Associations of unintended pregnancy with autism spectrum disorders and the modification of folic acid supplements.

There is limited evidence on the associations of unintended pregnancy with autism spectrum disorders (ASD). This study aimed to examine this relationship and the modification of pre-conceptional and prenatal folic acid supplements. Six thousand and five toddlers aged 16 to 30 months from seven cities of six provinces in China were eligible for participation. Information on unintended pregnancy and folic acid supplements was obtained via questionnaires from caregivers of toddlers. The diagnosis of ASD was based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and the Chinese version of the Childhood Autism Rating Scale (CARS). Of the 6005 toddlers in the study (3337 boys and 2668 girls), 71 (1.18%) received the diagnosis of ASD. Generalized linear models with a logit link function showed unintended pregnancy was positively associated with ASD (odds ratios [OR] = 1.69, 95% confidence interval [CI], 1.05-2.79). Stratified estimates indicated that the association remained stable among toddlers of mothers without pre-conceptional and prenatal folic acid supplements (OR = 2.75, 95% CI, 1.04-7.27; n = 1243, 20.70%). Unintended pregnancy was associated with higher odds of ASD in 16-30 months of toddlers, and the association was consistent among toddlers of mothers without prenatal folic acid supplements. Our findings emphasize the need to raise awareness of the risk of unintended pregnancy and the benefits of folic acid supplements among Chinese women.

Specific brain imaging alterations underlying autistic traits in children with attention-deficit/hyperactivity disorder.

BACKGROUND: Autistic traits (ATs) are frequently reported in children with Attention-Deficit/Hyperactivity Disorder (ADHD). This study aimed to examine ATs in children with ADHD from both behavioral and neuroimaging perspectives. METHODS: We used the Autism Spectrum Screening Questionnaire (ASSQ) to assess and define subjects with and without ATs. For behavioral analyses, 67 children with ADHD and ATs (ADHD + ATs), 105 children with ADHD but without ATs (ADHD - ATs), and 44 typically developing healthy controls without ATs (HC - ATs) were recruited. We collected resting-state functional magnetic resonance imaging (rs-fMRI) data and analyzed the mean amplitude of low-frequency fluctuation (mALFF) values (an approach used to depict different spontaneous brain activities) in a sub-sample. The imaging features that were shared between ATs and ADHD symptoms or that were unique to one or the other set of symptoms were illustrated as a way to explore the "brain-behavior" relationship. RESULTS: Compared to ADHD-ATs, the ADHD + ATs group showed more global impairment in all aspects of autistic symptoms and higher hyperactivity/impulsivity (HI). Partial-correlation analysis indicated that HI was significantly positively correlated with all aspects of ATs in ADHD. Imaging analyses indicated that mALFF values in the left middle occipital gyrus (MOG), left parietal lobe (PL)/precuneus, and left middle temporal gyrus (MTG) might be specifically related to ADHD, while those in the right MTG might be more closely associated with ATs. Furthermore, altered mALFF in the right PL/precuneus correlated with both ADHD and ATs, albeit in diverse directions. CONCLUSIONS: The co-occurrence of ATs in children with ADHD manifested as different behavioral characteristics and specific brain functional alterations. Assessing ATs in children with ADHD could help us understand the heterogeneity of ADHD, further explore its pathogenesis, and promote clinical interventions.

Psychometric properties of the Chinese version of the children's empathy quotient and systemizing quotient: 4-12 years.

We aimed to validate the Children's Empathy Quotient (EQ-C) and Systemizing Quotient (SQ-C) in Mainland China, which can reflect the profiles of empathizing and systemizing, and describing specific characteristics of autism spectrum disorder (ASD) and gender-typical behaviors in general population. A total of 800 typically developing (TD) children, aged 4-12 years was recruited initially with whose parents/guardians complete the measurements, and 782 TD children who met inclusion criteria were finally included. A 23-item three-factor EQ-C and a 22-item four-factor SQ-C was developed with good internal consistency (Omega total values of 0.87 and 0.86) and test-retest reliability (Pearson correlation coefficients of 0.82 and 0.69). In TD children, girls scored significantly higher on EQ-C (31.4 ± 7.8 vs. 28.2 ± 7.7) but there were no gender differences in SQ-C scores. TD children showed different cognitive styles (empathizing-dominant for girls with 42.6% identified as Type E; systemizing-dominant for boys with 40.7% identified as Type S). A further sample of 222 children with ASD indicated that they scored lower on EQ/SQ-C compared to TD children (13.2 ± 5.1 vs. 29.7 ± 7.9, 12.4 ± 5.8 vs. 23.5 ± 8.3) and were generally systemizing-dominant (Type S: 50.8% for boys and 64.0% for girls). Autistic children scored higher on the SQ-C in those without intellectual disability and with higher paternal education level and family income (14.2 ± 6.1 vs. 10.9 ± 5.0, 13.3 ± 6.2 vs. 11.5 ± 5.1, 13.7 ± 5.6 vs. 11.9 ± 5.8), while there were no differences in the EQ-C. This study indicated good reliability and validity of the Chinese version of EQ/SQ-C, which can be used in Chinese children with and without ASD. LAY SUMMARY: We developed the Chinese version of the Children's Empathy Quotient (EQ-C) and Systemizing Quotient (SQ-C) in 782 typically developing (TD) children aged 4-12 years in Mainland China, yielding a 23-item, 3-factor EQ-C and a 22-item, 4-factor SQ-C with good psychometric properties. In TD children, we found gender difference only in scores of EQ-C. Further analyses of 222 autistic children indicated that differences were found in scores of SQ-C when considering their gender, intelligence and socio-economic status.

Empathy, Theory of Mind, and Prosocial Behaviors in Autistic Children.

Background: Previous research has suggested that children with autism spectrum disorder (ASD) display fewer prosocial behaviors, and the role of empathy or Theory of Mind (ToM) in prosocial behaviors of autistic children remains unclear. Methods: Data were obtained from an ongoing longitudinal study in Guangzhou, China. A total of 96 autistic children and 167 typically developing (TD) children were enrolled. Prosocial behaviors were assessed using a subscale of the Strength and Difficulties Questionnaire and Dictator Game (DG) paradigm with stickers as incentives. Empathic traits and ToM ability were measured using the children's Empathy Quotient and the Chinese version of ToM toolkit. Generalized linear models were used to assess the differences of prosocial behaviors and empathic traits, ToM ability between the two groups and the associations between empathic traits, ToM ability and prosocial behaviors in autistic children. Results: Compared with TD children, autistic children exhibited worse ToM ability and performed less pro-socially in the DG paradigm, while there were no differences regarding empathic traits. In autistic children, empathic traits especially affective empathy, were positively associated with parent-reported prosocial behaviors [ß = 0.17, 95% confidence interval (CI): 0.07-0.27; ß = 0.47, 95%CI: 0.33-0.60]. ToM ability was associated with DG paradigm (ß = 1.03, 95%CI: 0.16-1.89). Conclusion: Autistic children showed less pro-sociality and ToM ability than TD children. In autistic children, empathic trait was associated with parent-reported prosocial behaviors while their ToM ability was associated with prosocial behaviors in experimental condition. Our findings indicated that better ToM ability and empathic trait might promote prosocial behaviors in autistic children.

Cognitive, Language, and Behavioral Outcomes in Children With Autism Spectrum Disorders Exposed to Early Comprehensive Treatment Models: A Meta-Analysis and Meta-Regression.

Background: Early comprehensive treatment models (CTMs) have been developed as effective treatments for children with autism spectrum disorder (ASD). Numerous studies have suggested that CTMs can improve short-term outcomes, but little is known about precise outcome information in childhood. The current meta-analysis reviewed studies reporting broader outcomes in children with ASD who had ever participated in a CTM and examined the predictors of developmental gains. Methods: We searched eight databases up to June 13, 2019, for relevant trials and natural experiments. Longitudinal studies were selected if they investigated the outcomes of CTMs. Two meta-analyses were undertaken to provide a summary estimate of change in treatment outcomes and to evaluate the effect of CTMs; one used the standardized mean change between the pretest and posttest, and the other was a classical meta-analysis. Stratified and random-effects meta-regression analyses were performed to search for outcome differences among studies. Results: Eighteen intervention studies (involving 495 children with ASD) met all the inclusion criteria: 12 used early intensive behavioral intervention (EIBI), and two used the Early Start Denver Model (ESDM). Outcomes were categorized into three parts: cognitive, language and behavioral (e.g., adaptive functioning and symptomatology). Overall, most children with ASD who had ever participated in an early CTM made gains in many areas of functioning, especially in terms of symptom- and language-related outcomes. Stratified analyses indicated that the ESDM displayed the largest effect on IQ improvement (ES = 1.37, 95% CI: 0.95 to 1.80), while EIBI was more effective for symptom reduction (ES = -1.27, 95% CI: -1.96 to -0.58). Further, meta-regression suggested that interventions with parent involvement, higher intensity, and longer treatment hours yielded greater improvements in IQ and social adaptive functioning, respectively. Conclusion: The results demonstrate a positive association between CTMs and better prognosis in childhood, especially regarding symptoms, and language. However, most extant research involves small, non-randomized studies, preventing definitive conclusions from being drawn. Clearly, the outcomes of children with ASD are still far from normal, especially with respect to adaptive functioning, and the four mediating variables pertaining to treatment elements can affect their gains, including approach, implementer, intensity, and total treatment hours. Systematic Review Registration: [www.crd.york.ac.uk/PROSPERO], identifier [CRD42019146859].

Reliability and validity of Adaptive Behavior Scale for Children with Autism Spectrum Disorder / 中国学校卫生

Objective@#To develop a native adaptive behavior scale for children with autism spectrum disorder(ASD) and to explore its reliability and validity.@*Methods@#Items of ASD adaptive behavior rating scale were selected based on the scale development theory, ASD knowledge and adaptive behavior concept through preliminary survey and statistical, and 301 ASD children aged 2 to 12 from hospitals in Guangzhou, Huizhou, Shenzhen who met the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition were selected, data was analyzed by the item analysis.@*Results@#After item analysis and exploratory factor analysis, the final version of the scale contains 58 items, and 64.24% of the total variation could be explained by 6 factors; The Cronbach’s α coefficient of the full scale was 0.98, and the coefficient value of dimen sional factors were 0.94，0.93，0.91，0.95，0.88，0.94. The test-test reliability r of full scale was 0.86, the r of the factor were 0.88，0.81，0.81，0.87，0.88，0.79. The criterion-related validity r with the ABAS-Ⅱ scale was -0.77, the criterion-related validity r with the CARS scale was 0.64.@*Conclusion@#The ASD Child Adaptive Behavior Scale showed good reliability and validity, and could be used widely.

Altered Gut Microbiota in Chinese Children With Autism Spectrum Disorders.

The link between gut microbes and autism spectrum disorders (ASD) has been already observed in some studies, but some bacterial families/species were found to be inconsistently up or down regulated. This issue has been rarely explored in the Chinese population. In this study, we assessed whether or not gut microbiota dysbiosis was associated with children with ASD in China. We enrolled 45 children with ASD (6-9 years of age; 39 boys and 6 girls) and 45 sex- and age-matched neurotypical children. Dietary and other socio-demographic information was obtained via questionnaires. We characterized the composition of the fecal microbiota using bacterial 16S ribosomal RNA (16S rRNA) gene sequencing. The ASD group showed less diversity and richness of gut microbiota than the neurotypical group, as estimated by the abundance-based coverage estimator index and the phylogenetic diversity index. The analysis of beta diversity showed an altered microbial community structure in the ASD group. After adjustment for confounders and multiple testing corrections, no significant group difference was found in the relative abundance of microbiota on the level of the phylum. At the family level, children with ASD had a lower relative abundance of Acidaminococcaceae than the healthy controls. Moreover, a decrease in the relative abundance of genera Lachnoclostridium, Tyzzerella subgroup 4, Flavonifractor, and unidentified Lachnospiraceae was observed in ASD group. This study provides further evidence of intestinal microbial dysbiosis in ASD and sheds light on the characteristics of the gut microbiome of autistic children in China.

Gender Difference in the Association Between Executive Function and Autistic Traits in Typically Developing Children.

Autistic traits and executive function (EF) were assessed in 413 typically developing children aged 6-9 years. The children were divided into the high- autistic-trait (HAT) and low-autistic-trait (LAT) groups based on their total autistic traits. Results suggested that there were gender differences in specific autistic traits in children with LAT. There were gender-specific associations between EF and autistic traits in children with HAT: the set shifting of EF predicted difficulties in social awareness in boys; whereas all the EF components predicted difficulties in social communication and social cognition in girls. These findings may have implications for developing customized interventions that are targeted at specific autistic deficits in males and females.

Psychometric properties of the chinese version of autism spectrum quotient-children's version: A sex-specific analysis.

A Simplified Chinese translation of the Autism Spectrum Quotient-Children's Version (AQ-C) is needed for research in mainland China. Autism Spectrum Disorder (ASD) is a condition that differs in presentation and prevalence by sex. Thus, evaluating the psychometric validity of the AQ-C in males and females is an important step in its validation. The present study aims to develop a Chinese translation of the parent-report AQ-C, and test its psychometric properties among Mandarin Chinese speaking boys and girls. A total of 1,020 non-clinical children and 134 children with ASD were assessed. Factor analyses were performed for the whole sample, as well as for girls and boys separately. A 30-item, 5-factor model (the Chinese AQ-C) showed adequate goodness of fit (root mean square error of approximation [RMSEA] = 0.037; comparative fit index [CFI] = 0.907; Tucker-Lewis index [TLI] = 0.901) for the whole sample. According to parents' reports, non-clinical boys had significantly higher scores than non-clinical girls on the Chinese AQ-C. Sex-specific factor structures were identified resulting in a 4-factor model with 32 items for girls (the Chinese AQ-Girls), and a 4-factor model with 34 items for boys (the Chinese AQ-Boys). The cut-off scores of the Chinese AQ-C, AQ-Girls, and AQ-Boys were 44.5, 42.5, and 46.5, respectively. These three Chinese versions of the AQ-C all showed satisfactory internal consistency (α = 0.786-0.840) and concurrent validity with the Social Responsiveness Scale (r = 0.789-0.814) for the total scale. Differences have been found in the sex-specific factor structures of the AQ-C which would be more reliable to use for future research when measuring autistic traits in the general population. Autism Res 2019, 12: 303-315 © 2018 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: This study developed Chinese versions of the Autism Spectrum Quotient-Children's Version (AQ-C) in Chinese boys and girls together and separately. The AQ-C showed good psychometric properties in boys and girls together and separately. There were differences in sex-specific factor structures of the AQ-C. These results suggest that the sex-specific Chinese versions of the AQ-C provide reliable and valid measurement of autistic traits.

Incidence of childhood overweight and obesity and its association with weight-related attitudes and behaviors in China: a national longitudinal study.

BACKGROUND: Childhood obesity is a major public health challenge. We aimed to investigate the incidence of overweight/obesity among Chinese children; and prospectively examine the associations of weight-change intention with risk of overweight/obesity and behavioral changes in initially normal-weight children. METHODS: A national sample of 21,796 children aged 6-17 years were investigated in September 2013 and followed up nine months later, of which 19,887 (91%) were normal weight and 1909 (9%) were underweight at baseline. Weight and height were objectively measured. Weight perception, weight-change intention, weight control practices, weight-related behaviors, and demographic information were obtained by questionnaires. RESULTS: Among children with underweight or normal-weight, the cumulative incidence of overweight/obesity was 2.77% (95% CI 2.55-2.99). Among normal-weight children, those who overestimated their weight had higher baseline BMI z-scores and an increased relative risk (RR) of overweight/obesity (RR 1.51, 95% CI 1.15-1.99). Children who misperceived themselves as underweight or overweight had stronger weight-change intention than their counterparts. However, children with weight-change intention did not develop greater changes in dietary intakes, physical activities, or sedentary behaviors than those without intention. There was no significant association between weight-change intention and incidence after adjusting for BMI z-scores at baseline. Self-reported improving diet, increasing physical activity, and dieting were associated with certain actual behavioral improvements and smaller increase in BMI z-score, but not associated with decreased risk of overweight/obesity. CONCLUSION: The 9-months cumulative incidence of overweight/obesity was 2.77% among Chinese children. Weight-change intention was not associated with incidence of overweight/obesity in normal-weight children, regardless of their weight perception. More importantly, children's weight-change intention was insufficient in achieving desirable behavioral changes. Future overweight and obesity prevention programs should directly target on promoting children's actual behavioral changes.

Differences in relationships of maternal and paternal age at childbirth with body fat distribution in offspring.

OBJECTIVES: Although delayed parenthood has been linked to various adverse health outcomes in offspring, little attention has been given to the relationship between an increased parental age at childbirth and fat distribution in offspring. We aimed to determine the relationship between parental age at childbirth and body fat partitioning in Chinese children. METHODS: A total of 463 children (mean age, 8 years; 43% female) were recruited. Dual-energy X-ray absorptiometry was used to determine the fat mass (FM) and percentage of fat mass (%FM) in various areas of the body. Weight and height were measured. The body mass index (BMI) and fat mass index (FMI) were calculated. A questionnaire was used to collect information about parental variables and other confounders. RESULTS: Multiple linear regression analyses suggested that for each additional year of maternal age at delivery, the BMI, FMI, and FM at whole-body, trunk, android, gynoid, and appendicular region increased by 0.115 kg/m2 , 0.076 kg/m2 ; 128.4 g, 57.71 g, 10.96 g, 25.07 g, and 67.88 g, respectively, after adjusting for covariates (P = .002-.017). In the analysis of covariance, children of mothers aged ≥31 years exhibited higher BMI, FMI, total-body and segmental FM, compared to those of mothers aged ≤25 years (P-trend = 0.002-0.017). Similar tendencies were also observed for the %FM (P-trend = 0.002-0.017). However, there was no significant relationship between paternal age at childbirth and any of the body fat measures in children. CONCLUSIONS: An increasing maternal age at childbirth was associated with increased body fat accumulation in offspring, whereas paternal age at childbirth appeared to have no such association.

One-child policy, weight status, lifestyles and parental concerns in Chinese children: a nationwide cross-sectional survey.

BACKGROUND/OBJECTIVES: China's one-child policy has been in place for 35 years, yet its impact on the differences of weight status including thinness and overweight/obesity, lifestyles, and parental concerns between only children (OC) and non-only children (NOC) were seldom discussed. SUBJECTS/METHODS: A total of 62,444 children aged 6-17 years were recruited in 2013. Thinness and overweight/obesity were calculated from anthropometric measurements. Information on dietary consumption, dietary behaviors, physical activities (PA)-related behaviors, and parental concerns were obtained via questionnaires. RESULTS: Overall, 68.6% of children were OC. The prevalence of thinness and overweight/obesity were 6.98% and 24.86% in OC, in contrast to 6.57% and 19.46% in NOC, respectively. In comparison with NOC, OC had more dietary intakes of vegetables, fruits, meat products, and sugar-sweetened beverages (SSBs). OC had better dietary behaviors including more regular breakfast, regular dairy products, less fried food, and less eating-out habits, but worse dietary behaviors including more SSBs and fast food intakes. Parents of OC showed more concerns toward their child's health, but the difference became nonsignificant after adjustment for parental education levels. Similar situations were also found in the differences of PA-related behaviors between OC and their counterparts. CONCLUSIONS: More than two-thirds of the children were OC in this study. Notably, OC were more likely to have higher food intakes and behaved worse in certain dietary behaviors, and were at higher risks of overweight and obesity. There were no differences in the prevalence of thinness, PA-related behaviors, and parental concerns between groups.

Association between Cesarean Section and Weight Status in Chinese Children and Adolescents: A National Survey.

Previous research on the association between cesarean section (CS) and childhood obesity has yielded inconsistent findings. This study assessed the secular trend of CS and explored the relationship between CS and the risks of overweight and obesity in Chinese children and adolescents. Data came from a national multicenter school-based study conducted in seven provinces of China in 2013. Covariate data including weight, height and delivery mode were extracted. Poisson regression was applied to determine the risk ratios (RRs) and 95% confidence intervals (CIs) for the risks of overweight and obesity associated with the delivery mode. A total of 18,780 (41.2%) subjects were born by CS between 1997 and 2006. The rate of CS increased from 27.2% in 1997 to 54.1% in 2006. After adjusting for major confounders, the RRs (95% CI) of overweight and obesity among subjects born by CS were 1.21 (1.15 to 1.27) and 1.51 (1.42 to 1.61), respectively. Similar results were observed in different subgroups stratified by sex, age, and region. In summary, the CS rate increased sharply in China between 1997 and 2006. CS was associated with increased risks of overweight and obesity in offspring after accounting for major confounding factors.

[Effects of environmental factors on ß diversity of zooplankton community in thermal discharge seawaters near Guohua Power Plant in Xiangshan Bay, Zhejiang, China].

Zooplankton samples were seasonally collected at 10 stations in thermal discharge seawaters near Guohua Power Plant in Xiangshan Bay. The abundance data from these samples were pooled and further combined with field environmental factors, then generalised dissimilarity modelling (GDM) was used to explore the effects of environmental factors on ß diversity of zooplankton community. The results showed that altogether 95 species of zooplankton belonging to 14 taxa were found. In these taxa, small zooplankton with 62.6% of abundance was the main taxa, while copepods dominated in adult groups, which abundance accounted for 35.3%. According to Whittaker's definition and additive partition, a diversity accounted for 36.3% and ß diversity 63.7%. Environmental factors explained 43.8% of ß diversity, and geographical distance between sampling sites had no effect on ß diversity. However, there were still 19.9% of ß diversity remained to be explained. After GDM fitting, there were nine environmental variables affecting zooplankton ß diversity and explaining 68.8% of ß diversity. The variables contributing to ß diversity from high to low were seasonal water temperature, dissolved oxygen, seawater temperature increment, conductivity, suspended particulate matter, salinity, transparency, water depth and redox potential, respectively. Seasonal water temperature, dissolved oxygen and seawater temperature increment were the most important factors for driving ß diversity changes, and accounted for 23.9%, 13.7% and 9.7% of absolute contribution to the interpretable portion of the ß diversity, respectively. When seasonal water temperature, dissolved oxygen and seawater temperature increment were below 25 °C, greater than 5 mg · L(-1) and over 1 °C, respectively, ß diversity rapidly increased with the increasing variable gradients. Furthermore, other predictors had little effect on ß diversity.