The Weak Link: Hypotonia in Infancy and Autism Early Identification.

Background: Presenting symptoms and age specific differential diagnosis of Autism Spectrum Disorder (ASD), determine the age of initial assessment and the age of a definite diagnosis. The AAP recommends screening all children for ASD at 18 and 24 months followed by a comprehensive evaluation for children with developmental concerns. More recently it has been recommended that the evaluation should be performed at a younger age, with a diagnosis being made as early as the beginning of the second year of life resulting in earlier intensive intervention. Objective: To assess early developmental milestones in a cohort of children diagnosed with Autism Spectrum Disorder (ASD) in order to find an objective and reliable early marker. We suggest that low muscle tone- hypotonia, is a sign that meets the above criteria of consistency and reliability and may be related to early diagnosis. Methods: We compared age distributions of ASD diagnosis in the presence of hypotonia in a dataset of 5,205 children diagnosed at Keshet Center. One thousand, one hundred eighty-two children (953 males) were diagnosed with ASD and compared to other developmental diagnoses. Within the ASD cohort we further analyzed for gender and pre-maturity differences. Results: In the presence of hypotonia, the mean age for ASD diagnosis was significantly lower (by 1.5 years for males and females) and this effect increased in children born at term as compared to pre-maturity. Conclusions: Hypotonia is a recognizable marker of ASD and may serve as a "red flag" to prompt earlier recognition and neurodevelopmental evaluation toward an autism diagnosis.

Benefits of medical clowning in the treatment of young children with autism spectrum disorder.

We investigated the contribution of group therapy delivered by a medical clown to young children diagnosed with autism spectrum disorder (ASD). So far, scientific publications regarding medical clowning focus on general health advantages. The current study is the first controlled research examining the use of medical clowning in the therapy for children with ASD. Twenty-four children aged 2-6 years old with ASD enrolled in our special education intensive program were examined before and after group sessions with clown intervention (CI) and other intervention (OI). We tested stereotypic behaviors, verbal expression, play reciprocity, and social smiles. Data was collected during 12 weeks of intervention, and the trajectory of change was evaluated in addition to the pre-/post-intervention.Conclusion: improvement over time in all measures: Significant increase in word production, play reciprocity, and amount of social smiles during CI as compared with OI. We also found a reduction in frequency of stereotypic behaviors during and following CI as compared with before CI. These preliminary results indicate that medical clowning may be beneficial for young children with ASD, since it promotes communication and social reciprocity in a fun and lively interventional setting. What is Known: • Many therapies are used and proven as efficacious interventions for children with ASD. • So far, medical clowning was not tested as an intervention or therapy for ASD. What is New: • Medical clowning sessions with children with ASD elicited enhanced communication during the interventions as compared with other interventions. • Medical clowning sessions contributed to a decrease in frequency of stereotypic movements over time, in children with ASD.

Genetic vulnerability, timing of short-term stress and mood regulation: A rodent diffusion tensor imaging study.

UNLABELLED: Early stressful life events predict depression and anxiety in carriers of specific polymorphisms and alter brain responses but brain structural phenotypes are largely unknown. We studied the interaction between short-term stress during specific time-windows and emotion-regulation using a genetic animal model of depression, the Wistar-Kyoto (WKY) rat. Brain structural alterations were analyzed using Diffusion Tensor Imaging (DTI). WKY (n=49) and Wistar (n=55) rats were divided into experimental groups: Early stress (ES): From postnatal day (PND) 27 rats were exposed to three consecutive days of stressors; Late stress (LS): From PND 44 rats were exposed to the same protocol; CONTROL: No stressors. From PND 50, all animals were behaviorally tested for levels of anxiety and despair-like behaviors and then scanned. Gene×Environment×Timing (G×E×T) interactions (p=0.00022 after Hochberg correction) were found in ventral orbital cortex, cingulate cortex, external capsule, amygdala and dentate gyrus and in the emotion regulation measures. WKY showed longer immobility in forced swim test, but no effect of ES was detected. ES increased open-field anxiety-like behaviors in Wistar rats but not in WKY, possibly indicating a ceiling effect in WKY. Stress in pre-pubertal or adolescent phases in development may influence structural integrity of specific brain regions and emotion regulation behaviors depending on genetic vulnerability, consistent with a G×E×T interaction in mood dysregulation.