Treatments for Autism Spectrum Disorder: Literature Review

This paper is a literature review of some of the popular treatments for autism spectrum disorder (ASD). It begins with an overview of ASD, the common symptoms, and comorbidities. It includes a review of pharmacological treatments, behavioral treatments, and dietary treatments. Some treatment options in each of those categories are explained and reviewed. The paper also presents the comparison of various treatments to determine which is the most effective. The paper then concludes with what the most effective treatments are and how combined treatments are used

Using Telehealth to Adapt Service Delivery for Children during the COVID-19 Pandemic

Staff from the Institute for Human Development (IHD) at Northern Arizona University have provided evaluations for children with developmental disabilities (DD) in Arizona communities for over 20 years. These evaluations include Developmental Evaluations, Augmentative and Alternative Communication (AAC) evaluations, and evaluations for eligibility for Part C of IDEA (Individuals with Disabilities in Education Act) early intervention services. Following the evaluations, IHD staff may provide interventions that consist of training, coaching, and direct services. Evaluations and follow-up interventions have historically been provided in homes, the community, or a clinic setting by interdisciplinary teams that consist of two or more of the following: Occupational Therapists, Speech-Language Pathologists, Physical Therapists, Educational Psychologists, or Developmental Specialists. During the COVID-19 pandemic and subsequent need for physical distancing, three IHD programs modified the standard in-person evaluation process. Staff from the Growing in Beauty Partnership Program (GIBPP, the Navajo Part C program), the Interdisciplinary Training Clinic, and the Augmentative Communication Evaluation and Training Program conducted evaluations through televisits that consisted of parent interviews and observations of the child performing specific tasks. GIBPP staff modified intervention methods for children birth to three years old already on caseload at the time of the pandemic outbreak, providing coaching to families through telepractice. For AAC evaluations, AAC equipment was delivered to the family before the evaluation. In reporting the adaptation of our processes due to the COVID-19 pandemic, we used the expanded Framework for Modifications and Adaptations (FRAME) developed by Stirman et al. (2019). Using the eight components of the FRAME, we described the processes developed and undertaken to implement telepractice in these three programs at IHD during COVID-19. The article includes a summary of the decision-making processes used to determine which clients to include or exclude. The decision- making process included such criteria as the child’s characteristics and capabilities, technology access of the parents, and equipment needs. The outbreak of COVID-19 provided opportunities for practical experiences in the utilization of telepractice in a variety of settings and with a diverse clientele with developmental disabilities. These experiences informed diagnostic and intervention telepractice efforts that are potentially efficient, beneficial, and sustainable over the long-term. Steps to guide the criteria for inclusion of families in telepractice, the operational procedures for evaluation and intervention, and the contextual factors that influence quality and fidelity are further explained. The role of telepractice in reducing and accentuating health disparities are discussed based on our experiences in rural and tribal communities. This information will help to guide other practitioners working in similar settings with similar populations

Controlled ecological evaluation of an implemented exercise training programme to prevent lower limb injuries in sport: Differences in implementation activity

OBJECTIVE: The public health benefits of injury prevention programmes are maximised when programmes are widely adopted and adhered to. Therefore, these programmes require appropriate implementation support. This study evaluated implementation activity outcomes associated with the implementation of FootyFirst, an exercise training injury prevention programme for community Australian football, both with (FootyFirst+S) and without (FootyFirst+NS) implementation support. METHOD: An evaluation plan based on the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) Sports Setting Matrix was applied in a controlled ecological evaluation of the implementation of FootyFirst. RE-AIM dimension-specific (range: 0-2) and total RE-AIM scores (range: 0-10) were derived by triangulating data from a number of sources (including surveys, interviews, direct observations and notes) describing FootyFirst implementation activities. The mean dimension-specific and total scores were compared for clubs in regions receiving FootyFirst+S and FootyFirst+NS, through analysis of variance. RESULTS: The mean total RE-AIM score forclubs in the FootyFirst+S regions was 2.4 times higher than for clubs in the FootyFirst+NS region (4.73 vs 1.94; 95% CI for the difference: 1.64 to 3.74). Similarly, all dimension-specific scores were significantly higher for clubs in the FootyFirst+S regions compared with clubs in the FootyFirst+NS region. In all regions, the dimension-specific scores were highest for reach and adoption, and lowest for implementation. CONCLUSION: Implementing exercise training injury prevention programmes in community sport is challenging. Delivering programme content supported by a context-specific and evidence-informed implementation plan leads to greater implementation activity, which is an important precursor to injury reductions

Controlled ecological evaluation of an implemented exercise-training programme to prevent lower limb injuries in sport: Population-level trends in hospital-treated injuries

Objective: Exercise-training programmes have reduced lower limb injuries in trials, but their population-level effectiveness has not been reported in implementation trials. This study aimed to demonstrate that routinely collected hospital data can be used to evaluate population-level programme effectiveness. Method: A controlled ecological design was used to evaluate the effect of FootyFirst, an exercise-training programme, on the number of hospital-treated lower limb injuries sustained by males aged 16–50 years while participating in community-level Australian Football. FootyFirst was implemented with ‘support’ (FootyFirst+S) or ‘without support’ (FootyFirst+NS) in different geographic regions of Victoria, Australia: 22 clubs in region 1: FootyFirst+S in 2012/2013; 25 clubs in region 2: FootyFirst+NS in 2012/2013; 31 clubs region 3: control in 2012, FootyFirst+S in 2013. Interrupted time-series analysis compared injury counts across regions and against trends in the rest of Victoria. Results: After 1 year of FootyFirst+S, there was a non-statistically significant decline in the number of lower limb injuries in region 1 (2012) and region 3 (2013); this was not maintained after 2 years in region 1. Compared with before FootyFirst in 2006–2011, injury count changes at the end of 2013 were: region 1: 20.0% reduction (after 2 years support); region 2: 21.5% increase (after 2 years without support); region 3: 21.8% increase (after first year no programme, second year programme with support); rest of Victoria: 12.6% increase. Conclusion: Ecological analyses using routinely collected hospital data show promise as the basis of population-level programme evaluation. The implementation and sustainability of sports injury prevention programmes at the population-level remains challenging

Caring values in undergraduate nurse students: a qualitative longtitudinal study

Introduction: Given the emerging evidence internationally of poor care within the healthcare sector, a recent report in the United Kingdom recommended the need for education to produce nurses who are prepared both intellectually and with compassion. Aim: This paper aims to understand the beliefs and values of caring, held by student nurses from entry to completion of their education programme. Methods: Using a prospective qualitative longtitudinal approach, two cohorts of nursing students (February 2013 and 2014) each following a different undergraduate curriculum (the February 2013, based on a philosophy of person-centred care and the February 2014, based on the philosophy of humanisation) were followed throughout their programme leading to Registration. Data were collected from February 2013 to February 2017 using individual interviews at commencement and completion of their programme with focus groups after their first placement and at the end of years one and two. Using purposive sampling, from February 2013, 12 commenced the study and five finished. From February 2014, 24 started, with nine completing. Findings: Data were analysed using thematic analysis with four themes emerging: i) Articulating the terms caring and dignity ii) Recognising the need for individualisation iii) Learning nursing and iv) Personal journey. Conclusion: Reporting on the final phase of this 5-phase study and on the brink of qualifying, both cohorts of students recognised the impact of their different curriculum and their exposure to the same educators who had embraced the humanisation philosophy. They each acknowledged just how they had changed as individuals and how determined they were to influence the quality of care

Treatment of Acute Intracranial Vertebrobasilar Dissection with Angioplasty and Stent Placement: Report of Two Cases

Acute vertebrobasilar dissection may cause subarachnoid hemorrhage by rupturing through the adventia or cerebral infarct by progressive occlusion of the true lumen. Recent reports on the endovascular management of this condition have focused on treatment of pseudoaneurysms. We report two cases where angioplasty or stent placement was successfully used to improve compromised blood flow secondary to vertebrobasilar dissection

Priorities for investment in injury prevention in community Australian football

Objective:High-quality sport-specific information about the nature, type, cause, and frequency of injuries is needed to set injury prevention priorities. This article describes the type, nature, and mechanism of injuries in community Australian Football (community AF) players, as collected through field-based monitoring of injury in teams of players.Data Sources:Compilation of published prospectively collected injury data from 3 studies in junior community AF (1202 injuries in 1950+ players) and 3 studies in adult community AF (1765 injuries in 2265 players). This was supplemented with previously unpublished data from the most recent adult community AF injury cohort study conducted in 2007 to 2008. Injuries were ranked according to most common body regions, nature of injury, and mechanism.Main Results:In all players, lower limb injuries were the most frequent injury in community AF and were generally muscle strains, joint sprains, and superficial injuries. These injuries most commonly resulted from incidental contact with other players, or from overexertion. Upper limb injuries were less common but included fractures, strains, and sprains that were generally caused by incidental contact between players and the result of players falling to the ground.Conclusions:Lower limb injuries are common in community AF and could have an adverse impact on sustained participation in the game. Based on what is known about their mechanisms, it is likely that a high proportion of lower limb injuries could be prevented and they should therefore be a priority for injury prevention in community AF

Loss-of-function mutations in Lysyl-tRNA synthetase cause various leukoencephalopathy phenotypes

Objective: To expand the clinical spectrum of lysyl-tRNA synthetase (KARS) gene–related diseases, which so far includes Charcot-Marie-Tooth disease, congenital visual impairment and microcephaly, and nonsyndromic hearing impairment. Methods: Whole-exome sequencing was performed on index patients from 4 unrelated families with leukoencephalopathy. Candidate pathogenic variants and their cosegregation were confirmed by Sanger sequencing. Effects of mutations on KARS protein function were examined by aminoacylation assays and yeast complementation assays. Results: Common clinical features of the patients in this study included impaired cognitive ability, seizure, hypotonia, ataxia, and abnormal brain imaging, suggesting that the CNS involvement is the main clinical presentation. Six previously unreported and 1 known KARS mutations were identified and cosegregated in these families. Two patients are compound heterozygous for missense mutations, 1 patient is homozygous for a missense mutation, and 1 patient harbored an insertion mutation and a missense mutation. Functional and structural analyses revealed that these mutations impair aminoacylation activity of lysyl-tRNA synthetase, indicating that de- fective KARS function is responsible for the phenotypes in these individuals. Conclusions: Our results demonstrate that patients with loss-of-function KARS mutations can manifest CNS disorders, thus broadening the phenotypic spectrum associated with KARS-related disease