Regression In Children Research Articles

Gastrointestinal symptoms have a non-temporal association with regression in a cohort with autism spectrum disorder using the simons simplex collection

Autism spectrum disorder (ASD) can present with developmental regression. In this study, we hypothesize an association between Gastrointestinal (GI) symptoms and regression. We conducted a two-part analysis using data from the Simon Simplex Collection consisting of 2564 ASD probands. Independent sample t-tests or chi-squared tests were utilized comparing regression against no-regression groups, and regression in children with and without early onset of GI symptoms. The presence of GI symptoms of any kind is associated with regression (odds ratio= 1.51; 95% CI 1.25 - 2.82; p < 0.001). Early GI effects on subsequent development of regression demonstrate no association (OR=0.81; 95% CI 0.649–1.01; p < 0.062). Although a clear relationship between GI symptoms and regression is demonstrated in this study, the lack of temporal relationship between the two highlight the need for a better understanding of the underlying mechanism behind this phenomenon.

Clinical, laboratory and ultrasonographic criteria for reveaing inflammation of the appendix and its regression in children

Introduction. Because of the numerous studies on a possible regression of inflammation in the cecum appendix, the question of finding reliable criteria for preoperative verification of inflammation and of assessing its dynamics in children is relevant.Material and methods. In January 2017 – December 2021, case-histories of 92 children aged from 3 to 18 years – (Me (age median) = 12; Q1 (lower quartile) = 9; Q2 (upper quartile) = 14.5 – were analyzed in the Yaroslavl Children's Clinical Hospital. The researchers assessed diagnostic and management algorithms. All children had a high risk of appendicitis (PAS (Pediatrics appendicitis score) ≥ 6 points) because of changes in the appendix and findings of ultrasound examination, but due to the symptoms relief, no surgical interventions were performed.Results. 78 (84.8%) children were prescribed antibacterial therapy. The median duration of symptom regression was 2 days (Q1 = 1 day; Q2 =4 days). On days 5–8 (Q1–Q2) (Me = 6 days), relief of all symptoms of the disease was recorded. The average diameter dimensions of the vermiform process, by ultrasound findings at the initial examination, were 8.6 ± 1.47 (95% CI 8.31–8.92), wall thickness – 3.2 ± 0.39 (95% CI 3.12–3.28). After the symptom relief , these indicators were 6.3 ± 1.29 (95% CI 5.95–6.58) and 2.0 ± 0.63 (95% CI 1.18–1.88), respectively. The decrease in size was statistically significant (p 0.001), signs regressed in parallel (r = 0.63; p 0.0001).95% CI lower limit of ultrasonographic parameters at the initial examination exceeded the threshold values indicating inflammatory changes (8 mm and 2.7 mm, respectively). After regression of the disease symptoms, 95% CI upper limit returned to the normal state.Conclusion. The presented clinical observations may be considered as cases of appendix inflammation with regression. The selected clinical and ultrasonographic criteria can be used both for verifying inflammation and for assessing the regression of inflammatory process.

Loss of Acquired Skills: Regression in Young Children With Autism Spectrum Disorders.

Regression, while not a core symptom of autism spectrum disorder (ASD), has been suggested to be a distinct subtype by previous studies. Therefore, this study aimed to explore the prevalence and clinical differences between those with and without regression in children with ASD. This study includes data from toddlers and young children aged 2-7 years acquired from other projects at Seoul National University Bundang Hospital. The presence and characteristics of regression were explored using question items #11-28 from the Autism Diagnostic Interview-Revised. Chi-square and independent t-tests were used to compare various clinical measurements such as autistic symptoms, adaptative behavior, intelligence, and perinatal factors. Data from 1438 young children (1020 with ASD) were analyzed. The overall prevalence rate of regression, which was mainly related to language-related skills, was 10.2% in the ASD group, with an onset age of 24 months. Regarding clinical characteristics, patients with ASD and regression experienced ASD symptoms, especially restricted and repetitive interests and behaviors, with greater severity than those without regression. Furthermore, there were significant associations between regression and hypertension/placenta previa. In-depth surveillance and proactive interventions targeted at young children with ASD and regression should focus on autistic symptoms and other areas of functioning.

Description of Clinician-Diagnosed Regression at Time of Autism Spectrum Disorder Diagnosis in Toddlers.

Previous studies have reported varying rates of regression in children with autism spectrum disorder (ASD). We sought to (1) determine the rate of clinician-diagnosed regression for young children with ASD and (2) compare developmental functioning and ASD symptoms of children with versus without regression. We conducted a retrospective chart review of toddlers (age 18-36 months) with Diagnostic and Statistical Manual-5 ASD. We abstracted cognitive, language, adaptive, and motor functioning standard scores and ASD core symptoms. Regression was defined as "clinician-diagnosed regression accompanied by recommendation for a medical workup." We used propensity scores to match each participant with regression (n = 20) one-to-one with a participant without regression (n = 20). We compared the groups on developmental scores using independent sample t tests and on core ASD symptoms using Pearson's χ 2 test. Of the 500 children with ASD, n = 20 (4%) had regression (defined above). Children with regression had lower Bayley cognitive and language scores and lower Vineland adaptive scores compared with those without regression (cognitive: 78.0 vs 85.5, p < 0.05; language: 56.9 vs 68.2, p < 0.01; adaptive: 70.0 vs 80.3; p < 0.01). There was no difference in motor scores across groups. There were no significant differences in the frequency of exhibiting core ASD symptoms for those with versus without regression. In this clinical sample of children with ASD, regression was diagnosed in a small percentage (4%). Those with regression had lower cognitive, language, and adaptive skills compared with those without regression. Rates of clinician-diagnosed regression referred for medical workup are significantly lower than prior estimates based on parent report.

A Multi-Center Study on the Relationship Between Developmental Regression and Disease Severity in Children With Autism Spectrum Disorders.

IntroductionThis study aimed to investigate the prevalence of developmental regression in children with Autism Spectrum Disorder (ASD) and to explore its relationship with disease severity.MethodsWe finally included 1,027 ASD children aged 2–5 years from 13 cities in China: 138 with regressive ASD and 889 with non-regressive ASD. The Social Responsiveness Scale (SRS), Autism Behavior Checklist (ABC), Child Autism Rating Scale (CARS), and Children Neuropsychological and Behavioral Scale-Revision 2016 (CNBS-R2016) were used to evaluate the core symptoms and developmental status of children in the two groups.ResultsAmong the 1,027 ASD children eventually included, 138 (13.44%) cases showed regressive behavior and the average regression occurring age was 24.00 (18.00–27.00) months. Among the regressive children, 105 cases (76.09%) had language regression, 79 cases (57.25%) had social regression, and 4 cases (2.90%) had motor regression. The total scores of ABC and the sub-score of sensory and stereotypic behavior (β = 5.122, 95% CI: 0.818, 9.426, P < 0.05; β = 1.104, 95% CI: 0.120, 2.089, P < 0.05; β = 1.388, 95% CI: 0.038, 2.737, P < 0.05), the SRS total scores and the sub-score of autistic mannerisms (β = 4.991, 95% CI: 0.494, 9.487, P < 0.05; β = 1.297, 95% CI: 0.140, 2.453, P < 0.05) of children in the regressive group were all higher than the non-regressive group. The total developmental quotient (DQ) of CNBS-R2016 and the DQ of gross motor, fine motor, adaptive behavior, language (β = −5.827, 95% CI: −11.529, −0.125, P < 0.05) and personal society in the regressive group were lower than the non-regressive group and the proportion of children with intelligent developmental impairment was higher the non-regressive group.ConclusionRegressive autism is mainly manifested as language and social regression. Children with regressive ASD have more severe core symptoms, lower neurodevelopmental level DQ, and more serious disease degree than children with non-regressive ASD, which requires further etiological examinations and more clinical attention.

Potential early identification markers for children with autism spectrum disorder: Unusual vocalizations and theoretical explanations

<p id=C10>Early identification and intervention of children with autism spectrum disorder (ASD) are critical to their developmental outcomes. Vocalizations are sounds produced by children before they learn to talk. These can be divided into two categories: nonspeech-like and speech-like. Speech-like vocalizations include consonant and vowel sounds. Nonspeech-like vocalizations are natural, vegetative sounds that do not resemble speech. The common analysis indicators of nonspeech-like vocalizations in children with ASD are fundamental frequency, pause length, and duration of crying. Commonly used analytical indicators for speech-like vocalizations are vocal complexity and vocal communication. <p id=C11>Compared with typically developing children, those with ASD display a higher fundamental frequency of crying, yet shorter pauses in its length and duration. Atypical crying may represent an early biomarker for children with ASD that aids in early detection. The complexity of speech-like vocalizations in children with ASD is unusual and manifests as a lower or higher vocal complexity than those with typical development. Unusual vocal complexity appears to be a potentially useful indicator of emergent ASD, especially high vocal complexity, which may be an early identification marker for regression in children with ASD. When compared to typically developing children, children with ASD display low rates of vocal communication production, which may also be a useful early identification marker for the presence of ASD. <p id=C12>The theoretical explanations for unusual vocalizations mainly include: motivation orientation theories, neuromotor orientation theories, perceptual orientation theory, and social feedback orientation theory. In motivation orientation theories, potential sources of variation in vocal complexity are strong intrinsic motivation of special interests and social motivation deficits. The social motivation deficits may also lead to less communicative vocalizations in children with ASD. According to neuromotor orientation theories, the immaturity or disorder of nerves leads to atypical vocal complexity in children with ASD. The delay in the development of sitting posture limits the acquisition of speech-like vocalizations in children with ASD. Damage to the vagal cranial nerve complex leads to higher fundamental frequency, shorter pauses between cry episodes of crying, and shorter crying episodes in children with ASD. The perceptual orientation theory suggests that atypical auditory processing of speech sound stimuli in children with ASD makes them unable to learn speech-like vocalizations, affecting the development of vocal complexity. Social feedback orientation theory proposes that the effectiveness of the social feedback loop of children with ASD is reduced. Thus, if the number of iterations of the social feedback loop decreases, their speech-like vocalizations are further reduced. <p id=C13>Future research may consider in (1) exploring the possibility of unusual vocalizations as unique early identification markers for children with ASD, (2) strengthening the study of crying in early screening of children with ASD, (3) constructing an automatic learning classification model based on the strongest predictive acoustic parameters, (4) analyzing the influence of intrinsic and social motivation on speech-like vocalizations in children with ASD, and (5) investigating the neural mechanisms of unusual speech-like vocalizations. These evidence may be helpful for early identification and intervention of children with ASD.

Infant feeding practices associated with adiposity peak and rebound in the EDEN mother-child cohort.

High magnitude of adiposity peak and early adiposity rebound are early risk markers of later obesity. Infant diet represents one of the main modifiable determinants of early growth. This study aimed to investigate the association between infant feeding practices and age and magnitude of adiposity peak and rebound. Analyses were based on data from the French EDEN mother-child cohort. Data on breastfeeding and complementary feeding were collected at birth and 4, 8, and 12 months. From clinical examinations and measurements collected in the child's health booklet up to 12 years, individual growth curves were modeled, and ages and magnitudes of adiposity peak and rebound were estimated. Associations between infant feeding practices and growth were investigated by multivariable linear regression in children after testing a child-sex interaction. In the studied population (n = 1225), adiposity peak occurred at a mean of 9.9 ± 2 months and adiposity rebound at 5.5 ± 1.4 years. Associations between infant feeding practices and adiposity peak or rebound were moderated by child sex. For girls, each additional month of breastfeeding was related to a 2-day increase in the age at adiposity peak (p < 0.001), and an 18-day increase in the age at adiposity peak (p = 0.004). Whereas for boys, each additional month for the age at complementary food introduction was associated with a 29-day increase in the age at adiposity rebound (p = 0.02). For boys, long breastfeeding duration was only related to reduced body mass index at adiposity peak. Child sex has a moderating effect on the association between infant feeding practices and adiposity peak or rebound. The well-known association between breastfeeding duration and early growth seems stronger in girls than boys. The association found for complementary feeding in boys may give new insights into preventing obesity.

Impact of Adding Oseltamivir to Usual Care on Quality-Adjusted Life-Years During Influenza-Like Illness

ObjectivesThe ALIC4E trial has shown that oseltamivir reduces recovery time while increasing the risk of nausea. This secondary analysis of the ALIC4E trial aimed to determine the gain in quality-adjusted life-years (QALYs) associated with adding oseltamivir to usual primary care in patients presenting with influenza-like illness (ILI). MethodsPatients with ILI were recruited during the influenza season (2015-2018) in 15 European countries. Patients were assigned to usual care with or without oseltamivir through stratified randomization (age, severity, comorbidities, and symptom onset). Patients’ health status was valued with the EQ-5D and visual analog scale (VAS) for up to 28 days. Average EQ-5D and VAS scores over time were estimated for both treatment groups using one-inflated beta regression in children (<13 years old) and adults (≥13 years old). QALY gain was calculated as the difference between the groups. Sensitivity analysis considered the value set to convert EQ-5D answers to summary scores and the follow-up period. ResultsIn adults, oseltamivir gained 0.0006 (95% confidence interval 0.0002-0.0010) QALYs, whereas no statistically significant gain was found in children (14-day follow-up, EQ-5D). QALY gains were statistically significant in patients aged ≥65 years, patients without relevant comorbidities, or patients experiencing symptoms for ≤48 hours. Using VAS and accounting for 28-day follow-up resulted in higher QALY gain. ConclusionsQALY gain owing to oseltamivir is limited compared with other diseases, and its clinical meaningfulness remains to be determined. Further analysis is needed to evaluate whether QALY gain and its impact on ILI treatment cost render oseltamivir cost-effective.

Developmental regression in children with autism based on parental reports: A crosssectional study from eastern India

Background: The study attempts to investigate the prevalence and onset patterns of the phenomenon of regression in Autism Spectrum Disorder (ASD) and explore its possible associations with socio-demographic factors, birth history and preceding medical and psychosocial events. Methods: 88 children diagnosed to have ASD according to DSM-5 criteria, of ages 1-10, were evaluated. M-CHAT was used for initial screening of the subject, followed by the administration of validated tools such as Developmental Screening Test (DST) and Childhood Autism Rating Scale (CARS). Responses were tabulated and analyzed using SPSS version 22. Results: 60.2% of the sample had a history of developmental regression as per parental reports; the regression involved loss of both language and social skills. However, there was no statistically significant difference between children with and without regression with respect to cognitive ability and severity of autism. It was observed that children may present with 4 different patterns of onset of Autism, more specifically: pure delay, developmental plateau, delay with regression and pure regression. Conclusion: Prevalence of regression in our study was higher than existing literature. Mean age of regression was between 15-24 months preceded by medical or psychosocial event.

Clinical and Laboratory Profiles of Children with West Syndrome: Experience of 50 Cases in a Tertiary Hospital in Bangladesh

Background: West Syndrome (WS) consists of epileptic spasms, hypsarrhythmia on EEG and psychomotor delay or regression in children.&#x0D; Objective: To observe the clinical and laboratory profiles of children with west syndrome.&#x0D; Materials &amp; Methods: This was a cross sectional study and done from July 2017 to June 2018 in Pediatric Neurology OPD, NINS among total 50 cases of WS (age of &gt; 2 month to 2 years). WS was diagnosed by direct observation or video recording of spasm, along with history of developmental delay or regression and EEG change. Collected data regarding demography, detailed of spasm, clinical examination, radiological and EEG findings were analyzed.&#x0D; Results: Mean age of the patients was 12.61 ± 7.11 months. Males (58.0%) were predominant than females (42.0%). Mean age of onset of spasm was 5.88 ± 3.73 months. Type of spasm: Flexor in 88.0% cases, extensor in 6.0% cases, mixed in 4.0% and asymmetric in 2.0%. Microcephaly was present in 90.0% cases and in 64% cases H/o perinatal asphyxia (PNA) was present. In EEG, Hypsarrhythmia was found in 62.0% cases and modified hypsarrhythmia in 38.0% cases. In CT scan of brain, cerebral atrophy was found in 62.5.0% cases, stroke in 6.0% cases. Out of all WS patients 82% were symptomatic and 18% were either cryptogenic or idiopathic.&#x0D; Conclusion: Flexor type spasm was found more commonly in West syndrome. History of perinatal asphyxia (PNA) was present in majority of cases. In EEG findings, hypsarrhythmia was found more than modified hypsarrhythmia.&#x0D; Bangladesh J Child Health 2020; VOL 44 (3) :139-142

Prevalence and Age of Onset of Regression in Children with Autism Spectrum Disorder: A Systematic Review and Meta-analytical Update.

A systematic review published in 2013 reported 32% of children on the autism spectrum experience skill loss, known as autistic regression. However, the frequency varied depending on definition and measures used to capture skills. Retrospective parent report and prospective observation indicate loss of language and/or social skills, with motor skills typically unaffected. Our aim was to update the prevalence and age of onset of autistic regression through a meta-analysis of the literature to understand if there have been changes to the reported onset and prevalence since 2010. A systematic literature search was conducted using Medline, Embase, PsycINFO, and the Cochrane Library databases and included studies published from 2010 onward. Risk of bias assessment was performed on included studies. A random effects model was used to calculate the pooled prevalence and age of onset of autistic regression. Ninety-seven studies were included in the systematic review, of which 75 studies involving 33,014 participants had sufficient data for meta-analytic syntheses. The pooled proportion of autistic regression was 30% (95% confidence interval [CI]: 27-32%) but heterogeneity was high (I2 = 96.91) and did not reduce with sensitivity or subgroup analyses based on study design or clinical differences, respectively. Prevalence varied according to risk of bias (low: 27%) and definition of regression (language: 20%, language/social: 40%, mixed: 30%, and unspecified: 27%). Weighted average age of onset was 19.8 months. Findings from this meta-analysis highlight the importance of developing a standardized definition of autistic regression, and tools to measure this at multiple time points during early childhood development. LAY SUMMARY: About a third of children with Autism Spectrum Disorder experience loss of skills, which is also known as autistic regression. This paper provides an update of the rate of autistic regression in children and the age when they first experience loss of skills, based on current studies. The findings from this review contribute to our understanding of the onset patterns of autistic regression. Unfortunately, studies are not sufficiently similar, making it difficult to provide clear answers on the exact timing or type of regression seen in different children.

Down Syndrome Disintegrative Disorder: A Clinical Regression Syndrome of Increasing Importance

Down syndrome disintegrative disorder (DSDD), a developmental regression in children with Down syndrome (DS), is a clinical entity that is characterized by a loss of previously acquired adaptive, cognitive, and social functioning in persons with DS usually in adolescence to early adulthood. Initially reported in 1946 as "catatonic psychosis," there has been an increasing interest among the DS community, primary care, and subspecialty providers in this clinical area over the past decade. This condition has a subacute onset and can include symptoms of mood lability, decreased participation in activities of daily living, new-onset insomnia, social withdrawal, autistic-like regression, mutism, and catatonia. The acute phase is followed by a chronic phase in which baseline functioning may not return. No strict criteria or definitive testing is currently available to diagnose DSDD, although a comprehensive psychosocial and medical evaluation is warranted for individuals presenting with such symptoms. The etiology of DSDD is unknown, but in several hypotheses for regression in this population, psychological stress, primary psychiatric disease, and autoimmunity are proposed as potential causes of DSDD. Both psychiatric therapy and immunotherapies have been described as DSDD treatments, with both revealing potential benefit in limited cohorts. In this article, we review the current data regarding clinical phenotypes, differential diagnosis, neurodiagnostic workup, and potential therapeutic options for this unique, most disturbing, and infrequently reported disorder.

COVID 19 Influence on Teaching Process for Children with Disabilities

Research has been conducted to find how isolation affected their competencies: progress, regression, areas need to be strengthened, approaches need to be used, how to plan further work. As an instrument, were used the Assessment Protocol. Strategies and approaches used in working with the child were evaluated, then, assessment of developmental areas of progress and regression in children. After that, academic and developmental progress and regression. This was followed by an assessment of the areas in which the child needs to work additionally. 43 children were assessed and are dominated by intellectual and autism spectrum disorders, which correspond to the general education inclusive context. Findings show that teachers mostly worked and communicated via viber, less through platforms and applications. They were based on the adaptation and individualization of teaching and working materials prescribed by the IDEP done for each child. We find that teachers know the didactic material significantly, but that some resources have not been used to a sufficient, justified and desirable extent - Daisy textbooks and assistive technology. The emotional status of the child was relatively maintained thanks to a more individualized approach. Behavior, interaction and communication are the developmental areas in which in a significant number of children happened attachment, awareness because that they have enjoyed an individualized teacher orientation. But, it is at the same time estimated the presence of regression in this area. Quality of knowledge has been achieved in accordance with the reduced content and expectations. Especially affected are practice and application because the teaching took place at home, not in a structured school environment, so this is an area that should be emphasized in the future. Therefore, after the school beginning, the principle of individualization should be maintained, taking into account the characteristic of child disability, his potentials, and appropriate methods of work especially in areas where the child needs support. Intensive work should be done on the catch up activities and materials, practical application, socialization, interaction, communication in a real context.

Anthropometry-based estimation of body heat capacity in individuals aged 7\u201369 years: the Size Korea Survey 2010

Although our previously developed anthropometry-based calculation of heat capacity (HC) for adults appeared to be precise and valid, its use in children and adolescents may be associated with bias. This study investigated a large dataset from the Size Korea survey, a national anthropometric survey conducted in 2010, to revalidate our previous HC equation and to develop another one that is appropriate for children and adolescents. We enrolled 12,766 participants aged 7–69 years with body composition data measured by multi-frequency bioelectrical impedance analysis. Age was associated with HC in children aged 7–19 years (R2 = 0.58) but not in adults (R2 = 0.007). Linear regression was appropriate to describe the relationship between HC and body surface area (BSA) in adults, whereas the regression in children and adolescent was quadratic. The previously developed HC equation had high reliability (intra-class correlation coefficient = 0.995) and predictive power (accurate prediction rate = 86.1%) in the >20 age group. The model composed of sex, body weight, BSA, and BSA2 was appropriate for the prediction of HC in young individuals aged 7–19 years. In conclusion, anthropometric-based modelling is a simple, reliable, and useful method for the calculation of HC.

Ultrasonographic Evaluation of the Sacrococcyx and Spinal Canal in Children with Constipation

Background The occult neurological disorders are an important cause of constipation in children. This study aimed to evaluate the spinal canal and lumbosacral by ultrasound in pediatric constipation to better identifying neurological causes of constipation. Materials and Methods In this case-control study, 100 children with constipation (age range 1 to 14 years) without previously known chronic illness referred to the Radiology Department of the Mashhad Pediatric Dr. Sheikh Hospital were selected. After recording clinical data, the patients were undergone sacral and spinal cord ultrasound examinations and the results were compared with the control group (healthy children with transient illness (otherwise constipation or urinary disorders) who had referred to radiology department for sonographic examination). Results The mean age of patients was 6 ± 3.3 years old. The tethered cord and occult intrasacral meningocele were observed in 2% of patients group. Spina bifida was found in 64% patients, and 31% control subjects with significant difference (P = 0.009). About one third of cases with spina bifida were found in lumbar L5 vertebra, and another two third were in high sacral vertebrae (S1 or S2). Various degrees of caudal regression were observed in 8% patients suffering from constipation and in control group, 2% children had coccyx hypoplasia. No significant correlation was found between case and control groups regarding the location of spina bifida and non-formation of the posterior arch of the sacrum, the mean coccyx length, dural diameter and the ossification age of first vertebra of coccyx. Conclusion In pediatric age, lumbosacral spinal anomalies can easily evaluate with ultrasound. The prevalence of spina bifida and caudal regression in children with constipation was significantly higher compared with normal control group.

Autism risk following antidepressant medication during pregnancy.

Background.Previous studies have examined if maternal antidepressant medication during pregnancy increase the risk of autism spectrum disorder (ASD) in the offspring, but the results have been conflicting.Methods.In a population-based cohort of 179 007 children born in 2006 and 2007 and followed through 2014 when aged 7 and 8, we estimated relative risks (RRs) of ASD and 95% confidence intervals (CIs) from Cox regression in children exposed to any antidepressant medication during pregnancy, and nine specific antidepressant drugs. Analyses were adjusted for potential confounders and were conducted in the full population sample, and in a clinically relevant sub-sample of mothers with at least one diagnosis of depression or anxiety during life.Results.The adjusted RR of ASD in children of mothers who used antidepressant medication during pregnancy was estimated at 1.23 (95% CI 0.96–1.57), and at 1.07 (95% CI 0.80–1.43) in women with a history of depression or anxiety. Analyses of specific antidepressants initially revealed increased RRs of offspring ASD confined to citalopram and escitalopram (RR: 1.47; 95% CI 0.92–2.35) and clomipramine (RR: 2.86; 95% CI 1.04–7.82).Conclusion.Medication with antidepressants during pregnancy does not appear to be causally associated with an increased risk of ASD in the offspring. Instead, the results suggest that the association is explained by factors related to the underlying susceptibility to psychiatric disorders. Based on these findings, the risk of ASD in the offspring should not be a consideration to withhold treatment with commonly used antidepressant drugs from pregnant women.

Regression in autism spectrum disorders.

Since the Journal of Paediatrics and Child Health was first published, there has been substantial change in the field of autism spectrum disorders (ASDs) with an exponential increase in the amount of funded and published research. In this paper, we focus on regression in children with ASD, a phenomenon that remains poorly understood. We discuss the implications of what we know about regression in ASD for the way we think about ASD more broadly and for paediatric practice.

Language regression in children with Autism Spectrum Disorders

ObjectivesRegression in autism applies to the phenomenon of apparently normal early development followed by the loss of previously acquired skills and manifestation of symptoms of autism. Estimates of the frequency of regression in autism range from 10% to 50%. Although there are tools available to evaluate and diagnose Autism Spectrum Disorders, however, there is no published tool available in Indian context to identify the children with ASD at an early age. The study was aimed to describe the differences in language regression between children with ASD and typically developing children and also to determine the age of regression. MethodsRegression screening tool, a questionnaire was developed based on Regression Supplement Form (Goldberg et al., 2003). The skills were validated by five Clinical Psychologists. It comprised of 16 skills which included domains like, ‘spoken language and non verbal communication’, ‘social interest and responsiveness’ and ‘play and imagination’. This retrospective study was conducted on a single group. The participants consisted of parents of 30 children with ASD (22 males and 8 females). ResultsThe findings revealed a significant regression in children with ASD. The mean regression age is 20.19 months (SD-5.2). The regression profile of the children with ASD revealed regression of language skills occurred at 19.16 months followed by non language skills at 20.5 months. ConclusionsBased on the findings it can be stated that inclusion of regression screening tool will offer clinicians a convenient tool to examine the phenomena of regression in children with ASD and identify them as early as 21 months of age for early intervention.

BP Control and Left Ventricular Hypertrophy Regression in Children with CKD

In adult patients with CKD, hypertension is linked to the development of left ventricular hypertrophy, but whether this association exists in children with CKD has not been determined conclusively. To assess the relationship between BP and left ventricular hypertrophy, we prospectively analyzed data from the Chronic Kidney Disease in Children cohort. In total, 478 subjects were enrolled, and 435, 321, and 142 subjects remained enrolled at years 1, 3, and 5, respectively. Echocardiograms were obtained 1 year after study entry and then every 2 years; BP was measured annually. A linear mixed model was used to assess the effect of BP on left ventricular mass index, which was measured at three different visits, and a mixed logistic model was used to assess left ventricular hypertrophy. These models were part of a joint longitudinal and survival model to adjust for informative dropout. Predictors of left ventricular mass index included systolic BP, anemia, and use of antihypertensive medications other than angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. Predictors of left ventricular hypertrophy included systolic BP, female sex, anemia, and use of other antihypertensive medications. Over 4 years, the adjusted prevalence of left ventricular hypertrophy decreased from 15.3% to 12.6% in a systolic BP model and from 15.1% to 12.6% in a diastolic BP model. These results indicate that a decline in BP may predict a decline in left ventricular hypertrophy in children with CKD and suggest additional factors that warrant additional investigation as predictors of left ventricular hypertrophy in these patients.

Myeloid dendritic cells frequencies are increased in children with autism spectrum disorder and associated with amygdala volume and repetitive behaviors.

The pathophysiology of autism spectrum disorder (ASD) is not yet known; however, studies suggest that dysfunction of the immune system affects many children with ASD. Increasing evidence points to dysfunction of the innate immune system including activation of microglia and perivascular macrophages, increases in inflammatory cytokines/chemokines in brain tissue and CSF, and abnormal peripheral monocyte cell function. Dendritic cells are major players in innate immunity and have important functions in the phagocytosis of pathogens or debris, antigen presentation, activation of naïve T cells, induction of tolerance and cytokine/chemokine production. In this study, we assessed circulating frequencies of myeloid dendritic cells (defined as Lin-1(-)BDCA1(+)CD11c(+) and Lin-1(-)BDCA3(+)CD123(-)) and plasmacytoid dendritic cells (Lin-1(-)BDCA2(+)CD123(+) or Lin-1(-)BDCA4(+) CD11c(-)) in 57 children with ASD, and 29 typically developing controls of the same age, all of who were enrolled as part of the Autism Phenome Project (APP). The frequencies of dendritic cells and associations with behavioral assessment and MRI measurements of amygdala volume were compared in the same participants. The frequencies of myeloid dendritic cells were significantly increased in children with ASD compared to typically developing controls (p<0.03). Elevated frequencies of myeloid dendritic cells were positively associated with abnormal right and left amygdala enlargement, severity of gastrointestinal symptoms and increased repetitive behaviors. The frequencies of plasmacytoid dendritic cells were also associated with amygdala volumes as well as developmental regression in children with ASD. Dendritic cells play key roles in modulating immune responses and differences in frequencies or functions of these cells may result in immune dysfunction in children with ASD. These data further implicate innate immune cells in the complex pathophysiology of ASD.