[Epidemiological investigation on autism spectrum disorders among preschool children in Shanghai].

OBJECTIVE: To investigate the prevalence of autism spectrum disorders (ASD) of children aged 4-6 years in public kindergartens in Shanghai. METHODS: Songjiang district and Xuhui district were selected randomly as the representative sample. By means of "Clancy Autism Behavior Scale", "Social Communication Questionnaire" and "high-functioning Autism Spectrum Screening Questionnaire", all of the 33 public kindergartens in chosen area, which contained 10 385 children aged 4-6 years, were surveyed. Those who were screened as suspected cases would be further diagnosed by "Autism Diagnostic Interview-Revised" and "Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition". RESULTS: Among 9 665 valid questionnaires, 9 children were diagnosed with ASD. The ratio of male to female was 8:1, the point prevalence rate was 0.93‰. The results of ADI-R corresponded with that of DSM-5. There were two children who never had medical records. For others, "language" problem was the most likely reason for their parents to seek medical help, while "deficits in social communication" was the main symptom of patients. CONCLUSION: The prevalence of ASD was lower than those recorded in literature, home and abroad which might be related to some patients not going to public kindergartens.

Lack of association between NLGN3, NLGN4, SHANK2 and SHANK3 gene variants and autism spectrum disorder in a Chinese population.

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by deficits in social communication, absence or delay in language development, and stereotyped or repetitive behaviors. Genetic studies show that neurexin-neuroligin (NRXN-NLGN) pathway genes contribute susceptibility to ASD, which include cell adhesion molecules NLGN3, NLGN4 and scaffolding proteins SHANK2 and SHANK3. Neuroligin proteins play an important role in synaptic function and trans-synaptic signaling by interacting with presynaptic neurexins. Shank proteins are scaffolding molecules of excitatory synapses, which function as central organizers of the postsynaptic density. Sequence level mutations and structural variations in these genes have been identified in ASD cases, while few studies were performed in Chinese population. In this study, we examined the copy numbers of four genes NLGN4, NLGN3, SHANK2, and SHANK3 in 285 ASD cases using multiplex fluorescence competitive polymerase chain reaction (PCR). We also screened the regulatory region including the promoter region and 5'/3' untranslated regions (UTR) and the entire coding region of NLGN4 in a cohort of 285 ASD patients and 384 controls by direct sequencing of genomic DNA using the Sanger method. DNA copy number calculation in four genes showed no deletion or duplication in our cases. No missense mutations in NLGN4 were identified in our cohort. Association analysis of 6 common SNPs in NLGN4 did not find significant difference between ASD cases and controls. These findings showed that these genes may not be major disease genes in Chinese ASD cases.

Twelve-year retrospective analysis of outpatients with Attention-Deficit/Hyperactivity Disorder in Shanghai.

BACKGROUND: Attention-Deficit/Hyperactivity Disorder (ADHD) is the most common diagnosis among children treated in outpatient psychiatric clinics in China, accounting for up to 50% of all patients. OBJECTIVE: Understand changes over time in the characteristics and treatment of children with ADHD seen at specialty psychiatric clinics in China. METHODS: For each year from 2000 through 2011, 250 charts of patients who made their initial visit to the Child and Adolescent Psychological Counseling Clinic of the Shanghai Mental Health Center were randomly selected. Among the 3000 selected patients, 998 (33%) had a diagnosis of ADHD. RESULTS: About 80% of the ADHD patients were male and the majority of them fell ill prior to the age of seven. The mean (sd) age at the time of first attendance at the clinic was 10.0 (2.6) years and the mean duration of illness at the time of the initial visit was 2.9 (1.2) years; both of these values decreased significantly over time. About 20% of them were non-residents of Shanghai and about 11% had comorbid psychiatric diagnoses (primarily depression and tic disorder); both of these proportions increased significantly over time. Among the 576 (58%) who visited the clinic more than once, 77% were treated with central nervous system stimulants, but the proportion administered behavioral treatments (either solely on in combination with medications) increased significantly over time. CONCLUSION: ADHD remains the most common diagnosis of children seen in specialty psychiatric clinics in China but the proportion of clinic attendees with ADHD is gradually declining as non-specialty treatment services expand and other diagnoses become more prominent. There are encouraging trends of earlier identification and treatment of ADHD and of increasing use of non-pharmacological interventions. Nevertheless, most children with ADHD have been ill for at least two years at the time of the initial diagnosis, so continued research efforts are needed to identify the best ways to speed up the recognition and treatment of this disabling condition.