Communication on Sexuality Between Parents and Adolescents with Autism Spectrum Disorder: A Systematic Review

The objective of this systematic review was to identify and analyze the information available on sexual communication between parents and adolescents with autism spectrum disorder (ASD). Medline/PubMed, Lilacs, Ebsco, Embase, Scielo, Google Scholar, Scirus and Redalyc databases were used to find articles. The inclusion criteria were studies published in indexed databases in English, Spanish and Portuguese with a quantitative and qualitative approach in full text, studies that include a population of parents of adolescents with ASD and adolescents between 10 and 19 years of age with a diagnosis of ASD, and studies that covered communication about sexuality. Keywords combined with Boolean operators were used. Three topics were identified that covered the communication of parents and adolescents with ASD: sexual issues, parents' romantic expectations, and sexual experiences. This systematic review highlights the need for training of health professionals and sex education programs for parents of adolescents with ASD.

     

Beyond the Label: Asexual Identity Among Individuals on the High-Functioning Autism Spectrum

Researchers have suggested that asexuality, which has been conceptualized traditionally as a persistent lack of sexual attraction to others, may be more common among individuals with autism spectrum disorder than in the neurotypical population. However, no studies to date have considered how these individuals understand and conceptualize their sexual identity. The aim of this study was to provide a more nuanced understanding of asexuality among individuals with high-functioning autism spectrum disorder (HF-ASD) than has been done in the past. Individuals with ASD, 21–72 years old (M?=?34.04 years, SD?=?10.53), were recruited from online communities that serve adults with ASD and Amazon’s Mechanical Turk to complete an online survey of sexual and gender identity. Overall, 17 (5.1%) participants who met study criteria (N?=?332) self-identified as asexual. However, 9 of the 17 people identifying as asexual expressed at least some sexual attraction to others. In addition, based on open-ended responses, some participants linked their asexual identity more with a lack of desire or perceived skill to engage in interpersonal relations than a lack of sexual attraction. Results suggest that researchers should be cautious in attributing higher rates of asexuality among individuals with ASD than in the general population to a narrow explanation and that both researchers and professionals working with individuals with ASD should consider multiple questions or approaches to accurately assess sexual identity.

     

The Effects of Microbial Materials Adhered to Asian Sand Dust on Allergic Lung Inflammation

Asian sand dust (ASD) containing microbiological materials, sulfate (SO₄²), and nitrate (NO₃⁻) derived from air pollutants in East China, reportedly cause adverse respiratory health effects. ASD aggravates ovalbumin (OVA)-associated experimental lung eosinophilia. In this study, the toxic materials adsorbed onto ASD were excluded by heat treatment at 360°C for 30 min. The effects of nonheated ASD or heated ASD (H-ASD) toward the allergic lung inflammation were compared in murine lungs. ICR mice were administered intratracheally with normal saline (control), H-ASD, ASD, OVA, OVA + H-ASD, and OVA + ASD, four times at 2-week intervals. ASD only increased neutrophils in bronchoalveolar lavage fluids (BALFs) along with pro-inflammatory mediators, such as keratinocyte chemoattractant (KC). H-ASD and ASD enhanced eosinophil recruitment induced by OVA in the alveoli and in the submucosa of the airway, which has a goblet cell proliferation in the bronchial epithelium. The two ASDs synergistically increased interleukin-5 (IL-5), monocyte chemotactic protein-3 (MCP-3), and eotaxin, which were associated with OVA, in BALF. The enhancing effects were much greater in ASD than in H-ASD. The two ASDs induced the adjuvant effects to specific IgE and IgG1 production by OVA. In the in vitro study using RAW264.7 cells, ASD increased the expression of Toll-like receptor 2 (TLR 2) mRNA but not TLR4 mRNA. H-ASD caused no expression of either TLR mRNA. These results suggest that the aggravated lung eosinophilia by ASD may be due to activation of Th2-associated immune response via the activation of TLR2 by microbial components adhered to ASD.     

Safety of measles and pertussis-containing vaccines in children with autism spectrum disorders

ObjectivesTo determine whether children aged 4–7 years with a diagnosis of autism spectrum disorders (ASD) were at increased risk of fever, febrile seizures, or emergency department (ED) visits following measles- or pertussis-containing vaccines compared with children without ASD.MethodsThe study included children born between 1995–2012, aged 4–7 years at vaccination, and members of six healthcare delivery systems within Vaccine Safety Datalink. We conducted self-controlled risk interval analyses comparing rates of outcomes in risk and control intervals within each group defined by ASD status, and then compared outcome rates between children with and without ASD, in risk and control intervals, by estimating difference-in-differences using logistic regressions.ResultsThe study included 14,947 children with ASD and 1,650,041 children without ASD. After measles- or pertussis-containing vaccination, there were no differences in association between children with and without ASD for fever (ratio of rate ratio for measles-containing vaccine = 1.07, 95% CI 0.58–1.96; for pertussis-containing vaccine = 1.16, 95% CI 0.63–2.15) or ED visits (ratio of rate ratio for measles-containing vaccine = 1.11, 95% CI 0.80–1.54; for pertussis-containing vaccine = 0.87, 95% CI 0.59–1.28). Febrile seizures were rare. Pertussis-containing vaccines were associated with small increased risk of febrile seizures in children without ASD.ConclusionChildren with ASD were not at increased risk for fever or ED visits compared with children without ASD following measles- or pertussis-containing vaccines. These results may provide further reassurance that these vaccines are safe for all children, including those with ASD.     

Dating and Courtship Behaviors Among Those with Autism Spectrum Disorder

There has been growing concern among stakeholders about individuals with autism spectrum disorder (ASD), their sexual and intimate relationship experience, and their ability to pursue and maintain interpersonal relationships in a healthy manner. ASD is characterized, in part, by communication and socialization deficits, which may lead to miscommunications, inappropriate communications, or inappropriate actions towards romantic interests. This study sought to describe the romantic experiences of a small sample of individuals with ASD and explore any inappropriate courtship behaviors while pursuing a romantic interest.

     

Brief report: The impact of the COVID-19 pandemic on health behaviors in adolescents with Autism Spectrum Disorder

BackgroundThere is concern that the COVID-19 pandemic may negatively affect health behaviors in youth, especially youth diagnosed with Autism Spectrum Disorder (ASD).ObjectiveThe purpose of this paper was to examine changes in physical activity, screen-time, and sleep in adolescents with ASD due to the COVID-19 pandemic.MethodsNine adolescents with ASD completed surveys measuring physical activity, screen-time, and sleep duration prior to and during the pandemic.ResultsA significant decrease in days of physical activity (4.17 vs 2.27; p = 0.0006), and a significant increase in hours of both weekday (3.69 vs 6.25; p = 0.007) and weekend screen-time (5.94 vs. 7.39; p = 0.004) was observed during the pandemic. No changes regarding sleep duration was observed.ConclusionsAlthough preliminary, results suggest that physical activity and screen-time may be negatively affected by the COVID-19 outbreak in youth with ASD. The development of interventions to promote health behaviors in ASD populations during long periods of less-structured time (quarantine) should be considered.     

Sleep habits and sleep disorders among children with autism spectrum disorders,intellectual disabilities and typically developing children in Oman: a case-control study

ABSTRACT

Studies conducted in the West countries suggest that sleep habits and disordered sleep are common among children with autism spectrum disorder (ASD). To explore the rates of sleep habits and disordered sleep among children with ASD in comparison to typically developing (TD) children, and children with other intellectual disabilities (ID). A case control study was conducted among 122 cases of children with ASD (ASD group), and 2 randomly-selected control groups: 81 children with intellectual disabilities other than ASD (ID group) and 90 typically developed children (TD group). Overall, the mean score of the Children's Sleep Habit Questionnaire for the ASD group was higher compared to the ID group and TD group which indicated that children with ASD had a lower quality of sleep compared to TD and ID children. Congruent with international trend, children in Oman with ASD performed poorly compared to other children including those with other developmental disorders.

Abbreviations: ADHD: attention deficit hyperactivity disorder; ASD: autism spectrum disorder; ID: intellectual disabilities; TD: typically developed; DSM-V-TR: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision; SQUH: Sultan Qaboos University Hospital; CSHQ: Children Sleep Habits Questionnaire     

Beliefs about causes of autism and vaccine hesitancy among parents of children with autism spectrum disorder

Vaccine hesitancy may be more common among parents of children with autism spectrum disorder (ASD). We examined factors associated with ASD-specific vaccine hesitancy among caregivers of children with ASD who participated in the SPARK study (Simons Foundation Powering Autism Research for Knowledge). 225 participants completed an online survey containing the Parent Attitudes About Childhood Vaccines (PACV) questionnaire (measure of vaccine hesitancy) and the Illness Perception Questionnaire revised for parents of children with ASD (IPQ-R-ASD; measure of parents’ views about ASD). 65 participants (28.8%) were vaccine hesitant (PACV score ≥ 50); children of vaccine-hesitant parents (VHPs) were less likely to be first born (n = 27, 41.5%), had greater ASD-symptom severity (mean Social Communication Questionnaire score = 23.9, SD = 6.9), and were more likely to have experienced developmental regression (n = 27, 50.9%) or plateau (n = 37, 69.8%). Compared to non-hesitant parents, VHPs significantly more often endorsed accident/injury, deterioration of the child’s immune system, diet, environmental pollution, general stress, parents’ negative views, parents’ behaviors/decisions, parents’ emotional state, and vaccines as causes for ASD. VHPs also had higher scores on the Personal Control, Treatment Control, Illness Coherence, and Emotional Representations subscales of the IPQ-R than did non-hesitant parents. In the final model, ASD-related vaccine hesitancy was significantly associated with higher scores on the Emotional Representations subscale (OR = 1.13, p = 0.10), agreement with deterioration of the child’s immunity as a cause of ASD (OR = 12.47, p < 0.001), the child not having achieved fluent speech (OR = 2.67, p = 0.17), and the child experiencing a developmental plateau (OR = 3.89, p = 0.002). Findings suggest that a combination of child functioning and developmental history, as well as parents’ negative views about and their sense of control over ASD, influence vaccine hesitancy among parents of children with ASD.     

Clinical improvement following vitamin D3 supplementation in Autism Spectrum Disorder

Objective: High prevalence of vitamin D deficiency was previously reported in children with Autism Spectrum Disorder (ASD), but little is known about the efficacy of vitamin D3 treatment in ASD, although data from pilot studies seem promising. We hypothesized that serum vitamin D levels are reduced in ASD and correlate with the severity of disease. Also, we hypothesized that vitamin D3 treatment may be beneficial for a considerable portion of children with ASD.

Methods: In total, 215 children with ASD and 285 healthy control children were recruited in our study. Thirty seven of 215 ASD children received vitamin D3 treatment. The Autism Behaviour Checklist (ABC) and the Childhood Autism Rating Scale (CARS) were used to assess autism symptoms. High-performance liquid chromatography was used to assess the serum 25-hydroxyvitamin D [25(OH) D] level. Evaluations of ABC, CARS, and serum 25(OH) D levels were performed before and after 3 months of treatment.

Results: Serum levels of 25(OH) D were significantly lower in ASD children than typically developing children. Levels of serum 25(OH) D were negatively correlated with ABC total scores and language subscale scores. After vitamin D3 supplementation, symptom scores were significantly reduced on the CARS and ABC. In addition, the data also suggest that treatment effects were more pronounced in younger children with ASD.

Conclusion: Vitamin D deficiency might contribute to the aetiology of ASD. Supplementation of vitamin D3, which is a safe and cost-effective form of treatment, may significantly improve the outcome of some children with ASD, especially younger children (identifier ChiCTR-CCC-13004498).

Clinical Trial Registration: The trial ‘Association of Polymorphisms of Vitamin D Metabolism-Related Genes With Autism and the Treatment of Autism with Vitamin D’ has been registered at www.chictr.org/cn/proj/show.aspx? proj=6135 (identifier ChiCTR-CCC-13004498).     

Association between pica and gastrointestinal symptoms in preschoolers with and without autism spectrum disorder: Study to Explore Early Development

BackgroundPica, the repeated ingestion of nonfood items, can result in gastrointestinal (GI) outcomes. Children with autism spectrum disorder (ASD) and other developmental disabilities (DDs) are disproportionately affected by both pica and GI symptoms. Study of the inter-relationship between pica, GI symptoms, and ASD/DD is limited.Objective/HypothesisWe assessed associations between pica and GI symptoms in preschool-aged children with and without ASD and other (non-ASD) DDs in the Study to Explore Early Development.MethodsOur sample included children with ASD (n = 1244), other DDs (n = 1593), and population (POP) controls (n = 1487). Data to define final case-control status, pica, and GI symptoms were from standardized developmental assessments/questionnaires. Prevalence ratios, adjusted for sociodemographic factors (aPRs), and 95% confidence intervals were derived from modified Poisson regression.ResultsWithin each group (ASD, DD, POP) and for the total sample, pica was associated with vomiting (aPR for total sample 2.6 [1.7, 4.0]), diarrhea (1.8 [1.4, 2.2]), and loose stools (1.8 [1.4, 2.2]). In the DD group, pica was associated with constipation (1.4 [1.03, 1.9]) and pain on stooling (1.8 [1.2, 2.6]). In analyses of the subgroup without pica, increases in GI symptoms were still evident in the ASD and DD groups compared to POP group.ConclusionThese findings highlight an important adverse effect of pica, GI symptoms, in children with and without ASD and DDs; nonetheless, pica does not fully explain the increased risk for GI symptoms among children with ASD and DDs. These findings inform the specialized healthcare needs of children with ASD and other DDs.     

Patient attitudes towards and experiences with an intervention programme to reduce chronic acid-suppressing drug intake in primary care

Abstract

Objective: Many patients are using acid-suppressing drugs (ASD) unnecessary. An insurance company initiated intervention programme aiming at reduction of chronic ASD use, was introduced in primary care-practices. We evaluated the attitude and experiences of the participating patients. Methods: A survey was conducted among a random sample of 2376 long-term ASD users using a validated questionnaire that combined CAHPS and QUOTE methodology. Using a psychometric principal component analysis we assessed the role of GPs in three scales: quality of support; communication and conduct; involvement in decisions. Both the importance of and experiences with quality items, transformed into quality impact indices, were measured. Results: Of 2376 questionnaires distributed, 1808 (76%) were returned, 1270 (54%) were valid. 188 were of patients that participated in the programme. The majority was dissatisfied with the GPs’ support: no information about rebound side effects (76%), lifestyle habits (68%), and reasons to stop (50%). Compared to the non-participants 9% more participants stopped ASD use (P = 0.04).

Conclusion: A majority of patients on chronic ASD was prepared to participate in the drug-reduction programme. Although 16% succeeded in stopping ASD use, the majority was dissatisfied with the role of the GP. Improved GP support might have make more patients stop using ASD.     

Interventions on Sexuality for Adolescents with Autism Spectrum Disorder: A Systematic Review

Sexuality and intimate relationships are topics of interest to adolescents and young adults with Autism Spectrum Disorder (ASD). Given their relative difficulties to the social dimension, several intervention programs have been developed to meet this demand, but the complexity of the reality experienced by these young people limits the effectiveness of these intervention programs. To find the effects of different intervention programs to influence the development of sexuality and sexual health of adolescents with ASD and determine the impact of these interventions on the parents, through a systematic review. Literature review conducted on November 27, 2019 in the psycINFO, Pubmed, web of science and CINAHL databases. Intervention programs consisting solely of teaching sessions improve the knowledge of the youth. However, when they also included a direct approach or homework, behavioral effects were also observable. Parent-focused intervention programs resulted in a slight increase in parents’ comfort level and ability to interact well with their youth. Intervention programs targeting school-based workers appear to have a limited effect, having good concrete results with youth for some workers and no results for others, while intervention programs targeting health professionals have no conclusive results. The results of the literature review are not very transferable to practice because of the low level of evidence in the articles included, however, they offer an interesting starting point. Further research is needed to equip health professionals to intervene in sexuality after youth with ASD.

     

Fat intake in children with autism spectrum disorder in the Mediterranean region (Valencia,Spain)

Objective: Children with autism spectrum disorder (ASD) have been found to have alterations in dietary fat intake and fat quality. The fat intakes of the foods consumed by children with and without ASD were compared, and the deficiency and excess of these nutrients were examined.

Methods: In a matched case–control study, 3-day food diaries were completed by 105 children with ASD and 495 typically developing (TD) 6- to 9-year-old children in Valencia (Spain). We used the probabilistic approach and estimated average requirement cut-point to evaluate the risk of inadequate nutrients intakes. These were compared between groups and with Spanish recommendations using linear and logistic regression, respectively.

Results: Groups did not differ significantly in age, total dietary intake, Healthy Eating Index, or food variety score. Children with ASD had lower saturated fatty acids (SFAs) and ω-3 polyunsaturated fatty acids (PUFAs) intakes, but their total PUFAs and (PUFAs?+?monounsaturated fatty acids (MUFAs)/SFAs, PUFAs/SFAs intakes and ω-6/ω-3 ratios were higher than TD children. The total fat and cholesterol intakes of both groups were slightly above Spanish recommendations. Both groups had low ω-6 intakes, very low ω-3 intakes, and high ω-6/ω-3 ratios.

Conclusion: Further research is required to clarify associations between ASD symptomatology, fat-eating patterns and health status.     

A Case Series of Cognitive-Behavioral Therapy Augmentation of Antidepressant Medication for Anxiety in Children With Autism Spectrum Disorders

Objective: To provide preliminary estimates of the effectiveness of cognitive-behavioral therapy (CBT) in treating anxiety disorders among youth with autism spectrum disorders (ASD) whose anxiety remained clinically problematic following an adequate course of pharmacotherapy.

Method: Seven youth with ASD and one or more comorbid anxiety disorders, who were non- or partial-responders to serotonin reuptake inhibitor (SRI) treatment delivered by their community provider (age range = 12–15 years), received 16 sessions of weekly CBT. Assessments were administered at baseline, approximately 17 weeks following baseline (pre-treatment), and after receiving CBT (post-treatment).

Results: Four of seven participants were classified as treatment responders (much or very much improved) at post-treatment. Clinician severity ratings for 6 of 7 participants—as measured by the PARS, ADIS-IV-P, and CGI-Severity—decreased following CBT, with effect sizes ranging from 1.35 to 1.54. Parent-rated anxiety and ASD symptoms in the child were not significantly reduced.

Conclusions: This study provides preliminary support for use of CBT in augmenting SRI treatment in youth with ASD and anxiety.     

The role of probiotics in children with autism spectrum disorder: A prospective,open-label study

Objective: There are limited data on the efficacy of probiotics in children with ASD, therefore, this study aims to evaluate the efficacy and tolerability of probiotics in an Egyptian cohort of children with ASD.

Methods: Gastrointestinal (GI) flora were assessed by quantitative real-time PCR of stool samples of 30 autistic children from 5 to 9 years old. GI symptoms of autistic children were assessed with a modified six-item Gastrointestinal Severity Index (6-GSI) questionnaire, and autistic symptoms were assessed with Autism Treatment Evaluation Checklist (ATEC) before and after 3 months of supplementation of probiotics nutritional supplement formula (each gram contains 100?×?10⁶ colony forming units of three probiotic strains; Lactobacillus acidophilus, Lactobacillus rhamnosus and Bifidobacteria longum).

Results: After probiotic supplementation, the stool PCR of autistic children showed increases in the colony counts of Bifidobacteria and Lactobacilli levels, with a significant reduction in their body weight as well as significant improvements in the severity of autism (assessed by the ATEC), and gastrointestinal symptoms (assessed by the 6-GSI) compared to the baseline evaluated at the start of the study.

Conclusions: We concluded that probiotics have beneficial effects on both behavioral and GI manifestations of ASD. Probiotics (a non-pharmacological and relatively risk-free option) could be recommended for children with ASD as an adjuvant therapy. At this stage, this study is a single center with a small number of patients and a great deal of additional wide-scale randomized controlled trials are needed to critically confirm the efficacy of probiotics in ASD.

Trial registration number: UMIN-CTR Study Design: Trial Number UMIN000026157     

Mediators of the association between parental severe mental illness and offspring neurodevelopmental problems

PurposeParental severe mental illness (SMI) is associated with an increased risk of offspring autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD). We conducted a study to examine the extent to which risk of preterm birth, low birth weight, and small for gestational age mediated this association.MethodsWe obtained data on offspring born 1992–2001 in Sweden (n = 870,017) through the linkage of multiple population-based registers. We used logistic and Cox regression to assess the associations between parental SMI, adverse pregnancy outcomes, and offspring ASD and ADHD, as well as tested whether adverse pregnancy outcomes served as mediators.ResultsAfter controlling for measured covariates, maternal and paternal SMI were associated with an increased risk for preterm birth, low birth weight, and gestational age, and for offspring ASD and ADHD. These pregnancy outcomes were also associated with an increased risk of ASD and ADHD. We found that pregnancy outcomes did not mediate the association between parental SMI and offspring ASD and ADHD, as there was no substantial change in magnitude of the risk estimates after controlling for pregnancy outcomes.ConclusionsParental SMI and adverse pregnancy outcomes appear to be independent risk factors for offspring ASD and ADHD.     

Vitamin A and vitamin D deficiencies exacerbate symptoms in children with autism spectrum disorders

Objectives: This study was designed to investigate the vitamin A (VA) and vitamin D (VD) levels in children with autism spectrum disorders (ASD) and to determine whether co-deficiency of VA and VD exacerbates clinical symptoms in autistic children.

Methods: The Autism Behavior Checklist, Childhood Autism Rating Scale (CARS), and Social Responsiveness Scale (SRS) were used to assess the symptoms of 332 children diagnosed as ASD. And the Gesell Developmental Scale (GDS) was used to evaluate neurodevelopment in children with ASD. Anthropometric measurement and questionnaire results were compared for all autistic children and 197 age- and gender-matched control children. Serum retinol levels were detected with high-performance liquid chromatography, and serum levels of 25-OH vitamin D were measured with an immunoassay method in the two groups.

Results: The Z_HA, Z_WA, and Z_BMIA of the children with ASD were significantly lower than those of the control children. Furthermore, higher proportions of children with picky eating, resistance to new foods, and eating problems were observed in the ASD group when compared with the control group. Serum retinol and 25-OH vitamin D levels in autistic children were significantly lower than those in the control children. Additionally, VA and VD co-deficiency impacts more on the symptoms and development in autistic children.

Conclusions: We found that children with autism have more VA and VD deficiencies than control children, and VA and VD co-deficiency may exacerbate the symptoms of children with ASD.     

Community participation and environment of children with and without autism spectrum disorder: parent perspectives

Aim: This study explored parent perspectives of participation patterns and environmental supports and barriers for high-functioning children with autism spectrum disorder (ASD) within their communities compared with a group of children without ASD.

Method: The Participation and Environment Measure for Children and Youth was used to gather online data from parents of 99 children with ASD and 241 children without ASD. Mann–Whitney U test and chi-square tests were used to explore differences between groups and Cohen's d was calculated to examine effect sizes.

Results: Significant differences between children with and without ASD were observed for all participation and environment summary scores. Children with ASD participated less frequently, were less involved, and their parents were less satisfied with their child’s participation in community-based activities. Parents of children with ASD also identified fewer supports for their child’s participation and more environmental barriers than other parents.

Conclusion: Children with ASD participated less in community-related activities than children without ASD as perceived by their parents. Barriers limiting community participation included features of the social and physical environment and limited resources.

Significance: Occupational therapists should focus on decreasing environmental challenges in their efforts to facilitate participation of children with ASD in the community.     

Parental report of vaccine receipt in children with autism spectrum disorder: Do rates differ by pattern of ASD onset?

A contentious theory espoused by some parents is that regressive-onset of autism spectrum disorder (ASD) is triggered by vaccines. If this were true, then vaccine receipt should be higher in children with regressive-onset ASD compared with other patterns of onset. Parental report of rate of receipt for six vaccines (DPT/DTaP, HepB, Hib, polio, MMR, varicella) was examined in children with ASD (N = 2755) who were categorized by pattern of ASD onset (early onset, plateau, delay-plus-regression, regression). All pairwise comparisons were significantly equivalent within a 10% margin for all vaccines except varicella, for which the delay-plus-regression group had lower rates of receipt (81%) than the early-onset (87%) and regression (87%) groups. Findings do not support a connection between regressive-onset ASD and vaccines in this cohort.