Restricted Behaviors Research Articles

Planning and Pedagogical Considerations for Teaching Children With Autism Spectrum Disorder in Physical Education

Around the world, autism spectrum disorder (ASD) is a prevalent neurodevelopmental condition. It is linked to a wide range of deficiencies across multiple domains, including restrictive and repetitive behaviors that impair interaction or engagement with others. School-aged children with ASD face challenges that make physical activity more difficult. To address challenges associated with ASD, physical education interventions need to be tailored to the child’s needs and abilities. Despite advances in research on children with ASD in physical education, adopting contemporary approaches is yet to be the norm. This review aimed to examine the literature on intervention models to improve the physical activity skills of children with ASD and to suggest practical considerations for delivering an effective physical education program and lessons. The recommendations provided in this review support teachers in applying strategies that maximize meaningful learning opportunities for children with ASD and use effective pedagogies that meet their needs.

Near-Infrared Light-Powered and DNA Nanocage-Confined Catalytic Hairpin Assembly Nanobiosensor with a Nucleic Acid Restriction Behavior and Reinforced Enzymatic Resistance for Robust Imaging Assay in Live Biosystems.

While DNA amplifier-built nanobiosensors featuring a DNA polymerase-free catalytic hairpin assembly (CHA) reaction have shown promise in fluorescence imaging assays within live biosystems, challenges persist due to unsatisfactory precision stemming from premature activation, insufficient sensitivity arising from low reaction kinetics, and poor biostability caused by endonuclease degradation. In this research, we aim to tackle these issues. One aspect involves inserting an analyte-binding unit with a photoinduced cleavage bond to enable a light-powered notion. By utilizing 808 nm near-infrared (NIR) light-excited upconversion luminescence as the ultraviolet source, we achieve entirely a controllable sensing event during the biodelivery phase. Another aspect refers to confining the CHA reaction within the finite space of a DNA self-assembled nanocage. Besides the accelerated kinetics (up to 10-fold enhancement) resulting from the nucleic acid restriction behavior, the DNA nanocage further provides a 3D rigid skeleton to reinforce enzymatic resistance. After selecting a short noncoding microRNA (miRNA-21) as the modeled low-abundance sensing analyte, we have verified that the innovative NIR light-powered and DNA nanocage-confined CHA nanobiosensor possesses remarkably high sensitivity and specificity. More importantly, our sensing system demonstrates a robust imaging capability for this cancer-related universal biomarker in live cells and tumor-bearing mouse bodies, showcasing its potential applications in disease analysis.

Repetitive Behaviors in Autism and Obsessive-Compulsive Disorder: A Systematic Review.

Obsessive-compulsive disorder (OCD) and autism are characterized by the presence of repetitive behaviors. Differentiating between repetitive behaviors attributable to a diagnosis of autism, and those attributable to OCD, poses challenges for differential and co-occurring diagnosis. Differentiation is important to inform appropriate supports and interventions for phenotypically similar but functionally distinct behaviors. In this systematic review, the quantitative literature was examined to explore the similarities and differences in repetitive behaviors (including restricted and repetitive behaviors and interests, and obsessive-compulsive behaviors) in autistic individuals and those with OCD, and those with co-occurring diagnoses, in terms of: (1) expression, (2) content, and (3) associated factors. Thirty-one studies were identified that compared repetitive behaviors in autistic individuals, individuals with OCD, or individuals with both diagnoses. The results suggest considerable overlap in the intensity and content of repetitive behaviors between groups. The findings of this review highlight that research aimed specifically at understanding similarities and differences in repetitive behaviors between autistic individuals and individuals with OCD is limited and frequently only compare at total score or composite measure levels. Further research into differences in the presentation of repetitive behaviors at a subscale and item level is required to inform clearer differentiation of specific behaviors in autism versus OCD. Understanding and more accurately differentiating is essential for efficient diagnosis, effective treatment, and better outcomes.

Cluster analysis of teachers report for identifying symptoms of autism spectrum and/or attention deficit hyperactivity in school population: EPINED study.

An early detection of Neurodevelopmental Disorders (NDDs) is crucial for their prognosis; however, the clinical heterogeneity of some disorders, such as autism spectrum disorder (ASD) or attention-deficit hyperactivity disorder (ADHD) is an obstacle to accurate diagnoses in children. In order to facilitate the screening process, the current study aimed to identify symptom-based clusters among a community-based sample of preschool and school-aged children, using behavioral characteristics reported by teachers. A total of 6894 children were assessed on four key variables: social communication differences, restricted behavior patterns, restless-impulsiveness, and emotional lability (pre-schoolers) or inattention and hyperactivity-impulsivity (school-aged). From these behavioral profiles, four clusters were identified for each age group. A cluster of ASD + ADHD and others including children with no pathology was clearly identified, whereas two other clusters were characterized by subthreshold ASD and/or ADHD symptoms. In the school-age children, the presence of ADHD was consistently observed with ASD patterns. In pre-schoolers, teachers were more proficient at identifying children who received a diagnosis for either ASD and/or ADHD from an early stage. Considering the significance of early detection and intervention of NDDs, teachers' insights are important. Therefore, promptly identifying subthreshold symptoms in children can help to minimize consequences in social and academic functioning.

Stem Cell Secretions as a Potential Therapeutic Agent for Autism Spectrum Disorder: A Narrative Review.

Autism spectrum disorder (ASD) is a neurodevelopmental illness characterized by impaired social interaction and restricted repetitive behaviors or interests. The rising prevalence of ASD diagnosis has triggered a surge in research into investigating the underlying neuropathological processes and finding new therapeutic approaches. ASD is characterized by neuroinflammation and dysregulation of neuro-immune cross-talk, which suggests that stem cell treatment might be a potential therapeutic approach. The beneficial and restorative effects of stem cells are mainly due to their paracrine activity, in which stem cells generate and release extracellular vesicles such as exosomes and distinct secreted non-vesicle soluble proteins, including, growth factors, chemokines, cytokines, and immunomodulatory molecules referred to as the Secretome. In this paper, we reviewed the existing research exploring the therapeutic potential of stem cell secretome focusing on their role in addressing ASD pathology. Furthermore, we proposed a comprehensive mechanism of action for stem cell secretions, encompassing the broader secretome as well as the specific contribution of exosomes, in alleviating ASD neuropathology. Across the reviewed studies, exosomes and secreted soluble factors of the transplanted stem cell demonstrate a potential efficacy in ameliorating autistic-like behaviors. The proposed mechanism of action involves the modulation of signaling pathways implicated in neuroinflammation, angiogenesis, cellular apoptosis, and immunomodulation.

Self-perceived bullying victimization in pre-adolescents on the autism spectrum: EPINED study.

Autistic individuals face a higher risk of various forms of victimization throughout their lives, with bullying being especially prevalent during their school years. Previous studies indicate that autistic children are 2.4 times more likely to be bullied than their typically developing peers and twice as vulnerable as those with other disabilities. However, the extent of this issue among Spanish schoolchildren with autism remains unexplored. In addition, there is no information regarding the presence of bullying victimization in children with marked but undiagnosed autistic traits (i.e. subthreshold autistic traits). This study examines the self-reported prevalence of bullying victimization in autistic pre-adolescents and those with subthreshold autistic traits, comparing them with peers without neurodevelopmental conditions. The study involved 323 participants (11 and 12 years old; 45 with autism or subthreshold autistic traits) from Spanish general education schools. The results revealed a higher rate of bullying victimization among autistic participants (58%; 3.1 times higher risk) and those with subthreshold autistic traits (27%; 1.5 times higher risk) compared with their peers without neurodevelopmental conditions (18.3%). Victimization was linked to more intense restrictive behaviours and increased behavioural and emotional problems. No significant associations were found with other individual or family factors. Our findings underscore the heightened risk of bullying faced by autistic pre-adolescents and those with subthreshold autistic traits at school, emphasizing the need to identify and implement preventive measures to mitigate bullying and its detrimental impact on their mental well-being and overall quality of life.

Identification and support of autistic individuals within the UK Criminal Justice System: a practical approach based upon professional consensus with input from lived experience

BackgroundAutism spectrum disorder (hereafter referred to as autism) is characterised by difficulties with (i) social communication, social interaction, and (ii) restricted and repetitive interests and behaviours. Estimates of autism prevalence within the criminal justice system (CJS) vary considerably, but there is evidence to suggest that the condition can be missed or misidentified within this population. Autism has implications for an individual’s journey through the CJS, from police questioning and engagement in court proceedings through to risk assessment, formulation, therapeutic approaches, engagement with support services, and long-term social and legal outcomes.MethodsThis consensus based on professional opinion with input from lived experience aims to provide general principles for consideration by United Kingdom (UK) CJS personnel when working with autistic individuals, focusing on autistic offenders and those suspected of offences. Principles may be transferable to countries beyond the UK. Multidisciplinary professionals and two service users were approached for their input to address the effective identification and support strategies for autistic individuals within the CJS.ResultsThe authors provide a consensus statement including recommendations on the general principles of effective identification, and support strategies for autistic individuals across different levels of the CJS.ConclusionGreater attention needs to be given to this population as they navigate the CJS.

Trust as a catalyst: revealing the impact of government trust and professional trust on public health policy compliance during a pandemic.

Existing research has extensively explored the relationship between government trust and compliance behaviour, but significant controversies exist. Some studies suggest a strong positive correlation between the two. Other studies have found that government trust hinders compliance behaviour. However, during the pandemic, the effectiveness of public health policies largely depends on the public's compliance with these policies. To examine the aforementioned controversies, this study utilizes survey data on the Chinese population during the COVID-19 period to explore the relationship between compliance with public health policies and government trust. The study conducted a questionnaire survey of 1,395 individuals from 25 provinces in China from mid-November to mid-December 2022. Firstly, we categorized the public's compliance behaviour with public health policies based on the results of factor analysis. Subsequently, we examined the impact of government trust and professional trust on compliance behaviour with public health policies by constructing a structural equation model. Based on the results of factor analysis, we classified public adherence to public health policies into protective compliance and restrictive compliance. Results from the structural equation model show a positive correlation between the public's trust in the government and both protective and restrictive compliance, with a stronger influence on protective compliance. Government trust also exerts a positive impact on restrictive compliance behaviour through professional trust. Additionally, the study indicates a significant positive correlation between the public's professional trust and restrictive compliance, while it does not significantly affect protective compliance. Moreover, the public from rural areas demonstrates a greater willingness to adhere to both types of public health policies. Married individuals exhibit a stronger inclination toward protective compliance, while females show a stronger tendency toward restrictive compliance. The study revealed a significant positive impact of government trust and professional trust on compliance behaviour with public health policies during the COVID-19 pandemic, refuting any negative correlation between government trust and compliance behaviour. Normative motivations for compliance behaviour had a substantial impact on adherence. These findings offer valuable insights for future public health crisis management and public policy formulation.

The Efficacy of Music Therapy Programs on the Development of Social Communication in Children with Autism Spectrum Disorder: A Systematic Review

Autism spectrum disorder (ASD) in children is characterized by difficulties in social communication and restricted repetitive behavior patterns. Music therapy appears to have beneficial effects in the area of social interaction and communication. The aim of this systematic literature review is to investigate the effectiveness of music therapy programs on the development of social communication among preschool- and school-aged children with ASD. For this purpose, a detailed study of the relevant literature that has been published in the last decade in peer-reviewed scientific journals was conducted. Web of Science, Springer Link, PsyINFO, and ERIC databases were searched, and according to the eligibility and exclusion criteria, 12 studies were finally selected from the 167 initially found. From the analysis of the results, the following categories were defined to contribute to enhancing social communication: (a) improvisational music therapy; (b) joint attention and eye contact; (c) therapeutic relationship, synchronization, and attunement; (d) imitation; (e) understanding and interaction; (f) family-centered music therapy; and (g) language and socioemotional adjustment. The results of the review were mixed, as music therapy appeared to have a positive effect on improving the social communication of children with ASD, but a general conclusion could not be drawn about the degree of its effectiveness compared to the standard treatments that children usually receive. In the future, further research in this field, especially on the improvisational music Therapy technique, is recommended. Moreover, an increased focus on the development of a common methodological practice regarding the sample selection process and measurement tools is suggested.

Innate Immune Dysfunction and Neuroinflammation in Autism Spectrum Disorder (ASD).

Autism spectrum disorder (ASD) is a highly heterogeneous neurodevelopmental disorder characterized by communication and social behavior deficits. The presence of restricted and repetitive behaviors often accompanies these deficits, and these characteristics can range from mild to severe. The past several decades have seen a significant rise in the prevalence of ASD. The etiology of ASD remains unknown; however, genetic and environmental risk factors play a role. Multiple hypotheses converge to suggest that neuroinflammation, or at least the interaction between immune and neural systems, may be involved in the etiology of some ASD cases or groups. Repeated evidence of innate immune dysfunction has been seen in ASD, often associated with worsening behaviors. This evidence includes data from circulating myeloid cells and brain resident macrophages/microglia in both human and animal models. This comprehensive review presents recent findings of innate immune dysfunction in ASD, including aberrant innate cellular function, evidence of neuroinflammation, and microglia activation. Appeared originally in Brain Behav Immun 2023; 108:245-254.

Dysregulated metabolic sensing of appetite in anorexia nervosa: implications of LEAP-2 regulation

AbstractGrowing interests on the role of metabolic sensors in anorexia nervosa led to implicate metabolic sensing as consequences of anorectic sensing but also in the perpetuation of the disorder. Ghrelin is an orexigenic peptide secreted by the fundic cells of the stomach in situation of fasting and kown to initiate food intake through its activity on hypothalamic and motivation aspect of food intake. A body opf evidenc previously showed that patients suffering from anorexia nervosa display high plasma levels of ghrelin correlated with the nutritionnal status but his orexigenic signal do not seem to modify restrictive behavior. LEAP-2 (Liver Expressed Antimicrobial Peptide 2) is a recently discovered endogenous ghrelmin antagonist, increased during overnutrition and that decreases food intake in humans and animals.We explored ghanges of ghrelin and LEAP-2 in a longitudinal cohort of 30 patients suffering from anorexia nervosa during a 4 months refeeding program. We show abnormal regulation of LEAP-2 in patients with higher levels in acute stages that decrease with refeeding. This abnormal regulation was associated with early relapse in patients. This abnormal regulation could counteract with the orexigenic signal of ghrelin in patients.We discuss these results in light with recent evidence on the consequences of LEAP-2 increase of food intake and hedonic feeding relevant in understanding anorexia nervosa.Disclosure of InterestNone Declared

Autism Spectrum Disorder Detection in Children Via Deep Learning Models Based on Facial Images

Autism spectrum disorder (ASD) is a complicated psychiatric disease that causes difficulty in communicating with others, and restricted behavior, speech, as well as nonverbal interaction. Children with autism have unique facial characteristics that distinguish them from ordinarily developing children. Therefore, there is a requirement for a precise and automated system capable of early detection of autism in children, yielding accurate results. The objective of this research is to assist both families and psychiatrists in diagnosing autism through a straightforward approach. Specifically, the study employs a deep learning method that utilizes experimentally validated facial features. The technique involves a convolutional neural network along with transfer learning for the detection of autism. MobileNetv2, Xception, ResNet-50, VGG16 and DenseNet-121 were the pretrained models used for detection of autism. The evaluation of these models utilized a dataset sourced from Kaggle, comprising 2,940 facial images. We evaluated the five deep learning models using standard measures like recall, precision, accuracy, F1 score, and ROC curve. The proposed DenseNet-121 model outperformed existing transfer learning models, with 96% accuracy rate. With respect to performance evaluation, the proposed method exhibited superiority over the most recent models. Our model possesses the capability to support healthcare professionals in validating the precision of their initial screening for Autism Spectrum Disorders (ASDs) in pediatric patients.

Knowledge and experience of pediatricians and pedodontists in identifying and managing child abuse and neglect cases.

Child abuse, by definition parents and other family members, caregivers, or any adult he does not know culturally inappropriate, harmful to the child described, inhibiting growth and development, or exposure to a restrictive behavior. This study aims to evaluate the capabilities of pediatricians and pedodontists in identifying and managing child abuse and neglect within healthcare settings, a crucial responsibility for professionals across various medical disciplines. Questionnaire was performed on 53 pediatricians and 89 pedodontists. Utilizing a 28-item expert-designed electronic questionnaire, the study solicited responses from pediatricians and pedodontists to assess their demographic characteristics, professional experience, and self-perceived competence in this critical area. The results indicate that 42% of the participating healthcare providers have encountered at least one case of child abuse and neglect. Notably, pedodontists displayed a higher level of uncertainty in identifying abuse and neglect cases compared to pediatricians. Furthermore, participants who had a higher level of self-perceived competence were significantly more willing to identify and manage cases, although this self-assessment did not correlate with their actual skills or level of willingness to intervene effectively. The study concludes that there is a pressing need for specialized training programs tailored to enhance the skill sets of healthcare providers in identifying and managing child abuse and neglect. These programs should encompass not only academic knowledge but also practical applications and psychosocial support techniques to ensure a holistic approach to combating this serious issue.

Expectations and experiences of a dance programme for autistic children: A qualitative study of parents, teachers and therapists

AbstractThis study explores the expectations of dance therapists/practitioners and parents and teachers of autistic children engaging in a developmental dance programme. Information gathered will support development of an evaluation tool aligned with the International Classification of Functioning Disability and Health (ICF) Core Sets for autism spectrum disorders (ASD). A qualitative study included a convenience cohort of teachers (n = 6), parents (n = 2) of children with ASD and therapists (n = 3). Three role specific focus groups were undertaken considering potential benefits and challenges of the programme. Content and thematic analysis was undertaken using NVivo12. Findings reflected four positive themes relating to behaviour, skills, social interaction and environmental supports. Therapists, teachers and parents focused differently on stereotypical and restricted behaviours, environmental supports and habits and routines respectively. These themes also emerged as challenges (to implement/achieve); with parents identifying more emotional and behavioural restrictions. A fourth challenge theme of transferability of skills emerged from teachers and therapists. Items mapped against 28 ICF Core Sets (across the lifespan) and six to ICF categories, with creativity and imagination mismatched. Findings highlight need for a specific outcome measure for dance and/or movement programmes for autistic individuals that captures meaningful functions across ICF domains for differing stakeholders.

Effects of hyperbaric oxygen therapy on autistic behaviors and GRIN2B gene expression in valproic acid-exposed rats.

Autism is a complex neurodevelopmental condition characterized by deficits in social interaction, communication, and restricted repetitive behaviors. Hyperbaric oxygen therapy (HBOT) has emerged as a potential treatment for autism, although its effects on behavior and gene expression are not well understood. The GRIN2B gene, known for its involvement in encoding a glutamate receptor subunit crucial for neuron communication and associated with autism, was a focus of this study. Using a rat model induced by prenatal exposure to valproic acid, we examined the impact of HBOT on autism-like behaviors and GRIN2B gene expression. Male Wistar rats were categorized into four groups: control, VPA (valproic acid-exposed), VPA+HBOT [2 atmosphere absolute (ATA)], and VPA+HBOT (2.5 ATA). The rats underwent several behavioral tests to assess social behavior, anxiety, stereotype and exploratory behaviors, and learning. Following the behavioral tests, the HBOT groups received 15 sessions of HBOT at pressures of 2 and 2.5 (ATA), and their behaviors were re-evaluated. Subsequently, real-time PCR was employed to measure GRIN2B gene expression in the frontal lobe. Our results indicated that HBOT significantly increased social interaction and exploratory behaviors in VPA-exposed rats, alongside elevated GRIN2B gene expression in their frontal lobe. Our findings imply that HBOT might have a potential role in ameliorating autism-related behaviors in the VPA rat model of autism through potential modulation of GRIN2B gene expression. However, additional research is essential to fully comprehend the underlying mechanisms and refine the HBOT protocol for optimizing its effectiveness in improving autism-related symptoms.

Social cognition, personality and social-political correlates of health behaviors: Application of an integrated theoretical model

ObjectiveDispositional, intra-personal constructs such as personality traits and generalized beliefs are consistently related to health behaviors, but relatively few studies have tested the theory-based mechanisms by which these constructs relate to health behaviors and compared them across behavior type. In the current study we tested an integrated theoretical model in which belief-based social cognition constructs (attitudes, subjective norms, perceived behavioral control) were proposed to mediate effects of personality traits (conscientiousness, extroversion) and socio-political beliefs (political beliefs, locus of control, free will beliefs) on participation in three health-related behaviors: physical activity, COVID-19 vaccination, and sugar-sweetened beverage restriction. MethodsProposed integrated model effects were tested in a five-week prospective correlational study. Finnish residents completed measures of personality, socio-political, and social cognition constructs with respect to physical activity participation (N = 557), COVID-19 vaccination uptake (N = 1,115), and sugar-sweetened beverage restriction (N = 558) and self-reported their behavior at follow-up. ResultsStructural equation models revealed direct effects of intention on behavior, and of social-cognition constructs on intention, across all behaviors. We also found indirect effects of political beliefs on behavior mediated by social cognition constructs and intentions for COVID-19 vaccination and sugar-sweetened beverage restriction behaviors, indirect effects of conscientiousness on behavior mediated by social cognition constructs and intentions for physical activity and sugar-sweetened beverage restriction behaviors, and indirect effects of health locus of control on behavior mediated by social cognition constructs and intentions for physical activity behavior. Finally, we found a negative total effect of populist beliefs on behavior for COVID-19 vaccination behavior. ConclusionFindings contribute to an evidence base for the effects of dispositional and social cognition constructs of health behaviors, point to a possible mechanism by which these generalized constructs relate to health behavior, and outline how the pattern of effects varies across the different behaviors.

Sex Differences in Autistic Youth Born Extremely Preterm.

To evaluate sex differences in autistic traits in youth born extremely preterm (EP; 23-27 weeks) who were later diagnosed with autism spectrum disorder (ASD) at 10-years. A longitudinal cohort design from the Extremely Low Gestational Age Newborn Study (ELGAN) followed N = 857 EP infants from birth through 10-years. EP infants later diagnosed with ASD (N = 61, 20 females) participated in the study. Group differences were evaluated via inferential and Bayesian statistics (values > 1 suggest evidence for alternate hypothesis) on ASD screeners (M-CHAT at 2-years, SCQ and SRS-2 at 10-years), and gold-standard diagnostic measures (ADOS-2, ADI-R) at 10-years. Males scored significantly higher than females on measures of Social Affect from the ADOS-2, t(34.27)=-2.20, BF10 = 2.33, and measures of Repetitive and Restricted Behaviors from the ADI-R, t(40.52)=-2.85, BF10 = 5.26. Bayesian estimates suggested marginal evidence for sex differences in Nonverbal Communication, t(30.66)=-1.81, BF10 = 1.25, and Verbal Communication, t(24.64)=-1.89, BF10 = 1.39, from the ADI-R, wherein males scored higher than females. No statistically significant sex differences were identified on any of the ASD screeners at 2 (M-CHAT) or 10 years (SCQ). No significant sex differences were observed on any subscales of the SRS at 10 years. EP autistic males present with more autistic traits than EP autistic females on gold-standard diagnostic measures of autism at 10-years of age, despite not presenting with higher autistic traits on screeners at either age. These results align with sex differences observed in full-term, autistic youth. These results suggest ASD screeners may under identify autism in EP youth, particularly females.

What Factors Predict Adaptive Functioning in Preschool Children with Autism Spectrum Disorder? A Longitudinal Study.

Adaptive functioning constitutes a fundamental aspect of the phenotype associated with autism spectrum disorder (ASD) in preschool-aged children, exerting a significant influence on both the child and the family's overall quality of life. The aim of this study was to investigate the predictors of the adaptive functioning domains in preschool-age children with ASD at two time points, providing a snapshot of this fundamental developmental step. Methods: Ninety-five children with ASD (M = 3.89, SD = 1.13) were included in the study and longitudinal data (the mean length of the longitudinal data collection was 1 year) on ASD features such as social communication and social interaction, repetitive and restricted behavior, cognitive level, and adaptive functioning were collected. We considered autistic features, cognitive level, and sociodemographic factors as possible predictors of the different adaptive functioning domains one year later. Results: Data obtained showed a worsening of the ASD features and adaptive functioning after one year. Furthermore, the severity of repetitive and restricted behavior predicted adaptive functioning, especially in the social and practical domains of the child, one year later. This prediction was observed alongside the child's cognitive level. Conclusions: The study identifies some potential predictive factors of specific adaptive functioning domains in preschoolers with ASD. Considering how critical adaptive functioning is for the well-being of both the child and their family, it becomes imperative to design early-stage interventions focused on nurturing adaptive skills in children with ASD.

Validation of factor structure of the neurodevelopmental parent report for outcome monitoring in down syndrome: confirmatory factor analysis.

The Neurodevelopmental Parent Report for Outcome Monitoring (ND-PROM), initially developed to monitor developmental and behavioral functions in children with autism spectrum disorder (ASD), assesses symptoms across a wide range of domains relevant in Down syndrome (DS). Psychometric properties of ND-PROM were assessed in 385 individuals with DS and 52 with a combined diagnosis of DS and ASD (DS+ASD), whose caregivers completed the ND-PROM questionnaire for a clinical visit in a specialized Down syndrome program at a tertiary pediatric hospital. Confirmatory factor analysis was conducted to evaluate the internal structure validity of the ND-PROM. Measurement invariance was assessed, with a comparison group of 246 individuals with ASD, and latent mean differences between the DS and ASD-only groups, as well as the combined DS+ASD groups, were assessed. Findings support the existence of the 12 clinically-derived factors in the DS population: Expressive Language, Receptive Language, Adaptive skills/Toileting, Social Emotional Understanding, Social Interaction, Independent Play, Sensory Processes, Challenging Behaviors, Impulse/ADHD, and Mental Health. Differences in response patterns of development and behaviors were observed between those with DS and those with ASD, including those with DS having higher abilities in nonverbal communication, social emotional understanding, and social interaction, and fewer restricted and repetitive behaviors and interests, impulsivity or ADHD symptoms, and mental health concerns compared to those with ASD. Individuals in the DS+ASD group had more difficulties with expressive and receptive language, nonverbal and social communication, social interaction, independent play, and adaptive skills than either the DS-only group or the ASD-only groups. The ND-PROM has a desirable factor structure and is a valid and clinically useful tool that captures a range of distinct and independent areas of developmental and behavioral functioning in DS, for individuals with and without an ASD diagnosis.

Health follow-up visits of children with autism

Child health follow-up is the most important of basic health services and should continue at regular intervals until the age of 18 years. Physicians’ child health follow-up examinations present the best opportunity to deliver evidence-based preventive health services, such as monitoring the growth and development of the child, conducting age-appropriate screenings, providing vitamin/mineral support according to age and requirements, administering childhood vaccinations, informing the family about home accidents and nutrition, monitoring the child in terms of child neglect and abuse risks, and raising the awareness of the family in this regard. Child health follow-up should encompass not only children without any health problems but also those with mental, physical, visual, or hearing impairments, or special needs such as those with autism. Autism spectrum disorder is a neurodevelopmental disorder characterized by social and communication limitations and repetitive, restricted behaviors. The presence of a child with special needs such as autism can have social, psychological, and economic implications for family members. While there are many difficulties in caring for a healthy child, these difficulties increase exponentially in the care of a child with special needs. Professional assistance is necessary for families to address matters such as monitoring the child’s development, providing nourishment, and administering vaccinations. Children with autism constitute a group that needs to be closely followed up for vitamin-mineral deficiencies and growth retardation due to their higher risk of malnutrition. For these reasons, regular health follow-up of children with autism is essential at regular intervals.