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Introducción. Se describen los resultados preliminares del Programa de Acompañamiento al Sueño en la Infancia desde Terapia Ocupacional (PASITO) en niños y niñas con trastornos del neurodesarrollo (NN-TND), de 3 a 10 años, y con insomnio; realizado entre junio de 2020 y septiembre de 2021. Población y métodos. Estudio cuasiexperimental de preintervención y posintervención con un grupo de intervención y otro grupo de control, medido por el Cuestionario de Hábitos de Sueño (CHS) y el Diario de Sueño (DS). Resultados. Participaron 22 NN-TND, 8 en el grupo control. El puntaje total del CHS del grupo de intervención mejoró (p <0,001) de 54,9 (DE 5,5) a 48,4 (DE 4,5) y se acercó al rango de referencia 42,6 (DE 4,9). El DS evidenció aumento en duración, adelanto de fase de sueño y reducción en cantidad de despertares. Conclusión. Estos resultados provisorios y favorables muestran que PASITO podría ser una intervención posible para dificultades del sueño en NN-TND

Introduction. Here we describe the interim results of the Program to Support Child Sleep from the Occupational Therapy Perspective (Programa de Acompañamiento al Sueño en la Infancia desde Terapia Ocupacional, PASITO) for children with neurodevelopmental disorders (NDDs) aged 3­10 years with insomnia, conducted between June 2020 and September 2021. Population and methods. Pre- and post-intervention quasi-experiment in an intervention group and a control group using the Sleep Habits Questionnaire (SHQ) and the Consensus Sleep Diary (CSD). Results. A total of 22 children with NDDs participated, 8 in the control group. The overall SHQ score for the intervention group improved (p < 0.001) from 54.9 (SD: 5.5) to 48.4 (SD: 4.5) and moved closer to the reference range of 42.6 (SD: 4.9). The CSD showed an increased sleep duration, earlier sleep onset, and fewer night wakings. Conclusion. These interim favorable results demonstrate that the PASITO may be a possible intervention to manage sleep problems in children with NDDs.

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Introduction. Here we describe the interim results of the Program to Support Child Sleep from the Occupational Therapy Perspective (Programa de Acompañamiento al Sueño en la Infancia desde Terapia Ocupacional, PASITO) for children with neurodevelopmental disorders (NDDs) aged 3-10 years with insomnia, conducted between June 2020 and September 2021. Population and methods. Pre- and post-intervention quasi-experiment in an intervention group and a control group using the Sleep Habits Questionnaire (SHQ) and the Consensus Sleep Diary (CSD). Results. A total of 22 children with NDDs participated, 8 in the control group. The overall SHQ score for the intervention group improved (p < 0.001) from 54.9 (SD: 5.5) to 48.4 (SD: 4.5) and moved closer to the reference range of 42.6 (SD: 4.9). The CSD showed an increased sleep duration, earlier sleep onset, and fewer night wakings. Conclusion. These interim favorable results demonstrate that the PASITO may be a possible intervention to manage sleep problems in children with NDDs.

Introducción. Se describen los resultados preliminares del Programa de Acompañamiento al Sueño en la Infancia desde Terapia Ocupacional (PASITO) en niños y niñas con trastornos del neurodesarrollo (NN-TND), de 3 a 10 años, y con insomnio; realizado entre junio de 2020 y septiembre de 2021. Población y métodos. Estudio cuasiexperimental de preintervención y posintervención con un grupo de intervención y otro grupo de control, medido por el Cuestionario de Hábitos de Sueño (CHS) y el Diario de Sueño (DS). Resultados. Participaron 22 NN-TND, 8 en el grupo control. El puntaje total del CHS del grupo de intervención mejoró (p <0,001) de 54,9 (DE 5,5) a 48,4 (DE 4,5) y se acercó al rango de referencia 42,6 (DE 4,9). El DS evidenció aumento en duración, adelanto de fase de sueño y reducción en cantidad de despertares. Conclusión. Estos resultados provisorios y favorables muestran que PASITO podría ser una intervención posible para dificultades del sueño en NN-TND.

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Delayed diagnosis and a lack of adequate care for people with autism spectrum disorder (ASD) are related to worse outcomes and quality of life. This study aimed to identify the profile of service use, barriers to access care, and factors related to those barriers in Brazilian families with children with ASD. A total of 927 families with children with ASD (3-17 years) from five Brazilian regions completed an online version of the Caregivers Needs Survey. Results showed that the most used services were behavioral interventions and pharmacotherapy, while the most used professionals were neurologists, nutritionists, speech therapists, psychiatrists, psychologists, and pediatricians. The main barriers included waiting lists, costs, and the absence of services or treatment. Service use varied according to age, the region of residence, type of health care system used, and the parents/caregivers' education. Access to behavioral interventions was more frequent among users of the private system/health insurance and families whose caregivers had higher education. The absence of specialized services/treatments was less frequent among residents of state capitals and families whose caregivers had higher levels of education. This study highlights how families with children/adolescents with ASD in Brazil face significant barriers to access care related to sociodemographic factors.

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Background: Many countries have developed health initiatives to protect those with disabilities and developmental concerns in the past few years. However, the needs of autistic individuals are still short of being fulfilled. Partially due to limited research expenditure, which would allow bridging the gap between evidence and practice, the long time it takes to implement passed laws, and the limited operationalization of inclusive policies. Objective: To quantitatively examine changes in the child's age at the time of caregiver's first developmental concerns and age of diagnosis of their autistic child across 5 years. Also, to address challenges experienced by caregivers (e.g., reported service barriers) and the work still needing to be done in Argentina based on caregivers' reports of their priorities (e.g., ensuring their child receives better services). Methods: Two independent samples of caregivers of autistic individuals were surveyed by the Red Espectro Autista Latinoamerica (REAL) in 2015 (n = 763) and the World Health Organization (WHO) in 2020 (n = 422). Similar items in both surveys were compared through descriptive inferential analysis and chi-square tests for categorical variables. Results: Compared to the 2015 sample, for the 2020 sample, more caregivers reported an earlier age of first concerns and an earlier age of a professional diagnosis. In the 2020 sample, more children diagnosed before the age of three had a doctor or a teacher noticing the first developmental concern. Also, in this sample, fewer caregivers reported service barriers (e.g., limited availability, waitlist, costs, etc.) and a need for better social support and better health services. However, rates of caregivers indicating a need for more rights for autistic individuals and greater protection of existing rights increased. There was no change in the reported rate of family members who stopped working to care for the autistic individual. For both samples, there was statistically significant differences in individual (physician, teacher, caregiver) noticing first developmental concern and the age of diagnosis, with the majority having a caregiver noticing the first concern. Conclusion: The 5 years that separate both samples show an improvement in developmental concerns being noticed, a decrease in age of diagnosis, and an improvement in several service areas such as community awareness. Also, caregivers reported fewer barriers to service accessibility, thus suggesting a positive impact stemming from changes in public policies, non-profit organizations' work through awareness campaigns, and advocates' strives toward greater awareness. Nonetheless, a similar proportion of family members reported ceasing working to care for autistic individuals and perceived that the fundamental rights of their autistic children needed to be protected. These results imply that despite better care pathways in Argentina, there are still gaps when attempting to meet the needs of autistic individuals and their families. The present study provides a meaningful understanding of existing gaps and help exemplify the perceived improvements when non-profit agencies and advocates promote increased rights and community awareness in addition to the established laws focusing on ASD.

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INTRODUCTION: People on the Autism Spectrum (AS) face multiple health, education, social, and economic pro blems. There is limited available information in Chile. OBJECTIVE: To describe the access and satisfac tion with health and education services, family and economic impact, stigma, and quality of life of people with AS and their families in Chile. SUBJECTS AND METHOD: Parents/caregivers of AS persons completed the Caregiver Needs Survey, developed by Autism Speaks, which includes demographic information, characteristics of AS persons (previously published), use of health and education servi ces, parents/caregivers' perceptions of satisfaction, impact, stigma, and quality of life. RESULTS: 291 caregivers (86% mothers) of 291 AS persons participated, 89% were male, aged 1-40 years (X:10.4 SD:6.1). Limited and unspecific access to health services is reported. 77% are regularly attending a standard or special school system. Families pay for over 60% of therapies/medical care and over 40% of specific educational support, and 25% report difficulties in accessing services. The family income is affected by resignation (35%) or reduced working hours (46%). Stigma is associated with possi ble discrimination and feelings of helplessness. The main priorities mentioned for a better quality of life are support for inclusive schooling, better adjustment at home, and improved socialization. CONCLUSIONS: This survey provides relevant information about the needs, barriers, and challenges of AS people in Chile and highlights the difficulties in accessing health services and the severe impact on family income. Feelings of stigma, discrimination, and helplessness are reported. Collaborative strategies are needed to improve the quality and access to services and to reduce the economic and mental health burden on the family.

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La pandemia de covid-19 y las medidas asociadas determinaron cambios profundos en los individuos con trastorno del espectro autista (TEA) y sus familias. Se busca explorar estos efectos a nivel de las emociones y comportamientos en esta población en Uruguay. Dentro de un estudio multicéntrico de ocho países de Latinoamérica, se utilizó la submuestra de Uruguay para analizar los cambios de los comportamientos exhibidos por los individuos con TEA sobre la base de género y edad. Entre los 269 cuidadores que completaron una encuesta anónima, el 43,9 % reportó mayores problemas de convivencia y el 75,4 % reportó retrocesos. El empeoramiento de los comportamientos externalizados fue mayor en el sexo masculino y de los internalizados, en los adolescentes de 13 a 18 años. Estos resultados deberían considerarse a la hora de tomar medidas que comprometen la continuidad educativa, apoyos terapéuticos y de asistencia a las familias con personas con TEA en Uruguay.

COVID-19 pandemic and its associated measures, determined pro-found changes in individuals with autism spectrum disorder (ASD) and their families. Authors explore consequences regarding emotions and behaviors in this population in Uruguay. Within a multicentric study of eight Latin American countries, changes in behaviors in individuals with ASD based on gender and age were analyzed in the Uruguayan sub-sample. Among the 269 caregivers who completed an anonymous survey, 43.9% reported greater problems in daily life and 75.4% reported setbacks. The worsening of externalizing behaviors was greater in males. The internalizing ones were higher in adolescents aged 13 to 18 years. These results should be considered when taking measures that compromise educational continuity, therapeutic supports and assistance to families with people with ASD in Uruguay.

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LAY ABSTRACT: Approximately 6 million individuals with autism spectrum disorder live in Latin America. In order to strengthen autism spectrum disorder research collaborations and awareness in the region, the Latin American Autism Spectrum Network (Red Espectro Autista Latinoamerica) was constituted in 2015, comprising researchers and clinicians from the following six countries: Brazil Argentina, Chile, Uruguay, Venezuela, and the Dominican Republic. This first multisite study from the Red Espectro Autista Latinoamerica network aims to describe the challenges and priorities to identify barriers to care and to map stigma among families of individuals with autism spectrum disorder living in Latin America. A total of 2942 caregivers from these six countries completed an online survey showing that the main priorities were greater community awareness and improvements in the educational system for individuals with autism spectrum disorder. In addition to that, the main barriers to care were related to lack of structure, mainly waiting lists (50.2%), high treatment costs (35.2%), and lack of specialized services (26.1%). Stigma experienced by families was frequent: one third reported feeling discriminated against and helpless for having a child with autism spectrum disorder. Also, 48.8% of the caregivers declared financial problems, 47.4% of them had to cut down work hours, and 35.5% had to leave their jobs because of their child's autism spectrum disorder. This is a pioneer study providing a description of the needs and challenges faced by families affected by autism spectrum disorder in Latin America, helping to build data-driven strategies at the national and regional levels.

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No medication has been proven effective in treating core characteristics of intellectual disability or autism. Psychotropic medications are frequently used to target psychiatric symptoms in children, adolescents and adults with developmental conditions, despite the little evidence for their efficacy. This article aimed to summarize current evidence on efficacy of pharmacological interventions for the most frequent symptoms and disorders associated to autism and to intellectual disability. And also, novel molecules being studied for core symptoms of these conditions. Electronic databases were searched and supplemented with a hand search. Data were described narratively prioritizing meta-analysis and randomized controlled trials but considering also open label trials and preliminary studies. The main conclusions were that only few drugs showed efficacy for reducing psychiatric symptoms associated to these developmental conditions, mainly risperidone and aripiprazole to treat irritability and methylphenidate and atomoxetine for hyperactivity and attention deficit. Evidence is inconclusive regarding the effectiveness of other drug groups. Novel therapeutic agents showed mixed results and quality of evidence is low; some of these agents aim at biologically targeted pharmacotherapy, which may lead to successful individualized treatment options in the future. To this day, clinicians should use pharmacotherapy with caution, carefully weighing risks and benefits, and as a part of a comprehensive personalized approach.

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BACKGROUND: The dimensional approach to autism spectrum disorder (ASD) considers ASD as the extreme of a dimension traversing through the entire population. We explored the potential utility of electroencephalography (EEG) functional connectivity as a biomarker. We hypothesized that individual differences in autistic traits of typical subjects would involve a long-range connectivity diminution within the delta band. METHODS: Resting-state EEG functional connectivity was measured for 74 neurotypical subjects. All participants also provided a questionnaire (Social Responsiveness Scale, SRS) that was completed by an informant who knows the participant in social settings. We conducted multivariate regression between the SRS score and functional connectivity in all EEG frequency bands. We explored modulations of network graph metrics characterizing the optimality of a network using the SRS score. RESULTS: Our results show a decay in functional connectivity mainly within the delta and theta bands (the lower part of the EEG spectrum) associated with an increasing number of autistic traits. When inspecting the impact of autistic traits on the global organization of the functional network, we found that the optimal properties of the network are inversely related to the number of autistic traits, suggesting that the autistic dimension, throughout the entire population, modulates the efficiency of functional brain networks. CONCLUSIONS: EEG functional connectivity at low frequencies and its associated network properties may be associated with some autistic traits in the general population.

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Anatomical and functional brain studies have converged to the hypothesis that autism spectrum disorders (ASD) are associated with atypical connectivity. Using a modified resting-state paradigm to drive subjects' attention, we provide evidence of a very marked interaction between ASD brain functional connectivity and cognitive state. We show that functional connectivity changes in opposite ways in ASD and typicals as attention shifts from external world towards one's body generated information. Furthermore, ASD subject alter more markedly than typicals their connectivity across cognitive states. Using differences in brain connectivity across conditions, we ranked brain regions according to their classification power. Anterior insula and dorsal-anterior cingulate cortex were the regions that better characterize ASD differences with typical subjects across conditions, and this effect was modulated by ASD severity. These results pave the path for diagnosis of mental pathologies based on functional brain networks obtained from a library of mental states.

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Autism Spectrum Disorders do not have a treatment that offers definitive solution to the serious challenges faced by people who suffer from them. Consequently, as in other chronic conditions, many therapeutic interventions are offered, each based on different neurobiological or psychological hypotheses. In the present article criteria for the organization of the proposed interventions are suggested, and the main aspects of the affective diathesis hypothesis are summarized. This theory emphasizes the importance of emotional signaling as a basis for development and is the theoretical framework for one of the therapeutic options in the field of autism that is earning recognition in our country: the DIR-Floortime model.

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Over the last years, increasing evidence has fuelled the hypothesis that Autism Spectrum Disorder (ASD) is a condition of altered brain functional connectivity. The great majority of these empirical studies relies on functional magnetic resonance imaging (fMRI) which has a relatively poor temporal resolution. Only a handful of studies has examined networks emerging from dynamic coherence at the millisecond resolution and there are no investigations of coherence at the lowest frequencies in the power spectrum-which has recently been shown to reflect long-range cortico-cortical connections. Here we used electroencephalography (EEG) to assess dynamic brain connectivity in ASD focusing in the low-frequency (delta) range. We found that connectivity patterns were distinct in ASD and control populations and reflected a double dissociation: ASD subjects lacked long-range connections, with a most prominent deficit in fronto-occipital connections. Conversely, individuals with ASD showed increased short-range connections in lateral-frontal electrodes. This effect between categories showed a consistent parametric dependency: as ASD severity increased, short-range coherence was more pronounced and long-range coherence decreased. Theoretical arguments have been proposed arguing that distinct patterns of connectivity may result in networks with different efficiency in transmission of information. We show that the networks in ASD subjects have less Clustering coefficient, greater Characteristic Path Length than controls - indicating that the topology of the network departs from small-world behaviour - and greater modularity. Together these results show that delta-band coherence reveal qualitative and quantitative aspects associated with ASD pathology.

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Objetivos: Identificar conductas, signos y otras variables que puedan ser observables por los familiares de los niños y adolescentes en riesgo de desarrollar Trastornos de la Conducta Alimentaria (TCA) como pautas de alarma, para tomar alguna conducta preventiva o intentar modificar patrones maladaptativos...

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Autism constitutes one of the most investigated disorders in child psychiatry. The heterogeneous clinical phenomena that characterize it have been exhaustibly described along the last 62 years. Multiple aetiological hypothesis, neuropsychological theories and physiopathological mechanisms, sometimes complementary and other times mutually exclusive, and different descriptions of neurobiological alterations that resulted, in general, of low replicability, have attempted to account for the marked variability of its manifestations. An integration of these different levels of analysis results even harder than the comprehension of each of them separately. In this article the author revises the three aspects considered the most characteristic of the syndrome (social interaction, communication and flexibility) and tries to integrate its clinical manifestations with some neuropsychological variables and the neurobiological substrates.

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Autism constitutes one of the most investigated disorders in child psychiatry. The heterogeneous clinical phenomena that characterize it have been exhaustibly described along the last 62 years. Multiple aetiological hypothesis, neuropsychological theories and physiopathological mechanisms, sometimes complementary and other times mutually exclusive, and different descriptions of neurobiological alterations that resulted, in general, of low replicability, have attempted to account for the marked variability of its manifestations. An integration of these different levels of analysis results even harder than the comprehension of each of them separately. In this article the author revises the three aspects considered the most characteristic of the syndrome (social interaction, communication and flexibility) and tries to integrate its clinical manifestations with some neuropsychological variables and the neurobiological substrates.

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Incluye: Cap.1- Uso de ansiolíticos en niños y adolescentes; Cap.2- Antidepresivos, depresión y otras indicaciones en la psiquiatría de niños y adolescentes, Cap.3- Teoría y práctica del tratamiento con antipsicóticos en niños y adolescentes; Cap.4- Trastorno por déficit de atención con hiperactividad; Cap.5- Tratamiento farmacológico de las epilepsias; Cap.6- Trastornos de la alimentación en la adolescencia. Tratamiento psicofarmacológico; Cap.7- Las adicciones tóxicos en nuestro medio; Cap.8- Urgencias en psiquiatría infanto-juvenil. Intervencion específica y terapia farmacológica; Cap.9- Intoxicación aguda por psicofármacos. Estudio comparativo entre los años 1992 y 2003 en la Ciudad de Buenos Aires; Cap.10- Prácticas actuales de prescripción en la psiquiatría de niños y adolescentes en Gran Bretaña; Cap.11- La utilización de psicotrópicos en el tratamiento de niños y adolescentes en Francia; Cap.12- Psicofarmacología de niños y adolescentes. Perspectivas actuales de los Estados Unidos de América

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Incluye: Cap.1- Uso de ansiolíticos en niños y adolescentes; Cap.2- Antidepresivos, depresión y otras indicaciones en la psiquiatría de niños y adolescentes, Cap.3- Teoría y práctica del tratamiento con antipsicóticos en niños y adolescentes; Cap.4- Trastorno por déficit de atención con hiperactividad; Cap.5- Tratamiento farmacológico de las epilepsias; Cap.6- Trastornos de la alimentación en la adolescencia. Tratamiento psicofarmacológico; Cap.7- Las adicciones tóxicos en nuestro medio; Cap.8- Urgencias en psiquiatría infanto-juvenil. Intervencion específica y terapia farmacológica; Cap.9- Intoxicación aguda por psicofármacos. Estudio comparativo entre los años 1992 y 2003 en la Ciudad de Buenos Aires; Cap.10- Prácticas actuales de prescripción en la psiquiatría de niños y adolescentes en Gran Bretaña; Cap.11- La utilización de psicotrópicos en el tratamiento de niños y adolescentes en Francia; Cap.12- Psicofarmacología de niños y adolescentes. Perspectivas actuales de los Estados Unidos de América

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Incluye: Cap.1- Uso de ansiolíticos en niños y adolescentes; Cap.2- Antidepresivos, depresión y otras indicaciones en la psiquiatría de niños y adolescentes, Cap.3- Teoría y práctica del tratamiento con antipsicóticos en niños y adolescentes; Cap.4- Trastorno por déficit de atención con hiperactividad; Cap.5- Tratamiento farmacológico de las epilepsias; Cap.6- Trastornos de la alimentación en la adolescencia. Tratamiento psicofarmacológico; Cap.7- Las adicciones tóxicos en nuestro medio; Cap.8- Urgencias en psiquiatría infanto-juvenil. Intervencion específica y terapia farmacológica; Cap.9- Intoxicación aguda por psicofármacos. Estudio comparativo entre los años 1992 y 2003 en la Ciudad de Buenos Aires; Cap.10- Prácticas actuales de prescripción en la psiquiatría de niños y adolescentes en Gran Bretaña; Cap.11- La utilización de psicotrópicos en el tratamiento de niños y adolescentes en Francia; Cap.12- Psicofarmacología de niños y adolescentes. Perspectivas actuales de los Estados Unidos de América

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Autism constitutes one of the most investigated disorders in child psychiatry. The heterogeneous clinical phenomena that characterize it have been exhaustibly described along the last 62 years. Multiple aetiological hypothesis, neuropsychological theories and physiopathological mechanisms, sometimes complementary and other times mutually exclusive, and different descriptions of neurobiological alterations that resulted, in general, of low replicability, have attempted to account for the marked variability of its manifestations. An integration of these different levels of analysis results even harder than the comprehension of each of them separately. In this article the author revises the three aspects considered the most characteristic of the syndrome (social interaction, communication and flexibility) and tries to integrate its clinical manifestations with some neuropsychological variables and the neurobiological substrates.