Challenges Surrounding the Diagnosis of Autism in Children

This comprehensive thematic review aims to highlight and familiarize readers with the challenges and pitfalls encountered in differential diagnosis of autism spectrum disorders (ASD) in children to facilitate the process of accurate identification by stakeholders. Accordingly, articles that best answer our questions and highlight our concerns were chosen from well-established publishers with prime peer reviewed journals. Included are studies showing alternate views of the issues so as to point readers to other possibilities. ASD, a complex dynamic biological-neurodevelopmental disorder, is underscored by its heterogeneous symptomology, severity, and phenotypes - all characterized by social communication deficits and presence of restricted interests and repetitive behaviours (RRBs), the core symptoms in ASD. Language and intellectual capacities do not form ASD core symptoms although vary considerably. Accurate identification is challenging as ASD is often enmeshed with other neurodevelopmental disorders, and medical comorbidities, a situation now recognized as the rule rather than the exception in child psychiatry and developmental medicine. ASD is a disorder with varying performance and severity of symptoms over time, including unexpected loss of early skills, and lost diagnosis in some children following treatment. The review reiterates the urgency in accurate diagnosis in face of the rapid rise in ASD prevalence globally, and risk-increase in delayed or denied treatment with undesirable life-long consequences for most of the affected children. In addition, a call for change is advised to circumvent the ethical dilemma posed by the present "deficit model" in ASD diagnosis. Here, ASD prevalence is presented first, followed by emphasis on importance of accurate early diagnosis, and challenges in its accomplishment due to flaws in diagnostic instruments and other contributing factors. Next follow the required criteria for accurate identification, and its difficulties attributed to comorbid conditions, gender differences, and socio-economic and cultural influences. The conclusion includes future directions and a take away message

Challenges Surrounding the Diagnosis of Autism in Children

This comprehensive thematic review aims to highlight and familiarize readers with the challenges and pitfalls encountered in differential diagnosis of autism spectrum disorders (ASD) in children to facilitate the process of accurate identification by stakeholders. Accordingly, articles that best answer our questions and highlight our concerns were chosen from well-established publishers with prime peer reviewed journals. Included are studies showing alternate views of the issues so as to point readers to other possibilities. ASD, a complex dynamic biological-neurodevelopmental disorder, is underscored by its heterogeneous symptomology, severity, and phenotypes - all characterized by social communication deficits and presence of restricted interests and repetitive behaviours (RRBs), the core symptoms in ASD. Language and intellectual capacities do not form ASD core symptoms although vary considerably. Accurate identification is challenging as ASD is often enmeshed with other neurodevelopmental disorders, and medical comorbidities, a situation now recognized as the rule rather than the exception in child psychiatry and developmental medicine. ASD is a disorder with varying performance and severity of symptoms over time, including unexpected loss of early skills, and lost diagnosis in some children following treatment. The review reiterates the urgency in accurate diagnosis in face of the rapid rise in ASD prevalence globally, and risk-increase in delayed or denied treatment with undesirable life-long consequences for most of the affected children. In addition, a call for change is advised to circumvent the ethical dilemma posed by the present "deficit model" in ASD diagnosis. Here, ASD prevalence is presented first, followed by emphasis on importance of accurate early diagnosis, and challenges in its accomplishment due to flaws in diagnostic instruments and other contributing factors. Next follow the required criteria for accurate identification, and its difficulties attributed to comorbid conditions, gender differences, and socio-economic and cultural influences. The conclusion includes future directions and a take away message

Infant Recognition of Hebrew Vocalic Word Patterns

The ability of infants to recognize phonotactic patterns in their native language is widely acknowledged. However, the specific ability of infants to recognize patterns created by nonadjacent vowels in words has seldom been investigated. In Semitic languages such as Hebrew, groups of multisyllabic words are identical in their nonadjacent vowel sequences and stress position but differ in the consonants interposed between the vowels. The goals of this study were to assess whether infants learning Hebrew show a preference for (1) a nonadjacent vocalic pattern or template, common in Hebrew nouns (CéCeC), over a nonattested nonadjacent vocalic pattern (CóCoC), and (2) a nonadjacent vocalic pattern common in Hebrew words (CaCóC) over an existing but less common pattern (CaCéC). Twenty Hebrew-learning infants aged 8 to 11 months were presented with lists of nonsense words featuring the first two patterns (Experiment 1), and 20 were presented with nonsense words featuring the second two patterns (Experiment 2). The results showed longer listening to CéCeC than to CóCoC lists and to CaCóC than to CaCéC lists, suggesting that infants recognized the common nonadjacent vocalic patterns in both cases. The study thus demonstrates that Hebrew-learning infants are able to disregard the intervening consonants within words and generalize their vocalic pattern to previously unheard nonwords, whether this pattern includes identical or different vowels and regardless of the rhythmic pattern of the word (trochaic or iambic). Analysis of the occurrence of the relevant vowel patterns in input speech in three Hebrew corpora (two addressed to children and one to adults) suggests that exposure to these patterns in words underlies the infants' preferences

Recognition and comprehension of “narrow focus” (Segal & Kishon-Rabin, 2017)

<div><b>Purpose: </b>The stressed word in a sentence (narrow focus [NF]) conveys information about the intent of the speaker and is therefore important for processing spoken language and in social interactions. The ability of participants with severe-to-profound prelingual hearing loss to comprehend NF has rarely been investigated. The purpose of this study was to assess the recognition and comprehension of NF by young adults with prelingual hearing loss compared with those of participants with normal hearing (NH).</div><div><b>Method: </b>The participants included young adults with hearing aids (HA; <i>n</i> = 10), cochlear implants (CI; <i>n</i> = 12), and NH (<i>n</i> = 18). The test material included the Hebrew Narrow Focus Test (Segal, Kaplan, Patael, & Kishon-Rabin, in press), with 3 subtests, which was used to assess the recognition and comprehension of NF in different contexts.</div><div><b>Results: </b>The following results were obtained: (a) CI and HA users successfully recognized the stressed word, with the worst performance for CI; (b) HA and CI comprehended NF less well than NH; and (c) the comprehension of NF was associated with verbal working memory and expressive vocabulary in CI users.</div><div><b>Conclusions: </b>Most CI and HA users were able to <i>recognize</i> the stressed word in a sentence but had considerable difficulty <i>understanding</i> it. Different factors may contribute to this difficulty, including the memory load during the task itself and linguistic and pragmatic abilities.</div><div><br></div><div><b>Supplemental Material S1.</b> Mean (<i>M</i>) and standard deviation (<i>SD</i>) of duration (in ms), fundamental frequency (in Hz) and intensity (RMS units) of the stressed vowel in the word carrying "narrow focus" compared to stressed vowels in the other words in the sentence. Also shown are the results of the statistical analyses comparing the measured acoustic parameters in the vowels carrying "narrow focus" to those measured in other stressed vowels in the sentence for each of the subtests.</div><div><br></div><div>Segal, O., & Kishon-Rabin, L. (2017). Recognition and comprehension of "narrow focus" by young adults with prelingual hearing loss using hearing aids and cochlear implants.<i> Journal of Speech, Language, and Hearing Research, 60, </i>3609<i>–</i>3624. https://doi.org/10.1044/2017_JSLHR-H-16-0342</div

Prophylactic antenatal N-Acetyl Cysteine administration combined with postnatal administration can decrease mortality and injury markers associated with necrotizing enterocolitis in a rat model.

BACKGROUND:Necrotizing enterocolitis (NEC) is a devastating gastrointestinal disease of neonates, especially premature neonates. To date, there is no prophylactic treatment against NEC, except breast milk and slow increase in enteral feeding, and there is no antenatal prophylaxis. AIMS:To assess possible protective effects of antenatal N-Acetyl Cysteine (NAC) against the intestinal pathophysiological changes associated with NEC in a rat model of NEC and against its associated mortality. METHODS:Newborn Sprague-Dawley rats were divided into 5 groups: control (n = 33); NEC (n = 32)-subjected to hypoxia and formula feeding for 4 days to induce NEC; NEC-NAC (n = 34)-with induced NEC and concomitant postnatal NAC administration; NAC-NEC (n = 33)-born to dams treated with NAC for the last 3 days of pregnancy starting at gestational age of 18 days, and then subjected to induced NEC after birth; NAC-NEC-NAC (n = 36)-subjected to induced NEC with both prenatal and postnatal NAC treatment. At day of life 5, weight and survival of pups in the different groups were examined, and pups were euthanized. Ileal TNF-α, IL-6, IL-1β, IL-10, NFkB p65, iNOS and cleaved caspase 3 protein levels (western blot) and mRNA expression (RT-PCR) were compared between groups. RESULTS:Pup mortality was significantly reduced in the NAC-NEC-NAC group compared to NEC (11% vs. 34%, P<0.05). Ileal protein levels and mRNA expression of all injury markers tested except IL-10 were significantly increased in NEC compared to control. These markers were significantly reduced in all NAC treatment groups (NEC-NAC, NAC-NEC, and NAC-NEC-NAC) compared to NEC. The most pronounced decrease was observed in the NAC-NEC NAC group. CONCLUSIONS:Antenatal NAC decreases injury markers and mortality associated with NEC in a rat model. Antenatal administration of NAC may present a novel approach for NEC prophylaxis in pregnancies with risk for preterm birth