The challenges for early intervention and its effects on the prognosis of autism spectrum disorder: a systematic review / Os desafios para a intervenção precoce e seus efeitos no prognóstico do transtorno do espectro autista: uma revisão sistemática

ABSTRACT. Autism spectrum disorder (ASD) is expressed with neurobehavioral symptoms of different degrees of intensity. It is estimated that, for every three cases detected, there are two cases that reach adulthood without treatment. Objective: To establish what challenges are still present in the implementation of early intervention (EI) and its effects on the prognosis of ASD. Methods: A systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (Prisma) methodology was carried out in the PubMed and ScienceDirect databases in January 2023. The search keywords were "autism spectrum disorder", "early intervention" and "prognosis". Results: Sixteen studies were included, two randomized and 14 non-randomized. Knowledge about the signs of ASD, diagnostic and therapeutic methods, age at the start of treatment, and socioeconomic factors were the main challenges encountered in the implementation of the EI. Conclusion: EI is capable of modifying the prognosis of ASD and challenges in its implementation persist, especially in developing regions with low socioeconomic status.

RESUMO. O transtorno do espectro autista (TEA) expressa-se com sintomas neurocomportamentais de diferentes graus de intensidade. Estima-se que, para cada três casos detectados, existam dois casos que atingem a idade adulta sem tratamento. Objetivo: Estabelecer quais são os desafios ainda presentes na implementação efetiva da intervenção precoce (IP) e quais são os seus efeitos no prognóstico do TEA. Métodos: Revisão sistemática com a metodologia Preferred Reporting Items for Systematic Reviews and Meta-Analyses (Prisma) foi realizada nos bancos de dados PubMed e ScienceDirect em janeiro de 2023. As palavras-chave da pesquisa foram "autism spectrum disorder", "early intervention" e "prognosis". Resultados: Dezesseis estudos foram incluídos, sendo dois randomizados e 14 não randomizados. O conhecimento sobre os sinais do TEA, os métodos diagnósticos e terapêuticos, a idade de início de tratamento e os fatores socioeconômicos foram os principais desafios encontrados na implementação da IP. Conclusão: A IP é capaz de modificar o prognóstico do TEA e os desafios em sua implementação ainda afetam, principalmente, regiões em desenvolvimento e de baixo status socioeconômico.

Transtorno do espectro do autismo e o uso materno e paterno de medicamentos, tabaco, álcool e drogas ilícitas / Maternal and paternal licit and illicit drug use, smoking and drinking and autism spectrum disorder

Resumo O presente estudo objetivou investigar a associação entre o TEA e o uso materno e paterno de medicamentos, tabaco, álcool e drogas ilícitas. Trata-se de um estudo caso-controle realizado com crianças e adolescentes diagnosticados com TEA e indivíduos neurotípicos. Os dados foram colhidos por meio de entrevista com as mães ou responsáveis. Foram analisadas as variáveis sexo e idade das crianças/adolescentes; idade dos pais; uso de medicamentos antes e durante a gestação; classes de medicamentos usados na gestação; tabagismo materno e paterno; etilismo materno e paterno; uso de drogas ilícitas pelos pais. Para a análise das informações, utilizou-se o modelo de regressão logística, além da razão de chances (OR) bruta e ajustada. Os resultados mostraram que, após os ajustes, foi encontrada associação entre o uso materno na gestação de antitérmicos/analgésicos (OR = 2,26; IC95% 1,29-3,95; p < 0,040) com o TEA. Já o uso de tabaco, álcool e drogas ilícitas materno e paterno, antes e durante a gestação, não apontou relação com o TEA. Os dados encontrados sugerem que existe influência de fatores ambientais no desenvolvimento do TEA.

Abstract The aim of this study was to investigate the association between maternal and paternal licit and illicit drug use, smoking and drinking and autism spectrum disorder (ASD). We conducted a case-control study with children and adolescents diagnosed with ASD and neurotypical individuals. The data were collected using a semi-structured questionnaire administered during interviews with the children's mothers or guardians. The following variables were analyzed: child sex and age; maternal and parental age; use of medicines before and during pregnancy; classes of medicines used during pregnancy; maternal and paternal smoking; maternal and paternal drinking; maternal and paternal illicit drug use. The data were analyzed using logistic regression and crude and adjusted odds ratios (OR). After adjustment, the results showed an association between maternal use of antipyretics/pain killers during pregnancy (OR = 2.26; 95%CI 1.29-3.95; p < 0.040) and ASD. No association was found between maternal and paternal smoking, drinking and illicit drug use before and during pregnancy and ASD. The findings suggest that the development of ASD is influenced by environmental factors.

Uso do método de Pontos para a Reestruturação de Objetivos Fonéticos e Oro-Musculares (PROMPT) no Transtorno do Espectro Autista: um estudo de caso / Use of the Prompts for Reestructuring Oral Muscular Phonetic Targets (PROMPT) in Autism Spectrum Disorder: a case study

RESUMO O Transtorno do Espectro Autista (TEA) é classificado pelo Manual de Diagnóstico e Estatístico de Transtornos Mentais (DSM-5) como um Transtorno do Neurodesenvolvimento, sendo caracterizado, principalmente, por alterações na comunicação social e pela presença de um repertório restrito de atividades e interesses. Na literatura, há muitos estudos sobre autismo, fala e linguagem, mas poucos correlacionando fala e autismo. Este estudo teve como finalidade realizar um estudo de caso que abordou autismo, fala e PROMPT (Pontos para a Reestruturação de Objetivos Fonéticos e Oro-Musculares) e mensurou a melhora da fala no participante com autismo, utilizando o método. Foram definidas palavras-alvo para toda a intervenção, conforme o Sistema de Observação e Análise (SOA) e Hierarquia Motora de Fala (HMF), que fazem parte da avaliação de PROMPT. Após a avaliação, o participante foi atendido por 16 sessões, uma vez semanalmente. Após análise dos dados, observou-se melhora em todos os aspectos que foram delineados de acordo com a avaliação no pré-tratamento, como controle fonatório, controle mandibular, controle lábio-facial e controle lingual, como também no movimento sequenciado, apesar deste não ser o objetivo traçado na avaliação. Também foi possível mensurar melhora no número de vocábulos adequados, número de fonemas adequados, porcentagens de consoantes corretas - revisado (PCC-R) e inteligibilidade.

ABSTRACT Autism Spectrum Disorder (ASD) is classified by Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a neurodevelopmental disorder, whose characteristics are mainly deficits in social communication and a restricted range of interests. There are several studies about autism, speech, and language in the literature, but few correlate speech and autism. This study aims to carry out a case study that will address autism, speech, and PROMPT (Restructuring Oral Muscular Phonetic Targets) and also to describe the speech improvement in the participant with autism using the method. The target words were defined for the entire intervention according to the System Analysis Observation (SAO) and Motor Speech Hierarchy (MSH), which are parts of the PROMPT evaluation. After the evaluation, the participant was attended for 16 sessions, once weekly, with the objective of improving their speech. After analyzing the data, it was possible to observe improvement in all aspects outlined according to the pre-treatment evaluation of the method such as phonatory control, mandibular control, lip-facial control and lingual control as well as in the sequenced movement although this was not the aim outlined in the evaluation. It was also possible to measure the improvement of an adequate number of words, an adequate number of phonemes, percentages of correct consonants - revised (PCC-R), and intelligibility.

Sedation and its Potential Risks in Children with Autism Spectrum Due to Drug Overlaps: A Critical Review

ABSTRACT Objective: To analyse pharmacological overlap in patients with autism spectrum disorder (ASD) under conscious sedation in a dental office environment, identifying any potential risks and complications. Material and Methods: A critical review was conducted by selecting articles from online databases (Pubmed and Lilacs), using a search algorithm and eligibility criteria. The Medscape® platform was used to verify interactions between drugs commonly used by patients with ASD and medications used for sedation in paediatric dentistry. Results: Due to their polydrug use, children with ASD are at risk of complications, namely Serotonin Syndrome (SS), Neuroleptic Malignant Syndrome (NMS), increase or decrease of the QT interval (QTi) and Torsade de Pointes (TdP), due to pre-existence of metabolic syndrome, deepening the sedation level or even leading to a decrease in the sedative capacity of the drugs used. Conclusion: It is essential to assess better drug interaction in ASD patients submitted to sedation. The severity of the disorder and the need for sedation for dental treatment are directly proportional. However, increases in sedative doses tend to increase risks and complications in children with ASD.

Revisiting the history of autism before Kanner and Asperger: a tribute to Grunya Sukhareva / Revisitando a história do autismo antes de Kanner e Asperger: um tributo a Grunya Sukhareva

Abstract Almost two decades before Kanner's and Asperger's works, the original paper by child psychiatrist Grunya Efimovna Sukhareva had already been written. It was published in 1926 by Sukhareva in a German scientific journal of psychiatry and neurology, with a detailed description of children who presented clinical conditions whose characteristics and evolution closely resemble autism, according to current criteria. In the present historical note, we intend to present Sukhareva's pioneering work and retrieve the meaning of her original contribution.

Resumo Quase duas décadas antes dos trabalhos de Kanner e Asperger, o artigo original da psiquiatra infantil Grunya Efimovna Sukhareva já havia sido escrito. Foi publicado por Sukhareva em 1926, em uma revista científica alemã de psiquiatria e neurologia, com uma descrição detalhada de crianças que apresentavam quadro clínico cujas características e evolução em muito se assemelham ao autismo, segundo os critérios atuais. Nesta nota histórica, pretende-se apresentar o trabalho pioneiro de Sukhareva e resgatar o significado da sua contribuição original.

Impacto del aislamiento social por COVID-19 en niños y niñas con trastornos del espectro autista y sus familias en la provincia de Misiones / Impact of social isolation by COVID-19 on children with autism spectrum disorders and their families in the province of Misiones

RESUMEN INTRODUCCIÓN El trastorno del espectro autista (TEA) se caracteriza por alteraciones en la comunicación y patrones restrictivos del comportamiento. El Aislamiento Social, Preventivo y Obligatorio (ASPO) en Argentina generó cambios en las dinámicas familiares de personas con TEA. El objetivo del estudio fue describir el impacto del ASPO en el acompañamiento de niños/as con TEA. MÉTODOS Se creó un instrumento específico de diseño mixto, con implementación de encuestas virtuales a familiares de personas con TEA. RESULTADOS Las 66 encuestas obtenidas revelaron ventajas, tales como la posibilidad de compartir tiempo en familia y conocer las necesidades de las/os hijas/os, el establecimiento de un ambiente con estímulos adecuados y ausencia de distractores, y la enseñanza con ritmos de aprendizaje y contenidos ajustados a las necesidades de niños/as con TEA. También se encontraron dificultades para la socialización: surgimiento de comportamientos no adaptativos (crisis, ansiedad, agresividad), barreras en la comunicación entre docentes y familias, imposibilidad de acceder a terapias y obstáculos para acceder a terapias virtuales. DISCUSIÓN El ASPO incidió en la vida cotidiana de las personas con TEA, de manera similar a lo observado en otras latitudes. A partir de lo experimentado durante el ASPO se proponen estrategias contextualizadas a la situación de pandemia actual y a potenciales escenarios similares.

ABSTRACT INTRODUCTION Autism spectrum disorder (ASD) is characterized by alterations in communication and restrictive behavior patterns. The Social, Preventive and Compulsory Isolation in Argentina changed family dynamics of people with ASD. The objective of this study was to describe the impact of isolation on accompanying children with ASD. METHODS A specific instrument of mixed design was created by conducting virtual surveys to relatives of ASD children. RESULTS The 66 surveys included in the study revealed advantages, such as the possibility of sharing family time and recognizing children's needs, environment with adequate stimuli and without distractors as well as teaching according to learning pace and content adjusted to ASD children. They also found difficulties in socialization: emergence of non-adaptive behaviors (crisis, anxiety, aggressiveness), communication barriers between teachers and families, therapy inaccessibility and obstacles to access to online therapies. DISCUSSION The isolation affected ASD people's daily life, similarly as in other countries. Based on the experiences during the isolation, strategies are proposed within the framework of the current pandemic situation and for potential similar scenarios.

Effects of stage recovery training on children with autism spectrum disorder / 中国学校卫生

Objective@#To explore the impact of stage recovery training on children with autism spectrum disorder, and to provide reference for the scientific and rational rehabilitation and recovery training plans.@*Methods@#A total of 59 children with autism spectrum disorder in Luzhou were recruited and randomly divided into control group, intervention group Ⅰ and intervention group Ⅱ for 4 stages of T1-T4 recovery training. Before and after the training, Autism Behavior Checklist(ABC) was used to assess child s sensation, language, motor, communication and self care ability.@*Results@#There was no significant difference in the overall score of the ABC among the three groups in T1 and T2 stages ( P >0.05), but there was significant difference in T3 and T4 stages ( F= 3.98, 5.09, P < 0.05), which showed the intervention group Ⅰ and Ⅱ were lower than the control group. In terms of dimensions, in addition to the insignificant difference in language scores ( P >0.05), there were significant differences in feeling, communication, movement, and self care scores ( P <0.05). Overall score of the ABC in intervention group I and group II was lower than the control group ( P <0.05). Compared with the control group, the overall scores of children in intervention Ⅰ and intervention Ⅱ were significant in both T3 and T4 stages ( P <0.05). Compared with T1 stage, there were no significant differences in the overall scores of children in the control group in T2 stage, T3 stage and T4 stage ( P >0.05), while significant difference was observed in the intervention group Ⅰ and group Ⅱ in T2-T4 stage ( P <0.05).@*Conclusion@#Stage recovery training might help to alleviate the overall symptoms of children with autism spectrum disorder in sensation, communication, motor development and self care behaviors. The stage recovery training focusing on physical exercise can effectively alleviate the physical function of the child, while those focusing on social interaction is more conducive to improving child s social ability.

Relationship between sensory characteristics and gray matter volumes in children with autism spectrum disorders / 中国学校卫生

Objective@#To investigate the potential relationship between sensory characteristics and gray matter volumes in children with autism spectrum disorders (ASD), to provide a basis for the diagnosis and treatment of children with ASD.@*Methods@#A total of 40 ASD children who were treated or recovered in Xi an medical institutions and 16 typically developing (TD) children who were from several kindergatens in Xi an were invited for participation. Sensory characteristics were evaluated by the sensory processing and self regulation checklist, 3D structural brain images were obtained with TIWI, and gray matter volumes were analyzed by voxel based morphometry. Sensory characteristics and gray matter volumes were compared between groups and the relationship between sensory characteristics and different gray matter volumes were analyzed.@*Results@#The scores of auditory, visual, tactile, sensory processing ability and sensory under responsivity in the ASD group were lower than those in the TD group ( Z/t =-2.63, -2.57 , -3.11, -2.19, -3.83, P <0.05). Gray matter volumes in nine brain regions increased in the ASD group compared to the TD group, including the left and right posterior inferior lobe, right parahippocamal gyrus, left insula, left media frontal gyrus, left superion occipital gyrus, right superion occipital gyrus, right superion parietal lobe, and right posterion central gyrus ( t =3.53, 3.69 , 3.37, 3.86, 3.61, 3.37, 4.04, 3.38, 3.16, P <0.01). In the ASD group, the scores of visual, vestibular, proprioceptive, sensory processing ability, sensory seeking behavior and sensory over responsivity were negatively correlated with gray matter volumes of left superior occipital gyrus ( r =-0.36, -0.40, -0.39, -0.36, -0.40, -0.36), and the scores of visual, vestibular, and sensory over responsivity were negatively correlated with gray matter volumes of the right superior parietal lobule ( r =-0.36, -0.50, -0.42)( P <0.05).@*Conclusion@#The presence of paresthesia in children with ASD is associated with gray matter volumes of the left superior occipital gyrus and right superior parietal lobule.

Research progress on the association between screen exposure and autism spectrum disorder in preschool children / 中国学校卫生

Abstract@#Autism spectrum disorder (ASD) is a lifelong neurodevelopmental disorder. Early life social experience assessment before symptoms of ASD might be helpful for determining the causal link between social experiences and early childhood ASD. Younger children are exposed to excessive screen time in recent years. This paper summarizes the association between screen exposure with ASD in preschool children, and proposes future research directions and provides evidencebased guidance to optimize and support children s early media experiences.

Association between motor coordination and core symptoms in children with autism spectrum disorder / 中国学校卫生

Objective@#To study the relationship between motor coordination, social communication impairment, and restricted/repetitive behaviors (RRBs) in children with autism spectrum disorder (ASD).@*Methods@#A total of 123 ASD children aged 2-12 were recruited from rehabilitation service institutions for autistic children in Guangzhou, including 105 boys and 18 girls. The Developmental Coordination Disorder Questionnaire, Social Communication Questionnaire, and Restrictive Behavior Scale Revised were collected to measure motor coordination, social communication skills and RRBs, respectively. Multiple linear regression was used to explore the association between motor coordination and core symptoms.@*Results@#In children aged 2-5 years old, those without motor coordination deficits scored lower in social interaction (7.73±4.00) than others (9.76±2.90)( Z=-2.29, P <0.05). In children aged 6-12 years old, those without motor coordination deficits scored lower in restricted, repetitive, and stereotyped patterns of behavior (4.22±1.93), repetitive sensory-motor behaviors (3.91±2.63), and insistence on sameness (13.52±10.59) than those with motor coordination deficits (6.11±1.54, 14.00±8.49, 31.33±15.05)( Z=-2.48, -3.83, -3.28, P <0.01)。Multiple linear regression analysis showed that fine motor/handwriting and control during movement were negatively correlated with the severity of social communication impairment and RRBs respectively among children aged 2-5 and 6-12( β=-0.85--0.03, -2.98--0.17, P <0.05).@*Conclusion@#Among autistic children, those with motor deficits suffered from more severe core symptoms. Motor assessment should be included in the ASD screening, diagnosis and management. Motor intervention should also be promoted in the rehabilitation in order to improve the prognosis and life quality.

Effect of types of educational institutions on social communication functions among children with autism spectrum disorder:an observation study / 中国学校卫生

Objective@#To explore changes in the social interactions of school aged children with autism spectrum disorder (ASD) enrolled in ordinary schools and special education institutions during a one year observation period.@*Methods@#A total of 44 children with ASD were recruited from the Research Center of Children and Adolescent Psychological and Behavioral Development in the Department of Public Health, Sun Yat sen University, during 2017 and 2018. At the baseline and follow up periods, a self report questionnaire (completed by parents) was administered in order to collect demographic information related to the children, the survey included the Social Responsiveness Scale (SRS), Strengths and Difficulties Questionnaire (SDQ), Social Communication Questionnaire (SCQ), Screen for Child Anxiety Related Emotional Disorder (SCARED) and the Swan son Nolan and Pelham, Version IV Scale(SNAP-IV).@*Results@#At baseline, compared with children in ordinary schools, the total score of SRS (114.56±6.02, 93.63 ±3.82) and its subscale scores (social awareness:13.54±0.71, 11.02±0.45; social cognition:22.73±1.16, 18.19±0.73; social interaction:37.47±2.12, 30.40±1.35; autistic mannerisms: 23.11±1.70, 19.02±1.08) were higher in children attending special education institutions, as well as the SCQ total score (20.37±1.60, 12.92±1.02) and its subscale scores(social interaction domain:8.77±0.92, 4.23±0.58; social communication domain:6.07±0.55, 4.19±0.35)( P <0.05). Further comparison of baseline and follow up results showed no significant difference in time effect or in the interaction between time and the educational environment( P >0.05).@*Conclusion@#Compared with special education institutions, school aged children with ASD in ordinary schools had lower levels of social impairment. During the one year observation period, there was no correlation between the educational environment and changes in symptoms of children and their parents. Parents should choose an appropriate educational environment according to the children s abilities, and ordinary schools and teachers should be prepared for inclusive education.

Association between parenting style and sleep problems among school aged children with autism spectrum disorder / 中国学校卫生

Objective@#To investigate the association between parenting style and sleep problems among school aged children with autism spectrum disorder (ASD).@*Methods@#A total of 98 children with ASD aged 6-10 years old and 98 age and gender matched typically developing (TD) children from mainstream schools were recruited. Parenting style and sleep problems were measured via Parent Behavior Inventory (PBI) and Children s Sleep Habits Questionnaire(CSHQ), respectively. The symptom severity and intelligence level were also evaluated. Generalized linear model was used to analyze the relationship between parenting style and sleep problems.@*Results@#There was no statistically significant difference in the parenting style of the two groups of children( P > 0.05 ); weekend sleep time of children with ASD was significantly shorter than that of the TD group [(9.1±0.7)(9.5±0.8)h, P < 0.01 ], and the score of sleep onset delay was significantly higher than that of the TD group[(1.8±0.7)(1.5±0.7), P <0.01]. However, there was no statistically significant difference in the incidence of total sleep problems and various problems between the two groups of children( P >0.05). The parental support/engagement of children with ASD was negatively associated with the total score of sleep problems( β=-2.68, 95%CI =-4.88--0.47), bedtime resistance ( β=-1.65, 95%CI =-2.54--0.77) and sleep anxiety( β=-1.01, 95%CI =-1.70--0.32). The parental hostility/coercion was positively correlated with score of daytime sleepiness( β=1.41, 95%CI =0.53-2.29)( P <0.05).@*Conclusion@#Parenting style of support/engagement is associated with lower sleep problems in children with ASD, while hostile/coercion is associated with higher sleep problems. It should be improve parental style to reduce the sleep problems in children with ASD.

Correlation between early life exposure to PM 2.5 and risk of autism spectrum disorder among school aged children / 中国学校卫生

Objective@#To investigate the associations between early life exposure to particulate matter with an aerodynamic diameter less than 2.5 μm (PM 2.5 ) and the risk of autism spectrum disorder (ASD) among school aged children.@*Methods@#A total of 165 children with ASD and 165 age and gender matched typical development (TD) children were recruited. Children s basic information were obtained via questionnaires, and the severity of ASD symptoms was assessed with Social Responsiveness Scale (SRS). Early life PM 2.5 exposure (preconception, entire pregnancy, and the first two years after birth) were extracted from the Tracking Air Pollution in China (TAP) datasets. Conditional Logistic regression and generalized linear model were used to evaluate the associations of early life exposure to PM 2.5 with the risk and the ASD severity symptoms, respectively.@*Results@#The PM 2.5 exposure of ASD group during preconception[(55.08±9.34)μg/m 3], entire pregnancy[(50.44±8.71)μg/m 3], the first year after birth [(45.04± 8.25 )μg/m 3] and the second year after birth [(40.19±7.12)μg/m 3] were significant higher than those in TD children [(47.66± 7.63 , 44.19±7.16, 38.95±6.07, 35.76±5.65)μg/m 3]( t =7.94, 7.13, 7.70, 6.32, P <0.05). After adjusting for potential confounding, each increase of 1 μg/m 3 in PM 2.5 was associated with higher risk of ASD during preconception ( OR=1.21, 95%CI =1.13-1.29), entire pregnancy( OR=1.18, 95%CI =1.11-1.26), the first year after birth ( OR=1.30, 95%CI =1.18-1.43) and the second year after birth ( OR=1.29, 95%CI =1.17-1.42). No similar results were observed regarding the analyses of SRS total and sub scale scores( P >0.05).@*Conclusion@#Early life exposure to PM 2.5 is relate to the risk of ASD, these findings indicated that more attention should be paid to ambient PM pollution in the early life prevention and control of ASD.

Prevalence and relevant factors of physical and emotional abuse by parents among children with autism spectrum disorder / 中国学校卫生

Objective@#To explore the prevalence and relevant factors of physical and emotional abuse by parents among children with autism spectrum disorder (ASD), so as to provide basis for intervention program of children abuse.@*Methods@#A total of 221 ASD children from 3 special education institutions in Tangshan were investigated from March to October in 2021, 395 non ASD children from two kindergartens in urban and rural areas were selected by convenient sampling. Parents of these children were invited for online and on site questionnaire survey. The self designed violence questionnaire, Childhood Autism Rating Scale and Patient Health Questionnaire-9 were used to assess violence, severity of autism, depression of parents. Chi square test, Fisher s exact probability method and Logistic regression were used to analyze the influencing factors of violence.@*Results@#About 81.9% of children with ASD and 72.9% of non ASD children experienced violence( P <0.05). The reported rates of physical and emotional violence in ASD children were 74.2% and 73.8% respectively, which in non ASD children were 58.7% and 65.8% respectively. There were significant differences in the 3 types of violence rate between the two groups ( P <0.05). Multivariate Logistic regression analysis showed that boys ( OR =1.70, 95% CI =1.12-2.60), annual per capita income <10 000 yuan( OR =2.43, 95% CI =1.45- 4.08 ), and parental depression ( OR mild =11.01, 95% CI =5.38-22.49; OR moderate =69.97，95% CI =24.25-201.93) were the risk factors for child violence exposure; ASD disease ( OR=1.96，95%CI =1.32-2.92), older age ( OR=1.19, 95%CI =1.01-1.41) and parental depression( OR mild =7.83, 95% CI =3.67-16.74; OR moderate =14.37，95% CI =6.17-33.46) were risk factors for physical violence; boys ( OR =1.62, 95% CI =1.11-2.36), mothers who work in manual labor ( OR=1.68, 95%CI =1.09-2.59) and parental depression ( OR mild =7.69, 95% CI =3.74-15.81; OR moderate =25.37, 95% CI =10.80-59.63) were risk factors for emotional violence( P < 0.05 ).@*Conclusion@#The reported rate of parental violence against children with ASD is high. Mental health promotion and social support for families with ASD should be strengthened.

Focus on autism spectrum disorder s sensory abnormalities and the integration of mechanism research and intervention treatment / 中国学校卫生

Abstract@#Sensory abnormalities are common in patients with autism spectrum disorder (ASD), and its manifestations are complex and diverse, which may be an important factor that affects and aggravates core damages such as social barriers and rigid behaviors. However, at present, there is obviously insufficient emphasis on sensory abnormality in ASD, and a lack of questionnaires and evaluation tools for comprehensively evaluating the characteristics of sensory abnormality in China. The research on the peripheral and central nervous mechanisms behind abnormal behavior is still in its infancy, sensory evaluation tools and methods should be developed and enriched as soon as possible, for ultraearly identification and clinical accurate classification of ASD. Future researches on the neural mechanism related to sensory abnormality should be promoted for targeted intervention therapy,and individualized and diversified intervention in ASD and individualized and diversified.

Functional connectivity among insula, sensory and social brain regions in boys with autism spectrum disorder / 中国学校卫生

Objective@#To identify the functional connectivity characteristics of insula, sensory and social related brain regions in boys with autism spectrum disorder(ASD), to explore the central nervous basis of sensory abnormality affecting core symptoms in boys with ASD.@*Methods@#Resting state functional magnetic resonance imaging (rs fMRI) data were collected from 34 boys with ASD and 29 typical development boys (TD group). Based on functional connectivity analysis, the sensory related brain regions, insula, and social related brain regions were taken as regions of interest to calculate the functional connectivity (FC) level between the regions of interest, the differences between the two groups were compared and the results were corrected by FDR. The Autism Diagnostic Observation Schedule (ADOS), Childhood Autism Rating Scale (CARS) and Autism Spectrum Quotient-Children s Version (AQ-Child) were used to assess the core phenotypes of boys with ASD.@*Results@#Compared with the TD group, the levels of FC between tactile brain regions and insula, olfactory brain regions and insula, auditory brain regions and insula in boys with ASD group were significantly increased. The level of FC between the insula and bilateral amygdala，insula and the medial prefrontal cortex(mPFC) were significantly increased( P <0.05).Pearson correlation analysis showed that the level of FC between auditory brain region(BA42)and left insula in ASD group was negatively correlated with the scores of communication subscale of ADOS( r =-0.44)，social interaction subscale of ADOS( r =-0.43), communication & social interaction subscale of ADOS( r =-0.49),attention to details subscale of AQ-Child( r =-0.41). The level of FC between the right insula and right amygdala was positively correlated with the attention switch subscale of AQ-Child( r =0.38), the level of FC between right insula and mPFC was positively correlated with the scores of repetitive behavior subscale of ADOS( r =0.48), the attention switch subscale of AQ-Child( r =0.49), total scale subscale of AQ-Child( r =0.41), total scale of CARS( r =0.41)( P < 0.05 ).@*Conclusion@#The levels of FC between insula and sensory related, social related brain regions are abnormal in children with ASD, which have significant correlations with clinical symptoms. In depth studies can be conducted to explore underlying neutral mechanisms.

Autism spectrum disorder s sensory characteristics and its correlation with core phenotype / 中国学校卫生

Objective@#To explore the differences of sensory manifestations between ASD children and typical development children, and to clarify the characteristics of sensory abnormalities in ASD and their relationship with various clinical symptoms, so as to provide scientific basis for early identification and specific intervention.@*Methods@#A total of 265 ASD children who received rehabilitation training in autism rehabilitation institutions in Heilongjiang Province were collected as the case group, and 223 typical development children in ordinary kindergartens and schools in Harbin were taken as the control group. Short Sensory Profile (SSP) was used to evaluate the difference of children s sensory perception level between the two groups, and Social Response Scale (SRS) and Autism Behavior Checklist (ABC) were used to evaluate the severity of symptoms including social disorder of autistic children. The correlation between SSP scores in ASD group and clinical scales was analyzed.@*Results@#The comparison of SSP scores between the two groups found that the median scores of all sensory dimensions in ASD group (tactile=33, taste/smell=18, motion sensitivity=13, Low response/sensation seeking=28, auditory filtering=19, low strength=22, visual/auditory=20) were lower than those of the healthy control group( Z =-2.73,-4.36,-3.17,-5.09,-11.00,-10.45,-3.43, P <0.05). The abnormal rate of multisensory score in children in ASD group was 55.1%, and that in control group was 21.2%, with significant difference( χ 2=57.15, P <0.05). Correlation analysis showed that SSP score in ASD group was negatively correlated with all dimensions of SRS, nonverbal communication, and social function of ADI-R scale, ADOS communication and social interaction, and total scores of ABC and CARS( P < 0.05 ).@*Conclusion@#Children with ASD have atypical sensory experiences, especially in auditory filtering dimension, and the level of atypical sensation is related to the severity of clinical symptoms of autism. In the future clinical diagnosis, treatment and research, it is necessary to strengthen the ability to recognize the sensory symptoms of children with ASD, so as to realize the early diagnosis and intervention.

Atypical developmental of the sensorimotor network optimal frequency in children with autism spectrum disorder / 中国学校卫生

Objective@#On the basis of the dominant frequency index of functional connectivity, the "brain age" analysis method was used to explore abnormal development patterns of sensorimotor networks in boys with autism spectrum disorder(ASD).@*Methods@#The resting state functional magnetic resonance data (7-12 years old) for 105 boys with ASD and 102 matched boys with normal development from the ABIDE public database were screened. Functional connection networks in different frequency bands of sensorimotor related brain regions were constructed for each individual, and the frequency of the strongest connection were constructed as the optimal frequency of the connection. Brain age analysis was used to explore the difference between brain age and chronological age in boys with ASD.@*Results@#The brain sensorimotor network of boys with ASD showed an abnormal development pattern of overdevelopment followed by underdevelopment, and the transition between the two patterns occurred at approximately 7.8 years of age. Older boys with ASD (older than 10 years) whose underdevelopment trend was suppressed had lower ASD severity( r=-0.43, P < 0.05 ).@*Conclusion@#The brain sensorimotor network in boys with ASD has an abnormal development process, and the brain chronological age difference in the sensorimotor network has potential as a neuroimaging marker to measure the development of ASD.

Características socioeconômicas, demográficas e nutricionais de crianças com transtorno do espectro autista / Socioeconomic, demographic and nutritional characteristics of children with autism spectrum disorder

Introdução: O transtorno do espectro autista (TEA) é um grupo de desordens neurocomportamentais de grande complexidade. Ao longo dos anos, um número crescente de pessoas vem apresentando o diagnóstico. No Brasil, ainda há poucos estudos sobre o perfil nutricional desse grupo populacional. Objetivo: Traçar o perfil socioeconômico, demográfico, antropométrico e consumo alimentar de crianças com TEA de um movimento social de Macaé, Rio de Janeiro. Métodos: Realizou-se um estudo do tipo exploratório, descritivo, quantitativo, de base primária, no período entre março e junho de 2020, com 92 crianças entre 2 e 9 anos e suas respectivas mães vinculadas ao movimento social de Macaé. Utilizaram-se dois questionários, o primeiro semiestruturado contendo variáveis socioeconômicas, demográficas, clínicas e antropométricas; e o segundo estruturado sobre consumo alimentar. As variáveis contínuas foram descritas por média, desvio-padrão, e as variáveis categóricas como proporção (%). Para verificar a significância das diferenças encontradas nas respostas por grupos e categorias, foi utilizado o teste estatístico qui-quadrado. Utilizou-se o pvalor <0,05 para significância estatística. Resultados: A maioria das crianças era do sexo masculino (81,5%) e não estava alfabetizada (75,0%). Detectaram-se 53,5% crianças com excesso de peso para a idade, segundo IMC por idade, e 91,1% com estatura adequada, segundo estatura por idade. Das 59 crianças avaliadas quanto ao consumo alimentar, 78,0% consumiram feijão no dia anterior; 57,6% frutas frescas e 54,2% vegetais e/ou legumes; 59,3% bebidas adoçadas e 37,3% doces. Conclusão: O excesso de peso e o consumo de marcadores de alimentos não saudáveis foram elevados no grupo avaliado.

Introduction: Autism spectrum disorder (ADS) is a group of highly complex disorders. Over the years, there has been a growing number of ADS-diagnosed persons. In Brazil, there are few studies on the nutritional profile of this population. Objective: To describe the socioeconomic, demographic, anthropometric characteristics and food consumption of children with ADS from a social movement in Macaé, Rio de Janeiro. Methods: An exploratory, descriptive, quantitative, primary research was carried out between March and June 2020, with 92 children aged 2 to 9 years and their respective mothers, members of the social movement in Macaé. Two questionnaires were used: the first was semi-structured containing socioeconomic, demographic clinical and anthropometric variables; the second, a structured questionnaire about foods consumption. The continuous variables were described as means, standard deviation, and the categorical variables as proportion (%). To determine the significance of the differences found in the responses by groups and categories, the chi-square test was used. P-value <0.05 was used for statistical significance. Results: Most children were male (81.5%) and illiterate (75.0%). It was found that 53.5% of the children were overweight, according to the BMI for age, and 91.1% had adequate height for age. Out of 59 children assessed for foods intake, 78.0% ate beans the day before the interview; 57.6% ate fresh fruits, and 54.2% vegetables; 59.3% consumed sweetened drinks and 37.3%, sweets. Conclusion: Overweight and markers of unhealthy eating habits were high for he assessed group.

Early exposure to agricultural pesticides and the occurrence of autism spectrum disorder: a systematic review / Exposição precoce a agrotóxicos de uso agrícola e ocorrência do transtorno do espectro autista: uma revisão sistemática

Abstract Objective: The aim of this study was to evaluate the influence of early exposure to agricultural pesticides and their relationship with autism spectrum disorder. Data source: This systematic review was registered at PROSPERO as CRD42020204842. The subject was systematically analyzed on PubMed, Scopus, and Web of Science databases until April 2021. Only studies with humans with early exposure to agricultural pesticides and diagnosis of autism were included. Exclusion criteria were studies on pesticides for domestic or veterinary use and late exposure. There were no language and time restriction. The quality analysis of the studies used the Newcastle-Ottawa Scale. Data synthesis: Six case-control studies were included; three of them measured the route of exposure by maternal biomarkers and the others by the residence address. The studies had scores between moderate and high in the quality assessment tool. It was found high rates of association between early exposure to agricultural pesticides and autism and detection limit above the quantification for a sample of polychlorinated biphenyls, hexachlorobenzene, and dichlorodiphenyldichloroethylene. Conclusions: There is evidence concerning the exposure to agricultural pesticides in early life and the development of the autism spectrum disorder; however, more studies are required to better understand their possible association.

RESUMO Objetivo: Compreender a influência da exposição precoce a agrotóxicos de uso agrícola e sua relação com o transtorno do espectro autista. Fontes de dados: Esta revisão sistemática foi registrada no banco de dados PROSPERO sob número CRD42020204842. Por meio das bases de dados PubMed, Scopus e Web of Science, o assunto foi analisado sistematicamente até abril de 2021. Foram incluídos somente estudos com humanos, sendo critérios de inclusão a exposição precoce a agrotóxicos de uso agrícola e o diagnóstico de autismo e critérios de exclusão agrotóxicos de uso doméstico ou veterinário e exposição tardia. Todos os estudos foram analisados sem restrição de linguagem e tempo. A qualidade dos estudos foi avaliada pela NewCastle Ottawa Scale. Síntese dos dados: No total, seis estudos caso-controle foram incluídos. Três deles mensuraram a exposição pelos biomarcadores maternos e os demais (50%) pelo endereço de moradia. Os trabalhos apresentaram qualidade entre moderada e alta. Encontrou-se alta taxa de associação entre a exposição precoce à agrotóxicos e o autismo e detecção acima do limite de quantificação para amostras de bifenilas policloradas, hexaclorobenzeno e diclorodifenildicloroetileno. Conclusões: Existem evidências sobre a exposição a agrotóxicos de uso agrícola precocemente e o desenvolvimento do transtorno do espectro autista, porém mais pesquisas são necessárias para melhor compreensão da associação.