•This study provides a comprehensive profiling of different axes of motor ability in children with ASD.•Gross and fine motor skills, praxis, coordination, and interpersonal synchrony were examined in ...low and high IQ ASD groups.•Multiple motor variables were impaired in children with ASD with low and high IQ.•Motor performance correlated with IQ and praxis performance correlated with autism severity.•Clinicians and families must advocate for motor evaluations and interventions in children with ASD.
Children with Autism Spectrum Disorder (ASD) have basic motor impairments in balance, gait, and coordination as well as autism-specific impairments in praxis/motor planning and interpersonal synchrony. Majority of the current literature focuses on isolated motor behaviors or domains. Additionally, the relationship between cognition, symptom severity, and motor performance in ASD is unclear. We used a comprehensive set of measures to compare gross and fine motor, praxis/imitation, motor coordination, and interpersonal synchrony skills across three groups of children between 5 and 12 years of age: children with ASD with high IQ (HASD), children with ASD with low IQ (LASD), and typically developing (TD) children. We used the Bruininks-Oseretsky Test of Motor Proficiency and the Bilateral Motor Coordination subtest of the Sensory Integration and Praxis Tests to assess motor performance and praxis skills respectively. Children were also examined while performing simple and complex rhythmic upper and lower limb actions on their own (solo context) and with a social partner (social context). Both ASD groups had lower gross and fine motor scores, greater praxis errors in total and within various error types, lower movement rates, greater movement variability, and weaker interpersonal synchrony compared to the TD group. In addition, the LASD group had lower gross motor scores and greater mirroring errors compared to the HASD group. Overall, a variety of motor impairments are present across the entire spectrum of children with ASD, regardless of their IQ scores. Both, fine and gross motor performance significantly correlated with IQ but not with autism severity; however, praxis errors (mainly, total, overflow, and rhythmicity) strongly correlated with autism severity and not IQ. Our study findings highlight the need for clinicians and therapists to include motor evaluations and interventions in the standard-of-care of children with ASD and for the broader autism community to recognize dyspraxia as an integral part of the definition of ASD.
Recent evidence suggests that childhood obesity is increasing in children who are developing typically as well as in children with developmental disabilities such as autism spectrum disorders (ASDs). ...Impairments specific to autism as well as general environmental factors could lead to an imbalance between the intake and expenditure of energy, leading to obesity. In this article, we describe the mechanisms by which autism-specific impairments contribute to obesity. The evidence on exercise interventions to improve physical fitness, address obesity, and reduce autism-specific impairments in children and adolescents with ASDs is discussed. Limited evidence is currently available for exercise interventions in individuals with ASDs. Therefore, literature on other pediatric developmental disabilities and children who are developing typically was reviewed to provide recommendations for clinicians to assess physical activity levels, to promote physical fitness, and to reduce obesity in children and adolescents with ASDs. There is a clear need for further systematic research to develop sensitive assessment tools and holistic multisystem and multifactorial obesity interventions that accommodate the social communication, motor, and behavioral impairments of individuals with ASDs.
Young adults with autism spectrum disorder are an underserved population. Evidence-based guidelines for physical activity programs to address the lifelong needs of this population are presently ...unavailable. Our systematic review critically appraises the research to date on the effects of physical activity/exercise-based interventions on physical fitness, motor skills, core autism symptoms, and functional participation in young adults with autism spectrum disorder between 19 and 30 years. We reviewed 22 experimental and quasi-experimental studies that assessed the effects of physical activity/exercise-based interventions in 763 young adults with autism spectrum disorder. Evidence is strongest for improvements of medium-to-large size in physical fitness followed by medium-to-large improvements in motor outcomes, medium-to-large improvements in psychological function, and small-to-large improvements in quality of life. Aerobic, resistance, and movement skill/sport-specific training can improve cardiovascular function and muscular strength/endurance in young adults. Movement/sport training can help improve fundamental motor skills. Finally, holistic interventions combining elements of physical activity, diet, and lifestyle modifications are effective in improving outcomes related to body composition and quality of life in young adults. There is presently insufficient evidence for improvements in physical activity engagement or core autism symptoms following exercise interventions. We provide recommendations for assessment and intervention for clinicians working with young adults with autism spectrum disorder.
Lay abstract
Young adults with autism spectrum disorder over 18 years of age are an underserved population, and there is presently limited evidence examining the effects of physical activity programs in this population. Our review synthesizes the evidence to date from studies that have assessed the effects of physical activity/exercise programs in young adults with autism spectrum disorder between 19 and 30 years. We reviewed 22 studies that included a total of 763 young adults with autism spectrum disorder. There is the strongest evidence for improvements in physical fitness, followed by motor skills, psychological function, and quality of life following physical activity interventions in young adults with autism spectrum disorder. Specifically, aerobic and resistance training as well as programs focused on movement skill and sport-specific training lead to improved physical fitness and movement performance. Holistic interventions focusing on physical activity, dietary changes, and lifestyle modifications lead to improvements in body composition and quality of life of young adults with autism spectrum disorder. There is presently limited evidence to support the use of exercise/activity programs to improve physical activity levels and core autism symptoms in young adults with autism spectrum disorder. Based on our review results, we also provide practical recommendations for clinicians working with young adults with autism spectrum disorder.
Tuberculosis is an ancient human disease, estimated to have originated and evolved over thousands of years alongside modern human populations. Despite considerable advances in disease control, ...tuberculosis remains one of the world's deadliest communicable diseases with 10 million incident cases and 1·8 million deaths in 2015 alone based on the annual WHO report, due to inadequate health service resources in less-developed regions of the world, and exacerbated by the HIV/AIDS pandemic and emergence of multidrug-resistant strains of Mycobacterium tuberculosis. Recent findings from studies of tuberculosis infection and of patients with Mendelian predisposition to severe tuberculosis have started to reveal human loci influencing tuberculosis outcomes. In this Review, we assess the current understanding of the contribution of host genetics to disease susceptibility and to drug treatment. Despite remarkable progress in technology, only a few associated genetic variants have so far been identified, strongly indicating the need for larger global studies that investigate both common and under-represented rare variants to develop new approaches to combat the disease. Pharmacogenomic discoveries are also likely to lead to more efficient drug design and development, and ultimately safer and more effective therapies for tuberculosis.
Our study compared means‐end exploration in infants at risk (AR) for autism and typically developing (TD) infants using a nested box paradigm. Sixteen AR and 16 TD infants were observed at 9, 12, and ...15 months with follow‐up at 18 and 24 months. We collected video data on three tasks involving retrieval of a small toy by opening (a) an opaque box, (b) a transparent box, and (c) two nested boxes. Dependent variables included hand bias, time to completion, bilateral hand use, problem‐solving strategies used, and tester assistance required. There were no group differences in terms of hand biases. Compared to TD infants, AR infants had lower bilateral hand use, poor problem solving skills, and required greater assistance. Both groups demonstrated age‐related improvements in motor and cognitive skills. Means‐end exploration provides a window into the bilateral coordination and motor planning/problem‐solving abilities of young infants at risk for autism. Lastly, object retrieval tasks could serve as important learning contexts for at‐risk infants.
Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder affecting multiple developmental domains including social communication, behavioral-affective, sensorimotor, and cognitive systems. ...There is growing evidence for the use of holistic, whole-body, Creative Movement Therapies (CMT) such as music, dance, yoga, theater, and martial arts in addressing the multisystem impairments in ASD. We conducted a comprehensive quantitative and qualitative review of the evidence to date on the effects of CMT on multiple systems in individuals with ASD. The strongest evidence, both in terms of quantity and quality, exists for music and martial arts-based interventions followed by yoga and theater, with very limited research on dance-based approaches. Our review of 72 studies (
= 1,939 participants) across participants with ASD ranging from 3 to 65 years of age suggests that at present there is consistent evidence from high quality studies for small-to-large sized improvements in social communication skills following music and martial arts therapies and medium-to-large improvements in motor and cognitive skills following yoga and martial arts training, with insufficient evidence to date for gains in affective, sensory, and functional participation domains following CMT. Although promising, our review serves as a call for more rigorous high-quality research to assess the multisystem effects of CMT in ASD. Based on the existing literature, we discuss implications of our findings for autism researchers and also provide evidence-based guidelines for clinicians to incorporate CMT approaches in their plan of care for individuals with ASD.
Following the outbreak of the COVID-19 pandemic, the delivery of face-to-face (F2F) therapeutic interventions and neuroimaging assessments for children with autism spectrum disorder has been ...disrupted. To resume interventions and assessments, many services are now using telehealth-based online platforms. Using the Zoom conferencing platform, our research group has been providing creative play-based interventions to school-age children with autism spectrum disorder. The feedback on this telehealth intervention experience has been generally positive (mean satisfaction score: 4.4 on a 5-point Likert-type scoring range) and our preliminary data from six children with autism spectrum disorder suggest training-related improvements in gross motor, balance, and imitation skills. Despite the positive results, it remains to be explored if the effects of telehealth interventions are similar to those of F2F interventions. Neuroimaging techniques could provide objective measures of intervention effects. However, this will require researchers to resume neuroimaging research while adopting safe public health protocols to control the risk of COVID-19 transmission. In this short report, we summarize existing safety protocols for F2F neuroimaging research, our own experiences of safely conducting alternative, on-site and off-site neuroimaging data collection, as well as the potential opportunities of using online data sharing and low-cost, remote neuroimaging/electrophysiological techniques to continue brain research during the pandemic.
Lay abstract
The COVID-19 pandemic has caused disruption in F2F healthcare delivery and neuroimaging research, especially when involving vulnerable populations such as children with autism spectrum disorder. Given the easy access to multiple video conferencing platforms, many healthcare services have moved to an online delivery format (i.e. telehealth). It is important to monitor the behavioral and neural effects of telehealth interventions and resume neuroimaging research while adopting public health safety protocols to control the risk of COVID-19 transmission. We summarize existing safety protocols and our own experience from in-person functional near-infrared spectroscopy neuroimaging data collection (on-site, at home, and in outdoor settings), as well as potential opportunities of using online data sharing and low-cost, remote neuroimaging/electrophysiological techniques to continue brain research during the pandemic.
Human dirofilarial infection usually presents as pulmonary coin lesion or as subcutaneous nodule. We report the case of a 60-year-old female presented clinically with swelling in the lower-outer ...quadrant of the right breast for 2 weeks. Ultrasound reported as atypical lesion suggest fine-needle aspiration cytology (FNAC) correlation and follow-up. Clinical examination - subcutaneous nodule of size 2 cm × 2 cm presents in the lower-outer quadrant. Clinical suspicious of carcinoma was considered and FNAC was done. Aspirated pus-like material and adult worm about 4 cm in length were attached to the needle. Smear was air-dried and stained with Giemsa. Smears were cellular and showed numerous neutrophils, eosinophils, and a few histiocytes in a necrotic background and also noted coiled adult dirofilarial worm. Cellblock was prepared and it showed the cut section of dirofilarial worm with cuticle, muscular layer, intestine, and reproductive tube. We report this case entity due to diagnostic confusion with breast malignancy clinically and radiologically.
The more than 1.5 billion people who live in South Asia are correctly viewed not as a single large population but as many small endogamous groups. We assembled genome-wide data from over 2,800 ...individuals from over 260 distinct South Asian groups. We identified 81 unique groups, 14 of which had estimated census sizes of more than 1 million, that descend from founder events more extreme than those in Ashkenazi Jews and Finns, both of which have high rates of recessive disease due to founder events. We identified multiple examples of recessive diseases in South Asia that are the result of such founder events. This study highlights an underappreciated opportunity for decreasing disease burden among South Asians through discovery of and testing for recessive disease-associated genes.
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