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AimsInterventions to support people with autism are multidimensional, but primarily psychosocial in nature. These interventions include behavioural, educational and support therapies. Some psychotropic medications are used to manage medical and psychiatric comorbidities associated with autism, which interfere with daily social and occupational functioning or limit the implementation of psychosocial interventions. The aim of this study is to describe the trajectories of psychotropic medications in people newly diagnosed with autism according to sex and age.MethodsThis is a retrospective cohort study based on medico-administrative data from the Régie de l'assurance santé du Québec. The cohort included all people living in the province of Quebec (Canada) with a first diagnosis of autism (incident cases) recorded during hospitalisation or during a medical visit between January 2012 and December 2016 (index date: first diagnosis). Only individuals covered by the public prescription drug insurance plan one year before and one year after the index date were included. A patient was considered exposed to a drug from the date a prescription was claimed at a community pharmacy and for the time the drug was provided. However, as no information was available on inpatient drug, the drug trajectory represents the outpatient drug trajectory. The five classes of psychotropic drugs considered were: 1) anticonvulsants and mood stabilisers; 2) antipsychotics; 3) antidepressants; 4) anxiolytics/hypnotics; and 5) psychostimulants. Drug trajectories are represented using state sequence analyses.ResultsThe study cohort included 3284 people, of which 867 (26.4%) were females and 2417 (73.6%) were males. Overall, 51.6% of the cohort claimed a psychotropic medication in the year preceding diagnosis and 61.1% in the following year, with higher proportions among females and increasing with age. Psychostimulants were the most prescribed medications among people diagnosed at ages ≤12 years, while antipsychotic use increased considerably with age, becoming the most commonly prescribed medication among those diagnosed in adulthood (≥18 years), with use rates reaching as much as 80% among those diagnosed between 36 and 60 years. State sequence analyses demonstrate slight variations in the use of psychotropic medications over time, but significant variations by age category and sex.ConclusionAlthough psychosocial interventions are recognised by clinical practice guidelines as the cornerstone of interventions for people with autism, the use of psychotropic medications is widespread. This highlights a significant gap between the recommendations of these guidelines and what is observed in the real world.

This multimethod process evaluation aimed to explore the implementation of a telehealth coaching intervention for parents of children with motor difficulties. Four therapists and 59 parents participated. The dosage of 525 sessions was compared to the study protocol. Thirty-three external rater assessments, 62 therapists’ self-adherence and 59 parent satisfaction surveys were analyzed descriptively for adherence, parent responsiveness and intervention quality. Therapists’ interviews were analyzed thematically for implementation experience. A median of nine sessions per family was provided; only 58% were received within the prescribed timeframe. Adherence (83%), participant responsiveness (91%), and intervention quality (85%) were high, along with therapists’ self-adherence (84%) and parent satisfaction (87%). Therapists reported partnering effectively with parents in the intervention and maintaining a family-oriented approach. Regular feedback and mentorship were the most effective implementation strategies identified by therapists. Telehealth coaching interventions can be implemented with high fidelity when therapists receive proper training and support.

This project aims to gain a thoroughly understanding of the characteristics and experiences of psychological mistreatment among older adults, acknowledging the diversity within this population. It also seeks to identify clinical tools and practices for its detection and intervention. While there is extensive literature on mistreatment of older adults, specific studies focusing on psychological aspects and intersecting social and identity dimensions are scarce. The findings will provide valuable insights for policymakers and healthcare professionals, helping to shape interventions and policies aimed at countering mistreatment in the ageing population. Psychological mistreatment involves a range of behaviors, expressions, and gestures-or the lack of appropriate actions-that negatively impact an individual's health and dignity. Often subtle and difficult to detect, this type of mistreatment is prevalent and can coexist with other types of abuse. Examination of psychological mistreatment, shaped by various social and identity dimensions, is lacking in current research, particularly regarding how it is experienced by older adults. This scoping review seeks to map the current knowledge on psychological mistreatment of older adults, while highlighting gaps and future directions for research. This scoping review will encompass studies that explore the characteristics and experiences of psychological mistreatment among older adults, including their experiences and those of perpetrators and witnesses. It will also identify clinical tools and practices for the detection and intervention of psychological mistreatment in this population. A scoping review will be undertaken by a multidisciplinary team, examining studies from post-2010, sourced from both bibliographic databases and grey literature, available in English or French. Employing an intersectional framework, the review will use Gender-Based Analysis Plus (GBA+) to examine how different forms of discrimination intersect and shape experiences of mistreatment. That is, this approach will help explore how social and identity dimensions-including gender, age, sexual orientation, ethnicity, socioeconomic status, and health conditions-shape the experiences and manifestations of psychological mistreatment.

Deep learning models have gained prominence in human activity recognition using ambient sensors, particularly for telemonitoring older adults’ daily activities in real-world scenarios. However, collecting large volumes of annotated sensor data presents a formidable challenge, given the time-consuming and costly nature of traditional manual annotation methods, especially for extensive projects. In response to this challenge, we propose a novel AttCLHAR model rooted in the self-supervised learning framework SimCLR and augmented with a self-attention mechanism. This model is designed for human activity recognition utilizing ambient sensor data, tailored explicitly for scenarios with limited or no annotations. AttCLHAR encompasses unsupervised pre-training and fine-tuning phases, sharing a common encoder module with two convolutional layers and a long short-term memory (LSTM) layer. The output is further connected to a self-attention layer, allowing the model to selectively focus on different input sequence segments. The incorporation of sharpness-aware minimization (SAM) aims to enhance model generalization by penalizing loss sharpness. The pre-training phase focuses on learning representative features from abundant unlabeled data, capturing both spatial and temporal dependencies in the sensor data. It facilitates the extraction of informative features for subsequent fine-tuning tasks. We extensively evaluated the AttCLHAR model using three CASAS smart home datasets (Aruba-1, Aruba-2, and Milan). We compared its performance against the SimCLR framework, SimCLR with SAM, and SimCLR with the self-attention layer. The experimental results demonstrate the superior performance of our approach, especially in semi-supervised and transfer learning scenarios. It outperforms existing models, marking a significant advancement in using self-supervised learning to extract valuable insights from unlabeled ambient sensor data in real-world environments.

AimsAutism spectrum is a neurodevelopmental condition usually diagnosed in early childhood. The broadened diagnostic criteria of the DSM–5 (2013) have led to an increasing number of autism spectrum diagnoses of individuals requiring lower levels of support. Barriers to diagnosis, especially in adults, include the complexity of differential diagnosis with co-occurring psychiatric disorders. This study explored the various pathways of psychiatric diagnosis preceding an autism spectrum diagnosis in adulthood.MethodsThis retrospective cohort study was extracted from health-administrative data from Quebec (Canada) and included all adults with a first recorded autism spectrum diagnosis between 2010 and 2017 (index date). A Trajectory of psychiatric Diagnoses (TDx) was defined as a succession of categorical states, each corresponding to a medical record of a psychiatric diagnosis. These TDx were analysed from 2002 to 2017, using a state sequence analysis with trimester as time units. For each trimester, we defined the following diagnoses in order of priority: 1) autism spectrum, 2) intellectual disability (ID), 3) schizophrenia, 4) bipolar disorder (BP), 5) depressive disorder (DD), 6) anxiety disorder (AD), 7) attention-deficit/hyperactivity disorder (ADHD), and 8) other psychiatric disorders. The simple Hamming metric was used to measure the dissimilarity between TDx, followed by a hierarchical cluster analysis to categorise similar trajectories.ResultsThe study cohort included 2799 adults diagnosed with autism spectrum between 2010 and 2017. Several psychiatric disorders were recorded during the study period, including AD (77.5%), DD (58.0%), schizophrenia (49.4%), BP (48.3%) and ID (33.2%). Results revealed 5 distinct types of TDx. Types 1 and 2, shared by 63.8% and 17.6% of the cohort respectively, represented individuals in younger age groups with similar characteristics, but with very different sequences of psychiatric diagnoses. Slight or sharp increases in diagnoses were observed around 2010, predominantly associated to autism spectrum in Type 1, and to schizophrenia and AD in Type 2. Individuals in Type 4 (6%) were little different from Types 1 and 2, but the TDx showed high prevalence of diagnoses of ID, DD, AD and ADHD, decreasing progressively around the diagnosis of autism. Types 3 and 5 (9.0% and 3.6%), representing middle-aged/older groups, displayed distinctive trajectories of high healthcare use, almost entirely associated with schizophrenia (Type 3), and BD (Type 5).ConclusionThis study proposes a complementary examination of the multiple pathways to diagnosis experienced by autistic adults, highlighting the need for further investigation into co-occurring psychiatric disorders.

Background In the context of increased media use and family distress during the pandemic, we examine whether preschooler screen time at age 3.5 contributes to later expressions of anger/frustration at 4.5, while also considering the inverse association. Methods Data are from a cohort of 315 Canadian preschool-aged children during the COVID-19 pandemic. Parent-reported measures included child h/day of screen time and child temperamental anger/frustration, both measured at 3.5 and 4.5 years of age. Indicators of family distress include use of childcare and child sleep, family income, parenting stress, and parent education, marital and employment status. We also consider child sex as a control variable. Results A crossed-lagged panel model revealed continuity in screen time between the ages of 3.5 and 4.5 ( ß  = 0.68) and temperamental anger/frustration from 3.5 to 4.5 ( ß  = 0.60). Child screen time at age 3.5 predicted increased proneness to anger/frustration at age 4.5 ( ß  = 0.14). Anger/frustration at age 3.5 did not predict screen time at age 4.5. Conclusion Our results suggest that preschooler screen time during the pandemic may have undermined the ability to regulate negative emotions, a key component of social and academic competence. Supporting parents in implementing healthy media habits post pandemic may benefit young children’s development. Impact Key message: this study observes prospective bidirectional associations between preschoolers screen time and temperamental displays of anger or frustration during the COVID-19 pandemic. What does it add: we provide evidence that preschool screen time at age 3.5 prospectively contributes to the tendency to react in anger/frustration at age 4.5. In contrast, greater proneness to anger/frustration did not predict later exposure to screen time. What is the impact: health practitioners should enquire about media use habits during well-child visits to foster children’s healthy development during the preschool years.

To explore the benefits of a brief autism education intervention on peer engagement and inclusion of autistic children at day camps. A convergent, parallel, two-arm (intervention/no intervention), non-randomized, mixed-methods design was used. The individualized, peer-directed, 5–10 min intervention included four components: (1) diagnostic label, (2) description and purpose of unique behaviors, (3) favorite activities and interests, and (4) strategies to engage. A timed-interval behavior-coding system was used to evaluate engagement between each autistic camper and their peers based on videos taken at camp (days 1, 2, 5). Interviews with campers and camp staff explored why changes in targeted outcomes may have occurred. Percent intervals in which the autistic campers were jointly engaged with peers improved in the intervention group (n = 10) and did not change in the control group (n = 5). A large between group intervention effect occurred by day 5 (Z = − 1.942, η 2  = 0.29). Interviews (5 autistic campers, 34 peers, 18 staff) done on the last day of camp in the intervention group garnered three themes: (1) Changed behavioral attribution , (2) Knowledge facilitates understanding and engagement , and (3) (Mis)perceptions of increased inclusion. A brief educational intervention that includes individualized explanatory information and strengths-based strategies might improve peers’ understanding of and social engagement with autistic children in community programs such as camps.

The origin of complex worker-caste systems in ants perplexed Darwin 1 and has remained an enduring problem for evolutionary and developmental biology 2 – 6 . Ants originated approximately 150 million years ago, and produce colonies with winged queen and male castes as well as a wingless worker caste 7 . In the hyperdiverse genus Pheidole , the wingless worker caste has evolved into two morphologically distinct subcastes—small-headed minor workers and large-headed soldiers 8 . The wings of queens and males develop from populations of cells in larvae that are called wing imaginal discs 7 . Although minor workers and soldiers are wingless, vestiges or rudiments of wing imaginal discs appear transiently during soldier development 7 , 9 – 11 . Such rudimentary traits are phylogenetically widespread and are primarily used as evidence of common descent, yet their functional importance remains equivocal 1 , 12 – 14 . Here we show that the growth of rudimentary wing discs is necessary for regulating allometry—disproportionate scaling—between head and body size to generate large-headed soldiers in the genus Pheidole . We also show that Pheidole colonies have evolved the capacity to socially regulate the growth of rudimentary wing discs to control worker subcaste determination, which allows these colonies to maintain the ratio of minor workers to soldiers. Finally, we provide comparative and experimental evidence that suggests that rudimentary wing discs have facilitated the parallel evolution of complex worker-caste systems across the ants. More generally, rudimentary organs may unexpectedly acquire novel regulatory functions during development to facilitate adaptive evolution. In the ant genus Pheidole the growth of rudimentary wing discs—which influence developmental allometry to produce castes with distinct morphologies—is socially regulated to determine the worker-to-soldier ratio in Pheidole colonies.

Sensori-motor development and performance of daily living skills (DLS) remain little explored in children with autism spectrum disorders (ASD). The objective of this study was to determine the impact of sensori-motor skills on the performance of DLS in preschool children with ASD. Thirty-five children, 3–4 years of age, were recruited and assessed with a battery of diagnostic and clinical tests. Children showed atypical sensory responses, very poor motor and DLS. Sensory avoiding, an excessive reaction to sensory stimuli, and fine motor skills were highly correlated with DLS, even when cognitive performance was taken into account. Sensori-motor deficits have an impact on the autonomy of children with ASD and interventions should aim at improving and supporting the development of sensori-motor skills.

Older adults with cognitive deficits face difficulties in recalling daily challenges and lack self-awareness, impeding home care clinicians from obtaining reliable information on functional decline and home care needs and possibly resulting in suboptimal service delivery. Activity of daily living (ADL) telemonitoring has emerged as a tool to optimize evaluation of ADL home care needs. Using ambient sensors, ADL telemonitoring gathers information about ADL behaviors such as preparing meals and sleeping. However, there is a significant gap in understanding on how ADL telemonitoring data can be integrated into clinical reasoning to better target home care services. This paper aims to describe (1) how ADL telemonitoring data are used by clinicians to maintain care recipients with cognitive deficits at home and (2) the impact of ADL telemonitoring on home care service delivery. We used an embedded mixed methods multiple-case study design to examine 3 health institutions located in the greater Montreal region in Quebec that offer public home care services. An ADL telemonitoring system-Innovative Easy Assistance System-Support for Older Adults' Autonomy (Soutien à l'autonomie des personnes âgées in French)-was deployed within these 3 health institutions for 4 years. Subcases (care recipient, informal caregiver, and clinicians) were embedded within each case. For this paper, we used the data collected during interviews (45-60 min) with clinicians only. Quantitative metadata were also collected on each service provided to care recipients before and after the implementation of NEARS-SAPA to triangulate the qualitative data. We analyzed 27 subcases comprising 29 clinicians who completed 57 postimplementation interviews concerning 147 telemonitoring reports. Data analysis showed a 4-step decision-making process used by clinicians: (1) extraction of relevant telemonitoring data, (2) comparison of telemonitoring data with other sources of information, (3) risk assessment of the care recipient's ADL performance and ability to remain at home, and (4) maintenance or modification of the intervention plan. Quantitative data reporting the number of services received allowed the triangulation of qualitative data pertaining to step 4. Overall, the results suggest a stabilization in monthly services after the introduction of the ADL telemonitoring system, particularly in cases where the number of services were increasing before its implementation. This is consistent with qualitative data indicating that, in light of the telemonitoring data, most clinicians decided to maintain the current intervention plan rather than increase or reduce services. Results suggest that ADL telemonitoring contributed to service optimization on a case-by-case basis. ADL telemonitoring may have an important role in reassuring clinicians about their risk management and the appropriateness of service delivery, especially when questions remain regarding the relevance of services. Future studies may further explore the benefits of ADL telemonitoring for public health care systems with larger-scale implementation studies. RR2-10.2196/52284.