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Sahuquillo-Leal R, Navalón P, Moreno-Giménez A, Almansa B, Vento M, García-Blanco A. Attentional biases towards emotional scenes in autism spectrum condition: An eye-tracking study. RESEARCH IN DEVELOPMENTAL DISABILITIES 2022; 120:104124. [PMID: 34775276 DOI: 10.1016/j.ridd.2021.104124] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 10/08/2021] [Accepted: 10/27/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Different attentional processing of emotional information may underlie social impairments in Autism Spectrum Condition (ASC). It has been hypothesized that individuals with ASC show hypersensitivity to threat, which may be related to an avoidance behaviour. However, research on the attentional processing of emotional information in autism is inconclusive. AIM To examine the attentional processing biases of 27 children with ASC and 25 typically developed (TD) participants. METHODS AND PROCEDURES The initial orienting of attention, the attentional engagement, and the attentional maintenance to complex emotional scenes in competition (happy, neutral, threatening, sad) were assessed in a 20-second eye-tracking based free-viewing task. OUTCOMES AND RESULTS i) children with ASC showed an initial orienting bias towards threatening stimuli; ii) TD children demonstrated an attentional engagement and maintenance bias towards threat, while children with ASC did not; and iii) in children with ASC, attentional problems and somatic complaints were associated with higher initial orienting and with higher attentional maintenance towards threat, respectively. CONCLUSIONS AND IMPLICATIONS These results suggest that a perceived threat induces an early overwhelming response in autism, giving rise to an avoidance behaviour. The findings endorse affective information processing theories and shed light on the mechanisms underlying social disturbances in ASC.
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Affiliation(s)
- Rosa Sahuquillo-Leal
- Department of Personality, Evaluation, and Psychological Treatments, University of Valencia, Valencia, Spain
| | - Pablo Navalón
- La Fe University and Polytechnic Hospital, Department of Psychiatry, Valencia, Spain; Neonatal Research Group, La Fe Health Research Institute, Valencia, Spain
| | | | - Belén Almansa
- Neonatal Research Group, La Fe Health Research Institute, Valencia, Spain
| | - Máximo Vento
- Neonatal Research Group, La Fe Health Research Institute, Valencia, Spain; La Fe University and Polytechnic Hospital, Division of Neonatology, Valencia, Spain
| | - Ana García-Blanco
- Department of Personality, Evaluation, and Psychological Treatments, University of Valencia, Valencia, Spain; La Fe University and Polytechnic Hospital, Department of Psychiatry, Valencia, Spain; Neonatal Research Group, La Fe Health Research Institute, Valencia, Spain.
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2
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Zhang L, Yan G, Benson V. The influence of emotional face distractors on attentional orienting in Chinese children with autism spectrum disorder. PLoS One 2021; 16:e0250998. [PMID: 33945576 PMCID: PMC8096071 DOI: 10.1371/journal.pone.0250998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 04/16/2021] [Indexed: 11/18/2022] Open
Abstract
The current study examined how emotional faces impact on attentional control at both involuntary and voluntary levels in children with and without autism spectrum disorder (ASD). A non-face single target was either presented in isolation or synchronously with emotional face distractors namely angry, happy and neutral faces. ASD and typically developing children made more erroneous saccades towards emotional distractors relative to neutral distractors in parafoveal and peripheral conditions. Remote distractor effects were observed on saccade latency in both groups regardless of distractor type, whereby time taken to initiate an eye movement to the target was longest in central distractor conditions, followed by parafoveal and peripheral distractor conditions. The remote distractor effect was greater for angry faces compared to happy faces in the ASD group. Proportions of failed disengagement trials from central distractors, for the first saccade, were higher in the angry distractor condition compared with the other two distractor conditions in ASD, and this effect was absent for the typical group. Eye movement results suggest difficulties in disengaging from fixated angry faces in ASD. Atypical disengagement from angry faces at the voluntary level could have consequences for the development of higher-level socio-communicative skills in ASD.
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Affiliation(s)
- Li Zhang
- Faculty of Psychology, Tianjin Normal University, Tianjin, P. R. China
- School of Psychology, University of Central Lancashire, Preston, United Kingdom
| | - Guoli Yan
- Faculty of Psychology, Tianjin Normal University, Tianjin, P. R. China
- Center of Collaborative Innovation for Assessment and Promotion of Mental Health, Tianjin, P. R. China
| | - Valerie Benson
- School of Psychology, University of Central Lancashire, Preston, United Kingdom
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3
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Hull L, Levy L, Lai MC, Petrides KV, Baron-Cohen S, Allison C, Smith P, Mandy W. Is social camouflaging associated with anxiety and depression in autistic adults? Mol Autism 2021; 12:13. [PMID: 33593423 PMCID: PMC7885456 DOI: 10.1186/s13229-021-00421-1] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/03/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND There is inconsistent evidence for a clear pattern of association between 'camouflaging' (strategies used to mask and/or compensate for autism characteristics during social interactions) and mental health. METHODS This study explored the relationship between self-reported camouflaging and generalised anxiety, depression, and social anxiety in a large sample of autistic adults and, for the first time, explored the moderating effect of gender, in an online survey. RESULTS Overall, camouflaging was associated with greater symptoms of generalised anxiety, depression, and social anxiety, although only to a small extent beyond the contribution of autistic traits and age. Camouflaging more strongly predicted generalised and social anxiety than depression. No interaction between camouflaging and gender was found. LIMITATIONS These results cannot be generalised to autistic people with intellectual disability, or autistic children and young people. The sample did not include sufficient numbers of non-binary people to run separate analyses; therefore, it is possible that camouflaging impacts mental health differently in this population. CONCLUSIONS The findings suggest that camouflaging is a risk factor for mental health problems in autistic adults without intellectual disability, regardless of gender. We also identified levels of camouflaging at which risk of mental health problems is highest, suggesting clinicians should be particularly aware of mental health problems in those who score at or above these levels.
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Affiliation(s)
- Laura Hull
- Research Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB UK
| | - Lily Levy
- Research Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB UK
- Present Address: Homerton University Hospital NHS Foundation Trust, London, UK
| | - Meng-Chuan Lai
- Centre for Addiction and Mental Health and The Hospital for Sick Children, Department of Psychiatry, University of Toronto, Toronto, Canada
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - K. V. Petrides
- London Psychometrics Laboratory, University College London, London, UK
| | - Simon Baron-Cohen
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Carrie Allison
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Paula Smith
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Will Mandy
- Research Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB UK
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Anxiety and Attentional Bias in Children with Specific Learning Disorders. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2020; 47:487-497. [PMID: 30043123 DOI: 10.1007/s10802-018-0458-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Children with specific learning disorders (SLDs) face a unique set of socio-emotional challenges as a result of their academic difficulties. Although a higher prevalence of anxiety in children with SLD is often reported, there is currently no research on cognitive mechanisms underlying this anxiety. One way to elucidate these mechanisms is to investigate attentional bias to threatening stimuli using a dot-probe paradigm. Our study compared children ages 9-16 with SLD (n = 48) to typically-developing (TD) controls (n = 33) on their attentional biases to stimuli related to general threats, reading, and stereotypes of SLD. We found a significant threat bias away from reading-related stimuli in the SLD, but not TD group. This attentional bias was not observed with the general threat and stereotype stimuli. Further, children with SLD reported greater anxiety compared to TD children. These results suggest that children with SLD experience greater anxiety, which may partially stem from reading specifically. The finding of avoidance rather than vigilance to reading stimuli indicates the use of more top-down attentional control. This work has important implications for therapeutic approaches to anxiety in children with SLD and highlights the need for attention to socio-emotional difficulties in this population. Future research is needed to further investigate the cognitive aspects of socio-emotional difficulties in children with SLD, as well as how this may impact academic outcomes.
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English MCW, Maybery MT, Visser TAW. Autistic-traits, not anxiety, modulate implicit emotional guidance of attention in neurotypical adults. Sci Rep 2019; 9:18376. [PMID: 31804549 PMCID: PMC6895229 DOI: 10.1038/s41598-019-54813-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 11/13/2019] [Indexed: 11/09/2022] Open
Abstract
Although autistic and anxious traits are positively correlated, high levels of autistic traits are associated with poorer emotional guidance of attention (EGA) whilst high levels of anxious traits are associated with greater EGA. In order to better understand how these two trait dimensions influence EGA, we simultaneously examined the effects of anxiety and autistic traits in neurotypical adults on target identification in an attentional blink task. Analyses indicated that implicit EGA is attenuated in individuals with higher levels of autistic traits, but largely unaffected by variation in anxious traits. Our results suggest that anxiety plays a comparatively limited role in modulating implicit EGA and reinforces the importance of disentangling correlated individual differences when exploring the effects of personality, including emotional predisposition, on attention.
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Affiliation(s)
- Michael C W English
- University of Western Australia, School of Psychological Science, Perth, Australia.
| | - Murray T Maybery
- University of Western Australia, School of Psychological Science, Perth, Australia
| | - Troy A W Visser
- University of Western Australia, School of Psychological Science, Perth, Australia
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Shephard E, Bedford R, Milosavljevic B, Gliga T, Jones EJ, Pickles A, Johnson MH, Charman T. Early developmental pathways to childhood symptoms of attention-deficit hyperactivity disorder, anxiety and autism spectrum disorder. J Child Psychol Psychiatry 2019; 60:963-974. [PMID: 29963709 PMCID: PMC6694009 DOI: 10.1111/jcpp.12947] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/06/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Children with autism spectrum disorder (ASD) often have co-occurring symptoms of attention-deficit/hyperactivity disorder (ADHD) and/or anxiety. It is unclear whether these disorders arise from shared or distinct developmental pathways. We explored this question by testing the specificity of early-life (infant and toddler) predictors of mid-childhood ADHD and anxiety symptoms compared to ASD symptoms. METHODS Infants (n = 104) at high and low familial risk for ASD took part in research assessments at 7, 14, 24 and 38 months, and 7 years of age. Symptoms of ASD, ADHD and anxiety were measured by parent report at age 7. Activity levels and inhibitory control, also measured by parent report, in infancy and toddlerhood were used as early-life predictors of ADHD symptoms. Fearfulness and shyness measured in infancy and toddlerhood were used as early-life predictors of anxiety symptoms. Correlations and path analysis models tested associations between early-life predictors and mid-childhood ADHD and anxiety symptoms compared to mid-childhood ASD symptoms, and the influence of controlling for ASD symptoms on those associations. RESULTS Increased activity levels and poor inhibitory control were correlated with ADHD symptoms and not ASD or anxiety; these associations were unchanged in path models controlling for risk-group and ASD symptoms. Increased fearfulness and shyness were correlated with anxiety symptoms, but also ASD symptoms. When controlling for risk-group in path analysis, the association between shyness and anxiety became nonsignificant, and when further controlling for ASD symptoms the association between fearfulness and anxiety became marginal. CONCLUSIONS The specificity of early-life predictors to ADHD symptoms suggests early developmental pathways to ADHD might be distinct from ASD. The overlap in early-life predictors of anxiety and ASD suggests that these disorders are difficult to differentiate early in life, which could reflect the presence of common developmental pathways or convergence in early behavioural manifestations of these disorders.
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Affiliation(s)
- Elizabeth Shephard
- Department of Child and Adolescent PsychiatryInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
| | - Rachael Bedford
- Biostatistics DepartmentInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
| | - Bosiljka Milosavljevic
- Department of PsychologyInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
| | - Teodora Gliga
- Centre for Brain and Cognitive DevelopmentBirkbeck, University of LondonLondonUK
| | - Emily J.H. Jones
- Centre for Brain and Cognitive DevelopmentBirkbeck, University of LondonLondonUK
| | - Andrew Pickles
- Biostatistics DepartmentInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
| | - Mark H. Johnson
- Centre for Brain and Cognitive DevelopmentBirkbeck, University of LondonLondonUK
| | - Tony Charman
- Department of PsychologyInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
- South London and Maudsley NHS Foundation TrustLondonUK
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7
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Stephenson KG, Luke SG, South M. Separate contributions of autistic traits and anxious apprehension, but not alexithymia, to emotion processing in faces. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2019; 23:1830-1842. [DOI: 10.1177/1362361319830090] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Reduced eye fixation has been commonly reported in autistic samples but may be at least partially explained by alexithymia (i.e., difficulty understanding and describing one’s emotional state). Because anxiety is often elevated in autism, and emotion-processing differences have also been observed in anxious samples, anxiety traits may also influence emotion processing within autism. This study tested the contribution of dimensional traits of autism, anxious apprehension, and alexithymia in mediating eye fixation during face processing. Participants included 105 adults from three samples: autistic adults (AS; n = 30), adults with clinically elevated anxiety and no autism (HI-ANX; n = 29), and neurotypical adults without elevated anxiety (NT; n = 46). Experiment 1 used an emotion identification task with dynamic stimuli, while Experiment 2 used a static luminance change detection task with emotional- and neutral-expression static photos. The emotions of interest were joy, anger, and fear. Dimensional mixed-effects models showed that autism traits, but not alexithymia, predicted reduced eye fixation across both tasks. Anxious apprehension was negatively related to response time in Experiment 1 and positively related to eye fixation in Experiment 2. Attentional avoidance of negative stimuli occurred at lower levels of autism traits and higher levels of worry traits. The results highlight the contribution of autism traits to emotional processing and suggest additional effects of worry-related traits.
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8
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White SW, Simmons GL, Gotham KO, Conner CM, Smith IC, Beck KB, Mazefsky CA. Psychosocial Treatments Targeting Anxiety and Depression in Adolescents and Adults on the Autism Spectrum: Review of the Latest Research and Recommended Future Directions. Curr Psychiatry Rep 2018; 20:82. [PMID: 30155584 PMCID: PMC6421847 DOI: 10.1007/s11920-018-0949-0] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
PURPOSE OF REVIEW This synthesis of treatment research related to anxiety and depression in adolescents and adults with autism spectrum disorder (ASD) focuses on the scientific support for various forms of psychosocial interventions, useful adaptations to standard interventions, and engagement of candidate therapeutic mechanisms. RECENT FINDINGS There is considerable evidence for the efficacy of cognitive-behavioral therapy (CBT) to treat co-occurring problems with anxiety, but there has been relatively little research on treatment of co-occurring depression. Multiple mechanisms of treatment effect have been proposed, but there has been little demonstration of target engagement via experimental therapeutics. Comorbidity between ASD and anxiety and/or mood problems is common. Although there is evidence for the use of CBT for anxiety, little work has addressed how to effectively treat depression. There is emerging support for alternative treatment approaches, such as mindfulness-based interventions. We encourage rigorous, collaborative approaches to identify and manipulate putative mechanisms of change.
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Affiliation(s)
- Susan W White
- Department of Psychology, University of Alabama, Box 870348, Tuscaloosa, AL, 35487-0348, USA.
| | - Grace Lee Simmons
- Department of Psychology, University of Alabama, Box 870348, Tuscaloosa, AL, 35487-0348, USA
| | - Katherine O Gotham
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Caitlin M Conner
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Isaac C Smith
- Department of Psychology, University of Alabama, Box 870348, Tuscaloosa, AL, 35487-0348, USA
| | - Kelly B Beck
- Clinical Rehabilitation and Mental Health Counseling, School of Health and Rehabilitation Sciences, Pittsburgh, PA, USA
| | - Carla A Mazefsky
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Milosavljevic B, Shephard E, Happé FG, Johnson MH, Charman T. Anxiety and Attentional Bias to Threat in Children at Increased Familial Risk for Autism Spectrum Disorder. J Autism Dev Disord 2018; 47:3714-3727. [PMID: 28116669 PMCID: PMC5676835 DOI: 10.1007/s10803-016-3012-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Anxiety and threat bias were examined in 6-8-year-old children at familial-risk for Autism Spectrum Disorder (ASD) and low-risk (LR, n = 37) controls. The high-risk (HR) group was divided into those who met diagnostic criteria for ASD (HR-ASD, n = 15) and those who did not (HR-non ASD, n = 24). The HR-ASD group had highest levels of parent-reported anxiety. The HR-non ASD group exhibited increased threat bias on a spatial-cueing task, while the HR-ASD group did not. Anxiety symptoms were associated with both threat bias and ASD severity. These findings suggest that the mechanisms underlying anxiety in HR siblings without ASD are similar to those in non-ASD populations. However, among children with ASD, hypersensitivity to threat may not underlie anxiety symptoms.
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Affiliation(s)
- Bosiljka Milosavljevic
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, De Crespigny Park, London, SE5 8AF UK
| | - Elizabeth Shephard
- MRC Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, De Crespigny Park, London, SE5 8AF UK
| | - Francesca G. Happé
- MRC Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, De Crespigny Park, London, SE5 8AF UK
| | - Mark H. Johnson
- Centre for Brain and Cognitive Development, Birkbeck College, University of London, Malet Street, London, WC1E 7HX UK
| | - Tony Charman
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, De Crespigny Park, London, SE5 8AF UK
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10
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Psychophysiological and Behavioral Responses to a Novel Intruder Threat Task for Children on the Autism Spectrum. J Autism Dev Disord 2018. [PMID: 28646372 DOI: 10.1007/s10803-017-3195-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
We measured skin conductance response (SCR) to escalating levels of a direct social threat from a novel, ecologically-relevant experimental paradigm, the Intruder Threat Task. We simultaneously evaluated the contribution of social symptom severity and behavioral movement. Children with AS group showed less psychophysiological reactivity to social threat than controls across all three phases of the experiment. In the AS group, greater social impairment was significantly associated with reduced SCR. However, movement activity predicted SCR while diagnosis did not. Research and treatment need to account for the complex interplay of emotional reactivity and social behavior in AS. Psychophysiology studies of AS should consider the impact of possible confounds such as movement.
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11
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Ozsivadjian A, Hollocks MJ, Southcott J, Absoud M, Holmes E. Anxious Imagery in Children With and Without Autism Spectrum Disorder: An Investigation into Occurrence, Content, Features and Implications for Therapy. J Autism Dev Disord 2017; 47:3822-3832. [PMID: 27328680 PMCID: PMC5676832 DOI: 10.1007/s10803-016-2840-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Mental imagery has been implicated in anxiety disorders in adults, but has not been investigated in child and adolescent populations. Anxiety is highly prevalent in autism spectrum disorder (ASD), and as people with ASD are often thought of as 'visual thinkers', the potential role of distressing imagery in children with ASD merits exploration. Participants aged 8-16 years were grouped as follows: ASD/high anxiety, ASD/low anxiety, non-ASD/high anxiety and non-ASD/low anxiety. Imagery and associated features were assessed using an interview. Group differences were found in number and frequency of images experienced. There were few differences between the groups in the characteristics of the spontaneous images, which included emotional valence, vividness, controllability and realism. Implications for treatment are discussed.
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Affiliation(s)
- Ann Ozsivadjian
- Children's Complex Neurodevelopmental Disability Service, Children's Neurosciences Centre Newcomen at St Thomas', South Wing, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK.
| | - Matthew J Hollocks
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Jess Southcott
- Children's Complex Neurodevelopmental Disability Service, Children's Neurosciences Centre Newcomen at St Thomas', South Wing, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Michael Absoud
- Children's Complex Neurodevelopmental Disability Service, Children's Neurosciences Centre Newcomen at St Thomas', South Wing, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Emily Holmes
- MRC Cognition and Brain Sciences Unit, Cambridge, UK
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12
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Hollocks MJ, Pickles A, Howlin P, Simonoff E. Dual Cognitive and Biological Correlates of Anxiety in Autism Spectrum Disorders. J Autism Dev Disord 2017; 46:3295-307. [PMID: 27465243 DOI: 10.1007/s10803-016-2878-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Young people with autism spectrum disorder (ASD) have a high prevalence (~40 %) of anxiety disorders compared to their non-ASD peers. It is unclear whether cognitive and biological processes associated with anxiety in ASD are analogous to anxiety in typically developing (TD) populations. In this study 55 boys with ASD (34 with a co-occurring anxiety disorder, 21 without) and 28 male controls, aged 10-16 years and with a full-scale IQ ≥ 70, completed a series of clinical, cognitive (attention bias/interpretation bias) and biological measures (salivary cortisol/HR response to social stress) associated with anxiety in TD populations. Structural equation modelling was used to reveal that that both attentional biases and physiological responsiveness were significant, but unrelated, predictors of anxiety in ASD.
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Affiliation(s)
- Matthew J Hollocks
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK. .,Neurology Unit, R3, Department of Clinical Neurosciences, University of Cambridge, Box 83, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK. .,Department of Clinical Psychology, Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK.
| | - Andrew Pickles
- Department of Biostatistics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Patricia Howlin
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Emily Simonoff
- Department of Child and Adolescent Psychiatry and Biomedical Research Centre for Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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13
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Magiati I, Lerh JW, Hollocks MJ, Uljarevic M, Rodgers J, McConachie H, Ozsivadjian A, South M, Van Hecke A, Hardan A, Libove R, Leekam S, Simonoff E. The measurement properties of the spence children's anxiety scale-parent version in a large international pooled sample of young people with autism spectrum disorder. Autism Res 2017; 10:1629-1652. [DOI: 10.1002/aur.1809] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 02/03/2017] [Accepted: 04/07/2017] [Indexed: 12/27/2022]
Affiliation(s)
- Iliana Magiati
- Department of Psychology; National University of Singapore, 9 Arts Link; Singapore 117570
| | - Jian Wei Lerh
- Department of Psychology; National University of Singapore, 9 Arts Link; Singapore 117570
| | - Matthew J. Hollocks
- Department of Child and Adolescent Psychiatry; Institute of Psychiatry, Psychology & Neuroscience, King's College London, DeCrespigny Park, Denmark Hill; London SE5 8AF UK
- Department of Clinical Psychology; Faculty of Medicine and Health Sciences, Norwich Medical School, University of East Anglia; Norwich UK
| | - Mirko Uljarevic
- Olga Tennison Autism Research Centre; School of Psychological Science, La Trobe University; Victoria 3086 Australia
- Cooperative Research Centre for Living with Autism (Autism CRC), Long Pocket; Brisbane Queensland Australia
| | - Jacqui Rodgers
- Clinical Psychology; Ridley Building, Institute of Neuroscience, Newcastle University; Newcastle NE1 7RU UK
| | - Helen McConachie
- Institute of Health and Society, Newcastle University, Sir James Spence Institute, Royal Victoria Infirmary, Queen Victoria Road; Newcastle upon Tyne NE1 4LP UK
| | - Ann Ozsivadjian
- Evelina London Children's Hospital, St Thomas' Hospital; London UK
| | - Mikle South
- Department of Psychology; College of Family, Home and Social Sciences, Brigham Young University; Provo Utah
| | - Amy Van Hecke
- Department of Psychology; College of Arts and Sciences, Marquette University, Cramer Hall; Milwaukee Wisconsin 53201-1881
| | - Antonio Hardan
- Department of Psychiatry and Behavioral Sciences; Stanford University School of Medicine, Stanford University; Stanford California 94305
| | - Robin Libove
- Department of Psychiatry and Behavioral Sciences; Stanford University School of Medicine, Stanford University; Stanford California 94305
| | - Susan Leekam
- Wales Autism Research Centre; School of Psychology, Cardiff University; Cardiff CF10 3AT UK
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Restoring effects of oxytocin on the attentional preference for faces in autism. Transl Psychiatry 2017; 7:e1097. [PMID: 28418399 PMCID: PMC5416705 DOI: 10.1038/tp.2017.67] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 01/26/2017] [Accepted: 02/15/2017] [Indexed: 12/17/2022] Open
Abstract
Reduced attentional preference for faces and symptoms of social anxiety are common in autism spectrum disorders (ASDs). The neuropeptide oxytocin triggers anxiolytic functions and enhances eye gaze, facial emotion recognition and neural correlates of face processing in ASD. Here we investigated whether a single dose of oxytocin increases attention to faces in ASD. As a secondary question, we explored the influence of social anxiety on these effects. We tested for oxytocin's effects on attention to neutral faces as compared to houses in a sample of 29 autistic individuals and 30 control participants using a dot-probe paradigm with two different presentation times (100 or 500 ms). A single dose of 24 IU oxytocin was administered in a randomized, double-blind placebo-controlled, cross-over design. Under placebo, ASD individuals paid less attention to faces presented for 500 ms than did controls. Oxytocin administration increased the allocation of attention toward faces in ASD to a level observed in controls. Secondary analyses revealed that these oxytocin effects primarily occurred in ASD individuals with high levels of social anxiety who were characterized by attentional avoidance of faces under placebo. Our results confirm a positive influence of intranasal oxytocin on social attention processes in ASD. Further, they suggest that oxytocin may in particular restore the attentional preference for facial information in ASD individuals with high social anxiety. We conclude that oxytocin's anxiolytic properties may partially account for its positive effects on socio-cognitive functioning in ASD, such as enhanced eye gaze and facial emotion recognition.
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Herrington JD, Maddox BB, McVey AJ, Franklin ME, Yerys BE, Miller JS, Schultz RT. Negative Valence in Autism Spectrum Disorder: The Relationship Between Amygdala Activity, Selective Attention, and Co-occurring Anxiety. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2017; 2:510-517. [PMID: 29348040 DOI: 10.1016/j.bpsc.2017.03.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 02/03/2017] [Accepted: 03/02/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND A critical agenda of the National Institutes of Health Research Domain Criteria (RDoC) initiative is establishing whether domains within the RDoC matrix are truly transdiagnostic. Rates of anxiety disorders are elevated in autism spectrum disorder (ASD), but it is unclear whether the same mechanisms contribute to anxiety in individuals with and without ASD. As changes in selective attention are a hallmark of anxiety disorders in non-ASD samples, the identification of these changes in ASD would support the transdiagnostic nature of anxiety. METHODS This functional magnetic resonance imaging study focused on the negative valence domain from RDoC (manifest as anxiety symptoms) in youth with ASD (n = 38) and typically developing control participants (n = 25). The task required selective attention toward and away from social information (faces) with negative and neutral affect. Participants underwent in-depth characterization for both anxiety and ASD symptoms. RESULTS Dimensional and categorical measures of anxiety were significantly related to increased amygdala activation-evidence of enhanced attentional capture by social information. CONCLUSIONS This pattern fits with decades of research among non-ASD samples using selective attention and attentional bias paradigms, suggesting that anxiety in ASD shares mechanisms with anxiety alone. Overall, results from this study support the transdiagnostic nature of the negative valence domain from RDoC and increase the likelihood that anxiety in ASD should be responsive to interventions targeting maladaptive responses to negative information.
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Affiliation(s)
- John D Herrington
- Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Brenna B Maddox
- Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Alana J McVey
- Department of Psychology, Marquette University, Milwaukee, Wisconsin
| | - Martin E Franklin
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Benjamin E Yerys
- Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Judith S Miller
- Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert T Schultz
- Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
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García-Blanco A, López-Soler C, Vento M, García-Blanco MC, Gago B, Perea M. Communication deficits and avoidance of angry faces in children with autism spectrum disorder. RESEARCH IN DEVELOPMENTAL DISABILITIES 2017; 62:218-226. [PMID: 28214050 DOI: 10.1016/j.ridd.2017.02.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 02/04/2017] [Accepted: 02/05/2017] [Indexed: 06/06/2023]
Abstract
BACKGROUND Understanding how emotional faces are processed is important to help characterize the social deficits in Autism Spectrum Disorder (ASD). AIMS We examined: (i) whether attention is modulated by emotional facial expression; (ii) the time course of the attentional preferences (short vs. long stimulus presentation rates); and (iii) the association between attentional biases and autistic symptomatology. METHOD AND PROCEDURES We applied a dot-probe experiment with emotional faces (happy, sad, and angry). The sample was composed of ASD children without additional language and/or intellectual impairments (n=29) and age-matched Typically Developing (TD) children (n=29). OUTCOMES AND RESULTS When compared to the TD group, the ASD group showed an attentional bias away from angry faces at long presentation rates. No differences between groups were found for happy or sad faces. Furthermore, correlational analyses showed that the higher avoidance of angry faces, the greater are the social communication difficulties of ASD children. The attentional bias away from angry faces may be an underlying mechanism of social dysfunction in ASD. We discuss the implications of these findings for current theories of emotional processing in ASD.
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Affiliation(s)
- Ana García-Blanco
- Health Research Institute La Fe, Av. de Fernando Abril Martorell, 106, 46026 Valencia, Spain; University of Valencia, Av. Blasco Ibáñez, 21, Valencia 46010, Spain.
| | - Concepción López-Soler
- Virgen de la Arrixaca University Hospital, Ctra. Madrid-Cartagena, s/n, 30120 El Palmar, Murcia, Spain
| | - Máximo Vento
- Health Research Institute La Fe, Av. de Fernando Abril Martorell, 106, 46026 Valencia, Spain
| | | | - Belén Gago
- Health Research Institute La Fe, Av. de Fernando Abril Martorell, 106, 46026 Valencia, Spain
| | - Manuel Perea
- University of Valencia, Av. Blasco Ibáñez, 21, Valencia 46010, Spain
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van Steensel FJA, Heeman EJ. Anxiety Levels in Children with Autism Spectrum Disorder: A Meta-Analysis. JOURNAL OF CHILD AND FAMILY STUDIES 2017; 26:1753-1767. [PMID: 28680259 PMCID: PMC5487760 DOI: 10.1007/s10826-017-0687-7] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
The aim of the current study was to meta-analytically examine whether anxiety levels in children with autism spectrum disorders (ASD) are elevated. A total of 83 articles were selected from a systematic literature search and were included in the meta-analyses. Results demonstrated that children with ASD had higher anxiety levels compared to typically developing children, and this difference increased with IQ. Youth with ASD also tended to have higher anxiety levels compared to clinically referred children, and this difference increased with age. Children with ASD had higher anxiety levels compared to youth with externalizing or developmental problems, but not when compared to youth with internalizing problems. The study findings highlight the importance of more research in order to fully understand the nature and development of anxiety in children with ASD. More specifically, the results suggest that especially high-functioning adolescents with ASD may be at risk for developing anxiety disorders. Therefore, it seems important to carefully follow and monitor children with ASD transcending to adolescence.
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Affiliation(s)
- Francisca J. A. van Steensel
- Child Development and Education, University of Amsterdam, Research priority area Yield, Nieuwe Achtergracht 127, 1018 WS Amsterdam, Netherlands
| | - Emma J. Heeman
- De Opvoedpoli B.V., Dorpstraat 145, 2712 AG Zoetermeer, Netherlands
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Social-Emotional Inhibition of Return in Children with Autism Spectrum Disorder Versus Typical Development. J Autism Dev Disord 2016; 46:1236-46. [PMID: 26586556 DOI: 10.1007/s10803-015-2661-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
In typical development there is a bias to orient visual attention to social information. Children with ASD do not reliably demonstrate this bias, and the role of attention orienting has not been well studied. We examined attention orienting via the inhibition of return (IOR) mechanism in a spatial cueing task using social-emotional cues; we studied 8- to 17-year-old children with ASD (n = 41) and typically developing controls (TDC) (n = 25). The ASD group exhibited a significantly stronger IOR effect than the TDC group, and the IOR effect correlated positively with social impairments but was unrelated to co-occurring ADHD or anxiety symptoms. The results provide evidence of an early altered attention mechanism that is associated with to core social deficits in ASD.
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Edgington L, Hill V, Pellicano E. The design and implementation of a CBT-based intervention for sensory processing difficulties in adolescents on the autism spectrum. RESEARCH IN DEVELOPMENTAL DISABILITIES 2016; 59:221-233. [PMID: 27639063 DOI: 10.1016/j.ridd.2016.09.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 08/19/2016] [Accepted: 09/05/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Unusual reactions to sensory input now form part of the diagnostic criteria for autism. These features are common and can have an often-devastating impact on autistic individuals and their families. Yet there are few validated interventions that help to remediate or support autistic individuals' adverse sensory experiences. To date, both measurement of sensory experiences and the resulting interventions have been based on assumptions of neurological sensitivities and largely ignored the role of cognition. This study therefore sought to assess the feasibility of a new 8-week CBT-based group intervention for self-regulation of sensory processing difficulties. METHOD Seven cognitively able adolescents diagnosed with autism aged 11-16 years from one mainstream secondary school received the 8-week intervention. Measures of sensory reactivity, anxiety and repetitive behaviours were taken at baseline, post-intervention and follow-up, 8 weeks after the intervention had ceased. Semi-structured interviews and focus groups were also conducted with adolescents and their parents to examine further the acceptability of the intervention. RESULTS The results showed that the intervention itself was feasible - both in its implementation and its acceptability to participants. Qualitative analysis clearly showed that the intervention was effective in raising meta-conscious awareness and self-regulation in these autistic adolescents. Analysis of outcome variables showed no significant change over the intervention period, although effect sizes were moderate-to-large. CONCLUSIONS These preliminary results are encouraging and should inform the design of a future pilot randomized controlled trial to test its efficacy with a larger group of participants.
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Affiliation(s)
- Louise Edgington
- Triborough Educational Psychology and Consultation Service, London, UK; Centre for Research in Autism and Education (CRAE), UCL Institute of Education, University College London, UK.
| | - Vivian Hill
- Department of Psychology and Human Development, UCL Institute of Education, University College London, UK
| | - Elizabeth Pellicano
- Centre for Research in Autism and Education (CRAE), UCL Institute of Education, University College London, UK; School of Psychology, University of Western Australia, Perth, Australia.
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May T, Cornish K, Rinehart NJ. Mechanisms of anxiety related attentional biases in children with autism spectrum disorder. J Autism Dev Disord 2016; 45:3339-50. [PMID: 26070278 DOI: 10.1007/s10803-015-2500-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Children with autism spectrum disorder (ASD) have high levels of anxiety. It is unclear whether they exhibit threat-related attentional biases commensurate with anxiety disorders as manifest in non-ASD populations, such as facilitated attention toward, and difficulties disengaging engaging from, threatening stimuli. Ninety children, 45 cognitively able with ASD and 45 age, perceptual-IQ, and gender matched typically developing children, aged 7-12 years, were administered a visual dot probe task using threatening facial pictures. Parent-reported anxiety symptoms were also collected. Children with ASD showed similarly high levels of anxiety compared with normative data from an anxiety disordered sample. Children with ASD had higher levels of parent-reported anxiety but did not show differences in disengaging from, or facilitated attention toward, threatening facial stimuli compared with typically developing children. In contrast to previously published studies of anxious children, in this study there were no differences in attentional biases in children with ASD meeting clinical cutoff for anxiety and those who did not. There were no correlations between attentional biases and anxiety symptoms and no gender differences. These findings indicate the cognitive mechanisms underlying anxiety in cognitively able children with ASD could differ from those commonly found in anxious children which may have implications for both understanding the aetiology of anxiety in ASD and for anxiety interventions.
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Affiliation(s)
- Tamara May
- Deakin Child Study Centre, School of Psychology, Deakin University, Melbourne Burwood Campus, 221 Burwood Highway, Burwood, VIC, 3125, Australia.
| | - Kim Cornish
- Monash School of Psychological Sciences, Building 17, Monash University Clayton Campus, Wellington Rd, Clayton, VIC, 3800, Australia
| | - Nicole J Rinehart
- Deakin Child Study Centre, School of Psychology, Deakin University, Melbourne Burwood Campus, 221 Burwood Highway, Burwood, VIC, 3125, Australia
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Attentional biases to faces expressing disgust in children with autism spectrum disorders: an exploratory study. Sci Rep 2016; 6:19381. [PMID: 26758779 PMCID: PMC4725836 DOI: 10.1038/srep19381] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 12/07/2015] [Indexed: 12/16/2022] Open
Abstract
Previous studies on attentional bias towards emotional faces in individuals with autism spectrum disorders (ASD) provided mixed results. This might be due to differences in the examined attentional bias components and emotional expressions. This study assessed three bias components, hypervigilance, disengagement, and avoidance, using faces with a disgust, happy, or neutral expression in a dot-probe and external cuing task in 18 children with ASD and 21 typically developing (TD) children. The children with ASD initially displayed hypervigilance towards the disgust faces, followed by a general tendency to avoid looking back at the spatial location at which any face, irrespective of its emotional expression, had been presented. These results highlight the importance of differentiating between attentional bias components in research on ASD.
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Abstract
PURPOSE OF REVIEW Anxiety is one of the most common co-occurring psychiatric conditions in youth with autism spectrum disorders (ASDs). This article reviews recent evidence as well as earlier relevant studies regarding the characteristics, assessment, and treatment of anxiety in youth with ASD. RECENT FINDINGS It is well established that the prevalence of anxiety in youth with an ASD is significantly greater than the prevalence of anxiety in the general population. Recent studies have highlighted the importance of informant, method, and instrument when measuring anxiety in this population. Despite the high prevalence, findings to date have been unable to identify any consistent risk factors for anxiety. New psychological treatments, including modified cognitive behavioral therapy for youth with high functioning ASD and co-occurring anxiety, are emerging. Pharmacological data, however, are scant. Existing studies show that youth with ASD are at increased risk for behavioral activation when taking SSRIs. SUMMARY Clinicians working with youth with ASD are encouraged to routinely screen for anxiety. Until further data are available, clinical judgment is needed when prescribing treatments, particularly selective serotonin reuptake inhibitors, which require close monitoring of side-effects. Research on risk factors, pathophysiology, and treatment of this condition is needed.
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