Autism Spectrum Disorder in Children with Complex Presentations

A special issue of Medicina (ISSN 1648-9144).

Deadline for manuscript submissions: closed (30 November 2019) | Viewed by 50316

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Guest Editor
Hull York Medical School and Department of Health Sciences, University of York, York YO10 5DD, UK
Interests: deaf children; autism; child mental health interventions
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Special Issue Information

Dear Colleagues,

In recent years, there has been more research exploring the challenges of assessing and providing treatment and support for children on the autism spectrum and their parents when they have complex presentations. In November 2018 there was a large conference at Great Ormond Street Hospital, where experts from around the world presented. The large interest in this topic has led to a groundswell of opinion that it would be helpful to have a special journal edition that published a number of expert papers on this topic in one place. This could include presentations of autism spectrum disorder in people who are deaf or blind or who have another disorder such as tuberous sclerosis or a syndrome (e.g., CHARGE or fragile X syndrome), or where there are other co-morbidities such as profound anxiety, psychosis, or learning disability.

Prof. Barry Wright
Guest Editor

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Keywords

  • autism spectrum disorder
  • co-morbidity
  • complexity

Published Papers (7 papers)

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Editorial

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12 pages, 507 KiB  
Editorial
Should Autism Spectrum Conditions Be Characterised in a More Positive Way in Our Modern World?
by Barry Wright, Penny Spikins and Hannah Pearson
Medicina 2020, 56(5), 233; https://doi.org/10.3390/medicina56050233 - 13 May 2020
Cited by 18 | Viewed by 7370
Abstract
In a special issue that focuses on complex presentations related to Autism, we ask the question in this editorial whether an Autism Spectrum Condition without complexity is a disorder, or whether it represents human diversity? Much research into Autism Spectrum Conditions (ASCs) over [...] Read more.
In a special issue that focuses on complex presentations related to Autism, we ask the question in this editorial whether an Autism Spectrum Condition without complexity is a disorder, or whether it represents human diversity? Much research into Autism Spectrum Conditions (ASCs) over the years has focused on comparisons between neuro-typical people and people with Autism Spectrum Conditions. These comparisons have tended to draw attention to ‘deficits’ in cognitive abilities and descriptions of behaviours that are characterised as unwanted. Not surprisingly, this is reflected in the classification systems from the World Health Organisation and the American Psychiatric Association. Public opinion about ASC may be influenced by presentations in the media of those with ASC who also have intellectual disability. Given that diagnostic systems are intended to help us better understand conditions in order to seek improved outcomes, we propose a more constructive approach to descriptions that uses more positive language, and balances descriptions of deficits with research finding of strengths and differences. We propose that this will be more helpful to individuals on the Autism Spectrum, both in terms of individual self-view, but also in terms of how society views Autism Spectrum Conditions more positively. Commentary has also been made on guidance that has been adjusted for people with ASC in relation to the current COVID-19 pandemic. Full article
(This article belongs to the Special Issue Autism Spectrum Disorder in Children with Complex Presentations)
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Research

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12 pages, 1133 KiB  
Article
Comparison of Physiological and Biochemical Autonomic Indices in Children with and without Autism Spectrum Disorders
by Remya Bharath, Shailaja S. Moodithaya, Shrinivasa U. Bhat, Amrit M. Mirajkar and Sumanth B. Shetty
Medicina 2019, 55(7), 346; https://doi.org/10.3390/medicina55070346 - 7 Jul 2019
Cited by 14 | Viewed by 3390
Abstract
Background and objectives: Autism Spectrum Disorder (ASD) is a complex neuro-developmental disorder and it has been suggested that symptoms of ASD are associated with neural networks that regulate the Autonomic Nervous System (ANS). However, the nature of autonomic atypicalities in ASDs remain largely [...] Read more.
Background and objectives: Autism Spectrum Disorder (ASD) is a complex neuro-developmental disorder and it has been suggested that symptoms of ASD are associated with neural networks that regulate the Autonomic Nervous System (ANS). However, the nature of autonomic atypicalities in ASDs remain largely unknown. Measures like Heart Rate Variability (HRV) and urinary Vanillylmandelic Acid (VMA) estimation are sensitive and non-invasive physiological and biochemical indicators of autonomic nervous activity. This study aimed to compare the physiological and biochemical autonomic indices in children with and without ASD. Materials and Methods: In this case-control study, 40 children with autism and 40 Typically Developing (TD) children were recruited. Measures of physiological autonomic index were assessed by the analysis of short term HRV, and the urinary levels of VMA estimation was used as a biochemical autonomic index. Results: Cardiac sympathetic activity assessed by Low Frequency (nu) of HRV was significantly higher in the ASD group in comparison with the TD group (p = 0.006). On the contrary, both the High Frequency (abs) and (nu) of HRV were found to be significantly lower in autistic children (p = 0.034 and p = 0.000) than controls. Autistic children also exhibited a significantly higher level (p = 0.049) of VMA concentration compared to TD children. Conclusion: The study concludes that children with ASD exhibit lower cardio-vagal activity as measured by HRV and increased sympathetic activity as assessed by urinary VMA compared to that of TD children. The core autistic symptoms exhibited by children with ASD could be due to the differences in baseline arousal or stress which might be associated with autonomic dysfunction. Further studies are needed to examine the association of this autonomic dysregulation with ASD symptoms and comorbidities. Full article
(This article belongs to the Special Issue Autism Spectrum Disorder in Children with Complex Presentations)
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12 pages, 723 KiB  
Article
Nutrition, BMI and Motor Competence in Children with Autism Spectrum Disorder
by Ting Liu, Julie Kelly, Lyndsay Davis and Krystal Zamora
Medicina 2019, 55(5), 135; https://doi.org/10.3390/medicina55050135 - 15 May 2019
Cited by 20 | Viewed by 6770
Abstract
Background and objectives: The purpose of this study was to examine the relationship between motor competence, body mass index (BMI), and nutrition knowledge in children with autism spectrum disorder (ASD). Materials and Methods: Fifty-one children with ASD (five females and 46 males) aged [...] Read more.
Background and objectives: The purpose of this study was to examine the relationship between motor competence, body mass index (BMI), and nutrition knowledge in children with autism spectrum disorder (ASD). Materials and Methods: Fifty-one children with ASD (five females and 46 males) aged 7–12 participated in the study. The Movement Assessment Battery for Children-2 (MABC-2) was used to examine children’s fine and gross motor skill competence; the nutrition knowledge survey assessed children’s overall knowledge of food groups and healthful eating; and BMI-for-age determined their weight status. Descriptive analysis and Pearson correlation was used to analyze the relationship between nutrition knowledge, BMI, and motor competence in children with ASD. Results: The majority of children with ASD (82%) showed significant motor delays in MABC-2 assessments. The BMI-for-age percentile data suggested that 20% of participants were obese, 17% were overweight, and 12% were underweight. The nutrition knowledge data indicated that 55% of children scored below 70% on accuracy in the nutrition knowledge survey. Pearson correlation analysis revealed a significant positive relationship between MABC-2 manual dexterity and nutrition knowledge (r = 0.327, p < 0.01), and between MABC-2 balance skills and nutrition knowledge (r = 0.413, p < 0.01). A significant negative relationship was also found between BMI and MABC-2 balance skills (r = −0.325, p < 0.01). Conclusions: The findings of the study suggest that nutrition knowledge and motor competence may be key factors influencing BMI in children with ASD and therefore interventions tackling both sides of the energy balance equation are necessary. Full article
(This article belongs to the Special Issue Autism Spectrum Disorder in Children with Complex Presentations)
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Review

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18 pages, 1057 KiB  
Review
Effects of Physical Exercise on the Stereotyped Behavior of Children with Autism Spectrum Disorders
by José Pedro Ferreira, Thaysa Ghiarone, Cyro Rego Cabral Júnior, Guilherme Eustáquio Furtado, Humberto Moreira Carvalho, Aristides M. Machado-Rodrigues and Chrystiane Vasconcelos Andrade Toscano
Medicina 2019, 55(10), 685; https://doi.org/10.3390/medicina55100685 - 14 Oct 2019
Cited by 49 | Viewed by 13392
Abstract
Background and Objectives: Recent studies have shown the existence of a positive relationship between physical exercise, symptomatic improvement, and reduction of damage caused by comorbidities associated with autistic spectrum disorder (ASD) in children, adolescents, and adults. The aim of this systematic review [...] Read more.
Background and Objectives: Recent studies have shown the existence of a positive relationship between physical exercise, symptomatic improvement, and reduction of damage caused by comorbidities associated with autistic spectrum disorder (ASD) in children, adolescents, and adults. The aim of this systematic review with meta-analysis (SRM) was to estimate the effects of physical exercise (PE) on the stereotyped behaviors of children with a diagnosis of ASD in intervention studies. Materials and Methods: The design followed the PRISMA guidelines and the TREND statement to assess the quality of information in each study. Nine non-randomized intervention trial studies with low, moderate, and vigorous physical exercise, with a duration varying from 8 to 48 weeks and a frequency of 3 times a week, were included in the SRM. The dependent variable episodes of stereotypical behaviors was analyzed in all studies and assessed as the number of episodes demonstrated by the child in pre- versus post-exercise intervention conditions. Results: The eight studies included a total 129 children (115 males and 14 females) with an average age of 8.93 ± 1.69 years. Children with ASD showed a reduction of 1.1 in the number of occurrences of stereotypical behaviors after intervention with physical exercise. Conclusion: Evidence was found to support physical exercise as an effective tool in reducing the number of episodes of stereotypical behaviors in children diagnosed with ASD. Full article
(This article belongs to the Special Issue Autism Spectrum Disorder in Children with Complex Presentations)
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13 pages, 499 KiB  
Review
Use of the LENA Autism Screen with Children who are Deaf or Hard of Hearing
by Mark VanDam and Christine Yoshinaga-Itano
Medicina 2019, 55(8), 495; https://doi.org/10.3390/medicina55080495 - 16 Aug 2019
Cited by 6 | Viewed by 3826
Abstract
Background and Objectives: This systematic review reports the evidence from the literature concerning the potential for using an automated vocal analysis, the Language ENvironment Analysis (LENA, LENA Research Foundation, Boulder, CO, USA) in the screening process for children at risk for autism [...] Read more.
Background and Objectives: This systematic review reports the evidence from the literature concerning the potential for using an automated vocal analysis, the Language ENvironment Analysis (LENA, LENA Research Foundation, Boulder, CO, USA) in the screening process for children at risk for autism spectrum disorder (ASD) and deaf or hard of hearing (D/HH). ASD and D/HH have increased comorbidity, but current behavioral diagnostic and screening tools have limitations. The LENA Language Autism Screen (LLAS) may offer an additional tool to disambiguate ASD from D/HH in young children. Materials and Methods: We examine empirical reports that use automatic vocal analysis methods to differentiate disordered from typically developing children. Results: Consensus across the sampled scientific literature shows support for use of automatic methods for screening and disambiguation of children with ASD and D/HH. There is some evidence of vocal differentiation between ASD, D/HH, and typically-developing children warranting use of the LLAS, but additional empirical evidence is needed to better understand the strengths and weaknesses of the tool. Conclusions: The findings reported here warrant further, more substantive, methodologically-sound research that is fully powered to show a reliable difference. Findings may be useful for both clinicians and researchers in better identification and understanding of communication disorders. Full article
(This article belongs to the Special Issue Autism Spectrum Disorder in Children with Complex Presentations)
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18 pages, 459 KiB  
Review
Computer- and Robot-Assisted Therapies to Aid Social and Intellectual Functioning of Children with Autism Spectrum Disorder
by Joan DiPietro, Arpad Kelemen, Yulan Liang and Cecilia Sik-Lanyi
Medicina 2019, 55(8), 440; https://doi.org/10.3390/medicina55080440 - 5 Aug 2019
Cited by 39 | Viewed by 7880
Abstract
Background and objectives: Children with autism spectrum disorder (ASD) experience challenges with social interactions, a core feature of the disorder. Social skills therapy has been shown to be helpful. Over the past several years, computer-assisted and robot-assisted therapies have been infiltrating the [...] Read more.
Background and objectives: Children with autism spectrum disorder (ASD) experience challenges with social interactions, a core feature of the disorder. Social skills therapy has been shown to be helpful. Over the past several years, computer-assisted and robot-assisted therapies have been infiltrating the social skills teaching environment. Rapid progress in the field of technology, especially in the robotics area, offers tremendous possibilities for innovation and treatment or even education for individuals with ASD. This paper’s purpose is to drive awareness of these innovative interventions in order to support the social lives of children with ASD. The aims of the paper are identifying (1) the types of Information Technology platforms that are being evaluated in computer and robot-assisted therapies for children with ASD; (2) the various disciplines or professions studying and utilizing these computer and robot-assisted social skill therapies; (3) the outcomes being evaluated in each trial; and (4) if results demonstrate benefits to children with autism. Materials and Methods: PubMed, CINAHL, Science Direct, and Web of Science databases were searched for clinical trials published over the past five years. Search terms incorporated the subject intersection of autism, and computer or robot-assisted therapy. Results were mined for pediatric populations only and study designs establishing controlled comparisons. Results: Eighteen unique international studies were identified that utilize robot interventions (11 studies) and serious computer game interventions (seven studies). Most demonstrated promising results in improving outcomes for children with ASD. Study implications reveal a rapidly evolving assistive technology for ASD social skills therapy. Conclusions: These interventions show considerable promise, but more effectiveness and cost effectiveness research of high quality should be carried out with larger numbers of children. Also, further studies are necessary to evaluate these technologies’ effectiveness amongst adults with ASD and within unique subsets of the higher functioning autism population. Full article
(This article belongs to the Special Issue Autism Spectrum Disorder in Children with Complex Presentations)
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15 pages, 687 KiB  
Review
The Role of Gut Microbiota in Gastrointestinal Symptoms of Children with ASD
by Agustín Ernesto Martínez-González and Pedro Andreo-Martínez
Medicina 2019, 55(8), 408; https://doi.org/10.3390/medicina55080408 - 26 Jul 2019
Cited by 39 | Viewed by 6991
Abstract
Background and objectives: Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by impaired communication, social interaction disorder, and repetitive behavior. Dysbiotic gut microbiota (GM) could be a contributing factor to the appearance of ASD, as gastrointestinal (GI) symptoms are comorbidities frequently [...] Read more.
Background and objectives: Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by impaired communication, social interaction disorder, and repetitive behavior. Dysbiotic gut microbiota (GM) could be a contributing factor to the appearance of ASD, as gastrointestinal (GI) symptoms are comorbidities frequently reported in ASD. As there is a lack of reviews about the role played by GM in the GI symptoms of ASD, this work aimed to carry out a systematic review of current studies comparing the GM of children with ASD and GI symptoms with those of healthy controls in the last six years. Materials and Methods: The systematic review was performed following the PRISMA guidelines. The databases chosen were Web of Science, Scopus, PubMed, and PsycINFO, and the keywords were (gut* OR intestine* OR bowel* OR gastrointestinal*) AND (microbiota* OR microflora* OR bacteria* OR microbiome* OR flora* OR bacterial* OR bacteria* OR microorganism* OR feces* OR stool*) AND (autistic* OR autism* OR ASD*). Results: A total of 16 articles were included. Ten articles performed correlations analysis between GI symptoms and ASD. Among those 10 articles, 7 found differences between the GI symptoms present in children with ASD and healthy controls. The most common GI symptom was constipation. Among the seven articles that found differences, three performed correlations analysis between GI symptoms and gut microbe abundance. Candida, Prevotella, Streptococcus, and Veillonella showed higher and lower abundance, respectively, in children with ASD and GI symptoms in more than one article. Bacteroidetes, Firmicutes, Actinomyces, Dorea, Lactobacillus, Faecalibacterium prausnitzii, and Bacteroidetes/Firmicutes ratios showed abundance discrepancies. Conclusions: It is still too early to draw a conclusion about the gut microbes involved in GI symptoms of ASD. Future research should consider the relationship between ASD behavior, GM, and GI symptoms in a multidisciplinary way and homogenize sample characteristics. Full article
(This article belongs to the Special Issue Autism Spectrum Disorder in Children with Complex Presentations)
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