Eficacia y seguridad de la melatonina para el manejo de los trastornos del sueño en el autismo: meta-análisis

INTRODUCCIÓN: El 80% de los niños y adolescentes con trastornos del espectro autista (TEA) presenta algún trastorno del sueño, en cuya génesis al parecer intervienen alteraciones en la regulación de la melatonina. El objetivo de este metaanálisis fue determinar la eficacia y seguridad de la melatonina para el manejo de ciertos trastornos del sueño en niños con TEA. MÉTODOS: Tres revisores extrajeron los datos relevantes de los ensayos clínicos aleatorizados doble ciego de alta calidad publicados en bases de datos primarias, de ensayos clínicos, de revisiones sistemáticas y de literatura gris; además se realizó búsqueda en bola de nieve. Se analizaron los datos con RevMan 5.3. Se realizó un análisis del inverso de la varianza por un modelo de efectos aleatorios para las diferencias de medias de los desenlaces propuestos: duración del tiempo total, latencia de sueño y número de despertares nocturnos. Se evaluó la heterogeneidad interestudios con el parámetro I2 RESULTADOS: La búsqueda inicial arrojó 355 resultados, de los cuales tres cumplieron los criterios de selección. La melatonina resultó ser un medicamento seguro y eficaz para aumentar la duración total del sueño y disminuir la latencia de sueño en niños y adolescentes con TEA; hasta el momento la evidencia sobre el número de despertares nocturnos no es estadísticamente significativa. DISCUSIÓN: A la luz de la evidencia disponible, la melatonina es una elección segura y eficaz para el manejo de ciertos problemas del sueño en niños y adolescentes con TEA. Es necesario realizar estudios con mayores tamaños muestrales y comparados con otros medicamentos disponibles en el mercado.

Movement-related potentials in high-functioning autism and Asperger's disorder

Autism and Asperger's disorder (AD) are neurodevelopmental conditions that affect cognitive and social-communicative function. Using a movement-related potential (MRP) paradigm, we investigated the clinical and neurobiological issue of 'disorder separateness' versus 'disorder variance' in autism and AD. This paradigm has been used to assess basal ganglia/supplementary motor functioning in Parkinson's disease. Three groups (high functioning autism [HFA]: 16 males, 1 female; mean age 12y 5mo [SD 4y 4mo]; AD: 11 males, 2 females; mean age 13y 5mo [SD 3y 8mo]; comparison group: 13 males, 8 females; mean age 13y 10mo, [SD 3y 11 mo]) completed a cued motor task during electroencephalogram recording of MRPs. The HFA group showed reduced peak amplitude at Cz, indicating less activity over the supplementary motor area during movement preparation. Although an overall significant between-group effect was found for early slope and peak amplitude, subanalysis revealed that the group with AD did not differ significantly from either group. However, it is suggested that autism and AD may be dissociated on the basis of brain-behaviour correlations of IQ with specific neurobiological measures. The overlap between MRP traces for autism and Parkinson's disease suggests that the neurobiological wiring of motor functioning in autism may bypass the supplementary motor area/primary motor cortex pathway.

Asperger's Disorder in College Students: Application of Acceptance and Commitment Therapy

College students with Asperger's Disorder (AD) are likely to face significant challenges as they encounter the unpredictable and socially demanding environment of their university setting. Acceptance and Commitment Therapy (ACT) can be a valuable approach to addressing many of these struggles. This paper will explore the application of ACT to problems that are commonly associated with individuals diagnosed with AD. Utilizing ACT and the Hexaflex Model as a guide for working with AD students can assist in establishing a greater understanding and acceptance of their unique internal experience, as well as their interaction with the external world. ACT can offer these students the ability to be more present in the moment, to recognize efforts to avoid negative experiences, and to move in directions in life that are personally meaningful.

Emotion recognition of static and dynamic faces in autism spectrum disorder

There is substantial evidence for facial emotion recognition (FER) deficits in autism spectrum disorder (ASD). The extent of this impairment, however, remains unclear, and there is some suggestion that clinical groups might benefit from the use of dynamic rather than static images. High-functioning individuals with ASD (n = 36) and typically developing controls (n = 36) completed a computerised FER task involving static and dynamic expressions of the six basic emotions. The ASD group showed poorer overall performance in identifying anger and disgust and were disadvantaged by dynamic (relative to static) stimuli when presented with sad expressions. Among both groups, however, dynamic stimuli appeared to improve recognition of anger. This research provides further evidence of specific impairment in the recognition of negative emotions in ASD, but argues against any broad advantages associated with the use of dynamic displays.

Cortical processing of speech and non-speech sounds in autism and Asperger syndrome

Autism and Asperger syndrome (AS) are neurodevelopmental disorders characterised by deficient social and communication skills, as well as restricted, repetitive patterns of behaviour. The language development in individuals with autism is significantly delayed and deficient, whereas in individuals with AS, the structural aspects of language develop quite normally. Both groups, however, have semantic-pragmatic language deficits. The present thesis investigated auditory processing in individuals with autism and AS. In particular, the discrimination of and orienting to speech and non-speech sounds was studied, as well as the abstraction of invariant sound features from speech-sound input. Altogether five studies were conducted with auditory event-related brain potentials (ERP); two studies also included a behavioural sound-identification task. In three studies, the subjects were children with autism, in one study children with AS, and in one study adults with AS. In children with autism, even the early stages of sound encoding were deficient. In addition, these children had altered sound-discrimination processes characterised by enhanced spectral but deficient temporal discrimination. The enhanced pitch discrimination may partly explain the auditory hypersensitivity common in autism, and it may compromise the filtering of relevant auditory information from irrelevant information. Indeed, it was found that when sound discrimination required abstracting invariant features from varying input, children with autism maintained their superiority in pitch processing, but lost it in vowel processing. Finally, involuntary orienting to sound changes was deficient in children with autism in particular with respect to speech sounds. This finding is in agreement with previous studies on autism suggesting deficits in orienting to socially relevant stimuli. In contrast to children with autism, the early stages of sound encoding were fairly unimpaired in children with AS. However, sound discrimination and orienting were rather similarly altered in these children as in those with autism, suggesting correspondences in the auditory phenotype in these two disorders which belong to the same continuum. Unlike children with AS, adults with AS showed enhanced processing of duration changes, suggesting developmental changes in auditory processing in this disorder.

Gêmeos monozigóticos com Síndrome de Asperger: sociabilidade e cognição

Os obstáculos encontrados por crianças e adolescentes com Síndrome de Asperger em termos de interação social, comunicação e imaginação são notórios e causam sentimentos de angústia nos pais que procuram escolas para inserir seus filhos e centros especializados para tratá-los. As pesquisas tem evoluído sobremaneira através dos anos, desde as primeiras descrições sobre o transtorno na primeira metade do século XX, apontando diferentes visões e modos de intervenção, alguns destes que pudessem ser levados à cabo por pais, professores e cuidadores. Entretanto, em termos de língua portuguesa em geral e da realidade brasileira especificamente, há uma carência de instrumentos que possam ser utilizados no ensino de habilidades sociais e cognitivas à esses indivíduos com Síndrome de Asperger. Aproveitando a experiência de pesquisadores ingleses, que na década de noventa elaboraram um guia prático para pais e professores intitulado Teaching children with autism to mind-read: a practical guide for teachers and parents, partindo da intervenção com tradução para a língua portuguesa, o presente estudo exploratório tem os objetivos de: verificar a efetividade de referido instrumento no ensino de habilidades sociais e cognitivas, identificar as estratégias de ensino utilizadas e comparar o desempenho de dois meninos de doze anos, gêmeos monozigóticos com Síndrome de Asperger, alunos de uma escola da rede pública do município do Rio de Janeiro. A metodologia utilizada implicou na análise comparativa dos escores obtidos na pré e pós intervenção, pela avaliação das habilidades sociais com o Inventário Multimídia de Habilidades Sociais para Crianças e das habilidades cognitivas, em especial as funções executivas, via alguns dos subtestes da Escala de Inteligência Wechsler para Crianças WISC-III; e a filmagem das sessões de intervenção e posterior análise dos vídeos para identificação das estratégias de ensino. A análise mostrou que o instrumento foi efetivo no ensino de habilidades sociais e cognitivas, merecendo novos estudos visando sua adaptação para nossa realidade cultural; que as estratégia de ensino mais utilizadas e que contribuíram para a modificação do comportamento dos sujeitos foram levantamento de questões para verificar a compreensão, explicação de conceitos pouco familiares e a ampliação da resposta verbal.

Genes related to sex steroids, neural growth, and social-emotional behavior are associated with autistic traits, empathy, and Asperger syndrome

Genetic studies of autism spectrum conditions (ASC) have mostly focused on the "low functioning" severe clinical subgroup, treating it as a rare disorder. However, ASC is now thought to be relatively common ( approximately 1%), and representing one end of a quasi-normal distribution of autistic traits in the general population. Here we report a study of common genetic variation in candidate genes associated with autistic traits and Asperger syndrome (AS). We tested single nucleotide polymorphisms in 68 candidate genes in three functional groups (sex steroid synthesis/transport, neural connectivity, and social-emotional responsivity) in two experiments. These were (a) an association study of relevant behavioral traits (the Empathy Quotient (EQ), the Autism Spectrum Quotient (AQ)) in a population sample (n=349); and (b) a case-control association study on a sample of people with AS, a "high-functioning" subgroup of ASC (n=174). 27 genes showed a nominally significant association with autistic traits and/or ASC diagnosis. Of these, 19 genes showed nominally significant association with AQ/EQ. In the sex steroid group, this included ESR2 and CYP11B1. In the neural connectivity group, this included HOXA1, NTRK1, and NLGN4X. In the socio-responsivity behavior group, this included MAOB, AVPR1B, and WFS1. Fourteen genes showed nominally significant association with AS. In the sex steroid group, this included CYP17A1 and CYP19A1. In the socio-emotional behavior group, this included OXT. Six genes were nominally associated in both experiments, providing a partial replication. Eleven genes survived family wise error rate (FWER) correction using permutations across both experiments, which is greater than would be expected by chance. CYP11B1 and NTRK1 emerged as significantly associated genes in both experiments, after FWER correction (P<0.05). This is the first candidate-gene association study of AS and of autistic traits. The most promising candidate genes require independent replication and fine mapping.

Anxiety problems in young people with Asperger syndrome: a case series

It is now well established that the prevalence of mental health difficulties in individuals with autism spectrum disorders (ASD) is considerably higher than in the general population. With recent estimates of the prevalence of autism spectrum disorders being as high as one percent, increasing numbers of children and young people are presenting to local and specialist services with mental health problems in addition to a diagnosis of ASD. Many families report that the impact of the mental health problems can be as or more impairing than the autism spectrum difficulties themselves. Clinical services are frequently called upon to treat these difficulties; however, there is limited evidence for the effectiveness of treatments in this population. This paper reports a case series of children and adolescents with ASD and an anxiety disorder who were treated with a standard cognitive behaviour therapy (CBT) rationale adapted to take account of the neuropsychological features of ASD. Common features of the presentation of the disorders and also treatment processes are discussed.

The neuropsychology of male adults with High-Functioning Autism or Asperger Syndrome

Autism Spectrum Disorder (ASD) is diagnosed on the basis of behavioral symptoms, but cognitive abilities may also be useful in characterizing individuals with ASD. One hundred seventy-eight high-functioning male adults, half with ASD and half without, completed tasks assessing IQ, a broad range of cognitive skills, and autistic and comorbid symptomatology. The aims of the study were, first, to determine whether significant differences existed between cases and controls on cognitive tasks, and whether cognitive profiles, derived using a multivariate classification method with data from multiple cognitive tasks, could distinguish between the two groups. Second, to establish whether cognitive skill level was correlated with degree of autistic symptom severity, and third, whether cognitive skill level was correlated with degree of comorbid psychopathology. Fourth, cognitive characteristics of individuals with Asperger Syndrome (AS) and high-functioning autism (HFA) were compared. After controlling for IQ, ASD and control groups scored significantly differently on tasks of social cognition, motor performance, and executive function (P's < 0.05). To investigate cognitive profiles, 12 variables were entered into a support vector machine (SVM), which achieved good classification accuracy (81%) at a level significantly better than chance (P < 0.0001). After correcting for multiple correlations, there were no significant associations between cognitive performance and severity of either autistic or comorbid symptomatology. There were no significant differences between AS and HFA groups on the cognitive tasks. Cognitive classification models could be a useful aid to the diagnostic process when used in conjunction with other data sources-including clinical history.

Síndrome de Asperger e educação inclusiva: análise de atitudes sociais e interações sociais

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

O conceito de morte e a Síndrome de Asperger

O conceito de morte é adquirido paralelamente ao desenvolvimento cognitivo e afetivo da criança, sendo descritos três estágios, paralelos aos estágios piagetianos. O objetivo deste trabalho foi verificar se o conceito de morte em portadores da síndrome de Asperger é similar ao observado em pessoas sem psicopatologia, ou se tem relação com o observado em portadores de deficiência intelectual leve. Para tanto, foram avaliados indivíduos com síndrome de Asperger, indivíduos com deficiência intelectual leve e indivíduos sadios, sem doenças mentais e/ou neurológicas, utilizando-se o Instrumento de Sondagem do Conceito de Morte elaborado por Wilma Torres. Os resultados apontam deficits na aquisição do conceito de morte por indivíduos com síndrome de Asperger, possivelmente relacionados aos deficits na teoria da mente, função executiva e fraca coerência central.

Revisión bibliométrica en Síndrome de Asperger: impacto en el ámbito de la psicología y educación

La productividad científica en Síndrome de Asperger (SA) se ha incrementado considerablemente en los últimos años desde distintos campos de la Educación y la Psicología. Incluido dentro de los Trastornos del Espectro del Autismo según el DSM-5, el SA se caracteriza por una alteración en las capacidades de relación social, comunicación y flexibilidad mental. Es objeto del presente estudio ofrecer una revisión del estado actual de la investigación en dicho ámbito e identificar las principales aportaciones científicas. La unidad de análisis se compuso por 1741 documentos extraídos de la Social Science Citation Index y revisados minuciosamente. Los resultados evidenciaron un incremento de la productividad temporal y el interés científico en las áreas de caracterización del SA, comorbilidad y tratamiento. Además, se observó una tendencia a realizar los trabajos en colaboración y un número considerable de autores clasificados como grandes productores por sus niveles de productividad superiores a los diez trabajos. La funcionalidad de esta revisión se encuentra en su valor como material de referencia para futuras líneas de investigación en tanto que abarca la identificación y análisis de los principales campos de estudio en este ámbito.

Del pictograma a la imagen: herramientas de comunicación y lenguaje en personas con síndrome de Asperger a través de recursos visuales para la inclusión social

Se presenta en este texto, una introducción al Síndrome de Asperger y aquellas características que lo distinguen, con el fin de conocer un poco más, en qué consiste este Trastorno Generalizado del Desarrollo (TGD). Además, se pretende facilitar cuales son las herramientas de comunicación y lenguaje más aptas para la enseñanza y aprendizaje del sujeto, haciendo hincapié en los recursos visuales, audiovisuales y artísticos como herramientas de aprendizaje para su inclusión social en cualquier ámbito de la sociedad (colegios, institutos, asociaciones, universidades o administraciones).

O percurso escolar e a orientação vocacional dos jovens com síndrome de asperger

Trabalho apresentado à Escola Superior de Educação de Paula Frassinetti realizado no âmbito da Tese de Mestrado