Autism Detection in Early Childhood (ADEC) in a Low-Income Spanish-Speaking Population in Guayaquil (Ecuador).

Autism Spectrum Disorder (ASD) must be present early in development, but may not fully manifest until social demands exceed capacities. In the absence of adequate biological or brain imaging markers to detect and diagnose autism, diagnosis relies on clinical judgment based on observation of symptoms. Many tools have been developed in English-speaking countries (questionnaires for parents, symptom checklists for professionals, observation systems, etc.). Screening in countries with other languages requires cultural and linguistic adaptation of these instruments. This paper presents the adaptation of the ADEC (Autism Detection in Early Childhood). METHODS: The original version of the ADEC was translated and culturally and linguistically adapted to the characteristics of the population of Guayaquil (Ecuador). PARTICIPANTS: A pilot study was conducted with a sample of 613 children aged 18-48 months. RESULTS: Cronbach's alpha values (0.89) indicate high internal consistency. The correlation between the MCHAT-R/F follow-up interview and the ADEC (mean r = 0.93) indicates high construct validity. In terms of predictive validity, using the original cut-off points of the ADEC, they show excellent diagnostic ability. The sensitivity and specificity results (sensitivity 1.00; specificity 0.92; positive predictive value 0.83; negative predictive value 0.99) are even better than those obtained in a similar study in the Mexican population. CONCLUSIONS: Considering that the MCHAT R/F is a parent-reported instrument, the Guayaquil Spanish version of the ADEC (ADEC-GU) seems to be a suitable instrument to be used in a complementary way as a second-level screening instrument for autism, before resorting to a full diagnostic process.

Use of Digitalisation and Machine Learning Techniques in Therapeutic Intervention at Early Ages: Supervised and Unsupervised Analysis.

Advances in technology and artificial intelligence (smart healthcare) open up a range of possibilities for precision intervention in the field of health sciences. The objectives of this study were to analyse the functionality of using supervised (prediction and classification) and unsupervised (clustering) machine learning techniques to analyse results related to the development of functional skills in patients at developmental ages of 0-6 years. We worked with a sample of 113 patients, of whom 49 were cared for in a specific centre for people with motor impairments (Group 1) and 64 were cared for in a specific early care programme for patients with different impairments (Group 2). The results indicated that in Group 1, chronological age predicted the development of functional skills at 85% and in Group 2 at 65%. The classification variable detected was functional development in the upper extremities. Two clusters were detected within each group that allowed us to determine the patterns of functional development in each patient with respect to functional skills. The use of smart healthcare resources has a promising future in the field of early care. However, data recording in web applications needs to be planned, and the automation of results through machine learning techniques is required.

Mindfulness Parenting and Childish Play: A Clinical Trial With Parents of Children With Autism Spectrum Disorders.

BACKGROUND: Problems of behaviour, communication, and social interaction associated with Autism Spectrum Disorders can overwhelm parents. Disturbances in parents' psychological well-being (anxiety, depression) affect adherence to treatment, making it less effective. There is a need to investigate how to increase psychological wellbeing in parents of children with autism. METHOD: An 8-week brief training programme using the Mindfulness Parenting (MP) intervention was applied to fourteen parents (6 couples and two mothers). Participants were assigned to one of two groups, both groups received the same treatment but at two different time points. Measures of anxiety (SCAARED), parental stress (PSI-4), autism severity level (AIM) and mindfulness awareness (FFMQ), were assessed. RESULTS: Analysis indicates that MP training increased mindfulness awareness, increasing non-judgment and reactivity, and consequently, reduced anxiety (parental, general, social), improving parent-child interaction. This improvement did not influence parents' perception of the severity of the disorder. CONCLUSIONS: The small number of participants precludes generalisation of the results. More clinical trials are needed to demonstrate the usefulness of including these programmes in early intervention services, as well as profiles of parents who may potentially benefit from it.

Do Savant Syndrome and Autism Spectrum Disorders Share Sex Differences? A Comprehensive Review.

Savant syndrome was described before autism. However, they soon became closely associated, as many of their symptoms (intellectual disability, repetitive behaviors, alterations in social communication, and islets of abilities) overlap. Only a few women with autism have been diagnosed with savant syndrome. The theories or hypotheses that attempt to explain savant syndrome, which are common in autism, present differential treatment according to sex. We postulate that savant syndrome associated with autism as well as autism in general is underdiagnosed in women.

Autism and Children: Diagnosis, Functional Profiles and Intervention.

In the last forty years, approaches to and the social perception of autism have changed significantly [...].

Autism and Neurodevelopmental Disorders: The SARS-CoV-2 Pandemic Implications.

The Special Issue (SI) "Autism and Neurodevelopmental Disorders: The SARS-CoV-2 Pandemic Implications" is an interesting project that adopted a scientific point of view with important implications in clinical and practical fields [...].

Behavior Rating Inventory of Executive Function in Preschool (BRIEF-P) and Attention-Deficit and Hyperactivity Disorders (ADHD): A Systematic Review and Meta-Analysis of Floor and Ceiling Effects.

BACKGROUND: ADHD is a neurodevelopmental disorder that is accompanied by executive challenges. OBJECTIVES: To obtain evidence of the usefulness of the BRIEF-P and to analyze the possible ceiling and floor effect of its scores in the assessment of executive function in preschoolers with signs compatible with a possible diagnosis of ADHD. METHOD: A search was performed in Science Direct, NCBI (PubMed), and ProQuest Education Journals during the period 2012-2022. We included studies that evaluated samples of individuals with symptomatology compatible with ADHD, with an age range between 2 and 6 years, published in English or Spanish. Of a total of 2538 articles, only seven met the inclusion criteria. The risk of bias was assessed using the QUADAS-2 questionnaire. The main variables were age and executive functioning. CONCLUSIONS: Executive deficits in early-age individuals with symptoms compatible with ADHD are more extensive than just deficits in working memory. A floor effect has been found in tests associated with hot executive functions and a ceiling effect in cold executive functions. This makes it necessary to use different tests to assess executive performance in preschoolers with ADHD-compatible symptomatology and to design intervention proposals accordingly. The BRIEF-P is an instrument that facilitates obtaining a sensitive and discriminative executive profile, although it should be used in combination with other neuropsychological performance tests.

Mindfulness Parenting and Childish Play: A Clinical Trial With Parents of Children With Autism Spectrum Disorders / Mindfulness Parenting y Juego Infantil: un Ensayo Clínico con Padres de Niños con Trastornos del Espectro del Autismo

Background: Problems of behaviour, communication, and social interaction associated with Autism Spectrum Disorders can overwhelm parents. Disturbances in parents’ psychological well-being (anxiety, depression) affect adherence to treatment, making it less effective. There is a need to investigate how to increase psychological wellbeing in parents of children with autism. Method: An 8-week brief training programme using the Mindfulness Parenting (MP) intervention was applied to fourteen parents (6 couples and two mothers). Participants were assigned to one of two groups, both groups received the same treatment but at two different time points. Measures of anxiety (SCAARED), parental stress (PSI-4), autism severity level (AIM) and mindfulness awareness (FFMQ), were assessed. Results: Analysis indicates that MP training increased mindfulness awareness, increasing non-judgment and reactivity, and consequently, reduced anxiety (parental, general, social), improving parent-child interaction. This improvement did not influence parents’ perception of the severity of the disorder. Conclusions: The small number of participants precludes generalisation of the results. More clinical trials are needed to demonstrate the usefulness of including these programmes in early intervention services, as well as profiles of parents who may potentially benefit from it.(AU)

Antecedentes: Los síntomas asociados a los Trastornos del Espectro Autista pueden abrumar a los padres. Las alteraciones del bienestar psicológico de los padres (ansiedad, depresión) afectan a la adherencia al tratamiento, haciéndolo menos eficaz. Es necesario investigar cómo aumentar el bienestar psicológico de los padres de niños con autismo. Método: Se aplicó un programa de entrenamiento de 8 semanas en Mindfulness Parenting (MP) a catorce padres (6 parejas y dos madres). Los participantes fueron asignados a dos grupos, ambos grupos recibieron el mismo tratamiento, pero en dos momentos diferentes. Se evaluaron medidas de ansiedad (SCAARED), estrés parental (PSI-4), nivel de gravedad del autismo (AIM) y conciencia de la atención plena (FFMQ). Resultados: Se sugiere que el entrenamiento en MP aumenta la atención plena, incrementando el no juicio y la no reactividad y, como consecuencia, reduce la ansiedad (parental, general, social), mejorando la interacción entre padres e hijos pero no influye en la percepción de la gravedad del trastorno. Conclusiones: El reducido número de participantes impide la generalización de los resultados encontrados. Son necesarios más ensayos clínicos para demostrar la pertinencia de incluir estos programas en los servicios de intervención temprana, así como los perfiles de los padres potencialmente beneficiarios.(AU)

Ansiedad y trastornos del espectro del autismo: notas para la intervención psicoeducativa / Anxiety and Autism Spectrum Disorders: Notes for Psychoeducational Intervention

Se analizan de forma narrativa las relaciones entre comportamiento sensorial atípico, intolerancia a la incertidumbre y regulación emocional como generadores de los trastornos de ansiedad en niños y niñas autistas. El objetivo es estudiar el origen de la ansiedad en los niños y niñas autistas con la finalidad de determinar cuál o cuáles pueden ser los procedimientos de intervención más adecuados. Se han revisado algunos de los programas de intervención cognitivo-conductuales más utilizados en niños y niñas autistas y las adaptaciones realizadas a los mismos. Se observa un divorcio entre los programas psicoeducativos escolares y los programas clínicos de intervención para el tratamiento de la ansiedad. Como conclusión, se recomienda que en los programas psicoeducativos escolares se incorporen acciones proactivas en forma de programas de intervención cognitivo-conductuales para evitar o aminorar los efectos negativos de la ansiedad en el aprendizaje e inclusión escolar de los niños y las niñas autistas. (AU)

The relationships between atypical sensory behavior, intolerance to un-certainty and emotional regulation as generators of anxiety disorders in autistic chil-dren are analyzed in narrative form. The aim is to study the origin of anxiety in autistic children in order to determine the most appropriate intervention procedures. Some of the most widely used cognitive-behavioral intervention for autistic children and the ad-aptations made to them have been reviewed. A gap is observed between school psych-oeducational programs and clinical intervention programs for the treatment of anxiety. In conclusion, it is recommended that school psychoeducational programs incorporate proactive actions in the form of cognitive-behavioral intervention programs to prevent or reduce the negative effects of anxiety on the learning and school inclusion of autistic children. (AU)

Research-Based Intervention (RBI) for Autism Spectrum Disorder: Looking beyond Traditional Models and Outcome Measures for Clinical Trials.

The rising prevalence of Autism Spectrum Disorders (ASD) has led to a quickly increasing need for effective interventions. Several criteria and measures have been developed to critically assess these interventions with particular focus on the evaluation of the efficacy. Given the huge diversity of ASD symptoms and the different levels of severity across individuals, identifying a one size fits all intervention approach is challenging, and the question What works and for whom? Remains still unanswered. Why do we seem to be dragging our feet on this fundamental issue? The main aim of this paper is to answer this question through four non-alternative points. First, there are a scarce number of studies with a solid methodology. Secondly, most trials on intervention efficacy for ASD are designed exclusively in terms of behavioral outcomes. Thirdly, there is a reduced use of biologically oriented outcome measures. Fourthly, in most clinical trials, appropriate practices emerging from research evidence are not systematically applied. A strong effort to improve the methodology of clinical trials is mandatory for the future of autism research. The development of a research-based intervention (RBI) perspective aimed at better integrating: (a) evidence-based approaches; (b) more sensitive behavioral outcome measures; and (c) biomarkers, with the aim of increasing a more detailed clustering of phenotypes, may strongly improve our approach to a precision medicine.

Screening, Diagnosis and Early Intervention in Autism Spectrum Disorders.

The increment of prevalence is among the most important changes that have taken place in recent years with regard to Autism Spectrum Disorder (ASD); in the 1970s and 1980s of the 20th century, the prevalence of ASD was estimated to be 4/10,000 [...].

Assessment of Anxiety in Cognitive-Behavior Therapy in Young University Students with Autism Spectrum Disorders: A Review.

The university provides academic support to disabled students, however, few institutions provide academic, extra-academic or preventive support to students with Autism Spectrum Disorders High-Functioning (ASD-HF). Among the most commonly requested needs is support for coping with anxiety arising from academic and social activity itself. When planning an intervention program, it is necessary to screen those who have problems and are likely to benefit from such a program. In this article we propose a systematic search for measures of anxiety for young people and adults with ASD-HF. Of a total of 683 documents, only 7 met the selection criteria. Of these, a total of 35 tools were detected, of which only 11 mediated anxiety. Screening should be carried out for all students, so that we can detect the "risk" of anxiety disturbance in all cases and, in particular, in students with ASD-HF. However, the instruments eligible for assessing intervention outcomes should be agreed upon in order to be able to compare results from different trials.

A Systematic Review on the Impact of the Social Confinement on People with Autism Spectrum Disorder and Their Caregivers during the COVID-19 Pandemic.

The COVID-19 pandemic had imposed a variety of containment measures on the general population for prolonged periods. Confinement has had, and still has, social, economic, educational, health, and psychological consequences on the entire population. OBJECTIVE: In this article, a systematic search has been performed based on studies carried out since the beginning of the pandemic, regarding the impact of these containment measures on the autism spectrum disorder (ASD) population and their caregivers. METHOD: We consulted six databases (i.e., PubMed, Medline, Embase, Scopus, Web of Science, and Science Direct) and selected ten studies that met the inclusion criteria. The chosen studies have been classified according to their theoretical focus, methodology, and target population. RESULTS: We found an increase in stress and a decrease in psychological well-being among individuals diagnosed with ASD (i.e., parents and caregivers). Additionally, in studies focused on children, youth, and adults with ASD diagnosis, the results are contradictory depending on variables such as age, ASD severity, or type of family structure. CONCLUSIONS: The results show that the consequences of quarantine and social confinement are quite contradictory and depend on variables such as age, ASD severity, and family features.

Diagnostic Tools for Autism Spectrum Disorders by Gender: Analysis of Current Status and Future Lines.

Studies on the prevalence of autism spectrum disorders have shown gender disproportion. In recent years, there has been an increasing interest in this investigation area. There are two main research lines; the first is focused mostly on gender-related biological reasons that could account for low ASD prevalence in women (i.e., related to some protective factors related to hormones or the immune system, among others), and the second research line studies possible diagnostic biases. In the present study, a review of the latter line of research is made based on two main objectives: (a) analysis of possible biases in diagnostic tools and (b) other nonbiological ASD prevalence explained by gender differences. As a result of our theoretical review, we found that the articles reviewed showed contradictory results and possible diagnostic biases, not only in their design but also in their assessment standards. We concluded that specific or complementary diagnostic tools and procedures differentiated by gender should be developed in order to reduce these biases.

Mindfulness-Based Stress Reduction (MBSR) and Self Compassion (SC) Training for Parents of Children with Autism Spectrum Disorders: A Pilot Trial in Community Services in Spain.

This study aims to develop a clinical trial to test the efficacy of a mindfulness-based stress reduction (MBSR) and self-compassion (SC) program on self-reported values of anxiety, depression, and stress in parents of children with autism spectrum disorder (ASD) in primary school, in order to assess their integration into the framework of community intervention programs in Spain. METHODS: A brief 8-week training program using mindfulness-based intervention (MBSR) and self-compassion (SC) has been applied to twelve Valencian ASD parents, ten of whom completed the program. Participants were assigned to two groups; both groups received the same treatment but at two different measurement moments. Depression, anxiety, stress, satisfaction with life and mindful attention awareness measurements were performed, in all participants, in three testing stages. RESULTS: Analysis of variance results suggested that MBSR and SC training reduces stress and anxiety and increases mindful attention awareness. No significant changes were found in life satisfaction measurements. CONCLUSIONS: The small number of participants prevents us from generalizing the results found. More MBSR and SC clinical trials are needed in parents of ASD with results on anxiety, depression and stress in order to demonstrate the relevance of the inclusion of these programs in community-based early intervention services.

Psychometrics of the Spanish Version of the Screen for Adult Anxiety Related Disorders (SCAARED).

Objectives: To translate and validate the Screen for Adult Anxiety Related Disorders (SCAARED) questionnaire into Spanish. Method: The original SCAARED was translated into Spanish and administered to a non-clinical sample of 131 university students (92.4% women, mean age 22 years) in Valencia, Spain. To assess the concurrent validity of the SCAARED, the Depression, Anxiety and Stress Scale-21(DASS) and the Beck's Anxiety Inventory (BAI) were also administered. Test-retest reliability was evaluated 2 weeks after the first administration. Results: The internal consistency of SCAARED was high (α = 0.91) and the stability of the measurement was also high (test-retest 0.81). The results of the Exploratory Factor Analysis showed four factors comparable to the original SCAARED (generalized anxiety disorder, social phobia disorder, panic disorder, and separation anxiety disorder). The Area Under the Curve was excellent (0.88). Conclusions: The Spanish version of the SCAARED showed good psychometric properties comparable to the original SCAARED suggesting that it may be a useful instrument to screen for anxiety disorders in Spanish-speaking adult populations. Future studies are needed to replicate these findings in larger community and clinical samples.

Early Intervention with Parents of Children with Autism Spectrum Disorders: A Review of Programs.

The aim of this article was to analyze the evidence regarding the effectiveness of intervention programs for children with autism based on the participation of their parents. To obtain the data, a systematic search was carried out in four databases (PsycARTICLES (ProQuest), ERIC (ProQuest), PubMed (ProQuest), and Scopus). The retrieved documents were refined under the inclusion/exclusion criteria, and a total of 51 empirical studies were selected. These studies were first classified according to the function of the intervention objective and, later, by the methodology applied (19 studies were based on comprehensive interventions, 11 focused on the nuclear symptoms of autism spectrum disorder (ASD), 12 focused on the promotion of positive parenting, and nine interactions focused on child play). Once all of the documents had been analyzed, the evidence indicated scientific efficacy in most studies, mainly in those based on child development and the application of behavioral analysis principles. Moreover, the positive influence of parent participation in such programs was demonstrated.

Revisión de evidencias de las técnicas de DIR/Floortime™ para la intervención en niños y niñas con Trastornos del Espectro del Autismo / Review of evidence of DIR/Flortime™ techniques for intervention in children with Autism Spectrum Disorders

Las técnicas de DIR/Floortime(TM) han tomado en nuestro país un cierto impulso. El objetivo de este artículo es analizar las evidencias sobre la eficacia que estas técnicas, para lo cual se han realizado búsquedas en cuatro bases de datos (PsychArticles, ERIC, PubMed y Medline). Después de depurar los documentos encontrados aplicando los criterios de inclusión/exclusión, se han detectado solo 18 estudios empíricos (7 estudios de caso único, 3 estudios cuasi-experimentales y 6 ensayos clínicos aleatorizados). Dos de los estudios son reanálisis de estudios anteriores o estudios de seguimiento. Una vez valorados los diferentes estudios, se concluye que es necesaria más investigación sobre las técnicas de DIR/Floortime(TM). Aunque las evidencias apuntan hacia la eficacia de la incorporación de los padres y las técnicas de juego en el suelo, los estudios son muy heterogéneos y no permiten realizar ningún metaanálisis de resultados para evidenciar su eficacia

The techniques of DIR/Floortime(TM) have taken a certain momentum in our country. The aim of this article is to analyze the evidence on the efficacy of these techniques for which four databases have been searched (PsychArticles, ERIC, PubMed and Medline). After refining the documents found by applying the inclusion/exclusion criteria, only 18 empirical studies were detected (7 single case studies, 3 quasi-experimental studies and 6 randomized clinical trials). Two of the studies are re-analyses of previous studies or follow-up studies. Once the different studies have been evaluated, it is concluded that more research is needed on the techniques of DIR/Floortime(TM). Although the evidence points to the efficacy of parental involvement and soil play techniques, the studies are very heterogeneous and do not allow any meta-analysis of results to show their efficacy

Screening instruments for early detection of autism spectrum disorder in spanish speaking communities / Instrumentos de detección temprana de los trastornos del espectro autista para poblaciones de habla hispana

BACKGROUND: Since autism detection protocols rely primarily on parental accounts of early symptoms, the use by Spanish-speaking populations of screening tools developed in a different language and socio-cultural context (usually English) might hamper the success of early detection programs. METHOD: A systematic search in four databases was completed, identifying 59 tools used for ASD detection. Of these, only nine tools had been applied in Spanish-speaking populations, and of those, only five can be considered specific tools for the early detection of autism. RESULTS: Sensitivity detecting autism was generally lower in the Spanish versions of the reviewed instruments, while specificity tended to be equal to or higher than that reported in the original screeners. CONCLUSIONS: Heterogeneity and poor methodological rigor of the studies conducted to date emphasize an urgent need for a concerted effort to develop reliable and valid instruments for the early detection of autism in Spanish-speaking populations worldwide

ANTECEDENTES: puesto que los protocolos de detección del autismo se basan principalmente en el relato de los padres sobre los síntomas tempranos, el uso de herramientas de detección desarrolladas en un idioma y un contexto sociocultural diferentes (generalmente en inglés) en las poblaciones de habla hispana podría obstaculizar el éxito de los programas de detección temprana. MÉTODO: se completó una búsqueda sistemática en cuatro bases de datos, identificando 59 herramientas utilizadas para la detección de TEA. De estas, solo nueve herramientas habían sido aplicadas en poblaciones hispanohablantes, y de estas, solo cinco pueden considerarse herramientas específicas para la detección temprana del autismo. RESULTADOS: la sensibilidad para detectar el autismo fue generalmente menor en las versiones en español de los instrumentos revisados, mientras que la especificidad tendió a ser igual o mayor que la reportada en las revisiones originales. CONCLUSIONES: la heterogeneidad y el escaso rigor metodológico de los estudios realizados hasta la fecha ponen de manifiesto la urgente necesidad de un esfuerzo concertado para desarrollar instrumentos fiables y válidos para la detección precoz del autismo en las poblaciones hispanohablantes de todo el mundo

Screening instruments for early detection of autism spectrum disorder in Spanish speaking communities.

BACKGROUND: Since autism detection protocols rely primarily on parental accounts of early symptoms, the use by Spanish-speaking populations of screening tools developed in a different language and socio-cultural context (usually English) might hamper the success of early detection programs. METHOD: A systematic search in four databases was completed, identifying 59 tools used for ASD detection. Of these, only nine tools had been applied in Spanish-speaking populations, and of those, only five can be considered specific tools for the early detection of autism. RESULTS: Sensitivity detecting autism was generally lower in the Spanish versions of the reviewed instruments, while specificity tended to be equal to or higher than that reported in the original screeners. CONCLUSIONS: Heterogeneity and poor methodological rigor of the studies conducted to date emphasize an urgent need for a concerted effort to develop reliable and valid instruments for the early detection of autism in Spanish-speaking populations worldwide.