Audiovisual integration and the P2 component in adult Asperger’s syndrome: An ERP-study

BackgroundA widened temporal window of integration (TWI) in audiovisual processing has been detected for children with autism spectrum disorder. However, research indicates a narrowing of this TWI and an associated change in audiovisual integration in the course of development.MethodsTo further elucidate audiovisual integration processes in adulthood, we compared adult participants with Asperger’s Syndrome (AS) to healthy controls (HC) by using the sound-induced double flash illusion. For a better understanding of underlying neural mechanisms, event-related potentials were measured via electroencephalography (EEG).ResultsThe number of reported sound-induced flash illusions indicated audiovisual integration. A similar TWI size for both, participants with AS and HC, was found. Additionally, enhanced P2 amplitudes were detected for participants with AS compared to HC.ConclusionResults indicate an involvement of attentional processes in audiovisual perception in participants with AS.     

Psychophysiological measures of stress in caregivers of individuals with autism spectrum disorder: a systematic review

Purpose: Parents of children with autism spectrum disorder (ASD) often self-report heightened levels of stress and physical health problems. This paper reviewed studies assessing physiological measures of stress among parents of children with ASD.

Methods: Systematic database searches identified 15 studies meeting inclusion criteria. Studies were reviewed to determine: (a) control group characteristics; (b) caregiver and care recipient characteristics; (c) setting; (d) physiological measures employed; (e) physiological outcomes; and (f) stressor type. A measure of methodological quality was also applied.

Results: Salivary cortisol was the most common physiological measure employed. A pattern of blunted physiological activity emerged within the reviewed studies, though some studies reported normal or even higher physiological activity among this population.

Conclusions: Findings suggested dysfunction of the hypothalamic-pituitary-adrenal-axis and autonomic nervous system for some, but not all, parents of children with ASD. Further research is warranted.     

Influence of a Gluten-free,Casein-free Diet on Behavioral Disturbances in Children and Adolescents Diagnosed with Autism Spectrum Disorder: A 3-month Follow-up Pilot Study

ABSTRACT

Introduction: Diet and dietary interventions have drawn considerable attention in the literature as etiopathogenic factors and therapeutic approaches to Autism Spectrum Disorders (ASD), respectively. The objective of this study was to determine the influence of a gluten-free, casein-free (GFCF) diet on the alterations of behavior in children and adolescents diagnosed with ASD. We also aim to explore the possible association between ASD symptoms and urinary concentrations of beta-casomorphin.

Methods: A total of 28 patients were recruited for this crossover clinical trial. Patients followed a normal diet (including gluten and casein) for three months and a GFCF diet for another three months. The order of the intervention —i.e., beginning with normal diet or with GFCF diet— was determined at random. The subjects were evaluated at three time points: at the onset of the study, after the first diet, and after the second diet. Each evaluation entailed three questionnaires on behavior and autism, a food frequency questionnaire (to determine adherence to the diet) and a determination of concentrations of beta-casomorphin in urine using chromatographic techniques.

Results: No significant behavioral changes were found after a GFCF diet. No association was found between ASD symptoms and urinary concentrations of beta-casomorphin.

Conclusion: A GFCF diet followed for three months do neither show significant changes in behavioral symptoms of autism nor in urine concentrations of beta-casomorphin using chromatographic detection. However, we need further studies including elements of placebo and double-blindness and more sophisticated beta-casomorphin detection techniques to better define subjects who might benefit from these diets.     

Exploring maximizing,satisficing and minimizing tendency in decision-making among autistic and neurotypical individuals

BackgroundThe tendency to maximize is one of the most frequently studied personal traits in choice-making and decision-making. In spite of the large resemblances between the decision behaviour that is characteristic for maximizers and the decision behaviour displayed by individuals with autism, and the considerable overlap in the list of decision problems and decision experiences commonly reported by maximizers and individuals with autism, the question whether individuals with autism are more maximizing in decision-making as compared to neurotypical controls, has remained unexamined in the literature. The paper measures and compares the tendency to maximize, satisfice, and minimize in choice- and decision-making among autistic individuals and age, gender- and education degree-matched neurotypical individuals.MethodThe Decision Making Tendency Inventory measurement scale (Misuraca et al., 2015) is used to measure six types of decision-making tendency: fearful maximizing, resolute maximizing, more ambitious satisficing, less ambitious satisficing, parsimonious minimizing, and indolent minimizing. A multi-group confirmatory factor analysis and comparison of the differences in latent means is performed.ResultsThe results demonstrate that autistic individuals are similar to neurotypical individuals when it comes to having a tendency to satisfice or minimize in decision-making, however, autistic individuals do score higher in terms of adopting a fearful and resolute maximizing tendency than neurotypical individuals.ConclusionsResults suggest that higher maximizing tendency may explain for some of the difficulties experienced by autistic individuals in decision-making     

Créativité numérique et innovation thérapeutique : recréer un lieu de soin sur Minecraft

ObjectivesToday, video games are recognized as an excellent tool for therapeutic mediation with young children with Autism Spectrum Disorder (ASD), playing the role of a malleable medium facilitating the evolution of group dynamics and creating a play area between the child and the adult, a space of creativity and shared pleasure allowing them to “be together,” to communicate, and to enter into a secure and holding-type intersubjective relationship. This is why we wanted to maintain this type of treatment during the general lockdown imposed in France in March 2020.MethodWe set up a virtual activity based on the use of the video game Minecraft, after having reconstituted our outpatient clinic for children and adolescents on a private server. Following the end of the lockdown, we were able to experiment with two workshops: one face-to-face; and the other in video therapy.ResultsWe were able to observe similarities and differences in the use of this medium by our young ASD patients, but also in the way in which this treatment allowed us to “put a little institution” back into the daily lives of youth during lockdown. Thus, we were able to see that the content of the Minecraft game, and more specifically the reconstructed clinic, functioned as a space of holding for the adolescents. The comparison between the digital institution and the real institution was present throughout the session in the adolescents’ exploratory actions. However, they were never “tricked” by this virtual reality, each one considering this digital clinic as a simple simulation of the institution where they go for treatment.DiscussionIt should be noted, however, that this type of mediation is not the easiest to set up for a team of professionals. Indeed, we were confronted with certain difficulties, notably the amount of time required to recreate the clinic in the game, problems with the private servers, the quality of the hardware, and the extraordinary public health situation.ConclusionThis therapeutic workshop with digital mediation allowed the very early establishment of a group dynamic and of a group psychic envelope. Therapy sessions conducted in Minecraft allowed us to work on group dynamics, on the real and digital representations of a place of care, on the children's identity references (therapeutic groups, home, etc.), and on their capacity to play in a group. The adolescents enrolled were able to individually search for their own identity markers, according to their place in the institution. Finally, the Minecraft project allowed for the emergence of many interactions and shared emotions between the members of the therapeutic group (children and adults).     

Packing : quand des parents témoignent

ObjectiveIn a very controversial context that led to a packing ban in 2016, the aim of this study was to give a voice to parents of autistic children who are not visible in the media and who have experienced packing for their child.Methods and resultsThrough the intermediary of a child psychiatrist, seven in-depth interviews were carried out in Seine-Saint-Denis, a suburb where the index of social disadvantage is very high and where there is a significant shortage of places and resources. Seven mothers of children with autism agreed to testify to report on the help provided by professionals and the beneficial effects of packing on the most problematic manifestations: self-injury, perceptual problems, anxiety, agitation, and shouting.ConclusionThese testimonies reveal a clear discrepancy between the satisfaction of the parents who spoke out and the anti-packing movement of parents’ associations that influence public policy. They reflect a complex situation that requires the cooperation of different professionals to best answer the questions posed by certain symptoms and manifestations of extreme distress.     

Approches thérapeutiques des troubles du sommeil et des rythmes chez l’enfant avec TSA

Sleep disturbances are extremely common (40–86%) in children and adolescents, especially those with autism spectrum disorders (ASD) and are often among the first symptoms identified by parents at a very early stage of their child's development. These abnormalities are among the main parental concerns when having a child with ASD and have a significant impact on the quality of life of patients, their parents, and more broadly their siblings. Sleep disorders are essentially abnormalities of the sleep-wake rhythm – primarily sleep onset insomnia or nocturnal awakenings (with difficulty falling back to sleep). These disturbances can be accompanied by other sleep disorders, requiring notably a systematic elimination of the presence of a sleep apnea or restless legs syndrome – to ensure a personalized and efficient therapeutic approach. Physiologically, the determinants of these sleep disorders are poorly understood, even though several studies point to a significant decrease in melatonin synthesis in people with ASD. Melatonin is a hormone that facilitates falling asleep and maintaining sleep and is also involved in the endogenous synchronization of internal biological clocks. However, the causal factors of this decrease in melatonin synthesis are largely unknown, involving to a small extent the genes involved in melatonin synthesis pathway. The treatment of sleep disorders is relatively systematic: after eliminating other specific sleep disorders associated with the complaint of insomnia, as well as other possible associated comorbidities (such as seizures), a global and graduated therapeutic approach must be put in place. This treatment will be non-pharmacological as a first line, then pharmacological as a second line. A number of non-pharmacological treatment strategies for sleep disorders in typically developing children and adolescents, as well as those with ASD, have been shown to be effective. This treatment requires a combination of: 1) parental education to promote sleep development; 2) setting up bedtime rituals adapted to the child's age and particularities; 3) specific behavioral strategies including bedtime fading, gradual extinction and positive reinforcement of adapted behaviors. It is very essential that the parents are accompanied throughout this therapy. Sleep hygiene and behavioral care must also take into consideration the important role of the zeitgebers of sleep-wake rhythms, i.e. the external environmental factors involved in the synchronization of the biological clocks: regular exposure to light at adapted times, regular meal and wake-up times, social activities and times for going to school. The evidence for the effectiveness of behavioral interventions in the treatment of behavioral insomnia in the typical developmental child is strong, since 94% of children show clinically significant improvements in nighttime sleepiness and waking. By contrast, only about 25% of children with ASD are improved by an approach combining sleep hygiene and behavioral therapy. Melatonin has a special and prominent place in the drug management of sleep disorders associated with ASD. Several clinical trials have shown that melatonin is effective in treating sleep disorders in patients with ASD. This work led to the European Medicines Agency (EMA) granting marketing authorization in September 2018 for a sustained-release paediatric melatonin molecule (Slenyto®). This synthetic molecule is a prolonged release melatonin (PRM) which mimics the physiological pharmacokinetic and secretory characteristics of endogenous melatonin, having a very short blood half-life and prolonged secretion for several hours during the night. A recent study evaluated the efficacy and safety of pediatric PRM (mini-tablets) in 125 children, aged 2 to 17.5 years with mainly ASD. After 15 days on placebo, the children were randomized into two parallel groups, PRM or placebo in a double-blind design for 13 weeks. At endpoint, total sleep time was increased by an average of 57.5 minutes on PRM and only 9.14 minutes on placebo (P = 0.034). This difference between the two groups was already significant after three weeks of treatment (P = 0.006). Sleep latency was also improved in the PRM group (?39.6 minutes) compared to placebo (?12.51 minutes) (P = 0.01). Consolidated sleep duration (uninterrupted by awakenings) was improved by 77.9 minutes for the PRM group and only 25.4 minutes for the placebo group (P < 0.001). PRM was well tolerated, the most frequent side effects being headache and daytime drowsiness at the same level with PRM or placebo. In addition, the acceptability by the children for swallowing the mini-tablets was excellent (100% compliance). The efficacy and tolerability of PRM was maintained over the medium and long term in the open phase, over a total study duration of 2 years.