Moderating effects of challenging behaviors and communication deficits on social skills in children diagnosed with an autism spectrum disorder

One-hundred nine children 3–16 years of age diagnosed with Autistic Disorder, Pervasive Developmental Disorder Not Otherwise Specified, or Asperger's Syndrome were studied. Children resided in six states in the United States. Using moderation analysis via multiple regression, verbal communication and challenging behaviors and how they interact with social skills were examined. Children and adolescents exhibiting fewer challenging behaviors and presenting with better verbal communication skills had the greatest strengths in social skills. Furthermore, challenging behaviors adversely affected social skills more than verbal communication skills. Thus, regardless of verbal communication level, children with low levels of challenging behaviors exhibited greater social skills. Clinical implications of these findings and directions for future research are discussed.     

The management of cyclic vomiting syndrome: a systematic review

Cyclic vomiting syndrome (CVS) is a rare abnormality of the neuroendocrine system that affects 2% of children. It is a frequently missed diagnosis in the emergency department and may require a number of emergency department visits before the diagnosis is made. The objectives of this review are to identify the clinical features that suggest a diagnosis of CVS and to review the literature on its management. The MEDLINE and EMBASE databases were searched from January 1948 to October 2011 using the keywords 'Cyclic' or 'Vomiting'. Papers were excluded if they did not follow the consensus guidelines or if they were case reports. This review analysed 1093 cases of cyclic vomiting in 25 papers that fulfilled the inclusion criteria. All except one paper were retrospective studies. The size of these cohort studies ranged from three to 181 patients, with a mean patient size of 29. This review found that over 40% of patients have headaches/migraines, with associated anxiety and depression in ≈ 30% of cases. There is a family history of headaches/migraines in 38.9%, and this association was much stronger in the adult CVS cohort compared with the paediatric cohort. Compared with paediatric CVS, adults have a longer duration of attacks and they occur more frequently (5.9 vs. 3.4 days, 14.4 vs. 9.6 episodes/year). Limited data are available on the treatment of the acute phase of CVS, but in adults, sumatriptan has been shown to be effective. For prophylactic treatment, tricyclics are effective in both adult and paediatric CVS, with a clinical response in 75.5 and 67.6% of patients, respectively, in nonplacebo-controlled cohort studies. Furthermore, propranolol has been shown to be useful in children. CVS is an intractable illness with a major impact on the patient's quality of life. There is a long duration between the onset of symptoms and the diagnosis of the condition. There is a high association with headaches/migraines and anxiety/depression. The symptoms are more severe in adult-onset CVS. Tricyclic antidepressants have good efficacy in reducing the frequency/duration or the intensity of attacks. There is limited evidence on the acute management of CVS.     

A case of severe osteomalacia secondary to phosphate diabetes in a renal transplant recipient

Transient hypophosphatemia is frequently observed during the first months after renal transplantation and is usually asymptomatic. Phosphate diabetes is defined as inadequate tubular phosphorus reabsorption leading to persistent renal phosphorus wasting, which is an important but overlooked cause of osteodystrophy in the post-renal transplantation population. We report the case of a 58-year-old male who presented with severe multiple osteoarticular pains within 3 months after successful first kidney transplantation. Bone disease was attributed initially to mild hyperparathyroidism secondary to vitamin D deficiency. Despite the correction of the hyperparathyroidism, the withdrawal of corticosteroids, and the reduction of immunosuppressive treatment to tacrolimus-based monotherapy, the osteoarticular pains persisted. Skeletal investigations at month 9 post-transplantation demonstrated a significant bone mineral density loss associated with osteomalacia and osteoporosis on the bone biopsy. Laboratory data showed persistent hypophosphatemia, and phosphate diabetes was then diagnosed explaining the post-transplant bone disease. A tacrolimus-induced renal tubular disorder was suspected to contribute to the excessive renal phosphorus wasting. The replacement of tacrolimus by sirolimus, in addition to oral phosphorus and vitamin D supplementations, led to the disappearance of pains, the normalization of urinary and plasma phosphate level, and a significant improvement of bone mineralization.     

The moderating effects of intellectual development on core symptoms of autism and PDD-NOS in toddlers and infants

Little research has been conducted on whether deficits in developmental functioning affect the range of core symptoms for autism spectrum disorders (ASD). This study represents a first attempt to determine whether developmental level has an effect on the expression of ASD symptoms in infants and toddlers. Eight hundred and fifty-three infants were evaluated with respect to the nature and extent of their ASD symptoms and developmental functioning. Young children with autism displayed a higher number of symptoms than those with PDD-NOS on all three domains of impairment (social, communication, repetitive behaviors). As expected, children without an ASD evinced far fewer symptoms than both these groups. Developmental level was not found to be a moderator for expression of ASD symptoms for the entire sample, or individual diagnostic groups. Higher developmental level was associated with lower severity of evinced ASD symptoms in the sample.     

Questions About Behavioral Function (QABF): Adaptation and validation of the Spanish version

People with intellectual disabilities (ID) often engage in problem behaviors, such as verbal or physical aggression, property destruction, or self-injury. These behaviors become a challenge for the families and for professionals. Functional behavioral assessment (FBA) is a method used to identify variables that influence or maintain challenging behaviors (CB) and aid in the development of intervention plans. Two major concerns of FBA are that it is time-consuming and requires specialized professionals to interpret data from the natural or experimental environment. Therefore, indirect FBA methods can be used as an alternative. An instrument with excellent psychometric properties that aims to identify the function of behavior is the Questions About Behavioral Function (QABF). This study presents the adaptation of the QABF in Spain. Data from 300 participants with ID and 328 behavioral problems were obtained. An exploratory factor analysis was conducted to identify the components of the QABF, and the test–retest reliability was assessed to evaluate the stability of the QABF over time.     

Food selectivity in children with and without an autism spectrum disorder: Investigation of diagnosis and age

Feeding problems are common in children with autism spectrum disorders (ASDs), with food selectivity being the most frequently reported. Selectivity based on type and/or texture of food is of concern in those with ASD. Variations in symptom presentation of food selectivity in children with different autism spectrum diagnoses across childhood have not often been investigated. Parent-report of food selectivity was examined in 525 children age 2–18 years diagnosed with autistic disorder, PDD-NOS, Asperger's disorder, atypical development, and typical development using information garnered from the Autism Spectrum Disorder-Comorbidity for Children (ASD-CC), a tool to assess emotional issues and comorbid psychopathology. Individuals with an ASD were reported to have significantly more food selectivity than both the atypically developing group and the typically developing group. In addition, the ASD groups, when looked at together, showed a decrease in food selectivity across childhood with significant decrease in the Asperger's disorder group.     

The acute effect of exercise intensity on free throws in young basketball players

Purpose

Free throws (FT) accuracy is a major determinant of performance in basketball game. However, the effect of exercise intensities on FT accuracy has not been well studied. The aim of the present study was to examine the effect of different exercise intensities on FT accuracy in young male basketball players.

Methods

For this aim, 22 basketball players (age 16.12 ± 1.16 years, body mass 76.4 ± 13.3 kg and height 186.4 ± 8.9 cm), classified into 2 age groups (younger 15.28 ± 0.48 years, n = 11; older 16.97 ± 1.00 years, n = 11). The participants performed 50 FT under five conditions (i.e. 10 FT per condition): after rest (A), after 3 min shuttle running with ~9 km h^?1 (B), ~9.5 km h^?1 (C), ~10 km h^?1 (D) and ~10.5 km h^?1 (E).

Results

The analysis of variance showed a main effect of exercise intensity on FT accuracy (p = 0.003, η ² = 0.585), heart rate (HR) (p < 0.001, η ² = 0.990) and rate of perceived exertion (RPE) (p < 0.001, η ² = 0.703): (a) FT accuracy in the C and D conditions was higher than the A condition (p ≤ 0.004); (b) all conditions differed for HR (p ≤ 0.047), the higher was the exercise intensity the higher was the HR, whereas no difference was revealed between D and E conditions; (c) the same trend as in the HR was observed in RPE (i.e. the higher the exercise intensity, the higher the RPE), too, where all conditions differed (p ≤ 0.047), except between C and D, and between D and E conditions.

Conclusions

There was a significant exercise intensity × age interaction for RPE (p = 0.011, η ² = 0.516), but not for FT accuracy (p = 0.336, η ² = 0.224) or HR (p = 0.128, η ² = 0.329). The findings of the present study showed that a minimum of exercise intensity was necessary to achieve peak FT performance and a shape of inverse U was suggested for the relationship between FT accuracy and exercise intensity.