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Early diagnosis of autism spectrum disorder (ASD) is essential for improved outcomes. There is a paucity of data on the prevalence of ASD in low- and middle-income countries (LMIC), but early identifcation may be further delayed in those communities. In this paper, recent studies on strategies for the early detection of ASD, and the prevalence of ASD in LMIC are reviewed. The limitations that can arise in the early identifcation of ASD in LMIC communities are discussed, and screening tools and strategies that can be helpful are identifed. The goal is to recommend models that are culturally appropriate and scientifcally valid, easily integrated within community settings while strengthening community systems and reducing disparities in the early identifcation of ASD. Starting locally by simplifying and demystifying the ASD identifcation process and building community connections will inform global researchers and policymakers while making a diference in the lives of the children and families afected by ASD.
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Resumen: El presente artículo muestra la importancia que tiene el consentimiento informado en los procesos de investigación científica y, por ende, la vulnerabilidad que enfrentan ante este procedimiento las personas con discapacidad. Se presenta la evolución del concepto del consentimiento informado en diferentes países de Iberoamérica y Estados Unidos. De igual manera, se abordan los diversos criterios que deben considerarse dentro del consentimiento informado, así como los tratados y declaraciones que deben tomarse en cuenta para no vulnerar los derechos humanos de los participantes en investigaciones científicas. Además, dentro de este dilema ético en nuestros tiempos, se aborda el trastorno del espectro autista (TEA), un trastorno del neurodesarrollo que, al presentar diversos grados de severidad, no permite que las personas con tea puedan dar su opinión, aunado a esto que sean menores de edad, aspectos que los pone en condición de vulnerabilidad.
Abstract: This article shows the importance of informed consent in scientific research processes and therefore the vulnerability faced by people with disabilities in this procedure. The evolution of the concept of informed consent in different countries of Latin America and the United States is presented. Similarly, the various criteria that must be considered within the informed consent are addressed, as well as the treaties and declarations that must be taken into account so as not to violate the human rights of the participants in scientific research. In addition, within this ethical dilemma in our times, the autism spectrum disorder (ASD) is addressed, a neurodevelopmental disorder that, by presenting varying degrees of severity, does not allow people with ASD to give their opinion, combined with the cases where the participants are underage, an issue that puts them in a condition of vulnerability.
Resumo: O presente artigo mostra a importância que o consentimento informado tem nos processos de pesquisa científica e, portanto, a vulnerabilidade que as pessoas com deficiência enfrentam diante desse procedimento. Apresenta-se a evolução do conceito do consentimento informado em diferentes países da América Ibérica e nos Estados Unidos. Do mesmo modo, abordam-se os diversos critérios que devem ser considerados dentro do consentimento informado, bem como os tratados e declarações que devem ser levados em consideração para não vulnerar os direitos humanos dos participantes em pesquisas científicas. Além disso, dentro desse dilema ético em nossos tempos, aborda-se o transtorno do espectro autista (TEA), um transtorno do neurodesenvolvimento que, ao apresentar diversos graus de severidade, não permite que as pessoas com TEA possam dar sua opinião, além de serem menores de idade, aspectos que os põe em condição de vulnerabilidade.
Subject(s)
Humans , Autism Spectrum Disorder , Informed Consent , United States , Developmental Disabilities , Scientific Research and Technological Development , Human RightsABSTRACT
RESUMO: Este estudo teve como objetivo realizar uma revisão sistemática da literatura nacional e internacional quanto a artigos de periódicos científicos sobre a inclusão escolar de crianças com Transtorno do Espectro Autista (TEA), atentando-se para o período e o periódico, os temas investigados e suas metodologias. Foram localizados 25 estudos nacionais, nas bases LILACS, BVS, SCIELO e Portal de Periódicos da CAPES, publicados entre 1998 e 2014, e 92 internacionais, localizados nas bases EBSCOhost e Medline, publicados entre 1993 e 2013. As pesquisas nacionais e internacionais foram agrupadas de acordo com os temas de investigação e os seus objetivos. A maioria dos estudos localizados caracterizou-se como empírico e de abordagem qualitativa. De modo geral, a revisão da literatura realizada possibilitou o resgate de experiências sobre a inclusão escolar de crianças com TEA, além de esboçar um breve panorama dos principais temas que estão sendo investigados.
ABSTRACT: This study aimed to perform a systematic review of national and international literature, published in indexed journals, on the inclusion of children with Autism Spectrum Disorder (ASD), focusing on the period and journal of the publishing, research themes, and methodological choices. A number of 25 national studies, taken from LILACS, BVS, SciELO and CAPES Portal databases and published between 1998 and 2014, were found, as well as 92 international studies, published from 1993 to 2013, taken from EBSCOhost e Medline databases. The study have grouped the national e international surveys according to the research topics and considering their objectives. An empirical and qualitative approach characterized most of the found studies. Overall, the literature review has enabled the rescue of experiences on inclusion of children with ASD, in addition to outlining a brief overview of the issues currently under investigation.
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Objective To explore the white matter microstructural change between autism spectrum disorder(ASD) children and the healthy controls and it's correlation with the age and the clinical symptoms.Methods Thirty-three patients with ASD and thirty-three healthy controls (HC) matched for sex-,age-and handedness underwent diffusion tensor imaging (DTI) scans.Use the Autism Diagnostic Observation Schedule(ADOS) and the Neuropsychological Development Inventory for Children Aged 0-6 Years Old (SLAS) to assess the clinical symptoms.Use tract-based spatial statistics (TBSS) based on fiber skeleton to analyze the fractional anisotropy (FA) of the whole brain DTI then to identify the differentiated brain regions.And analyze the correlation with age and clinical symptoms.Results (1) FA value of the body of corpus callosum (BCC) (x =-10,y =11,z =26;P=0.0012),left posterior limb of internal capsule (LPLI) (x =-23,y =-11,z =12;P＜0.01),left anterior corona radiata (LACR) (x =-28,y =28,z =16;P＜ 0.01),lift superior corona radiata(LSCR) (x=-27,y=-1,z=21;P=0.0017) was significantly lower in ASD group.(2) There was a positive correlation between the FA value of LPLI and the LACR,LSCR with age among the ASD group(r=0.436,P=0.012;r=0.443,P=0.010;r=0.475,P=0.005).There was a negative correlation between the FA value of the BCC,LPLI and the LACR,LSCR with the age among the HC children.(3) There was a correlation between the LPLI with the score of A DOS (communication:r=0.406,P=0.025;communication+social behavior:r=0.377,P=0.039;restrictive interests and repetitive behaviors:r=0.375,P=0.041) and SLAS (gross motor:r=-0.409,P=0.024),There was a correlation between the LSCR with the score of the SLAS (gross motor:r=-0.539,P=0.002,adaptive capacity:r=-0.373,P=0.041,mental age:r=-0.388,P=0.034).Conclusion The brain white matter microstructure change of BCC,LPLI,LACR,LSCR may be the pathophysiological basis of ASD.The development trend of brain white matter structure varied with age in ASD children is different from that of normal children.Brain white matter microstructure of the LPLI,LSCR is correlation with ASD symptoms.
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Objective To explore the white matter microstructural change between autism spectrum disorder(ASD) children and the healthy controls and it's correlation with the age and the clinical symptoms.Methods Thirty-three patients with ASD and thirty-three healthy controls (HC) matched for sex-,age-and handedness underwent diffusion tensor imaging (DTI) scans.Use the Autism Diagnostic Observation Schedule(ADOS) and the Neuropsychological Development Inventory for Children Aged 0-6 Years Old (SLAS) to assess the clinical symptoms.Use tract-based spatial statistics (TBSS) based on fiber skeleton to analyze the fractional anisotropy (FA) of the whole brain DTI then to identify the differentiated brain regions.And analyze the correlation with age and clinical symptoms.Results (1) FA value of the body of corpus callosum (BCC) (x =-10,y =11,z =26;P=0.0012),left posterior limb of internal capsule (LPLI) (x =-23,y =-11,z =12;P＜0.01),left anterior corona radiata (LACR) (x =-28,y =28,z =16;P＜ 0.01),lift superior corona radiata(LSCR) (x=-27,y=-1,z=21;P=0.0017) was significantly lower in ASD group.(2) There was a positive correlation between the FA value of LPLI and the LACR,LSCR with age among the ASD group(r=0.436,P=0.012;r=0.443,P=0.010;r=0.475,P=0.005).There was a negative correlation between the FA value of the BCC,LPLI and the LACR,LSCR with the age among the HC children.(3) There was a correlation between the LPLI with the score of A DOS (communication:r=0.406,P=0.025;communication+social behavior:r=0.377,P=0.039;restrictive interests and repetitive behaviors:r=0.375,P=0.041) and SLAS (gross motor:r=-0.409,P=0.024),There was a correlation between the LSCR with the score of the SLAS (gross motor:r=-0.539,P=0.002,adaptive capacity:r=-0.373,P=0.041,mental age:r=-0.388,P=0.034).Conclusion The brain white matter microstructure change of BCC,LPLI,LACR,LSCR may be the pathophysiological basis of ASD.The development trend of brain white matter structure varied with age in ASD children is different from that of normal children.Brain white matter microstructure of the LPLI,LSCR is correlation with ASD symptoms.
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Autism Spectrum Disorder (ASD) is a neurodevelopmental childhood disorder associated with cognitive and language impairments. Previous research found that children with developmental disorders increase parenting stress but parents of children with ASD, specifically have recorded higher parenting stress than any other developmental disabilities. Hence, this study investigates the difference in parenting stress levels among parents of children with ASD compared to a typical development (TD) control group. Parenting Stress Index, 3rd Edition Short Form was used to assess the parenting stress levels of 30 parents of children with ASD and 36 parents of TD children. Parents of children with ASD were sampled at Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Tangkak Hospital and National Autism Society of Malaysia (NASOM) in Muar and Segamat. Parents of children with ASD recorded significantly higher levels of parenting stress compared to the TD group (p<0.001). Parents of male children of ASD recorded significantly higher levels of parenting stress compared to the parents of male children of TD group (p<0.001). Parents of female children of ASD also recorded significantly higher levels of parenting stress compared to parents of female children of TD group (p<0.001). Intervention towards ASD children should not only focus on minimizing the core symptoms but should also pay attention to the family’s mental health as well.
Subject(s)
Autism Spectrum Disorder , ParentingABSTRACT
O Transtorno do Espectro do Autismo (TEA) é caracterizado por deficits persistentes na comunicação e na interação social em múltiplos contextos e por padrões restritos e repetitivos de comportamento, interesses ou atividades. Tais comprometimentos devem estar presentes no indivíduo precocemente no desenvolvimento e causar prejuízos significativos em áreas importantes da vida. Como forma de promover o desenvolvimento das crianças com autismo, pesquisas se dedicam a estudar os tipos de intervenção mais eficientes para diminuir os sintomas autísticos e aumentar comportamentos adaptativos. O objetivo deste estudo é realizar uma revisão da literatura especificamente sobre treinamento de pais de pessoas com autismo a fim de sintetizar as evidências atuais a respeito do impacto desta modalidade de intervenção tanto para a criança quanto para a sua família. Foram consultadas as bases de dados Academic Search Premier, Journals Ovid Full Text, PsycArticles (APA),ScienceDirect (Elservier), SpringerLink (MetaPress) e Wiley Online Library para a seleção dos artigos. Foram selecionados e lidos integralmente 15 artigos. Os estudos revisados apontam para uma indeterminação quanto à eficácia do treinamento de pais como forma de facilitar o desenvolvimento de crianças com autismo. Não foi encontrado resultado conclusivo no que diz respeito ao aumento da qualidade de vida dos pais dessas crianças após a intervenção
The Autism Spectrum Disorder (ASD) is characterized by persistent deficits in communication and social interaction in multiple contexts and by restricted and repetitive patterns of behavior, interests or activities. These commitments must be present in person early in development and must cause significant damage in important areas of life. As a way to promote the development of children with autism, research devoted to study the most effective types of intervention to reduce autistic symptoms and increase adaptive behaviors. The aim of this study was to review the literature specifically on parent training with autism to synthesize current evidence on the impact of this type of intervention for both the child and the family.Databases Academic Search Premier, Journals Ovid Full Text, PsycARTICLES (APA), ScienceDirect (Elservier), SpringerLink (MetaPress) and Wiley Online Library for selecting articles were consulted. Were selected and read 17 articles. The reviewed studies suggest a vagueness idea about the effectiveness of parent management training in order to facilitate the development of children with autism. No conclusive results were found in regard to enhancing the quality of life of parents of these children after the intervention
Subject(s)
Humans , Child, Preschool , Child , Parents , Autistic Disorder , Child , Father-Child Relations , Mother-Child Relations , Behavior , Child Care , Child, Preschool , CaregiversABSTRACT
Autism spectrum disorder (ASD) is a highly prevalent neurodevelopmental disorder characterized by impaired social communication and restricted and repetitive behaviors (RRBs). Over the past decade, neuroimaging studies have provided considerable insights underlying neurobiological mechanisms of ASD. In this review, we introduce recent findings from brain imaging studies to characterize the brains of ASD across the human lifespan. Results of structural Magnetic Resonance Imaging (MRI) studies dealing with total brain volume, regional brain structure and cortical area are summarized. Using task-based functional MRI (fMRI), many studies have shown dysfunctional activation in critical areas of social communication and RRBs. We also describe several data to show abnormal connectivity in the ASD brains. Finally, we suggest the possible strategies to study ASD brains in the future.
Subject(s)
Child , Humans , Autistic Disorder , Brain , Autism Spectrum Disorder , Magnetic Resonance Imaging , NeuroimagingABSTRACT
OBJECTIVES: In children and adolescents, the prevalence of overweight has increased in the last 20 years. little research is available on the prevalence of obesity in children with autism spectrum disorders(ASD). The purpose of our study was to determine the prevalence of overweight among a clinical population of children diagnosed with autism spectrum disorders(ASD). METHODS: Retrospective chart review of children ages 3-18 years seen between 2012 and 2015 at a Konyang University hospital psychiatric clinic. Diagnostic, medical, and demographic information was extracted from the charts. Body mass index(BMI) was calculated from measures of height and weight recorded in the child's chart. The Center for Disease Control's BMI growth reference was used to determine an age and gender-specific BMI z-score for the children. RESULTS: In our study, children with ASD compared to non ASD group had significantly higher BMI percentiles (p=0.032). The prevalence of overweight(BMI≥85th to 95th percentiles) and obesity(BMI≥95th percentiles) was 35% and 19% respectively in children with ASD and without ASD. CONCLUSION: Despite noted limitations, our data suggest that overweight and obesity in children with ASD are more prevalent than without ASD. Longitudinal and further study is needed to examine the factors associated with obesity in this population.
Subject(s)
Adolescent , Child , Humans , Autistic Disorder , Child Development Disorders, Pervasive , Obesity , Overweight , Prevalence , Retrospective StudiesABSTRACT
PURPOSE: The purpose of this study was to explore the utility of autism spectrum disorder (ASD) screening tools using community network of home childcare center visiting nurses. METHODS: The design of this study is multilevel survey to find the ASD using modified checklist for autism in toddlers (M-CHAT) for first screening by childcare teachers, checklist for autism in toddlers (CHAT) for secondary screening by nurses, Autism diagnostic observation schedule (ADOS) and Autism diagnostic interview revised (ADI-R) for final diagnosis by pediatric psychiatrists. RESULTS: In first screening by using M-CHAT, 61 subjects(0.56%) were detected among 8,926 subjects. Among the first screened 61 subjects, 13 subjects were exempted for normal finding in CHAT. 24 subjects consented participation for final diagnosis and 23 of them were diagnosed ASD. CONCLUSION: In conclusion, M-CHAT and CHAT were verified their utility as screening tools for ASD in the community and the community health networks as a childcare visiting nurses can be useful network in early detection and referral of ASD.
Subject(s)
Child , Appointments and Schedules , Autistic Disorder , Checklist , Autism Spectrum Disorder , Community Networks , Diagnosis , Mass Screening , Nurses, Community Health , Psychiatry , Referral and ConsultationABSTRACT
Ha sido ampliamente estudiado, cómo el estudio de la psicopatología del trastorno del espectro autista (TEA) tiene grandes consecuencias para algunas teorías de filosofía de la mente. Empero, no solo los estudios en psicología dejan huella en la filosofía, sino que también algunos estudios en filosofía surten efecto en la psicología. El caso que se presenta en este artículo es de doble vía. Por un lado, cómo la psicopatología del TEA obliga a la filosofía de la mente a repensar la vida mental y, por otro, cómo un cambio de perspectiva en la explicación de la interpretación psicológica, de la mano de Wittgenstein, obliga a la psicología a repensar la psicopatología del TEA.
It has been widely studied how the study of the psychopathology of Autism Spectrum Disorder (ASD) has major implications for some theories of the philosophy of mind. However, not only studies in psychology leave their mark on philosophy, but studies in philosophy also have an effect on psychology. The case presented in this article is twofold: on the one hand, how psychopathology of ASD requires the philosophy of mind to rethink mental life and, secondly, how a change of perspective in explaining psychological interpretation raised by Wittgenstein requires psychology to rethink the psychopathology of ASD.
Tem sido vastamente estudado como o estudo da psicopatologia do transtorno do espetro autista (TEA) tem grande consequências para algumas teorias da filosofia da mente. Embora, nÃo só os estudos em psicologia repercutem na filosofia, também alguns estudos em filosofia tem efeito na psicologia. No caso que se apresenta em este artigo a via é dupla. Por um lado como a psicopatologia do TEA obriga à filosofia da mente a repensar a vida mental, e pelo outro, como uma mudança de perspectiva na explicaçÃo da interpretaçÃo psicológica, da mÃo de Wittgenstein, obriga à psicologia a repensar a psicopatologia do TEA.
Subject(s)
Humans , Autistic Disorder , Theory of Mind , Facial ExpressionABSTRACT
Autism diagnosis requires validated diagnostic tools employed by mental health professionals with expertise in autism spectrum disorders. This conventionally requires lengthy information processing and technical understanding of each of the areas evaluated in the tools. Classifying the impact of these areas and proposing a system that can aid experts in the diagnosis is a complex task. This paper presents the methodology used to find the most significant items from the ADOS-G tool to detect Autism Spectrum Disorders through Feed-forward Artificial Neural Networks with back-propagation training. The number of cases for the network training data was determined by using the Taguchi method with Orthogonal Arrays reducing the sample size from 531,441 to only 27. The trained network provides an accuracy of 100% with 11 different cases used only for validation, which provides a specificity and sensitivity of 1. The network was used to classify the 12 items from the ADOS-G tool algorithm into three levels of impact for Autism diagnosis: High, Medium and Low. It was found that the items "Showing", "Shared enjoyment in Interaction" and "Frequency of vocalization directed to others", are the areas of highest impact for Autism diagnosis. The methodology here presented can be replicated to different Autism diagnosis tests to classify their impact areas as well.
El diagnóstico del autismo requiere del uso de herramientas de diagnóstico validadas internacionalmente que son utilizadas por los profesionales de la salud expertos en trastornos del espectro autista, lo cual requiere de procesamiento de mucha información y un entendimiento técnico de cada una de las áreas evaluadas en ellas. La clasificación del impacto que tienen cada una de estas áreas, así como la propuesta de un sistema que pueda ayudar a los expertos en el diagnóstico, es una tarea compleja, por lo que en este artículo se presenta una metodología utilizada para encontrar los elementos más significativos de la herramienta de diagnóstico de autismo ADOS-G a través de redes neuronales artificiales entrenadas con retropropagación del error. El número de casos para entrenamiento de la red se seleccionó utilizando el método de Taguchi con arreglos ortogonales, reduciendo el tamaño de la muestra de 531,441 a solo 27 casos. La red entrenada tiene una exactitud del 100% validada con 11 casos diferentes de niños evaluados para diagnóstico de trastorno del espectro autista con lo que se obtuvo una especificidad y sensibilidad de 1. La red neuronal artificial se utilizó para clasificar los 12 elementos del algoritmo de la herramienta ADOS-G en tres niveles de impacto: Alto, Medio y Bajo. Se encontró que los elementos "Mostrar", "Placer compartido durante la interacción" y "Frecuencia de vocalizaciones dirigidas a otros" son las áreas de mayor impacto para el diagnóstico de autismo. La metodología presentada puede ser replicada para diferentes herramientas de diagnóstico de autismo para clasificar sus áreas de mayor impacto también.
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Introduction: Autism Spectrum Disorder is increasing day by day around the world. Recent finding of CDC shows that this problem occurs 1 in 110 populations. This problem is such a disorder, which not only affects to the individuals but also the families, society and nation as a whole if not managed properly. Aim: The aim of this study was to assess the knowledge and management practices of Paediatricians about Autism Spectrum Disorder. Methods: The study design was descriptive and cross sectional. A census was used to select the study unit and self-administered questionnaire was used to collect data. Results: Out of 54 Paediatricians, 64.8 percent had inadequet knowledge and 59.3 percent had inadequet practice related to Autism Spectrum Disorder. Majority of them (79.6%) knew that Autism Spectrum Disorder is a Developmental Disorder but they (24.1%) also mentioned it to be mental retardation and 13 percent thought that it as a form of psychosis. Most of Paediatricians, (72.2%) knew that Autism Spectrum Disorder could be due to genetic reason. However, a significant number of respondents 22.2 percent also believed that Autism Spectrum Disorder could occur due to the neglect of children. Almost fifty percent of Paediatricians had rarely handled the Autistic child and a majority of the Paediatricians, (90.7%) found it difficult to diagnose this disease. Conclusion: Most of the Paediatricians in Nepal have inadequet knowledge and practice related to Autism Spectrum Disorder. Although some of the practice was good, they also had misconceptions as to managing the children with Autistic disorders. Most of the Paediatricians need to improve their knowledge and practice related to Autism Spectrum Disorder.
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In addition to aberrant features in the speech, children with Autism Spectrum Disorder (ASD) may present unusual responses to sensory stimuli, especially to auditory stimuli. We investigated the auditory ability of children with ASD by using Auditory Brainstem Responses (ABR) as they can directly judge both hearing status and the integrity of auditory brainstem pathways. One hundred twenty-one children (71: ASD; M 58/ F 13, mean age; 41.8 months, 50: control group; M 41/ F 9, mean age; 38 months) were induded in the study. As compared with the values in the control group, the latency of wave V, wave I-V, and wave III-V inter-peak latencies were significantly prolonged (p<0.05) in the ASD group. The findings indicate that children with ASD have a dysfunction or immaturity of the central auditory nervous system. We suggest any children with prolonged III-V inter-peak latencies, especially high functioning children should be further evaluated for central auditory processing to set up a more appropriate treatment plan.