This dissertation is a call to place the health of adults with autistic traits and autism-caregivers higher on the agenda of clinicians, researchers, policymakers, and autistic adults and autism... Show moreThis dissertation is a call to place the health of adults with autistic traits and autism-caregivers higher on the agenda of clinicians, researchers, policymakers, and autistic adults and autism-caregivers themselves. Primarily, clinicians should be educated about the increased health risks in autistic adults and autism-caregivers, in order to be able to prevent or recognize these comorbidities timely. This is relevant because of the higher prevalence of both metabolic syndrome and gastrointestinal symptoms in adults from the general population with higher levels of autistic traits, as shown in this dissertation. The associations we found between biopsychosocial factors and respectively metabolic syndrome and gastrointestinal symptoms ask for more psychiatric and somatic integrated care for autistic adults. Future research could use the associations we found between the biopsychosocial model and autistic traits to develop preventive interventions specifically targeted for adults with autism (or higher levels of autistic traits). To make sure future preventive measures and the treatment of physical health problems are effective for this target population to improve their health, barriers in the healthcare for autistic people should be reduced. Therefore, this dissertation also offers recommendations for improvement of primary care, the gatekeeper of adequate healthcare for autistic adults. Show less
Evidence of the effectivity of play-based interventions in children with autism spectrum disorder (ASD) was evaluated by PRISMA-based literature study and a Risk of Bias (RoB) assessment. Many of... Show moreEvidence of the effectivity of play-based interventions in children with autism spectrum disorder (ASD) was evaluated by PRISMA-based literature study and a Risk of Bias (RoB) assessment. Many of the 32 eligible randomized controlled trials (RCT) reported improved social interaction, communication, daily functioning and play behaviour. They also reported decreased problem behaviour, better parental attunement and parent-child interaction. We assessed 25/32 of the RCTs with high RoB, mainly related to homogeneity of the study population, lack of power, and performance bias. We concluded with due care that the effectivity of play-based interventions differed across RCTs, most reported improvements are found in ASD symptoms, everyday functioning, and parental attunement. In future research, findings should be replicated, taking account of the RoB. Show less
Speyer, R.; Chen, Y.W.; Kim, J.H.; Wilkes-Gillan, S.; Nordahl-Hansen, A.J.; Wu, H.C.; Cordier, R. 2021
To determine the effects of non-pharmacological randomised controlled trials in adults with autism, a systematic review was conducted across five electronic databases. A total of 3865 abstracts... Show moreTo determine the effects of non-pharmacological randomised controlled trials in adults with autism, a systematic review was conducted across five electronic databases. A total of 3865 abstracts were retrieved, of which 41 articles met all inclusion criteria: randomised controlled trial; non-pharmacological intervention; adults with autism; and English publication. Twenty included studies had strong methodological quality ratings. No meta-analysis could be performed due to heterogeneity between studies. Articles reported on interventions for (1) social functioning and language skills, (2) vocational rehabilitation outcomes, (3) cognitive skills training, and (4) independent living skills. Social functioning was the most studied intervention. PEERS for young adults and Project SEARCH plus ASD support interventions had the strongest evidence. Emerging evidence suggests non-pharmacological interventions could be effective. Show less
van't Hof, M.; Nieuwenhuyzen, A.D.Y. van; Berckelaer-Onnes, I. van; Deen, M.; Hoek, H.W.; Ester, W.A. 2021
We investigated the effect of a live online educational program in 93 Dutch Youth and Family Center (YFC) physicians who were screening for Autism Spectrum Disorder (ASD) in the general child... Show moreWe investigated the effect of a live online educational program in 93 Dutch Youth and Family Center (YFC) physicians who were screening for Autism Spectrum Disorder (ASD) in the general child population. The educational program raised the physicians' level of specific ASD knowledge and it remained higher at six months follow-up (p < .01). Their self-confidence in detecting ASD was also higher and maintained at follow-up (p < .01). The educational program had no effect on the physicians' stigmatizing attitudes toward mental illness nor on the number of potential ASD referrals in children of 4-6 years of age. In conclusion, the online educational program on early detection of ASD has a six month long effect on YFC physicians' level of ASD knowledge and self-confidence. Show less
van't Hof, M.; Ester, W.A.; Berckelaer-Onnes, I. van; Hillegers, M.H.J.; Hoek, H.W.; Jansen, P.W. 2021
Eating problems are common among children with Autism Spectrum Disorder (ASD), but it is unknown to what extent infant eating behavior is associated with later autistic traits. As eating behavior... Show moreEating problems are common among children with Autism Spectrum Disorder (ASD), but it is unknown to what extent infant eating behavior is associated with later autistic traits. As eating behavior is currently not included in ASD screening instruments, it is important to evaluate whether infant eating behavior predicts later autistic traits and might therefore be used to enhance the early detection of ASD. We investigated the association of breast-feeding and eating behavior during infancy with later autistic traits in the population-based Generation R cohort. We included 3546 mother-child dyads with maternal reports on feeding and eating at age two months and autistic traits at six years. Eating behavior was assessed with seven items on specific eating habits and the Social Responsiveness Scale was used to evaluate autistic traits. Covariates included child sex, and maternal psychopathology and autistic traits. Linear regression analyses showed that being formula fed at two months was associated with a higher autistic trait score at six years (adjusted B = 0.07; 95% CI: 0.00-0.14). Children who were drinking only small quantities (adjusted B = 0.17, 95% CI: 0.04-0.30) and were hungry/not satisfied (adjusted B = 0.23, 95% CI: 0.08-0.39) at age two months also had a higher autistic traits score at age six years. We found no interactions with sex or breastfeeding. This study shows that eating behavior during infancy is related with autistic traits in childhood. Although the associations were fairly small, these findings suggest that early-life eating problems might be relevant for early detection of ASD and a potential addition to ASD-specific screening instruments. Show less
Jong, R.K. de; Snoek, H.; Staal, W.G.; Klip, H. 2019
The systematic use of feedback from patients on treatment progress and treatment satisfaction is a promising method to increase treatment effectiveness. The extent to which this also applies to the... Show moreThe systematic use of feedback from patients on treatment progress and treatment satisfaction is a promising method to increase treatment effectiveness. The extent to which this also applies to the treatment of children with severe psychiatric problems is not clear. We conducted a Randomized Controlled Trial (RCT) to study the effect of adding Feedback Informed Treatment (FIT) to care as usual in a child psychiatric sample. Quality of Life (QoL) was used as the primary outcome measure and symptom severity as the second. Fifty-one therapists from eight Autism Care Teams in a multi-center facility for Child and Adolescent Psychiatry (Karakter) participated and were cluster randomized to the FIT condition (n = 4 teams) or the Care as Usual (CAU) condition (n = 4 teams). Children aged 6–18 years, mainly with an Autism Spectrum Disorder (ASD) and treated in one of the Autism Care Teams were allocated to the FIT condition (n = 86) or the CAU condition (n = 80). Results indicated that adding FIT leads to an increased QoL [F (2,165) = 3.16, p = 0.045]. No additional effects were observed for symptom severity decrease [F (2,158) = 0.19, p = 0.825]. No interaction with time was found for QoL nor symptom severity. Adding FIT in a child psychiatric setting may increase QoL, but does not appear to decrease symptom severity as compared with CAU. It is suggested that FIT positively changes parents’ expectations. Results should be replicated in other child psychiatric samples and with an extended theoretical model. Show less
Boer, A. de; Vermeulen, K.; Egger, J.I.M.; Janzing, J.G.E.; Leeuw, N. de; Veenstra-Knol, H.E.; ... ; Kleefstra, T. 2018
Sleep problems are highly prevalent in ADHD and autism spectrum disorder (ASD). Better insight in the etiology is of clinical importance since intervention and prevention strategies of sleep... Show moreSleep problems are highly prevalent in ADHD and autism spectrum disorder (ASD). Better insight in the etiology is of clinical importance since intervention and prevention strategies of sleep problems are directed at underlying mechanisms. We evaluated the association of sleep problems and sleep patterns with sleep hygiene (behavioral/environmental practices that influence sleep quality, e.g. caffeine use), access to electronic media, chronotype, and anxiety/depression in children aged 6–12 years with ADHD, ASD, or typical development (TD) using parental questionnaires. ANOVA and linear regression analyses were adjusted for age and sex. Children with ADHD and ASD showed more sleep problems (63.6 and 64.7%, vs 25.1% in TD) and shorter sleep duration than controls, while differences between ADHD and ASD were not significant. Sleep hygiene was worse in ADHD and ASD compared to TD, however, the association of worse sleep hygiene with more sleep problems was only significant in ASD and TD. There was a significant association of access to electronic media with sleep problems only in typically developing controls. Chronotype did not differ significantly between groups, but evening types were associated with sleep problems in ADHD and TD. Associations of greater anxiety/depression with more sleep problems were shown in ADHD and TD; however, anxiety/depression did not moderate the effects of chronotype and sleep hygiene. We conclude that sleep problems are highly prevalent in ADHD and ASD, but are differentially related to chronotype and sleep hygiene. In ASD, sleep problems are related to inadequate sleep hygiene and in ADHD to evening chronotype, while in TD both factors are important. Clinical implications are discussed. Show less
Mensen, V.T.; Wierenga, L.M.; Dijk, S. van; Rijks, Y.; Oranje, B.; Mandl, R.C.W.; Durston, S. 2017
Klinefelter syndrome (47,XXY) is associated with a wide range of behavioral problems, including autism symptomatology. In the current thesis, brain structure and function were assesed in boys with... Show moreKlinefelter syndrome (47,XXY) is associated with a wide range of behavioral problems, including autism symptomatology. In the current thesis, brain structure and function were assesed in boys with 47,XXY, boys with idiopathic autism spectrum disorder, and non-clinical controls, using multiple imaging techniques. The goal was to assess the mechanisms underlying social dysfunction in 47,XXY, and to investigate to what degree these mechanisms differ from those in individuals with idiopathic autism. The results show that individuals with 47,XXY show characteristic deviations in brain structure and function associated with higher order cognitive functions, social emotional information processing, and language processing. Additionally, while boys with 47,XXY show considerable overlap with boys with idiopathic ASD in autism symptomatology, there are specific differences in the underlying neural mechanisms that revolve around the frontal lobes and insular cortices. These findings may have implications for intervention studies (e.g. focused on real time fMRI neurofeedback), as well as clinical practice. It may impact the selection of mental health care strategies that take into account this variability in mechanisms underlying social dysfunction in individuals with autism spectrum disorder. Show less
