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Relationship of the Acoustic Startle Response and Its Modulation to Emotional and Behavioral Problems in Typical Development Children and Those with Autism Spectrum Disorders. J Autism Dev Disord 2016; 46:534-43. [PMID: 26362152 DOI: 10.1007/s10803-015-2593-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Auditory hyper-reactivity is a common sensory-perceptual abnormality in autism spectrum disorders (ASD), which interrupts behavioral adaptation. We investigated acoustic startle response (ASR) modulations in 17 children with ASD and 27 with typical development (TD). Compared to TD, children with ASD had larger ASR magnitude to weak stimuli and more prolonged peak startle-latency. We could not find significant difference of prepulse inhibition (PPI) or habituation in ASD children compared to TD. However, habituation and PPI at 70-dB prepulses were negatively related to several subscales of Social Responsiveness Scale and the Strengths and Difficulties Questionnaire, when considering all children. Comprehensive investigation of ASR and its modulation might increase understanding of the neurophysiological impairments underlying ASD and other mental health problems in children.
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302
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Arnevik EA, Helverschou SB. Autism Spectrum Disorder and Co-occurring Substance Use Disorder - A Systematic Review. SUBSTANCE ABUSE-RESEARCH AND TREATMENT 2016; 10:69-75. [PMID: 27559296 PMCID: PMC4990150 DOI: 10.4137/sart.s39921] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 06/16/2016] [Accepted: 06/22/2016] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Patients with co-occurring autism spectrum disorders (ASD) and substance use disorder (SUD) require special attention from clinical services. Screening for this co-occurrence is not generally an integral part of routine clinical assessments, and failure to identify and understand this group of patients may contribute to a worsening of their symptoms and/or an increase in drug abuse. Thus, there is a need to review the evidence base on patients with co-occurring ASD and SUD in order to enhance clinical practice and future research. METHODS We reviewed all identified papers on patients with co-occurring ASD and SUD. The focus of the review was on epidemiology, patient characteristics, function of drug use, and the effect of current interventions. RESULTS A total of 18 papers were included in the analysis. Eleven papers were based on epidemiological studies, although only one study reported the prevalence of ASD in an SUD population. Two papers explored the role of personality, three papers studied subgroups of individuals serving prison for violent or sexual crimes, and one paper explored the function of drugs in the ASD patient group. There were no studies testing specific treatment interventions. CONCLUSIONS In most of the treatment settings studied, there were relatively few patients with co-occurring ASD and SUD, but due to differences in study samples it was difficult to establish a general prevalence rate. The one consistent finding was the lack of focused treatment studies. There is clearly a need for research on interventions that take account of the special needs of this patient group.
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Affiliation(s)
- Espen Ajo Arnevik
- National Advisory Unit on SUD Treatment, Oslo University Hospital, Oslo, Norway.; Institute of Psychology, University of Oslo, Oslo, Norway
| | - Sissel Berge Helverschou
- NevSom - Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnias, Oslo University Hospital, Oslo, Norway
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Lehnhardt FG, Falter CM, Gawronski A, Pfeiffer K, Tepest R, Franklin J, Vogeley K. Sex-Related Cognitive Profile in Autism Spectrum Disorders Diagnosed Late in Life: Implications for the Female Autistic Phenotype. J Autism Dev Disord 2016; 46:139-154. [PMID: 26319250 DOI: 10.1007/s10803-015-2558-7] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Females with high-functioning ASD are known to camouflage their autistic symptoms better than their male counterparts, making them prone to being under-ascertained and delayed in diagnostic assessment. Thus far the underlying cognitive processes that enable such successful socio-communicative adaptation are not well understood. The current results show sex-related differences in the cognitive profile of ASD individuals, which were diagnosed late in life exclusively. Higher verbal abilities were found in males (n = 69) as opposed to higher processing speed and better executive functions in females with ASD (n = 38). Since both sexes remained unidentified during childhood and adolescence, these results are suggestive for sex-distinctive cognitive strategies as an alternative to typically-developed reciprocal social behavior and social mimicry in high functioning ASD.
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Affiliation(s)
- Fritz-Georg Lehnhardt
- Department of Psychiatry and Psychotherapy, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
| | - Christine Michaela Falter
- Department of Psychiatry and Psychotherapy, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Astrid Gawronski
- Department of Psychiatry and Psychotherapy, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Kathleen Pfeiffer
- Department of Psychiatry and Psychotherapy, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Ralf Tepest
- Department of Psychiatry and Psychotherapy, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Jeremy Franklin
- Institute of Medical Statistics, Computer Science and Epidemiology (IMSIE), University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Kai Vogeley
- Department of Psychiatry and Psychotherapy, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.,Institute of Neuroscience and Medicine - Cognitive Neurosciences (INM-3), Research Center Juelich, 52425, Juelich, Germany
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304
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Kerns CM, Roux AM, Connell JE, Shattuck PT. Adapting Cognitive Behavioral Techniques to Address Anxiety and Depression in Cognitively Able Emerging Adults on the Autism Spectrum. COGNITIVE AND BEHAVIORAL PRACTICE 2016. [DOI: 10.1016/j.cbpra.2016.06.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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305
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Taylor JL, Gotham KO. Cumulative life events, traumatic experiences, and psychiatric symptomatology in transition-aged youth with autism spectrum disorder. J Neurodev Disord 2016; 8:28. [PMID: 27468315 PMCID: PMC4962443 DOI: 10.1186/s11689-016-9160-y] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 07/17/2016] [Indexed: 11/30/2022] Open
Abstract
Background Co-occurring mood and anxiety symptomatology is commonly observed among youth with autism spectrum disorders (ASD) during adolescence and adulthood. Yet, little is known about the factors that might predispose youth with ASD to mood and anxiety problems. In this study, we focus on the role of cumulative stressful life events and trauma in co-occurring psychopathology among youth with ASD who are preparing to exit high school. Specifically, we examined the distribution of cumulative life events and traumatic experiences and their relations with mood and anxiety symptomatology. Methods Participants included 36 youth with ASD, all of whom were in their last year of high school. Cumulative life events and trauma were assessed by parent report. Mood and anxiety symptomatology was determined using a variety of methods (structured interview, questionnaire, self- and informant report). Frequencies were used to examine the distributions of cumulative life events (count of total events) and trauma (coded into any trauma vs. no trauma), as well as mood and anxiety symptomatology (categorized into clinical-level, sub-threshold, or none for each). Bivariate relations between life events/trauma and mood/anxiety symptomatology were assessed using analysis of variance and chi-square. Ordinal logistic regression models were used to test whether significant bivariate relations remained after controlling for the sex of the youth with ASD and his/her IQ. Results Over 50 % of youth had experienced at least one trauma. Nearly one half had clinical-level mood or anxiety symptomatology. There was a statistically significant relation between absence/presence of trauma and mood symptomatology; nearly 90 % of the youth with clinical-level mood symptoms had at least one trauma, compared to 40 % of those with no mood symptomatology. Conclusions Our findings suggest that contextual factors such as trauma might be important for the development of mood symptomatology in individuals with ASD. Although this idea is well-accepted in typically developing populations, contextual factors are rarely studied in investigations of psychopathology or transition outcomes in ASD. Given the high rates of psychiatric comorbidities in this population, future research should continue to identify the range of possible factors—both behavioral and contextual—that might influence the emergence of these disorders. Electronic supplementary material The online version of this article (doi:10.1186/s11689-016-9160-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Julie Lounds Taylor
- Department of Pediatrics and Vanderbilt Kennedy Center, Vanderbilt University School of Medicine, PMB 40 - 230 Appleton Pl., Nashville, TN 37203 USA
| | - Katherine O Gotham
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University School of Medicine, Vanderbilt Kennedy Center, 1200 21st Ave. S, suite 2272, Nashville, TN 37203 USA
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306
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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: 117] [Impact Index Per Article: 14.6] [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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307
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May T, Cornish K, Rinehart NJ. Gender Profiles of Behavioral Attention in Children With Autism Spectrum Disorder. J Atten Disord 2016; 20:627-35. [PMID: 22912506 DOI: 10.1177/1087054712455502] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The attention profile of girls with autism spectrum disorder (ASD) is unclear compared with boys with ASD and typical children. This study aimed to investigate parent-reported ASD and ADHD symptoms in a large sample of boys and girls with and without ASD. METHOD A total of 124 normally intelligent children, half of them girls, 64 with autistic disorder or Asperger's disorder, and 60 age- and gender-matched typically developing, aged 7 to 12 years, were recruited. Parents completed questionnaires regarding autistic and ADHD symptoms. RESULTS No gender differences in social difficulties but more repetitive motor movements, communication difficulties, and inattention were reported in males, regardless of group. Younger boys with ASD had more elevated levels of hyperactivity-impulsivity than younger girls with ASD. CONCLUSION Gender differences in autistic symptoms and inattention in ASD reflected gender differences in typical children. More pronounced hyperactivity in younger boys with ASD could contribute to higher rates of clinical referral than girls.
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Affiliation(s)
- Tamara May
- School of Psychology & Psychiatry, Monash University, Victoria, Australia Centre for Developmental Psychiatry & Psychology, Monash University, Victoria, Australia
| | - Kim Cornish
- School of Psychology & Psychiatry, Monash University, Victoria, Australia
| | - Nicole J Rinehart
- School of Psychology & Psychiatry, Monash University, Victoria, Australia Centre for Developmental Psychiatry & Psychology, Monash University, Victoria, Australia
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308
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Resting-State Functional Connectivity Changes Between Dentate Nucleus and Cortical Social Brain Regions in Autism Spectrum Disorders. CEREBELLUM (LONDON, ENGLAND) 2016. [PMID: 27250977 DOI: 10.1007/s12311‐016‐0795‐8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Autism spectrum disorders (ASDs) are known to be characterized by restricted and repetitive behaviors and interests and by impairments in social communication and interactions mainly including "theory of mind" (ToM) processes. The cerebellum has emerged as one of the brain regions affected by ASDs. As the cerebellum is known to influence cerebral cortex activity via cerebello-thalamo-cortical (CTC) circuits, it has been proposed that cerebello-cortical "disconnection" could in part underlie autistic symptoms. We used resting-state (RS) functional magnetic resonance imaging (fMRI) to investigate the potential RS connectivity changes between the cerebellar dentate nucleus (DN) and the CTC circuit targets, that may contribute to ASD pathophysiology. When comparing ASD patients to controls, we found decreased connectivity between the left DN and cerebral regions known to be components of the ToM network and the default mode network, implicated in specific aspects of mentalizing, social cognition processing, and higher order emotional processes. Further, a pattern of overconnectivity was also detected between the left DN and the supramodal cerebellar lobules associated with the default mode network. The presented RS-fMRI data provide evidence that functional connectivity (FC) between the dentate nucleus and the cerebral cortex is altered in ASD patients. This suggests that the dysfunction reported within the cerebral cortical network, typically related to social features of ASDs, may be at least partially related to an impaired interaction between cerebellum and key cortical social brain regions.
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309
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Olivito G, Clausi S, Laghi F, Tedesco AM, Baiocco R, Mastropasqua C, Molinari M, Cercignani M, Bozzali M, Leggio M. Resting-State Functional Connectivity Changes Between Dentate Nucleus and Cortical Social Brain Regions in Autism Spectrum Disorders. THE CEREBELLUM 2016; 16:283-292. [DOI: 10.1007/s12311-016-0795-8] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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310
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Strunz S, Schermuck C, Ballerstein S, Ahlers CJ, Dziobek I, Roepke S. Romantic Relationships and Relationship Satisfaction Among Adults With Asperger Syndrome and High-Functioning Autism. J Clin Psychol 2016; 73:113-125. [PMID: 27196958 DOI: 10.1002/jclp.22319] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 01/05/2016] [Accepted: 03/23/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Individuals with autism spectrum disorder (ASD) often experience difficulties in maintaining romantic relationships. In this study high-functioning adults with ASD were examined concerning their romantic relationship interest and experience. METHOD Participants, 31 recruited via an outpatient clinic and 198 via an online survey, were asked to answer a number of self-report questionnaires. The total sample comprised 229 high-functioning adults with ASD (40% males, average age: 35 years). RESULTS Of the total sample, 73% indicated romantic relationship experience and only 7% had no desire to be in a romantic relationship. ASD individuals whose partner was also on the autism spectrum were significantly more satisfied with their relationship than those with neurotypical partners. Severity of autism, schizoid symptoms, empathy skills, and need for social support were not correlated with relationship status. CONCLUSION Our findings indicate that the vast majority of high-functioning adults with ASD are interested in romantic relationships.
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Affiliation(s)
| | | | | | | | - Isabel Dziobek
- Charité-Universitätsmedizin Berlin.,Freie Universität Berlin
| | - Stefan Roepke
- Charité-Universitätsmedizin Berlin.,Freie Universität Berlin
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311
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Domes G, Spenthof I, Radtke M, Isaksson A, Normann C, Heinrichs M. Autistic traits and empathy in chronic vs. episodic depression. J Affect Disord 2016; 195:144-7. [PMID: 26895092 DOI: 10.1016/j.jad.2016.02.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 01/12/2016] [Accepted: 02/03/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Difficulties in social interaction are characteristic for depressive disorders and one of the cardinal symptoms of Autism Spectrum Disorders (ASD). It has been proposed that chronically depressed persons have profoundly impaired empathic abilities in comparison to episodically depressed persons, and that specifically they exhibit a deficit in cognitive empathy, but not in affective empathy, a pattern also reported in ASD. This study aimed to explore autistic traits and empathy deficits in chronic depression, and identify specific differences to episodic depression. METHOD Autistic traits and multimodal empathy were assessed in chronically depressed patients (n=59), episodically depressed patients (n=40), and a healthy control group (n=55) using standardized questionnaires. RESULTS Regardless of the disorder's chronicity, depressed patients exhibited higher levels of autistic traits and lower levels of perspective-taking than healthy controls. Chronically depressed patients reported significantly higher impairment in social skills and higher levels of personal distress in social interactions than episodic patients. DISCUSSION Our results suggest that patients with chronic depression share two distinct characteristics, namely lower levels of social skills and higher levels of distress in tense social situations than patients with episodic depression. Future studies will need to determine whether the elevated autistic traits in chronic depression are specific to chronic depression, or represent the general tendency to withdraw from social situations. We conclude that chronically depressed patients are not specifically impaired in understanding another person's state of mind, but are unable to deal with another person's suffering or negative affective state.
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Affiliation(s)
- Gregor Domes
- Department of Psychology, Laboratory for Biological and Personality Psychology, University of Freiburg, Germany.
| | - Ines Spenthof
- Department of Psychology, Laboratory for Biological and Personality Psychology, University of Freiburg, Germany
| | - Martina Radtke
- Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Germany
| | - Alexandra Isaksson
- Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Germany
| | - Claus Normann
- Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Germany
| | - Markus Heinrichs
- Department of Psychology, Laboratory for Biological and Personality Psychology, University of Freiburg, Germany
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312
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Chandrasekhar T, Sikich L. Challenges in the diagnosis and treatment of depression in autism spectrum disorders across the lifespan. DIALOGUES IN CLINICAL NEUROSCIENCE 2016. [PMID: 26246795 PMCID: PMC4518704 DOI: 10.31887/dcns.2015.17.2/tchandrasekhar] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Diagnosis and treatment of comorbid neuropsychiatric illness is often a secondary focus of treatment in individuals with autism spectrum disorder (ASD), given that substantial impairment may be caused by core symptoms of ASD itself. However, psychiatric comorbidities, including depressive disorders, are common and frequently result in additional functional impairment, treatment costs, and burden on caregivers. Clinicians may struggle to appropriately diagnose depression in ASD due to communication deficits, atypical presentation of depression in ASD, and lack of standardized diagnostic tools. Specific risk and resilience factors for depression in ASD across the lifespan, including level of functioning, age, family history, and coping style, have been suggested, but require further study. Treatment with medications or psychotherapy may be beneficial, though more research is required to establish guidelines for management of symptoms. This review will describe typical presentations of depression in individuals with ASD, review current information on the prevalence, assessment, and treatment of comorbid depression in individuals with ASD, and identify important research gaps.
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Affiliation(s)
- Tara Chandrasekhar
- Assistant Professor of Psychiatry, University of North Carolina at Chapel Hill School of Medi-cine; University of North Carolina Hospitals, Chapel Hill, North Carolina, USA
| | - Linmarie Sikich
- Associate Professor of Psychiatry, Director, ASPIRE Research Program, University of North Carolina at Chapel Hill School of Medi-cine; University of North Carolina Hospitals, Chapel Hill, North Carolina, USA
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313
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Abu-Akel AM, Wood SJ, Hansen PC, Apperly IA. Perspective-taking abilities in the balance between autism tendencies and psychosis proneness. Proc Biol Sci 2016; 282:20150563. [PMID: 25972469 DOI: 10.1098/rspb.2015.0563] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Difficulties with the ability to appreciate the perspective of others (mentalizing) is central to both autism and schizophrenia spectrum disorders. While the disorders are diagnostically independent, they can co-occur in the same individual. The effect of such co-morbidity is hypothesized to worsen mentalizing abilities. The recent influential 'diametric brain theory', however, suggests that the disorders are etiologically and phenotypically diametrical, predicting opposing effects on one's mentalizing abilities. To test these contrasting hypotheses, we evaluated the effect of psychosis and autism tendencies on the perspective-taking (PT) abilities of 201 neurotypical adults, on the assumption that autism tendencies and psychosis proneness are heritable dimensions of normal variation. We show that while both autism tendencies and psychosis proneness induce PT errors, their interaction reduced these errors. Our study is, to our knowledge, the first to observe that co-occurring autistic and psychotic traits can exert opposing influences on performance, producing a normalizing effect possibly by way of their diametrical effects on socio-cognitive abilities. This advances the notion that some individuals may, to some extent, be buffered against developing either illness or present fewer symptoms owing to a balanced expression of autistic and psychosis liability.
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Affiliation(s)
- Ahmad M Abu-Akel
- School of Psychology, University of Birmingham, Edgbaston B15 2TT, UK
| | - Stephen J Wood
- School of Psychology, University of Birmingham, Edgbaston B15 2TT, UK Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Melbourne, Victoria, Australia
| | - Peter C Hansen
- School of Psychology, University of Birmingham, Edgbaston B15 2TT, UK
| | - Ian A Apperly
- School of Psychology, University of Birmingham, Edgbaston B15 2TT, UK
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314
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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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Findon J, Cadman T, Stewart CS, Woodhouse E, Eklund H, Hayward H, De Le Harpe Golden D, Chaplin E, Glaser K, Simonoff E, Murphy D, Bolton PF, McEwen FS. Screening for co-occurring conditions in adults with autism spectrum disorder using the strengths and difficulties questionnaire: A pilot study. Autism Res 2016; 9:1353-1363. [PMID: 27120552 PMCID: PMC5215637 DOI: 10.1002/aur.1625] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 02/22/2016] [Accepted: 02/24/2016] [Indexed: 11/24/2022]
Abstract
Adolescents and adults with autism spectrum disorder (ASD) are at elevated risk of co‐occurring mental health problems. These are often undiagnosed, can cause significant impairment, and place a very high burden on family and carers. Detecting co‐occurring disorders is extremely important. However, there is no validated screening tool for this purpose. The aim of this pilot study is to test the utility of the strengths and difficulties questionnaire (SDQ) to screen for co‐occurring emotional disorders and hyperactivity in adolescents and adults with ASD. The SDQ was completed by 126 parents and 98 individuals with ASD (in 79 cases both parent and self‐report were available from the same families). Inter‐rater reliability, test‐retest stability, internal consistency, and construct validity were examined. SDQ subscales were also compared to clinically utilized measures of emotional disorders and hyperactivity to establish the ability to predict risk of disorder. Inter‐rater reliability (r = 0.42), test‐retest stability (r = 0.64), internal consistency (α = 0.52–0.81) and construct validity (r = 0.42–0.57) for the SDQ subscales were comparable to general population samples. Parent‐ and self‐report SDQ subscales were significantly associated with measures of anxiety, depression and hyperactivity (62–74% correctly classified). Parent‐report performed significantly better than self‐report; adults with ASD under‐reported difficulties. The SDQ shows promise as a simple and efficient way to screen for emotional disorders and hyperactivity in adolescents and adults with ASD that could help reduce the impact of these disorders on individuals and their families. However, further more systematic attempts at validation are warranted. Autism Res2016, 9: 1353–1363. © 2016 International Society for Autism Research, Wiley Periodicals, Inc.
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Affiliation(s)
- James Findon
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Tim Cadman
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Catherine S Stewart
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK.,South London & Maudsley NHS Foundation Trust, London, UK
| | - Emma Woodhouse
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Hanna Eklund
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Hannah Hayward
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Daniel De Le Harpe Golden
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK.,South London & Maudsley NHS Foundation Trust, London, UK
| | - Eddie Chaplin
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Karen Glaser
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Emily Simonoff
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK.,South London & Maudsley NHS Foundation Trust, London, UK
| | - Declan Murphy
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Patrick F Bolton
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK.,South London & Maudsley NHS Foundation Trust, London, UK
| | - Fiona S McEwen
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK.,South London & Maudsley NHS Foundation Trust, London, UK
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316
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Visser JC, Rommelse NNJ, Greven CU, Buitelaar JK. Autism spectrum disorder and attention-deficit/hyperactivity disorder in early childhood: A review of unique and shared characteristics and developmental antecedents. Neurosci Biobehav Rev 2016; 65:229-63. [PMID: 27026637 DOI: 10.1016/j.neubiorev.2016.03.019] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 03/06/2016] [Accepted: 03/08/2016] [Indexed: 12/31/2022]
Abstract
Autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) have overlapping characteristics and etiological factors, but to which extent this applies to infant- and preschool age is less well understood. Comparing the pathways to ASD and ADHD from the earliest possible stages is crucial for understanding how phenotypic overlap emerges and develops. Ultimately, these insights may guide preventative and therapeutic interventions. Here, we review the literature on the core symptoms, temperament and executive function in ASD and ADHD from infancy through preschool age, and draw several conclusions: (1) the co-occurrence of ASD and ADHD increases with age, severity of symptoms and lower IQ, (2) attention problems form a linking pin between early ASD and ADHD, but the behavioral, cognitive and sensory correlates of these attention problems partly diverge between the two conditions, (3) ASD and ADHD share high levels of negative affect, although the underlying motivational and behavioral tendencies seem to differ, and (4) ASD and ADHD share difficulties with control and shifting, but partly opposite behaviors seem to be involved.
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Affiliation(s)
- Janne C Visser
- Karakter Child and Adolescent Psychiatry University Center, Nijmegen, The Netherlands.
| | - Nanda N J Rommelse
- Karakter Child and Adolescent Psychiatry University Center, Nijmegen, The Netherlands; Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Department of Psychiatry, Nijmegen, The Netherlands
| | - Corina U Greven
- Karakter Child and Adolescent Psychiatry University Center, Nijmegen, The Netherlands; Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Department of Cognitive Neuroscience, Nijmegen, The Netherlands; King's College London, Medical Research Council Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Jan K Buitelaar
- Karakter Child and Adolescent Psychiatry University Center, Nijmegen, The Netherlands; Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Department of Cognitive Neuroscience, Nijmegen, The Netherlands
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317
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Hirvikoski T, Mittendorfer-Rutz E, Boman M, Larsson H, Lichtenstein P, Bölte S. Premature mortality in autism spectrum disorder. Br J Psychiatry 2016; 208:232-8. [PMID: 26541693 DOI: 10.1192/bjp.bp.114.160192] [Citation(s) in RCA: 458] [Impact Index Per Article: 57.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Accepted: 01/15/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Mortality has been suggested to be increased in autism spectrum disorder (ASD). AIMS To examine both all-cause and cause-specific mortality in ASD, as well as investigate moderating role of gender and intellectual ability. METHOD Odds ratios (ORs) were calculated for a population-based cohort of ASD probands (n = 27,122, diagnosed between 1987 and 2009) compared with gender-, age- and county of residence-matched controls (n = 2,672,185). RESULTS During the observed period, 24,358 (0.91%) individuals in the general population died, whereas the corresponding figure for individuals with ASD was 706 (2.60%; OR = 2.56; 95% CI 2.38-2.76). Cause-specific analyses showed elevated mortality in ASD for almost all analysed diagnostic categories. Mortality and patterns for cause-specific mortality were partly moderated by gender and general intellectual ability. CONCLUSIONS Premature mortality was markedly increased in ASD owing to a multitude of medical conditions.
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Affiliation(s)
- Tatja Hirvikoski
- Tatja Hirvikoski, PhD, Department of Women's and Children's Health, Pediatric Neuropsychiatry Unit, Center for Neurodevelopmental Disorders at Karolinska Institutet (KIND), Karolinska Institutet, Stockholm, Sweden and Habilitation and Health, Stockholm County Council, Sweden; Ellenor Mittendorfer-Rutz, PhD, Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden; Marcus Boman, BSc, Henrik Larsson, PhD, Paul Lichtenstein, PhD, Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Sven Bölte, PhD, Department of Women's and Children's Health, Pediatric Neuropsychiatry Unit, Center for Neurodevelopmental Disorders at Karolinska Institutet (KIND), Karolinska Institutet, Stockholm and Division of Child and Adolescent Psychiatry, Stockholm County Council, Sweden
| | - Ellenor Mittendorfer-Rutz
- Tatja Hirvikoski, PhD, Department of Women's and Children's Health, Pediatric Neuropsychiatry Unit, Center for Neurodevelopmental Disorders at Karolinska Institutet (KIND), Karolinska Institutet, Stockholm, Sweden and Habilitation and Health, Stockholm County Council, Sweden; Ellenor Mittendorfer-Rutz, PhD, Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden; Marcus Boman, BSc, Henrik Larsson, PhD, Paul Lichtenstein, PhD, Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Sven Bölte, PhD, Department of Women's and Children's Health, Pediatric Neuropsychiatry Unit, Center for Neurodevelopmental Disorders at Karolinska Institutet (KIND), Karolinska Institutet, Stockholm and Division of Child and Adolescent Psychiatry, Stockholm County Council, Sweden
| | - Marcus Boman
- Tatja Hirvikoski, PhD, Department of Women's and Children's Health, Pediatric Neuropsychiatry Unit, Center for Neurodevelopmental Disorders at Karolinska Institutet (KIND), Karolinska Institutet, Stockholm, Sweden and Habilitation and Health, Stockholm County Council, Sweden; Ellenor Mittendorfer-Rutz, PhD, Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden; Marcus Boman, BSc, Henrik Larsson, PhD, Paul Lichtenstein, PhD, Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Sven Bölte, PhD, Department of Women's and Children's Health, Pediatric Neuropsychiatry Unit, Center for Neurodevelopmental Disorders at Karolinska Institutet (KIND), Karolinska Institutet, Stockholm and Division of Child and Adolescent Psychiatry, Stockholm County Council, Sweden
| | - Henrik Larsson
- Tatja Hirvikoski, PhD, Department of Women's and Children's Health, Pediatric Neuropsychiatry Unit, Center for Neurodevelopmental Disorders at Karolinska Institutet (KIND), Karolinska Institutet, Stockholm, Sweden and Habilitation and Health, Stockholm County Council, Sweden; Ellenor Mittendorfer-Rutz, PhD, Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden; Marcus Boman, BSc, Henrik Larsson, PhD, Paul Lichtenstein, PhD, Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Sven Bölte, PhD, Department of Women's and Children's Health, Pediatric Neuropsychiatry Unit, Center for Neurodevelopmental Disorders at Karolinska Institutet (KIND), Karolinska Institutet, Stockholm and Division of Child and Adolescent Psychiatry, Stockholm County Council, Sweden
| | - Paul Lichtenstein
- Tatja Hirvikoski, PhD, Department of Women's and Children's Health, Pediatric Neuropsychiatry Unit, Center for Neurodevelopmental Disorders at Karolinska Institutet (KIND), Karolinska Institutet, Stockholm, Sweden and Habilitation and Health, Stockholm County Council, Sweden; Ellenor Mittendorfer-Rutz, PhD, Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden; Marcus Boman, BSc, Henrik Larsson, PhD, Paul Lichtenstein, PhD, Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Sven Bölte, PhD, Department of Women's and Children's Health, Pediatric Neuropsychiatry Unit, Center for Neurodevelopmental Disorders at Karolinska Institutet (KIND), Karolinska Institutet, Stockholm and Division of Child and Adolescent Psychiatry, Stockholm County Council, Sweden
| | - Sven Bölte
- Tatja Hirvikoski, PhD, Department of Women's and Children's Health, Pediatric Neuropsychiatry Unit, Center for Neurodevelopmental Disorders at Karolinska Institutet (KIND), Karolinska Institutet, Stockholm, Sweden and Habilitation and Health, Stockholm County Council, Sweden; Ellenor Mittendorfer-Rutz, PhD, Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden; Marcus Boman, BSc, Henrik Larsson, PhD, Paul Lichtenstein, PhD, Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Sven Bölte, PhD, Department of Women's and Children's Health, Pediatric Neuropsychiatry Unit, Center for Neurodevelopmental Disorders at Karolinska Institutet (KIND), Karolinska Institutet, Stockholm and Division of Child and Adolescent Psychiatry, Stockholm County Council, Sweden
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318
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Gardner M, Suplee PD, Bloch J, Lecks K. Exploratory Study of Childbearing Experiences of Women With Asperger Syndrome. Nurs Womens Health 2016; 20:28-37. [PMID: 26902438 DOI: 10.1016/j.nwh.2015.12.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 09/08/2015] [Indexed: 10/22/2022]
Abstract
Increasing numbers of girls have been diagnosed with Asperger syndrome and other autism spectrum disorders (ASDs) over the past two decades; therefore, more women with ASDs are entering the childbearing phase of their lives. Little is known about the childbearing experiences of women with ASDs. This qualitative study describes the childbearing experiences of eight women with Asperger syndrome. Four major themes emerged: Processing Sensations, Needing to Have Control, Walking in the Dark, and Motherhood on My Own Terms. Clinicians can provide sensitive, individualized care by asking women with Asperger syndrome about their specific sensory experiences, counseling them about coping strategies for sensory intrusions, providing targeted support, and modifying the clinical environment to decrease distressing stimuli.
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Affiliation(s)
| | | | | | - Karen Lecks
- University of Pennsylvania in Philadelphia, PA
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319
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Geurts HM, Stek M, Comijs H. Autism Characteristics in Older Adults with Depressive Disorders. Am J Geriatr Psychiatry 2016; 24:161-9. [PMID: 26577259 DOI: 10.1016/j.jagp.2015.08.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 08/10/2015] [Accepted: 08/14/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To study the prevalence of autism spectrum disorder (ASD) characteristics in older adults with and without depressive disorders and the social network and past negative life events in those with a high number of ASD characteristics and those without a large number of these characteristics. METHODS This large, multisite, naturalistic, prospective cohort study used data from the Netherlands Study of Depression in Older persons (aged 60-90 years) with (N = 259) and without (N = 114) a depressive disorder according to DSM-IV criteria. ASD characteristics were measured with the abbreviated Autism Spectrum Quotient with a cutoff score of 70. Additional measures were the Composite International Diagnostic Interview, the Inventory of Depressive Symptomatology, the Becks Anxiety Inventory, the Close Person Inventory, and the life events questionnaire. RESULTS Of the older adults with a depressive disorder, 31% showed elevated ASD characteristics, which is much higher than the observed 6% in the comparison group. High ASD characteristics were associated with elevated depression and anxiety symptoms and more comorbid anxiety disorders. Those with a high number of ASD characteristics did not differ in the size of their social network or the number of negative life events as compared with those with less ASD characteristics. CONCLUSION ASD might be overlooked in older adults, especially within geriatric psychiatry. When diagnosing and treating depression and anxiety in older patients, one should be attentive to ASD.
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Affiliation(s)
- Hilde M Geurts
- Autism & ADHD Research Center (d'Arc), Brain and Cognition, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands; Research & Development, Dr. Leo Kannerhuis Center for Autism, Amsterdam, The Netherlands.
| | - Max Stek
- GGZ InGeest, Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Hannie Comijs
- GGZ InGeest, Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
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320
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Rutherford M, McKenzie K, Johnson T, Catchpole C, O’Hare A, McClure I, Forsyth K, McCartney D, Murray A. Gender ratio in a clinical population sample, age of diagnosis and duration of assessment in children and adults with autism spectrum disorder. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2016; 20:628-34. [DOI: 10.1177/1362361315617879] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
This article reports on gender ratio, age of diagnosis and the duration of assessment procedures in autism spectrum disorder diagnosis in a national study which included all types of clinical services for children and adults. Findings are reported from a retrospective case note analysis undertaken with a representative sample of 150 Scottish children and adults recently diagnosed with autism spectrum disorder. The study reports key findings that the gender ratio in this consecutively referred cohort is lower than anticipated in some age groups and reduces with increasing age. The gender ratio in children, together with the significant difference in the mean age of referral and diagnosis for girls compared to boys, adds evidence of delayed recognition of autism spectrum disorder in younger girls. There was no significant difference in duration of assessment for males and females suggesting that delays in diagnosis of females occur prior to referral for assessment. Implications for practice and research are considered.
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321
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Wilson CE, Murphy CM, McAlonan G, Robertson DM, Spain D, Hayward H, Woodhouse E, Deeley PQ, Gillan N, Ohlsen JC, Zinkstok J, Stoencheva V, Faulkner J, Yildiran H, Bell V, Hammond N, Craig MC, Murphy DG. Does sex influence the diagnostic evaluation of autism spectrum disorder in adults? AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2016; 20:808-19. [PMID: 26802113 PMCID: PMC5363500 DOI: 10.1177/1362361315611381] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
It is unknown whether sex influences the diagnostic evaluation of autism spectrum disorder, or whether male and female adults within the spectrum have different symptom profiles. This study reports sex differences in clinical outcomes for 1244 adults (935 males and 309 females) referred for autism spectrum disorder assessment. Significantly, more males (72%) than females (66%) were diagnosed with an autism spectrum disorder of any subtype (x(2) = 4.09; p = 0.04). In high-functioning autism spectrum disorder adults (IQ > 70; N = 827), there were no significant sex differences in severity of socio-communicative domain symptoms. Males had significantly more repetitive behaviours/restricted interests than females (p = 0.001, d = 0.3). A multivariate analysis of variance indicated a significant interaction between autism spectrum disorder subtype (full-autism spectrum disorder/partial-autism spectrum disorder) and sex: in full-autism spectrum disorder, males had more severe socio-communicative symptoms than females; for partial-autism spectrum disorder, the reverse was true. There were no sex differences in prevalence of co-morbid psychopathologies. Sex influenced diagnostic evaluation in a clinical sample of adults with suspected autism spectrum disorder. The sexes may present with different manifestations of the autism spectrum disorder phenotype and differences vary by diagnostic subtype. Understanding and awareness of adult female repetitive behaviours/restricted interests warrant attention and sex-specific diagnostic assessment tools may need to be considered.
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Affiliation(s)
- C Ellie Wilson
- King's College London, UK South London and Maudsley NHS Foundation Trust, UK University of Seville, Spain
| | - Clodagh M Murphy
- King's College London, UK South London and Maudsley NHS Foundation Trust, UK
| | - Grainne McAlonan
- King's College London, UK South London and Maudsley NHS Foundation Trust, UK
| | - Dene M Robertson
- King's College London, UK South London and Maudsley NHS Foundation Trust, UK
| | - Debbie Spain
- King's College London, UK South London and Maudsley NHS Foundation Trust, UK
| | - Hannah Hayward
- King's College London, UK South London and Maudsley NHS Foundation Trust, UK
| | - Emma Woodhouse
- King's College London, UK South London and Maudsley NHS Foundation Trust, UK
| | - P Quinton Deeley
- King's College London, UK South London and Maudsley NHS Foundation Trust, UK Bethlem Royal Hospital, UK
| | - Nicola Gillan
- South London and Maudsley NHS Foundation Trust, UK Bristol Autism Spectrum Service, UK University of Bristol, UK
| | | | - Janneke Zinkstok
- King's College London, UK South London and Maudsley NHS Foundation Trust, UK
| | | | - Jessica Faulkner
- King's College London, UK South London and Maudsley NHS Foundation Trust, UK
| | | | - Vaughan Bell
- South London and Maudsley NHS Foundation Trust, UK University College London, UK
| | - Neil Hammond
- South London and Maudsley NHS Foundation Trust, UK
| | - Michael C Craig
- King's College London, UK South London and Maudsley NHS Foundation Trust, UK Bethlem Royal Hospital, UK
| | - Declan Gm Murphy
- King's College London, UK South London and Maudsley NHS Foundation Trust, UK
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322
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Postorino V, Fatta LM, De Peppo L, Giovagnoli G, Armando M, Vicari S, Mazzone L. Longitudinal comparison between male and female preschool children with autism spectrum disorder. J Autism Dev Disord 2016; 45:2046-55. [PMID: 25633919 DOI: 10.1007/s10803-015-2366-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Epidemiological studies have highlighted a strong male bias in autism spectrum disorder (ASD), however few studies have examined gender differences in autism symptoms, and available findings are inconsistent. The aim of the present study is to investigate the longitudinal gender differences in developmental profiles of 30 female and 30 male age-matched preschool children with ASD. All the children underwent a comprehensive evaluation at T0 and at T1. Our results have shown no significant interaction between time and gender for predicting autism symptoms, developmental quotient, parental stress, children's adaptive skills and behavior problems. Shedding light on the developmental trajectories in ASD could help clinicians to recognize children with ASD at an earlier age and contribute to the development of appropriate treatments.
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Affiliation(s)
- Valentina Postorino
- Child Neuropsychiatry Unit, Department of Neuroscience, I.R.C.C.S. Children's Hospital Bambino Gesù, Piazza S. Onofrio, 4, 00165, Rome, Italy
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323
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Spain D, O'Neill L, Harwood L, Chaplin E. Psychological interventions for adults with ASD: clinical approaches. ADVANCES IN AUTISM 2016. [DOI: 10.1108/aia-09-2015-0016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– Empirical research indicates that adults who have autism spectrum disorders (ASD) can derive clinically and statistically meaningful benefits from individual and group-based psychological interventions, specifically those which employ skills-based, behavioural, and cognitive techniques. Given the inherent socio-communication, executive functioning, and theory of mind impairments that individuals with ASD can experience, it is deemed necessary to modify the design and delivery of interventions so as to enhance engagement and outcomes. The paper aims to discuss these issues.
Design/methodology/approach
– This general review provides a summary of the extant literature and clinical guidelines for the provision of psychological interventions for adults with ASD.
Findings
– Adaptations to the structure, process, content, and outcome measurement are outlined. It is likely that optimal treatment gains for adults with ASD are contingent on a prolonged assessment phase, pre-therapy interventions including psycho-education and skills-based interventions, thoughtful regard to the formulation of presenting difficulties, and consideration of, and methods to overcome, the difficulties that may arise when seeking to implement change, identify goals, and manage endings.
Originality/value
– This is one of the first reviews to condense the clinical implications for providing psychological interventions for adults with ASD.
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324
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Reducing Barriers to Care in the Office-Based Health Care Setting for Children With Autism. J Pediatr Health Care 2016; 30:5-14. [PMID: 26455786 DOI: 10.1016/j.pedhc.2015.08.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 07/22/2015] [Accepted: 08/31/2015] [Indexed: 11/22/2022]
Abstract
The purpose of this survey-design research study was to evaluate the usefulness of a researcher-developed tool designed to improve office-based health care services and to assess the barriers and resources affecting office-based health care services for children with autism spectrum disorder. Fifty-four health care providers (HCPs) and 59 parents participated in the study. HCPs reported child behaviors, communication, and fears as barriers to providing care, whereas parents reported child behavior, sensory issues, and feelings of a disconnect with the HCP as barriers. HCPs identified the parent as a key resource. Parent-identified resources included provider adaptations to the patient, including slowing down the delivery of care and environmental adaptations to the office. In addition, both HCPs and parents indicated that the researcher-developed tool would be useful in reducing barriers during the HCE. Reducing barriers and improving health care interactions during delivery of care for children with autism spectrum disorder has the potential to improve health outcomes.
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325
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Characteristics of Two-Year College Students on the Autism Spectrum and Their Support Services Experiences. AUTISM RESEARCH AND TREATMENT 2015; 2015:391693. [PMID: 26649197 PMCID: PMC4662964 DOI: 10.1155/2015/391693] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 10/23/2015] [Accepted: 10/25/2015] [Indexed: 11/26/2022]
Abstract
Approximately 80% of college-going youth with autism in the US attend a 2-year college at some point. These community-based, universally accessible institutions offer both academic and vocational courses and have experience in teaching diverse learners. This study used nationally representative survey data from the National Longitudinal Transition Study-2 to describe the characteristics and services experiences of adults with autism who attended postsecondary education after high school, focusing on those who attended a 2-year college. Over 60% of those who attended 2-year colleges had little to no trouble conversing or performing functional skills like counting change during high school, and extracurricular participation was common (93.8%). Most 2-year college attenders (85.7%) were able to navigate to places outside the home versus 43.9% of those with no postsecondary education. Over half took vocational courses at 2-year colleges, while one-quarter pursued academic study. Less than half (48.6%) of those who disclosed their disability to the school reported receiving services, accommodations, or other help. Most (87.3%) felt they received enough help, but fewer (68.0%) felt the services they received were useful. Future research should delineate specific needs of students with autism in 2-year college settings and identify what supports are needed to improve persistence and completion rates.
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326
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Do social networks differ? Comparison of the social networks of people with intellectual disabilities, people with autism spectrum disorders and other people living in the community. J Autism Dev Disord 2015; 45:1191-203. [PMID: 25326258 PMCID: PMC4544488 DOI: 10.1007/s10803-014-2279-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The aim of this study was to determine the similarities and differences in social network characteristics, satisfaction and wishes with respect to the social network between people with mild or borderline intellectual disabilities (ID), people with autism spectrum disorders (ASD) and a reference group. Data were gathered from 105 young adults living independently in the community. The social networks of people with ID and ASD are more restricted than those of the reference group. Compared with the other groups, people with ASD are less often satisfied with their networks. Each group has its own characteristics, issues and wishes with respect to their social network. Practical measures to enable professionals to adapt to these issues are discussed.
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327
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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: 337] [Impact Index Per Article: 37.4] [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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328
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Taghizadeh N, Davidson A, Williams K, Story D. Autism spectrum disorder (ASD) and its perioperative management. Paediatr Anaesth 2015; 25:1076-84. [PMID: 26248302 DOI: 10.1111/pan.12732] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/24/2015] [Indexed: 11/29/2022]
Abstract
Autism spectrum disorder (ASD) is now diagnosed in more than 1 in 100 children, so it is not surprising that anesthetists are increasingly providing care for children with this diagnosis. The diagnostic classification for ASD has recently changed and our understanding of the causes and management of ASD are also changing rapidly. This review provides a timely update to increase understanding and awareness of the problems that children with ASD experience, and to minimize perioperative problems. Current literature on premedication and the increasing use of alpha-2 agonists such as clonidine and dexmedetomidine as well as the use of old favorites midazolam and ketamine is reviewed. Some simple strategies that will improve care and decrease anxiety, like social stories, the use of tablet computers, other comfort items or games for distraction, and using favorite drinks to disguise the bitter taste of medications, are described. Remember, the parents are their child's expert and will know what agitates and settles them. Talking to them prior to the day of the procedure is ideal. The importance of staff training and having a clinical practice guideline available at every institution cannot be overstated.
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Affiliation(s)
- Neda Taghizadeh
- Anaesthetic Research Group, Murdoch Children Research Institute, Parkville, VIC, Australia.,Department of Paediatrics and Psychological Sciences, University of Melbourne, Parkville, VIC, Australia
| | - Andrew Davidson
- Anaesthetic Research Group, Murdoch Children Research Institute, Parkville, VIC, Australia.,Department of Paediatrics and Psychological Sciences, University of Melbourne, Parkville, VIC, Australia
| | - Katrina Williams
- Department of Paediatrics and Psychological Sciences, University of Melbourne, Parkville, VIC, Australia.,Department of Paediatrics, Royal Children's Hospital, Parkville, VIC, Australia
| | - David Story
- Anaesthesia, Perioperative and Pain Medicine Unit, University of Melbourne, Parkville, VIC, Australia
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329
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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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330
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Oxytocin enhances orienting to social information in a selective group of high-functioning male adults with autism spectrum disorder. Neuropsychologia 2015; 79:53-69. [PMID: 26498227 DOI: 10.1016/j.neuropsychologia.2015.10.025] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 10/16/2015] [Accepted: 10/20/2015] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The study investigated the effects of nasally administered oxytocin on neurophysiological orienting to empathy-evoking pictures in normally intelligent male adults with and without an autism spectrum disorder (ASD). It further investigated whether these effects might be moderated by the individual's approach and avoidance tendencies. METHODS All subjects participated in a randomised double-blind placebo controlled crossover trial where either oxytocin (OXT) or placebo was administered preceding the viewing of affective pictures.The pictures, selected from the International Affective Picture System (IAPS), represented a systematic variation of pleasant, unpleasant and neutral scenes with and without humans. Both cardiac (ECR) and cortical (LPP) evoked orienting responses were measured and both were enhanced for the pictures with humans, in particular for the unpleasant ones. RESULTS No significant group differences were found, nor were there any treatment effects. Moderator analysis, however, demonstrated that OXT did enhance orienting to affective pictures with humansin male adults with ASD who are easily distressed when seeing others in stressful situations and in healthy males who are highly sensitive to anticipated punishment and criticism or have a low drive for goal achievement. CONCLUSION Individual differences in stress-related avoidance tendencies should be taken into account when considering OXT as a treatment of social deficiencies in autism.
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331
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Spain D, Sin J, Paliokosta E, Furuta M, Chalder T, Murphy DG, Happé FG. Family therapy for autism spectrum disorders. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2015. [DOI: 10.1002/14651858.cd011894] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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332
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Lai MC, Lombardo MV, Ecker C, Chakrabarti B, Suckling J, Bullmore ET, Happé F, Murphy DGM, Baron-Cohen S. Neuroanatomy of Individual Differences in Language in Adult Males with Autism. Cereb Cortex 2015; 25:3613-28. [PMID: 25249409 PMCID: PMC4585508 DOI: 10.1093/cercor/bhu211] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
One potential source of heterogeneity within autism spectrum conditions (ASC) is language development and ability. In 80 high-functioning male adults with ASC, we tested if variations in developmental and current structural language are associated with current neuroanatomy. Groups with and without language delay differed behaviorally in early social reciprocity, current language, but not current autistic features. Language delay was associated with larger total gray matter (GM) volume, smaller relative volume at bilateral insula, ventral basal ganglia, and right superior, middle, and polar temporal structures, and larger relative volume at pons and medulla oblongata in adulthood. Despite this heterogeneity, those with and without language delay showed significant commonality in morphometric features when contrasted with matched neurotypical individuals (n = 57). In ASC, better current language was associated with increased GM volume in bilateral temporal pole, superior temporal regions, dorsolateral fronto-parietal and cerebellar structures, and increased white matter volume in distributed frontal and insular regions. Furthermore, current language-neuroanatomy correlation patterns were similar across subgroups with or without language delay. High-functioning adult males with ASC show neuroanatomical variations associated with both developmental and current language characteristics. This underscores the importance of including both developmental and current language as specifiers for ASC, to help clarify heterogeneity.
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Affiliation(s)
- Meng-Chuan Lai
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge CB2 8AH, UK,Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei 10051, Taiwan
| | - Michael V. Lombardo
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge CB2 8AH, UK,Department of Psychology and Center for Applied Neuroscience, University of Cyprus, Nicosia CY 1678, Cyprus
| | - Christine Ecker
- Sackler Institute for Translational Neurodevelopment, Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, King's College London, PO23, Institute of Psychiatry, London SE5 8AF, UK
| | - Bhismadev Chakrabarti
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge CB2 8AH, UK,School of Psychology and Clinical Language Sciences, Centre for Integrative Neuroscience and Neurodynamics, University of Reading, Reading RG6 6AL, UK
| | - John Suckling
- Brain Mapping Unit, Department of Psychiatry, University of Cambridge, Cambridge CB2 0SZ, UK,Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge CB21 5EF, UK
| | - Edward T. Bullmore
- Brain Mapping Unit, Department of Psychiatry, University of Cambridge, Cambridge CB2 0SZ, UK,GlaxoSmithKline, Clinical Unit Cambridge, Addenbrooke's Hospital, Cambridge CB2 2QQ, UK,Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge CB21 5EF, UK
| | - Francesca Happé
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, PO80, Institute of Psychiatry, London SE5 8AF, UK
| | | | - Declan G. M. Murphy
- Sackler Institute for Translational Neurodevelopment, Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, King's College London, PO23, Institute of Psychiatry, London SE5 8AF, UK
| | - Simon Baron-Cohen
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge CB2 8AH, UK,Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge CB21 5EF, UK
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333
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Zerbo O, Massolo ML, Qian Y, Croen LA. A Study of Physician Knowledge and Experience with Autism in Adults in a Large Integrated Healthcare System. J Autism Dev Disord 2015; 45:4002-14. [DOI: 10.1007/s10803-015-2579-2] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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334
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Tebartz van Elst L, Bach M, Blessing J, Riedel A, Bubl E. Normal Visual Acuity and Electrophysiological Contrast Gain in Adults with High-Functioning Autism Spectrum Disorder. Front Hum Neurosci 2015; 9:460. [PMID: 26379525 PMCID: PMC4549567 DOI: 10.3389/fnhum.2015.00460] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 08/06/2015] [Indexed: 12/29/2022] Open
Abstract
A common neurodevelopmental disorder, autism spectrum disorder (ASD), is defined by specific patterns in social perception, social competence, communication, highly circumscribed interests, and a strong subjective need for behavioral routines. Furthermore, distinctive features of visual perception, such as markedly reduced eye contact and a tendency to focus more on small, visual items than on holistic perception, have long been recognized as typical ASD characteristics. Recent debate in the scientific community discusses whether the physiology of low-level visual perception might explain such higher visual abnormalities. While reports of this enhanced, "eagle-like" visual acuity contained methodological errors and could not be substantiated, several authors have reported alterations in even earlier stages of visual processing, such as contrast perception and motion perception at the occipital cortex level. Therefore, in this project, we have investigated the electrophysiology of very early visual processing by analyzing the pattern electroretinogram-based contrast gain, the background noise amplitude, and the psychophysical visual acuities of participants with high-functioning ASD and controls with equal education. Based on earlier findings, we hypothesized that alterations in early vision would be present in ASD participants. This study included 33 individuals with ASD (11 female) and 33 control individuals (12 female). The groups were matched in terms of age, gender, and education level. We found no evidence of altered electrophysiological retinal contrast processing or psychophysical measured visual acuities. There appears to be no evidence for abnormalities in retinal visual processing in ASD patients, at least with respect to contrast detection.
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Affiliation(s)
- Ludger Tebartz van Elst
- Section for Experimental Neuropsychiatry, Department for Psychiatry and Psychotherapy, Albert-Ludwigs-University, Freiburg, Germany
| | - Michael Bach
- Section Visual Function, Eye Center, University Medical Center, Freiburg, Germany
| | - Julia Blessing
- Section for Experimental Neuropsychiatry, Department for Psychiatry and Psychotherapy, Albert-Ludwigs-University, Freiburg, Germany
| | - Andreas Riedel
- Section for Experimental Neuropsychiatry, Department for Psychiatry and Psychotherapy, Albert-Ludwigs-University, Freiburg, Germany
| | - Emanuel Bubl
- Section for Experimental Neuropsychiatry, Department for Psychiatry and Psychotherapy, Albert-Ludwigs-University, Freiburg, Germany
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335
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Gillberg IC, Helles A, Billstedt E, Gillberg C. Boys with Asperger Syndrome Grow Up: Psychiatric and Neurodevelopmental Disorders 20 Years After Initial Diagnosis. J Autism Dev Disord 2015. [DOI: 10.1007/s10803-015-2544-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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336
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Kronenberg LM, Goossens PJJ, van Busschbach JT, van Achterberg T, van den Brink W. Burden and Expressed Emotion of Caregivers in Cases of Adult Substance Use Disorder with and Without Attention Deficit/Hyperactivity Disorder or Autism Spectrum Disorder. Int J Ment Health Addict 2015; 14:49-63. [PMID: 26798327 PMCID: PMC4710653 DOI: 10.1007/s11469-015-9567-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To identify and compare caregiver burden and expressed emotion (EE) in adult substance use disorder (SUD) patients with and without co-occurring attention deficit/hyperactivity disorder (ADHD) or autism spectrum disorder (ASD). To examine possible differences in correlations between caregiver burden and EE across patient groups. DESIGN AND METHODS Cross-sectional study with measures of perceived burden (Involvement Evaluation Questionnaire: IEQ), subjective stress (General Health Questionnaire: GHQ) and perceptions of expressed emotion (Level of Expressed Emotion: LEE) in informal caregivers for patients with SUD, SUD+ADHD or SUD+ASD. FINDINGS No differences in caregiver burden or expressed emotion when caregivers for patients with SUD were compared to caregivers for patients with SUD+ADHD. A moderate but non-significant difference for caregivers of patients with SUD versus SUD+ASD, which disappeared when the number of contact hours between patient and caregiver for the SUD only group was controlled for. The IEQ sum scores also substantially correlated with the LEE sum scores. CONCLUSION Informal caregivers for patients with only SUD show higher levels of burden and EE than informal caregivers for patients with SUD and a co-occurring ASD. This difference was largely explained by the higher number of contact hours between patient and caregiver in the SUD only group.
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Affiliation(s)
- Linda M. Kronenberg
- />Department of Residency Training MANP Mental Health, Dimence, Deventer, The Netherlands
- />Expertise Centre Developmental Disorders, Dimence, Deventer, The Netherlands
- />Dimence, P.O. Box 5003, 7400 GC Deventer, The Netherlands
| | - Peter J. J. Goossens
- />GGZVS, Institute for the Education of Clinical Nurse Specialists in Mental Health, Utrecht, The Netherlands
- />SCBS, Dimence, Deventer, The Netherlands
- />Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
- />Department of Public Health, University Centre for Nursing and Midwifery, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | | | - Theo van Achterberg
- />Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
- />Centre for Health Services and Nursing Research, KU Leuven, Leuven, Belgium
- />Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Wim van den Brink
- />Amsterdam Institute for Addiction Research, Academic Medical Center University of Amsterdam, Amsterdam, The Netherlands
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337
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Lalanne L, Weiner L, Trojak B, Berna F, Bertschy G. Substance-use disorder in high-functioning autism: clinical and neurocognitive insights from two case reports. BMC Psychiatry 2015; 15:149. [PMID: 26149411 PMCID: PMC4493816 DOI: 10.1186/s12888-015-0541-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 06/24/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Low prevalence of substance-use disorder has been reported in adults with autism. However, on a superficial level, adults with high-functioning autism (HFA) display a 'normal' façade when they drink alcohol, which may explain why their alcohol dependency is not better diagnosed. CASE PRESENTATION Here, we report two cases of HFA adults who use alcohol and psychostimulants to cope with their anxiety and improve their cognitive abilities and social skills. We analyze how neurocognitive traits associated with HFA may be potential triggers for substance-use disorder. CONCLUSION Better identification of autism and its cognitive impairments, which may be vulnerability traits for developing substance-use disorders, could help improve the diagnosis and treatment of substance-use disorders among this population.
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Affiliation(s)
- Laurence Lalanne
- Department of Psychiatry, Strasbourg University Hospital, 1 place de l'Hôpital, 67000, Strasbourg, France. .,INSERM 1114, FMTS, Strasbourg University Hospital, 1 place de l'Hôpital, 67000, Strasbourg, France.
| | - Luisa Weiner
- Department of Psychiatry, Strasbourg University Hospital, 1 place de l'Hôpital, 67000, Strasbourg, France. .,INSERM 1114, FMTS, Strasbourg University Hospital, 1 place de l'Hôpital, 67000, Strasbourg, France.
| | - Benoit Trojak
- Department of Psychiatry and Addictology, Dijon University Hospital, Dijon, France. .,EA 4452, LPPM, University of Burgundy, Dijon, France.
| | - Fabrice Berna
- Department of Psychiatry, Strasbourg University Hospital, 1 place de l'Hôpital, 67000, Strasbourg, France. .,INSERM 1114, FMTS, Strasbourg University Hospital, 1 place de l'Hôpital, 67000, Strasbourg, France.
| | - Gilles Bertschy
- Department of Psychiatry, Strasbourg University Hospital, 1 place de l'Hôpital, 67000, Strasbourg, France. .,INSERM 1114, FMTS, Strasbourg University Hospital, 1 place de l'Hôpital, 67000, Strasbourg, France.
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338
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Carré A, Chevallier C, Robel L, Barry C, Maria AS, Pouga L, Philippe A, Pinabel F, Berthoz S. Tracking Social Motivation Systems Deficits: The Affective Neuroscience View of Autism. J Autism Dev Disord 2015; 45:3351-63. [DOI: 10.1007/s10803-015-2498-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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339
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Psychiatric comorbidity and medication use in adults with autism spectrum disorder. J Autism Dev Disord 2015; 44:3063-71. [PMID: 24958436 DOI: 10.1007/s10803-014-2170-2] [Citation(s) in RCA: 191] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The purpose of this study was to investigate comorbid psychiatric disorders and psychotropic medication use among adults with autism spectrum disorder (ASD) ascertained as children during a 1980's statewide Utah autism prevalence study (n = 129). Seventy-three individuals (56.6 %) met criteria for a current psychiatric disorder; 89 participants (69.0 %) met lifetime criteria for a psychiatric disorder. Caregivers reported a psychiatric diagnosis in 44 participants (34.1 %). Anxiety disorder had the highest current and lifetime prevalence (39.5 and 52.7 %, respectively). Participants with intellectual disability (n = 94, 72.8 %) were significantly less likely to have community-based diagnoses of anxiety (χ(2) = 5.37, p = 0.02) or depression (χ(2) = 13.18, p < 0.001) reported by caregivers. Seventy-six participants (58.9 %) were taking ≥1 psychotropic medication. Comorbid psychiatric disorders occur frequently in adults with ASD, though identifying these disorders poses a challenge in community settings. A greater understanding of the presentation of these conditions within this population will increase assessment validity and the potential for efficacious intervention.
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340
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Daly BP, Nicholls EG, Patrick KE, Brinckman DD, Schultheis MT. Driving behaviors in adults with autism spectrum disorders. J Autism Dev Disord 2015; 44:3119-28. [PMID: 24925544 DOI: 10.1007/s10803-014-2166-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
This pilot study investigated driving history and driving behaviors between adults diagnosed with autism spectrum disorders (ASD) as compared to non-ASD adult drivers. Seventy-eight licensed drivers with ASD and 94 non-ASD comparison participants completed the Driver Behavior Questionnaire. Drivers with ASD endorsed significantly lower ratings of their ability to drive, and higher numbers of traffic accidents and citations relative to non-ASD drivers. Drivers with ASD also endorsed significantly greater numbers of difficulties on the following subscales: intentional violations, F(1, 162) = 6.15, p = .01, η p (2) = .04; mistakes, F(1, 162) = 10.15, p = .002, η p (2) = .06; and slips/lapses, F(1, 162) = 11.33, p = .001, η p (2) = .07. These findings suggest that individuals with ASD who are current drivers may experience more difficulties in driving behaviors and engage in more problematic driving behaviors relative to non-ASD drivers.
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Affiliation(s)
- Brian P Daly
- Department of Psychology, Drexel University, 3401 Chestnut Street, Philadelphia, PA, 19104, USA,
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341
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Spain D, Blainey SH. Group social skills interventions for adults with high-functioning autism spectrum disorders: A systematic review. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2015; 19:874-86. [DOI: 10.1177/1362361315587659] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Autism spectrum disorders are characterised by impairments in communication and social interaction. Social skills interventions have been found to ameliorate socio-communication deficits in children and adolescents with autism spectrum disorders. Little is known about the effectiveness of social skills interventions for adults with high-functioning autism spectrum disorders (hf-ASD) – a clinical population who can present with more subtle core deficits, but comparable levels of impairment and secondary difficulties. A systematic review was undertaken to investigate the effectiveness of social skills interventions for adults with high-functioning autism spectrum disorders. Five studies met the pre-specified review inclusion criteria: two quasi-experimental comparative trials and three single-arm interventions. There was a degree of variation in the structure, duration and content of the social skills interventions delivered, as well as several methodological limitations associated with included studies. Nevertheless, narrative analysis tentatively indicates that group social skills interventions may be effective for enhancing social knowledge and understanding, improving social functioning, reducing loneliness and potentially alleviating co-morbid psychiatric symptoms.
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Affiliation(s)
- Debbie Spain
- King’s College London, UK
- South London and Maudsley NHS Foundation Trust, UK
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342
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Moss P, Howlin P, Savage S, Bolton P, Rutter M. Self and informant reports of mental health difficulties among adults with autism findings from a long-term follow-up study. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2015; 19:832-41. [DOI: 10.1177/1362361315585916] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Data on psychiatric problems in adults with autism are inconsistent, with estimated rates ranging from around 25% to over 75%. We assessed difficulties related to mental health in 58 adults with autism (10 females, 48 males; mean age 44 years) whom we have followed over four decades. All were of average non-verbal intelligence quotient when diagnosed as children. Overall ratings of mental health problems were based on data from the Family History Schedule (Bolton et al., 1994). Informant reports indicated that many of the cohort (44%) had experienced no mental health problems in adulthood; 28% had experienced mild to moderate difficulties, 23% had severe and 5% very severe problems. Depression was the most commonly reported problem. Among those adults ( n = 22) able to report on their own mental state, again many (45%) reported no mental health problems, although 27% reported very severe mental health problems related to anxiety, depression and/or obsessive–compulsive symptoms. Informant ratings of poor mental health were not associated with gender, severity of autism in childhood, or child or adult intelligence quotient, but there were small correlations with overall social functioning (rho = 0.34) and current autism severity (rho = 0.37). The findings highlight the difficulties of assessing mental health problems in adults with autism and the need for appropriately validated measures.
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Affiliation(s)
| | - Patricia Howlin
- King’s College London, UK
- The University of Sydney, Australia
- Joint first authors
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343
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Lai MC, Baron-Cohen S, Buxbaum JD. Understanding autism in the light of sex/gender. Mol Autism 2015; 6:24. [PMID: 25973161 PMCID: PMC4429357 DOI: 10.1186/s13229-015-0021-4] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 04/20/2015] [Indexed: 11/10/2022] Open
Affiliation(s)
- Meng-Chuan Lai
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Douglas House, 18B, Trumpington Road, Cambridge, CB2 8AH UK ; CLASS Clinic, Cambridgeshire and Peterborough NHS Foundation Trust, Chitra Sethia Autism Centre, The Gatehouse, Fulbourn Hospital, Fulbourn, Cambridge, CB21 5EF UK ; Department of Psychiatry, National Taiwan University Hospital and College of Medicine, No.1 Jen-Ai Road Section 1, Taipei, 10051 Taiwan
| | - Simon Baron-Cohen
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Douglas House, 18B, Trumpington Road, Cambridge, CB2 8AH UK ; CLASS Clinic, Cambridgeshire and Peterborough NHS Foundation Trust, Chitra Sethia Autism Centre, The Gatehouse, Fulbourn Hospital, Fulbourn, Cambridge, CB21 5EF UK
| | - Joseph D Buxbaum
- Seaver Autism Center for Research and Treatment, Departments of Psychiatry, Neuroscience, and Genetics and Genomic Sciences, Friedman Brain Institute and Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, New York, NY 10029 USA
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Chisholm K, Lin A, Abu-Akel A, Wood SJ. The association between autism and schizophrenia spectrum disorders: A review of eight alternate models of co-occurrence. Neurosci Biobehav Rev 2015; 55:173-83. [PMID: 25956249 DOI: 10.1016/j.neubiorev.2015.04.012] [Citation(s) in RCA: 185] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 03/30/2015] [Accepted: 04/25/2015] [Indexed: 01/06/2023]
Abstract
Although now believed to be two distinct disorders, autism spectrum disorders (ASD) and schizophrenia spectrum disorders (SSD) share multiple phenotypic similarities and risk factors, and have been reported to co-occur at elevated rates. In this narrative review, we give a brief overview of the phenomenological, genetic, environmental, and imaging evidence for the overlap between ASD and SSD, highlighting similarities and areas of distinction. We examine eight possible alternate models of explanation for the association and comorbidity between the disorders, and set out a research agenda to test these models. Understanding how and why these disorders co-occur has important implications for diagnosis, treatment, and prognosis, as well as for developing fundamental aetiological models of the disorders.
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Affiliation(s)
| | - Ashleigh Lin
- Telethon Kids Institute, The University of Western Australia, 100 Roberts Rd, Subiaco, WA, 6008, Australia
| | - Ahmad Abu-Akel
- School of Psychology, University of Birmingham, Edgbaston, B15 2TT, UK
| | - Stephen J Wood
- School of Psychology, University of Birmingham, Edgbaston, B15 2TT, UK; Melbourne Neuropsychiatry Centre, National Neuroscience Facility, Level 3, Alan Gilbert Building, 161 Barry St, Carlton, Vic, 3053, Australia
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345
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Croen LA, Zerbo O, Qian Y, Massolo ML, Rich S, Sidney S, Kripke C. The health status of adults on the autism spectrum. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2015; 19:814-23. [DOI: 10.1177/1362361315577517] [Citation(s) in RCA: 534] [Impact Index Per Article: 59.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Compared to the general pediatric population, children with autism have higher rates of co-occurring medical and psychiatric illnesses, yet very little is known about the general health status of adults with autism. The objective of this study was to describe the frequency of psychiatric and medical conditions among a large, diverse, insured population of adults with autism in the United States. Participants were adult members of Kaiser Permanente Northern California enrolled from 2008 to 2012. Autism spectrum disorder cases ( N = 1507) were adults with autism spectrum disorder diagnoses (International Classification of Diseases-9-Clinical Modification codes 299.0, 299.8, 299.9) recorded in medical records on at least two separate occasions. Controls ( N = 15,070) were adults without any autism spectrum disorder diagnoses sampled at a 10:1 ratio and frequency matched to cases on sex and age. Adults with autism had significantly increased rates of all major psychiatric disorders including depression, anxiety, bipolar disorder, obsessive–compulsive disorder, schizophrenia, and suicide attempts. Nearly all medical conditions were significantly more common in adults with autism, including immune conditions, gastrointestinal and sleep disorders, seizure, obesity, dyslipidemia, hypertension, and diabetes. Rarer conditions, such as stroke and Parkinson’s disease, were also significantly more common among adults with autism. Future research is needed to understand the social, healthcare access, and biological factors underlying these observations.
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Affiliation(s)
- Lisa A Croen
- Kaiser Permanente Northern California—Oakland, USA
| | | | - Yinge Qian
- Kaiser Permanente Northern California—Oakland, USA
| | | | - Steve Rich
- Kaiser Permanente Northern California—Santa Rosa, USA
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346
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Matsuo J, Kamio Y, Takahashi H, Ota M, Teraishi T, Hori H, Nagashima A, Takei R, Higuchi T, Motohashi N, Kunugi H. Autistic-like traits in adult patients with mood disorders and schizophrenia. PLoS One 2015; 10:e0122711. [PMID: 25838109 PMCID: PMC4383414 DOI: 10.1371/journal.pone.0122711] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 02/13/2015] [Indexed: 11/18/2022] Open
Abstract
Autism spectrum disorder often co-occurs with other psychiatric disorders. Although a high prevalence of autistic-like traits/symptoms has been identified in the pediatric psychiatric population of normal intelligence, there are no reports from adult psychiatric population. This study examined whether there is a greater prevalence of autistic-like traits/symptoms in patients with adult-onset psychiatric disorders such as major depressive disorder (MDD), bipolar disorder, or schizophrenia, and whether such an association is independent of symptom severity. The subjects were 290 adults of normal intelligence between 25 and 59 years of age (MDD, n=125; bipolar disorder, n=56; schizophrenia, n=44; healthy controls, n=65). Autistic-like traits/symptoms were measured using the Social Responsiveness Scale for Adults. Symptom severity was measured using the Positive and Negative Symptoms Scale, the Hamilton Depression Rating Scale, and/or the Young Mania Rating Scale. Almost half of the clinical subjects, except those with remitted MDD, exhibited autistic-like traits/symptoms at levels typical for sub-threshold or threshold autism spectrum disorder. Furthermore, the proportion of psychiatric patients that demonstrated high autistic-like traits/symptoms was significantly greater than that of healthy controls, and not different between that of remitted or unremitted subjects with bipolar disorder or schizophrenia. On the other hand, remitted subjects with MDD did not differ from healthy controls with regard to the prevalence or degree of high autistic-like traits/symptoms. A substantial proportion of adults with bipolar disorder and schizophrenia showed high autistic-like traits/symptoms independent of symptom severity, suggesting a shared pathophysiology among autism spectrum disorder and these psychiatric disorders. Conversely, autistic-like traits among subjects with MDD were associated with the depressive symptom severity. These findings suggest the importance of evaluating autistic-like traits/symptoms underlying adult-onset psychiatric disorders for the best-suited treatment. Further studies with a prospective design and larger samples are needed.
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Affiliation(s)
- Junko Matsuo
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan; Department of Neuropsychiatry, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Yoko Kamio
- Department of Child and Adolescent Mental Health, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Hidetoshi Takahashi
- Department of Child and Adolescent Mental Health, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Miho Ota
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Toshiya Teraishi
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Hiroaki Hori
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan; Department of Adult Mental Health, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Anna Nagashima
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Reiko Takei
- Department of Child and Adolescent Mental Health, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Teruhiko Higuchi
- National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Nobutaka Motohashi
- Department of Neuropsychiatry, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Hiroshi Kunugi
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan; Department of Neuropsychiatry, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Yamanashi, Japan
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347
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Zablotsky B, Bramlett M, Blumberg SJ. Factors associated with parental ratings of condition severity for children with autism spectrum disorder. Disabil Health J 2015; 8:626-34. [PMID: 25910554 DOI: 10.1016/j.dhjo.2015.03.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 02/02/2015] [Accepted: 03/10/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND There is currently little consensus on how the severity of a child's autism spectrum disorder (ASD) should be measured, and yet despite the lack of a standardized definition, parents were readily able to answer a question asking them to describe the severity of his/her child's ASD in a national survey. OBJECTIVE The current study examined factors associated with a parent's judgment of ASD severity, by identifying child and household characteristics that were associated with a parent's severity rating of his/her child's ASD, including child ASD symptomatology, child impact, and family impact. METHODS Data came from the 2011 Survey of Pathways to Diagnosis and Services ("Pathways"). A total of 967 parents in households with a child diagnosed with ASD between the ages of 6-17 were eligible for the current study. A measurement model was used to create latent factors of child symptoms, child impact, and family impact; multivariate logistic regression models examined the relationship between these latent factors and the parent's severity rating of their child's ASD. RESULTS Children with higher family impact factor scores were more likely to have parents who rated their child's ASD as the most severe. Surprisingly, symptomatology and impact on the child were less predictive of severe ratings. CONCLUSIONS A parent's conceptualization of their child's ASD severity may vary more as a function of the impact of the child's condition on the family and less as a function of the symptoms exhibited by the child or the impact directly felt by the child.
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Affiliation(s)
- Benjamin Zablotsky
- National Center for Health Statistics, 3311 Toledo Road, Hyattsville, MD 20782, USA.
| | - Matthew Bramlett
- National Center for Health Statistics, 3311 Toledo Road, Hyattsville, MD 20782, USA
| | - Stephen J Blumberg
- National Center for Health Statistics, 3311 Toledo Road, Hyattsville, MD 20782, USA
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348
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Cadman T, Spain D, Johnston P, Russell A, Mataix-Cols D, Craig M, Deeley Q, Robertson D, Murphy C, Gillan N, Wilson CE, Mendez M, Ecker C, Daly E, Findon J, Glaser K, Happé F, Murphy D. Obsessive-Compulsive Disorder in Adults with High-Functioning Autism Spectrum Disorder: What Does Self-Report with the OCI-R Tell Us? Autism Res 2015; 8:477-85. [DOI: 10.1002/aur.1461] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Accepted: 12/23/2014] [Indexed: 11/07/2022]
Affiliation(s)
- Tim Cadman
- Sackler Institute for Translational Neurodevelopment and Department of Forensic and Neurodevelopmental Sciences, King's College London, Institute of Psychiatry, Psychology & Neuroscience; London UK
| | - Debbie Spain
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London; UK
| | - Patrick Johnston
- Sackler Institute for Translational Neurodevelopment and Department of Forensic and Neurodevelopmental Sciences, King's College London, Institute of Psychiatry, Psychology & Neuroscience; London UK
| | | | - David Mataix-Cols
- Karolinska Institutet; Department of Clinical Neuroscience; King's College London, Institute of Psychiatry, Psychology and Neuroscience; London UK
| | - Michael Craig
- Sackler Institute for Translational Neurodevelopment and Department of Forensic and Neurodevelopmental Sciences, King's College London, Institute of Psychiatry, Psychology & Neuroscience; London UK
- Behavioural Genetics Clinic, Adult Autism Service, Behavioural and Developmental Psychiatry Clinical Academic Group, South London and Maudsley Foundation NHS Trust; London UK
- National Autism Unit, Bethlem Royal Hospital; Bromley Kent UK
| | - Quinton Deeley
- Sackler Institute for Translational Neurodevelopment and Department of Forensic and Neurodevelopmental Sciences, King's College London, Institute of Psychiatry, Psychology & Neuroscience; London UK
- Behavioural Genetics Clinic, Adult Autism Service, Behavioural and Developmental Psychiatry Clinical Academic Group, South London and Maudsley Foundation NHS Trust; London UK
- National Autism Unit, Bethlem Royal Hospital; Bromley Kent UK
| | - Dene Robertson
- Sackler Institute for Translational Neurodevelopment and Department of Forensic and Neurodevelopmental Sciences, King's College London, Institute of Psychiatry, Psychology & Neuroscience; London UK
- Behavioural Genetics Clinic, Adult Autism Service, Behavioural and Developmental Psychiatry Clinical Academic Group, South London and Maudsley Foundation NHS Trust; London UK
- National Autism Unit, Bethlem Royal Hospital; Bromley Kent UK
| | - Clodagh Murphy
- Sackler Institute for Translational Neurodevelopment and Department of Forensic and Neurodevelopmental Sciences, King's College London, Institute of Psychiatry, Psychology & Neuroscience; London UK
- Behavioural Genetics Clinic, Adult Autism Service, Behavioural and Developmental Psychiatry Clinical Academic Group, South London and Maudsley Foundation NHS Trust; London UK
| | - Nicola Gillan
- Sackler Institute for Translational Neurodevelopment and Department of Forensic and Neurodevelopmental Sciences, King's College London, Institute of Psychiatry, Psychology & Neuroscience; London UK
| | - C. Ellie Wilson
- Sackler Institute for Translational Neurodevelopment and Department of Forensic and Neurodevelopmental Sciences, King's College London, Institute of Psychiatry, Psychology & Neuroscience; London UK
- Behavioural Genetics Clinic, Adult Autism Service, Behavioural and Developmental Psychiatry Clinical Academic Group, South London and Maudsley Foundation NHS Trust; London UK
| | - Maria Mendez
- Sackler Institute for Translational Neurodevelopment and Department of Forensic and Neurodevelopmental Sciences, King's College London, Institute of Psychiatry, Psychology & Neuroscience; London UK
- Behavioural Genetics Clinic, Adult Autism Service, Behavioural and Developmental Psychiatry Clinical Academic Group, South London and Maudsley Foundation NHS Trust; London UK
| | - Christine Ecker
- Sackler Institute for Translational Neurodevelopment and Department of Forensic and Neurodevelopmental Sciences, King's College London, Institute of Psychiatry, Psychology & Neuroscience; London UK
| | - Eileen Daly
- Sackler Institute for Translational Neurodevelopment and Department of Forensic and Neurodevelopmental Sciences, King's College London, Institute of Psychiatry, Psychology & Neuroscience; London UK
| | - James Findon
- Sackler Institute for Translational Neurodevelopment and Department of Forensic and Neurodevelopmental Sciences, King's College London, Institute of Psychiatry, Psychology & Neuroscience; London UK
| | - Karen Glaser
- Department of Social Science; Health and Medicine; King's College London; UK
| | - Francesca Happé
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London; UK
| | - Declan Murphy
- Sackler Institute for Translational Neurodevelopment and Department of Forensic and Neurodevelopmental Sciences, King's College London, Institute of Psychiatry, Psychology & Neuroscience; London UK
- Behavioural Genetics Clinic, Adult Autism Service, Behavioural and Developmental Psychiatry Clinical Academic Group, South London and Maudsley Foundation NHS Trust; London UK
- National Autism Unit, Bethlem Royal Hospital; Bromley Kent UK
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349
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Lai MC, Lombardo MV, Auyeung B, Chakrabarti B, Baron-Cohen S. Sex/gender differences and autism: setting the scene for future research. J Am Acad Child Adolesc Psychiatry 2015; 54:11-24. [PMID: 25524786 PMCID: PMC4284309 DOI: 10.1016/j.jaac.2014.10.003] [Citation(s) in RCA: 556] [Impact Index Per Article: 61.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 10/10/2014] [Accepted: 10/13/2014] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The relationship between sex/gender differences and autism has attracted a variety of research ranging from clinical and neurobiological to etiological, stimulated by the male bias in autism prevalence. Findings are complex and do not always relate to each other in a straightforward manner. Distinct but interlinked questions on the relationship between sex/gender differences and autism remain underaddressed. To better understand the implications from existing research and to help design future studies, we propose a 4-level conceptual framework to clarify the embedded themes. METHOD We searched PubMed for publications before September 2014 using search terms "'sex OR gender OR females' AND autism." A total of 1,906 articles were screened for relevance, along with publications identified via additional literature reviews, resulting in 329 articles that were reviewed. RESULTS Level 1, "Nosological and diagnostic challenges," concerns the question, "How should autism be defined and diagnosed in males and females?" Level 2, "Sex/gender-independent and sex/gender-dependent characteristics," addresses the question, "What are the similarities and differences between males and females with autism?" Level 3, "General models of etiology: liability and threshold," asks the question, "How is the liability for developing autism linked to sex/gender?" Level 4, "Specific etiological-developmental mechanisms," focuses on the question, "What etiological-developmental mechanisms of autism are implicated by sex/gender and/or sexual/gender differentiation?" CONCLUSIONS Using this conceptual framework, findings can be more clearly summarized, and the implications of the links between findings from different levels can become clearer. Based on this 4-level framework, we suggest future research directions, methodology, and specific topics in sex/gender differences and autism.
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Affiliation(s)
- Meng-Chuan Lai
- National Taiwan University Hospital and College of Medicine, Taipei, Taiwan and the Autism Research Centre, University of Cambridge, Cambridge, UK.
| | - Michael V Lombardo
- University of Cyprus, Nicosia, Cyprus and the Autism Research Centre, University of Cambridge
| | - Bonnie Auyeung
- University of Edinburgh and the Autism Research Centre, University of Cambridge
| | - Bhismadev Chakrabarti
- Centre for Integrative Neuroscience and Neurodynamics, School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK and the Autism Research Centre, University of Cambridge
| | - Simon Baron-Cohen
- Cambridge Lifespan Asperger Syndrome Service (CLASS) Clinic, Cambridgeshire and Peterborough National Health Service Foundation Trust, Cambridge, and the Autism Research Centre, University of Cambridge
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350
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Riedel A, Suh H, Haser V, Hermann I, Ebert D, Riemann D, Bubl E, Tebartz van Elst L, Hölzel LP. Freiburg Questionnaire of linguistic pragmatics (FQLP): psychometric properties based on a psychiatric sample. BMC Psychiatry 2014; 14:374. [PMID: 25539681 PMCID: PMC4296675 DOI: 10.1186/s12888-014-0374-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 12/19/2014] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Asperger's Syndrome (AS) is an autism spectrum disorder that is characterized by significant difficulties in social interaction and nonverbal communication, and restricted and repetitive patterns of behavior and interests. Difficulties with respect to pragmatic speech, reading emotional and social cues, differentiating between fact and fiction, and taking into account the influence of context on a statement are commonly described features. However, hitherto established questionnaires did not focus on these symptoms. METHODS In this study we present a short (11 questions) questionnaire which focuses on self-rated pragmatic speech abilities, the Freiburg Questionnaire of linguistic pragmatics (FQLP). Psychometric properties of the questionnaire were explored in a sample of 57 patients with Asperger's Syndrome, 66 patients with other psychiatric disorders, and a convenience sample of 56 people. RESULTS Reliability analysis showed a high Cronbach's α. Strong correlations could be demonstrated for the FQLP with the Autism Quotient and the Empathy Quotient. Concerning divergent validity a moderate correlation was found between the FQLP and self-rated symptoms of personality disorders. No significant correlation was found between the FQLP and the vocabulary skills. The receiver operating characteristics curve showed an excellent diagnostic accuracy of the FQLP (.97). CONCLUSIONS As the control group consisted of people without mental disorder and patients with different psychiatric disorders, the results indicate that the construct examined by the FQLP is quite specific to the peculiarities of AS. The FQLP is a reliable, brief and valid instrument. First results regarding sensitivity and specificity are highly promising.
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Affiliation(s)
- Andreas Riedel
- Clinic for Psychiatry and Psychotherapy, University Medical Center Freiburg, Hauptstr. 5, Freiburg, 79104, Germany.
| | - Heejung Suh
- Clinic for Psychiatry and Psychotherapy, University Medical Center Freiburg, Hauptstr. 5, Freiburg, 79104, Germany.
| | - Verena Haser
- Department of English Linguistics, University of Freiburg, Freiburg, Germany.
| | - Ismene Hermann
- Clinic for Psychiatry and Psychotherapy, University Medical Center Freiburg, Hauptstr. 5, Freiburg, 79104, Germany.
| | - Dieter Ebert
- Clinic for Psychiatry and Psychotherapy, University Medical Center Freiburg, Hauptstr. 5, Freiburg, 79104, Germany.
| | - Dieter Riemann
- Clinic for Psychiatry and Psychotherapy, University Medical Center Freiburg, Hauptstr. 5, Freiburg, 79104, Germany.
| | - Emanuel Bubl
- Clinic for Psychiatry and Psychotherapy, University Medical Center Freiburg, Hauptstr. 5, Freiburg, 79104, Germany.
| | - Ludger Tebartz van Elst
- Clinic for Psychiatry and Psychotherapy, University Medical Center Freiburg, Hauptstr. 5, Freiburg, 79104, Germany.
| | - Lars P Hölzel
- Clinic for Psychiatry and Psychotherapy, University Medical Center Freiburg, Hauptstr. 5, Freiburg, 79104, Germany.
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