[Autism and attachment difficulties in adulthood : Overlap of symptoms]. / Autisme et séquelles de trouble réactionnel de l'attachement à l'âge adulte : chevauchement des symptômes.

This article explores the overlap of symptoms between autism and attachment difficulties in adulthood. Clinicians express difficulties in differentiating between these conditions contributing to misdiagnosis. Distinguishing autism spectrum behaviors from behaviors relating to disorganized attachment can be challenging. Urgency is added by the fact that the number of cases is increasing in the diagnosis of autism spectrum disorder (ASD). It is becoming increasingly recognized that ASD shares phenotypic similarities with other traditionally distinct developmental conditions. This article aims enhance the clinicians' critical reasoning regarding the patient's behavior to distinguish if its autism or attachment-related behavior disorders. For us, the clearest differentiation factor seemed to be the nature of the behavior.

Cet article a pour ambition de rendre attentif le clinicien quant au chevauchement des symptômes de l'autisme et des séquelles des troubles réactionnels de l'attachement. Il n'est pas aisé de différencier ces deux conditions en termes de comportements, que cela soit dans les interactions sociales, la communication et les patterns de comportements stéréotypés qui peuvent conduire à un diagnostic erroné. La différence significative semble être la nature des comportements en termes qualitatifs. Dans le cas d'une évaluation diagnostique à l'âge adulte, la probabilité d'erreur est importante car les schémas d'attachement ne peuvent être évalués et seules les séquelles de l'attachement dit insécure peuvent être détectées. Par ailleurs, à la fin de l'article est proposé un tableau récapitulatif des symptômes présents/absents dans les deux conditions.

[Autism spectrum disorder in verbal adults without intellectual disabilities (Asperger syndrome)]. / Trouble du spectre de l'autisme chez l'adulte verbal sans déficience intellectuelle (syndrome d'Asperger).

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder associating persistent communication and social interaction deficits with behaviors, interests or activities of a restricted and repetitive nature. The etiology of ASD is not yet fully understood but appears to be multifactorial, including both genetic and environmental factors. The concept of autism underwent a major evolution before arriving at the current definition in DSM-5. The diagnosis has two parts: a categorical from cut-off and differential diagnosis established from a specification of the category by dimensional variables (intelligence, language, associated diseases, adaptation). These two parts (categorical diagnosis and specifiers) are complementary but pose a certain number of practical problems in establishing the diagnosis in adulthood.

Le trouble du spectre de l'autisme (TSA) est un trouble neurodéveloppemental associant des déficits persistants de la communication et des interactions sociales à des comportements, intérêts ou activités présentant un caractère restreint et répétitif. L'étiologie du TSA n'est pas complètement élucidée mais semble plurifactorielle, comportant des facteurs génétiques et environnementaux. La notion d'autisme a subi une évolution importante avant d'aboutir à l'actuelle définition dans le DSM-5. Le diagnostic comprend : a) un diagnostic catégoriel établi à partir de seuils et b) un diagnostic dimensionnel établi à partir de variables dimensionnelles (intelligence, langage, maladies associées, adaptation). Ces 2 parties sont complémentaires mais posent un certain nombre de problèmes pratiques à l'établissement du diagnostic à l'âge adulte.

Temporal regularity of cerebral activity at rest correlates with slowness of reaction times in intellectual disability.

OBJECTIVE: Intellectual disability (ID) is described as a general slowness in behavior and an inadequacy in adaptive skills. The present study examines whether behavioral slowness in ID could originate from abnormal complexity in brain signals. METHODS: Participants (N = 29) performed a reaction times (RTs) task assessing their individual information processing speeds. Half of the participants had moderate intellectual disability (intelligence quotient (IQ) < 70). Continuous electroencephalogram recording during the resting period was used to quantify brain signal complexity by approximate entropy estimation (ApEn). RESULTS: For all participants, a negative correlation between RTs and IQ was found, with longer RTs coinciding with lower IQ. This behavioral slowness in ID was associated with increased temporal regularity in electrocortical brain signals. CONCLUSIONS: Behavioral slowness in ID subjects is closely related to lower brain signal complexity. SIGNIFICANCE: Brain signal ApEn is shown to correspond with processing speed for the first time: in ID participants, the higher the regularity in brain signals at rest, the slower RTs will be in the active state. ID should be understood as a lack of lability in the cortical transition to the active state, weakening the efficiency of adaptive behavior.

[Guideline for behaviors problems in adults with intellectual disabilities]. / Prise en charge des patientspsychiatriques présentantune déficience intellectuelle.

A significant number of individuals with intellectual disability also display serious behavioral problems. We believe that improving the care and medical treatment for this population is essential because there is a great disparity in care between these individuals and the general population. This article elaborates a little guideline in the mental health.

Bon nombre de personnes adultes présentant une déficience intellectuelle ont des troubles graves du comportement (TGC) nécessitant parfois une intervention médicale. A cet effet, il est indispensable d'améliorer la prise en charge médicale de cette population car il existe une très grande disparité des soins offerts à cette dernière en comparaison de la population générale. Cet article propose quelques recommandations quant à la prise en charge clinique de ces patients.

Changes in Heart Rate Variability Recorded in Natural Situation with T-Shirt Integrated Sensors and Level of Observed Behavioral Excitation: A Pilot Study of Patients with Intellectual Disabilities and Psychiatric Disorders.

BACKGROUND: The present study investigates the possibilities of using heart rate variability (HRV) parameters as physiological markers that precede increase in observed behavioral excitation of intellectually disabled individuals. The ability to recognize or predict such patterns, especially in patients showing unpredictable reactions and language deficiencies, might be a major step forward in clinical research. METHOD: Thirteen volunteers with intellectual disabilities, who had suffered of at least one event of overt aggression in the preceding 3 months, participated to the study. The protocol consists in the acquisition of continuous electrocardiogram (ECG) throughout approximately two times of 8 h in natural situation, using a T-shirt integrated with sensors. Simultaneously, an observer evaluates the patient's level of overt excitation from calm (level 1) to extremely tense (level 5) and send online via Bluetooth these triggers into the ECG signals. The HRV indexes were then estimated offline on the basis of the inter-beat intervals recorded by the ECG, independently for the 30 min preceding each behavioral tension marking point, averaged, and compared through non-parametric Wilcoxon matched-pairs test. Of these, the RMSSD and LF/HF calculations were used to observe the fluctuations of inhibitory activity and cardiovagal balance through different tension states. RESULTS: Seven individuals have sufficient reliable data for analysis. They have reached at least a level 3 of behavioral excitation (moderately tense) or more (very to extremely tense, level 4 and 5) and have been retained for further analysis. In sum, a total of 197 periods of tension were kept, made up of 46 periods of slight excitation (level 2), 18 of moderate excitation (level 3), 10 of high excitation (level 4), and 5 of extreme agitation (level 5). Variations in the HRV as a function of degree of excitation are observed for RMSSD index only (inhibitory parasympathetic activity). The changes from calm to increasing levels of excitation are characterized by a significant downfall in RMSSD index when patients were evaluated to be in a very high level of tension (level 4). CONCLUSION: The presence of precursors to agitation, reflected in the falling-off of parasympathetic activity, offers potentially interesting prospects for therapeutic development.

Spatial radial maze procedures and setups to dissociate local and distal relational spatial frameworks in humans.

BACKGROUND: Radial maze tasks have been used to assess optimal foraging and spatial abilities in rodents. The spatial performance was based on a capacity to rely on a configuration of local and distant cues. We adapted maze procedures assessing the relative weight of local cues and distant landmarks for arm choice in humans. NEW METHOD: The procedure allowed testing memory of places in four experimental setups: a fingertip texture-groove maze, a tactile screen maze, a virtual radial maze and a walking size maze. During training, the four reinforced positions remained fixed relative to local and distal cues. During subsequent conflict trials, these frameworks were made conflictive in the prediction of reward locations. RESULTS: Three experiments showed that the relative weight of local and distal relational cues is affected by different factors such as cues' nature, visual access to the environment, real vs. virtual environment, and gender. A fourth experiment illustrated how a walking maze can be used with people suffering intellectual disability. COMPARISON WITH EXISTING METHODS: In our procedure, long-term (reference) and short-term (working) memory can be assessed. It is the first radial task adapted to human that enables dissociating local and distal cues, to provides an indication as to their relative salience. Our mazes are moveable and easily used in limited spaces. Tasks are performed with realistic and spontaneous though controlled exploratory movements. CONCLUSION: Our tasks enabled highlighting the use of different strategies. In a clinical perspective, considering the use of compensatory strategies should orient towards adapted behavioural rehabilitation.

Vision, spatial cognition and intellectual disability.

Vision is the most synthetic sensory channel and it provides specific information about the relative position of distant landmarks during visual exploration. In this paper we propose that visual exploration, as assessed by the recording of eye movements, offers an original method to analyze spatial cognition and to reveal alternative adaptation strategies in people with intellectual disabilities (ID). Our general assumption is that eye movement exploration may simultaneously reveal whether, why, and how, compensatory strategies point to specific difficulties related to neurological symptoms. An understanding of these strategies will also help in the development of optimal rehabilitation procedures.

French version validation of the psychotic symptom rating scales (PSYRATS) for outpatients with persistent psychotic symptoms.

BACKGROUND: Most scales that assess the presence and severity of psychotic symptoms often measure a broad range of experiences and behaviours, something that restricts the detailed measurement of specific symptoms such as delusions or hallucinations. The Psychotic Symptom Rating Scales (PSYRATS) is a clinical assessment tool that focuses on the detailed measurement of these core symptoms. The goal of this study was to examine the psychometric properties of the French version of the PSYRATS. METHODS: A sample of 103 outpatients suffering from schizophrenia or schizoaffective disorders and presenting persistent psychotic symptoms over the previous three months was assessed using the PSYRATS. Seventy-five sample participants were also assessed with the Positive And Negative Syndrome Scale (PANSS). RESULTS: ICCs were superior to .90 for all items of the PSYRATS. Factor analysis replicated the factorial structure of the original version of the delusions scale. Similar to previous replications, the factor structure of the hallucinations scale was partially replicated. Convergent validity indicated that some specific PSYRATS items do not correlate with the PANSS delusions or hallucinations. The distress items of the PSYRATS are negatively correlated with the grandiosity scale of the PANSS. CONCLUSIONS: The results of this study are limited by the relatively small sample size as well as the selection of participants with persistent symptoms. The French version of the PSYRATS partially replicates previously published results. Differences in factor structure of the hallucinations scale might be explained by greater variability of its elements. The future development of the scale should take into account the presence of grandiosity in order to better capture details of the psychotic experience.

Accurate memory for object location by individuals with intellectual disability: absolute spatial tagging instead of configural processing?

Using head-mounted eye tracker material, we assessed spatial recognition abilities (e.g., reaction to object permutation, removal or replacement with a new object) in participants with intellectual disabilities. The "Intellectual Disabilities (ID)" group (n = 40) obtained a score totalling a 93.7% success rate, whereas the "Normal Control" group (n = 40) scored 55.6% and took longer to fix their attention on the displaced object. The participants with an intellectual disability thus had a more accurate perception of spatial changes than controls. Interestingly, the ID participants were more reactive to object displacement than to removal of the object. In the specific test of novelty detection, however, the scores were similar, the two groups approaching 100% detection. Analysis of the strategies expressed by the ID group revealed that they engaged in more systematic object checking and were more sensitive than the control group to changes in the structure of the environment. Indeed, during the familiarisation phase, the "ID" group explored the collection of objects more slowly, and fixed their gaze for a longer time upon a significantly lower number of fixation points during visual sweeping.

Anticipatory pleasure skills training: a new intervention to reduce anhedonia in schizophrenia.

PURPOSE: Anhedonia is a challenging symptom of schizophrenia and remains largely recalcitrant to current pharmacological treatments. The goal of this exploratory pilot study was to assess if a cognitive-sensory intervention could improve anticipatory pleasure. DESIGN AND METHODS: Five participants meeting the Diagnostic and Statistical Manual of Mental Disorders (4th edition, Text Revision) criteria for schizophrenia, presenting severe anhedonia and stabilized on atypical antipsychotic medication, received between 10 hours and 25 hours of training. FINDINGS: Results show that the patients improved on the anticipatory scale of the Temporal Experience of Pleasure Scale. Daily activities of the patients were also increased. PRACTICE IMPLICATIONS: These preliminary data need to be interpreted with caution given the small sample of the study, but they offer promising paths to develop new interventions to alleviate anhedonia in schizophrenia.

Decreased behavioral impairments in an Alzheimer mice model by interfering with TNF-alpha metabolism.

The performance of mice expressing PDAPP (+/+ or +/-) was studied in the Morris place navigation task. Different lines of questions were investigated using PDAPP+/- mice in which the activity of the cytokine Tumor Necrosing Factor alpha (TNFalpha) was attenuated by chronic treatment with anti-TNF or deleting TNFalpha (TNF-/-). Two different categories of behavior were analyzed in adult (6 months) and middle aged (15 months) subjects. Classically, the cognitive performance was assessed from the escape efficacy and quantitative bias toward the training position in a Morris water maze. Second, stereotyped circling was quantified, along with more qualitative behavioral impairments such as self-mutilation or increased reactivity. Our results can be summarized as follows. (1) All of the PDAPP mice expressed reduced cognitive performance in the Morris task, but only those with a clear-cut amyloid burden in the hippocampus showed behavioral abnormalities such as stereotyped circling. (2) Chronic treatment with anti-TNF prevented the development of pathological circling in the 6-month-old mice but not in the 15-month-old mice and had no significant effect on amyloid burden. (3) The absence of TNFalpha prevented the development of stereotyped circling in 6- and 15-month-old mice but increased amyloid burden after 15 months. These data indicate that PDAPP mice express cognitive impairments disregarding absence of TNF. The pathological behavioral anomalies related to the PDAPP mutation seem reduced by treatments interfering with TNFalpha.

Characterization of the HeCo mutant mouse: a new model of subcortical band heterotopia associated with seizures and behavioral deficits.

In human, neuronal migration disorders are commonly associated with developmental delay, mental retardation, and epilepsy. We describe here a new mouse mutant that develops a heterotopic cortex (HeCo) lying in the dorsolateral hemispheric region, between the homotopic cortex (HoCo) and subcortical white matter. Cross-breeding demonstrated an autosomal recessive transmission. Birthdating studies and immunochemistry for layer-specific markers revealed that HeCo formation was due to a transit problem in the intermediate zone affecting both radially and tangentially migrating neurons. The scaffold of radial glial fibers, as well as the expression of doublecortin is not altered in the mutant. Neurons within the HeCo are generated at a late embryonic age (E18) and the superficial layers of the HoCo have a correspondingly lower cell density and layer thickness. Parvalbumin immunohistochemistry showed the presence of gamma-aminobutyric acidergic cells in the HeCo and the mutant mice have a lowered threshold for the induction of epileptic seizures. The mutant showed a developmental delay but, in contrast, memory function was relatively spared. Therefore, this unique mouse model resembles subcortical band heterotopia observed in human. This model represents a new and rare tool to better understand cortical development and to investigate future therapeutic strategies for refractory epilepsy.