Assessment of Parental Perceptions of Socio-Psychological Factors, Unmet Dental Needs, and Barriers to Utilise Oral Health Care in Autistic Children.

INTRODUCTION:  Parents' participation is crucial in the dental health intervention of children with autism spectrum disorder (ASD). Parenting children with ASD is extremely stressful and challenging. Parents and other caregivers have a responsibility to care for and raise children with ASD. Parental perception of the condition, situational adaptation, and attitude towards the issue are significant indicators of how they will respond and eventually adapt to it. METHODOLOGY: A comparative, descriptive study was done on parents of 154 autistic children and 235 normal children. An 11-variable questionnaire eliciting various details of socio-psychological factors affecting the utilisation of oral health care was designed and validated. The questionnaire also included parameters regarding barriers to accessing dental services. The dental caries and oral hygiene status of all children were examined using the Basic Oral Health Survey 2013 proforma. Chi-square and independent t-tests were applied to find significant differences between the groups. RESULTS: A greater number of male children (61.0%) were observed among autistic children. Parental perception regarding socio-psychological concerns with raising an autistic child showed significant differences for all variables between the groups except for assistance in the child's task with 90.2% as against 55% of the parents with non-autistic children. Parents of autistic children were more receptive to the idea of focus group discussion. Decayed teeth were significantly found to be higher in autistic cohorts (2.554 ± 1.616 versus 1.779 ± 1.841). Oral hygiene status was also statistically significant amongst autism-affected children than those who were not at p =0.000. CONCLUSION: The present study explored various socio-psychological factors of parental perception of autistic children. A better outcome can be suggested when parents gained awareness regarding various strategies and treatment options available for their child's oral health. Furthermore, dental health can be improved by bringing in certain environmental modifications in which the autistic child is groomed.

Assessment of children in the autistic spectrum disorder that carry the Thr92Ala-DIO2 polymorphism.

INTRODUCTION: A polymorphism in the type 2 deiodinase (Thr92Ala-DIO2) gene has been associated with behavioral and cognitive dysfunction as well as neurodegeneration and oxidative stress in the central nervous system. OBJECTIVE: To test whether the minor allele (Ala92) frequency (MAF) is increased in children in the autism spectrum disorder (ASD), and whether carriers of the minor allele exhibit more severe symptoms and/or worse adaptive behavior. STUDY DESIGN: ASD children were evaluated at baseline and yearly throughout the study by psychologists using the following tools: autism behavior checklist, Vineland Adaptative Behaviour Scales II, non-verbal intelligence test SON-R 21/2-7, SON-R 6-40, Weschler scale for intelligence, and autism treatment evaluation checklist. SETTINGS: Academic outpatient mental health facility in Sao Paulo, Brazil. PARTICIPANTS: ASD boys and girls younger than 18 years of age. 132 consecutive ASD children, mostly boys (~ 80%); ~ 50% was classified as verbal. Exclusion criteria were coexistence of sensory and/or physical impairment, or any associated genetic syndromes. RESULTS: Median follow-up was for an uninterrupted period of 937 days (139-1375 days), which did not vary significantly among the genotypes. The MAF was 47% in ASD patients vs. 51% in a local reference population with similar ethnic background; the clinical severity and progression were not affected by the minor allele. Carriers of the minor allele exhibited higher adaptive behavior in the domains "daily living skills" and "communication", which correlated positively with the dose of the minor allele. CONCLUSION: The MAF is not different in ASD children, but carriers of the Thr92Ala-DIO2 polymorphism exhibited higher adaptive behavior.

Muito além dos nutrientes: experiências e conexões com crianças autistas a partir do cozinhar e comer juntos / Far beyond nutrients: experiences and connections with autistic children based on cooking and sharing meals / Mucho más allá de los nutrientes: experiencias y conexiones con niños autistas a partir de cocinar y comer juntos

Este estudo indagou como ampliar a análise da alimentação de crianças autistas, considerada inadequada pela seletividade alimentar ou pela dificuldade de interação nos momentos das refeições, atribuídas a alterações no processamento sensorial e a dificuldades sociais, comunicativas e cognitivas descritas no transtorno. A partir da perspectiva etnográfica, foi realizada observação participante, com registro em diários de campo, de oficinas culinárias com crianças/adolescentes autistas com vistas a analisar as relações que as crianças estabelecem com o alimento e os utensílios, com o espaço físico, entre elas e com adultos. Os registros foram analisados a partir da noção de experiência de Bondía e da Teoria Ator-Rede. Os dados produzidos mostraram singularidades na realização das tarefas de cozinhar e na aceitação das receitas. Algumas crianças não comeram os alimentos, mas cheiraram, lamberam e manipularam os ingredientes em momentos de experimentação, a partir da mediação dos profissionais, facilitadora da conexão das crianças com a comida e o comer. As interações estabelecidas com alimentos e utensílios apontam para a importância da comida e do cozinhar como mediadores da conexão das crianças com seus pares, com os adultos e com o mundo. Essa experiência rompeu com a valorização homogeneizadora das dificuldades de interação das crianças autistas e reforçou a comensalidade como ferramenta de construção de redes de cuidado. Pensar a alimentação dessas crianças em uma perspectiva ampliada é valorizar a subjetividade, a relação com o alimento e a interação entre pessoas nos momentos das refeições para além da compreensão biológica restrita aos nutrientes.

This study examined ways to expand the analysis of diet in autistic children, widely considered inadequate according to food selectivity and/or difficulty interacting at mealtimes, attributed to alterations in sensorial processing and social, communicative, and cognitive difficulties. From an ethnographic perspective, a participant observational study was performed with field diary records and cooking workshops with autistic children and adolescents, aimed at analyzing the relations established by the children with the food and utensils, physical space, and between each other and the adults. The records were analyzed based on Bondía's notion of experience and Actor-Network Theory. The resulting data showed singularities in performing cooking tasks and accepting recipes. Some children did not eat the foods, but smelled, licked, and handled the ingredients in moments of experimentation through mediation by the educators, facilitating connection by the children with food and eating. The interactions established with foods and utensils highlight the importance of food and eating as mediators of the connection between autistic children and their peers, with adults, and with the world. This experience broke with the homogenizing value assigned to autistic children's difficulties with interaction and reinforced commensality as a tool for building networks of care. To conceive eating for these children from an expanded perspective means to value subjectivity, the relationship to food, and interaction with others at mealtimes, far beyond the biological understanding of the nutrients.

Este estudio indagó como ampliar el análisis de la alimentación de niños autistas, considerada inadecuada por la selectividad alimentaria o por la dificultad de interacción en los momentos de las comidas, atribuidas a alteraciones en el procesamiento sensorial y dificultades sociales, comunicativas y cognitivas descritas en el trastorno. A partir de la perspectiva etnográfica, se realizó una observación participante, con registro en diarios de campo, de talleres culinarios con niños/adolescentes autistas, con el fin de analizar las relaciones que los niños establecen con el alimento y utensilios, con el espacio físico, entre ellos y con adultos. Los registros fueron analizados a partir de la noción de experiencia de Bondía y de la Teoría Actor Red. Los datos producidos mostraron singularidades en la realización de las tareas de cocinar y en la aceptación de las recetas. Algunos niños no comieron los alimentos, pero los olieron, lamieron y manipularon los ingredientes, en momentos de esta experiencia, a partir de la mediación de los educadores, facilitadora de la conexión de los niños con la comida y el comer. Las interacciones establecidas con alimentos y utensilios apuntan a la importancia de la comida y del cocinar como mediadores de la conexión de los niños con sus compañeros, con adultos, así como con el mundo. Esta experiencia rompió con la valoración homogeneizadora de las dificultades de interacción de los niños autistas y reforzó la comensalía como herramienta de construcción de redes de cuidado. Pensar la alimentación de estos niños desde una perspectiva ampliada es valorar la subjetividad, la relación con el alimento, la interacción entre personas en los momentos de las comidas, para ir más allá de la comprensión biológica restringida a los nutrientes.

Cochlear implantation in autistic children with profound sensorineural hearing loss / Implante coclear em crianças autistas com perda auditiva neurossensorial profunda

Abstract Introduction Cochlear implants have become the method of choice for the treatment of severe-to-profound hearing loss in both children and adults. Its benefits are well documented in the pediatric and adult population. Also deaf children with additional needs, including autism, have been covered by this treatment. Objective The aim of this study was to assess the benefits from cochlear implantation in deafened children with autism as the only additional disability. Methods This study analyzes data of six children. The follow-up time was at least 43 months. The following data were analyzed: medical history, reaction to music and sound, Ling's six sounds test, onomatopoeic word test, reaction to spoken child's name, response to requests, questionnaire given to parents, sound processor fitting sessions and data. Results After cochlear implantation each child presented other communication skills. In some children, the symptoms of speech understanding were observed. No increased hyperactivity associated with daily use cochlear implant was observed. The study showed that in autistic children the perception is very important for a child's sense of security and makes contact with parents easier. Conclusion Our study showed that oral communication is not likely to be a realistic goal in children with cochlear implants and autism. The implantation results showed benefits that varied among those children. The traditional methods of evaluating the results of cochlear implantation in children with autism are usually insufficient to fully assess the functional benefits. These benefits should be assessed in a more comprehensive manner taking into account the limitations of communication resulting from the essence of autism. It is important that we share knowledge about these complex children with cochlear implants.

Resumo Introdução Os implantes Cocleares tornaram-se o metodo de escolha para o tratamento da perda auditiva severa a profunda em crianças e adultos. Seus beneficios estao bem documentados nas populaçoes pediatrica e adulta. Tambem as crianças surdas com necessidades adicionais, incluindo autismo, tem sido incluidas nesse tratamento. Objetivo O objetivo desse estudo foi avaliar os beneficios do implante coclear em crianças surdas com autismo como unica deficiencia adicional. Método Esse estudo analisa os dados de seis crianças. O tempo de seguimento foi de pelo menos 43 meses. Foram analisados os seguintes dados: historico medico, a reaçao a musica e ao som, teste dos seis sons de Ling, teste de palavra onomatopaica, reaçao ao nome falado da criança, resposta a pedidos, questionario aplicado aos pais, sessoes de ajustes e dados do processador de som. Resultados Apos o implante coclear, cada criança apresentou outras habilidades de comunicaçao. Em algumas crianças, foram observados sinais de compreensao da fala. Nao foi observado aumento de hiperatividade associada com o uso diario de implante coclear. O estudo mostrou que em crianças autistas a percepçao e muito importante para a sensaçao de segurança da criança e torna o contato com os pais mais facil. Conclusão Nosso estudo mostrou que a comunicaçao oral nao e uma meta realistica provavel em crianças com implantes cocleares e autismo. Os resultados do implante mostraram beneficios variaveis entre as crianças. Os metodos tradicionais de avaliaçao dos resultados do implante coclear em crianças com autismo sao geralmente insuficientes para avaliar plenamente os beneficios funcionais. Esses beneficios devem ser avaliados de forma mais abrangente, tendo em conta as limitaçoes de comunicaçao resultantes da essencia do autismo. E importante que compartilhemos conhecimentos sobre essas complexas crianças com implantes cocleares.

Cochlear implantation in autistic children with profound sensorineural hearing loss.

INTRODUCTION: Cochlear implants have become the method of choice for the treatment of severe-to-profound hearing loss in both children and adults. Its benefits are well documented in the pediatric and adult population. Also deaf children with additional needs, including autism, have been covered by this treatment. OBJECTIVE: The aim of this study was to assess the benefits from cochlear implantation in deafened children with autism as the only additional disability. METHODS: This study analyzes data of six children. The follow-up time was at least 43 months. The following data were analyzed: medical history, reaction to music and sound, Ling's six sounds test, onomatopoeic word test, reaction to spoken child's name, response to requests, questionnaire given to parents, sound processor fitting sessions and data. RESULTS: After cochlear implantation each child presented other communication skills. In some children, the symptoms of speech understanding were observed. No increased hyperactivity associated with daily use cochlear implant was observed. The study showed that in autistic children the perception is very important for a child's sense of security and makes contact with parents easier. CONCLUSION: Our study showed that oral communication is not likely to be a realistic goal in children with cochlear implants and autism. The implantation results showed benefits that varied among those children. The traditional methods of evaluating the results of cochlear implantation in children with autism are usually insufficient to fully assess the functional benefits. These benefits should be assessed in a more comprehensive manner taking into account the limitations of communication resulting from the essence of autism. It is important that we share knowledge about these complex children with cochlear implants.

Efecto de la oxitocina en la conducta social de sujetos del espectro autista / Effect of oxytocin in social behavior of autistic spectrum subjects

El trastorno del espectro autista (TEA) es una condición del neurodesarrollo altamente prevalente. Desde su descripción, hace más de 70 años, se han postulado diferentes hipótesis sobre su génesis. Ciertos factores de riesgo han sido determinados, sin embargo, aún no existe claridad total sobre sus procesos etiológicos. Se caracteriza por déficit en la comunicación e interacción social, intereses restrictivos y un inicio temprano en el neurodesarrollo. Se ha visto como el déficit en la conducta social empobrece la calidad de vida de estas personas en diversas áreas. El tratamiento de los sujetos con TEA se centra fundamentalmente en el manejo sintomático conductual y biomédico, sin contar con un tratamiento definitivo ni orientado a los elementos centrales del trastorno como las dificultades en los aspectos relacionales. La oxitocina es un neuropéptido que se asocia a la vinculación entre sujetos de la misma especie, la vinculación resulta fundamental para la subsistencia de los individuos en diversas etapas de la vida. Se ha probado que el uso de oxitocina exógena potencia las conductas pro-sociales, específicamente el reconocimiento de individuos, la mentalización de estados emocionales de otros y la vinculación, en diferentes especies. Es por esto que se ha planteado el uso de oxitocina para promover las conductas pro-sociales en sujetos con TEA. Estudios preliminares muestran potenciación de conductas pro-sociales con uso de oxitocina exógena. Si bien aún falta más información al respecto, parece una interesante posibilidad terapéutica en función de la calidad de vida de los sujetos con TEA. Palabras clave: "Trastorno del espectro autista", "oxitocina", "conducta social

Autism spectrum disorder (ASD) is a highly prevalent neurodevelopmental condition. Since its description, more than 70 years ago, different hypotheses have been postulated about its genesis. Certain risk factors have been determined, but no clarity about its etiological processes had been achieved. ASD is characterized by deficits in social behavior, restricted interests and an early start in neurodevelopment. Deficit in social behavior impoverishes the quality of life of these people in various areas. The treatment of subjects with ASD is primarily focused on managing conduct symptoms, without orientation towards the central elements of the disorders such as their relational difficulties. Oxytocin is a neuropeptide that has been associated with the interpersonal vincule, which is essential for survival at various stages of life. It has been proven that the use of exogenous oxytocin enhances prosocial behaviors, specifically recognition of individuals, awareness of emotional states of others and vincule in different species. The use of exogenous oxytocin has been proposed to promote prosocial behaviors in individuals with ASD. Preliminary studies show enhancement of prosocial behaviors, with use of intranasal oxytocin. While there is still missing more information, it seems an interesting therapeutic option regarding on the quality of life of individuals with ASD.Key words: "Austism spectrum disorders", "oxcitocin", "Social Behavior"