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Cherepanov SM, Akther S, Nishimura T, Shabalova AA, Mizuno A, Ichinose W, Shuto S, Yamamoto Y, Yokoyama S, Higashida H. Effects of Three Lipidated Oxytocin Analogs on Behavioral Deficits in CD38 Knockout Mice. Brain Sci 2017; 7:brainsci7100132. [PMID: 29035307 PMCID: PMC5664059 DOI: 10.3390/brainsci7100132] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 10/03/2017] [Accepted: 10/11/2017] [Indexed: 12/13/2022] Open
Abstract
Oxytocin (OT) is a nonapeptide that plays an important role in social behavior. Nasal administration of OT has been shown to improve trust in healthy humans and social interaction in autistic subjects. As is consistent with the nature of a peptide, OT has some unfavorable characteristics: it has a short half-life in plasma and shows poor permeability across the blood-brain barrier. Analogs with long-lasting effects may overcome these drawbacks. To this end, we have synthesized three analogs: lipo-oxytocin-1 (LOT-1), in which two palmitoyl groups are conjugated to the cysteine and tyrosine residues, lipo-oxytocin-2 (LOT-2) and lipo-oxytocin-3 (LOT-3), which include one palmitoyl group conjugated at the cysteine or tyrosine residue, respectively. The following behavioral deficits were observed in CD38 knockout (CD38−/−) mice: a lack of paternal nurturing in CD38−/− sires, decreased ability for social recognition, and decreased sucrose consumption. OT demonstrated the ability to recover these disturbances to the level of wild-type mice for 30 min after injection. LOT-2 and LOT-3 partially recovered the behaviors for a short period. Conversely, LOT-1 restored the behavioral parameters, not for 30 min, but for 24 h. These data suggest that the lipidation of OT has some therapeutic benefits, and LOT-1 would be most useful because of its long-last activity.
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Affiliation(s)
- Stanislav M Cherepanov
- Department of Basic Research on Social Recognition, Research Center for Child Mental Development, Kanazawa University, Kanazawa 920-8640, Japan.
| | - Shirin Akther
- Department of Basic Research on Social Recognition, Research Center for Child Mental Development, Kanazawa University, Kanazawa 920-8640, Japan.
| | - Tomoko Nishimura
- Department of Basic Research on Social Recognition, Research Center for Child Mental Development, Kanazawa University, Kanazawa 920-8640, Japan.
| | - Anna A Shabalova
- Department of Basic Research on Social Recognition, Research Center for Child Mental Development, Kanazawa University, Kanazawa 920-8640, Japan.
| | - Akira Mizuno
- Faculty of Pharmaceutical Sciences, Center for Research and Education on Drug Discovery, Hokkaido University, Kita-12, Nishi-6, Kita-ku, Sapporo 060-0812, Japan.
| | - Wataru Ichinose
- Faculty of Pharmaceutical Sciences, Center for Research and Education on Drug Discovery, Hokkaido University, Kita-12, Nishi-6, Kita-ku, Sapporo 060-0812, Japan.
| | - Satoshi Shuto
- Faculty of Pharmaceutical Sciences, Center for Research and Education on Drug Discovery, Hokkaido University, Kita-12, Nishi-6, Kita-ku, Sapporo 060-0812, Japan.
| | - Yasuhiko Yamamoto
- Departments of Biochemistry and Molecular Vascular Biology, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-8640, Japan.
| | - Shigeru Yokoyama
- Department of Basic Research on Social Recognition, Research Center for Child Mental Development, Kanazawa University, Kanazawa 920-8640, Japan.
| | - Haruhiro Higashida
- Department of Basic Research on Social Recognition, Research Center for Child Mental Development, Kanazawa University, Kanazawa 920-8640, Japan.
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Sizoo BB, Kuiper E. Cognitive behavioural therapy and mindfulness based stress reduction may be equally effective in reducing anxiety and depression in adults with autism spectrum disorders. RESEARCH IN DEVELOPMENTAL DISABILITIES 2017; 64:47-55. [PMID: 28342404 DOI: 10.1016/j.ridd.2017.03.004] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 01/29/2017] [Accepted: 03/09/2017] [Indexed: 05/21/2023]
Abstract
Anxiety and depression co-occur in 50-70% of adults with autism spectrum disorder (ASD) but treatment methods for these comorbid problems have not been systematically studied. Recently, two ASD-tailored protocols were published: mindfulness based stress reduction (MBSR) and cognitive behavioural therapy (CBT). We wanted to investigate if both methods are equally effective in reducing anxiety and depression symptoms among adults with ASD. 59 adults with ASD and anxiety or depression scores above 7 on the Hospital Anxiety and Depression Scale, gave informed consent to participate; 27 followed the CBT protocol, and 32 the MBSR treatment protocol. Anxiety and depression scores, autism symptoms, rumination, and global mood were registered at the start, at the end of the 13-week treatment period, and at 3-months follow-up. Irrational beliefs and mindful attention awareness were used as process measures during treatment and at follow-up. Results indicate that both MBSR and CBT are associated with a reduction in anxiety and depressive symptoms among adults with ASD, with a sustained effect at follow-up, but without a main effect for treatment group. A similar pattern was seen for the reduction of autistic symptoms, rumination and the improvement in global mood. There are some indications that MBSR may be preferred over CBT with respect to the treatment effect on anxiety when the scores on measures of irrational beliefs or positive global mood at baseline are high. Mindfulness and cognitive behavioral therapies are both promising treatment methods for reducing comorbid anxiety and depression in adults with ASD.
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Affiliation(s)
- Bram B Sizoo
- Center for Developmental Disorders, Dimence Institute for Mental Health, Nico Bolkesteinlaan 1, 7416 SB Deventer, The Netherlands.
| | - Erik Kuiper
- Center for Developmental Disorders, Dimence Institute for Mental Health, Nico Bolkesteinlaan 1, 7416 SB Deventer, The Netherlands.
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Gillespie-Lynch K, Bublitz D, Donachie A, Wong V, Brooks PJ, D’Onofrio J. "For a Long Time Our Voices have been Hushed": Using Student Perspectives to Develop Supports for Neurodiverse College Students. Front Psychol 2017; 8:544. [PMID: 28458645 PMCID: PMC5394111 DOI: 10.3389/fpsyg.2017.00544] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 03/24/2017] [Indexed: 11/25/2022] Open
Abstract
Although the challenges that autistic students face adapting to college are often pronounced, they are similar to the challenges that students with other disabilities face (e.g., difficulties with social interaction, self-advocacy, and executive functioning). However, extant evaluations of services for autistic college students are very limited despite an emerging literature examining supports for college students with a range of other disabilities. Given that many autistic students do not self-identify as autistic in college, and consequently might avoid autism-specific services, autistic students might benefit from services that are designed to support a broad range of neurodiverse students, or services that are structured according to the principles of Universal Design. In order to develop such services, we assessed the self-reported needs of autistic college students and their peers with other disabilities. Guided by needs assessments and feedback from students, we developed and evaluated two semesters of mentor-led group programming for autistic college students and students with other disabilities. The first semester of the program focused on social skills; after receiving feedback from participants, the curriculum for the second semester focused on self-advocacy. Participation in social-skills groups was associated with decreased anxiety and autism symptoms. Participation in self-advocacy groups was associated with increased perceived social support from friends, academic self-efficacy, and more accurate definitions of self-advocacy. This research suggests that supports for neurodiverse college students should be developed with their input and should include opportunities to engage with diverse peers.
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Affiliation(s)
- Kristen Gillespie-Lynch
- Department of Psychology, College of Staten Island and The Graduate Center, The City University of New York, New YorkNY, USA
| | - Dennis Bublitz
- Department of Psychology, College of Staten Island and The Graduate Center, The City University of New York, New YorkNY, USA
| | - Annemarie Donachie
- Department of Psychology, College of Staten Island, The City University of New York, New YorkNY, USA
| | - Vincent Wong
- Department of Psychology, College of Staten Island, The City University of New York, New YorkNY, USA
| | - Patricia J. Brooks
- Department of Psychology, College of Staten Island and The Graduate Center, The City University of New York, New YorkNY, USA
| | - Joanne D’Onofrio
- Center for Student Accessibility, College of Staten Island, The City University of New York, New YorkNY, USA
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Otsuka S, Uono S, Yoshimura S, Zhao S, Toichi M. Emotion Perception Mediates the Predictive Relationship Between Verbal Ability and Functional Outcome in High-Functioning Adults with Autism Spectrum Disorder. J Autism Dev Disord 2017; 47:1166-1182. [PMID: 28194554 PMCID: PMC5357301 DOI: 10.1007/s10803-017-3036-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The aim of this study was to identify specific cognitive abilities that predict functional outcome in high-functioning adults with autism spectrum disorder (ASD), and to clarify the contribution of those abilities and their relationships. In total, 41 adults with ASD performed cognitive tasks in a broad range of neuro- and social cognitive domains, and information concerning functional outcomes was obtained. Regression analyses revealed that emotion perception and verbal generativity predicted adaptive functioning directly, and the former mediated between the other two. These findings provide the first evidence of a triadic relationship among neuro- and social cognition and functional outcome in this population. Our results suggest that psychosocial interventions targeting these cognitive abilities could benefit social adaptation in adults with ASD.
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Affiliation(s)
- Sadao Otsuka
- Faculty of Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
- The Organization for Promoting Neurodevelopmental Disorder Research (OPNDR), 40 Shogoin Sanno-cho, Sakyo-ku, Kyoto, 606-8392, Japan.
| | - Shota Uono
- Department of Neurodevelopmental Psychiatry, Habilitation and Rehabilitation, Faculty of Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Sayaka Yoshimura
- Department of Neurodevelopmental Psychiatry, Habilitation and Rehabilitation, Faculty of Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Shuo Zhao
- Faculty of Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
- International Research Fellow of the Japan Society for the Promotion of Science (JSPS), 5-3-1, Kojimachi, Chiyoda-ku, 102-0083, Tokyo, Japan
| | - Motomi Toichi
- Faculty of Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
- The Organization for Promoting Neurodevelopmental Disorder Research (OPNDR), 40 Shogoin Sanno-cho, Sakyo-ku, Kyoto, 606-8392, Japan
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García-Villamisar D, Dattilo J, Muela C. Effects of therapeutic recreation on adults with ASD and ID: a preliminary randomized control trial. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2017; 61:325-340. [PMID: 27465318 DOI: 10.1111/jir.12320] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 06/02/2016] [Accepted: 06/29/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND The purpose of this research was to examine effects of a therapeutic recreation (TR) program designed to increase executive function (EF), social skills, adaptive behaviours and well-being of adults with autism spectrum disorder (ASD) and intellectual disability (ID). METHOD A preliminary pre-test, post-test randomized control group experimental design was used to measure effects of a 40-week TR program designed to increase EF (TR-EF). The TR-EF used instructional electronically based games delivered during 200 1-h sessions (5/week). RESULTS Participants (experimental group, n = 19; wait-list group, n = 18) were evaluated at baseline and 10 months later. There was a positive and direct impact of the program on several EF and indirect effect on social skills, adaptive behaviour and personal well-being. CONCLUSIONS Findings provide support for inclusion of EF enrichment as a way to enhance effects of TR interventions for adults with ASD and ID. Preliminary results of this study can be considered in planning TR services in the future. In addition to TR-EF program primary effects on EF, there were indirect benefits on adaptive behaviours, personal well-being and social skills.
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Affiliation(s)
- D García-Villamisar
- Universidad Complutense, Department of Personality and Clinical Pschology, Madrid, Madrid, Spain
| | - J Dattilo
- The Pennsylvania State University, Department of Recreation, Park, and Tourism Management, University Park, PA, USA
| | - C Muela
- Asociacion Nuevo Horizonte, Technical Direction, Las Rozas, Madrid, Spain
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Bishop-Fitzpatrick L, Mazefsky CA, Eack SM, Minshew NJ. Correlates of Social Functioning in Autism Spectrum Disorder: The Role of Social Cognition. RESEARCH IN AUTISM SPECTRUM DISORDERS 2017; 35:25-34. [PMID: 28839456 PMCID: PMC5565224 DOI: 10.1016/j.rasd.2016.11.013] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Individuals with autism spectrum disorder (ASD) experience marked challenges with social function by definition, but few modifiable predictors of social functioning in ASD have been identified in extant research. This study hypothesized that deficits in social cognition and motor function may help to explain poor social functioning in individuals with ASD. METHOD Cross-sectional data from 108 individuals with ASD and without intellectual disability ages 9 through 27.5 were used to assess the relationship between social cognition and motor function, and social functioning. RESULTS Results of hierarchical multiple regression analyses revealed that greater social cognition, but not motor function, was significantly associated with better social functioning when controlling for sex, age, and intelligence quotient. Post-hoc analyses revealed that, better performance on second-order false belief tasks was associated with higher levels of socially adaptive behavior and lower levels of social problems. CONCLUSIONS Our findings support the development and testing of interventions that target social cognition in order to improve social functioning in individuals with ASD. Interventions that teach generalizable skills to help people with ASD better understand social situations and develop competency in advanced perspective taking have the potential to create more durable change because their effects can be applied to a wide and varied set of situations and not simply a prescribed set of rehearsed situations.
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Schema therapy as treatment for adults with autism spectrum disorder and comorbid personality disorder: Protocol of a multiple-baseline case series study testing cognitive-behavioral and experiential interventions. Contemp Clin Trials Commun 2017; 5:80-85. [PMID: 29740624 PMCID: PMC5936690 DOI: 10.1016/j.conctc.2017.01.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 12/05/2016] [Accepted: 01/03/2017] [Indexed: 12/27/2022] Open
Abstract
Background To our knowledge treatment of personality disorder (PD) comorbidity in adults with ASD is understudied and is still in its infancy. This study investigates the effectiveness of schema therapy for PD-psychopathology in adult patients with both ASD and PD. Methods/design Twelve adult individuals (age > 18 years) with ASD and at least one PD are given a treatment protocol consisting of 30 weekly offered sessions. A concurrent multiple baseline design is used with baseline varying from 4 to 9 weeks, after which weekly supportive sessions varying from 1 to 6 weeks start with the study therapist. After baseline and 1 to 6 supportive sessions, a 5-week exploration phase follows with weekly sessions during which current and past functioning, psychological symptoms, and schema modes are explored, and information about the treatment is given. This is followed by 15 weekly sessions with cognitive-behavioral interventions and 15 weekly sessions with experiential interventions: patients are vice versa and randomly assigned to the interventions. Finally, there is a 10-month follow-up phase with monthly booster sessions. Participants are randomly assigned to baseline length, and report weekly during treatment and monthly at follow-up on Belief Strength of negative core beliefs, and fill out SMI, SCL-90 and SRS-A 7 times during screening procedure (i.e. before baseline), after supportive sessions, after exploration, after cognitive and behavioral interventions, after experiential interventions, and after 5- and 10- month follow-up. The SCID-II is administered during screening procedure, at 5- and at 10-month follow-up. Trial registration The Netherlands National Trial Register NTR5788. Registered 01 April 2016.
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Key Words
- ABA, Applied Behavior Analysis
- APA, American Psychiatric Association
- AS, Asperger's disorder
- ASD, autism spectrum disorder
- Autism spectrum disorder
- CBT, Cognitive behavioral therapy
- CET, Cognitive enhancement therapy
- DSM, Diagnostic and Statistical Manual of mental disorders
- IQ, Intelligence quotient
- Multiple-baseline case series study
- N.S., not significant
- PD, personality disorder
- PDs, personality disorders
- Personality disorder
- RCT, randomized controlled trial
- SCID-II, Structured Clinical Interview for Axis II Personality Disorders
- SCL-90, Symptom Check List
- SMI, Schema Mode Inventory
- SRS-A, Social Responsiveness Scale – Adult version
- Schema therapy
- VAS, visual analogue scales
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Wang M, Jiang L, Tang X. Levetiracetam is associated with decrease in subclinical epileptiform discharges and improved cognitive functions in pediatric patients with autism spectrum disorder. Neuropsychiatr Dis Treat 2017; 13:2321-2326. [PMID: 28919764 PMCID: PMC5587198 DOI: 10.2147/ndt.s143966] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Subclinical epileptiform discharges (SEDs) are common in pediatric patients with autism spectrum disorder (ASD), but the effect of antiepileptic drugs on SEDs in ASD remains inconclusive. This physician-blinded, prospective, randomized controlled trial investigated an association between the anticonvulsant drug levetiracetam and SEDs in children with ASD. METHODS A total of 70 children with ASD (4-6 years) and SEDs identified by electroencephalogram were randomly divided into two equal groups to receive either levetiracetam and educational training (treatment group) or educational training only (control). At baseline and after 6 months treatment, the following scales were used to assess each individual's behavioral and cognitive functions: the Chinese version of the Psychoeducational Profile - third edition (PEP-3), Childhood Autism Rating Scale (CARS), and Autism Behavior Checklist (ABC). A 24-hour electroencephalogram was recorded on admission (baseline) and at follow-up. The degree of satisfaction of each patient was also evaluated. RESULTS Relative to baseline, at the 6-month follow-up, the PEP-3, CARS, and ABC scores were significantly improved in both the treatment and control groups. At the 6-month follow-up, the PEP-3 scores of the treatment group were significantly higher than those of the control, whereas the CARS and ABC scores were significantly lower, and the rate of electroencephalographic normalization was significantly higher in the treatment group. CONCLUSION Levetiracetam appears to be effective for controlling SEDs in pediatric patients with ASD and was also associated with improved behavioral and cognitive functions.
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Affiliation(s)
- Minjian Wang
- Department of Psychology.,Ministry of Education Key Laboratory of Child Development and Disorders.,Key Laboratory of Pediatrics in Chongqing.,Chongqing International Science and Technology Cooperation Center for Child Development and Disorders
| | - Li Jiang
- Ministry of Education Key Laboratory of Child Development and Disorders.,Key Laboratory of Pediatrics in Chongqing.,Chongqing International Science and Technology Cooperation Center for Child Development and Disorders.,Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Xiaoju Tang
- Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China
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59
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Bishop-Fitzpatrick L, Minshew NJ, Mazefsky CA, Eack SM. Perception of Life as Stressful, Not Biological Response to Stress, is Associated with Greater Social Disability in Adults with Autism Spectrum Disorder. J Autism Dev Disord 2017; 47:1-16. [PMID: 27696184 PMCID: PMC5225258 DOI: 10.1007/s10803-016-2910-6] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This study examined differences between adults with autism spectrum disorder (ASD; N = 40) and typical community volunteers (N = 25) on measures of stressful life events, perceived stress, and biological stress response (cardiovascular and cortisol reactivity) during a novel social stress task. Additional analyses examined the relationship between stress and social functioning as measured by the Social Adjustment Scale-II and the Waisman Activities of Daily Living scale. Results indicated that adults with ASD experienced significantly more stressful life events and perceived stress, and greater systolic blood pressure reactivity than typical community volunteers. Results also indicated that perceived stress and stressful life events were significantly associated with social disability. Interventions targeting stress management might improve social function in adults with ASD.
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Affiliation(s)
| | - Nancy J Minshew
- University of Pittsburgh School of Medicine, Webster Hall - Suite 300, 3811 O'Hara St., Pittsburgh, PA, 15213, USA
| | - Carla A Mazefsky
- University of Pittsburgh School of Medicine, Webster Hall - Suite 300, 3811 O'Hara St., Pittsburgh, PA, 15213, USA
| | - Shaun M Eack
- University of Pittsburgh, School of Social Work, 4200 Fifth Avenue, Pittsburgh, PA, 15260, USA
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Abstract
Social cognitive deficits are common in neuropsychiatric disorders. Given the proximity of social cognition (SC) to everyday functioning, many intervention studies (including targeted, comprehensive, and broad-based approaches) have focussed on SC. The aim of this paper was to quantitatively meta-analyse the efficacy of SC interventions in adult neuropsychiatric patients. Databases Pubmed, PsycINFO, Web of Knowledge, and Embase were searched for controlled SC intervention studies published between 01-01-2003 and 01-01-2016. Forty-one studies, comprising 1,508 patients with schizophrenia, autism spectrum disorders, or acquired brain injury were included. Outcome measures evaluated emotion perception (EP), social perception (SP), Theory of Mind (ToM), and social functioning (SF). The meta-analyses showed that interventions were effective in improving SC (Cohen'sd=.71). Interventions targeting one specific SC function were found to be most effective (d=.89), followed by broad-based interventions, targeting non-SC domains in addition to SC (d=.65), and comprehensive interventions, that target multiple SC processes (d=.61). Targeted interventions were especially effective in improving EP and ToM. Comprehensive interventions were able to ameliorate EP, ToM, and SF. Broad-based interventions were especially effective in improving SF, but also showed effects on EP and ToM.
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61
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Chen YW, Bundy A, Cordier R, Chien YL, Einfeld S. The Experience of Social Participation in Everyday Contexts Among Individuals with Autism Spectrum Disorders: An Experience Sampling Study. J Autism Dev Disord 2016; 46:1403-14. [PMID: 26687569 DOI: 10.1007/s10803-015-2682-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
This study explored the everyday life experiences of individuals with an autism spectrum disorder (ASD). Fourteen Australians and 16 Taiwanese (aged 16-45 years) with Asperger syndrome/high functioning autism recorded what they were doing, level of interest/involvement, emotional reactions and preference for being alone 7 times/day for 7 days. Multilevel analyses showed that 'solitary/parallel leisure' and 'social activities' were positively associated with interest and involvement. Engaging in these two activities and interacting with friends were positively associated with enjoyment. However, engaging in 'social activities' and having less severe ASD symptoms were associated with in-the-moment anxiety. Severity of ASD and social anxiety moderated experience in social situations. The findings highlight the importance of considering the in-the-moment experience of people with ASD.
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Affiliation(s)
- Yu-Wei Chen
- Faculty of Health Sciences, The University of Sydney, PO Box 170, Lidcombe, NSW, 1825, Australia.
| | - Anita Bundy
- Faculty of Health Sciences, The University of Sydney, PO Box 170, Lidcombe, NSW, 1825, Australia
| | - Reinie Cordier
- School of Occupational Therapy and Social Work, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Yi-Ling Chien
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Stewart Einfeld
- Faculty of Health Sciences, The University of Sydney, PO Box 170, Lidcombe, NSW, 1825, Australia
- Brain and Mind Research Institute, The University of Sydney, Sydney, NSW, Australia
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Koehne S, Behrends A, Fairhurst MT, Dziobek I. Fostering Social Cognition through an Imitation- and Synchronization-Based Dance/Movement Intervention in Adults with Autism Spectrum Disorder: A Controlled Proof-of-Concept Study. PSYCHOTHERAPY AND PSYCHOSOMATICS 2016; 85:27-35. [PMID: 26609704 DOI: 10.1159/000441111] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Accepted: 09/11/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Since social cognition is impaired in individuals with autism spectrum disorder (ASD), this study aimed at establishing the efficacy of a newly developed imitation- and synchronization-based dance/movement intervention (SI-DMI) in fostering emotion inference and empathic feelings (emotional reaction to feelings of others) in adults with high-functioning ASD. METHODS Fifty-five adults with ASD (IQ ≥85) who were blinded to the aim of the study were assigned to receive either 10 weeks of a dance/movement intervention focusing on interpersonal movement imitation and synchronization (SI-DMI, n = 27) or a control movement intervention (CMI, n = 24) focusing on individual motor coordination (2 participants from each group declined before baseline testing). The primary outcome measure was the objective Multifaceted Empathy Test targeting emotion inference and empathic feelings. Secondary outcomes were scores on the self-rated Interpersonal Reactivity Index. The well-established automatic imitation task and synchronization finger-tapping task were used to quantify effects on imitation and synchronization functions, complemented by the more naturalistic Assessment of Spontaneous Interaction in Movement. RESULTS Intention-to-treat analyses revealed that from baseline to 3 months, patients treated with SI-DMI showed a significantly larger improvement in emotion inference (d = 0.58), but not empathic feelings, than those treated with CMI (d = -0.04). On the close generalization level, SI-DMI increased synchronization skills and imitation tendencies, as well as whole-body imitation/synchronization and movement reciprocity/dialogue, compared to CMI. CONCLUSIONS SI-DMI can be successful in promoting emotion inference in adults with ASD and warrants further investigation.
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Affiliation(s)
- Svenja Koehne
- Cluster of Excellence, Languages of Emotion, Freie Universitx00E4;t, Berlin, Germany
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Murphy CM, Wilson CE, Robertson DM, Ecker C, Daly EM, Hammond N, Galanopoulos A, Dud I, Murphy DG, McAlonan GM. Autism spectrum disorder in adults: diagnosis, management, and health services development. Neuropsychiatr Dis Treat 2016; 12:1669-86. [PMID: 27462160 PMCID: PMC4940003 DOI: 10.2147/ndt.s65455] [Citation(s) in RCA: 116] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Autism spectrum disorder (ASD) is a common neurodevelopmental disorder characterized by pervasive difficulties since early childhood across reciprocal social communication and restricted, repetitive interests and behaviors. Although early ASD research focused primarily on children, there is increasing recognition that ASD is a lifelong neurodevelopmental disorder. However, although health and education services for children with ASD are relatively well established, service provision for adults with ASD is in its infancy. There is a lack of health services research for adults with ASD, including identification of comorbid health difficulties, rigorous treatment trials (pharmacological and psychological), development of new pharmacotherapies, investigation of transition and aging across the lifespan, and consideration of sex differences and the views of people with ASD. This article reviews available evidence regarding the etiology, legislation, diagnosis, management, and service provision for adults with ASD and considers what is needed to support adults with ASD as they age. We conclude that health services research for adults with ASD is urgently warranted. In particular, research is required to better understand the needs of adults with ASD, including health, aging, service development, transition, treatment options across the lifespan, sex, and the views of people with ASD. Additionally, the outcomes of recent international legislative efforts to raise awareness of ASD and service provision for adults with ASD are to be determined. Future research is required to identify high-quality, evidence-based, and cost-effective models of care. Furthermore, future health services research is also required at the beginning and end of adulthood, including improved transition from youth to adult health care and increased understanding of aging and health in older adults with ASD.
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Affiliation(s)
- Clodagh M Murphy
- Sackler Institute for Translational Neurodevelopment, Department of Forensic and Neurodevelopmental Sciences, King’s College London, Institute of Psychiatry, Psychology & Neuroscience
- Behavioural and Developmental Psychiatry Clinical Academic Group, Behavioural Genetics Clinic, National Adult Autism Service, South London and Maudsley Foundation NHS Trust, London, UK
| | - C Ellie Wilson
- Sackler Institute for Translational Neurodevelopment, Department of Forensic and Neurodevelopmental Sciences, King’s College London, Institute of Psychiatry, Psychology & Neuroscience
- Behavioural and Developmental Psychiatry Clinical Academic Group, Behavioural Genetics Clinic, National Adult Autism Service, South London and Maudsley Foundation NHS Trust, London, UK
- Individual Differences, Language and Cognition Lab, Department of Developmental and Educational Psychology, University of Seville, Spain
| | - Dene M Robertson
- Sackler Institute for Translational Neurodevelopment, Department of Forensic and Neurodevelopmental Sciences, King’s College London, Institute of Psychiatry, Psychology & Neuroscience
- Behavioural and Developmental Psychiatry Clinical Academic Group, Behavioural Genetics Clinic, National Adult Autism Service, South London and Maudsley Foundation NHS Trust, London, UK
| | - Christine Ecker
- Sackler Institute for Translational Neurodevelopment, Department of Forensic and Neurodevelopmental Sciences, King’s College London, Institute of Psychiatry, Psychology & Neuroscience
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, Goethe-University, Frankfurt am Main, Germany
| | - Eileen M Daly
- Sackler Institute for Translational Neurodevelopment, Department of Forensic and Neurodevelopmental Sciences, King’s College London, Institute of Psychiatry, Psychology & Neuroscience
- Behavioural and Developmental Psychiatry Clinical Academic Group, Behavioural Genetics Clinic, National Adult Autism Service, South London and Maudsley Foundation NHS Trust, London, UK
| | - Neil Hammond
- Sackler Institute for Translational Neurodevelopment, Department of Forensic and Neurodevelopmental Sciences, King’s College London, Institute of Psychiatry, Psychology & Neuroscience
- Behavioural and Developmental Psychiatry Clinical Academic Group, Behavioural Genetics Clinic, National Adult Autism Service, South London and Maudsley Foundation NHS Trust, London, UK
| | - Anastasios Galanopoulos
- Sackler Institute for Translational Neurodevelopment, Department of Forensic and Neurodevelopmental Sciences, King’s College London, Institute of Psychiatry, Psychology & Neuroscience
- Behavioural and Developmental Psychiatry Clinical Academic Group, Behavioural Genetics Clinic, National Adult Autism Service, South London and Maudsley Foundation NHS Trust, London, UK
| | - Iulia Dud
- Sackler Institute for Translational Neurodevelopment, Department of Forensic and Neurodevelopmental Sciences, King’s College London, Institute of Psychiatry, Psychology & Neuroscience
- Behavioural and Developmental Psychiatry Clinical Academic Group, Behavioural Genetics Clinic, National Adult Autism Service, South London and Maudsley Foundation NHS Trust, London, UK
| | - Declan G Murphy
- Sackler Institute for Translational Neurodevelopment, Department of Forensic and Neurodevelopmental Sciences, King’s College London, Institute of Psychiatry, Psychology & Neuroscience
- Behavioural and Developmental Psychiatry Clinical Academic Group, Behavioural Genetics Clinic, National Adult Autism Service, South London and Maudsley Foundation NHS Trust, London, UK
| | - Grainne M McAlonan
- Sackler Institute for Translational Neurodevelopment, Department of Forensic and Neurodevelopmental Sciences, King’s College London, Institute of Psychiatry, Psychology & Neuroscience
- Behavioural and Developmental Psychiatry Clinical Academic Group, Behavioural Genetics Clinic, National Adult Autism Service, South London and Maudsley Foundation NHS Trust, London, UK
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Haker H, Schneebeli M, Stephan KE. Can Bayesian Theories of Autism Spectrum Disorder Help Improve Clinical Practice? Front Psychiatry 2016; 7:107. [PMID: 27378955 PMCID: PMC4911361 DOI: 10.3389/fpsyt.2016.00107] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 06/03/2016] [Indexed: 11/13/2022] Open
Abstract
Diagnosis and individualized treatment of autism spectrum disorder (ASD) represent major problems for contemporary psychiatry. Tackling these problems requires guidance by a pathophysiological theory. In this paper, we consider recent theories that re-conceptualize ASD from a "Bayesian brain" perspective, which posit that the core abnormality of ASD resides in perceptual aberrations due to a disbalance in the precision of prediction errors (sensory noise) relative to the precision of predictions (prior beliefs). This results in percepts that are dominated by sensory inputs and less guided by top-down regularization and shifts the perceptual focus to detailed aspects of the environment with difficulties in extracting meaning. While these Bayesian theories have inspired ongoing empirical studies, their clinical implications have not yet been carved out. Here, we consider how this Bayesian perspective on disease mechanisms in ASD might contribute to improving clinical care for affected individuals. Specifically, we describe a computational strategy, based on generative (e.g., hierarchical Bayesian) models of behavioral and functional neuroimaging data, for establishing diagnostic tests. These tests could provide estimates of specific cognitive processes underlying ASD and delineate pathophysiological mechanisms with concrete treatment targets. Written with a clinical audience in mind, this article outlines how the development of computational diagnostics applicable to behavioral and functional neuroimaging data in routine clinical practice could not only fundamentally alter our concept of ASD but eventually also transform the clinical management of this disorder.
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Affiliation(s)
- Helene Haker
- Translational Neuromodeling Unit (TNU), Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Maya Schneebeli
- Translational Neuromodeling Unit (TNU), Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Klaas Enno Stephan
- Translational Neuromodeling Unit (TNU), Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland
- Wellcome Trust Centre for Neuroimaging, University College London, London, UK
- Max Planck Institute for Metabolism Research, Cologne, Germany
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65
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Turcotte P, Mathew M, Shea LL, Brusilovskiy E, Nonnemacher SL. Service Needs Across the Lifespan for Individuals with Autism. J Autism Dev Disord 2016; 46:2480-9. [DOI: 10.1007/s10803-016-2787-4] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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66
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Gadke DL, McKinney C, Oliveros A. Autism Spectrum Disorder Symptoms and Comorbidity in Emerging Adults. Child Psychiatry Hum Dev 2016; 47:194-201. [PMID: 25995020 DOI: 10.1007/s10578-015-0556-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Autism spectrum disorder (ASD) continues to grow in prevalence each passing year. As more children are diagnosed, it makes sense that the emerging adult and adult population with ASD also will continue to grow. Although the body of research is quite large for children with ASD, the literature for emerging adults with ASD is sparse in comparison. The current study aimed to extend existing literature further by beginning to explore the realm of emerging adulthood. Specifically, the study investigated the presence of comorbid psychiatric symptoms in emerging adults who also presented with ASD symptoms as measured by the Adult Self-Report (Rescorla and Achenbach in The Achenbach System of Empirically Based Assessment (ASEBA) for ages 18 to 90 years. The use of psychological testing for treatment planning and outcomes assessment: volume 3: instruments for adults, 3rd edn. Lawrence Erlbaum Associates, Mahwah, pp 115-152, 2004). Emerging adults were categorized as having normal, mild, moderate, or severe levels of ASD symptoms and were compared for the presence of comorbid psychiatric symptoms. Overall, results suggested that emerging adults who presented with greater ASD symptom severity were more likely to experience the presence of additional comorbid symptoms.
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Affiliation(s)
- Daniel L Gadke
- Department of Counseling and Educational Psychology, Mississippi State University, 508 Allen Hall, P.O. Box 9727, Mississippi State, MS, 39762, USA.
| | - Cliff McKinney
- Department of Psychology, Mississippi State University, P.O. Box 6161, Mississippi State, MS, 39762, USA.
| | - Arazais Oliveros
- Department of Psychology, Mississippi State University, P.O. Box 6161, Mississippi State, MS, 39762, USA.
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Zimmerman DL, Ownsworth T, O'Donovan A, Roberts J, Gullo MJ. Independence of Hot and Cold Executive Function Deficits in High-Functioning Adults with Autism Spectrum Disorder. Front Hum Neurosci 2016; 10:24. [PMID: 26903836 PMCID: PMC4742532 DOI: 10.3389/fnhum.2016.00024] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 01/18/2016] [Indexed: 11/13/2022] Open
Abstract
Individuals with autistic spectrum disorder (ASD) display diverse deficits in social, cognitive and behavioral functioning. To date, there has been mixed findings on the profile of executive function deficits for high-functioning adults (IQ > 70) with ASD. A conceptual distinction is commonly made between "cold" and "hot" executive functions. Cold executive functions refer to mechanistic higher-order cognitive operations (e.g., working memory), whereas hot executive functions entail cognitive abilities supported by emotional awareness and social perception (e.g., social cognition). This study aimed to determine the independence of deficits in hot and cold executive functions for high-functioning adults with ASD. Forty-two adults with ASD (64% male, aged 18-66 years) and 40 age and gender matched controls were administered The Awareness of Social Inference Test (TASIT; emotion recognition and social inference), Letter Number Sequencing (working memory) and Hayling Sentence Completion Test (response initiation and suppression). Between-group analyses identified that the ASD group performed significantly worse than matched controls on all measures of cold and hot executive functions (d = 0.54 - 1.5). Hierarchical multiple regression analyses revealed that the ASD sample performed more poorly on emotion recognition and social inference tasks than matched controls after controlling for cold executive functions and employment status. The findings also indicated that the ability to recognize emotions and make social inferences was supported by working memory and response initiation and suppression processes. Overall, this study supports the distinction between hot and cold executive function impairments for adults with ASD. Moreover, it advances understanding of higher-order impairments underlying social interaction difficulties for this population which, in turn, may assist with diagnosis and inform intervention programs.
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Affiliation(s)
- David L Zimmerman
- Behavioral Basis of Health, School of Applied Psychology and Menzies Health Institute Queensland, Griffith University Mt. Gravatt, QLD, Australia
| | - Tamara Ownsworth
- Behavioral Basis of Health, School of Applied Psychology and Menzies Health Institute Queensland, Griffith University Mt. Gravatt, QLD, Australia
| | - Analise O'Donovan
- Behavioral Basis of Health, School of Applied Psychology and Menzies Health Institute Queensland, Griffith University Mt. Gravatt, QLD, Australia
| | - Jacqueline Roberts
- School of Education and Professional Studies, Griffith University Mt. Gravatt, QLD, Australia
| | - Matthew J Gullo
- Centre for Youth Substance Abuse Research, University of Queensland St. Lucia, QLD, Australia
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Woodman AC, Smith LE, Greenberg JS, Mailick MR. Contextual Factors Predict Patterns of Change in Functioning over 10 Years Among Adolescents and Adults with Autism Spectrum Disorders. J Autism Dev Disord 2016; 46:176-189. [PMID: 26319253 PMCID: PMC4707127 DOI: 10.1007/s10803-015-2561-z] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
In the present study, we jointly employ and integrate variable- and person-centered approaches to identify groups of individuals with autism spectrum disorders (ASD) who have similar profiles of change over a period of 10 years across three critical domains of functioning: maladaptive behaviors, autism symptoms, and daily living skills. Two distinct developmental profiles were identified. Above and beyond demographic and individual characteristics, aspects of both the educational context (level of inclusion) and the family context (maternal positivity) were found to predict the likelihood of following a positive pattern of change. Implementing evidence-based interventions that target the school and home environments during childhood and adolescence may have lasting impacts on functioning into adulthood for individuals with ASD.
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Affiliation(s)
- Ashley C. Woodman
- Department of Psychological and Brain Sciences, University of Massachusetts-Amherst, Tobin Hall 509, 135 Hicks Way, Amherst, MA 01003, USA
| | - Leann E. Smith
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Avenue, Madison, WI 53705, USA
| | - Jan S. Greenberg
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Avenue, Madison, WI 53705, USA
| | - Marsha R. Mailick
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Avenue, Madison, WI 53705, USA
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69
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Lai MC, Baron-Cohen S. Identifying the lost generation of adults with autism spectrum conditions. Lancet Psychiatry 2015; 2:1013-27. [PMID: 26544750 DOI: 10.1016/s2215-0366(15)00277-1] [Citation(s) in RCA: 334] [Impact Index Per Article: 37.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 06/06/2015] [Accepted: 06/08/2015] [Indexed: 12/13/2022]
Abstract
Autism spectrum conditions comprise a set of early-onset neurodevelopmental syndromes with a prevalence of 1% across all ages. First diagnosis in adulthood has finally become recognised as an important clinical issue due to the increasing awareness of autism, broadening of diagnostic criteria, and the introduction of the spectrum concept. Thus, the idea of a lost generation of people who were previously excluded from a diagnosis of classic autism has arisen. Making a first diagnosis of autism spectrum conditions in adults can be challenging for practical reasons (eg, no person to provide a developmental history), developmental reasons (eg, the acquisition of learnt or camouflaging strategies), and clinical reasons (eg, high frequency of co-occurring disorders). The diagnostic process includes referral, screening, interviews with informants and patients, and functional assessments. In delineating differential diagnoses, true comorbidities, and overlapping behaviour with other psychiatric diagnoses, particular attention should be paid to anxiety, depression, obsessive-compulsive disorder, psychosis, personality disorders, and other neurodevelopmental disorders. Possible misdiagnosis, especially in women, should be explored. The creation of supportive, accepting, and autism-friendly social and physical environments is important and requires a coordinated effort across agencies and needs support from government policies.
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Affiliation(s)
- Meng-Chuan Lai
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK; Cambridge Lifespan Asperger Syndrome Service (CLASS) Clinic, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK; Centre for Addiction and Mental Health, The Hospital for Sick Children, and Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.
| | - Simon Baron-Cohen
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK; Cambridge Lifespan Asperger Syndrome Service (CLASS) Clinic, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
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Abstract
Purpose
– Adults who have autism spectrum disorders (ASD) experience a range of core and co-morbid characteristics which impede daily functioning and quality of life. Children and adolescents with ASD derive clinically meaningful benefits from psychological interventions, including those designed to reduce socio-communication deficits and mental health conditions. Relatively little is known about the effectiveness of these interventions for the adult ASD population. The paper aims to discuss this issue.
Design/methodology/approach
– A selective search of English language, peer-reviewed publications was undertaken, in order to summarise the empirical data pertaining to psychological interventions for adults with high-functioning ASD (HF-ASD).
Findings
– Thus far, social skills interventions, cognitive behaviour therapy techniques, and mindfulness-based approaches have been researched most extensively. Interventions have primarily sought to: reduce the impact of core ASD characteristics; enhance skills; and improve co-morbid mental health symptoms. Methodological and clinical heterogeneity render it difficult to generalise study findings across population samples, but overall, interventions appear to be associated with reductions in co-morbid symptom severity, and improved functioning.
Research limitations/implications
– Further studies that seek to improve functioning, reduce co-morbid characteristics, and enhance the propensity for attaining and maintaining independence are now needed.
Practical implications
– Adaptations to standard treatment protocols are likely required in order to enhance engagement and optimise treatment gains.
Originality/value
– This is one of the first reviews to focus specifically on psychological interventions for adults with HF-ASD.
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Schmidt L, Kirchner J, Strunz S, Broźus J, Ritter K, Roepke S, Dziobek I. Psychosocial Functioning and Life Satisfaction in Adults With Autism Spectrum Disorder Without Intellectual Impairment. J Clin Psychol 2015; 71:1259-68. [DOI: 10.1002/jclp.22225] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Howlin P, Taylor JL. Addressing the need for high quality research on autism in adulthood. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2015; 19:771-3. [DOI: 10.1177/1362361315595582] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Mercado E, Church BA, Coutinho MVC, Dovgopoly A, Lopata CJ, Toomey JA, Thomeer ML. Heterogeneity in perceptual category learning by high functioning children with autism spectrum disorder. Front Integr Neurosci 2015; 9:42. [PMID: 26157368 PMCID: PMC4477144 DOI: 10.3389/fnint.2015.00042] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Accepted: 06/10/2015] [Indexed: 01/19/2023] Open
Abstract
Previous research suggests that high functioning (HF) children with autism spectrum disorder (ASD) sometimes have problems learning categories, but often appear to perform normally in categorization tasks. The deficits that individuals with ASD show when learning categories have been attributed to executive dysfunction, general deficits in implicit learning, atypical cognitive strategies, or abnormal perceptual biases and abilities. Several of these psychological explanations for category learning deficits have been associated with neural abnormalities such as cortical underconnectivity. The present study evaluated how well existing neurally based theories account for atypical perceptual category learning shown by HF children with ASD across multiple category learning tasks involving novel, abstract shapes. Consistent with earlier results, children’s performances revealed two distinct patterns of learning and generalization associated with ASD: one was indistinguishable from performance in typically developing children; the other revealed dramatic impairments. These two patterns were evident regardless of training regimen or stimulus set. Surprisingly, some children with ASD showed both patterns. Simulations of perceptual category learning could account for the two observed patterns in terms of differences in neural plasticity. However, no current psychological or neural theory adequately explains why a child with ASD might show such large fluctuations in category learning ability across training conditions or stimulus sets.
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Affiliation(s)
- Eduardo Mercado
- Department of Psychology, The State University of New York Buffalo, NY, USA
| | - Barbara A Church
- Department of Psychology, The State University of New York Buffalo, NY, USA
| | | | | | | | | | - Marcus L Thomeer
- Institute for Autism Research, Canisius College, Buffalo, NY USA
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Brugha TS, Doos L, Tempier A, Einfeld S, Howlin P. Outcome measures in intervention trials for adults with autism spectrum disorders; a systematic review of assessments of core autism features and associated emotional and behavioural problems. Int J Methods Psychiatr Res 2015; 24:99-115. [PMID: 26077193 PMCID: PMC6878529 DOI: 10.1002/mpr.1466] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 12/17/2014] [Accepted: 02/20/2015] [Indexed: 12/27/2022] Open
Abstract
A systematic review was conducted of outcome measures used in treatment trials for older adolescents and adults with autism spectrum disorders (ASDs). Of 818 titles only 30 articles (19 of which involved pharmacological treatments) were identified that met inclusion criteria (sample size > 5; mean age of group > 15 years; mean IQ > 30; ASD diagnosis confirmed; use of objective ASD outcome measures; focus on symptoms core to or typically associated with ASDs). Selected studies included randomized and placebo-controlled trials, retrospective assessment studies, case series and open label or case-control trials. Use of outcome measures varied with frequent use of non-standardized assessments, very little use of measures designed specifically for individuals with ASD or of instruments focusing on core ASD deficits, such as communication or social functioning. Most commonly used were the Clinical Global Impression (CGI) rating scale and the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). The strengths or deficiencies of the outcome measures used were not systematically evaluated. Although there are now many well controlled treatment trials for children with ASDs, adult intervention research is very limited. The lack of valid and reliable outcome measures for adults with ASDs compromises attempts at treatment evaluation.
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Affiliation(s)
- Traolach S Brugha
- Department of Health Sciences, University of Leicester, Leicester General Hospital, Leicester, UK
| | - Lucy Doos
- Department of Public Health, Epidemiology and Biostatistics, University of Birmingham, Edgbaston, Birmingham, UK
| | - Althea Tempier
- Department of Psychology, Institute of Psychiatry, King's College London, London, UK
| | - Stewart Einfeld
- Centre for Disability Research and Policy, Brain & Mind Research Institute, The University Of Sydney, Camperdown, NSW, Australia
| | - Patricia Howlin
- Department of Psychology, Institute of Psychiatry, King's College London, London, UK.,Centre for Disability Research and Policy, Brain & Mind Research Institute, The University Of Sydney, Camperdown, NSW, Australia
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Mizuno A, Cherepanov SM, Kikuchi Y, Fakhrul AAKM, Akther S, Deguchi K, Yoshihara T, Ishihara K, Shuto S, Higashida H. Lipo-oxytocin-1, a Novel Oxytocin Analog Conjugated with Two Palmitoyl Groups, Has Long-Lasting Effects on Anxiety-Related Behavior and Social Avoidance in CD157 Knockout Mice. Brain Sci 2015; 5:3-13. [PMID: 25612002 PMCID: PMC4390788 DOI: 10.3390/brainsci5010003] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 11/03/2014] [Accepted: 01/12/2015] [Indexed: 12/23/2022] Open
Abstract
Oxytocin (OT) is a nonapeptide hormone that is secreted into the brain and blood circulation. OT has not only classical neurohormonal roles in uterine contraction and milk ejection during the reproductive phase in females, but has also been shown to have new pivotal neuromodulatory roles in social recognition and interaction in both genders. A single administration of OT through nasal spray increases mutual recognition and trust in healthy subjects and psychiatric patients, suggesting that OT is a potential therapeutic drug for autism spectrum disorders, schizophrenia, and some other psychiatric disorders. Although the mechanism is not well understood, it is likely that OT can be transported into the brain where it activates OT receptors to exert its function in the brain. However, the amount transported into the brain may be low. To ensure equivalent effects, an OT analog with long-lasting and effective blood-brain barrier penetration properties would be beneficial for use as a therapeutic drug. Here, we designed and synthesized a new oxytocin analog, lipo-oxytocin-1 (LOT-1), in which two palmitoyl groups are conjugated at the amino group of the cysteine9 residue and the phenolic hydroxyl group of the tyrosine8 residue of the OT molecule. To determine whether LOT-1 actually has an effect on the central nervous system, we examined its effects in a CD157 knockout model mouse of the non-motor psychiatric symptoms of Parkinson’s disease. Similar to OT, this analog rescued anxiety-like behavior and social avoidance in the open field test with the social target in a central arena 30 min after intraperitoneal injection in CD157 knockout mice. When examined 24 h after injection, the mice treated with LOT-1 displayed more recovery than those given OT. The results suggest that LOT-1 has a functional advantage in recovery of social behavioral impairment, such as those caused by neurodegenerative diseases, autism spectrum disorders, and schizophrenia.
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Affiliation(s)
- Akira Mizuno
- Faculty of Pharmaceutical Sciences, Hokkaido University, Kita-12, Nishi-6, Kita-ku, Sapporo 060-0812, Japan; E-Mails: (A.M.); (Y.K.)
| | - Stanislav M. Cherepanov
- Department of Basic Research on Social Recognition, Research Center for Child Mental Development, Kanazawa University, Kanazawa 920-8640, Japan; E-Mails: (S.M.C.); (A.A.F.); (S.A.); (T.Y.)
| | - Yusuke Kikuchi
- Faculty of Pharmaceutical Sciences, Hokkaido University, Kita-12, Nishi-6, Kita-ku, Sapporo 060-0812, Japan; E-Mails: (A.M.); (Y.K.)
| | - Azam AKM Fakhrul
- Department of Basic Research on Social Recognition, Research Center for Child Mental Development, Kanazawa University, Kanazawa 920-8640, Japan; E-Mails: (S.M.C.); (A.A.F.); (S.A.); (T.Y.)
| | - Shirin Akther
- Department of Basic Research on Social Recognition, Research Center for Child Mental Development, Kanazawa University, Kanazawa 920-8640, Japan; E-Mails: (S.M.C.); (A.A.F.); (S.A.); (T.Y.)
| | - Kisaburo Deguchi
- Medical Research Institute, Kanazawa Medical University and Medical Care Proteomics Biotechnology Co., Uchinada, Ishikawa 920-0293, Japan; E-Mail:
| | - Toru Yoshihara
- Department of Basic Research on Social Recognition, Research Center for Child Mental Development, Kanazawa University, Kanazawa 920-8640, Japan; E-Mails: (S.M.C.); (A.A.F.); (S.A.); (T.Y.)
| | - Katsuhiko Ishihara
- Department of Immunology and Molecular Genetics, Kawasaki Medical School, Kurashiki, Okayama 701-0192, Japan; E-Mail:
| | - Satoshi Shuto
- Faculty of Pharmaceutical Sciences, Hokkaido University, Kita-12, Nishi-6, Kita-ku, Sapporo 060-0812, Japan; E-Mails: (A.M.); (Y.K.)
- Center for Research and Education on Drug Discovery, Hokkaido University, Kita-12, Nishi-6, Kita-ku, Sapporo 060-0812, Japan
- Authors to whom correspondence should be addressed; E-Mails: (S.S.); (H.H.); Tel./Fax: +81-11-706-3769 (S.S.); +81-76-234-4213 (H.H.)
| | - Haruhiro Higashida
- Department of Basic Research on Social Recognition, Research Center for Child Mental Development, Kanazawa University, Kanazawa 920-8640, Japan; E-Mails: (S.M.C.); (A.A.F.); (S.A.); (T.Y.)
- Authors to whom correspondence should be addressed; E-Mails: (S.S.); (H.H.); Tel./Fax: +81-11-706-3769 (S.S.); +81-76-234-4213 (H.H.)
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Bishop-Fitzpatrick L, Mazefsky CA, Minshew NJ, Eack SM. The relationship between stress and social functioning in adults with autism spectrum disorder and without intellectual disability. Autism Res 2014; 8:164-73. [PMID: 25524571 DOI: 10.1002/aur.1433] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 09/29/2014] [Indexed: 12/20/2022]
Abstract
Adults with autism spectrum disorder (ASD) face substantial challenges accomplishing basic tasks associated with daily living, which are exacerbated by their broad and pervasive difficulties with social interactions. These challenges put people with ASD at increased risk for psychophysiological distress, which likely factors heavily into social functioning for adults with ASD, as suggested by a growing literature on stress in children that indicates that children with ASD have differential responses to stress than healthy children. We hypothesized that adults with ASD and without intellectual disability (n = 38) would experience more stress than healthy volunteers (n = 37) and that there would be an inverse relationship between stress and social functioning in individuals with ASD. Baseline, semi-structured interview data from a randomized controlled trial of two treatments for adults with ASD were used to assess differences in stress between adults with ASD and healthy volunteers and to assess the relationship between stress response and social functioning in adults with ASD. Findings indicate that adults with ASD experience greater perceived and interviewer-observed stress than healthy volunteers and that stress is significantly related to social functioning in adults with ASD. These findings highlight the role of stress in adult functioning and outcomes and suggest the need to develop and assess treatments designed to target stress and coping in adults with ASD.
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78
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Eack SM, Greenwald DP, Hogarty SS, Bahorik AL, Litschge MY, Mazefsky CA, Minshew NJ. Cognitive enhancement therapy for adults with autism spectrum disorder: results of an 18-month feasibility study. J Autism Dev Disord 2014; 43:2866-77. [PMID: 23619953 DOI: 10.1007/s10803-013-1834-7] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Adults with autism experience significant impairments in social and non-social information processing for which few treatments have been developed. This study conducted an 18-month uncontrolled trial of Cognitive Enhancement Therapy (CET), a comprehensive cognitive rehabilitation intervention, in 14 verbal adults with autism spectrum disorder to investigate its feasibility, acceptability, and initial efficacy in treating these impairments. Results indicated that CET was satisfying to participants, with high treatment attendance and retention. Effects on cognitive deficits and social behavior were also large (d = 1.40-2.29) and statistically significant (all p < .001). These findings suggest that CET is a feasible, acceptable, and potentially effective intervention for remediating the social and non-social cognitive impairments in verbal adults with autism.
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Affiliation(s)
- Shaun M Eack
- School of Social Work, University of Pittsburgh, 2117 Cathedral of Learning, Pittsburgh, PA, 15260, USA,
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Brief report: suitability of the Social Skills Performance Assessment (SSPA) for the assessment of social skills in adults with autism spectrum disorders. J Autism Dev Disord 2014; 43:2990-6. [PMID: 23624879 DOI: 10.1007/s10803-013-1843-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The present study aims at examining whether the 'Social Skills Performance Assessment' (SSPA; Patterson et al. in Schizophr Res 48(2-3):351-360, 2001) is a suitable performance-based measure to assess social skills in adults with autism spectrum disorders (ASD). For this purpose, social skills of individuals with ASD and non-ASD participants were assessed through the SSPA role plays. Results of this study suggest that the SSPA is suitable for the assessment of social skills in adults with ASD. The SSPA discriminates between individuals with ASD and non-ASD individuals, with the ASD group scoring significantly lower. Although no evidence was found for convergent validity of the SSPA in participants with ASD, divergent validity of the SSPA and interrater reliability among adults with ASD were good.
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80
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Koelkebeck K, Riedel A, Ohrmann P, Biscaldi M, Tebartz van Elst L. [High-functioning autism spectrum disorders in adulthood]. DER NERVENARZT 2014; 85:891-902. [PMID: 24969950 DOI: 10.1007/s00115-014-4050-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The prevalence of autism spectrum disorders in the general population is approximately 1 %. Some individuals with high-functioning autism graduate from regular schools without autism having been diagnosed and problems only occur when the demands for social competence increase. Then patients often present with secondary psychiatric symptoms, such as depression, anxiety or interpersonal problems. At this time, typical autistic features, such as social interaction deficits, restricted interests and stereotypic behavior can be camouflaged by high compensatory skills, particularly in highly intelligent patients. Therefore, missed or wrong diagnoses are frequent. Interviews, questionnaires and neuropsychological tests might be used to support the diagnosis. In cases where there is evidence for a secondary cause of autistic symptoms, somatic disorders should be excluded. Pharmacological treatment should be symptom-oriented. Individualized psychotherapeutic approaches are becoming increasingly more available; however, pragmatic solutions often need to be deployed.
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Affiliation(s)
- K Koelkebeck
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude A9, 48149, Münster, Deutschland,
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81
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Keshavan MS, Vinogradov S, Rumsey J, Sherrill J, Wagner A. Cognitive training in mental disorders: update and future directions. Am J Psychiatry 2014; 171:510-22. [PMID: 24700194 PMCID: PMC4114156 DOI: 10.1176/appi.ajp.2013.13081075] [Citation(s) in RCA: 181] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE This article reviews the conceptual basis, definitions, and evolution of cognitive training approaches for the treatment of mental disorders. METHOD The authors review the current state of the knowledge on cognitive training in psychiatric illnesses, and its neural and behavioral targets, and summarize the factors that appear to relate to a successful response, including learner characteristics that influence clinical outcome. They also discuss methodological issues relevant to the development and testing of cognitive training approaches, with the goal of creating maximally efficient and effective approaches to training. Finally, they identify gaps in existing knowledge and outline key research directions for the future. RESULTS While much of the early research has been conducted in schizophrenia, cognitive training has more recently been applied to a widening range of neuropsychiatric illnesses, including attention deficit hyperactivity disorder, mood disorders, and substance use disorders. Cognitive training harnesses the inherent neuroplastic capacities of the brain, targeting neural system function across psychiatric disorders, thus improving the cognitive processes that play a role in emotion regulation, clinical symptoms, and adaptive community functioning. CONCLUSIONS Cognitive training offers considerable promise, especially given the limited efficacy of pharmacological interventions in ameliorating cognitive deficits. However, more research is needed to understand the mechanisms underlying cognitive training, predictors of response, generalization and real-world applicability, and approaches to dissemination in practice settings.
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Smith CM, Walker AW, Hosken IT, Chua BE, Zhang C, Haidar M, Gundlach AL. Relaxin-3/RXFP3 networks: an emerging target for the treatment of depression and other neuropsychiatric diseases? Front Pharmacol 2014; 5:46. [PMID: 24711793 PMCID: PMC3968750 DOI: 10.3389/fphar.2014.00046] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 02/28/2014] [Indexed: 12/17/2022] Open
Abstract
Animal and clinical studies of gene-environment interactions have helped elucidate the mechanisms involved in the pathophysiology of several mental illnesses including anxiety, depression, and schizophrenia; and have led to the discovery of improved treatments. The study of neuropeptides and their receptors is a parallel frontier of neuropsychopharmacology research and has revealed the involvement of several peptide systems in mental illnesses and identified novel targets for their treatment. Relaxin-3 is a newly discovered neuropeptide that binds, and activates the G-protein coupled receptor, RXFP3. Existing anatomical and functional evidence suggests relaxin-3 is an arousal transmitter which is highly responsive to environmental stimuli, particularly neurogenic stressors, and in turn modulates behavioral responses to these stressors and alters key neural processes, including hippocampal theta rhythm and associated learning and memory. Here, we review published experimental data on relaxin-3/RXFP3 systems in rodents, and attempt to highlight aspects that are relevant and/or potentially translatable to the etiology and treatment of major depression and anxiety. Evidence pertinent to autism spectrum and metabolism/eating disorders, or related psychiatric conditions, is also discussed. We also nominate some key experimental studies required to better establish the therapeutic potential of this intriguing neuromodulatory signaling system, including an examination of the impact of RXFP3 agonists and antagonists on the overall activity of distinct or common neural substrates and circuitry that are identified as dysfunctional in these debilitating brain diseases.
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Affiliation(s)
- Craig M Smith
- Peptide Neurobiology Laboratory, Neuropeptides Division, The Florey Institute of Neuroscience and Mental Health, The University of Melbourne VIC, Australia ; Florey Department of Neuroscience and Mental Health, The University of Melbourne VIC, Australia
| | - Andrew W Walker
- Peptide Neurobiology Laboratory, Neuropeptides Division, The Florey Institute of Neuroscience and Mental Health, The University of Melbourne VIC, Australia ; Florey Department of Neuroscience and Mental Health, The University of Melbourne VIC, Australia
| | - Ihaia T Hosken
- Peptide Neurobiology Laboratory, Neuropeptides Division, The Florey Institute of Neuroscience and Mental Health, The University of Melbourne VIC, Australia ; Florey Department of Neuroscience and Mental Health, The University of Melbourne VIC, Australia
| | - Berenice E Chua
- Peptide Neurobiology Laboratory, Neuropeptides Division, The Florey Institute of Neuroscience and Mental Health, The University of Melbourne VIC, Australia
| | - Cary Zhang
- Peptide Neurobiology Laboratory, Neuropeptides Division, The Florey Institute of Neuroscience and Mental Health, The University of Melbourne VIC, Australia ; Florey Department of Neuroscience and Mental Health, The University of Melbourne VIC, Australia
| | - Mouna Haidar
- Peptide Neurobiology Laboratory, Neuropeptides Division, The Florey Institute of Neuroscience and Mental Health, The University of Melbourne VIC, Australia ; Florey Department of Neuroscience and Mental Health, The University of Melbourne VIC, Australia
| | - Andrew L Gundlach
- Peptide Neurobiology Laboratory, Neuropeptides Division, The Florey Institute of Neuroscience and Mental Health, The University of Melbourne VIC, Australia ; Florey Department of Neuroscience and Mental Health, The University of Melbourne VIC, Australia ; Department of Anatomy and Neuroscience, The University of Melbourne VIC, Australia
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83
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Ousley O, Cermak T. Autism Spectrum Disorder: Defining Dimensions and Subgroups. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2014; 1:20-28. [PMID: 25072016 PMCID: PMC4111262 DOI: 10.1007/s40474-013-0003-1] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Autism spectrum disorder (ASD) is a behaviorally defined neurodevelopmental disorder associated with the presence of social-communication deficits and restricted and repetitive behaviors. In the latest conceptualization of ASD, these two behavioral dimensions represent the core defining features of ASD, whereas associated dimensions, such as intellectual and language ability, provide a means for describing the ASD heterogeneity. In addition, the characterization of ASD subgroups, defined by the presence of known medical, genetic, or other psychiatric disorders, furthers our understanding of ASD heterogeneity. This paper reviews the history of autism, describes its core defining features, and provides an overview of the clinically and etiologically relevant subgroups that add to the complexity of this condition.
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Affiliation(s)
- Opal Ousley
- Emory Autism Center, Department of Psychiatry and Behavioral
Sciences, Emory University School of Medicine, 1551 Shoup Court, Atlanta, GA
30322, USA
| | - Tracy Cermak
- Marcus Autism Center, Children’s Healthcare of Atlanta,
1920 Briarcliff Road, Atlanta, GA 30329, USA
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84
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Cognitive, language, social and behavioural outcomes in adults with autism spectrum disorders: A systematic review of longitudinal follow-up studies in adulthood. Clin Psychol Rev 2014; 34:73-86. [DOI: 10.1016/j.cpr.2013.11.002] [Citation(s) in RCA: 359] [Impact Index Per Article: 35.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Revised: 10/03/2013] [Accepted: 11/18/2013] [Indexed: 11/21/2022]
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Baribeau DA, Anagnostou E. Social Communication is an Emerging Target for Pharmacotherapy in Autism Spectrum Disorder - A Review of the Literature on Potential Agents. JOURNAL OF THE CANADIAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY = JOURNAL DE L'ACADEMIE CANADIENNE DE PSYCHIATRIE DE L'ENFANT ET DE L'ADOLESCENT 2014; 23:20-30. [PMID: 24516474 PMCID: PMC3917666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 10/21/2013] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To review the published literature and registered clinical trials on pharmacologic interventions targeting social communication impairment in Autism Spectrum Disorder (ASD). METHODS A comprehensive search of several databases (PubMed, MEDLINE, PsycINFO, Clinical trials.gov) was conducted to identify pharmacologic agents that have been, or will be, tested as treatments for social communication impairment in individuals with ASD. Evidence from basic science research supporting rational drug discovery is surveyed. RESULTS Data from animal models and early clinical trials suggest that novel and existing compounds, including N-methyl-D-aspartate (NMDA) modulators, γ-aminobutyric acid (GABA) agonists, metabotropic glutamate receptor (mGluR) antagonists and neuropeptides, may enhance social communication/function in ASD. Results from numerous Phase 2 and Phase 3 clinical trials are expected in the near future. CONCLUSIONS Recent evidence suggests that social communication may be an appropriate target for pharmacologic manipulation. It is hoped that, in combination with behavioural interventions, novel therapeutics may soon be clinically available to help improve social outcomes.
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Affiliation(s)
| | - Evdokia Anagnostou
- University of Toronto, Department of Pediatrics, Bloorview Research Institute, Toronto, Ontario
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86
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Damiano CR, Mazefsky CA, White SW, Dichter GS. Future directions for research in autism spectrum disorders. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2014; 43:828-43. [PMID: 25216048 PMCID: PMC4163956 DOI: 10.1080/15374416.2014.945214] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
This article suggests future directions for research aimed at improving our understanding of the etiology and pathophysiology of autism spectrum disorder (ASD) as well as pharmacologic and psychosocial interventions for ASD across the lifespan. The past few years have witnessed unprecedented transformations in the understanding of ASD neurobiology, genetics, early identification, and early intervention. However, recent increases in ASD prevalence estimates highlight the urgent need for continued efforts to translate novel ASD discoveries into effective interventions for all individuals with ASD. In this article we highlight promising areas for ongoing and new research expected to quicken the pace of scientific discovery and ultimately the translation of research findings into accessible and empirically supported interventions for those with ASD. We highlight emerging research in the following domains as particularly promising and pressing: (a) preclinical models, (b) experimental therapeutics, (c) early identification and intervention, (d) psychiatric comorbidities and the Research Domain Criteria initiative, (e) ecological momentary assessment, (f) neurotechnologies, and (g) the needs of adults with ASD. Increased research emphasis in these areas has the potential to hasten the translation of knowledge on the etiological mechanisms of ASD to psychosocial and biological interventions to reduce the burden of ASD on affected individuals and their families.
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Affiliation(s)
- Cara R. Damiano
- Department of Psychology, University of North Carolina, Chapel Hill, NC
- Carolina Institute for Developmental Disabilities, University of North Carolina, Chapel Hill, NC
| | - Carla A. Mazefsky
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Susan W. White
- Department of Psychology, Virginia Polytechnic Institute and State University, Blacksburg, VA
| | - Gabriel S. Dichter
- Department of Psychology, University of North Carolina, Chapel Hill, NC
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC
- Carolina Institute for Developmental Disabilities, University of North Carolina, Chapel Hill, NC
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87
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Howlin P. Social disadvantage and exclusion: adults with autism lag far behind in employment prospects. J Am Acad Child Adolesc Psychiatry 2013; 52:897-9. [PMID: 23972691 DOI: 10.1016/j.jaac.2013.06.010] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Accepted: 06/28/2013] [Indexed: 11/24/2022]
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89
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Howlin P, Moss P, Savage S, Rutter M. Social outcomes in mid- to later adulthood among individuals diagnosed with autism and average nonverbal IQ as children. J Am Acad Child Adolesc Psychiatry 2013; 52:572-81.e1. [PMID: 23702446 DOI: 10.1016/j.jaac.2013.02.017] [Citation(s) in RCA: 248] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Revised: 02/05/2013] [Accepted: 03/15/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To describe current social functioning in a clinical sample of 60 adults with autism (mean age = 44 years) who were all of average nonverbal IQ (70+) when first diagnosed (mean age = 6.75 years). METHOD Outcome measures included standardized diagnostic and cognitive assessments and questionnaires on social functioning. Child and adult variables related to current outcomes were explored. RESULTS All individuals continued to meet criteria for autism spectrum disorder (ASD) on the Autism Diagnostic Interview-Revised (ADI-R), but severity of autism symptoms declined over time. Nevertheless, only 10 individuals (17%) were rated as having a "good" or "very good" outcome; the majority (60%) were assessed as having "poor" or "very poor" outcomes. The strongest predictor of adult outcome was the Reciprocal Social Interaction domain score on the ADI at diagnostic confirmation. Change over time was further examined in a subgroup (n = 44) previously assessed 20 years ago earlier (mean age = 26 years). Although severity of autism had continued to decrease during the adult period, social outcomes were poorer than in younger adulthood. CONCLUSIONS In this cohort of adults first diagnosed with autism, on average, 37 years previously, social inclusion remains very limited, despite general improvements in autism symptomatology with age. Whether these findings will be replicated in future generations of children with autism, who now have the benefits of earlier diagnosis and wider access to specialist provision, needs to be the focus of further longitudinal research.
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