Anorexia Nervosa (AN) is common in adolescents and has a high mortality and morbidity rate with a lifetime prevalence of 0.5% to 2%.1,2 We aim to review the neurobiology correlation of Anorexia Nervosa in Autism Spectrum Disorder as they are often associated together.

1. Understand the correlation between the neurobiology of Autism Spectrum Disorder (ASD) and Anorexia Nervosa.

2. Assess the association and prevalence of Anorexia nervosa in the ASD population.

3. To focus on the implications for the pathogenesis of Anorexia Nervosa and treatment of this disorder in the ASD population.

We searched PubMed, APA PscyINFO, Embase, CINAHL, and Google scholar databases with the keywords Autism Spectrum Disorder AND Anorexia Nervosa and included 6 relevant human studies out of 187 published in English.

Neilson et al. studied the outcome of ASD in teenage onset AN, and a statistically significant negative dose-response relationship is found in all the 3 Morgan-Russell Outcome Assessment Schedule (MROAS) domains in stable ASD over time, and the results on the subscales ‘mental state,’ ‘psychosexual state’ and ‘socio-economic state, “personal contacts,’ ‘social activities’ and ‘employment record.’3 The outcome of AN onset in adolescence is generally favorable regarding mortality and the persistence of eating disorders in adulthood. A study by Pruccoli et al. noted a high prevalence of ASD traits in a group of young AN patients, predominantly seen in 4 specific EDI-3 subscales and independent of BMI.4 Margari et al. found only AN diagnosis had a statistically significant difference (p = 0.04) in females vs. males when comparing sex differences for comorbidities.5

Morphological changes in brain areas are linked to social cognition and increase the risk of eating disorders in ASD. We recommend future studies with robust study design to explore the full spectrum of pathogenesis and association of AN in ASD.

None Declared

Anxiety disorder affects nearly 9.4% of children aged 3-17 years.1 Virtual Reality (VR) provides an alternative for managing anxiety due to immersive, multisensory, and excellent distraction.

The aim is to evaluate the efficacy of VR therapy in managing anxiety in children.

We searched PubMed, Medline, Embase, Web of Science, and Biosisdatabases with the keywords “Virtual Reality” in the context of “AnxietyDisorders” and included 8 relevant studies published in English until February 10, 2023, for our qualitative synthesis.

The VR-Guided relaxation (VR-GR) effectively decreased anxiety immediately after administration. In another trial, 4 of the 9 patients completely overcame their fears, and 8 of 9 saw an improvement in target behaviors in the autism population even after six weeks after the therapy, and the effect lasted 1 year post-treatment. In another study, VR-based therapy helped reduce anxiety and behavioral scores significantly in the VR group vs. the control. In another study, they found during pediatric intravenous catheter placement, patients who received VR therapy showed significantly less anxiety and pain compared to those who did not. In another study, they found VR therapy helped reduce anxiety during the induction of pre-operative anesthesia in children undergoing elective surgery.

A study discovered benefits with statistically significant results in reducing anxiety in children immediately after VR-based therapy. To explore the full spectrum of benefits and efficacy of VR-based therapy for anxiety as a standalone or adjunct to pharmacotherapy, we recommend future trials with robust study designs.

None Declared

The COVID pandemic caused an unprecedented public health crisis and adversely impacted children’s well-being. It has negatively affected children’s mental health due to social isolation, human losses, and remote learning. Our goal is to learn about the challenges and factors that these children and young adults face upon returning to school and college, which could further decline their mental health. We also need to understand parents’ concerns about this transition to a back-to-school routine.

1) To learn about the mental health challenges for children, adolescents, and young adults returning to school after the beginning of the COVID pandemic.

2) To identify the factors and challenges that parents and caregivers face during the COVID regarding the return of their children to school.

We conducted a literature search using relevant medical subject heading (MeSH) terms in PubMed, PubMed Central, Web of Science, and Medline databases. We identified all published relevant articles until June 4, 2021. After a thorough review of relevant published articles until October 30, 2022, we included 5 articles in our qualitative synthesis.

A cross-sectional study in China measured depression, anxiety, and social support in back-to-school students via PHQ-9, GAD-7, and SSQ, respectively. They found a significant rise in anxiety and depression among these students. This correlation was weak at higher social support. Data collected from 15 children’s hospitals found that students want to participate actively in returning to school and the recovery process as they are concerned about their future, family, and society. Another 2021 cross-sectional study in Texas revealed that parents are concerned about their children’s health and prefer an onsite-virtual hybrid learning setup over in-person learning (Limbers C. A. et al. The Journal of school health 2021; 91(1), 3–8.). Parents in Italy favored school reopening with reduced student numbers (70.1%), social distancing within classes (45.3%), and masks as they were concerned about their children due to COVID (Pierantoni, L et al. 2021; Acta paediatrica (Oslo, Norway : 1992), 110(3), 942–943 ). Fewer White parents were supportive of a mask mandate for students and staff members (62.5%) than parents of ethnicities like Hispanic (79.5%, p= 0.026) and other racial/ethnic groups (66.9%, p = 0.041) (Gilbert, L. K. et al. MMWR. Morbidity and mortality weekly report 2020; 69(49), 1848–1852).

The return to school after COVID is challenging for students and parents due to the rise in anxiety and depression in children. Social support has been found to be protective of children’s mental health. Future well-designed studies should identify challenges and factors that can help safeguard children’s mental health and develop appropriate policies.

None Declared

Methylphenidate (MPH) is used to treat attention deficit hyperactivity disorder (ADHD) and has shown unique benefits in children and adolescents with autism spectrum disorder (ASD). In addition to improving attention, hyperactivity, and repetitive movement, it also improves cognition in ASD. Our focus is to explore the understudied benefits and safety of methylphenidate use for cognition in ASD children.

1) To study the response and benefit of methylphenidate in autistic kids to improve cognition and life function.

2) To assess the safety profile and risks of using methylphenidate at different doses in children with autism as a guiding tool for prescribing physicians.

A literature search was conducted using relevant medical subject headings (MeSH) terms in PubMed, Medline, and PubMed Central. We identified all published articles from inception until September 30, 2022. Initial search results found 41 studies, of which 15 were excluded as they did not meet inclusion and exclusion criteria. After a thorough full-text review, we included 5 studies in our final qualitative synthesis review.

Methylphenidate was found to have the unique benefit of increasing cognitive processing speed, thus improving everyday life function in ASD and ADHD children compared with only ADHD, with a clinical significance of p<0.001. Stimulants may improve the processing of social situations and interactions or social functions due to this unique response (Peled, J et al. Nordic journal of psychiatry 2020; 74(3), 163–167) A clinically significant performance gain on cognitive tasks was identified with a linear dose-response at three different doses (10 mg, 15 mg, 20 mg) of methylphenidate. ASD children with ADHD made significantly fewer omission errors, [F(3,69) = 7.21, p < 0.001], and commission errors [F(3,69) = 4.64, p = 0.005] on MPH, compared to placebo. They also showed more response at higher MPH doses, [F(3,69) = 10.45, p < 0.001]. Thus, the children were faster, more accurate, and had fewer errors at higher MPH doses (Pearson, D. A. et al. Journal of child and adolescent psychopharmacology 2020; 30(7), 414–426). There were no serious side effects or suicidality reported for low dose and a medium dose of MPH in ASD children assessed with Response Impressions and Side Effects Checklist-Kids (RISC-K), A 38-item parent rating scale (Kim, S. J. et al. Journal of autism and developmental disorders 2017; 47(8), 2307–2313).

The findings support the positive response of methylphenidate on cognitive function in ASD children. No serious adverse effects or suicidality were noted. Multi-center well-designed studies are recommended to determine further efficacy and safety of MPH in ASD children for cognition.

None Declared

Attention Deficit Hyperactivity Disorder (ADHD) affects about 9.4% (6.4 million) children in the United States. Pharmacological treatment, including stimulants, is a known therapy for ADHD. However, its possible subtherapeutic effectiveness, residual symptoms, and adverse effects have prompted us to explore the current evidence of Yoga as an add-on therapy that has shown synergistic effects in recent studies.

1) We aim to assess Yoga’s efficacy as an add-on treatment for ADHD.

2) Assess the current evidence of Yoga as an add-on therapy for ADHD.

We searched PubMed, PubMed Central, Medline, Web of Science, and Biosis databases with the keywords “Attention Deficit Disorder with Hyperactivity” (MeSH) and “ADHD” in the context of “Yoga” (MeSH). Identified 4 relevant studies that were published until September 30, 2022.

A study by Jensen et al. found improvement in impulsivity, hyperactivity, and restlessness in the ADHD with medications patient group after 20 Yoga sessions. Study utilized Conners’ Parents Rating Scales and found improvement in the Yoga group on Oppositional, Global Index Emotional Lability, Global Index Total, Global Index Restless/Impulsive, and ADHD Index scale, changes associated with the number of sessions (Jensen et al. J Atten Disord 2004; 7 205-216). In another study, children with ADHD showed significant improvement after 8 weeks of 16 Yoga sessions in accuracy rate and reaction time in the Visual Pursuit Test and Determination Test (Chou et al. Peer J 2017; 5 e2883). A nine-year-old male case showed improvement in inattentive and hyperactive-impulsive symptoms on Vanderbilt Assessment Scales from parents and teachers after 6 months of Yoga practice (Gunaseelan et al. Cureus 2021; 5, e2883). Another 6-week Yoga intervention randomized trial in pre-school ADHD children showed significant improvement in hyperactivity and inattention with fewer distractibility errors of omission and faster reaction time (Cohen et al. J Dev Behav Pediatr 2018; 39 200).

The results suggest that Yoga has beneficial effects as an adjunct treatment to pharmacotherapy in ADHD for reducing hyperactivity and inattentiveness. Additionally, studies indicate its effectiveness in managing stress, anxiety, energy levels, and impulse control by staying focused with the help of breath and mind control. To explore the full spectrum of benefits and effectiveness of Yoga as an add-on therapy for ADHD patients, we recommend robust well-design future studies.

None Declared

Adolescents patients presenting with mood disorders, including disruptive mood dysregulation disorder (DMDD), often present with the comorbid disorders such as oppositional defiant disorder (ODD) and attention-deficit hyperactivity disorder (ADHD).

1) Evaluate the association between suicide in adolescents and various mood disorders. 2) To study the impact of comorbid conditions in DMDD on suicide ideation and attempt in adolescents.

We used 2016-2017 National Inpatient Sample dataset to select patients with mood disorders. Rao Scott adjusted Chi-Square test used to compare the groups with SPSS v26.

In this study, 15195 patients were in the DMDD group (Mean age:12.1,F: 38%) and 219205 in the ‘other mood disorders’ group (Mean age:14.4,F:67%). The odds of SI/SA were two times more in patients with the ‘other type of mood disorder’ (OR:2.07, 95%CI: 1.77-2.14). Patients with the primary diagnosis of DMDD sub-classified into four groups (Group 1: DMDD only (n=5160), Group 2: DMDD+ADHD (n=7240), Group 3: DMDD +ODD (n=700), and Group 4: DMDD+ADHD+ODD (n=2095). SI/SA was prevalent in 30.8%, 26.0%, 22.9% and 26.3% in Group 1, 2, 3 and 4 respectively (p: 0.03). SI/SA was more prevalent in females compared to males (31.3% vs. 25.2%). An increase of 1 year in age was associated with a higher SI/SA (OR:1.05, 95%CI:1.01-1.08, 0.01). The SI/SA odds were 5% more in female patients (OR:1.27, p:0.01).

The study reveals that the risk of suicide ideation or suicide attempt is almost twice in the adolescent with mood disorders without DMDD compared to the DMDD group.

No significant relationships.

To examine the utility of decline in arterial partial pressure of oxygen after exercise as a marker of pulmonary vascular obstructive disease in patients with atrial septal defect and pulmonary hypertension.

Treadmill exercise was performed in 18 patients with atrial septal defect and pulmonary hypertension. Arterial blood gas samples were obtained before and after peak exercise. A decline in the arterial pressure of oxygen of more than 10 millimetres of mercury after exercise was considered significant based on preliminary tests conducted on the controls. Cardiac catheterisation was performed in all patients and haemodynamic data sets were obtained on room air, oxygen, and a mixture of oxygen and nitric oxide (30–40 parts per million).

There were 10 patients who had more than a 10 millimetres of mercury drop in arterial partial pressure of oxygen after exercise and who had a basal pulmonary vascular resistance index of more than 7 Wood units per square metre. Out of eight patients who had less than a 10 millimetres of mercury drop in arterial partial pressure of oxygen after exercise, seven had a basal pulmonary vascular resistance index of less than 7 Wood units per square metre, p equals 0.0001. A decline in arterial partial pressure of oxygen of more than 10 millimetres of mercury predicted a basal pulmonary vascular resistance index of more than 7 Wood units per square metre with a specificity of 100% and a sensitivity of 90%.

A decline in arterial partial pressure of oxygen following exercise appears to predict a high pulmonary vascular resistance index in patients with atrial septal defect and pulmonary hypertension. This test is a useful non-invasive marker of pulmonary vascular obstructive disease in this subset.