaptive immune response without compensation by cytokines of Treg, the number of which is reduced in ASD, can lead to increased inflammation, even in the central nervous system, and correlates with the severity of ASD clinical symptoms. Despite extensive immunological evidence suggesting immune system dysregulation, further research is required to clarify the relationship between immune system cell function and ASD pathology.

BDNF content and catalase activity in the blood of children with autism spectrum disorders

BACKGROUND: With the increasing prevalence of autism spectrum disorders worldwide, it is relevant to study the mechanisms contributing to their development and progression. The participation of brain-derived neurotrophic factor and oxidative stress in the pathogenesis of the disease is considered, however, their role in this process remains unclear. The relationship between BDNF levels and oxidative stress in the blood of patients with autism spectrum disorders has not been studied.&#x0D; AIM: The aim was to evaluate the content of brain neurotrophic factor, BDNF, and catalase, an antioxidant defense enzyme, in children with various clinical forms of autism spectrum disorders.&#x0D; MATERIALS AND METHODS: BDNF content and catalase activity were assessed in the blood plasma of 78 children with autism spectrum disorders, including 41 patients with childhood autism, 19 children with atypical autism, 6 patients with Aspergers syndrome, and 12 patients with other general developmental disorders (with elements of autism). The control group consisted of 20 conditionally healthy children. The diagnosis was established in accordance with the ICD-10. The severity of disorders was determined using the Childhood Autism Rating Scale. The content of BDNF was evaluated using the method of enzyme immunoassay, catalase activity was determined by colorimetric method.&#x0D; RESULTS: The content of BDNF in blood plasma was reduced in children with autism spectrum disorders compared to its levels in control group subjects. BDNF levels depended on the clinical form of the disease: the content of BDNF was reduced in patients with childhood autism, atypical autism, Aspergers syndrome compared to control group subjects; in patients with atypical autism it is lower than in patients with childhood autism; BDNF levels in the group of patients with other general developmental disorders and in control group did not differ. The content of BDNF did not depend on gender, age and severity of autism spectrum disorders. A negative correlation was found between BDNF levels and the age of control group children. There were no differences in the activity of catalase in the blood of children with autism spectrum disorders and in control group. A positive correlation was found between BDNF levels and catalase activity in children with autism spectrum disorders and control group subjects.&#x0D; CONCLUSIONS: A decrease in the content of BDNF in the blood of children with autism spectrum disorders was revealed. Neurotrophin content differed in children with separate clinical forms of the disease. To varying degrees the decrease in BDNF levels in patients with childhood autism, atypical autism, Aspergers syndrome and the absence of changes in patients with other general developmental disorders compared with controls could be associated with a different contribution of neurotrophin to the pathogenesis of clinical forms of autism spectrum disorders. In children with autism spectrum disorders, there were no age-related changes in neurotrophin levels, while in healthy children a negative correlation was found between the content of BDNF and age. The absence of changes in the activity of catalase in the blood of children with autism spectrum disorders indicated the safety of the antioxidant defense system in terms of this indicator. The positive correlation between BDNF levels and catalase activity in the blood of patients with autism spectrum disorders and control group subjects reflected the protective role of neurotrophin from the damaging effects of oxidative stress.

Electrophysiological Changes in Patients with Pediatric Mental Disorders

Background Electroencephalography (EEG) measures represent an important data source for a new quantitative science of macroscopic and microscopic cortical brain dynamics. Objective To record the central neuro- electrophysiological pattern in children with different types of pediatric mental disorders. Methods In this cross-sectional observational study, 100 children with different types of pediatric mental disorders [Autism (n = 30), ADHD (n = 30) and nocturnal enuresis (n = 40)] were evaluated from those under regular follow up at the Child Psychiatry Clinic, Children’s hospital, Ain Shams University. Full history, detailed psychiatric interview, psychometric assessment using specific scales according to the disorder, IQ assessment, EEG and Diagnostic and Statistical Manual of Mental Disorders (DSM-V) criteria for definitive diagnose of each disorder were assessed. Results The enrolled children age ranged between 5-16 years with a mean value of 9.09 ±2.49 years, and 74 were males. Eleven children had history of Neonatal Intensive Care Unit (NICU) admission.IQ ranged from 27 to 101 with a mean value of 78.92 ± 16.29 SD. Childhood Autism Rating Scale (CARS) for children with Autism ranged from 30 to 47 with a mean value of 35.53 ± 3.42 SD. The Conners Comprehensive Behavior Rating Scale for children with ADHD ranged from 61 to 78 with a mean value of 68.63 ± 4.66 SD. Only 5 children had epileptogenic activity in the EEG [autism (n = 3), ADHD(n = 1), nocturnal enuresis(n = 1)] with a (P-value= 0.362). In addition, history of NICU admission showed association with subsequent development of pediatric mental disorders (P-value =0.015). Furthermore, developmental history had association with pediatric mental disorder (Pvalue =0.00). Conclusion We observed a non-significant association between EEG changes and pediatric mental disorders. However, this study showed a significant association between NICU admission and subsequent development of pediatric mental disorders.

Characteristics of Autism Spectrum Disorder among a Sample of Egyptian Children

Background Autism spectrum disorder (ASD) is a biologically based neurodevelopmental disorder characterized by impairments in two major domains; deficits in social communication and social interaction and restricted repetitive patterns of behavior, interests and activities. Aim of the Work Understanding and correlating the socioeconomic status (SES), clinical characteristics and the severity of ASD. Patients and Methods 100 autistic patients were assessed using DSM-V criteria, intelligence quotient (IQ) assessment using Stanford Binnet intelligence scale, assessment of severity of autistic symptoms using childhood autism rating scale (CARS), and psychometric evaluation for comorbid psychiatric conditions by using Pediatric Symptoms Checklist (PSCL), Full clinical examination, neurological examination, Electroencephalography (EEG) for some patient &amp; socioeconomic status (SES) assessment were also done. Results Severity of ASD was correlated with each of motor &amp; social delay (p = 0.007) (p = 0.000) respectively, impairment in Sphincter control (p = 0.012), imitation impairment (p = 0.010) and stereotypic behavior (p = 0.015. Our patients had comorbidities in the form of; gastrointestinal tract (GIT) symptoms, eating disorders and EEG findings (p = 0.004) (p = 0.005) (p = 0.038) respectively. Our patients mainly belonged to middle SES (57%) and severity of ASD was correlated with family possessions domain of SES (p = 0.001). Children who belonged to high SES were more likely to be diagnosed earlier (p = 0.016) with better IQ (p = 0.003) than those from lower SES. Conclusion It is important for developing countries to have their own research and to increase public awareness in all socioeconomic strata and establish integrated services for autism.

Protocol for the safety and efficacy of fecal microbiota transplantation liquid in children with autism spectrum disorder: a randomized controlled study.

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by deficits in social interaction, repetitive behavior and language impairment, and its worldwide prevalence has been found to be increasing annually in recent years. Till now, ASD is uncurable as its pathogenesis remains unknown. However, studies on both animals and humans have demonstrated that fecal microbiota transplantation (FMT) may ameliorate the symptoms of ASD, as well as gastrointestinal symptoms. Nonetheless, there is still no agreement regarding the optimal dosage or duration of FMT treatment for individuals with ASD. This clinical study is a double-blind, randomized, interventional trial conducted at a single center. The aim is to investigate the safety and efficacy of a pediatric formulation of FMT for ASD. A total of 42 children between the ages of 3-9 with ASD will be randomly assigned in a 2:1 ratio to either an FMT treatment group (n = 28) or a placebo group (n = 14), forming cohort 1. Additionally, 30 healthy children of similar age and gender will be recruited as the control group (cohort 2). Cohort 1 will be assessed using a variety of scales, including the Autism Behavior Checklist, Childhood Autism Rating Scale, Social Responsiveness Scale, Gastrointestinal Symptom Rating Scale, Children's Sleep Habits Questionnaire, and Psychoeducational Profile (Third Edition). These assessments will evaluate the effectiveness of FMT in reducing core symptoms and comorbidities (such as gastrointestinal symptoms and sleep disturbances) in children with ASD. The study will use metagenomic and metabolomic sequencing to assess changes in the composition and structure of the intestinal flora and its metabolites in blood, urine, and feces following treatment. Furthermore, the study will evaluate the acceptability of the FMT formulation by participants' legal guardians and investigate differences in the intestinal flora and metabolism in the FMT group before and after treatment compared to 30 healthy children. https://www.chictr.org.cn/, identifier ChiCTR2200058459.

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.

A pilot study on glutamate receptor and carrier gene variants and risk of childhood autism spectrum.

Imbalanced glutamate signaling has been implicated in the development of autism spectrum disorder (ASD). This case-control study was to examine single nucleotide polymorphisms (SNPs) in glutamate receptor and carrier genes and determine their association with childhood ASD in a Chinese Han population.A total of 12 SNPs in genes encoding glutamate receptors (GRM7 and GRM8) and carriers (SLC1A1 and SLC25A12) were examined in 249 autistic children and 353 healthy controls. The Childhood Autism Rating Scale (CARS) and its verbal communication domain were applied to evaluate the severity of the disease and language impairment, respectively.The T allele of rs2292813 in the SLC25A12 gene was significantly associated with an increased risk of ASD (odds ratio (OD) = 1.7, 95% confidence interval (CI): 1.1-2.6, P = 0.0107). Neither the genotypes nor allele distributions of other SNPs were associated with the risk of ASD. Notably, rs1800656 and rs2237731 in the GRM8 gene, but not other SNPs, were related to the severity of language impairment. All SNPs were not correlated with the overall severity of ASD.Our findings support associations between the SLC25A12 gene variant and the risk of childhood ASD, and between the GRM8 gene variant and the severity of language impairment in the Chinese Han population.

Validation of the developmental, dimensional and diagnostic interview -short version (3Di-sv) for diagnosis of autism spectrum disorder in Chinese children

The purpose of this study was to evaluate the psychometric features of the Chinese version of the developmental dimensional diagnostic interview-short version (3Di-sv). A total sample of 138 children including 79 children with autism spectrum disorder (ASD) and 59 typically developing children completed the 3Di-sv interview. The Chinese version of the 3Di-sv has a good internal consistency (0.94). Test–retest analysis confirmed the instrument’s time stability (0.89). The instrument’s concurrent validity with the Autism Behavior Checklist (ABC), the Childhood Autism Rating Scale (CARS) and clinical diagnosis was verified; the correlation between total scores was 0.72, 0.82 and 0.90, respectively. The 3Di-sv significantly distinguished between autistic children and non-autistic children in every area of autism symptoms. Optimal cutoffs were derived using receiver operating characteristics curves. Using clinical diagnosis as criterion, overall sensitivity was 98 % and specificity was 90 %. The study determined that the Chinese version of 3Di-sv can well distinguish autistic children from typically developing children.

Otizm Spektrum Bozukluğu Olan Çocuklarda Gastrointestinal Sistem ve Uyku Sorunları: Bunların Problemli Davranışlarla İlişkisi

Objective: The purpose of this research is to investigate sleep and gastrointestinal problems in children with autism spectrum disorder (ASD) and their relationship with each other, autism severity and problematic behavior. Material and Methods: The children who were admitted to outpatient clinics of child psychiatry at our hospital in a 3-months period and had diagnosis of ASD according to DSM-5 were included. The parents filled Aberrant Behavior Checklist (AbBC), Rome-3 Diagnostic Questionnaire for Pediatric Functional Gastrointestinal Disorders Parent Report Form (QPGS-RIII), Children’s Sleep Habits Questionnaire (CSHQ), Autism Behavior Checklist (ABC) and sociodemographic data form. The clinician applied Childhood Autism Rating Scale (CARS). Results: Ninety-seven children with ASD were included. According to QPGS-RIII, 38.1% of the cases had probable functional gastrointestinal problems. Those were 26.8% (n=26) functional constipation, 8.2% (n=8) nonretentive fecal incontinence, 2.1% (n=2) aerofaji, 3.1% (n=3) rumination syndrome, 4.1% (n=4) irritable bowel syndrome, 1% (n=1) functional abdominal pain syndrome, 1% (n=1) functional dyspepsia, 3.1% (n=3) functional abdominal pain, 1% cyclic vomiting and 1% (n=1) abdominal migraine. According to CSHQ 58.8% of the cases had sleep problems. ASD patients with functional gastrointestinal problems, had higher total scores of CSHQ, ABC and AbBC, compared to children with no functional gastrointestinal problems. Conclusion: Our findings revealed that frequency of gastrointestinal and sleep problems were high in children with ASD. It is appropriate to evaluate patients with ASD in terms of gastrointestinal and sleep problems especially if behavioral problems accompanies. And treating gastrointestinal and sleep problems might decrease challenging behaviors that seen in ASD.

Early Diagnosis of Autism Spectrum Disorder: A Review and Analysis of the Risks and Benefits.

Autism spectrum disorder (ASD) is a neurodevelopmental condition made up of enduring challenges in social communication and interaction and the presence of repetitive and restricted behavior patterns. Early diagnosis of autism is crucial for timely intervention and improved long-term outcomes. This review aims to explore some of its signs and symptoms, look into some diagnostic tools, and analyze the benefits and risks associated with an early diagnosis of autism. The symptoms of ASD vary from child to child, some of which are: avoidance of eye contact, lack of response to names, excessive fear, and lack of interactive and pretend play. Early identification of these symptoms by caregivers and healthcare providers facilitates the need for diagnosis and appropriate interventions. Some screening and diagnostic tools that have been found to help make the diagnosis are the Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F), the Social Communication Questionnaire (SCQ), the Parents' Evaluation of Developmental Status (PEDS), and the Childhood Autism Rating Scale (CARS), amongst others. The benefits of early diagnosis include the opportunity for early intervention, which has been shown to enhance developmental outcomes and improve adaptive skills. Early identification allows for the implementation of specialized interventions tailored to the specific needs of individuals with autism, targeting social communication, language development, and behavioral challenges. Furthermore, early diagnosis enables families to access appropriate support services, educational resources, and community programs, facilitating better coping mechanisms, reducing parental stress, and increasing adult independence. However, early diagnosis of autism also entails certain risks. One significant concern is the potential for labeling and stigmatization, which can impact the child's self-esteem and social interactions. There is a risk of overdiagnosis or misdiagnosis, leading to unnecessary interventions and treatments. Additionally, the diagnostic process can be lengthy, complex, and emotionally challenging for families, requiring comprehensive assessments by multidisciplinary teams. This review highlights the importance of a balanced approach when considering the benefits and risks of early diagnosis. Early identification allows for timely interventions that significantly improve developmental outcomes and quality of life for individuals with autism. To mitigate the risks, it is crucial to ensure accurate and reliable diagnostic procedures, support families throughout the process, and promote societal awareness and acceptance. We also highlighted some future directions in the management of autism, including the use of biomarkers and the use of artificial intelligence and learning for diagnosing ASD.

Potential barriers to early diagnosis of autism in Turkey: an evaluative study

ABSTRACT Our objective was to evaluate pathways between initial concerns of parents regarding atypical development of their children and autism spectrum disorder (ASD) diagnosis in Turkey. The study included 199 children aged 18–97 months and diagnosed with ASD. The fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria were used along with information obtained from parents and direct observation of the child. The Childhood Autism Rating Scale (CARS) was used as a diagnostic tool. A 45-minute semi-structured interview was conducted with parents to evaluate the time until their child was diagnosed with ASD. A period longer than 1 year (mean: 13.69 ± 10.80 months) had passed from the first concern of parents until their children were diagnosed with ASD. Further, 53.8% of parents consulted a healthcare professional a few months after their initial concern and 46.2% did not for a longer time (9.34 ± 8.36 months). Maternal education level, socioeconomic status, and higher Autism Behavior Checklist (ABC) relating subscale scores predicted an earlier age for a diagnosis of ASD, while higher ABC language subscale scores predicted ASD diagnosis at older ages. Based on our results, it appears that factors such as spoken language and socioeconomic level may be related to significant delays in ASD diagnoses in Turkey.

A Disintegrin and Metalloproteinase Protein 8 (ADAM 8) in Autism Spectrum Disorder: Links to Neuroinflammation.

Converging lines of evidence confirmed neuroinflammation's role in autism spectrum disorder (ASD) etiological pathway. A disintegrin and metalloproteinase 8 (ADAM8) play major roles in inflammatory and allergic processes in various diseases. This study aimed to investigate ADAM8 plasma levels in autistic children compared to healthy controls. Also, to discover the association between ADAM8, disease severity, and neuroinflammation in ASD. This case-control study included children with ASD (n=40) and aged-matched healthy controls (n=40). The plasma levels of the ADAM 8 were determined using enzyme-linked immunosorbent assay (ELISA). The assessment of ASD severity and social and sensory behaviors were categorized as mild, moderate and severe. Correlations among ADAM8 plasma levels and ASD severity scores [Childhood Autism Rating Scale (CARS), Social Responsiveness Scale (SRS) and Short Sensory Profile (SSP)] were obtained by Spearman correlation coefficient (r). ASD children (n=40), including severe autism (n=21) and mild-to-moderate autism (n=19), showed significantly (p ≤ 0.05) lower plasma levels of ADAM8 [4683 (2885-5229); 4663 (4060-5000); 4632 (2885-5229)], respectively, than those of healthy controls [5000 (4047-5000)] [median (IQR) pg/mL]. However, there was no significant difference between the ADAM8 levels of children with severe and mild-to-moderate autism (p = 0.71). Moreover, ADAM8 plasma levels were not significantly correlated with the severity of ASD measured by behavioral scales [CARS (r= -0.11, p=0.55), SRS (r=0.11, p= 0.95), SSP (r=-0.23, p=0.23)]. The low ADAM8 plasma levels in children with ASD possibly indicated that ADAM8 might be implicated in the pathogenesis of ASD but not in the severity of the disease. These results should be interpreted with caution until additional studies are carried out with larger populations to decide whether the reduction in plasma ADAM8 levels is a mere consequence of ASD or if it plays a pathogenic role in the disease.

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.

Neurofeedback Recuperates Cognitive Functions in Children with Autism Spectrum Disorders (ASD).

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by impaired social interaction, verbal and nonverbal communication, and behaviors or interests. Besides behavioral, psychopharmacological and biomedical interventions there is increasing evidence of non-invasive treatments like neurofeedback (NFB) that can improve brain activity. In this study, we have investigated whether NFB can improve cognitive functions in children with ASD. Thirty-five children with ASD (7-17years) were selected by purposive sampling. The subjects underwent 30 sessions of NFB training for 20min over 10weeks' period. Psychometric tests i.e. Childhood Autism Rating Scale (CARS), IQ scoring and Reward sensitivity tests were administered at baseline. Pre and post NFB intervention assessment of executive functions, working memory and processing speed were done by NIH Toolbox Cognition Batteries. Friedman test revealed that children showed a statistically significant improvement in the NIH Tool Box cognitive assessments, including the Flankers Inhibitory Control and Attention Test (Pre-test = 3.63, Post-test = 5.22; p = 0.00), the Dimensional Change Card Sorting Test (Pre-test = 2.88, Post-test = 3.26; p = 0.00), the Pattern Comparison Processing Speed Test (Pre-test = 6.00, Post-test = 11:00; p = 0.00) and the List Sorting Working Memory Test (Pre-test = 4.00, Post-test = 6:00; p = 0.00), and displayed a trend of improvement at 2-month follow-up (Flankers Inhibitory Control and Attention Test (Post-test = 5.11 ± 2.79, Follow-Up = 5.31 ± 2.67; p = 0.21), the Dimensional Change Card Sorting Test (Post-test = 3.32 ± 2.37, Follow-Up = 3.67 ± 2.35; p = 0.054), the Pattern Comparison Processing Speed Test (Post-test = 13.69 ± 9.53, Follow-Up = 14.42 ± 10.23 p = 0.079) and the List Sorting Working Memory Test (Post-test = 6.17 ± 4.41, Follow-Up = 5.94 ± 4.03; p = 0.334). Our findings suggest NFB intervention for 10weeks produce improvement in executive functions (Inhibitory Control and Attention and Cognitive Flexibility), Processing Speed and Working Memory in ASD Children.

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.

Effects of Vitamin D Supplementation on Children with Autism Spectrum Disorder: A Systematic Review and Meta-analysis.

The effect of vitamin D supplementation on individuals with autism spectrum disorder (ASD) is inconclusive. We aimed to conduct a meta-analysis of the available randomized controlled trials (RCTs) to explore whether vitamin D supplementation can improve core symptoms and coexisting conditions in children with ASD. Data were obtained by searching the PubMed, Embase, Web of Science, CINAHL and Cochrane Library databases up to February 2022 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Using a random-effects model, mean differences with 95% confidence intervals (CIs) were calculated through a meta-analysis. There were eight RCTs with 266 children with ASD in the present review, among which six RCTs were included in the meta-analysis. Children who received vitamin D supplementation showed a significant improvement in stereotypical behavior scores (pooled mean difference (MD): -1.39; 95% CI: -2.7, -0.07; P = 0.04) with low heterogeneity (I2 = 34%), and there was a trend toward decreased total scores on the Social Responsiveness Scale (SRS) and Childhood Autism Rating Scale (CARS, P = 0.05); however, there were no other significant differences in the core symptoms of ASD and coexisting conditions between groups as measured by the Aberrant Behavior Checklist (ABC). Vitamin D supplementation appears to improve stereotypical behaviors but does not improve other core symptoms and coexisting conditions. Further randomized controlled trials with large sample sizes and individualized doses are needed.