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PubMed2005

Divalproex sodium vs. placebo in the treatment of repetitive behaviours in autism spectrum disorder.

Autism is a neurodevelopmental disorder characterized by impairment in three core symptom domains: socialization, communication, and repetitive/stereotyped behaviours. Other associated symptom domains are also affected including impulsivity/aggression, self-injury, anxiety, and mood lability. Divalproex has been shown to have efficacy in treating epilepsy, bipolar disorder, mood lability, and impulsive aggression. The present study evaluated the use of divalproex in the treatment of repetitive, compulsive-like symptoms of autism spectrum disorder (ASD). Thirteen individuals with ASD participated in an 8-wk, double-blind, placebo-controlled trial of divalproex sodium vs. placebo. There was a significant group difference on improvement in repetitive behaviours as measured by the Children's Yale-Brown Obsessive Compulsive Scale (C-YBOCS) (p=0.037) and a large effect size (d=1.616). This study provides preliminary support for the use of divalproex in treating repetitive behaviours in ASD. Further research is needed to evaluate the specificity and mechanism of action of these findings.

Adolescent↗
PubMed2001

Indoor dose conversion coefficients for radon progeny for different ambient environments.

Inhaled progeny of 222Rn (radon progeny) are the most important source of irradiation of the human respiratory tract. Their attachment to atmospheric aerosols follows a well-established relationship between the activity size distribution (ASD) and the number size distribution. Recent studies have shown that indoor aerosols are derived primarily from outdoor sources, so it is pertinent to study the effects of different ambient environments on the indoor radon dose (in terms of the dose conversion coefficient or DCC, in units of mSv WLM-1). Commonly encountered ambient aerosols were studied here, which included the traffic-, urban-, and marine-influenced aerosols. The ASDs of attached radon progeny for all three studied ambient environments were well-represented by normal distributions. From these ASDs, the DCCs were calculated using the ICRP66 model and the scaled Yeh-Schum model. All other employed parameters were adopted from original references or authoritative reports. The DCCs for a nominal home calculated using the James model and the Yeh-Schum model were 12 and 8 mSv WLM-1, respectively. The DCCs were largest for urban-influenced ambient environments and smallest for marine-influenced ambient environments, and those for traffic-influenced ambient environments were close to that for a nominal home. If we adopt the stochastic model, the probability of contracting radon-induced lung cancer by a person living with a marine-influenced ambient environment will be half that of a person living with an urban-influenced ambient environment.

Aerosols↗
PubMed2002

A comparison study of autism spectrum disorder referrals 1997 and 1989.

A number of overseas studies have indicated an increase in the prevalence of Autism Spectrum Disorder (ASD). In the Australian Capital Territory, information (number, age, sex, final diagnosis) was gathered on all children referred for suspected ASD to Child and Adolescent Mental Health Service during 1997, and the findings were compared with those from a similar study in 1989. It was found that (1) there was a 200% increase in positive diagnoses of ASD in 1997 despite a 0.5% decrease in population, (2) there was a wider age range in the 1997 cohort, (3) there was a 26% increase in milder cases in 1997, and (4) the ratio of boys to girls decreased from 8:1 in 1989 to 3.5:1 in 1997. These findings are compared with those overseas, and questions are raised for further exploration.

Adolescent↗
PubMed2003

Postural stability in children with autism spectrum disorder.

Maintaining upright posture is a complex process involving multiple afferent systems. The aim of this study was to measure the postural stability of children with Autism Spectrum Disorder (ASD) compared with children with typical neurodevelopment and to measure the relative contributions of the visual, somatosensory, and vestibular afferent systems in each group. Eight boys with ASD and eight age-, race-, and gender-matched controls participated in this study using force platform technology with customized software to measure postural sway under conditions designed to eliminate or modify visual and somatosensory input. Children with ASD had significantly larger sway areas under all test conditions in which afferent input was modified. These results are consistent with a deficit in the integration of visual, vestibular, and somatosensory input to maintain postural orientation.

Autistic Disorder↗
PubMed2004

Effects on communicative requesting and speech development of the Picture Exchange Communication System in children with characteristics of autism.

Few studies on augmentative and alternative communication (AAC) systems have addressed the potential for such systems to impact word utterances in children with autism spectrum disorders (ASD). The Picture Exchange Communication System (PECS) is an AAC system designed specifically to minimize difficulties with communication skills experienced by individuals with ASD. The current study examined the role of PECS in improving the number of words spoken, increasing the complexity and length of phrases, and decreasing the non-word vocalizations of three young children with ASD and developmental delays (DD) with related characteristics. Participants were taught Phases 1-4 of PECS (i.e., picture exchange, increased distance, picture discrimination, and sentence construction). The results indicated that PECS was mastered rapidly by the participants and word utterances increased in number of words and complexity of grammar.

Autistic Disorder↗
PubMed2004

The use and understanding of virtual environments by adolescents with autistic spectrum disorders.

The potential of virtual environments for teaching people with autism has been positively promoted in recent years. The present study aimed to systematically investigate this potential with 12 participants with autistic spectrum disorders (ASDs), each individually matched with comparison participants according to either verbal IQ or performance IQ, as well as gender and chronological age. Participants practised using a desktop 'training' virtual environment, before completing a number of tasks in a virtual café. We examined time spent completing tasks, errors made, basic understanding of the representational quality of virtual environments and the social appropriateness of performance. The use of the environments by the participants with ASDs was on a par with their PIQ-matched counterparts, and the majority of the group seemed to have a basic understanding of the virtual environment as a representation of reality. However, some participants in the ASD group were significantly more likely to be judged as bumping into, or walking between, other people in the virtual scene, compared to their paired matches. This tendency could not be explained by executive dysfunction or a general motor difficulty. This might be a sign that understanding personal space is impaired in autism. Virtual environments might offer a useful tool for social skills training, and this would be a valuable topic for future research.

Adolescent↗
PubMed1998

Treatment of acute stress disorder: a comparison of cognitive-behavioral therapy and supportive counseling.

Acute stress disorder (ASD) is a precursor of chronic posttraumatic stress disorder (PTSD). Twenty-four participants with ASD following civilian trauma were given 5 sessions of either cognitive-behavioral therapy (CBT) or supportive counseling (SC) within 2 weeks of their trauma. Fewer participants in CBT (8%) than in SC (83%) met criteria for PTSD at posttreatment. There were also fewer cases of PTSD in the CBT condition (17%) than in the SC condition (67%) 6 months posttrauma. There were greater statistically and clinically significant reductions in intrusive, avoidance, and depressive symptomatology among the CBT participants than among the SC participants. This study represents the 1st demonstration of successful treatment of ASD with CBT and its efficacy in preventing chronic PTSD.

Accidents↗
PubMed2004

Early social attention impairments in autism: social orienting, joint attention, and attention to distress.

This study investigated social attention impairments in autism (social orienting, joint attention, and attention to another's distress) and their relations to language ability. Three- to four-year-old children with autism spectrum disorder (ASD; n = 72), 3- to 4-year-old developmentally delayed children (n = 34), and 12- to 46-month-old typically developing children (n = 39), matched on mental age, were compared on measures of social orienting, joint attention, and attention to another's distress. Children with autism performed significantly worse than the comparison groups in all of these domains. Combined impairments in joint attention and social orienting were found to best distinguish young children with ASD from those without ASD. Structural equation modeling indicated that joint attention was the best predictor of concurrent language ability. Social orienting and attention to distress were indirectly related to language through their relations with joint attention. These results help to clarify the nature of social attention impairments in autism, offer clues to developmental mechanisms, and suggest targets for early intervention.

Attention↗
PubMed2005

A prospective study of autobiographical memory and posttraumatic stress disorder following cancer.

In this study, the authors investigated the relationship between autobiographical memory and the onset and maintenance of distressing memories following cancer. In Study 1, participants recently diagnosed with head, neck, or lung cancer were assessed for acute stress disorder (ASD). Participants with ASD reported fewer specific memories than did participants without ASD. In Study 2, the same participants were assessed 6 months later for autobiographical memory and cancer-related posttraumatic stress disorder (PTSD). Deficits in the retrieval of specific memories in Study 1 were not predictive of subsequent PTSD. Increased hopelessness during the 6 months was associated with a decline in the retrieval of positive memories and an increase in the retrieval of negative memories. These findings accord with propositions that retrieval of distressing memories is guided by current self-image and attitude toward one's future.

Autobiographies as Topic↗
PubMed2002

Acute stress disorder: a synthesis and critique.

The diagnosis of acute stress disorder (ASD) was introduced to describe initial trauma reactions that predict chronic posttraumatic stress disorder (PTSD). This review outlines and critiques the rationales underpinning the ASD diagnosis and highlights conceptual and empirical problems inherent in this diagnosis. The authors conclude that there is little justification for the ASD diagnosis in its present form. The evidence for and against the current emphasis on peritraumatic dissociation is discussed, and the range of biological and cognitive mechanisms that potentially mediate acute trauma response are reviewed. The available evidence indicates that alternative means of conceptualizing acute trauma reactions and identifying acutely traumatized people who are at risk of developing PTSD need to be considered.

Acute Disease↗
PubMed2005

Autoextraction in a child with autistic spectrum disorder.

Many children with mild/moderate autistic spectrum disorder (ASD) receive care in general dental practice. We report a seven year old boy with ASD presenting with dental pain who auto-extracted one of his deciduous canines. Children with ASD may have hyposensitivity to pain and can exhibit unusual forms of self-injurious behaviour.

Autistic Disorder↗
PubMed2006

A novel CSX/NKX2-5 mutation causes autosomal-dominant AV block: are atrial fibrillation and syncopes part of the phenotype?

The prevalence of congenital heart defects is approximately 1% of all live births. Identifying the genes responsible for cardiac malformation is the first step to understand pathogenesis. Heterozygous mutations in the CSX/NKX2-5 (NKX2E) gene have been identified to cause atrial septal defect (ASD) and/or atrioventricular (AV) conduction disturbance in some families. However, there is great variability in expressivity of the phenotype between the patients with a CSX/NKX2-5 mutation. We screened four sporadic patients and three index cases of families with ASD and/or conduction defects. In one of them, a CSX/NKX2-5 mutation was identified. This novel mutation (p.Tyr256X) was inherited in a three-generation family causing five individuals to have cardiac anomalies ranging from ASD to arrhythmias. Interestingly, all the observed AV conduction disturbances were at the nodal level, manifesting first as an AV block of the first degree and evolving toward a second-degree block. Atrial fibrillation, previously reported in three individuals with CSX/NKX2-5 mutations, was observed in three patients.

Female↗
PubMed2004

Variants of the serotonin transporter gene (SLC6A4) significantly contribute to hyperserotonemia in autism.

The role of the serotonin system in the etiology and pathogenesis of autism spectrum disorders (ASD) is not clearly defined. High levels of platelet serotonin (5-HT) have been consistently found in a proportion of patients, and it is known that specific 5-HT transporter gene (SLC6A4) variants modulate transporter reuptake function, therefore possibly influencing the occurrence of hyperserotonemia in a subset of autistic patients. We have examined the association of platelet serotonin levels with two SLC6A4 polymorphisms, 5-HTT gene-linked polymorphic region (HTTLPR) in the promoter and intron 2 variable number of tandem repeats (VNTR), in a sample of 105 ASD patients, their parents, and 52 control children. Quantitative transmission disequilibrium test (QTDT) results showed a significant effect on 5-HT levels of each SLC6A4 marker (P=0.017 for HTTLPR; P=0.047 for intron 2 VNTR) and of haplotypes of the two markers (P=0.017), with a major contribution of the L.Stin2.10 haplotype (P=0.0013). A 5-HT mean value in the range of hyperserotonemia was associated with the homozygous L.Stin2.10 haplotype (H (1,N=97)=7.76, P=0.0054), which occurred in 33% of hyperserotonemic patients against 6% of patients with normal 5-HT levels (Fisher's exact test: P=0.013, OR=8). Allele interaction at the HTTLPR locus was found, with a significant dominance variance effect on 5-HT levels. We found no transmission disequilibrium of any of the SLC6A4 variants in ASD. Our results show that the SLC6A4 gene is a significant factor in the determination of 5-HT levels, and that specific SLC6A4 variants are associated with an increased risk for hyperserotonemia in our sample of autistic patients. The biological mechanism, however, is unlikely to involve the SLC6A4 gene solely. The associated SLC6A4 alleles likely interact with other genes or environmental factors to produce the abnormally high 5-HT levels observed in this subset of autistic patients, who possibly represent a separate etiological group.

Adolescent↗
PubMed2002

Gluten and casein free diets in autism: a study of the effects on food choice and nutrition.

BACKGROUND: There is growing interest in possible dietary involvement in the aetiology and treatment of Autistic Spectrum Disorders (ASD). Research has focused on the physiological and behavioural effects of dietary change but has not examined the effect of exclusion diets on nutritional intake. AIMS: The aim of this study was to examine whether the removal of major dietary staples placed children with autism at risk of nutrient deficiency and compares their food choice with ASD children not following gluten and/or casein free diets. METHODS: A postal questionnaire was sent to parents of children aged 3-16 years, diagnosed with ASD belonging to the National Autistic Society in Leicestershire and southern Derbyshire. Detailed dietary information and a 3-day food diary were collected. The sample size was small: those using gluten/casein free diets (n = 8) and those not following diet (n = 29). RESULTS: Nutrient intakes fell below the Lower Reference Nutrient Intake (LRNI) in 12 children (32%) for zinc, calcium, iron, vitamin A, vitamin B12 and riboflavin in the nondiet group and four children (50%) for zinc and calcium in the diet group. Fruit and vegetable intakes were higher and cereal, bread and potato consumption were lower in those children using gluten and/or casein free diets. CONCLUSION: No significant differences in the energy, protein and micronutrient intakes were found between the two groups of children. A longitudinal prospective study is suggested to examine whether differences in food choice are the result of dietary intervention or the prerequisite for the successful application of diet in this special group of children.

Adolescent↗
PubMed2001

Arthroscopic subacromial decompression with a holmium:YAG laser: review of the literature.

BACKGROUND: The Australian Safety and Efficacy Register of New Interventional Procedures-Surgical (ASERNIP-S) undertook to systematically review the literature regarding arthroscopic subacromial decompression (ASD) using a holmium:YAG laser for patients with impingement syndrome, with respect to the safety and efficacy of the procedure. METHODS: Studies on ASD with a holmium:YAG laser were identified using MEDLINE (1984 to July 2000), EMBASE (1974 to August 2000) and Current Contents (1993 to week 33 2000). A number of search terms were used: (laser and shoulder) and (surgery or arthroscop* or acromioplasty or orthopaed* or orthoped* or subacromial decompression or impingement syndrome). The Cochrane Library was searched from 1966 to issue 3 2000, using the search terms 'shoulder and surgery'. Human studies were included for patients with impingement syndrome but without full-thickness rotator cuff tears or rheumatological disorders, and where shoulder pain had been experienced for more than 3 months. A surgeon and reviewer independently assessed the retrieved articles for their inclusion in the review. RESULTS: Seven papers were identified that related to ASD with a holmium:YAG laser. None of the papers for review offered high-quality evidence. There were no properly designed randomized controlled studies. The highest level of evidence came from time series studies. No quantitative analysis could be undertaken for this review. CONCLUSIONS: Given the extremely low level of evidence available for this procedure it was recommended that further research be conducted to establish the safety and efficacy of the technique. This reinforces the conclusion reached in the Cochrane review of interventions for shoulder pain where insufficient evidence was found to either support or refute the efficacy of other interventions for shoulder pain.

Arthroscopy↗
PubMed1998

Transcatheter occlusion of atrial septal defects: an initial experience with the Amplatzer septal occluder.

OBJECTIVE: To discuss the initial experience with the use of a new double disc occluding device, the Amplatzer septal occluder in transcatheter occlusion of secundum atrial septal defects (ASD). METHODS: Transvenous sizing of secundum ASD was performed in five children under general anaesthesia using transoesophageal echocardiographic and fluoroscopic guidance. An Amplatzer septal occluder equal to or minimally larger than the stretched diameter of the ASD was used for transcatheter occlusion of the defect in three suitable patients. Pulmonary balloon valvuloplasty with a 18 mm x 3 cm Mansfield balloon catheter was carried out in one patient with associated pulmonary valvar stenosis in the same procedure setting. RESULTS: Stretched diameters of the defects in the three patients ranged from 14 to 17 mm. Devices of sizes 14, 17 and 17 were deployed through 7F and 8F sheaths, respectively. The upper and lower rims of interatrial septum were more than 8 mm in all patients. All patients had successful occlusion with complete obliteration of the atrial left to right shunting. Simultaneous pulmonary balloon valvuloplasty for the valvar stenosis reduced pressure gradient from 53 mmHg to 22 mmHg across the valve prior to septal occlusion in one patient. No intraprocedural or short-term complication was encountered. CONCLUSIONS: The design of the Amplatzer septal occluder permits ease in loading, delivery, deployment and stable seating of the device. This initial experience shows that Amplatzer device occlusion is feasible, relatively safe and effective and appears to be a viable alternative to surgical closure of secundum atrial septal defects in properly selected patients.

Cardiac Catheterization↗
PubMed1999

Two-dimensional autoregressive analysis of carotid artery blood flow waveform in children with isolated atrial septal defect.

BACKGROUND: The aim of the present study was to analyze the carotid artery blood flow waveform, using a two-dimensional autoregressive modeling approach and component analysis, and to determine the relation between cardiac contractility, peripheral and cerebral circulation and characteristic values of component activities of carotid artery blood flow waveform in patients with atrial septal defect (ASD), with or without congestive heart failure. METHODS AND RESULTS: We analyzed the carotid artery blood flow waveform of nine patients with ASD and 35 normal controls using a two-dimensional autoregressive modeling approach. The component of impulse response was divided into six groups according to the damping frequency: (i) group I, 0 Hz; (ii) group II, 1-5 Hz; (iii) group III, 5-8 Hz; (iv) group IV, 8-13 Hz; (v) group V, 13-17 Hz and (vi) group VI, > 17 Hz. The decrease of impulse response power-density in patients of groups I, II, III and IV and the prolongation of damping time for patients in groups I and II were particularly noticeable in two ASD patients, whose pulmonary to systemic blood flow ratio was more than 2.7 and whose left ventricular stroke volume was less than 33.1 mL/m2. The power-density of groups I and II varied with cardiac contractility and the power-density of groups III and IV varied with cerebral circulation. In contrast, the damping time of groups I and II changed with the reflection velocity from the position of arterial reflection against blood flow from left ventricle. CONCLUSIONS: These results may be influenced by the decrease in left ventricular stroke volume and velocity in arterial reflection.

Blood Circulation↗
PubMed2003

An evaluation of a low-intensity intervention to introduce medical students to healthy older people.

This is a report of a controlled, prospective, longitudinal trial of an intervention to affect medical students' attitudes toward aging. Members of the Class of 2002 at the University of Oklahoma College of Medicine were assigned a senior mentor (a community-dwelling older person) upon matriculation into medical school. Students were required to perform a structured interview with the mentor once per semester for the first 2 preclinical years and to discuss these interviews in small groups mediated by geriatrics faculty. Members of the Class of 2001 were controls. Attitudes toward aging were determined using the Aging Semantic Differential (ASD) attitude scale in August 1998 and again at the end of the second year of medical school. Initial mean ASD scores were not significantly different for the two groups. Although both classes experienced improvements in their ASD scores from Time 0 to Time 1, the improvement for the class of 2002 was significantly greater than that for the class of 2001 (2001 class mean = 0.17, 2002 class mean = 0.40, t = -3.09, degrees of freedom (df) = 219, P =.002). This difference held up under controls for sex, age, prior visits to a nursing home, prior work/volunteering in an old-age environment, and a prior course on aging (Model F = 3.00, df = 6/214, P =.008; class F = 9.70, df = 1, P =.002). It was concluded that a low-intensity intervention to introduce entering medical students to healthy older people might have a positive effect on attitudes toward aging.

Aged↗