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Al-Beltagi M, Saeed NK, Bediwy AS, Alhawamdeh R, Elbeltagi R. Management of critical care emergencies in children with autism spectrum disorder. World J Crit Care Med 2025; 14. [DOI: 10.5492/wjccm.v14.i2.99975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2024] [Revised: 12/13/2024] [Accepted: 12/30/2024] [Indexed: 02/27/2025] Open
Abstract
BACKGROUND
Managing critical care emergencies in children with autism spectrum disorder (ASD) presents unique challenges due to their distinct sensory sensitivities, communication difficulties, and behavioral issues. Effective strategies and protocols are essential for optimal care in these high-stress situations.
AIM
To systematically evaluate and synthesize current evidence on best practices for managing critical care emergencies in children with ASD. The review focuses on key areas, including sensory-friendly environments, communication strategies, behavioral management, and the role of multidisciplinary approaches.
METHODS
A comprehensive search was conducted across major medical databases, including PubMed, Embase, and Cochrane Library, for studies published between 2000 and 2023. Studies were selected based on their relevance to critical care management in children with ASD, encompassing randomized controlled trials, observational studies, qualitative research, and case studies. Data were extracted and analyzed to identify common themes, successful strategies, and areas for improvement.
RESULTS
The review identified 50 studies that met the inclusion criteria. Findings highlighted the importance of creating sensory-friendly environments, utilizing effective communication strategies, and implementing individualized behavioral management plans. These findings, derived from a comprehensive review of current evidence, provide valuable insights into the best practices for managing critical care emergencies in children with ASD. Sensory modifications, such as reduced lighting and noise, visual aids, and augmentative and alternative communication tools, enhanced patient comfort and cooperation. The involvement of multidisciplinary teams was crucial in delivering holistic care. Case studies provided practical insights and underscored the need for continuous refinement of protocols.
CONCLUSION
The review emphasizes the need for a tailored approach to managing critical care emergencies for children with ASD. Sensory-friendly adjustments, effective communication, and behavioral strategies supported by a multidisciplinary team are integral to improving outcomes. Despite progress, ongoing refinement of care practices and protocols is necessary. This ongoing process addresses remaining challenges and engages healthcare professionals in continuous improvement of care for children with ASD in critical settings.
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Affiliation(s)
- Mohammed Al-Beltagi
- Department of Pediatric, Faculty of Medicine, Tanta University, Tanta 31511, Alghrabia, Egypt
- Department of Pediatric, University Medical Center, King Abdulla Medical City, Arabian Gulf University, Manama 26671, Manama, Bahrain
| | - Nermin Kamal Saeed
- Medical Microbiology Section, Department of Pathology, Salmaniya Medical Complex, Ministry of Health, Kingdom of Bahrain, Manama 26671, Manama, Bahrain
- Medical Microbiology Section, Department of Pathology, Irish Royal College of Surgeon, Bahrain, Busaiteen 15503, Muharraq, Bahrain
| | - Adel Salah Bediwy
- Department of Pulmonology, Faculty of Medicine, Tanta University, Tanta 31527, Alghrabia, Egypt
- Department of Pulmonology, University Medical Center, King Abdulla Medical City, Arabian Gulf University, Manama 26671, Manama, Bahrain
| | - Rawan Alhawamdeh
- Department of Pediatrics Research and Development, Sensoryme Dwc-llc, Dubai 712495, Dubai, United Arab Emirates
- Department of Pediatrics Research and Development, Genomics Sensory Play and Creativity Center, Manama 22673, Manama, Bahrain
| | - Reem Elbeltagi
- Department of Medicine, The Royal College of Surgeons in Ireland-Bahrain, Busiateen 15503, Muharraq, Bahrain
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Kacimi FE, Didou L, Ed Day S, Azzaoui FZ, Ramchoun M, Berrougui H, Khalki H, Boulbaroud S. Gut microbiota, vitamin A deficiency and autism spectrum disorder: an interconnected trio - a systematic review. Nutr Neurosci 2025; 28:492-502. [PMID: 39137920 DOI: 10.1080/1028415x.2024.2389498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2024]
Abstract
Accumulating evidence proves that children with autism have gastrointestinal problems. However, a significant difference in gut microbiota (GM) exists between autistic and non-autistic children. These changes in the GM may stem from several factors. Recently, researchers focused on nutritional factors, especially vitamin deficiency. Thus, our systematic review investigates the connections among autism, GM alterations, and vitamin A deficiency (VAD), by analyzing studies sourced from PubMed and Embase databases spanning from 2010 to 2022. Adhering to PRISMA guidelines, we meticulously selected 19 pertinent studies that established links between autism and GM changes or between autism and VAD. Our findings uniformly point to significant alterations in the GM of individuals with autism, indicating these changes as promising biomarkers for the disorder. Despite the consistent association of GM alterations with autism, our analysis revealed no notable differences in GM composition between individuals with autism and those experiencing VAD. This suggests that VAD, especially when encountered early in life, might play a role in the onset of autism. Furthermore, our review underscores a distinct correlation between reduced levels of retinoic acid in children with autism, a disparity that could relate to the severity of autism symptoms. The implications of our findings are twofold: they not only reinforce the significance of GM alterations as potential diagnostic markers but also spotlight the critical need for further research into nutritional interventions. Specifically, vitamin A supplementation emerges as a promising avenue for alleviating autism symptoms, warranting deeper investigation into its therapeutic potential.
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Affiliation(s)
- Fatima Ezzahra Kacimi
- Biotechnology and Sustainable Development of Natural Resources Unit, Multidisciplinary Faculty, Sultan Moulay Slimane University, Beni Mellal, Morocco
| | - Latifa Didou
- Unit of Neuroscience, Neuroimmunology and Behavior, Laboratory of Biology and Health, Department of Biology, Faculty of Science, Ibn Tofail University, Kenitra, Morocco
| | - Soumia Ed Day
- Unit of Neuroscience, Neuroimmunology and Behavior, Laboratory of Biology and Health, Department of Biology, Faculty of Science, Ibn Tofail University, Kenitra, Morocco
| | - Fatima Zahra Azzaoui
- Unit of Neuroscience, Neuroimmunology and Behavior, Laboratory of Biology and Health, Department of Biology, Faculty of Science, Ibn Tofail University, Kenitra, Morocco
| | - Mhamed Ramchoun
- Biotechnology and Sustainable Development of Natural Resources Unit, Multidisciplinary Faculty, Sultan Moulay Slimane University, Beni Mellal, Morocco
| | - Hicham Berrougui
- Biotechnology and Sustainable Development of Natural Resources Unit, Multidisciplinary Faculty, Sultan Moulay Slimane University, Beni Mellal, Morocco
| | - Hanane Khalki
- Biotechnology and Sustainable Development of Natural Resources Unit, Multidisciplinary Faculty, Sultan Moulay Slimane University, Beni Mellal, Morocco
| | - Samira Boulbaroud
- Biotechnology and Sustainable Development of Natural Resources Unit, Multidisciplinary Faculty, Sultan Moulay Slimane University, Beni Mellal, Morocco
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Santos CLD, Barreto II, Silva ACFD, Soriano JFB, Castro JDLS, Tristão LS, Bernardo WM. Behavioral therapies for the treatment of autism spectrum disorder: A systematic review. Clinics (Sao Paulo) 2024; 80:100566. [PMID: 39729835 PMCID: PMC11732605 DOI: 10.1016/j.clinsp.2024.100566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2024] [Accepted: 12/09/2024] [Indexed: 12/29/2024] Open
Abstract
INTRODUCTION Autism Spectrum Disorder (ASD) is a neurodevelopment spectrum characterized by persistent deficits in social communication and interpersonal interaction, along with restricted and repetitive patterns of behavior, interest, or activities. The appropriate screening and diagnosis must be realized to improve the children's prognosis. Moreover, appropriate treatments are necessary to promote better social integration and development. In this scenario, this systematic review aims to evaluate the impacts of behavioral therapies applied in healthcare settings for patients with ASD. METHODS This systematic review followed the PRISMA guidelines. The databases MEDLINE, Embase, CENTRAL (Cochrane), and Lilacs were accessed, and gray and manual searches were performed. The search strategy was created with terms referring to autism and behavioral therapy. The studies were assessed qualitatively. RESULTS Randomized clinical trials and observational studies demonstrated improvements in cognitive and verbal components of patients who received behavioral therapies in therapeutic settings. These results indicate a positive impact of both cognitive-behavioral therapy and ESDM on the development of patients' skills. Among the cognitive-behavioral therapies, the one based on the MASSI protocol did not impact the reduction of anxious symptoms. As for cognitive-behavioral therapy, one study demonstrated that the Behavioral Intervention for Anxiety in Children with Autism (BIACA), when compared to the Coping Cat protocol, improves cognition and reduces anxiety symptoms. Despite these results, further randomized clinical trials comparing behavioral therapies with one another are needed. CONCLUSION In the context of behavioral therapy within a healthcare setting, the Early Start Denver Model (ESDM) showed improvements in the cognitive, verbal, and social aspects of the evaluated patients. Improvement in scores sometimes is achieved independently of the group and related to the time of interventions.
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Affiliation(s)
- Clara Lucato Dos Santos
- Department of Evidence-Based Medicine, Faculdade de Ciências Médicas de Santos (UNILUS), Santos, SP, Brazil
| | - Indyanara Inacio Barreto
- Center for Evidence-Based Medicine, Unimed Campinas, SP, Brazil; Evidence-Based Medicine Committee at Federação das Unimeds do Estado de São Paulo (FESP), São Paulo, SP, Brazil
| | - Ana Carolina Furian da Silva
- Center for Evidence-Based Medicine, Unimed Campinas, SP, Brazil; Evidence-Based Medicine Committee at Federação das Unimeds do Estado de São Paulo (FESP), São Paulo, SP, Brazil
| | | | | | - Luca Schiliró Tristão
- Department of Evidence-Based Medicine, Faculdade de Ciências Médicas de Santos (UNILUS), Santos, SP, Brazil
| | - Wanderley Marques Bernardo
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil; Coordinator of The Evidence-Based Medicine Department at Federação das Unimeds do Estado de São Paulo (FESP), São Paulo, SP, Brazil
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Al-Beltagi M. Nutritional management and autism spectrum disorder: A systematic review. World J Clin Pediatr 2024; 13:99649. [PMID: 39654662 PMCID: PMC11572612 DOI: 10.5409/wjcp.v13.i4.99649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2024] [Revised: 09/21/2024] [Accepted: 10/15/2024] [Indexed: 10/30/2024] Open
Abstract
BACKGROUND Autism spectrum disorder (ASD) presents unique challenges related to feeding and nutritional management. Children with ASD often experience feeding difficulties, including food selectivity, refusal, and gastrointestinal issues. Various interventions have been explored to address these challenges, including dietary modifications, vitamin supplementation, feeding therapy, and behavioral interventions. AIM To provide a comprehensive overview of the current evidence on nutritional management in ASD. We examine the effectiveness of dietary interventions, vitamin supplements, feeding therapy, behavioral interventions, and mealtime practices in addressing the feeding challenges and nutritional needs of children with ASD. METHODS We systematically searched relevant literature up to June 2024, using databases such as PubMed, PsycINFO, and Scopus. Studies were included if they investigated dietary interventions, nutritional supplements, or behavioral strategies to improve feeding behaviors in children with ASD. We assessed the quality of the studies and synthesized findings on the impact of various interventions on feeding difficulties and nutritional outcomes. Data extraction focused on intervention types, study designs, participant characteristics, outcomes measured, and intervention effectiveness. RESULTS The review identified 316 studies that met the inclusion criteria. The evidence indicates that while dietary interventions and nutritional supplements may offer benefits in managing specific symptoms or deficiencies, the effectiveness of these approaches varies. Feeding therapy and behavioral interventions, including gradual exposure and positive reinforcement, promise to improve food acceptance and mealtime behaviors. The findings also highlight the importance of creating supportive mealtime environments tailored to the sensory and behavioral needs of children with ASD. CONCLUSION Nutritional management for children with ASD requires a multifaceted approach that includes dietary modifications, supplementation, feeding therapy, and behavioral strategies. The review underscores the need for personalized interventions and further research to refine treatment protocols and improve outcomes. Collaborative efforts among healthcare providers, educators, and families are essential to optimize this population's nutritional health and feeding practices. Enhancing our understanding of intervention sustainability and long-term outcomes is essential for optimizing care and improving the quality of life for children with ASD and their families.
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Affiliation(s)
- Mohammed Al-Beltagi
- Department of Pediatric, Faculty of Medicine, Tanta University, Tanta 31511, Alghrabia, Egypt
- Department of Pediatric, University Medical Center, King Abdulla Medical City, Arabian Gulf University, Manama 26671, Bahrain
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Acero-Ferrero M, Escolano-Pérez E. Executive Functions Assessment in a Child with Autism: A Pilot Single-Case Study from a Longitudinal and Mixed Methods Approach. CHILDREN (BASEL, SWITZERLAND) 2024; 11:1468. [PMID: 39767897 PMCID: PMC11674081 DOI: 10.3390/children11121468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2024] [Revised: 11/27/2024] [Accepted: 11/28/2024] [Indexed: 01/11/2025]
Abstract
Although the literature confirms executive deficits in individuals with autism spectrum disorder (ASD) that hinder adaptation, evidence-based intervention programs targeting this area are scarce, and even fewer have evaluated their effectiveness. OBJECTIVES This study aimed to assess a pilot program designed to improve the executive functions of a child five years and nine months in age with ASD. METHODS To evaluate the effects of the intervention, observational methodology was used, which is considered a mixed method in itself as it integrates both qualitative and quantitative elements in its various phases. Specifically, an idiographic, longitudinal, and multidimensional design was followed. A lag sequential analysis was conducted using GSEQ software Version 5.1, enabling us to study changes in the executive functions of a child before, during, and after the intervention, including whether its effects are sustained over time. RESULTS The sequential patterns obtained indicate more appropriate and complex executive functioning after the three-month intervention, specifically increased cognitive flexibility, improved self-regulation, more accurate evaluation, and progress in inhibitory processes. However, these improvements do not persist over time. CONCLUSION This study contributes to the scarcely explored field of executive function interventions in children with ASD, although it is necessary to consider the generalization of the results to other contexts, such as family and school, during interaction with peers.
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Affiliation(s)
| | - Elena Escolano-Pérez
- Faculty of Education, Department of Psychology and Sociology, University of Zaragoza, 50009 Zaragoza, Spain;
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Purba CAP, Febriyana N, Setiawati Y. Managing Aggressive Behavior in Adolescents With Autism Spectrum Disorder: Pharmacological and Non-Pharmacological Approaches. Soa Chongsonyon Chongsin Uihak 2024; 35:223-229. [PMID: 39380568 PMCID: PMC11456650 DOI: 10.5765/jkacap.240026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Revised: 08/04/2024] [Accepted: 09/03/2024] [Indexed: 10/10/2024] Open
Abstract
Adolescents diagnosed with autism spectrum disorder (ASD) often encounter significant challenges, particularly aggressive behaviors that persist into adulthood and profoundly affect their daily functioning and quality of life. These behaviors not only pose hurdles for affected individuals but also present considerable challenges for caregivers and families. Managing aggression in adolescents with ASD requires comprehensive treatment approaches encompassing both non-pharmacological and pharmacological interventions. This paper reviews current interventions that have proven to be effective through empirical studies in managing aggression among adolescents with ASD. By synthesizing evidence-based practices, this study underscores the importance of a multidisciplinary approach involving medical, psychological, and educational interventions to effectively manage aggression among adolescents with ASD. It aimed to inform clinicians, educators, and caregivers of practical strategies and evidence-based interventions to address aggression in this population.
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Affiliation(s)
- Christopher Ade Putra Purba
- Department of Child and Adolescent Psychiatry, Dr. Soetomo General Academic Hospital, Faculty of Medicine, Airlangga University, Surabaya, Indonesia
| | - Nining Febriyana
- Department of Child and Adolescent Psychiatry, Dr. Soetomo General Academic Hospital, Faculty of Medicine, Airlangga University, Surabaya, Indonesia
| | - Yunias Setiawati
- Department of Child and Adolescent Psychiatry, Dr. Soetomo General Academic Hospital, Faculty of Medicine, Airlangga University, Surabaya, Indonesia
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Yoo HJ. Understanding Evidence-Based Practice for Autism Spectrum Disorder: Korean Practice Clinical Guidelines. Soa Chongsonyon Chongsin Uihak 2024; 35:1. [PMID: 38204747 PMCID: PMC10774560 DOI: 10.5765/jkacap.230076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024] Open
Affiliation(s)
- Hee Jeong Yoo
- Department of Psychiatry, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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