Risk factors for ASD : Risk Factors for Autism Spectrum Disorder in Shanghai, China: A Population-based Case-control Study.

Autism spectrum disorder (ASD) is a pervasive neurodevelopmental disorder that brings heavy burdens to families and the society. This case-control study explored risk factors for ASD based on 74,252 children aged 3-12 years who were recruited from general education kindergartens, primary schools, and special education schools in Shanghai, China. One hundred ninety-two children were identified with ASD according to the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition. Male sex, the presence of anoxia or asphyxia at birth, artificial feeding, adverse maternal psychological status, complications during pregnancy and higher paternal education were associated with ASD even after controlling for age, residential district, family history of mental disorders, parental personality, and amount of daily TV viewing.

Chronic Exercise for Core Symptoms and Executive Functions in ADHD: A Meta-analysis.

BACKGROUND AND OBJECTIVES: The effects of chronic exercise interventions (CEIs) on core symptoms and executive functions (EFs) of attention-deficit/hyperactivity disorder (ADHD) and how different characteristics of CEIs could modify the effect remain unclear. We synthesized the current evidence on the effects of CEIs on core symptoms and EFs in children and adolescents with ADHD. METHODS: Data sources include PubMed, Embase, Web of Science, Cochrane Library, and China National Knowledge Infrastructure from database inception to July 31, 2022. Study selection includes randomized controlled trials that reported on the effects of CEIs on core symptoms and/or EFs in ADHD aged 6 to 18 years. RESULTS: Twenty-two randomized controlled trials were included. CEIs had a small beneficial effect on overall core symptoms (standardized mean difference [SMD] = -0.39, 95% confidence interval [CI]: -0.64 to -0.14), as well as inattention (SMD = -0.32, 95% CI: -0.63 to -0.004) among children and adolescents with ADHD. Closed-skill exercise showed a large improvement in core symptoms (SMD = -0.83, 95% CI: -1.30 to -0.35), whereas open-skill exercise did not. Additionally, CEIs had a moderately beneficial effect on overall EFs (SMD = -0.68, 95% CI: -0.91 to -0.45) and a moderate-to-large effect on the specific domains of EFs. The pooled effects on overall core symptoms and EFs were not significantly modified by study population (children or adolescents), exercise session duration (≤50 or >50 minutes per session, median), or total exercise sessions (<24 or ≥24 sessions, median). CONCLUSIONS: CEIs have small-to-moderate beneficial effects on overall core symptoms and EFs in children and adolescents with ADHD.

Inattention and hyperactivity in children and adolescents with repaired D-transposition of the great arteries: Prevalence, perioperative risk factors, and clinical outcomes.

Objective: The present study objectives were to determine the prevalence of attention-deficit/hyperactivity disorder symptoms (ADHD-like symptoms) in children and adolescent with d-transposition of great artery (D-TGA) after arterial switch operation (ASO) and examine associated risk factors and adverse personal, family dysfunctions. Methods: This cohort study included 103 patients with D-TGA who underwent ASO in early infancy at Shanghai Children's Medical Center between 2011 and 2016 and then follow-up. Data analysis was conducted from September 2020 to April 2022. A standardized Swanson, Nolan, and Pelham IV (SNAP-IV) questionnaire is used to evaluate inattention and hyperactivity symptoms. Demographic, preoperative, intraoperative, and postoperative factor were collected. Univariate and multivariable regression analyses were performed with odds ratios (OR) and 95% confidence intervals (CIs). Results: Prevalence of ADHD-like symptoms was 27.18% (28/103). Attention-deficit (18/28, 64.29%) symptom was the predominant subphenotype. After underwent TGA surgery, 39% of patients with ADHD-like symptoms receive remedial special academic services. There is none had repeated grade. Univariate analysis showed that, positive inotropic drug score (P = 0.03) and delayed sternal closure (P = 0.02) were risk factors of ADHD-like symptoms; increased preoperative oxygen saturation (SpO2) (P = 0.01) and surgical height (P = 0.01) and TGA subtype (VSD) (P = 0.02) were protective factor of ADHD-like symptoms. Multivariable analysis showed that delayed sternal closure (DSC) (OR, 1.50; 95% CI, 1.02-2.18) is a risk factor for the occurrence of ADHD-like symptom while increased preoperative oxygen saturation [odds ratio (OR), 0.95; 95% confidence interval (CI), 0.92-0.99] is a protective factor of ADHD-like symptom. Conclusion: The children and adolescents with D-TGA after ASO were at high risk of ADHD-like symptoms. Preoperative hypoxic status and postoperative DSC became predominant risk factors. Modification of the risk factors may be helpful to relieve ADHD-like symptoms for these patients.

Outdoor light at night and autism spectrum disorder in Shanghai, China: A matched case-control study.

BACKGROUND: Several environmental factors have been identified to be associated with autism spectrum disorder (ASD) over the past decades. However, evidence is limited for the effect of exposure to outdoor light at night (LAN) on ASD in China and even elsewhere in the world. METHODS: Participants in this study were from a multi-stage sampling survey on ASD conducted between June 2014 and October 2014 among children aged 3-12 years in Shanghai, China. All participants underwent a two-stage screening of ASD via questionnaire, and then, suspected cases were finally diagnosed by clinical examination. For data analyses, each ASD case was randomly matched with 10 healthy controls by age and sex. The LAN data were extracted from the stable lights product of the US Defense Meteorological Satellite Program's Operational Linescan System (DMSP-OLS) according to geolocation information of residential addresses. Mean levels of exposure to LAN during the 3 years after birth and 1 year before birth were calculated. We used conditional logistic regression models to examine the association between LAN and ASD. RESULTS: We investigated 84,934 children from 96 kindergartens, 55 primary schools, and 28 special education schools, and 203 children were diagnosed as ASD cases. A total of 1727 children (157 ASD cases and 1570 healthy controls) were included in the final analyses. Brighter LAN exposures after and before birth were significantly associated with higher risk of ASD. After adjusting for potential covariates, adjusted odd ratios and 95% confidence intervals associated with per unit increase in LAN were 1.066 (1.027, 1.107) during the 3 years after birth and 1.046 (1.018, 1.075) during the 1 year before birth. CONCLUSIONS: Results of our study concluded brighter LAN exposure was significantly associated with higher risk of ASD among Chinese children, which suggested that outdoor LAN could be a potential risk factor of ASD.

Abnormal body mass index may be related to poor social function of female children by a propensity score matching analysis.

This study sought to estimate the association of children's body mass index (BMI) with their social function in Shanghai China. A large population-based cross-sectional study based on a propensity score matching (PSM) analysis was conducted. BMI was compared according to social communication questionnaire (SCQ) classification, and then SCQ score was compared in terms of BMI grouping before and after PSM. A positive SCQ was considered to indicate poor social communication and a negative SCQ was then supposed to be normal. After 1:3 matching, a total of 7563 children aged 3-12 years were included in analysis. There were statistically significant positive correlation of BMI with SCQ scores for obese females of school age (R2 = 0.043, p < 0.001) and negative correlation of these two variables for school-aged females with malnutrition (R2 = 0.047, p = 0.027). In conclusion, BMI may be characterized as one of predictive factor for poor social function of these children.

Association of number of siblings, birth order, and thinness in 3- to 12-year-old children: a population-based cross-sectional study in Shanghai, China.

BACKGROUND: Sibship size and structure have a significant association with overweight and obesity in children, but the relationship with thinness has not been fully studied and understood, especially in Asia. This study evaluated the associations among number of siblings, birth order, and childhood thinness and investigated the association of number of younger or older siblings with childhood thinness. METHODS: In this study, we performed a population-based cross-sectional study among 84,075 3- to 12-year-old children in Shanghai using multistage stratified cluster random sampling. We defined grades 1, 2, and 3 thinness according to the body mass index cutoff points set by the International Obesity Task Force and used multinomial logistic regression models to estimate the odds ratio (OR) and 95% confidence interval (95% CI). RESULTS: Compared with only children, for boys, children with two or more siblings were more likely to suffer from grade 2 (OR = 1.29, 95% CI 1.02, 1.64) and grade 3 thinness (OR = 1.60, 95% CI 1.07, 2.40); and the youngest child faced a higher risk of grade 2 (OR = 1.44, 95% CI 1.09, 1.90) and grade 3 thinness (OR = 1.53, 95% CI 1.01, 2.33). For girls, children with one sibling were more likely to suffer from grade 1 thinness (OR = 1.22, 95% CI 1.05, 1.42); the oldest child, middle child, and youngest child faced a higher risk of grade 1 (OR = 1.42, 95% CI 1.09, 1.84), grade 2 (OR = 1.26, 95% CI 1.03, 1.54), and grade 1 thinness (OR = 1.87, 95% CI 1.21, 2.88) respectively. There was no statistically significant relationship, however, between a larger number of younger or older siblings and childhood thinness. CONCLUSIONS: Regardless of sex, having either siblings or a higher birth order was positively associated with childhood thinness. The present study has suggested that future interventions to prevent childhood thinness should consider family background as an important factor, especially in multi-child-families.

Association of low birth weight with thinness and severe obesity in children aged 3-12 years: a large-scale population-based cross-sectional study in Shanghai, China.

OBJECTIVES: Low birth weight (BW) is a general symbol of inadequate intrauterine conditions that elicit abnormal fetal growth and development. The aim of current study is to investigate the relationship between low BW and thinness or severe obesity during maturation. DESIGN: A large-scale cross-sectional population-based survey. SETTING: 134 kindergartens and 70 elementary schools. PARTICIPANTS: 70 284 Chinese children aged 3-12 years. OUTCOME MEASURES: International Obesity Task Force body mass index (BMI) cut-offs were used to define grade 1, grade 2 and grade 3 thinness, overweight, obesity and severe obesity. Multinomial logistic regression was used to estimate the association between BW and BMI category. RESULTS: A total of 70 284 children participated in the survey. The percentage of grade 1 thinness and severe obesity in children with low BW is significantly higher than that in children with normal BW (p<0.05). Low BW was associated with an increased risk of grade 1 thinness (OR 1.56, 95% CI 1.38 to 1.75), grade 2 thinness (OR 1.34, 95% CI 1.10 to 1.64), grade 3 thinness (OR 1.99, 95% CI 1.63 to 2.42) and severe obesity (OR 1.27, 95% CI 1.03 to 1.55) but was not associated with obesity (OR 0.85, 95% CI 0.67 to 1.06). CONCLUSION: There is a positive association between low BW and thinness or severe obesity risk.

Early life exposure to particulate matter air pollution (PM1, PM2.5 and PM10) and autism in Shanghai, China: A case-control study.

BACKGROUND: The evidence for adverse effects of ambient particulate matter (PM) pollution on mental health is limited. Studies in Western countries suggested higher risk of autism spectrum disorder (ASD) associated with PM air pollution, but no such study has been done in developing countries. METHODS: A case-control study was performed in Shanghai with a multi-stage random sampling design. Children's exposures to PM1, PM2.5 and PM10 (particulate matter with aerodynamic diameter < 1 µm, < 2.5 µm and < 10 µm, respectively) during the first three years after birth were estimated with satellite remote sensing data. Conditional logistic regression was used to examine the PM-ASD association. RESULTS: In total, 124 ASD cases and 1240 healthy controls were included in this study. The median levels of PM1, PM2.5 and PM10 exposures during the first three years of life were 48.8 µg/m3, 66.2 µg/m3 and 95.4 µg/m3, respectively, and the interquartile range (IQR) for these three pollutants were 4.8 µg/m3, 3.4 µg/m3 and 4.9 µg/m3, respectively. The adjusted odds ratios (and 95% confidence intervals) of ASD associated with an IQR increase for PM1, PM2.5 and PM10 were 1.86 (1.09, 3.17), 1.78 (1.14, 2.76) and 1.68 (1.09, 2.59), respectively. Higher ORs of ASD associated with PM pollution were observed in the second and the third year after birth. CONCLUSIONS: Exposures to PM1, PM2.5 and PM10 during the first three years of life were associated with the increased risk of ASD and there appeared to be stronger effects of ambient PM pollution on ASD in the second and the third years after birth.

Prevalence of DSM-5 Autism Spectrum Disorder Among School-Based Children Aged 3-12 Years in Shanghai, China.

We estimated the prevalence of ASD in a population-based sample comprising children aged 3-12 years (N = 74,252) in Shanghai. This included a high-risk group sampled from special education schools and a low-risk group randomly sampled from general schools. First, we asked parents and then teachers to complete the Social Communication Questionnaire for participating children. Children who screened positive based on both parental and teachers' reports were comprehensively assessed. ASD was identified based on DSM-5 criteria. We identified 711 children as being at-risk for ASD, of which 203 were identified as ASD cases. The prevalence of ASD was 8.3 per 10,000, which is likely an underestimate, given that 81.6% of the children diagnosed with ASD had IQs below 40. This is the first report on the prevalence of ASD according to DSM-5 in China.

Prevalence of grade 1, 2 and 3 thinness is associated with lower socio-economic status in children in Shanghai, China.

OBJECTIVE: We aimed to investigate the prevalence of grade 1, 2 and 3 thinness among Chinese children and to explore their associations with socio-economic status (SES). DESIGN: A population, school-based cross-sectional study using multistage, stratified cluster random sampling. Grade 1, 2 and 3 thinness, overweight, obesity and severe obesity were defined by the International Obesity Task Force BMI cut-offs. SETTING: Seven districts of Shanghai, China. SUBJECTS: Chinese children aged 3-12 years (n 84 075). RESULTS: In boys and girls, respectively, the prevalence of grade 1 thinness was 8·89 % and 11·78 %, of grade 2 thinness was 2·80 % and 3·74 %, and of grade 3 thinness was 2·23 % and 2·93 %. Compared with urban children, suburban children had higher prevalence of thinness. Children whose parent had low education had higher prevalence of grade 1, 2 and 3 thinness than those whose parent had high education. The prevalence of grade 2 and 3 thinness, obesity and severe obesity in low-SES children was higher than that in high-SES children, and the prevalence of grade 1 thinness was lower than that in high-SES children. Particular patterns of prevalence of grade 1, 2 and 3 thinness appeared in low-, middle- and high-SES children. CONCLUSIONS: The study describes associations of SES with grade 1, 2 and 3 thinness, overweight, obesity and severe obesity in Shanghai children. The patterns of thinness and obesity in Shanghai provide further insights into BMI patterns in mega-cities in developing countries.

A novel 47.2 Mb duplication on chromosomal bands Xq21.1-25 associated with mental retardation.

We present array comparative genomic hybridization (aCGH) characterization of a novel Xq21.1-25 duplication in a 2-year-old girl with facial dysmorphism, mental retardation and short stature. Analysis of aCGH results revealed a 47,232kb duplication region that harbored 231 RefSeq genes, including 32 OMIM genes. Ten genes (i.e., ZNF711, SRPX2, RAB40AL, MID2, ACSL4, PAK3, UBE2A, UPF3B, CUL4B, and GRIA3) in the duplication interval have been associated with mental retardation. We discuss the genotype-phenotype correlation in this case. Our case provides evidence for an association of mental retardation with X chromosome duplication.