Open access article: https://www.thieme-connect.com/products/ejournals/html/10.1055/s-0044-1788269

Abstract

Almost two decades before Kanner's and Asperger's works, the original paper by child psychiatrist Grunya Efimovna Sukhareva had already been written. It was published in 1926 by Sukhareva in a German scientific journal of psychiatry and neurology, with a detailed description of children who presented clinical conditions whose characteristics and evolution closely resemble autism, according to current criteria. In the present historical note, we intend to present Sukhareva's pioneering work and retrieve the meaning of her original contribution.

Citation: Cristina Maria Pozzi, Rudimar dos Santos Riesgo, Francisco Baptista Assumpção Junior. Revisiting the history of autism before Kanner and Asperger: a tribute to Grunya Sukhareva. Arq Neuropsiquiatr 2024; 82: s00441788269. DOI: 10.1055/s-0044-1788269

Open access article: https://www.preprints.org/manuscript/202406.0856/v1

Abstract

Autism Spectrum Disorder (ASD), a neurodevelopmental disorder, is increasingly diagnosed and significantly affects communication, behavior, and social interaction. The current diagnostic framework, guided by the DSM-5, has limitations that may lead to clinical gaps due to overlapping symptoms of ASD and other disorders. This study proposes a comprehensive approach to enhance ASD diagnosis through clinical stratification based on comorbidities. We applied precision medicine techniques to identify and categorize ASD into ten clinical profiles. Our findings contribute to a more profound understanding of ASD, including its varied clinical manifestations and comorbidities, and facilitate the development of personalized therapeutic strategies.

Οpen access article: (https://acamh.onlinelibrary.wiley.com/doi/full/10.1111/jcpp.13806)

Abstract

After attention was drawn in the late 1960s to the poor reproducibility of psychiatric diagnosis between clinicians, methods and procedures used to diagnose psychiatric disorders were greatly improved. Sources of variance contributing to the poor reliability of psychiatric diagnosis were identified that included: information variance (how clinicians go about enquiring about symptoms), interpretation variance (how clinicians weigh the observed symptomatology towards diagnostic formulations), and criterion variance (how clinicians arrange symptom constellations to generate specific diagnoses). To improve the reliability of diagnosis, progresses were made in two major directions. First, diagnostic instruments were developed to standardize the way symptoms are elicited, evaluated, and scored. These diagnostic interviews were either highly structured for use in large-scale studies (e.g. the DIS), by lay interviewers without a clinical background, and with a style of questioning that emphasized adherence to the exact wording of probes, reliance on closed questions with simple response formats (Yes/No) and recording respondents' answers without interviewer's judgment contribution. By contrast, semi-structured interviews (e.g. the SADS) were designed to be used by clinically trained interviewers and adopted a more flexible, conversational style, using open-ended questions, utilizing all behavioral descriptions generated in the interview, and developing scoring conventions that called upon the clinical judgment of the interviewer. Second, diagnostic criteria and algorithms were introduced in nosographies in 1980 for the DSM and soon after in ICD. Algorithm-derived diagnoses could subsequently be tested for their validity using follow-up, family history, treatment response studies, or other external criteria.

Citation: Fombonne, E. (2023), Editorial: Is autism overdiagnosed?. J Child Psychol
Psychiatr, 64: 711-714. https://doi.org/10.1111/jcpp.13806

https://www.researchgate.net/publication/380152228_ESCAP_statement_on_the_care_for_children_and_adolescents_with_gender_dysphoria_an_urgent_need_for_safeguarding_clinical_scientific_and_ethical_standards

Abstract

ESCAP firmly believes that there is an urgent need to apply widely endorsed clinical, scientific, and ethical standards to the care of children and adolescents with gender dysphoria. It is important to base decisions for possible medical transitions on a rigorous assessment of individual needs and their capacity to consent regarding the serious long-term consequences of these treatments. Long-term follow-up studies are urgently needed to better understand both the natural course of gender dysphoria in the absence of medical treatment and the consequences of medical transition. A clinical research framework with patient and public involvement should be established and promoted at the European level to facilitate relevant research. The standards of evidence-based medicine must ensure the best and safest possible care for each individual in this highly vulnerable group of children and adolescents. As such, ESCAP calls for healthcare providers not to promote experimental and unnecessarily invasive treatments with unproven psycho social effects and, therefore, to adhere to the "primum-nil nocere" (first, do no harm) principle. Finally, ESCAP insists that respect for all kinds of different views and attitudes is an essential part of an ongoing open professional debate that we wish to stimulate.

Citation: Drobnič Radobuljac, M., Grošelj, U., Kaltiala, R., ESCAP Policy Division, ESCAP Board, Vermeiren, R., Crommen, S., Kotsis, K., Danese, A., Hoekstra, P. J., & Fegert, J. M. (2024). ESCAP statement on the care for children and adolescents with gender dysphoria: an urgent need for safeguarding clinical, scientific, and ethical standards. European child & adolescent psychiatry, 10.1007/s00787-024-02440-8. Advance online publication. https://doi.org/10.1007/s00787-024-02440-8

Open access article: https://www.sciencedirect.com/science/article/pii/S0001691823001142

Abstract
The current “autism spectrum” DSM 5 diagnostic criteria and autism standardized diagnostic instruments promote considerable heterogeneity or clinical indecision and may be detrimental to the advancement of fundamental research on autism mechanisms. To increase clinical specificity and reorient research towards core autistic presentations, we propose new diagnostic criteria for prototypical autism during the age of 2- to 5-years. We include autism within other non-dominant, familiarly aggregated phenomena sharing asymmetrical developmental bifurcations, such as twin pregnancy, left handedness, and breech presentation/delivery. Following this model, nature, trajectory, and positive/negative signs structure of autism would result from the polarized problem of whether or not language and information is processed in a socially biased manner. Prototypical autism would follow a canonical developmental trajectory by which a gradual decline in social bias in the processing of incoming information, overtly beginning at the end of the first year, bifurcates into a prototypical autistic presentation in the second half of the second year of life. This bifurcation event is followed by a plateau, in which these atypicalities show maximal stringency and distinctiveness, and then ultimately, in most cases, by partial normalization. During the plateau period, the orientation towards, and processing of, information is considerably modified, with an absence of bias for social information, contrasting with a high level of interest in complex, unbiased information, independently of its social or non-social nature. Integrating autism into asymmetrical developmental bifurcations would explain the absence of deleterious neurological and genetic markers and the presence of familial transmission in canonical autistic presentations.

Citation: Laurent Mottron, David Gagnon, Prototypical autism: New diagnostic criteria and
asymmetrical bifurcation model, Acta Psychologica, Volume 237, 2023, 103938, ISSN 0001-
6918, https://doi.org/10.1016/j.actpsy.2023.103938.