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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Mental Health".

Deadline for manuscript submissions: closed (20 July 2019) | Viewed by 91043

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Special Issue Editors

Prof. Luigi Mazzone

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Guest Editor

Child Neurology and Psychiatry Unit, System Medicine Department, University of Rome Tor Vergata, Rome, Italy
Interests: autism; child development; ADHD; developmental disabilities; neurodevelopmental disorders; early childhood education
Special Issues, Collections and Topics in MDPI journals

Dr. Marco Armando

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Guest Editor

Developmental Imaging and Psychopathology Lab, Department of Psychiatry, School of Medicine, University of Geneva, Geneva, Switzerland
Interests: psychosis; early detection; early intervention; social cognition

Special Issue Information

Dear Colleagues,

Autism spectrum disorder (ASD) appear to have a dramatic increase over the last twenty years. Actually, despite considerable progress in understanding the neurobiology of ASD, established treatments for core symptoms are still needed. It is crucial to provide researchers and clinicians with the most updated information on the clinical features, etiopathogenesis and therapeutic strategies for the patients as well as to shed light on the other psychiatric conditions often associated with ASD.

Prof. Luigi Mazzone
Dr. Marco Armando
Guest Editors

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Keywords

autism
etiopathogenesis
screening and risk factor
psychiatric comorbidity
early intervention

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Published Papers (9 papers)

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Research

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15 pages, 1635 KiB

Open AccessArticle

Motor Capacities in Boys with High Functioning Autism: Which Evaluations to Choose?

by Véronique-Aurélie BRICOUT, Marion PACE, Léa DUMORTIER, Sahal MIGANEH, Yohan MAHISTRE and Michel GUINOT

J. Clin. Med. 2019, 8(10), 1521; https://doi.org/10.3390/jcm8101521 - 21 Sep 2019

Cited by 13 | Viewed by 3390

Abstract

The difficulties with motor skills in children with autism spectrum disorders (ASD) has become a major focus of interest. Our objectives were to provide an overall profile of motor capacities in children with ASD compared to neurotypically developed children through specific tests, and to identify which motor tests best discriminate children with or without ASD. Twenty-two male children with ASD (ASD—10.7 ± 1.3 years) and twenty controls (CONT—10.0 ± 1.6 years) completed an evaluation with 42 motor tests from European Physical Fitness Test Battery (EUROFIT), the Physical and Neurological Exam for Subtle Signs (PANESS) and the Movement Assessment Battery for Children ( M-ABC). However, it was challenging to design a single global classifier to integrate all these features for effective classification due to the issue of small sample size. To this end, we proposed a hierarchical ensemble classification method to combine multilevel classifiers by gradually integrating a large number of features from different motor assessments. In the ASD group, flexibility, explosive power and strength scores (p < 0.01) were significantly lower compared to the control group. Our results also showed significant difficulties in children with ASD for dexterity and ball skills (p < 0.001). The principal component analysis and agglomerative hierarchical cluster analysis allowed for the classification of children based on motor tests, correctly distinguishing clusters between children with and without motor impairments. Full article

(This article belongs to the Special Issue Advances in Autism Spectrum Disorders)

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16 pages, 3429 KiB

Open AccessArticle

Sensory Processing Issues and Their Association with Social Difficulties in Children with Autism Spectrum Disorders

by Nada Kojovic, Lylia Ben Hadid, Martina Franchini and Marie Schaer

J. Clin. Med. 2019, 8(10), 1508; https://doi.org/10.3390/jcm8101508 - 20 Sep 2019

Cited by 70 | Viewed by 20353

Abstract

Sensory processing issues have been frequently reported in individuals with Autism Spectrum Disorders (ASD), but their relationship with social and overall adaptive functioning has not been extensively characterized to date. Here, we investigate how sensory processing atypicalities relate with deficits in social skills, impaired social cognition, and general adaptive functioning in a group of preschoolers with ASD. Sixty-four children with ASD aged 3 to 6 were included in this study, along with 36 age-matched typically-developing (TD) peers. Parent-reported measures of sensory processing, social difficulties and overall adaptive functioning were collected for all children. We also obtained precise measures of social attention deployment using a custom-design eye-tracking task depicting naturalistic social scenes. Within the group of children with ASD, higher intensities of sensory issues were associated with more prominent social difficulties and lower adaptive functioning. We also found that children with ASD who had more sensory issues showed visual exploration patterns of social scenes that strongly deviated from the one seen in the TD group. The association of sensory processing atypicalities with “higher-order” functional domains such as social and adaptive functioning in children with ASD stresses the importance of further research on sensory symptoms in autism. Full article

(This article belongs to the Special Issue Advances in Autism Spectrum Disorders)

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14 pages, 252 KiB

Open AccessArticle

Mental Health Correlates of Autism Spectrum Disorder in Gender Diverse Young People: Evidence from a Specialised Child and Adolescent Gender Clinic in Australia

by Simone Mahfouda, Christina Panos, Andrew J.O. Whitehouse, Cati S. Thomas, Murray Maybery, Penelope Strauss, Florian D. Zepf, Amanda O’Donovan, Hans-Willem van Hall, Liz A. Saunders, Julia K. Moore and Ashleigh Lin

J. Clin. Med. 2019, 8(10), 1503; https://doi.org/10.3390/jcm8101503 - 20 Sep 2019

Cited by 43 | Viewed by 9907

Abstract

Research suggests an overrepresentation of autism spectrum diagnoses (ASD) or autistic traits in gender diverse samples, particularly in children and adolescents. Using data from the GENTLE (GENder identiTy Longitudinal Experience) Cohort at the Gender Diversity Service at the Perth Children’s Hospital, the primary objective of the current retrospective chart review was to explore psychopathology and quality of life in gender diverse children with co-occurring ASD relative to gender diverse children and adolescents without ASD. The Social Responsiveness Scale (Second Edition) generates a Diagnostic and Statistical Manual of Mental Disorders (DSM-5) score indicating a likely clinical ASD diagnosis, which was used to partition participants into two groups (indicated ASD, n = 19) (no ASD indicated, n = 60). Indicated ASD was far higher than would be expected compared to general population estimates. Indicated ASD on the Social Responsiveness Scale 2 (SRS 2) was also a significant predictor of Internalising behaviours (Anxious/Depressed, Withdrawn/Depressed, Somatic Complaints, Thought Problems subscales) on the Youth Self Report. Indicated ASD was also a significant predictor of scores on all subscales of the Paediatric Quality of Life Inventory. The current findings indicate that gender diverse children and adolescents with indicated ASD comprise an especially vulnerable group that are at marked risk of mental health difficulties, particularly internalising disorders, and poor quality of life outcomes. Services working with gender diverse young people should screen for ASD, and also provide pathways to appropriate care for the commonly associated mental health difficulties. Full article

(This article belongs to the Special Issue Advances in Autism Spectrum Disorders)

17 pages, 1542 KiB

Open AccessArticle

Early Clinical Predictors of Autism Spectrum Disorder in Infants with Tuberous Sclerosis Complex: Results from the EPISTOP Study

by Romina Moavero, Arianna Benvenuto, Leonardo Emberti Gialloreti, Martina Siracusano, Katarzyna Kotulska, Bernhard Weschke, Kate Riney, Floor E. Jansen, Martha Feucht, Pavel Krsek, Rima Nabbout, Anna C. Jansen, Konrad Wojdan, Julita Borkowska, Krzystof Sadowski, Christoph Hertzberg, Hanna Hulshof, Sharon Samueli, Barbora Benova, Eleonora Aronica, David J. Kwiatkowski, Lieven Lagae, Sergiusz Jozwiak, Paolo Curatolo and on behalf of the EPISTOP Consortium Show full author list Hide full author list

J. Clin. Med. 2019, 8(6), 788; https://doi.org/10.3390/jcm8060788 - 3 Jun 2019

Cited by 50 | Viewed by 5255

Abstract

Autism spectrum disorder (ASD) is highly prevalent in subjects with Tuberous Sclerosis Complex (TSC), but we are not still able to reliably predict which infants will develop ASD. This study aimed to identify the early clinical markers of ASD and/or developmental delay (DD) in infants with an early diagnosis of TSC. We prospectively evaluated 82 infants with TSC (6–24 months of age), using a detailed neuropsychological assessment (Bayley Scales of Infant Development—BSID, and Autism Diagnostic Observation Schedule—ADOS), in the context of the EPISTOP (Long-term, prospective study evaluating clinical and molecular biomarkers of EPIleptogenesiS in a genetic model of epilepsy—Tuberous SclerOsis ComPlex) project (NCT02098759). Normal cognitive developmental quotient at 12 months excluded subsequent ASD (negative predictive value 100%). The total score of ADOS at 12 months clearly differentiated children with a future diagnosis of ASD from children without (p = 0.012). Atypical socio-communication behaviors (p < 0.001) were more frequently observed than stereotyped/repetitive behaviors in children with ASD at 24 months. The combined use of BSID and ADOS can reliably identify infants with TSC with a higher risk for ASD at age 6–12 months, allowing for clinicians to target the earliest symptoms of abnormal neurodevelopment with tailored intervention strategies. Full article

(This article belongs to the Special Issue Advances in Autism Spectrum Disorders)

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9 pages, 807 KiB

Open AccessArticle

Cranio-Facial Characteristics in Children with Autism Spectrum Disorders (ASD)

by Gabriele Tripi, Sylvie Roux, Domenica Matranga, Laura Maniscalco, Pasqualino Glorioso, Frédérique Bonnet-Brilhault and Michele Roccella

J. Clin. Med. 2019, 8(5), 641; https://doi.org/10.3390/jcm8050641 - 9 May 2019

Cited by 17 | Viewed by 11689

Abstract

Background: Cranio-facial anomalies frequently occur in neurodevelopmental disorders because both face and brain are derived from neuroectoderm. The identification of differences in the facial phenotype of children with Autism Spectrum Disorders (ASD) may reflect alterations in embryologic brain development in children with ASD. Methods: we evaluated 33 caucasian children with ASD using a 2D computerized photogrammetry. Anthropometric euclidean measurements and landmarks located on the soft tissue of the face and head, were based on five cranio-facial indexes. Relationships between anthropometric z-scores and participant characteristics (i.e., age, Global IQ, severity of autistic symptoms measured using the CARS checklist) were assessed. Results: Cephalic index z-score differed significantly from 0 in our ASD group (p = 0.019). Moreover, a significant negative correlation was found between Facial Index z-score and CARS score (p = 0.003); conversely, a positive correlation was found between Interchantal Index z-score and CARS score (p = 0.028). Conclusion: our measurements shows a dolichocephalic head shape which is not correlated with autism severity. Importantly, two craniofacial markers were significantly correlated with autism severity: increased orbital hyperthelorism and decrease of height of the facial midline. These data support previous findings of craniofacial anomalies in autism spectrum disorder suggesting an “ASD facial phenotype” that could be used to improve ASD diagnoses. Full article

(This article belongs to the Special Issue Advances in Autism Spectrum Disorders)

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24 pages, 3323 KiB

Open AccessArticle

Brain Network Organization Correlates with Autistic Features in Preschoolers with Autism Spectrum Disorders and in Their Fathers: Preliminary Data from a DWI Analysis

by Lucia Billeci, Sara Calderoni, Eugenia Conti, Alessia Lagomarsini, Antonio Narzisi, Camilla Gesi, Claudia Carmassi, Liliana Dell’Osso, Giovanni Cioni, Filippo Muratori and Andrea Guzzetta

J. Clin. Med. 2019, 8(4), 487; https://doi.org/10.3390/jcm8040487 - 10 Apr 2019

Cited by 8 | Viewed by 6111

Abstract

Autism Spectrum Disorders (ASD) is a group of neurodevelopmental disorders that is characterized by an altered brain connectivity organization. Autistic traits below the clinical threshold (i.e., the broad autism phenotype; BAP) are frequent among first-degree relatives of subjects with ASD; however, little is known regarding whether subthreshold behavioral manifestations of ASD mirror also at the neuroanatomical level in parents of ASD probands. To this aim, we applied advanced diffusion network analysis to MRI of 16 dyads consisting of a child with ASD and his father in order to investigate: (I) the correlation between structural network organization and autistic features in preschoolers with ASD (all males; age range 1.5–5.2 years); (II) the correlation between structural network organization and BAP features in the fathers of individuals with ASD (fath-ASD). Local network measures significantly correlated with autism severity in ASD children and with BAP traits in fath-ASD, while no significant association emerged when considering the global measures of brain connectivity. Notably, an overlap of some brain regions that are crucial for social functioning (cingulum, superior temporal gyrus, inferior temporal gyrus, middle frontal gyrus, frontal pole, and amygdala) in patients with ASD and fath-ASD was detected, suggesting an intergenerational transmission of these neural substrates. Overall, the results of this study may help in elucidating the neurostructural endophenotype of ASD, paving the way for bridging connections between underlying genetic and ASD symptomatology. Full article

(This article belongs to the Special Issue Advances in Autism Spectrum Disorders)

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Review

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18 pages, 1814 KiB

Open AccessReview

Pathogenetical and Neurophysiological Features of Patients with Autism Spectrum Disorder: Phenomena and Diagnoses

by Yunho Jin, Jeonghyun Choi, Seunghoon Lee, Jong Won Kim and Yonggeun Hong

J. Clin. Med. 2019, 8(10), 1588; https://doi.org/10.3390/jcm8101588 - 2 Oct 2019

Cited by 4 | Viewed by 5289

Abstract

Autism spectrum disorder (ASD) is a neurodevelopmental disorder that is accompanied by social deficits, repetitive and restricted interests, and altered brain development. The majority of ASD patients suffer not only from ASD itself but also from its neuropsychiatric comorbidities. Alterations in brain structure, synaptic development, and misregulation of neuroinflammation are considered risk factors for ASD and neuropsychiatric comorbidities. Electroencephalography has been developed to quantitatively explore effects of these neuronal changes of the brain in ASD. The pineal neurohormone melatonin is able to contribute to neural development. Also, this hormone has an inflammation-regulatory role and acts as a circadian key regulator to normalize sleep. These functions of melatonin may play crucial roles in the alleviation of ASD and its neuropsychiatric comorbidities. In this context, this article focuses on the presumable role of melatonin and suggests that this hormone could be a therapeutic agent for ASD and its related neuropsychiatric disorders. Full article

(This article belongs to the Special Issue Advances in Autism Spectrum Disorders)

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10 pages, 440 KiB

Open AccessReview

Prevalence of Non-Affective Psychoses in Individuals with Autism Spectrum Disorders: A Systematic Review

by Riccardo De Giorgi, Franco De Crescenzo, Gian Loreto D’Alò, Nicola Rizzo Pesci, Valeria Di Franco, Corrado Sandini and Marco Armando

J. Clin. Med. 2019, 8(9), 1304; https://doi.org/10.3390/jcm8091304 - 24 Aug 2019

Cited by 35 | Viewed by 5637

Abstract

Autism spectrum disorders (ASD) and non-affective psychoses such as schizophrenia are commonly acknowledged as discrete entities. Previous research has revealed evidence of high comorbidity between these conditions, but their differential diagnosis proves difficult in routine clinical practice due to the similarities between core symptoms of each disorder. The prevalence of comorbid non-affective psychoses in individuals with ASD is uncertain, with studies reporting rates ranging from 0% to 61.5%. We therefore performed a systematic review and pooled analysis of the available studies reporting the prevalence of non-affective psychosis in ASD. Fourteen studies, including a total of 1708 participants, were included, with a weighted pooled prevalence assessed at 9.5% (95% CI 2.6 to 16.0). In view of significant heterogeneity amongst the studies, subgroup analyses were conducted. We observed higher prevalence of non-affective psychoses among ASD inpatients versus outpatients, when operationalised criteria were used, and in studies with smaller sample sizes, whereas the figures were comparable between children and adults with ASD. Our results suggest that future studies involving larger samples should implement both operationalized criteria and specific scales for the assessment of psychotic symptoms in individuals with ASD. A deeper understanding of both differential and comorbid features of ASD and non-affective psychosis will be required for the development of optimized clinical management protocols. Full article

(This article belongs to the Special Issue Advances in Autism Spectrum Disorders)

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23 pages, 842 KiB

Open AccessReview

Risk and Protective Environmental Factors Associated with Autism Spectrum Disorder: Evidence-Based Principles and Recommendations

by Leonardo Emberti Gialloreti, Luigi Mazzone, Arianna Benvenuto, Alessio Fasano, Alicia Garcia Alcon, Aletta Kraneveld, Romina Moavero, Raanan Raz, Maria Pia Riccio, Martina Siracusano, Ditza A. Zachor, Marina Marini and Paolo Curatolo

J. Clin. Med. 2019, 8(2), 217; https://doi.org/10.3390/jcm8020217 - 8 Feb 2019

Cited by 90 | Viewed by 22108

Abstract

Autism Spectrum Disorder (ASD) is a complex condition with early childhood onset, characterized by a set of common behavioral features. The etiology of ASD is not yet fully understood; however, it reflects the interaction between genetics and environment. While genetics is now a well-established risk factor, several data support a contribution of the environment as well. This paper summarizes the conclusions of a consensus conference focused on the potential pathogenetic role of environmental factors and on their interactions with genetics. Several environmental factors have been discussed in terms of ASD risk, namely advanced parental age, assisted reproductive technologies, nutritional factors, maternal infections and diseases, environmental chemicals and toxicants, and medications, as well as some other conditions. The analysis focused on their specific impact on three biologically relevant time windows for brain development: the periconception, prenatal, and early postnatal periods. Possible protective factors that might prevent or modify an ASD trajectory have been explored as well. Recommendations for clinicians to reduce ASD risk or its severity have been proposed. Developments in molecular biology and big data approaches, which are able to assess a large number of coexisting factors, are offering new opportunities to disentangle the gene–environment interplay that can lead to the development of ASD. Full article

(This article belongs to the Special Issue Advances in Autism Spectrum Disorders)

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