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Aldo Lorenzetti M.D, Internal Medicine & Hepatology, Milano - SIMEDET Delegate
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#Sex differences in parent-reported executive functioning and adaptive behavior in children and young adults with #autism spectrum disorder
http://onlinelibrary.wiley.com/doi/10.1002/aur.1811/abstract;jsessionid=2D63CB98F175F46007684DAABB288865.f03t02

This study is the largest to date examining executive function and adaptive skills in females with autism spectrum disorder (ASD). Its primary aim was to utilize parent ratings of real-world executive functioning and adaptive behavior to better understand whether females with ASD differ from males with ASD in these areas of everyday functioning.

Our results indicate relative weaknesses for females compared to males diagnosed with ASD on executive function and daily living skills. These differences occur in the absence of sex differences in our sample in age, IQ, clinician ratings of core ASD symptomatology, parent ratings of ADHD symptoms, and parent-reported social and communication adaptive skills on the VABS. These findings indicate specific liabilities in real world EF and daily living skills for females with ASD and have important implications for targeting their treatments
Effects of Improvisational #Music Therapy vs Enhanced Standard Care on Symptom Severity Among Children With #Autism Spectrum Disorder

The TIME-A Randomized Clinical Trial http://jamanetwork.com/journals/jama/article-abstract/2647867

Music therapy may facilitate skills in areas affected by autism spectrum disorder (ASD), such as social interaction and communication

From baseline to 5 months, mean ADOS social affect scores estimated by linear mixed-effects models decreased from 14.08 to 13.23 in the music therapy group and from 13.49 to 12.58 in the standard care group (mean difference, 0.06 95% CI, −0.70 to 0.81; P = .88), with no significant difference in improvement. Of 20 exploratory secondary outcomes, 17 showed no significant difference.

Conclusions and Relevance Among children with autism spectrum disorder, improvisational music therapy, compared with enhanced standard care, resulted in no significant difference in symptom severity based on the ADOS social affect domain over 5 months. These findings do not support the use of improvisational music therapy for symptom reduction in children with autism spectrum disorder
Antenatal nutritional #supplementation and #autism spectrum disorders in the Stockholm youth cohort: population based cohort study
http://www.bmj.com/content/359/bmj.j4273

To determine whether nutritional supplementation during pregnancy is associated with a reduced risk of autism spectrum disorder (ASD) with and without intellectual disability in offspring

Prevalence of ASD with intellectual disability was 0.26% (158 cases in 61 934) in the maternal multivitamin use group and 0.48% (430 cases in 90 480) in the no nutritional supplementation use group. Maternal multivitamin use with or without additional iron or folic acid, or both was associated with lower odds of ASD with intellectual disability in the child compared with mothers who did not use multivitamins, iron, and folic acid (odds ratio 0.69, 95% confidence interval 0.57 to 0.84). Similar estimates were found in propensity score matched (0.68, 0.54 to 0.86) and sibling control (0.77, 0.52 to 1.15) matched analyses, though the confidence interval for the latter association included 1.0 and was therefore not statistically significant. There was no consistent evidence that either iron or folic acid use were inversely associated with ASD prevalence.

Conclusions Maternal multivitamin supplementation during pregnancy may be inversely associated with ASD with intellectual disability in offspring. Further scrutiny of maternal nutrition and its role in the cause of autism is recommended
Association of Maternal Use of #Folic Acid and Multivitamin Supplements in the Periods Before and During Pregnancy With the Risk of #Autism Spectrum Disorder in Offspring
https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2667432

Of the 45 300 children in the study (22 090 girls and 23 210 boys; mean SD age, 10.0 1.4 years at the end of follow-up), 572 (1.3%) received a diagnosis of ASD. Maternal exposure to folic acid and/or multivitamin supplements before pregnancy was statistically significantly associated with a lower likelihood of ASD in the offspring compared with no exposure before pregnancy (RR, 0.39; 95% CI, 0.30-0.50; P < .001). Maternal exposure to folic acid and/or multivitamin supplements during pregnancy was statistically significantly associated with a lower likelihood of ASD in offspring compared with no exposure during pregnancy (RR, 0.27; 95% CI, 0.22-0.33; P < .001). Corresponding RRs were estimated for maternal exposure to folic acid before pregnancy (RR, 0.56; 95% CI, 0.42-0.74; P = .001), maternal exposure to folic acid during pregnancy (RR, 0.32; 95% CI, 0.26-0.41; P < .001), maternal exposure to multivitamin supplements before pregnancy (RR, 0.36; 95% CI, 0.24-0.52; P < .001), and maternal exposure to multivitamin supplements during pregnancy (RR, 0.35; 95% CI, 0.28-0.44; P < .001). The results generally remained statistically significant across sensitivity analyses.

Conclusions and Relevance Maternal exposure to folic acid and multivitamin supplements before and during pregnancy is associated with a reduced risk of ASD in the offspring compared with the offspring of mothers without such exposure
Association of Prenatal #Ultrasonography and #Autism Spectrum Disorder

https://jamanetwork.com/journals/jamapediatrics/fullarticle/2672728


A total of 420 participants were included in the study (328 boys 78.1% and 92 girls 21.9%; mean age as of January 1, 2016, 6.6 years; 95% CI, 6.5-6.8 years). The ASD group received a mean of 5.9 scans (95% CI, 5.2-6.6), which was not significantly different from the 6.1 scans (95% CI, 5.4-6.8) in the developmental delay group or the 6.3 scans (95% CI, 5.8-6.8) in the typical development group. Compared with the typical development group, the ASD group had shorter duration of ultrasound exposure during the first (290.4 seconds 95% CI, 212.8-368.0 seconds vs 406.4 seconds 95% CI, 349.5-463.3 seconds) and second (1687.6 seconds 95% CI, 1493.8-1881.4 seconds vs 2011.0 seconds 95% CI, 1868.9-2153.1 seconds) trimesters but no difference in the number of scans. The ASD group had greater mean depth of ultrasonographic penetration than the developmental delay group in the first trimester (12.5 cm 95% CI, 12.0-13.0 cm vs 11.6 cm 95% CI, 11.1-12.1 cm). The ASD group had greater mean depth than the typical development group during the first (12.5 cm 95% CI, 12.0-13.0 cm vs 11.6 cm 95% CI, 11.3-12.0 cm) and the second (12.9 cm 95% CI, 12.6-13.3 cm vs 12.5 cm 95% CI, 12.2-12.7 cm) trimesters.

Conclusions and Relevance This study found significantly greater mean depth of ultrasonographic penetration in the ASD group compared with the developmental delay group in the first trimester and compared with the typical development group in the first and second trimesters.
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Maternal Type 1 #Diabetes and Risk of #Autism in Offspring

https://jamanetwork.com/journals/jama/fullarticle/2685775


Unadjusted average annual ASD incidence rates per 1000 children were 4.4 for exposure to T1D; 3.6 for T2D; 2.9 for GDM by 26 weeks; 2.1 for GDM after 26 weeks; and 1.8 for no diabetes. The Figure depicts the cumulative incidence rates by maternal diabetes exposure groups. Relative to no diabetes exposure, the adjusted HRs for exposure to maternal diabetes were 2.36 (95% CI, 1.36-4.12) for T1D, 1.45 (95% CI, 1.24-1.70) for T2D, 1.30 (95% CI, 1.12-1.51) for GDM by 26 weeks’ gestation, and 0.99 (95% CI, 0.88-1.12) for GDM after 26 weeks. Additional adjustment for maternal smoking during pregnancy and prepregnancy BMI changed results only slightly (Table). Risks were not statistically significantly different between those with vs without antidiabetic medication exposure during pregnancy within the GDM group (adjusted HR, 1.18 95% CI, 0.97-1.43; P = .10).

Discussion
Among the 3 main types of diabetes complicating pregnancy, the risk of ASD in offspring was elevated in mothers with T1D, T2D, and GDM diagnosed by 26 weeks’ gestation compared with no diabetes. These results add new information on T1D and extend previous findings1 for preexisting T2D and GDM. GDM diagnosed after 26 weeks’ gestation was not associated with excess risk compared with no diabetes.

These results suggest that the severity of maternal diabetes and the timing of exposure (early vs late in pregnancy) may be associated with the risk of ASD in offspring of diabetic mothers. The potential role of maternal glycemia; other features of T1D such as autoimmunity and genetic factors3,4; prematurity; and neonatal hypoglycemia5 remains to be explored. Confounding due to paternal risk factors and other intrauterine and postnatal exposures could not be assessed
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Extra-axial #cerebrospinal fluid in high-risk and normal-risk children with #autism aged 2–4 years: a case-control study

https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(18)30294-3/fulltext

Both extra-axial CSF volume (p=0·004) and brain volume (p<0·0001) uniquely contributed to enlarged head circumference in the autism spectrum disorder group (p=0·04). Increased extra-axial CSF volume was associated with greater sleep disturbances (p=0·03) and lower non-verbal ability (p=0·04). The machine learning algorithm correctly predicted autism spectrum disorder diagnosis with a positive predictive value of 83% (95% CI 76·2–88·3).

Interpretation
Increased extra-axial CSF volume is a reliable brain anomaly that has now been found in three independent cohorts, comprising both high-risk and normal-risk children with autism spectrum disorder. Increased extra-axial CSF volume is detectable using conventional structural MRI scans from infancy through to age 3 years. These results suggest that increased extra-axial CSF volume could be an early stratification biomarker of a biologically based subtype of autism that might share a common underlying pathophysiology
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Long-term benefit of #Microbiota Transfer Therapy on #autism symptoms and gut microbiota

Many studies have reported abnormal gut microbiota in individuals with Autism Spectrum Disorders (ASD), suggesting a link between gut microbiome and autism-like behaviors. Modifying the gut microbiome is a potential route to improve gastrointestinal (GI) and behavioral symptoms in children with ASD, and fecal microbiota transplant could transform the dysbiotic gut microbiome toward a healthy one by delivering a large number of commensal microbes from a healthy donor.

We previously performed an open-label trial of Microbiota Transfer Therapy (MTT) that combined antibiotics, a bowel cleanse, a stomach-acid suppressant, and fecal microbiota transplant, and observed significant improvements in GI symptoms, autism-related symptoms, and gut microbiota..

..Important changes in gut microbiota at the end of treatment remained at follow-up, including significant increases in bacterial diversity and relative abundances of Bifidobacteria and Prevotella. Our observations demonstrate the long-term safety and efficacy of MTT as a potential therapy to treat children with ASD who have GI problems, and warrant a double-blind, placebo-controlled trial in the future.

https://go.nature.com/2F7f8Xw
Behavioral effects of multiple-dose #oxytocin treatment in #autism: a randomized, placebo-controlled trial with long-term follow-up

Intranasal administration of the “prosocial” neuropeptide oxytocin is increasingly explored as a potential treatment for targeting the core characteristics of autism spectrum disorder (ASD)..

..Among the secondary outcome measures, treatment-specific improvements were identified in the Repetitive Behavior Scale and State Adult Attachment Measure, indicating reductions in self-reported repetitive behaviors (p = .04) and reduced feelings of avoidance toward others (p = .03) in the oxytocin group compared to the placebo group, up to 1 month and even 1 year post-treatment. Treatment-specific effects were also revealed in screenings of mood states (Profile of Mood States), indicating higher reports of “vigor” (feeling energetic, active, lively) in the oxytocin, compared to the placebo group (p = .03).

Conclusions

While no treatment-specific improvements were evident in terms of core social symptoms, the current observations of long-term beneficial effects on repetitive behaviors and feelings of avoidance are promising and suggestive of a therapeutic potential of oxytocin treatment for ASD. However, given the exploratory nature of this pilot study, future studies are warranted to evaluate the long-term effects of OT administration further

https://bit.ly/2GCndUA
Relationship Among Sensory Over-Responsivity, Problem Behaviors, and #Anxiety in Emerging Adults with #Autism Spectrum Disorder
https://2medical.news/2020/09/30/relationship-among-sensory-over-responsivity-problem-behaviors-and-anxiety-in-emerging-adults-with-autism-spectrum-disorder/

Despite the highly prevailing rate of sensory over-responsivity, problem behaviors, and anxiety among emerging adults with autism spectrum disorder (ASD), little is known about the nature of their experiences. While previous studies have indicated potential relationships among these conditions, their connections still need to be clarified. This study aimed to examine the relationships between sensory over-responsivity, problem behaviors, and anxiety.. .. The percentage of emerging …
Association Between #Epidural Analgesia During Labor and Risk of #Autism Spectrum Disorders in Offspring
https://2medical.news/2020/10/16/association-between-epidural-analgesia-during-labor-and-risk-of-autism-spectrum-disorders-in-offspring/

Although the safety of labor epidural analgesia (LEA) for neonates has been well documented, the long-term health effects of LEA on offspring remain to be investigated… ..Among the cohort of 147 895 singleton children (74 425 boys [50.3%]; mean [SD] gestational age at delivery, 38.9 [1.5] weeks), 109 719 (74.2%) were exposed to maternal LEA. Fever during labor was observed in 13 055 mothers (11.9%) in the LEA group …