A presente dissertação visa investigar as convergências e divergências apresentadas pelas diversas partes interessadas no processo atual de formulação e revisão das políticas públicas para o autismo no Brasil. Para tal, realizamos uma análise documental crítica acerca de duas cartilhas institucionais, lançadas recentemente pelo Ministério da Saúde, sobre a assistência ao autismo no Sistema Único de Saúde. Uma delas recebe o título de "Diretrizes de Atenção à Reabilitação da Pessoa com Transtorno do Espectro Autista (TEA)" e aborda o transtorno como pertencente ao campo das deficiências, propondo seu tratamento sob a via da reabilitação. Outra, intitulada "Linha de Cuidado para a Atenção às Pessoas com Transtornos do Espectro do Autismo e suas Famílias na Rede de Atenção Psicossocial do Sistema Único de Saúde" apreende o autismo como um transtorno mental, pertencente ao campo de cuidados da atenção psicossocial. A divulgação de dois documentos oficiais que contemplam o tema de maneiras diferentes é ilustrativa de um aparente dissenso no rumo das políticas para tal população. Evidenciamos assim a constituição de dois grupos, aparentemente antagônicos, que disputam nas esferas políticas e assistenciais a primazia pela abordagem do fenômeno autístico. Trabalhamos com a hipótese de que foi produzida uma cisão no desenvolvimento e no subsequente entrecruzamento de três eixos de força, sendo eles: a evolução da categorização nosográfica do autismo, a participação assistencial e política das associações de pais de autistas e de outros grupos sociais e a construção das políticas públicas nacionais para a saúde mental da infância e adolescência. Analisamos tais elementos, acreditando que seu entrecruzamento nos auxilia a depreender os componentes básicos do contexto do TEA no Brasil. Por fim, a partir da análise dos documentos, é possível argumentar que, embora as divergências epistemológicas desempenhem um importante papel no dissenso em questão, estas não atuam como o principal fator do conflito, uma vez que se mostram negociáveis. Aparentemente, as controvérsias se tornaram acirradas devido a disputas políticas, por parte de diferentes grupos, em busca do protagonismo e do poder de deliberação na formulação de políticas públicas para o autismo no país.

Os transtornos do espectro autista (TEA) são caracterizados por dificuldades na interação social e na comunicação, interesses restritos e comportamentos estereotipados. Trata-se de doença complexa, podendo estar relacionada a fatores ambientais, genéticos ou a ambos. A heterogeneidade genética dos TEA pode ser explicada pela presença de variantes raras patogênicas únicas (modelo monogênico) bem como pela combinação de alelos raros (modelo oligogênico) ou ainda pela combinação de alelos comuns de baixo risco (poligênicos). Há um esforço mundial na tentativa de se identificar variantes que conferem risco e, nos últimos anos, a identificação de variantes raras tem sido mais bem sucedida. As estimativas indicam que 10% dos indivíduos dentro do espectro do autismo possuem uma síndrome de padrão de herança mendeliana dentre elas a síndrome do cromossomo X frágil cujo mecanismo molecular se explica pela mutação completa no gene FMR1. A partir dos anos 2000 aproximadamente, alguns trabalhos na literatura sugeriram que a pré-mutação do gene FMR1, associada à síndrome do tremor e ataxia e a insuficiência ovariana primária associada ao X frágil (FXTAS e FXPOI), pudesse estar relacionada ao TEA. Essa ligação, no entanto é incerta, sendo por isso, o foco deste trabalho. Para tanto, foi realizada uma revisão bibliográfica buscando dados na literatura que comparassem pacientes portadores da pré-mutação com controles quanto à manifestação dos TEA. Foi levantada a frequência de portadores da pré- mutação no gene FMR1 entre 1056 probandos do grupo de pesquisas em transtornos do espectro autista do Centro de Pesquisas sobre o Genoma Humano e Células Tronco. Nesses pacientes foram também realizados exames complementares. Efetuou-se também um levantamento de eventuais casos de TEA entre os portadores da pré-mutação em outra casuística, composta de famílias de afetados pela síndrome do X frágil, no laboratório de genética humana do Departamento de Biologia Evolutiva - Instituto de Biociências - USP O primeiro levantamento revelou uma frequência de 0.19% de pré-mutados na casuística composta por pacientes com TEA (2:1055), semelhante à da população em geral. O segundo levantamento não revelou nenhum paciente com TEA entre os pré- mutados. Além disso, os dois pacientes pré-mutados na primeira casuística são portadores de uma CNV patogênica. Este estudo não apóia, portanto, uma relação causal entre TEA e a pré-mutação do gene FMR1 / Autism spectrum disorders (ASDs) are characterized by impairments in social interaction and comunication as well as restricted interests and stereotyped behaviors. ASD is a complex disease that may be related to environmental factors, genetic factors or both. Genetic heterogeneity in ASD may be explained by rare pathogenic variants (monogenic model), by a combination of rare alleles (oligogenic model) or by other combinations of low-impact common alleles (polygenic model). Researchers are working to identify risk variants and have been more successful in finding rare variants in recent years. Monogenic disorders (Mendelian disorders), such as fragile X syndrome, are found in 10% of ASD patients. Fragile X syndrome is caused by full mutation in the FMR1 gene and account for a fraction of ASD cases. FMR1 premutation is related to two different conditions: fragile X-associated tremor/ataxia syndrome (FRAXTAS) and fragile X-associated primary ovarian insufficiency (FXPOI). In the last two decades some researchers have associated premutation with behavior problems. However the association between premutation and ASD remains unclear and thus it was the focus of this investigation. This study includes an extensive review of articles that compare ASD manifestations in premutation carriers and controls. The study also estimated the premutation frequency in 1056 male patients from the ASD cohort at the Human Genome and Stem Cell Research Center. Complementary tests were performed on these patients to rule out any other genetic alterations that could explain clinical presentations of ASD. Moreover, a survey was performed of possible ASD cases among premutation males from fragile X families in the database of the Human Genetics Laboratory at the Biology Department of the Biosciences Institute. A frequency of 0.19% of premutation carriers was detected in the sample of ASD patients(2:1055), which is similar to the general population. No ASD patients were detected among the premutated males. Furthermore the two pre-mutated patients in the first sample harbored a pathogenic CNV. Therefore this study do not support an association between the FMR1 premutation and ASD

Tuberous sclerosis complex (TSC) is an autosomal-dominant neurocutaneous disease caused by loss of the TSC1 (encoding hamartin) or TSC2 (encoding tuberin) genes. Neurologic symptoms are common and varied in TSC and include epilepsy and behavioral conditions like autism spectrum disorders (ASD). Between 17 and 61% of children with TSC exhibit symptoms of ASD. The purpose of this study was to investigate a potential correlate of poor neurological outcome in TSC by assessing the integrity of brain language pathways and the relationship to ASD. 42 patients with TSC and 42 age-matched control subjects were scanned with advanced diffusion-weighted MRI. White matter language pathways were identified with a validated automatic method and analyzed for microstructural characteristics, including fractional anisotropy (FA) and mean diffusivity (MD). Well-defined white matter pathways in the brain are characterized by high FA and low MD. During normal development, brain white matter pathways increase in FA and decrease in MD. Out of 42 patients with TSC, 12 had ASD (29%). After controlling for age, TSC patients without ASD showed a small decrease in FA of the arcuate fasciculus compared to control subjects, and TSC patients with ASD had much lower FA than both control subjects and TSC patients without ASD. Similarly, while TSC patients without ASD had only a small increase in MD compared to control subjects in the arcuate fasciculus, TSC patients with ASD had much higher MD than control subjects and TSC patients without ASD. A new method for assessing the microstructure of young patients showed similar results with decreased compactness in language pathways of TSC patients with ASD. Another new method designed to better analyze regions with crossing pathways showed modifications in language pathway microstructure that correlated with ASD diagnosis in the TSC patients. Preliminary analysis of neuropsychiatric data also showed a trend toward an association of arcuate fasciculus MD with verbal IQ, although the result was not significant after multiple comparisons correction. It remains unclear why some patients with TSC develop ASD, while others have better language outcomes. Our results suggest that aberrant development of language pathways may act as a marker for poor neurological outcome in TSC patients. The impaired microstructure in language pathways of TSC patients may be responsible for the development of ASD, although prospective studies examining the development of language pathways and subsequent ASD diagnosis in this patient population remain essential. It is also possible that a primary problem with language leads to decreased use and subsequent poor development of language pathways. Early diagnosis of ASD is crucial for improving the outcomes of affected children.

Mirror neurons are very specific nerve cells that are both motor and sensory in nature. Mirror neurons are a relatively new discovery first identified by a team of neurophysiologists at the University of Parma. These neurons were first observed in primates, and then later in humans in several regions of the cerebral cortex. A large amount of research on mirror neurons have shown that they play an important role in imitation, language acquisition and empathy. The theoretical part of this work summarizes what is currently known about mirror neurons. It emphasizes the relationship between mirror neurons, autism, empathy, and its training. This theoretical framework is followed by pilot research, which consists of two components: the quantitative part consisted of a questionnaire survey to ascertain the level of empathy of the participants using the Index of Interpersonal Reactivity. The participants were the parents of autistic children who were compared with a control group. A statistically significant difference in empathy levels between the two groups was not observed but there was a tendency for higher scoring in some questionnaire scales in experimental group The second part of this work is an analysis of observations of the interactions between parents and autistic children. Additionally, two...

Infants 5-34 weeks of age were observed in their homes playing with their mothers as part of a longitudinal study. Two mother-infant dyads were observed once per week for twelve weeks, during a ten-minute play session. The purpose of the observation system is to describe contingencies leading to the development of attention-seeking behaviors in typically developing infants. Observations were coded using a type-based format (person engagement, object engagement, supported joint engagement, coordinated joint engagement, and unengaged). Child eye gaze, reaching, and grabbing were coded as well as all child and adult vocalizations. It is suggested that the data from the observation system will help inform and assess the effectiveness of infant and toddler social interventions in autism spectrum disorders and advance our understanding of attention seeking behaviors.

The purpose of this study was to teach preschool children with autism spectrum disorders to make requests with a speech generating device using a naturalistic time delay prompting procedure. The participants in this study were two males, enrolled in a public preschool program, between four and five years old. Both participants showed significant delays in expressive communication requiring alternative and augmented communication. The study utilized a multiple probe design across behaviors. Results showed utilizing naturalistic time delay increases independent requests using a speech generating device.

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This session will provide PE teachers with specific strategies for modifying both formal and informal assessments for students with autism spectrum disorder (ASD). With an increased emphasis on assessment, and a rise in the prevalence of ASD, it is critical that teachers can adapt assessments to meet the needs of students with ASD. Session participants will learn practical strategies for modifying assessment specific to motor skill performance, FitnessGram, rubrics, checking for understanding, and peer assessments.

Identifying disease risk genes is a central topic of human genetics. Cost-effective exome and whole genome sequencing enabled large-scale discovery of genetic variations. However, the statistical power of finding new risk genes through rare genetic variation is fundamentally limited by sample sizes. As a result, we have an incomplete understanding of genetic architecture and molecular etiology of most of human conditions and diseases. In this thesis, I developed new computational methods that integrate functional genomics data sets, such as epigenomic profiles and single-cell transcriptomics, to improve power for identifying genetic risks and gain more insights on etiology of developmental disorders. The overall hypothesis that disease risk genes contributing to developmental disorders are bottleneck genes under normal development and subject to precise transcriptional regulations to maintain spatiotemporal specific expression during development. In this thesis I describe two major research projects. The first project, Episcore, predicts haploinsufficient genes based on a large integrated epigenomic profiles from multiple tissues and cell lines by supervised machine learning methods. The second one, A-risk, predicts plausibility of being risk genes of autism spectrum disorder based on single-cell RNA-seq data collected in human fetal midbrain and prefrontal cortex. Both methods were shown to be able to improve gene discovery in analysis of de novo mutations in developmental disorders. Overall, my thesis represents an effort to integrate functional genomics data by machine learning to facilitate both discovery and interpretation of genetic studies of human diseases. We believe that such integrative analysis can help us better understand genetic variants and disease etiology.

Aim. The aim of the present work is to examine and compare brain abnormalities found on magnetic resonance imaging (MRI) in children diagnosed with autism spectrum disorders (ASD) and in children without this diagnosis. In terms of psychopathology, the aim is to evaluate a possible relationship between the MRI findings and the severity of autistic symptomatology. Methods. The research study is based on a retrospective analysis of a sample of patients who attended a diagnostic examination focused on ASD and at the same time underwent brain MRI at the Department of Child Psychiatry of the Second Faculty of Medicine at Charles University and University Hospital Motol between the years 1998 and 2015. For clinical diagnosis of ASD, the International Classification of Diseases, 10th revision (ICD-10), was used. Between 1998 and 1999, the assessment of patients was supported by the Childhood Autism Rating Scale. Starting in 2000, the third version of the Autism Diagnostic Interview - Revised was used for assessments; and from 2012 onwards, the Autism Diagnostic Observation Schedule - Generic was added to the diagnostic procedures. From 1998 to 2015, a total of 489 children were diagnosed with pervasive developmental disorder (404 boys, 85 girls). The mean age in the group was 8.0 ± 4.2 years (range...