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Clinical Frontiers in Autism Spectrum Disorder

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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 (30 March 2023) | Viewed by 27310

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Special Issue Editors

Dr. Soo-jeong Kim

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Guest Editor

1. Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, USA
2. Seattle Children’s Autism Center, Seattle Children’s Hospital, Seattle, USA
Interests: autism spectrum disorder; Prader–Willi syndrome; psychopharmacology; genetics

Dr. Karen Bearss

E-Mail Website
Guest Editor

1. Seattle Children's Autism Center and Research Institute, 4909 25th Avenue, Northeast, Seattle, WA 98195, USA
2. Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 Northeast Pacific Street, Seattle, WA 98195, USA
Interests: autism spectrum disorder; co-occurring disruptive behaviors

Dr. Jill Locke

E-Mail Website
Guest Editor

Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
Interests: implementation science; school-based intervention; social functioning

Special Issue Information

Dear Colleagues,

In 2022, we will be launching our first Special issue on “Clinical Frontiers in Autism Spectrum Disorder (ASD)”. The goal is to provide both clinicians and researchers worldwide with cutting-edge research in ASD as well as clinical knowledge in assessing and caring for individuals with ASD across treatment settings. We welcome a wide range of manuscripts from expert clinicians and researchers on various topics, including but not limited to genetics, gender and equality, common medical and psychiatric co-occurring conditions, neuromodulation, management of severe behavior and mood dysregulation across various settings, employment and higher education, families and school, nonmedical intervention, substance use, and legal and government support. We welcome both solicited and unsolicited submissions that will contribute to this goal. We also welcome studies with negative studies, which is also one of the unique features of this journal.

Dr. Soo-jeong Kim
Dr. Karen Bearss
Dr. Jill Locke
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

autism
genetics
gender
equality
psychiatric
medical
comorbidity
employment
school
substance
legal

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Published Papers (10 papers)

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Editorial

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4 pages, 184 KiB

Open AccessEditorial

Accessible, Equitable, and Personalized Care for Autistic Individuals

by Karen Bearss, Soo-Jeong Kim and Jill Locke

J. Clin. Med. 2022, 11(17), 5217; https://doi.org/10.3390/jcm11175217 - 3 Sep 2022

Viewed by 1271

Abstract

When it comes to service accessibility for autistic individuals, there exists a pipeline problem [...] Full article

(This article belongs to the Special Issue Clinical Frontiers in Autism Spectrum Disorder)

Research

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14 pages, 866 KiB

Open AccessArticle

Mediators of Placebo Response to Cannabinoid Treatment in Children with Autism Spectrum Disorder

by Adi Aran, Moria Harel, Aminadav Ovadia, Shulamit Shalgy and Dalit Cayam-Rand

J. Clin. Med. 2023, 12(9), 3098; https://doi.org/10.3390/jcm12093098 - 24 Apr 2023

Cited by 1 | Viewed by 1454

Abstract

The placebo response has a substantial impact on treatment outcome. However, data regarding mediators of the placebo response in children with autism spectrum disorder (ASD) are sparse. This retrospective study investigated possible mediators of the placebo response among participants of a placebo-controlled trial of cannabinoid treatment for behavioral problems in children with ASD (CBA trial, age 5–21 years). We used a specifically designed questionnaire to explore possible mediators of the placebo response in 88 participants of the CBA trial who received a placebo and had valid outcome scores. The parents of 67 participants completed the questionnaire. The placebo response was positively associated with the child’s comprehension of the treatment purpose (p = 0.037). There was also a trend for participants who had a relative aggravation of symptoms before treatment onset to improve following placebo treatment (p = 0.053). No other domains, including parental expectations, previous positive experience with similar treatments (behavioral conditioning), parental locus of control, quality of the patient–physician relationships, and adherence to study medications were associated with placebo-response. This finding suggests that efforts to explain the treatment purpose to children with disabilities may enhance treatment efficacy in clinical practice and decrease differences in the placebo response between study arms. Contrary to our hypothesis, parental expectations regarding cannabinoid treatment were not associated with the placebo response. Full article

(This article belongs to the Special Issue Clinical Frontiers in Autism Spectrum Disorder)

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16 pages, 4114 KiB

Open AccessArticle

Auditory Domain Sensitivity and Neuroplasticity-Based Targeted Cognitive Training in Autism Spectrum Disorder

by Angela Tseng, Megan DuBois, Bruno Biagianti, Caroline Brumley and Suma Jacob

J. Clin. Med. 2023, 12(4), 1635; https://doi.org/10.3390/jcm12041635 - 18 Feb 2023

Cited by 3 | Viewed by 3420

Abstract

Sensory processing, along with the integration of external inputs into stable representations of the environment, is integral to social cognitive functioning; challenges in these processes have been reported in Autism Spectrum Disorder (ASD) since the earliest descriptions of autism. Recently, neuroplasticity-based targeted cognitive training (TCT) has shown promise as an approach to improve functional impairments in clinical patients. However, few computerized and adaptive brain-based programs have been trialed in ASD. For individuals with sensory processing sensitivities (SPS), the inclusion of some auditory components in TCT protocols may be aversive. Thus, with the goal of developing a web-based, remotely accessible intervention that incorporates SPS concerns in the auditory domain, we assessed auditory SPS in autistic adolescents and young adults (N = 25) who started a novel, computerized auditory-based TCT program designed to improve working memory and information processing speed and accuracy. We found within-subject gains across the training program and between pre/post-intervention assessments. We also identified auditory, clinical, and cognitive characteristics that are associated with TCT outcomes and program engagement. These initial findings may be used to inform therapeutic decisions about which individuals would more likely engage in and benefit from an auditory-based, computerized TCT program. Full article

(This article belongs to the Special Issue Clinical Frontiers in Autism Spectrum Disorder)

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14 pages, 910 KiB

Open AccessArticle

Age-Based Tracks: A Method to Tailor Autism Diagnostic Evaluation in Large-Scale Autism Specialty Centers

by Emily Fox, Jennifer Gerdts, Kaitlyn Ahlers and Beth Kotchick

J. Clin. Med. 2022, 11(21), 6332; https://doi.org/10.3390/jcm11216332 - 27 Oct 2022

Cited by 1 | Viewed by 1583

Abstract

This paper describes a proposed model of diagnostic evaluation for autism spectrum disorder (ASD) at a large-scale ASD specialty center. Our center has implemented age-based diagnostic tracks within an interdisciplinary team evaluation approach to assessing ASD. Data were collected as part of a program evaluation and included responses from provider surveys as well as patient medical record reviews. The results from 803 patients were included. The diagnostic outcomes, time for evaluation, and appropriateness of referral were analyzed in patients referred to the Younger (n = 155) and Older (n = 648) diagnostic tracks. In 92.8% of cases referred to the clinic’s standard team evaluation model, the provider teams were able to make a diagnostic decision within the allotted evaluation time. The results from an additional diagnostic pathway, termed the Autism Psych Team (APT), within the older track were also presented. The intake providers had the option to triage older patients to this pathway when they anticipated that the patient might be diagnostically complex. Most patients (45.1%) triaged to the APT were referred due to psychiatric complexity. In 96% of APT cases, the APT providers felt the patient was an appropriate referral. Overall, these results suggest a method to efficiently triage patients to diagnostic models equipped to serve them within a high-volume ASD center. Full article

(This article belongs to the Special Issue Clinical Frontiers in Autism Spectrum Disorder)

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14 pages, 296 KiB

Open AccessArticle

Clinical Characteristics of Youth with Autism or Developmental Disability during Inpatient Psychiatric Admission

by Emily Neuhaus, Anthony Osuna, Daina M Tagavi, Sina Shah-Hosseini, Shannon Simmons, Jennifer Gerdts and Alysha D Thompson

J. Clin. Med. 2022, 11(21), 6328; https://doi.org/10.3390/jcm11216328 - 27 Oct 2022

Cited by 5 | Viewed by 2249

Abstract

Children with autism spectrum disorder and developmental disabilities (ASD/DD) often experience severe co-occurring psychological and behavioral challenges, which can warrant inpatient psychiatric care. However, very little is known about the characteristics and clinical care of children with ASD/DD within the context of inpatient psychiatric settings. In this paper, we describe factors unique to inpatients with ASD or DD, by drawing on electronic health records from over 2300 children and adolescents ages 4–17 years admitted to a pediatric psychiatric inpatient unit over a 3-year period. Patients with ASD/DD accounted for approximately 16% of inpatients and 21% of admissions, were younger, more likely to be readmitted, more likely to be male, and more likely to have Medicaid insurance, as compared to patients without ASD/DD. Clinically, those with ASD/DD more frequently had externalizing concerns documented in their records, in contrast to more frequent internalizing concerns among other patients. Within the ASD/DD group, we identified effects of patient age, sex, and race/ethnicity on multiple dimensions of clinical care, including length of stay, use of physical restraint, and patterns of medication use. Results suggest the need for psychiatric screening tools that are appropriate for ASD/DD populations, and intentional integration of anti-racist practices into inpatient care, particularly with regard to use of physical restraint among youth. Full article

(This article belongs to the Special Issue Clinical Frontiers in Autism Spectrum Disorder)

15 pages, 1725 KiB

Open AccessArticle

Sibling Influences on Trajectories of Maladaptive Behaviors in Autism

by Nicole E. Rosen, Hillary K. Schiltz and Catherine Lord

J. Clin. Med. 2022, 11(18), 5349; https://doi.org/10.3390/jcm11185349 - 12 Sep 2022

Cited by 3 | Viewed by 4392

Abstract

Siblings play an important role in the behavioral trajectories of individuals with autism spectrum disorder (ASD). While having siblings has been associated with positive outcomes in ASD, including stronger adaptive functioning, social and non-verbal communication, and theory of mind, little is known about the impact of siblings on more negative outcomes, such as maladaptive behaviors. To address this gap, the present longitudinal study tested sibling predictors of trajectories of maladaptive behaviors (e.g., teacher- and parent-reported hyperactivity, irritability, and social withdrawal) from childhood through early adulthood among individuals with ASD and non-spectrum delays. Multilevel models revealed that, while the mere presence of a sibling did not impact maladaptive behavior trajectories apart from teacher-reported hyperactivity, the diagnostic profile of the sibling (e.g., emotional/behavioral disorder, ASD, medical condition) emerged as an important predictor. Specifically, although findings varied across teacher and parent reports, more hyperactivity and irritability across time was identified when the sibling had diagnoses of an emotional/behavioral disorder, ASD, and/or a medical condition. Overall, this study provides novel insight into the broader family-level factors that influence the presentation of maladaptive behaviors across time and across contexts. Full article

(This article belongs to the Special Issue Clinical Frontiers in Autism Spectrum Disorder)

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13 pages, 238 KiB

Open AccessArticle

A Retrospective Chart Review of Factors Impacting Psychotropic Prescribing Patterns and Polypharmacy Rates in Youth with Autism Spectrum Disorder during the COVID-19 Pandemic

by Evan Taniguchi, Kerry Conant, Kylie Keller and Soo-Jeong Kim

J. Clin. Med. 2022, 11(16), 4855; https://doi.org/10.3390/jcm11164855 - 18 Aug 2022

Viewed by 1619

Abstract

High but variable rates of psychotropic polypharmacy (PP) in youth with autism spectrum disorder (ASD) have been reported in previous studies. The effect of the COVID-19 pandemic on prescribing patterns has not been well described. This study aims to examine the factors associated with psychotropic prescribing patterns, including rates of PP and multiclass polypharmacy (MPP) in youth with ASD during the COVID-19 pandemic. We examined the prescription records and clinical characteristics of youth aged between 3–21 years with a clinical diagnosis of ASD who were followed at an urban tertiary autism center psychiatry clinic between 1 January 2019, and 31 December 2020. For study purposes, we treated 2019 as the pre-pandemic year and 2020 as the pandemic year and compared the clinical characteristics of the “total clinic cohort (n = 898)” across two years. We examined the clinical characteristics of patients seen in both years (“paired-sample,” n = 473) and those seen only in 219 (“not-paired sample,” n = 378) to identify factors associated with the likelihood of patients’ return to clinic in 2020. As the total clinic cohort was a naturalistic sample containing duplicate patients, we created a separate data set by randomly assigning duplicate patients to one of the years (“random unique sample,” n = 898) and examined the clinical characteristics across two years. We defined PP and MPP broadly as the use of ≥2 unique medications (PP) and ≥2 unique medication classes (MPP) within a calendar year in this study. In the total clinic cohort, increased rates of PP (71.6% to 75.6%), MPP (61.9% to 67.8%, p = 0.027), and antidepressant prescriptions (56.9% to 62.9%, p = 0.028) were noted, although only the latter two were nominally significant. The paired-sample had a higher proportion of teens (31.0% vs. 39.7%, p < 0.001 and persons who self-identified as non-Hispanic (77.8% vs. 85.4%, p = 0.016)), higher rates of anxiety (78.9% vs. 48.7%, p < 0.001), ADHD (71.0% vs. 44.4%, p < 0.001), depression (23.9% vs. 13.0%, p < 0.001) and disruptive behavior (63.3% vs. 33.3%, p < 0.001) diagnoses, higher rates of antidepressants (63.4% vs. 48.7%, p < 0.001), ADHD medications (72.5% vs. 59.8%, p < 0.001), and antipsychotics (36.8% vs. 26.2%, p < 0.001) prescribed, and higher rates of PP (81.6% vs. 59.0%, p < 0.001) and MPP (71.0% vs. 50.5%, p < 0.001) than the not-paired sample. In the random unique sample, the patient group assigned to 2020 had higher rates of anxiety (75.0% vs. 60.2%, p < 0.001), ADHD (69.9% vs. 54.6%, p < 0.001), and disruptive behavior (57.9% vs. 45.4%, p < 0.001) diagnoses but the PP and MPP rates did not differ across years. Overall, we found high rates of PP and MPP, likely due to the broader definition of PP and MPP used in this study than those in other studies as well as the study site being a tertiary clinic. While our study suggests a possible impact of the COVID-19 pandemic on comorbidity rates and prescribing patterns, a replication study is needed to confirm how pandemic-related factors impact prescribing patterns and polypharmacy rates in youth with ASD. Full article

(This article belongs to the Special Issue Clinical Frontiers in Autism Spectrum Disorder)

Review

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17 pages, 793 KiB

Open AccessReview

The Quality of Life among Siblings of Autistic Individuals: A Scoping Review

by Giuseppe Quatrosi, Dario Genovese, Emanuele Amodio and Gabriele Tripi

J. Clin. Med. 2023, 12(3), 735; https://doi.org/10.3390/jcm12030735 - 17 Jan 2023

Cited by 5 | Viewed by 4830

Abstract

Autism spectrum disorders are a heterogeneous group of neurodevelopmental disorders presenting at a tender age, defined by qualitative deficits in social interactions and communication, thus having a substantial influence on the subject’s family unit. Quality of life (QoL) refers to a person’s perspective of their life situation, cultural and value background, objectives, expectations, and standards. When focusing on childhood and adolescence, age-related changes should be considered. For this scoping review, the authors used three peer-review literature database sources (PubMed/MEDLINE, Scopus, and ERIC) to delve deeper into components of the QoL of non-autistic siblings of autistic individuals. At the completion of the eligibility phase, 9 studies were included out of the 96 initial records. A total of 4/9 articles (45%) compared the non-autistic siblings of autistic individuals to the siblings of non-autistic people, while 3/9 articles (33%) compared the first group to the non-autistic siblings of patients with other chronic diseases. A total of 5/9 studies adopted specific questionnaires to evaluate QoL. Results from 6/9 articles revealed that the autism condition has varying effects on non-autistic siblings’ QoL. According to the considered research, non-autistic siblings of autistic individuals experienced decreased psychological well-being, less perceived social support, increased aggressiveness and conflict-proneness, and higher levels of anxiety and stress impacting their QoL. The present findings provide important implications for additional and more punctual studies in this sector. Furthermore, as being a non-autistic sibling of an autistic individual is commonly undervalued, this review advocates the need to organize and improve support services for siblings. Full article

(This article belongs to the Special Issue Clinical Frontiers in Autism Spectrum Disorder)

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17 pages, 618 KiB

Open AccessReview

Recommendations for Diversifying Racial and Ethnic Representation in Autism Intervention Research: A Crossover Review of Recruitment and Retention Practices in Pediatric Mental Health

by Wendy Machalicek, Lindsay Glugatch, Buket Erturk, Tasia Brafford, Megan Kunze, Christine Drew, Allaina Douglas, Sloan Storie, Rebecca Crowe and Sandy Magaña

J. Clin. Med. 2022, 11(21), 6468; https://doi.org/10.3390/jcm11216468 - 31 Oct 2022

Cited by 6 | Viewed by 2559

Abstract

Disparities in diagnosis and access to healthcare and therapeutic services are well-documented for children with autism spectrum disorder (ASD) from minoritized races and ethnicities, but there is little empirical research to guide the selection and implementation of interventions and practices that will effectively support racially/ethnically diverse children with ASD and their families. This cross-over systematic review summarizes parent-mediated intervention research of children with or at risk for mental health disorders to identify potentially effective recruitment and retention strategies for diverse participants in parent-mediated intervention research for children with autism. Electronic database keyword, lead author name searches in PyschNet, MEDLINE, and ancestral searches were conducted to identify 68 relevant articles that used experimental designs to evaluate the effects of parent-mediated interventions on children with or at risk for mental health disorders. Articles were coded for participant demographics; intervention setting and type, recruitment and retention strategies, cultural adaptation of intervention, and reported attrition. Findings are discussed and applied to practices in autism parent-mediated intervention research. Suggestions for future research and limitations are discussed. Full article

(This article belongs to the Special Issue Clinical Frontiers in Autism Spectrum Disorder)

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Other

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13 pages, 1058 KiB

Open AccessSystematic Review

Autism Spectrum Disorders and Malocclusions: Systematic Review and Meta-Analyses

by Aline Barros, Paulo Mascarenhas, João Botelho, Vanessa Machado, Gabriela Balixa and Luísa Bandeira Lopes

J. Clin. Med. 2022, 11(10), 2727; https://doi.org/10.3390/jcm11102727 - 11 May 2022

Cited by 6 | Viewed by 2158

Abstract

Studies heretofore have shown inconsistent results on the link of ASD to malocclusion. Herein, we aimed to compare the prevalence of malocclusion among children and adolescents with ASD compared with non-ASD healthy counterparts through a systematic review. The electronic search focused on five databases, PubMed, Web of Science, EMBASE, LILACS, and OpenGrey until January 2022, and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (PROSPERO No. CRD42022298023). Observational and intervention studies that compared occlusion characteristics of ASD individuals under 18 years old with healthy controls were included. Pairwise random effects meta-analyses of odds ratio (OR) were performed. Methodological quality was assessed by using the Joanna Briggs Institute Critical Appraisal Checklist for cross-sectional studies. A total of thirteen studies were included for qualitative analysis, and seven for quantitative analysis. The results presented a great heterogeneity and moderate risk of bias; thus, it was not possible to state that there is a risk of malocclusion in individuals with ASD. Future studies should be carried out with strict criteria in the choice of samples, control group, and diagnosis of malocclusion in order to meet the necessary requirements for greater methodological quality. Full article

(This article belongs to the Special Issue Clinical Frontiers in Autism Spectrum Disorder)

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