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Pediatrics Aug 2023Autism spectrum disorder (ASD) and gender dysphoria (GD) frequently cooccur. However, existing research has primarily used smaller samples, limiting generalizability and...
BACKGROUND AND OBJECTIVES
Autism spectrum disorder (ASD) and gender dysphoria (GD) frequently cooccur. However, existing research has primarily used smaller samples, limiting generalizability and the ability to assess further demographic variation. The purpose of this study was to (1) examine the prevalence of cooccurring ASD and GD diagnoses among US adolescents aged 9 to 18 and (2) identify demographic differences in the prevalence of cooccurring ASD and GD diagnoses.
METHODS
This secondary analysis used data from the PEDSnet learning health system network of 8 pediatric hospital institutions. Analyses included descriptive statistics and adjusted mixed logistic regression testing for associations between ASD and GD diagnoses and interactions between ASD diagnosis and demographic characteristics in the association with GD diagnosis.
RESULTS
Among 919 898 patients, GD diagnosis was more prevalent among youth with an ASD diagnosis compared with youth without an ASD diagnosis (1.1% vs 0.6%), and adjusted regression revealed significantly greater odds of GD diagnosis among youth with an ASD diagnosis (adjusted odds ratio = 3.00, 95% confidence interval: 2.72-3.31). Cooccurring ASD/GD diagnoses were more prevalent among youth whose electronic medical record-reported sex was female and those using private insurance, and less prevalent among youth of color, particularly Black and Asian youth.
CONCLUSIONS
Results indicate that youth whose electronic medical record-reported sex was female and those using private insurance are more likely, and youth of color are less likely, to have cooccurring ASD/GD diagnoses. This represents an important step toward building services and supports that reduce disparities in access to care and improve outcomes for youth with cooccurring ASD/GD and their families.
Topics: Adolescent; Child; Female; Humans; Asian; Autism Spectrum Disorder; Electronic Health Records; Gender Dysphoria; Prevalence; Black or African American
PubMed: 37395084
DOI: 10.1542/peds.2023-061363 -
Development, Growth & Differentiation Oct 2023Autism spectrum disorder (ASD) is one of the most common, heritable neuropsychiatric disorders in the world, affecting almost 1% of the population. The core symptoms... (Review)
Review
Autism spectrum disorder (ASD) is one of the most common, heritable neuropsychiatric disorders in the world, affecting almost 1% of the population. The core symptoms used to diagnose ASD are decreased social interaction and increased repetitive behaviors. Despite the large number of affected individuals, the precise mechanisms that cause this disorder remain unclear. The identification of genes and environmental factors associated with ASD allows the study of the underlying mechanisms in animal models. Although ASD presents as a human disorder, based on recent advances in understanding their brain anatomy, physiology, behavior, and evolutionary conservation of neuronal cell types, I propose that zebrafish may provide novel insights into the etiology.
Topics: Animals; Humans; Autistic Disorder; Autism Spectrum Disorder; Zebrafish; Disease Models, Animal; Brain
PubMed: 37623916
DOI: 10.1111/dgd.12888 -
Current Problems in Pediatric and... Nov 2023Animal-assisted therapies have been increasingly used as part of treatment for a range of emotional-behavioral conditions and have more recently been incorporated into... (Meta-Analysis)
Meta-Analysis
Animal-assisted therapies have been increasingly used as part of treatment for a range of emotional-behavioral conditions and have more recently been incorporated into treatment for children with symptoms associated with autism spectrum disorder. Autism spectrum disorder affects one in 36 children and early interventions can be very effective. The aims of this paper are to: 1) provide background into animal-assisted therapies including a breakdown on the subtypes of therapies, 2) report broad summaries of research outcomes across various domains: social-emotional, physical, quality of life, behavioral skills, and adaptive skills, and 3) summarize key takeaways for pediatric practitioners when supporting families of youth with autism spectrum disorder who are interested in participating in animal-assisted therapy. This paper is not a systematic review or meta-analysis as several rigorous review studies have been published already. This paper is an overview of the background and research for pediatric practitioners when advising families on treatment options. Implications for future research are covered.
Topics: Adolescent; Animals; Humans; Child; Autistic Disorder; Autism Spectrum Disorder; Animal Assisted Therapy; Quality of Life; Early Intervention, Educational
PubMed: 37996312
DOI: 10.1016/j.cppeds.2023.101478 -
Pediatrics Dec 2023Youth with either autism spectrum disorder (ASD) or gender dysphoria (GD) alone have also been shown to be at greater risk for mental health (MH) concerns; however, very...
BACKGROUND AND OBJECTIVES
Youth with either autism spectrum disorder (ASD) or gender dysphoria (GD) alone have also been shown to be at greater risk for mental health (MH) concerns; however, very little research has considered how cooccurring ASD and GD may exacerbate MH concerns. The purpose of this study was to examine associations between ASD, GD, and MH diagnoses (anxiety, depression, eating disorder, suicidality, and self-harm) among US adolescent populations.
METHODS
This is a secondary analysis of a large administrative dataset formed by 8 pediatric health system members of the PEDSnet learning health system network. Analyses included descriptive statistics and adjusted mixed logistic regression models testing for associations between combinations of ASD and GD diagnoses and MH diagnoses as recorded in the patient's electronic medical record.
RESULTS
Based on data from 919 898 patients aged 9 to 18 years, adjusted mixed logistic regression indicated significantly greater odds of each MH diagnosis among those with ASD alone, GD alone, and cooccurring ASD/GD diagnoses compared with those with neither diagnosis. Youth with cooccurring ASD/GD were at significantly greater risk of also having anxiety (average predicted probability, 0.75; 95% confidence interval, 0.68-0.81) or depression diagnoses (average predicted probability, 0.33; 95% confidence interval, 0.24-0.43) compared with youth with ASD alone, GD alone, or neither diagnosis.
CONCLUSIONS
Youth with cooccurring ASD/GD are more likely to also be diagnosed with MH concerns, particularly anxiety and depression. This study highlights the need to implement developmentally appropriate, gender-affirming MH services and interventions for youth with cooccurring ASD/GD.
Topics: Humans; Child; Adolescent; Mental Health; Autism Spectrum Disorder; Gender Dysphoria; Anxiety Disorders; Anxiety
PubMed: 37909059
DOI: 10.1542/peds.2023-063289 -
Clinical Pediatrics Jul 2023While autism spectrum disorder (ASD) has traditionally been diagnosed in specialty care, rising prevalence rates have strained specialist capacity and created...
While autism spectrum disorder (ASD) has traditionally been diagnosed in specialty care, rising prevalence rates have strained specialist capacity and created significant diagnostic bottlenecks. With long wait times for specialist evaluations, pediatricians are increasingly being asked to play a greater role in identifying, diagnosing, and managing ASD within the medical home. In this commentary we draw parallels between the challenges pediatricians faced two decades ago learning how to manage pediatric asthma in the medical home, to those faced today in the field of primary care ASD management. Reflecting on the lessons learnt in primary care asthma management may help us construct a roadmap towards a higher and more consistent standard of ASD primary care for patients and their families.
Topics: Child; Humans; Autism Spectrum Disorder; Patient-Centered Care; Prevalence; Pediatricians; Asthma
PubMed: 36539943
DOI: 10.1177/00099228221144146 -
Pediatrics Aug 2023
Topics: Humans; Adolescent; Autism Spectrum Disorder; Autistic Disorder; Gender Dysphoria; Gender Identity; Transgender Persons
PubMed: 37395081
DOI: 10.1542/peds.2023-061813 -
World Journal of Pediatrics : WJP Aug 2023Neurodevelopmental disorders are a heterogeneous group of conditions that manifest as delays or deviations in the acquisition of expected developmental milestones and... (Review)
Review
BACKGROUND
Neurodevelopmental disorders are a heterogeneous group of conditions that manifest as delays or deviations in the acquisition of expected developmental milestones and behavioral changes. Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by deficits in communication and social interaction and by repetitive and restricted patterns of behavior, interests and activities. The aim of this review is to discuss the clinical features of the differential diagnoses of ASD that are prevalent among preschoolers, focusing on their similarities and disparities.
DATA SOURCES
The international medical literature search was conducted using PubMed and was revised regarding the subject using single and/or combined keywords as follows: differential diagnosis, preschoolers, diagnostic challenge, attention deficit hyperactivity disorder, intellectual disability, high abilities/giftedness, childhood apraxia of speech, social communication disorder, Landau-Kleffner syndrome, stereotyped movement disorder and excessive screen time.
RESULTS
We describe conditions commonly found in clinical practice, taking ASD as a reference. We addressed converging and divergent aspects of behavior, cognition, communication, language, speech, socialization, and stereotypes for the diagnosis of ASD and other disorders identified as potential differential or comorbid diagnoses.
CONCLUSIONS
The ranking and characterization of symptoms appear to be essential for better understanding the underlying common ground between children with developmental disorders and children with ASD, thus properly diagnosing and directing social, professional, or medication interventions. This detailed discussion adds to the literature since, although ASD differential diagnoses are frequently mentioned and discussed in textbooks and journal articles, they rarely occupy a prominent place as we aimed herein.
Topics: Child; Child, Preschool; Humans; Autism Spectrum Disorder; Diagnosis, Differential; Developmental Disabilities; Comorbidity; Cognition
PubMed: 36282408
DOI: 10.1007/s12519-022-00629-y -
International Journal of Environmental... Feb 2024Autism Spectrum Disorder (ASD) belongs to the group of neurodevelopmental disorders, and has a high prevalence, affecting 1 in 100 children according to data from the... (Review)
Review
Autism Spectrum Disorder (ASD) belongs to the group of neurodevelopmental disorders, and has a high prevalence, affecting 1 in 100 children according to data from the World Health Organization (WHO). To be diagnosed with ASD, the child must have persistent deficits in communication and social interactions, and restricted and repetitive patterns of behavior, interests, or activities. Despite its prevalence, the etiology of ASD is still uncertain, with multifactorial characteristics, including those associated with the gestational period, where maternal exposure to biological, chemical, or physical hazards occurs, some of which have already been proposed as causes of ASD outcomes. Since pregnancy requires a balance between the maternal-fetal binomial, the breakdown of this balance caused by such environmental hazards can lead to altered fetal neurodevelopment, including ASD. With this firmly in mind, this review aims to compile the most recent data on the gestational causes that may be associated with the development of ASD to help health professionals identify risk factors and act for the prevention and management of ASD.
Topics: Child; Pregnancy; Female; Humans; Autism Spectrum Disorder; Risk Factors; Maternal Exposure; Causality; Neurodevelopmental Disorders
PubMed: 38541246
DOI: 10.3390/ijerph21030244 -
Autism Spectrum Disorder: Brain Areas Involved, Neurobiological Mechanisms, Diagnoses and Therapies.International Journal of Molecular... Feb 2024Autism spectrum disorder (ASD), affecting over 2% of the pre-school children population, includes an important fraction of the conditions accounting for the... (Review)
Review
Autism spectrum disorder (ASD), affecting over 2% of the pre-school children population, includes an important fraction of the conditions accounting for the heterogeneity of autism. The disease was discovered 75 years ago, and the present review, based on critical evaluations of the recognized ASD studies from the beginning of 1990, has been further developed by the comparative analyses of the research and clinical reports, which have grown progressively in recent years up to late 2023. The tools necessary for the identification of the ASD disease and its related clinical pathologies are genetic and epigenetic mutations affected by the specific interaction with transcription factors and chromatin remodeling processes occurring within specific complexes of brain neurons. Most often, the ensuing effects induce the inhibition/excitation of synaptic structures sustained primarily, at dendritic fibers, by alterations of flat and spine response sites. These effects are relevant because synapses, established by specific interactions of neurons with glial cells, operate as early and key targets of ASD. The pathology of children is often suspected by parents and communities and then confirmed by ensuing experiences. The final diagnoses of children and mature patients are then completed by the combination of neuropsychological (cognitive) tests and electro-/magneto-encephalography studies developed in specialized centers. ASD comorbidities, induced by processes such as anxieties, depressions, hyperactivities, and sleep defects, interact with and reinforce other brain diseases, especially schizophrenia. Advanced therapies, prescribed to children and adult patients for the control of ASD symptoms and disease, are based on the combination of well-known brain drugs with classical tools of neurologic and psychiatric practice. Overall, this review reports and discusses the advanced knowledge about the biological and medical properties of ASD.
Topics: Humans; Child, Preschool; Child; Autism Spectrum Disorder; Autistic Disorder; Brain; Brain Diseases; Neurons
PubMed: 38397100
DOI: 10.3390/ijms25042423 -
Fortschritte Der Neurologie-Psychiatrie Jan 2024Although the DSM-5 has emphasised the relevance of sensory abnormalities in autism spectrum disorders (ASD), there are hardly any measures to assess them in German...
Although the DSM-5 has emphasised the relevance of sensory abnormalities in autism spectrum disorders (ASD), there are hardly any measures to assess them in German speaking countries. The present study translated the "Sensory Perception Questionnaire" (SPQ) by Tavassoli et al. (2014) to German and validated this scale. The SPQ is a self-rating scale for adults which focuses on perceptual aspects rather than cognitive or motivational antecedents or consequences of such perceptual processes. A total of 188 subjects participated in this study, including n=85 participants with ASD and n=103 neurotypical controls. The autism spectrum quotient (AQ) and the empathy quotient (EQ) were also administered, the IQ was measured using the CFT20-R, and participants were clinically evaluated using the SKID-I. Alternative items were generated to improve the semantic and psychometric properties of the SPQ. Of the 92 original SPQ items, 33 separated the clinical groups significantly and linguistically clearly in the sense of sensory hyper-sensitivity. These items covered primarily the sensory modalities of hearing, touch and vision. Increased sensory hyper-sensitivity was associated with greater scores in the AQ and increased slightly with increasing age. Sensory hyper-sensitivity in participants with ASD was, however, not significantly correlated with the EQ and the IQ. Due to the item-analytical rather than dimensional item selection, the short versions presented here exhibit a clearly better group separation with comparable concurrent validities when compared to Tavassoli's short version of the scale. Pending replication and proper norming, the SPQ short version presented here can be employed for screening purposes and supplement the clinical diagnostic process.
Topics: Adult; Humans; Autism Spectrum Disorder; Psychometrics; Surveys and Questionnaires; Language; Perception
PubMed: 36070771
DOI: 10.1055/a-1839-6095