Auditory symptoms and autistic spectrum disorder:A scoping review and recommendations for future research

Introduction:Auditory symptoms in individuals with Autistic Spectrum Disorder(ASD)are well described within the neurodevelopmental literature,yet there is minimal mention of ASD in Otolaryngology literature.This is surprising considering the potential clinical and diagnostic implications of this link,and the potential for ASD to present to Otolaryngologists in the form of unexplained auditory symptoms.The aims of this literature review were to explore the intersection of auditory symptoms and ASD from the perspective of clinical Otolaryngology,and to outline a clinically focused research agenda based on emerging themes relevant to Otolaryngology.Methods:We searched Pubmed,Embase,Ovid and Cochrane library for studies until November 2021.Four authors independently reviewed 227 publications identified.39 were filtered into the final analysis.The PRISMA 2020 guidelines were followed.The heterogeneity of literature meant that a Systematic Review was not feasible.Included studies were therefore classified thematically,forming the basis of the scoping review.Results:Diagnostic theories for auditory symptoms in ASD include the entire auditory pathway and brain.There is a growing body of literature on auditory symptoms in ASD,suggesting that a primary diagnosis of ASD should be considered in patients presenting with otherwise unexplained auditory symptoms,and indicating a learning need for Otolaryngologists and audiologists,to whom these patients may present.Conclusion:We recommend a research agenda focusing on multidisciplinary collaboration,stakeholder engagement,responsible clinical screening,and clarification of pathophysiological mechanisms and terminology.

Parents of Children with Autistic Spectrum Disorder (ASD) as Co-therapists: The Therapists’ View

Studies on the evaluation by therapists of parental behavior towards their children with Autistic Spectrum Disorder(ASD)and towards the therapists of their children are scarce.They are necessary,however,for enabling parents to become co-therapists.The present study’s purpose was the evaluation by therapists of the behavior of parents towards their children,of their relationship to therapists,and therapy outcome.The sample consisted of 178 parents of 89 children(72 boys)with ASD,who underwent intensive early intervention at a day centre for developmental disabilities.The professional team completed a questionnaire,separately for the mother and father,evaluating the parental attitude towards their children and towards the therapists.The behavior of parents was less satisfactory than expected.The fathers had difficulties in understanding their child’s problems,and had unrealistic expectations;mothers’behavior towards their children and therapists was better than the fathers’.Mothers had difficulty mostly in the management of the child’s behavior,and did not do well with feeding.It might be difficult for every parent to become co-therapist.Understanding the child’s difficulties by the mother,adequate handling of feeding and homework,were statistically significant in the good outcome of therapy.

Sex-biased single-cell genetic landscape in mice with autism spectrum disorder

Autistic spectrum disorder(ASD)is a male-biased,heterogeneous neurodevelopmental disorder that affects approximately 1%e2%of the population.Prenatal exposure to valproic acid(VPA)is a recognized risk factor for ASD,but the cellular and molecular basis of VPA-induced ASD at the single-cell resolution is unclear.Here,we aim to compare the cellular and molecular differences in the hippocampus between male and female prenatal mice with ASD at the single-cell transcriptomic level.The transcriptomes of more than 45,000 cells are assigned to 12 major cell types,including neurons,glial cells,vascular cells,and immune cells.Cell type-specific genes with altered expression after prenatal VPA exposure are analyzed,and the largest number of differentially expressed genes(DEGs)are found in neurons,choroid plexus epithelial cells,and microglia.In microglia,several pathways related to inflammation are found in both males and females,including the tumor necrosis factor(TNF),nuclear factor kappa B(NF-kB),toll-like receptor(TLR),and mitogen-activated protein kinase(MAPK)signaling pathways,which are important for the induction of autistic-like behavior.Additionally,we note that several X-linked genes,including Bex1,Bex3,and Gria3,were among the male-specific DEGs of neurons.This pioneering study describes the landscape of the transcriptome in the hippocampus of autistic mice.The elucidation of sexual differences could provide innovative strategies for the prevention and treatment of ASD.

Measures of empathy in children and adolescents:A systematic review of questionnaires

BACKGROUND Empathy has long been considered a multidimensional construct,encompassing cognitive,affective and behavioral domains.Deficits in empathic competences in early childhood contribute to psychopathology,and have been variably implicated in several clinical conditions,such as autism spectrum disorders(ASD)and conduct disorders.AIM To identify and describe empirically validated questionnaires assessing empathy in children and adolescents and to provide a summary of related theoretical perspectives on empathy definitional issues.METHODS A systematic review of the literature was conducted.Three bibliographic databases were searched.A total of 47 studies were selected for final analysis and 16 distinct measures were identified and described.RESULTS Questionable to excellent levels of internal consistency were observed,while few studies assessed test-retest reliability.Although construct definitions only partially overlapped,affective and cognitive domains of empathy were the commonest internal factors that were often separately evaluated.New facets of the construct(i.e.,somatic empathy and sympathy)and specific clinical populations(i.e.,ASD)could be specifically addressed through more recent instruments.CONCLUSION The combination of different assessment methods is recommended in order to foresee further improvements in this field and try to overcome the problem of limited convergence with more objective measures.

Global Functional Performance and Caregiver Assistance in Autism and Asperger Syndrome

Autism and Asperger’s syndrome belong to a family of neuro-developmental disorders called Pervasive Development Disorders. The aims of this study were to 1) quantify the overall functional performance and need for caregiver assistance in autism (A) and Asperger’s syndrome (AS), 2) compare the findings between groups and to normative data from Brazilian children. Methods: A cross-sectional study was carried out involving 52 children between three and eight years of age diagnosed with either A (n = 26) or SA (n = 26). The Brazilian version of the Pediatric Evaluation of Disability Inventory was administered. Results: The children with A and AS achieved significantly lower scores than that expected for normality. The children with AS had a significantly better social function than that the children with A had. However, those with A achieved significantly better scores than those with AS on activities related to self-care and mobility, requiring less assistance. Conclusion: While patients with AS are better at social interaction than typical autistic children, they exhibit greater deficits with regard to basic tasks, such as self-care and mobility, requiring greater assistance than children with A.

Clinical observation on acupuncture at thirteen ghost acupoints for children with autism spectrum disorder

Objective： To observe the clinical efficacy of needling thirteen ghost acupoints for children with autism spectrum disorder. Methods： A total of 90 cases with autism spectrum disorder （ASD） aged between 2 and 6 years were randomly allocated into 2 groups by random number table. The control group （n=45） received routine rehabilitative training, and the treatment group （n=45） received acupuncture at thirteen ghost acupoints plus routine rehabilitative training. The Beijing Gesell developmental （Gesell） scale and autism behavior checklist （ABC） were used to assess the intellectual, language and behavior development before and 3 months after the treatment. Results： After the treatment, the total effective rate in the treatment group was 82.2%, versus 55.6% in the control group, showing a statistical significance （P〈0.05）. As for the scores of social, emotional and language in Gesell scale, there were significant intra-group differences in the treatment group （all P〈0.05）, and all the five subscales in the Gesell scale in the treatment group were significantly better than those in the control group （all P〈0.05）. As for the scores of ABC, there were significant intra-group differences in the treatment group （P〈0.05）, and the scores in the treatment group were significantly better than those in the control group （all P〈0.05）. Conclusion： Rehabilitation training plus acupuncture at thirteen ghost acupoints can significantly improve the intellectual, language and abnormal behavior in autism spectrum disorder children.

Association of neonatal blood levels of brain-derived neurotrophic factor with development of autism spectrum disorder:a systematic review and meta-analysis

Background Our goal was to evaluate the association between neonatal blood brain-derived neurotrophic factor(BDNF)level and autism spectrum disorder(ASD)diagnosis later in life.Methods MEDLINE and Web of Science databases were searched from inception until September 16,2020.Reference lists of all relevant articles also were reviewed.Mean blood BDNF concentrations,standard deviations,sample sizes,and other data needed for calculation of effect sizes were extracted by two independent investigators.The quality of the included studies was appraised using the Newcastle-Ottawa Scale for case-control studies.Data were pooled using the random-effects model.Results Five case-control studies involving 1341 cases and 3395 controls were included in the meta-analysis.The meta-analysis of all included studies showed no significant difference in blood BDNF levels between neonates diagnosed with ASD later in life and healthy controls[standardized mean difference(SMD)=0.261;95%confidence interval(CI)-0.052 to 0.573;P=0.102],with high level of heterogeneity(Q=64.346;I2=93.784;P<0.001).A subgroup analysis by assay type showed decreased blood BDNF levels in ASDs compared to controls(SMD=—0.070;95%CI-0.114 to-0.026;P=0.002),with high level of homogeneity(Q=0.894;I2=0.000;P=0.827).No evidence of publication bias was observed.Conclusions Neonates diagnosed with ASD later in life have decreased blood levels of BDNF measured by double-antibody immunoassay.More studies are warranted to facilitate a more robust conclusion.

Mirror system based therapy for autism spectrum disorders

This paper reviews the present theories and empirical research of autisms’cognitive research and mir-ror systems and introduces a new hypothesis about the causes of autism spectrum disorders(ASD):autistic mir-ror neuron dysfunction hypothesis.ASD subjects show obvious lack of the activation of the mirror system during the task of observation or emotional cognition.It is sig-nificant to investigate the mirror system for revealing the causes of autism and it is also helpful for developing new ways to diagnose or treat this disorder.

Data-driven,client-centric applied behavior analysis treatment-dose optimization improves functional outcomes

Background With increasing numbers of individuals diagnosed with autism spectrum disorder(ASD)and with affirmation of applied behavior analysis(ABA)as an evidence-based standard of care for ASD,there has been a proliferation of agencies offering ABA services over the last several decades.Disagreement exists among ABA providers and health plans that reimburse those providers on the optimal number of hours of ABA services that should be reimbursed.This study aims to understand whether children who receive more hours of ABA therapy achieve better outcomes and to evaluate the impact of the COVID-19-induced shift to telehealth clinical supervision on outcomes.Methods A retrospective cohort analysis was performed using data from the Vineland 3 Comprehensive Interview Form to assess function throughout ABA treatment.Paired sample t tests,independent sample t tests,Cohen’s D,and Pearson correlations were used to determine relationships between Vineland scores and input variables including hours of service and modality of supervision(in-person vs.telehealth).Results While statistically and clinically significant improvements in function were observed,children appear to have improved outcomes independent of the number of hours of service received.There were also no significant associations between modality of supervision and Vineland standard scores.Conclusions These findings challenge prior research that demonstrated a linear dose–response relationship.By tailoring treatment dosage to the individual client’s needs,providers may be able to better maximize functional progress of the client,to preserve family time,and to utilize health plan dollars more efficiently.

Autism genetics: Methodological issues and experimental design

Autism is a complex neuropsychiatric disorder of developmental origin, where multiple genetic and environmental factors likely interact resulting in a clinical continuum between "affected" and "unaffected" individuals in the general population. During the last two decades, relevant progress has been made in identifying chromosomal regions and genes in linkage or association with autism, but no single gene has emerged as a major cause of disease in a large number of patients. The purpose of this paper is to discuss specific methodological issues and experimental strategies in autism genetic research, based on fourteen years of experience in patient recruitment and association studies of autism spectrum disorder in Italy.

Interference Effect of Acupuncture on Language Function of Children with Autism

Objective： To observe the clinical effect of acupuncture treatment for infantile autism. Methods： After being treated with the needling technique for enhancing wisdom and opening the orifice, 32 cases of sick children were assessed by Autism Treatment Evaluation Checklist （ATEC） depending upon their clinical symptoms. Results： After acupuncture treatments, language communication, interpersonal relationships, movements and behavior, and personal ability had all improved. Among them, the remarkable rate of language communication showed a statistical significance in comparison with the other three items （P〈0.05）. In the comparison of the ATEC scores before and after the treatments, the language items （P〈0.01）, social relationships, perception and behavior items, showed statistically significant differences （P〈0.05）. Conclusion： Acupuncture therapy can effectively improve the clinical symptoms of sick children with autism, and the interference effect on language function is especially remarkable.