Introduction Autism is a neurodevelopmental disorder characterized by qualitative impairments in social interaction, communication, and restricted and repetitive behaviors [1]. Despite of these symptoms, some patients present different manifestations of irritability. These can be expressed in different kinds of disruptive behaviors. Recent studies shown that, at least 20% of children with autism present irritability symptoms, which cause severe social and familiar disturbances [2]. Objectives The aim of this study was to evaluate short-term efficacy of aripiprazole in children in comparison with other antipsychotic. We include behaviors related to irritability as all kinds of aggressions, tantrums and self-injuries. Methods 90 patients were recruited. 45 of the patients received aripiprazole and 45 received other antipsychotic. The initial doses of aripiprazole was 2,5 mg/day. Doses were increase related to symptoms. The range of the doses were from 2,5 to 15 mg/day. Results From these 45 patients 12 had a relapse (26,6%) during the next two years. From the second group, 20 (44.4%) of the patients had a relapse during the next two years. Five of the aripiprazole group (11,1%) abandon treatment. From the second group twelve patients (26.6%) also abandon treatment. Prolactin rates with aripiprazole were 28.2 ng/ml for males and 14.1 ng/ml for women. Conclusions In general, the result of our research indicated that Aripiprazole was effective and generally safe and well tolerated in the treatment of irritability associated with ASD. One of the limitations was that we do not use scales in order to measure the changes. Disclosure No significant relationships.
Muñoz Martinez V, Beato-Fernández L, Segura-Escobar E
Background Immune-inflammatory dysregulation is increasingly implicated in the pathogenesis of autism spectrum disorder (ASD). Umbilical cord blood mononuclear cells (UCB-MNCs), with their immunomodulatory effects, represent a promising therapeutic avenue by potentially alleviating neuroinflammation. This study aimed to evaluate the safety and efficacy of multiple intravenous infusions of allogeneic UCB-MNCs in children with ASD and peripheral immune dysregulation. Methods In this single-center, double-blind, randomized, placebo-controlled trial (RCT), 34 children (aged 3 to 8 years) diagnosed with ASD were randomly assigned to receive intravenous infusion of allogeneic UCB-MNCs (3 × 10⁸ cells per infusion) (n = 17) or placebo (n = 17) four times with 1-week interval, alongside their existing rehabilitation therapy, and followed up for 13 weeks. The primary endpoint were the Total score of the Social Responsiveness Scale-2 (SRS-2). Additional endpoints was changes of the five domains of the SRS-2, the Vineland Adaptive Behavior Scales-3 (Vineland-3), the Childhood Autism Rating Scale (CARS), Aberrant Behavior Checklist (ABC), Swanson, Nolan, and Pelham Rating Scale-IV (SNAP-IV), Self-Rating Anxiety Scale (SAS) and safety. Results At final follow-up, the UCB-MNCs group demonstrated a significantly greater reduction in the SRS-2 Total scores (LS Mean Difference = - 6.03, 95% confidence interval [CI]: - 11.93 to - 0.14, P = 0.045) and Social Cognition domain (LS Mean Difference = - 9.95, 95% confidence interval [CI]: - 15.90 to - 4.00, P = 0.002) scores compared to the placebo group. No major allogeneic UCB-MNCs transplantation-related adverse events occurred. Conclusion Allogeneic UCB-MNCs transplantation demonstrated preliminary safety and potential efficacy in improving specific aspects of symptoms in children with ASD and peripheral immune dysregulation. Trial registration This study was registered on ChiCTR.org.cn (Identifier: ChiCTR2400082762). Date registered 12 April 2024. https://www.chictr.org.cn/index.html .
Background Many dental clinics reportedly accept Medicaid for young children per online sources, but parents' experiences suggest that this differs from actual access. Recognizing potential differences between reported and realized access, we studied realized dental care access and neighborhood-level barriers to care in the Chicago metro area. Methods We created a list of Medicaid-accepting dental clinics using the Centers for Medicare and Medicaid Services Insurekidsnow.gov "Find a Dentist" search engine tool. Limited to Coordinated Oral Health Promotion Chicago Cohort Study participants' ZIP Codes (N = 51), research staff called each clinic posing as parents trying to schedule their Medicaid-insured children for appointments. Dental clinic and participant addresses were geocoded; using American Community Survey data, we estimated the population's actual access to Medicaid-accepting clinics and neighborhood-level barriers. We used an Enhanced Two-Step Floating Catchment Area analysis to determine realized access and identify disparities. Results Of the 379 dental clinics identified online as taking Medicaid insurance for children, only 240 (63.32%) confirmed accepting Medicaid. The catchment area overall met the Health Professional Shortage Area threshold (1 dentist: 5000 population), indicating adequate access for the Medicaid-insured population. Yet, some southern Chicago/southwestern suburbs had exceptionally poor access (< 1 dental clinic: 10,000 population). Discussion Online data showed many dental clinics accepted Medicaid for children, but our study revealed that realized dental care access varied dramatically, with the fewest clinics in areas with the highest portion of children on Medicaid and the largest socioeconomic barriers. Multilevel change is needed to ensure access to critical dental health services for all.
Aims Though Autism Spectrum Disorder (ASD) is a common childhood neurodevelopmental disorders, the literature on presentation of undiagnosed ASD in Consultant Child and Adolescent Mental Health Services, (CAMHS) is scarce. The aim of the study was to look at symptoms at presentation among boys and girls in CAMHS, compare the symptom profile between the two genders, establish the main referral and assessment pathways and interventions employed after diagnosis Methods This was a retrospective review of patients’ files referred to ASD Walsall CAHMS Clinic conducted in February 2021. A random sample size of 44 boys and girls equally distributed from the ASD database was selected randomly from the completed ASD assessment list, the equal distribution between genders was intentional. We looked at presenting symptoms reported on the referral letters, assessments in CAMHS, and interventions outlined from ASD outcome letters of all subjects with completed ASD assessment, in age groups 7–18 years. Results Across genders, most patients presented in the teenage years with common age of presentation seen at ages 15 and 17, both at 15.9% and mean age being 13 years. Ninety-five percent of patients were in school at the time of referral. Only 4.5% of patient were referred through crisis and the rest through local GP. A variety of presenting symptoms were seen, with the majority of the patients presenting with social and communication difficulties (77.3%), under /overreaction to sensory stimuli (63.6%) and anxiety (61.4%). 9.1% of patients had a family history of ASD. 100% of assessments included ADOS, SALT and neurodevelopmental assessment. 77.3% of patients were referred to support groups like living with ASD parent support groups. Along with CAMHS, education (97.7%) was the main agency involved in the care of these patients. In 44.2% of patients, EHCP was requested or already in place. The in between gender comparison also showed that although most symptoms were similar in both groups, some such as self-harm were higher among girls (27.3%) as compared to boys (13.6%) as well as obsessional symptoms which were more common in boys (63.3%) as compared to girls (27.3%). Conclusion Undiagnosed ASD presents with a wide variety of symptoms amongst boys and girls. Previous UK studies have shown an earlier presentation of ASD and which is contrary to our findings demonstrating a much later presentation. Therefore, we recommend referrers to be aware of the varied presentations and have a lower threshold for referral to secondary services to aid quicker ASD diagnosis and management.
Online or other child sexual exploitation or abuse (OCSEA) perpetration prevention programs are designed to provide services to individuals prior to offending. There is limited research on OCSEA perpetration prevention programs in jurisdictions with mandatory reporting. The present study is a mixed-method feasibility evaluation of the OCSEA perpetration prevention therapy program, Talking for Change (TFC). The feasibility study broadly addressed whether adult clients could be recruited to the program, the clinical profile of clients, and their satisfaction with the program. In total, there were 162 distinct individuals referred with the number of referrals increasing on an annual basis. Clients in the evaluation (n = 40) presented with risk relevant factors related to paraphilic interests and sexual self regulation problems with interpersonal challenges as well as several protective factors (e.g., empathy). The population had a high level of comorbid mental health problems, and many had engaged in prior CSEM use. Program satisfaction interviews resulted in five themes that highlighted the value of the group (e.g., promoting acceptance and accountability) and challenges (e.g., problems with a one size fits all approach). The results indicated that OCSEA perpetration prevention programs are feasible in mandatory reporting jurisdictions. Implications for program delivery are discussed.
Introduction Malaria remains a leading cause of under-5 mortality in Nigeria, with Abia State exemplifying hyperendemic transmission. The 2024 introduction of the R21/Matrix-M and RTS,S/AS01 vaccines offers promise, but evidence on caregiver awareness and acceptance in the non-pilot South-East region to inform equitable rollout is scarce. Methods We conducted a mixed-methods study from June to August 2025 among 618 caregivers of under-5 children engaged with the routine immunisation programme in Abia State. Quantitative cross-sectional surveys assessed awareness (knowledge of malaria vaccines) and acceptance (willingness on Likert scales), and inferential analysis was carried out using logistic regression. Qualitative in-depth interviews (n=28) and focus group discussions (n=6, 50 participants) explored perceptions using thematic analysis. Triangulation was applied to integrate the findings. Results Awareness overall was low (38.2%; 95% CI 34.5% to 42.0%) but highest among urban educated caregivers (52.3%). However, acceptance was high (88.7%), driven by child protection (67.4%) and provider trust (59.8%). Barriers included fears of side effects (51.4%) and misinformation (18.7%). Significantly, education (adjusted OR (AOR)=3.28) and urban residence (AOR=1.78) predicted awareness, and income (AOR=2.05) and awareness status (AOR=6.92) influenced acceptance. Qualitative themes corroborated quantitative findings: 'fragmented information' explained rural gaps and 'maternal instinct' amplified willingness to accept. Conclusion Based on our findings, caregivers demonstrated strong acceptance of malaria vaccines despite critically low awareness, a disparity fuelled by information gaps and socio-demographic inequities such as low education and rural residence that threaten vaccine rollout and malaria elimination goals. Consequently, this pioneering mixed-methods study recommends that specific channels that leverage primary healthcare centre providers and community leaders for information dissemination should be used, given the high levels of trust, to ensure malaria vaccine uptake and accelerate progress in reducing under-5 deaths.
Abstract Introduction This qualitative study that investigates parents’ experiences of having a child with Down Syndrome (DS) and sleep difficulties is a part of a broader mixed-method study entitled Sleep Difficulties in Children with Down Syndrome: An Evaluation of Parent/Carer and Family Quality of Life. Methods We conducted semi-structured interviews with 26 parents (fathers n = 4 and mothers n = 22), and reflexive Thematic Analysis (TA) was operationalised for data analysis. The interviews covered the following key topics: DS diagnosis; timeline of their child’s sleep patterns and difficulties; implications for parental sleep, day-time function, and well-being; family dynamics; and access to supports. Results Most participants described negative experiences at time of diagnosis, including not feeling listened to, and receiving inconsistent, insensitive and inadequate information and/or treatment. Most strikingly, no parents recall receiving sleep specific information. Most participants described their child’s sleep difficulties affecting their own sleep, day-time function and family dynamics, yet they commonly normalised these experiences. Such normalisation was a recurring theme across their experiences of having a child with DS and is contextualised by their accounts of resisting prejudiced attitudes towards their child since diagnosis. Discussion This is the first qualitative study to investigate parents’ experiences of having a child with DS and sleep difficulties. Implications include professional development for health care workers focusing on sleep as a significant comorbidity for these children, and awareness of families’ tendencies to normalise their experiences when delivering care.
Background and aims The role of genetic testing as part of universal screening programmes for familial hypercholesterolaemia (FH) in children is not well defined. Here, a two-step approach to identify children carrying FH-causing variants was investigated. Methods In this study from Southern Germany, paediatricians were invited to offer FH screening to all children aged 4.8-14.9 years at routine paediatric examinations. The FH screening programme began in September 2020 in Bavaria and has involved up to 480 paediatricians. It included biochemical and genetic testing using 0.2 mL of blood taken from a fingertip. In case of low-density lipoprotein cholesterol (LDL-C) serum concentration ≥3.36 mmol/L (≥130 mg/dL), FH-causing variants were determined in the same sample with a focused panel covering most frequent variants (n = 48) and sequencing of relevant genes. Results Out of 25 431 children screened so far, 1689 children had an LDL-C ≥ 3.36 mmol/L (>130 mg/dL), which defined this concentration as the 93rd percentile. Pathogenic variants were identified by the focused panel in 157 and by next-generation sequencing in 283 children, respectively. While 17% (283/1670) of all genetically analysed children tested positive, the fraction of individuals with FH-causing variants increased across the spectrum of LDL-C serum concentrations from 4.7% (23/492) at 3.36-3.49 mmol/L (130-135 mg/dL) to 78.6% (81/103) above 5.17 mmol/L (200 mg/dL). Overall, the prevalence of FH-causing variants was high (1:90). One reason was a founder variant (n = 63) within the LDLR gene, found 40 times more frequent than European average. The analysis of recruitment data revealed significant ascertainment bias, with lower recruitment rate practices exhibiting higher prevalence. After adjustment for the bias using a generalized linear mixed model, the predicted prevalence was 1 in 163 (0.61%), which is highly consistent with large-scale genomic benchmarks as gnomAD (1:165, n = 622 057) and the UK Biobank (1:176, n = 48 741). Conclusions The prevalence of FH determined in this study is significantly higher than previously published estimates (∼1:250), highlighting the importance of this condition for public health and supporting calls for a national paediatric screening programme, given the availability of effective treatment options. For children between 5 and 15 years, biochemical screening is an effective way to select patients for genetic testing, with sequencing of candidate genes being superior to variant screening. In summary, the VRONI study demonstrates the feasibility and efficacy of a combined biochemical and genetic screening for FH in children.
Abstract Background Up to one-quarter of osteopathic consultations involve infants and children. Although the clinical effectiveness of osteopathic care in paediatric populations remains inconclusive, available evidence suggests that it is generally safe. In contrast, high velocity, low amplitude (HVLA) manipulation has been associated with potential adverse effects. To inform a professional position on the use of HVLA techniques in paediatric care, this study investigated (1) the use of HVLA techniques by osteopathic practitioners in the treatment of infants, children, and adolescents, and (2) the extent to which HVLA techniques are included in osteopathic training programmes for these paediatric age groups. Methods Two online cross-sectional surveys were conducted. The first targeted osteopathic practitioners and consisted of seven close-ended questions. The second survey was directed at osteopathic education institutes (OEIs) in Europe, Australia, Brazil, Israel, and New Zealand and consisted of three close-ended questions. Surveys were implemented via REDCap and made available in 11 languages. Participants were recruited between October 2025 and January 2026. Results Among responding practitioners (n = 2,607), 6.5% reported using HVLA in newborns or infants, 43.5% in children, and 78.3% in adolescents. Most respondents (54%) who apply HVLA to newborns and infants reported doing so “rarely”. Of the 62 responding OEIs, 91.4% offered osteopathic paediatric education; however, only 4.8% reported teaching HVLA for newborns and infants, 11.3% for children, and 56.4% for adolescents. Most respondents (70.2%) held an HVLA-opposed stance. Among the distinct practitioner profiles identified in the prioritisation of conditions for HVLA use in newborns and infants, the precaution-informed stance (11.2%) was the most strongly associated with paediatric practice and with the highest reported HVLA use in this age group. Conclusions Most respondents did not use HVLA in newborns and infants, with utilisation increasing in older paediatric age groups, and the majority expressed opposition to paediatric HVLA. More permissive stances were associated with greater HVLA use and more training. Given its continued application, an evidence-based position statement and robust research on the safety and effectiveness of HVLA in paediatrics are urgently needed.
Abstract Study question What are the views of men from Greece, Nepal, and the UK on having children and what is their knowledge of fertility? Summary answer Between countries, there were similarities and differences in men’s views to having children. Men showed limited fertility knowledge, and access to fertility information varied. What is known already The global total fertility rate (TFR) has dropped to below 2.5 compared to 5 in 1950, currently being 1.61 in the EU. Internationally, the age at which people are having children has increased and is over 30 in many countries. Delaying parenthood is leaving many with smaller family sizes than desired or involuntary childlessness due to age-related infertility. Although many men are keen to be fathers, existing studies relating to fertility knowledge and having children focus heavily on women. Compared to women, men’s fertility knowledge is limited as fertility education is rarely taught or tailored for men. Study design, size, duration Two anonymous surveys were conducted. The UK survey (live from 25 April – 1 December 2021) was launched via social media. Men internationally could complete the survey, and high numbers of men from Nepal participated. The Greek survey (live from 11 – 26 May 2021) was launched in Greece through a market research company. The end sample size was n = 244 for Greece, n = 205 for Nepal and n = 128 for the UK. Participants/materials, setting, methods Men aged 25 to 45 years old, who wanted children but were currently childless, were included. There were four parts to the survey: basic demographics; their attitude to having a family; their fertility concerns; and their fertility knowledge. For the UK survey, since one of the authors had a link with Nepal, particular effort was made to recruit from Nepal as well as from the UK. Main results and the role of chance When asked how many children men wanted, most Greek (59%), Nepalese (66%) and UK (58%) men wanted two children, but higher levels of Greek (24%) and UK (25%) men wanted three children compared to Nepalese men (9%)(p < 0.001). The ideal age men wanted to have had/have their first child was 35 years in Greece (23%), but it was 30 years in Nepal (24%) and in the UK (30%). The COVID-19 pandemic had not affected most men’s decision to have children: Greece’s (64%), Nepal (48%), UK (70%). But it had affected 21% Greek, 27% Nepalese and 16% UK men who are now intending to delay having children. Greek (46%), Nepalese (48%) and UK (47%) men felt moderately informed on female fertility. Greek (45%), Nepalese (50%) and UK (45%) men felt more informed about male than female fertility. When questioned on when they think a woman is fertile in her menstrual cycle, 50% Greek, 38% Nepalese, and 42% UK men answered incorrectly. The internet was the most common source men accessed fertility information from: Greece (67%), Nepal (30%) and the UK (26%). The second most common source for Greece (18%) was doctors, but for Nepalese (18%) and UK (18%) men, it was school. Limitations, reasons for caution The study had a relatively small sample size (n = 577). It is well documented that men typically do not show high engagement with surveys. It was only promoted on social media. Respondents were typically highly educated, active on social media and knew English or Greek to an adequate level. Wider implications of the findings The International Fertility Education Initiative is developing resources to deliver tailored fertility education across different populations. This survey shows that there are cultural differences that need to be considered when designing such resources. Trial registration number Not applicable
