The Psychometric Properties of a New Measure of Sensory Behaviors in Autistic Children

Unusual reactions to sensory input became part of the diagnostic criteria for autism spectrum disorder in the DSM-5. Measures accurately assessing these symptoms are important for clinical decisions. This study examined the reliability and validity of the Sensory Behavior Questionnaire, a parent-report scale designed to assess frequency and impact of sensory behaviors in autistic children. The scale demonstrated excellent internal consistency and concurrent validity, and was a better predictor of autistic symptoms than the Short Sensory Profile within a group of 66 school-age autistic children. The scale also successfully discriminated between autistic and typical children of similar age and ability. The Sensory Behavior Questionnaire has potential as a measure of sensory behaviors in children on the autism spectrum.Medical Research Council; Research at the Centre for Research in Autism and Education; The Clothworkers’ Foundation and Pears Foundation

Current issues around the pharmacotherapy of ADHD in children and adults

Background New drugs and new formulations enter the growing market for ADHD medication. The growing awareness of possible persistence of ADHD impairment beyond childhood and adolescence resulting in increased pharmacotherapy of ADHD in adults, is also a good reason for making an inventory of the what is generally known about pharmacotherapy in ADHD. Aim To discuss current issues in the possible pharmacotherapy treatment of ADHD in children, adolescents and adults with respect to the position of pharmacotherapy in ADHD treatment guidelines, the pharmacoepidemiological trends, and current concerns about the drugs used. Methods A search of the literature with an emphasis on the position of pharmacotherapy in ADHD treatment guidelines, the pharmacoepidemiological trends, and current concerns about the drugs used in pharmacotherapy. Results According to the guidelines, the treatment of ADHD in children consists of psychosocial interventions in combination with pharmacotherapy when needed. Stimulants are the first-choice drugs in the pharmacological treatment of ADHD in children despite a number of well known and frequently reported side effects like sleep disorders and loss of appetite. With regard to the treatment of adults, stimulant treatment was recommended as the first-choice pharmacotherapy in the single guideline available. Both in children and adults, there appears to be an additional though limited role for the nonadrenergic drug atomoxetine. The increase of ADHD medication use, in children, adolescents and in adults, can not only be interpreted as a sign of overdiagnosis of ADHD. Despite the frequent use of stimulants, there is still a lack of clarity on the effects of long-term use on growth and nutritional status of children. Cardiovascular effects of both stimulants and atomoxetine are rare but can be severe. The literature suggests that atomoxetine may be associated with suicidal ideation in children. Conclusion Although pharmacotherapy is increasing common in the treatment of ADHD in both children and adults, there are still a lot of questions about side effects and how best to counter them. This suggests an important role for close monitoring of children and adults treated with stimulants or atomoxetine

Incidence of stage 3 chronic kidney disease and progression on tenofovir-based regimens : a cohort study in HIV-infected adults in Cape Town, South Africa

Objective: To describe the incidence of rapid kidney function decline (RKFD), and stage 3 chronic kidney disease (CKD) in HIV-1-infected adults initiated on tenofovir (TDF)-containing antiretroviral therapy (ART). Methods: A retrospective cohort study at the infectious diseases clinic of Tygerberg Academic Hospital in Cape Town, South Africa. Patients with >3 ml/min/year decline in estimated glomerular filtration (eGFR) were classified as having RKFD, and stage 3 CKD was defined as a value <60 ml/min/1.73 m2. We used logistic and Cox proportional hazards regression models to determine factors associated with RKFD and stage 3 CKD. Results: Of 650 patients, 361 (55%) experienced RKFD and 15 (2%) developed stage 3 CKD during a median (interquartile range [IQR]) follow-up time of 54 (46.6-98) weeks. For every 10-year increase in age and 10 mL/min lower baseline eGFR, the odds of RKFD increased by 70% (adjusted odds ratio [aOR] = 1.70, 95% CI 1.36 to 2.13) and 57% (aOR = 1.57, 95% CI 1.38 to 1.80), respectively. Each 10-year older age was associated with a 1.90-fold increased risk of developing stage 3 CKD (adjusted HR [aHR] = 1.90, 95% CI: 1.10 to 3.29). Women had about 4-fold greater risk of stage 3 CKD compared to men (aHR = 3.96, 95% CI: 1.06 to 14.74). Conclusions: About half of our study population developed RKFD but only 2% progressed to stage 3 CKD. Approaches that provide balanced allocation of limited resources towards screening and monitoring for kidney dysfunction and HIV disease management are critically needed in this setting