Restricted Patterns Of Behavior Research Articles

Plasma level of transforming growth factor β 1 in children with autism spectrum disorder

BackgroundAutism spectrum disorders (ASDs) are a group of neurodevelopmental disorders characterized by pervasive abnormalities in social interaction and communication, and repetitive and restricted behavioral patterns and interests. ASD include autistic disorder, Asperger’s disorder, pervasive developmental disorder not otherwise specific and childhood disintegrative disorders. ObjectivesTo detect plasma level of transforming growth factor beta 1 (TGFβl) in children with ASD and to find out correlation between the plasma level of TGFβ1 and severity of ASD. Patients and methodsOur study included 30 patients with autistic spectrum disorder (ASD) diagnosed on the basis of criteria of autistic spectrum disorders as defined in Diagnostic and Statistical Manual of Mental Disorders fourth edition text revised (DSM-IV) (TR). They were 26 males and 4 females, their ages ranged from 3years to 13years. Thirty apparently healthy sex and age matched children served as controls (22 males and 8 females). They were subjected to full history taking, clinical examination and severity rating using Child Autistic Rating Scale of Children (CARS) and Diagnostic and Statistical Manual of Mental Disorders fourth edition text revised (DSM-IV) (TR). ResultsOur study revealed: (a) sex distribution among the patient group with male/female ratio 6.5:1; (b) mean value of maternal age was significantly higher among patients than controls; (c) about 50% of patients had a history of prenatal complication; (d) the patient group shows lower plasma level of TGFβ1 compared to the control group. ConclusionThere may be an important role for the immune system in autism spectrum disorders that may have profound implications for diagnosis and treatment of this disorder. A negative correlation was found between severities of ASD and TGFβ1 plasma level.

Gluten-free and casein-free diets in the treatment of autism

Background: Autism is a complex psychiatric disorder characterized by three core symptoms, i.e. impairments in social interaction, restricted patterns of behavior and impairments in communication. In the framework of the “opioid excess theory”, the disorder symptoms are compared to the behavioral effects of opiates. Based on this, a possible nutritional basis of autism has been proposed, hypothesizing that certain food proteins such as gluten and casein can be transformed to opioid peptides during digestion. These peptides might eventually be able to enter the blood stream and act upon the central nervous system. As a consequence, a diet low in such proteins has been hypothesized to ameliorate the behavioral symptoms of autistic children.Objective: The scope of this review was to analyze the effects of gluten-free and casein-free (GFCF) diets on children with autism, as well as to provide information concerning additional aspects related to the GFCF diet in autism.Methods: A literature search was conducted including scientific publications up until December 2013. Search results were screened for any kind of GFCF dietary intervention as well as surveys dealing with GFCF as a treatment for autism.Results: A review of survey data shows that up to 25 % of parents of affected children report on current use of a GFCF diet. The majority of identified studies evaluating GFCF diet outcomes failed to meet basic methodological standards of interventional science. Comparison of study results did not show any clear-cut results, with a substantial proportion of studies failing to show any positive dietary effect. The results of more sophisticated trials were far from equivocal and the studies differed by many methodological aspects. Some variables such as information source and trial duration seemed to affect outcome. Conclusions: Evidence for the effectiveness of the GFCF diet in the treatment of autism is sparse. Rigorous scientific evaluations partly failed to confirm therapeutic effects of the GFCF diet. These and other negative results related to the opioid excess theory weaken the underlying rationale for GFCF diet use. Nevertheless, more sophisticated investigations should be conducted in order to identify possible benefits and harms of such a dietary approach.Key words: gluten-free and casein-free diet, opioid excess theory, autism, autistic spectrum disorder, therapeutic effects, evidence base, prevalence of use

Copy‐number variation in the pathogenesis of autism spectrum disorder

Autism spectrum disorder is a neurodevelopmental disorder present in 1% of the population, characterized by impairments in reciprocal social interaction, communication deficits and restricted patterns of behavior. Approximately 10% of the autism spectrum disorder population is thought to have large chromosomal rearrangements. Copy-number variations (CNV) alter the genome structure either by duplication or deletion of a chromosomal region. The association between CNV and autism susceptibility has become more apparent through the use of methods based on comparative genomic hybridization in screening CNV. The nature of the high CNV rate in the human genome is partly explained by non-allelic homologous recombination between flanking repeated sequences derived from multiple copies of transposons or mobile genetic elements. There are hotspots for CNV in the human genome, such as 16p11.2 and 22q11.2. Genes involved in CNV are supposed to have copy-number dose-dependent effects on the behavior of affected individuals. Animal models give insight into the possible interactions between core genetic loci and additional factors contributing to the phenotypes of each individual. If affected genes code for cellular signaling molecules, reducing the dosage in the intracellular signaling pathway may result in the malfunction of the nervous system. The genetic background of autism spectrum disorder is highly heterogenic and most common or rare CNV do not lead to autism spectrum disorders in the majority of cases, but may occasionally increase the risk of developing an autism spectrum disorder.

Food Selectivity in Autism Spectrum Disorders

Autism spectrum disorders are characterized by difficulties with reciprocal social interactions and restricted patterns of behavior and interest; one of these characteristic behaviors is food selectivity. The objective of this study was to perform a systematic review of the literature published between 1970 and 2013 concerning this eating behavior. The articles identified were analyzed in terms of sample size, study design, and criteria for assessment and intervention, as well as the results, level of evidence and grade of recommendation. The main search was conducted in Medline, Cochrane Library, Scielo, ScienceDirect, and Embase). There is empirical evidence and an overall scientific consensus supporting an association between food selectivity and autism spectrum disorders.

Praxis and autism: the psychomotor regulation sensory processing dimension-a report from the field.

A quiet revolution is afoot in our understanding of autism spectrum disorder (ASD). Classically understood as a social disorder (Kanner, 1943) that presents clinically with social and communication difficulty and restricted patterns of behaviors (Lord et al., 2000), both diagnosis and therapeutic interventions have correspondingly focused upon behavioral and typical development theory (Lovaas, 1987; Dawson et al., 2010). Yet recent studies across multiple fields have begun to substantiate what my colleagues and I have come to learn about ASD through almost two decades of clinical work with children. In fact two recent papers propose a cognitive motor model of autism and summarize much of this research (Rizzolatti and Fabbri-Destro, 2010; Mostofsky and Ewen, 2011). That research is further bolstered by (auto) biographical work of several people living with ASD (Williams, 1994; Biklen, 2005; Iversen, 2007). The primary claim is as simple as it is radical ASD has as a primary, defining feature psychomotor regulation sensory processing disorder. Whether this psychomotor dimension simply parallels the social and communication deficits that consume almost all of the attention and resources in research and intervention, or plays an important role in producing those symptoms will have to be the topic of future research over the coming decade. What we can say at present is that an important psychomotor dimension that has etiological and symptomatic aspects exists, and that this has important, if only nascently understood, therapeutic implications.

How to use… an autism assessment tool

Autism is a neurodevelopmental condition affecting three main areas: social communication, social interaction and restricted patterns of behaviour, interests and activities. The Diagnostic and Statistical Manual of Mental Disorders, 4th...

A Systematic Review of the Literature on the Chiropractic Care of Patients with Autism Spectrum Disorder

In addition to impacting the affected child and his/her family's quality of life, recent estimates place the lifetime cost for an individual with ASD at $3.2 million and $35 billion for the entire birth cohort. Given the clinical heterogeneity of ASD, treatment approaches are multidisciplinary including alternative therapies, particularly when no pharmaceutical agent is effective for the core symptoms of ASD. Chiropractic is a popular alternative therapy for children. A systematic review of the literature was performed to provide context for future research endeavors in this field. A systematic review of the literature on the chiropractic care of patients with ASD utilized 8 databases. Eligibility criteria for inclusion included: (1) the study was a primary investigation/report published in an English peer-reviewed journal; (2) the study involved patients ≤18 years; and (3) patients are diagnosed with autism, Asperger's Syndrome, PDD-NOS, or ASD. Our systematic review of the literature revealed a total of five articles consisting of three case reports, one cohort study and one randomized comparison trial. The literature is lacking on documenting the chiropractic care of children with ASD. At the heart of the core symptoms of ASD (ie, impaired social interactions, deficits in communication and repetitive or restricted behavioral patterns) is abnormal sensory processing. Preliminary studies indicate that the chiropractic adjustment may attenuate sensorimotor integration based on somatosensory evoked potentials studies. We encourage further research for definitive studies on chiropractic's effectiveness for ASD. However, given the ineffectiveness of pharmaceutical agents, a trial of chiropractic care for sufferers of autism is prudent and warranted.

Preschool Neurobehavioral Outcome following Fetal Myelomeningocele Surgery

Objective: It was the aim of this study to assess the prevalence of preschool neurobehavioral problems in children following fetal myelomeningocele (fMMC) surgery. Methods: Prior to the Management of Myelomeningocele Study, 30 fMMC patients underwent a standardized neurodevelopmental examination at 5 years of age. The prevalence of behavioral problems was assessed by the Child Behavior Check List (CBCL), which includes a total problem score and 2 broad-band indices (internalizing and externalizing problems). fMMC children were classified as having normal, at-risk or clinically significant scores based on calculated T scores. Results: Twenty-two (73%) fMMC families completed the evaluation. Mean age at delivery following fMMC surgery was 35.5 ± 1.6 weeks. The prevalence of ‘at-risk’ or ‘clinically significant’ scores for internalizing, externalizing and total behavioral problems was similar to general population norms. No difference in overall internalizing (p = 0.19), externalizing (p = 0.54) and total behavioral (p = 0.18) scores was found between non-shunted and shunted fMMC children. However, shunted fMMC children were more likely to experience anxiety and depressive (p = 0.02), pervasive developmental (p = 0.03) and withdrawn (p = 0.06) behavior. Oppositional defiant, attention deficit and hyperactivity problems were not found. No correlation was found between overall neurodevelopmental outcome and abnormal CBCL scores. Conclusions: fMMC surgery and subsequent preterm delivery is not associated with increased behavioral problems, impaired social interactions and restricted behavior patterns. Shunted fMMC children were more likely to have scores in the ‘at-risk’ or ‘clinically significant’ range for multiple CBCL subindices. Early detection of behavioral problems following fMMC surgery provides an opportunity for targeted and timely intervention enabling affected fMMC children to be socially successful.

Use of Gilliam Asperger's Disorder Scale in Differentiating High and Low Functioning Autism and ADHD

Little is known about the validity of Gilliam Asperger's Disorder Scale (GADS), although it is widely used. This study of 199 children with high functioning autism or Asperger's disorder, 195 with low functioning autism, and 83 with attention deficit hyperactivity disorder (ADHD) showed high classification accuracy (autism vs. ADHD) for clinicians' GADS Quotients (92%), and somewhat lower accuracy (77%) for parents' Quotients. Both children with high and low functioning autism had clinicians' Quotients (M=99 and 101, respectively) similar to the Asperger's Disorder mean of 100 for the GADS normative sample. Children with high functioning autism scored significantly higher on the cognitive patterns subscale than children with low functioning autism, and the latter had higher scores on the remaining subscales: social interaction, restricted patterns of behavior, and pragmatic skills. Using the clinicians' Quotient and Cognitive Patterns score, 70% of children were correctly identified as having high or low functioning autism or ADHD.

Somatosensory and sensorimotor consequences associated with the heterozygous disruption of the autism candidate gene, Gabrb3

Autism spectrum disorder (ASD) is diagnosed based on three core features: impaired social interactions, deficits in communication and repetitive or restricted behavioral patterns. Against this backdrop, abnormal sensory processing receives little attention despite its prevalence and the impact it exerts on the core diagnostic features. Understanding the source of these sensory abnormalities is paramount to developing intervention strategies aimed at maximizing the coping ability of those with ASD. Consequently, we chose to examine whether sensory abnormalities were present in mice heterozygous for the Gabrb3 gene, a gene strongly associated with ASD. Mice were assessed for tactile and heat sensitivity, sensorimotor competence (accelerating rotarod task) and sensorimotor gating by prepulse inhibition of the acoustic startle reflex (PPI). All heterozygotes exhibited an increase in seizure susceptibility and similar reductions in Gabrb3 expression in the dorsal root ganglia, spinal cord, whole brain and amygdala. Interestingly, significant differences were noted between heterozygous variants in regards to tactile sensitivity, heat sensitivity, sensorimotor competence and PPI along with differences in Gabrb3 expression in the reticular thalamic nucleus and the bed nucleus of stria terminalis. These differences were influenced by the heterozygotes’ gender and whether the Gabrb3 gene was of paternal or maternal origin. These results are not adequately explained by simple haploinsufficiency of Gabrb3, therefore, additional mechanisms are likely to be involved. In addition, this is the first report of the occurrence of tactile and heat hypersensitivity in an ASD mouse model, two features often associated with ASD.

Apolipoprotein E Genotype Modifies the Risk of Behavior Problems After Infant Cardiac Surgery

The goal was to evaluate polymorphisms of the APOE gene as modifiers of neurobehavioral outcomes for preschool-aged children with congenital heart defects, after cardiac surgery. A prospective observational study with neurodevelopmental evaluation between the fourth and fifth birthdays was performed. Attention and behavioral skills were assessed through parental report. Parents of 380 children completed the neurobehavioral measures. Child Behavior Checklist scores for the pervasive developmental problem scale were in the at-risk or clinically significant range for 15% of the cohort, compared with 9% for the normative data (P < .00001). Attention problem scores were in the at-risk or clinically significant range for 12% of the cohort, compared with 7% for the normative data (P = .0002). The Attention-Deficit/Hyperactivity Disorder Rating Scale-IV, Preschool Version, was completed for 378 children; 30% scored in the clinically significant range for inattention and 22% for impulsivity. After adjustment for covariates, the APOE epsilon2 allele was significantly associated with higher scores (worse problems) for multiple Child Behavior Checklist indices, including somatic complaints (P = .009), pervasive developmental problems (P = .032), and internalizing problems (P = .009). In each case, the epsilon4 allele was associated with a better outcome. APOE epsilon2 carriers had impaired social skills, compared with epsilon4 carriers (P = .009). For preschool-aged children with congenital heart defects requiring surgery, parental rating scales showed an increased prevalence of restricted behavior patterns, inattention, and impaired social interactions. The APOE epsilon2 allele was associated with increased behavior problems, impaired social interactions, and restricted behavior patterns.

Maladaptive and Repetitive Behaviors in Children With Down Syndrome and Autism Spectrum Disorders: Implications for Screening

Researchers and clinicians are recognizing that a subgroup of children with Down syndrome (DS) also present with clinically significant impairments in social-communication and restricted patterns of behavior, such as those that characterize autism spectrum disorders (ASD). Efforts to better describe the behavioral presentation of children with co-occurring DS and ASD could be useful in developing screening and assessment procedures, which could, in turn, facilitate prompt access to appropriate intervention and supports. This study examines the specificity of various forms of maladaptive behavior (e.g., disruptive, repetitive, etc.) in children with co-occurring DS and ASD (n = 22), relative to children with DS (without ASD; n = 54) and those with a nonspecific developmental disorder (DD; n = 34). Parent report of child behavior was obtained on 110 children, ages 3–11 years (mean age = 73 months), who had completed a comprehensive diagnostic evaluation for autism. Two experienced clinical psychologists reviewed more than 50% of cases and independently determined ASD status. One-way analyses of variance were conducted to examine behavioral variables across diagnostic groups. Children with DS + ASD were reported to exhibit more problem behaviors than children in the DS group (without ASD) as well as more self-absorbed behaviors and poorer social relating. The DS + ASD group and DD group had significantly higher scores than the DS only group on overall repetitive behaviors and on “low forms” of repetitive behaviors. Children with DS + ASD were not significantly different from children in the DD group on any of the behavioral variables. Implications for screening and assessment of autism symptoms in children with DS are discussed.

Guía de buena práctica para el diagnóstico de los trastornos del espectro autista

The autism spectrum disorder (ASD) diagnostic process requires expertise both in the knowledge of autism as in teamwork strategies with different professionals, often working in different clinic services, and with parents. To recommend a consensus diagnostic procedure for ASD, that has been designed by the Study Group of the Instituto de Salud Carlos III. The reports emphasize the need to obtain a complete clinical history, covering personal, family and psychosocial antecedents; detailing the basic areas affected in ASD--social interaction, communication and restricted patterns of behaviour, activities and interests. Diagnostic tests to be used as a routine in all cases are described and analysed--including both psychoeducational and biomedical tests. Also, tests indicated in cases with suspected identifiable physical disorders are covered, as well as those medical tests to be used for research purposes only. The diagnostic procedure requires the implementation of a coordinated interdisciplinary assessment strategy, that needs to ensure the participation of professionals from very different fields in active collaboration with the family. Their role culminates in the preparation and delivery of a personalized report. Every diagnostic procedure needs to be accompanied by an action plan that includes immediate support to the person with ASD, as well as information to the family on resources and community initiatives in their living area.

Advances in the Pharmacotherapy of Pervasive Developmental Disorders (PDD)

Pervasive developmental disorders (PDDs) are profound neuropsychiatric conditions characterized by impairments in social interaction and communication, as well as restricted patterns of behavior, interests, and activities. In addition to these core criteria, interfering behaviors including aggression, self–injury, agitation, hyperactivity, and repetitive phenomena are commonly observed. Although a nonpharmacologic approach is frequently utilized in the management of maladaptive behavior, medications are often necessary to diminish severe target symptoms in individuals with PDDs. This review will address recent advances in the pharmacotherapy of PDDs, with an emphasis on well–designed trials.

Brief report: A comparison of the diagnostic criteria for Asperger syndrome

Asperger syndrome (AS) was first described under the title of psychopathy by the Austrian physician Hans Asperger (1944). Despite the growing interest in it, its nosological status remains uncertain. It is not clear to what extent it differs from autism, although some authorities have proposed that it is part of the autistic continuum (Wing, 1981). The DSMIII-R (American Psychiatric Association [APA], 1987) has no separate category for this disorder, and the DSM-IV has not yet decided whether or not to include it (APA, DSM-IV Options Book, 1991). However, the ICD-10 (World Health Organization [WHO], 1988) has included it as a distinct category within the pervasive developmental disorders, because it does not fulfill the usual criteria for and because it remains uncertain whether or not the syndrome is truly synonymous with autism (Rutter, 1989, p. 504). According to the ICD-10, AS is characterized by a qualitative impairment of reciprocal social interaction; a lack of clinically significant general delay in language or cognitive development; and restricted patterns of behavior and interests. In addition, the disorder is not attributable to the other varieties of pervasive developmental disorder (WHO, 1988). Most publications have not used any operational criteria for the diagnosis of AS while others have introduced substantial changes to the clinical features described by Asperger. For example, Asperger believed that the patients he described were of normal intelligence. However, some authors have since described patients of Asperger syndrome with mental