Motricità ed Autismo: studio dei pattern motori in bambini prescolari mediante PDMS (Peabody Developmental Motor Scales-2)

Sebbene nei Disturbi dello Spettro Autistico non siano riportati gravi disturbi del movimento, la letteratura riporta concordemente ritardi dell’acquisizione delle tappe motorie fondamentali, ipotonia muscolare, cammino sulle punte, difficoltà di pianificazione motoria e di esecuzione prassica e un generale deficit nelle abilità grosso e fino motorie. Un recente dibattito scientifico discute l’epoca d’esordio e la relazione tra l’entità del difetto motorio e le principali variabili cliniche dell’Autismo. Attraverso l’uso del Peabody Developmental Motor Scales-2 ( PDMS-2), uno strumento di misura clinica del livello di sviluppo motorio, sono stati esaminati i profili motori di 35 individui prescolari maschi affetti da Disturbo dello Spettro Autistico. Il livello di sviluppo motorio dei soggetti esaminati si colloca al di sotto di quanto atteso per l’età confermando un generale ritardo delle competenze grosso e fino-motorie nei DSA prescolari particolarmente pronunciato a carico delle abilità di locomozione e di afferramento dell’oggetto. Le performance motorie dei partecipanti sono significativamente correlate alle performance cognitive, all’età cronologica e alla gravità dell’autismo intesa come modello di comportamento, interessi e attività ristretti e ripetitivi. Inoltre, emerge una significativa correlazione tra livello di sviluppo motorio e competenze di autonomia personale e sociale

THE ITALIAN NETWORK FOR EARLY DETECTION OF AUTISM SPECTRUM DISORDER: RESEARCH ACTIVITIES AND NATIONAL POLICIES

Background: Well-structured monitoring system is crucial to identify interventions for children with Neurodevelopmental Disorders (NDD). Subjects and methods: The NIDA Network enrolled more than 760 at risk for NDD and typically developing infants to detect early signs of NDD. Results: The NIDA Network was born in some Italian regions to engage clinical centers in a research project. It is increasingly turning out to be a national monitoring project well integrated in the Italian National Health System policies. Conclusions: The NIDA Network activities are finalized at diagnosis and interventions to improve quality of life of children with NDD and their families

Early behavioral markers for neurodevelopmental disorders in the first 3 years of life: An overview of systematic reviews

Being able to recognize red flags for neurodevelopmental disorders (NDD) is crucial to provide timely intervention programs. This work aims to support - within a scientific framework - the construction of an instrument capable to early detect all spectrum of NDD and explore all areas of development, detect failures in typical developmental pathways and point out atypical signs at all ages. This overview of reviews provides evidence for differences in children later diagnosed with NDD compared to typically developing peers such as delays in motor, language development and temperament in the first three years of age, repetitive/stereotyped behaviors, atypicalities/delays in play, object use, attention, visual, sensory processing and social engagement in the first and second year, and difficulties in feeding and sleeping in the first year. These behaviors must be carefully observed as potential red flags for NDD. However, data of the systematic reviews are not yet useful to develop an evidence-based clinical screening. It urges to increase efforts in producing systematic reviews on early behavioral markers for each NDD. Trial registration:CRD42019137731. (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=137731)

Benefits and challenges of a personal budget for people with mental health conditions or intellectual disability: A systematic review

Personal budgets (PBs) may improve the lives of people with mental health conditions and people with intellectual disability (ID). However, a clear definition of PB, benefits, and challenges is still faded. This work aims to systematically review evidence on PB use in mental health and ID contexts, from both a qualitative and quantitative perspective, and summarize the recent research on interventions, outcomes, and cost-effectiveness of PBs in beneficiaries with mental health conditions and/or ID. The present systematic review is an update of the existing literature analyzed since 2013. We performed a systematic search strategy of articles using the bibliographic databases PubMed and PsycINFO. Six blinded authors screened the works for inclusion/exclusion criteria, and two blinded authors extracted the data. We performed a formal narrative synthesis of the findings from the selected works. A total of 9,800 publications were screened, and 29 were included. Improvement in responsibility and awareness, quality of life, independent living, paid work, clinical, psychological, and social domains, and everyday aspects of the users' and their carers' life have been observed in people with mental health conditions and/or ID. However, the PBs need to be less stressful and burdensome in their management for users, carers, and professionals. In addition, more quantitative research is needed to inform PBs' policymakers

mTOR Modulates Methamphetamine-Induced Toxicity through Cell Clearing Systems

Methamphetamine (METH) is abused worldwide, and it represents a threat for public health. METH exposure induces a variety of detrimental effects. In fact, METH produces a number of oxidative species, which lead to lipid peroxidation, protein misfolding, and nuclear damage. Cell clearing pathways such as ubiquitin-proteasome (UP) and autophagy (ATG) are involved in METH-induced oxidative damage. Although these pathways were traditionally considered to operate as separate metabolic systems, recent studies demonstrate their interconnection at the functional and biochemical level. Very recently, the convergence between UP and ATG was evidenced within a single organelle named autophagoproteasome (APP), which is suppressed by mTOR activation. In the present research study, the occurrence of APP during METH toxicity was analyzed. In fact, coimmunoprecipitation indicates a binding between LC3 and P20S particles, which also recruit p62 and alpha-synuclein. The amount of METH-induced toxicity correlates with APP levels. Specific markers for ATG and UP, such as LC3 and P20S in the cytosol, and within METH-induced vacuoles, were measured at different doses and time intervals following METH administration either alone or combined with mTOR modulators. Western blotting, coimmunoprecipitation, light microscopy, confocal microscopy, plain transmission electron microscopy, and immunogold staining were used to document the effects of mTOR modulation on METH toxicity and the merging of UP with ATG markers within APPs. METH-induced cell death is prevented by mTOR inhibition, while it is worsened by mTOR activation, which correlates with the amount of autophagoproteasomes. The present data, which apply to METH toxicity, are also relevant to provide a novel insight into cell clearing pathways to counteract several kinds of oxidative damage

Gut to brain interaction in Autism Spectrum Disorders: A randomized controlled trial on the role of probiotics on clinical, biochemical and neurophysiological parameters

Background: A high prevalence of a variety of gastrointestinal (GI) symptoms is frequently reported in patients with Autism Spectrum Disorders (ASD). The GI disturbances in ASD might be linked to gut dysbiosis representing the observable phenotype of a "gut-brain axis" disruption. The exploitation of strategies which can restore normal gut microbiota and reduce the gut production and absorption of toxins, such as probiotics addition/supplementation in a diet, may represent a non-pharmacological option in the treatment of GI disturbances in ASD. The aim of this randomized controlled trial is to determine the effects of supplementation with a probiotic mixture (Vivomixx®) in ASD children not only on specific GI symptoms, but also on the core deficits of the disorder, on cognitive and language development, and on brain function and connectivity. An ancillary aim is to evaluate possible effects of probiotic supplementation on urinary concentrations of phthalates (chemical pollutants) which have been previously linked to ASD. Methods: A group of 100 preschoolers with ASD will be classified as belonging to a GI group or to a Non-GI (NGI) group on the basis of a symptom severity index specific to GI disorders. In order to obtain four arms, subjects belonging to the two groups (GI and NGI) will be blind randomized 1:1 to regular diet with probiotics or with placebo for 6 months. All participants will be assessed at baseline, after three months and after six months from baseline in order to evaluate the possible changes in: (1) GI symptoms; (2) autism symptoms severity; (3) affective and behavioral comorbid symptoms; (4) plasmatic, urinary and fecal biomarkers related to abnormal intestinal function; (5) neurophysiological patterns. Discussion: The effects of treatments with probiotics on children with ASD need to be evaluated through rigorous controlled trials. Examining the impact of probiotics not only on clinical but also on neurophysiological patterns, the current trial sets out to provide new insights into the gut-brain connection in ASD patients. Moreover, results could add information to the relationship between phthalates levels, clinical features and neurophysiological patterns in ASD. Trial registration: ClinicalTrials.gov Identifier: NCT02708901. Retrospectively registered: March 4, 2016

Serological screening for Celiac Disease in 382 pre-schoolers with Autism Spectrum Disorder

Background: Recent investigations suggest a possible common genetic background between Autism Spectrum Disorders (ASD) and Celiac Disease (CD). However, studies regarding this association are scarce and often limited by the small sample sizes and/or large heterogeneity among ASD groups in terms of demographic and clinical features. The present study aims to investigate the overall CD prevalence (biopsy proven-CD patients plus screening detected tTG and EMA positive cases) in a large population of pre-schoolers with ASD referred to a tertiary care University Hospital. Methods: We retrospectively collected data about 382 children (mean age: 46.97 ± 13.55 months; age-range: 18-72 months) consecutively diagnosed as ASD (according to the Diagnostic and Statistical Manual of Mental Disorders 4th edition criteria) over the period 2010-2013, and who performed a serological CD screening. Results: The overall CD prevalence was 2.62%, which is statistically significant higher to that reported in the Italian paediatric population (p = 0.0246). Half of these children had no symptoms or risk factors related to CD when they performed the serological screening. Conclusions: If replicated, these data suggest the importance of regular screening for CD in young patients with ASD, and are of relevance for clinical and public health

Mental Health among Italian Children and Adolescents during and after the SARS-CoV-2 Pandemic: A Professionals’ Focus Group Study

The SARS-CoV-2 pandemic had a negative impact on the mental health of children and adolescents. Eight focus groups and six individual hearings were conducted to gain insights from the perspectives of 97 Italian professionals from a variety of disciplines, including child and adolescent neuropsychiatrists, pediatricians, general practitioners, social workers, psychologists, teachers, school deans, non-governmental organizations, and a researcher. Urban and rural settings were represented. The present research has been promoted by the Italian Independent Authority for Children and Adolescents (Autorita Garante per l'Infanzia e l'Adolescenza, AGIA) in collaboration with the National Institute of Health (Istituto Superiore di Sanita, ISS) and the Ministry of Education and its scientific value has been supervised by a Scientific Committee. The results of the focus groups' discussions revealed increased vulnerability, with the onset of new mental health disorders in healthy individuals and those in a condition of disadvantage, migratory contexts, and with disabilities. The already critical pre-pandemic structural and operational issues of existing services have been exacerbated. In healthcare, the activation of telemedicine has been a great asset but at the same time has generated challenges and critical issues that are still unresolved. Professionals emphasized the need to pay special attention to planning integrated responses aimed at overcoming inequalities and fragmentation. The result of this initiative translates into a set of operational recommendations useful for guiding investments and policies directed toward the protection of the mental health of minors in the health, educational, and social spheres from the outset

Sub-cellular motor neuron analysis in a model of spinal muscle atrophy

Spinal muscular atrophy (SMA) is a neurogenetic autosomal recessive disorder characterized by degeneration of lower motor neurons associated with muscle atrophy and paralysis. The disease course including onset and severity depends by reduced amounts of the survival motor neuron (SMN) protein. Such a protein is increased when the enzyme glycogen synthase kinase-3beta (GSK3beta) is inhibited. In the present study we used a knockout double transgenic mouse (Smn−/−; SMN1A2G; SMN2) modelling SMAIII to dissect the spinal cord pathology at ultrastructural analysis at prolonged survival time (18 months). We analysed the subcellular structure of spinal cord motor neurons both in baseline conditions and following the administration of a GSK3beta inhibitor. We found that motor neurons increased their diameter confirming our previous light microscopy data. The amount of immunogold labelled SMN particles was dramatically reduced in the whole cell body incuding nucleus and cytoplasm. Remarkably, at nuclear level we could detect marked reduction of the SMN protein with Cajal-like bodies thus mimicking the human disease. In mice receiving long-term lithium administration the level of the SMN protein were massively increase way more than other SMAIII mice and significantly exceeding the levels counted in controls. When compared with control mice administered long-term lithium SMN levels in SMA III mice were overlapping with healthy animals, at large. The effects of lithium on ultrastructural morphology of motor neurons extended to the preservation of mitochondrial compartment which was slightly affected in motor neurons from SMA III mice. These data confirm the essential role of GSK3beta inhibition in increasing the amount of the SMN protein and provide a novel action for an old drug which increases SMN level exceeding any other compound tested so far in this motor neuron pathology. At the same time the beneficial effects of lithium on mitochondrial morphology are confirmed. As an appendix to the present study we wish to mention the ubiquitous nature of these effects which were replicated in non-motor neuron cell lines. Apart from the significance in cell biology this latter observation provide the basis to analyze the effects of a lithium treatment on affected patients using peripheral or skin-derived cell cultures. This work was supported by an educational grant from CUCC