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Neuhaus E, Santhosh M, Kresse A, Aylward E, Bernier R, Bookheimer S, Jeste S, Jack A, McPartland JC, Naples A, Van Horn JD, Pelphrey K, Webb SJ. Frontal EEG alpha asymmetry in youth with autism: Sex differences and social-emotional correlates. Autism Res 2023; 16:2364-2377. [PMID: 37776030 PMCID: PMC10840952 DOI: 10.1002/aur.3032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 09/04/2023] [Indexed: 10/01/2023]
Abstract
In youth broadly, EEG frontal alpha asymmetry (FAA) associates with affective style and vulnerability to psychopathology, with relatively stronger right activity predicting risk for internalizing and externalizing behaviors. In autistic youth, FAA has been related to ASD diagnostic features and to internalizing symptoms. Among our large, rigorously characterized, sex-balanced participant group, we attempted to replicate findings suggestive of altered FAA in youth with an ASD diagnosis, examining group differences and impact of sex assigned at birth. Second, we examined relations between FAA and behavioral variables (ASD features, internalizing, and externalizing) within autistic youth, examining effects by sex. Third, we explored whether the relation between FAA, autism features, and mental health was informed by maternal depression history. In our sample, FAA did not differ by diagnosis, age, or sex. However, youth with ASD had lower total frontal alpha power than youth without ASD. For autistic females, FAA and bilateral frontal alpha power correlated with social communication features, but not with internalizing or externalizing symptoms. For autistic males, EEG markers correlated with social communication features, and with externalizing behaviors. Exploratory analyses by sex revealed further associations between youth FAA, behavioral indices, and maternal depression history. In summary, findings suggest that individual differences in FAA may correspond to social-emotional and mental health behaviors, with different patterns of association for females and males with ASD. Longitudinal consideration of individual differences across levels of analysis (e.g., biomarkers, family factors, and environmental influences) will be essential to parsing out models of risk and resilience among autistic youth.
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Affiliation(s)
- Emily Neuhaus
- Seattle Children’s Research Institute; Center on Child Health, Behavior & Development
- University of Washington Psychiatry & Behavioral Sciences
| | - Megha Santhosh
- Seattle Children’s Research Institute; Center on Child Health, Behavior & Development
| | - Anna Kresse
- Columbia University, Mailman School of Public Health
| | - Elizabeth Aylward
- Seattle Children’s Research Institute, Center for Integrative Brain Research
| | | | - Susan Bookheimer
- University of California Los Angeles School of Medicine, Dept. of Psychiatry & Biobehavioral Sciences
- University of California Los Angeles, Intellectual and Developmental Disabilities Research Center
| | - Shafali Jeste
- University of California Los Angeles School of Medicine, Dept. of Psychiatry & Biobehavioral Sciences
- University of California Los Angeles, Intellectual and Developmental Disabilities Research Center
| | | | | | | | - John D. Van Horn
- University of Virginia, Dept. of Psychology
- University of Virginia, School of Data Science
| | - Kevin Pelphrey
- University of Virginia, Dept. of Psychology
- University of Virginia, Dept. of Neurology, Brain Institute & School of Education & Human Development
| | - Sara Jane Webb
- Seattle Children’s Research Institute; Center on Child Health, Behavior & Development
- University of Washington Psychiatry & Behavioral Sciences
- University of Washington, Intellectual and Developmental Disabilities Research Center
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Warner K, Keville S, Hockley J, Ludlow A. Experiences of equine assisted therapy for females with autism spectrum disorders. ADVANCES IN AUTISM 2022. [DOI: 10.1108/aia-10-2021-0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
This research indicates females with autism spectrum disorders (ASDs) have a diverse clinical presentation compared to males. Furthermore, females with ASD are often diagnosed later and typically experience greater levels of mental health difficulties. Evidence suggests that clinic-based verbal interventions for ASD have limited efficacy; therefore, alternative therapies, such as equine-assisted therapies (EATs), are gaining recognition. The purpose of this study was to directly explore the experiences of females with an ASD who have undertaken EAT.
Design/methodology/approach
Five female participants with a diagnosis of ASD were recruited from two equine therapy centres. Participants were aged between 15 and 30 years and undertook semi-structured interviews, which were analysed using interpretative phenomenological analysis.
Findings
Three superordinate themes emerged: the difficult experience of the social world, the process of EAT and the emotional impact of horses.
Originality/value
Directly exploring the experiences of females with ASD highlights benefits from engaging therapeutically with horses, building confidence and independence to transferring this into more effective social communication with other people. Offering emotion-focused therapeutic complementary interventions for females with ASD should be forefronted to help remediate the impact of difficult and sometimes traumatic earlier experiences in the social world. This requires increased funding for EAT, combined with larger-scale research projects to evaluate this.
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Schwartzman JM, Williams ZJ, Corbett BA. Diagnostic- and sex-based differences in depression symptoms in autistic and neurotypical early adolescents. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 26:256-269. [PMID: 34180264 PMCID: PMC8710183 DOI: 10.1177/13623613211025895] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
LAY ABSTRACT Depression is more common in autistic adolescents than their neurotypical peers, but the effects of diagnosis and sex on the severity and types of depressive symptoms remain unclear. The study explored diagnostic- and sex-based differences in depressive symptoms in 212 autistic and neurotypical early adolescents. Results show that autism spectrum disorder and female may pose elevated risks, and depressive symptoms related to interpersonal problems and negative self-esteem are more frequent in autism spectrum disorder. Autistic males and females endorsed similar severity and type of depressive symptoms, but unique differences emerged when compared to sex-matched neurotypical peers. Exploratory analyses in a clinical subsample of early adolescents with elevated depressive symptoms (Children's Depression Inventory, Second Edition, Total T-score ⩾60) revealed more endorsement of beliefs of worthlessness in autistic early adolescents. Findings suggest initial intervention targets for treating depression in autistic early adolescents.
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Affiliation(s)
- Jessica M. Schwartzman
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Zachary J. Williams
- Medical Scientist Training Program, Vanderbilt University School of Medicine, Nashville, TN
- Department of Hearing & Speech Sciences, Vanderbilt University Medical Center, Nashville, TN
- Vanderbilt Brain Institute, Vanderbilt University School of Medicine, Nashville, TN
- Frist Center for Autism and Innovation, Vanderbilt University, Nashville, TN
| | - Blythe A. Corbett
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN
- Frist Center for Autism and Innovation, Vanderbilt University, Nashville, TN
- Vanderbilt Kennedy Center, Vanderbilt University Medical Center, Nashville, TN
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Developmental Paths to Anxiety in an Autism-Enriched Infant Cohort: The Role of Temperamental Reactivity and Regulation. J Autism Dev Disord 2021; 51:2631-2645. [PMID: 33037563 PMCID: PMC8254725 DOI: 10.1007/s10803-020-04734-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The aim of this study was to explore the associations between temperamental reactivity and regulation and the emergence of anxiety traits in a longitudinal sample of infants enriched for later ASD. Parents of 143 infants who were at high- and low-risk for ASD rated their child’s temperament traits when they were 9, 15 and 24 months old; they rated anxiety and ASD traits when they were 36 months old. The findings suggest that behavioural inhibition may be an early predictor of later anxiety in children with and without ASD and that lower levels of effortful control in children who later develop ASD may contribute to the higher expression of anxiety within this population.
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A conceptual model of risk and protective factors associated with internalizing symptoms in autism spectrum disorder: A scoping review, synthesis, and call for more research. Dev Psychopathol 2020; 32:1254-1272. [PMID: 32893766 DOI: 10.1017/s095457942000084x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
This paper reviews and synthesizes key areas of research related to the etiology, development, and maintenance of internalizing symptoms in children, adolescents, and adults with autism spectrum disorder (ASD). In developing an integrated conceptual model, we draw from current conceptual models of internalizing symptoms in ASD and extend the model to include factors related to internalizing within other populations (e.g., children that have experienced early life stress, children with other neurodevelopmental conditions, typically developing children) that have not been systematically examined in ASD. Our review highlights the need for more research to understand the developmental course of internalizing symptoms, potential moderators, and the interplay between early risk and protective factors. Longitudinal studies incorporating multiple methods and both environmental and biological factors will be important in order to elucidate these mechanisms.
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Schwartzman JM, Corbett BA. Higher depressive symptoms in early adolescents with Autism Spectrum Disorder by self- and parent-report compared to typically-developing peers. RESEARCH IN AUTISM SPECTRUM DISORDERS 2020; 77:101613. [PMID: 32802155 PMCID: PMC7423017 DOI: 10.1016/j.rasd.2020.101613] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Depression is more prevalent among male early adolescents with Autism Spectrum Disorder (ASD) than their typically- developing (TD) peers, but findings are limited to two male-only studies. Therefore, a broader understanding of depressive symptoms among both male and female early adolescents with ASD in larger samples is needed. Self- and parent-ratings are frequently used, yet rater differences may emerge and provide unique insights. METHOD Ratings of adolescent depressive symptoms were examined among 230 early adolescents (10:0-13:5 years) with and without ASD using self- (Children's Depression Inventory, Second Edition; CDI-2) and parent- report (Child Behavior Checklist; CBCL) measures. The influence of diagnostic group (ASD vs. TD) and rater (early adolescent vs. parent) on ratings were examined with Full Scale IQ and sex as covariates. Additionally, the reliability and strength of agreement between raters were examined. RESULTS Higher depressive symptoms were reported by both raters in the ASD group (Borderline range) compared to the TD group (Average range). The interaction of diagnostic group and rater was nonsignificant, but significant main effects emerged. Sex was a significant covariate, but Full Scale IQ was not. The reliability and strength of agreement between raters in the ASD group only were not significant. CONCLUSIONS Findings suggest that depressive symptoms may be higher in both male and female early adolescents with ASD across self- and parent- reports. However, measurement of depression in ASD may be complicated by nonsignificant reliability and strength of agreement between raters. Results have implications for screening and intervention for early adolescents with ASD.
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Affiliation(s)
- Jessica M. Schwartzman
- Vanderbilt University Medical Center, 1601 23 Avenue South, Nashville, TN, United States 37212
| | - Blythe A. Corbett
- Vanderbilt University Medical Center, 1601 23 Avenue South, Nashville, TN, United States 37212
- Vanderbilt Kennedy Center, 110 Magnolia Circle, Nashville, TN, United States 37203
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7
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Examining the Effectiveness of WhatsApp-Based Spiritual Posts on Mitigating Stress and Building Resilience, Maternal Confidence and Self-efficacy Among Mothers of Children with ASD. J Autism Dev Disord 2020; 51:1479-1495. [PMID: 32734420 DOI: 10.1007/s10803-020-04633-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Spiritual posts delivered via WhatsApp were found effective for mothers of children with ASD in mitigating parenting stress and building parental self-efficacy, confidence and resilience as compared to a control group. Intervention compliance was a prerequisite, and, middle-class mothers, highly qualified, salaried/self-employed, who perceived full support from their spouses/families and who also participated in other support groups or skill development programs benefitted most. Latent class analyses revealed six subgroups of participants likely to gain most from the intervention: middle class mothers, highly qualified, salaried/self-employed, who participated in other skill development programs, above threshold posts readers and homework doers. Spirituality built mothers' psychological resources, but dyadic interventions may be needed for dealing with challenges and uncertainties of autistic child's emotional/behavioral characteristics.
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8
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Kana RK, Hudac CM, White SW. Developmental Considerations of Comorbidity in Autism Spectrum Disorder: The Need for Science Across Multiple Units of Analysis. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2019; 4:1016-1017. [PMID: 31812222 DOI: 10.1016/j.bpsc.2019.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 10/03/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Rajesh K Kana
- Department of Psychology, University of Alabama, Tuscaloosa, Alabama.
| | - Caitlin M Hudac
- Department of Psychology, University of Alabama, Tuscaloosa, Alabama; Center for Youth Development and Intervention, University of Alabama, Tuscaloosa, Alabama
| | - Susan W White
- Department of Psychology, University of Alabama, Tuscaloosa, Alabama; Center for Youth Development and Intervention, University of Alabama, Tuscaloosa, Alabama
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Improving Emotional Competence in Children With Autism Spectrum Disorder and Mild Intellectual Disability in Schools: A Preliminary Treatment Versus Waitlist Study. BEHAVIOUR CHANGE 2019. [DOI: 10.1017/bec.2019.13] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractThis pilot study evaluated the effectiveness of delivering a new cognitive behavioural intervention package ‘Emotion-Based Social Skills Training (EBSST) for Children with Autism Spectrum Disorder (ASD) and Mild Intellectual Disability (ASD + MID)’ in schools. Fourteen school counsellors nominated 75 children (aged 7–13 years) with ASD + MID to receive 16 sessions of EBSST in groups of 3–8 children in their schools. Parent and teacher pre-post ratings of emotional competence (Emotions Development Questionnaire), social skills (Social Skills Improvement System Rating Scales) and mental health (Developmental Behaviour Checklist) were collected. Forty-three children received 16 sessions of EBSST and 32 children were allocated to the 9-month waitlist control group. Teachers and parents also received six EBSST training sessions in separate groups at school. Significant improvements in parent and teacher ratings of emotional competence were found at posttreatment among children in the EBSST group relative to controls; however, the results were not significant after the Bonferroni adjustment. Small to medium effect sizes were found. No difference in untrained social skills or mental health was observed. This study provides preliminary support for the utility of EBSST in teaching emotional competence skills for children with ASD + MID in schools and provides valuable pilot data for future research.
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10
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Çetinkaya M, Üneri ÖŞ, Göker Z. Serum oxytocin and vasopressin levels in children with social anxiety disorder and the effects of parent characteristics. PSYCHIAT CLIN PSYCH 2018. [DOI: 10.1080/24750573.2018.1505280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- Miray Çetinkaya
- Department of Child and Adolescant Psychiatry, Dr. Sami Ulus Maternity and Child Health Training Hospital, Ankara, Turkey
| | - Özden Şükran Üneri
- Department of Child and Adolescant Psychiatry, Ankara Child Health and Hematology/Oncology Training and Research Hospital, Ankara, Turkey
| | - Zeynep Göker
- Department of Child and Adolescant Psychiatry, Ankara Child Health and Hematology/Oncology Training and Research Hospital, Ankara, Turkey
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11
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Jitlina K, Zumbo B, Mirenda P, Ford L, Bennett T, Georgiades S, Waddell C, Smith IM, Volden J, Duku E, Zwaigenbaum L, Szatmari P, Vaillancourt T, Elsabbagh M. Psychometric Properties of the Spence Children's Anxiety Scale: Parent Report in Children with Autism Spectrum Disorder. J Autism Dev Disord 2018; 47:3847-3856. [PMID: 28409361 DOI: 10.1007/s10803-017-3110-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Although anxiety is frequently reported in children with autism spectrum disorder (ASD), existing anxiety scales are often psychometrically inappropriate for this population. This study examined the internal structure, reliability, convergent and discriminant validity of the Spence Children's Anxiety Scale-Parent Report (SCAS-P; Spence 1999) in 238 school-aged children with ASD. While confirmatory factor analysis did not support the original six-correlated-factor structure, structural support as well as acceptable internal consistency and convergent validity was found for Generalized Anxiety, Separation Anxiety, Panic, and Agoraphobia subscales. Use of the SCAS-P in its original form for assessment in children with ASD was not supported. However, four subscales showed viability, and may benefit re-analyses of existing SCAS-P data and future scale adaptations for research and clinical purposes.
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Affiliation(s)
- Katia Jitlina
- University of British Columbia, Vancouver, BC, Canada.
| | - Bruno Zumbo
- University of British Columbia, Vancouver, BC, Canada
| | - Pat Mirenda
- University of British Columbia, Vancouver, BC, Canada
| | - Laurie Ford
- University of British Columbia, Vancouver, BC, Canada
| | | | | | | | - Isabel M Smith
- Dalhousie University/IWK Health Centre, Halifax, NS, Canada
| | | | - Eric Duku
- McMaster University, Hamilton, ON, Canada
| | | | - Peter Szatmari
- Centre for Addiction and Mental Health, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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12
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Kerns CM, Rump K, Worley J, Kratz H, McVey A, Herrington J, Miller J. The Differential Diagnosis of Anxiety Disorders in Cognitively-Able Youth With Autism. COGNITIVE AND BEHAVIORAL PRACTICE 2016. [DOI: 10.1016/j.cbpra.2015.11.004] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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13
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McGrew JH, Ruble LA, Smith IM. Autism spectrum disorder and evidence‐based practice in psychology. ACTA ACUST UNITED AC 2016. [DOI: 10.1111/cpsp.12160] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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14
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Mikita N, Simonoff E, Pine DS, Goodman R, Artiges E, Banaschewski T, Bokde AL, Bromberg U, Büchel C, Cattrell A, Conrod PJ, Desrivières S, Flor H, Frouin V, Gallinat J, Garavan H, Heinz A, Ittermann B, Jurk S, Martinot JL, Paillère Martinot ML, Nees F, Papadopoulos Orfanos D, Paus T, Poustka L, Smolka MN, Walter H, Whelan R, Schumann G, Stringaris A. Disentangling the autism-anxiety overlap: fMRI of reward processing in a community-based longitudinal study. Transl Psychiatry 2016; 6:e845. [PMID: 27351599 PMCID: PMC4931605 DOI: 10.1038/tp.2016.107] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 04/01/2016] [Accepted: 04/20/2016] [Indexed: 12/28/2022] Open
Abstract
Up to 40% of youth with autism spectrum disorder (ASD) also suffer from anxiety, and this comorbidity is linked with significant functional impairment. However, the mechanisms of this overlap are poorly understood. We investigated the interplay between ASD traits and anxiety during reward processing, known to be affected in ASD, in a community sample of 1472 adolescents (mean age=14.4 years) who performed a modified monetary incentive delay task as part of the Imagen project. Blood-oxygen-level dependent (BOLD) responses to reward anticipation and feedback were compared using a 2x2 analysis of variance test (ASD traits: low/high; anxiety symptoms: low/high), controlling for plausible covariates. In addition, we used a longitudinal design to assess whether neural responses during reward processing predicted anxiety at 2-year follow-up. High ASD traits were associated with reduced BOLD responses in dorsal prefrontal regions during reward anticipation and negative feedback. Participants with high anxiety symptoms showed increased lateral prefrontal responses during anticipation, but decreased responses following feedback. Interaction effects revealed that youth with combined ASD traits and anxiety, relative to other youth, showed high right insula activation when anticipating reward, and low right-sided caudate, putamen, medial and lateral prefrontal activations during negative feedback (all clusters PFWE<0.05). BOLD activation patterns in the right dorsal cingulate and right medial frontal gyrus predicted new-onset anxiety in participants with high but not low ASD traits. Our results reveal both quantitatively enhanced and qualitatively distinct neural correlates underlying the comorbidity between ASD traits and anxiety. Specific neural responses during reward processing may represent a risk factor for developing anxiety in ASD youth.
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Affiliation(s)
- N Mikita
- Department of Child and Adolescent Psychiatry, King's CollegeLondon, Institute of Psychiatry, Psychology & Neuroscience, London, UK,Departmentof Child and Adolescent Psychiatry, PO85, King's College London, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London SE5 8AF, UK. E-mail:
| | - E Simonoff
- Department of Child and Adolescent Psychiatry, King's CollegeLondon, Institute of Psychiatry, Psychology & Neuroscience, London, UK,NIHR Biomedical Research Centre and Dementia Unit at SouthLondon and Maudsley NHS Foundation Trust and the Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - D S Pine
- Section on Development and Affective Neuroscience, National Institute of Mental Health, Bethesda, MD, USA
| | - R Goodman
- Department of Child and Adolescent Psychiatry, King's CollegeLondon, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - E Artiges
- Institut National de la Santé et de la Recherche Médicale, INSERM Unit 1000 “Neuroimaging & Psychiatry”, Service Hospitalier Frédéric Joliot, Orsay, France,University Paris-Sud 11, Orsay, France,University Paris Descartes - Sorbonne Paris Cité, Paris, France,Psychiatry Department, Orsay Hospital, Orsay, France
| | - T Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - A L Bokde
- Discipline of Psychiatry, School of Medicine and Trinity College Institute of Neuroscience, Trinity College, Dublin, Ireland
| | - U Bromberg
- University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - C Büchel
- University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - A Cattrell
- Medical Research Council - Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - P J Conrod
- Department of Psychiatry, Universite de Montreal, CHU Ste Justine Hospital, Montreal, QC, Canada,Department of Psychological Medicine and Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - S Desrivières
- Medical Research Council - Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - H Flor
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - V Frouin
- Neurospin, Commissariat à l'Energie Atomique, CEA-Saclay Center, Paris, France
| | - J Gallinat
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - H Garavan
- Department of Psychiatry, University of Vermont, Burlington, VT, USA,Department of Psychology, University of Vermont, Burlington, VT, USA
| | - A Heinz
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité, Universitätsmedizin Berlin, Berlin, Germany
| | - B Ittermann
- Physikalisch-Technische Bundesanstalt, Braunschweig, Germany
| | - S Jurk
- Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany
| | - J L Martinot
- Institut National de la Santé et de la Recherche Médicale, INSERM Unit 1000 “Neuroimaging & Psychiatry”, Service Hospitalier Frédéric Joliot, Orsay, France,University Paris-Sud 11, Orsay, France,University Paris Descartes - Sorbonne Paris Cité, Paris, France,AP-HP, Department of Adolescent Psychopathology and Medicine, Maison de Solenn, Cochin Hospital, Paris, France
| | - M L Paillère Martinot
- Institut National de la Santé et de la Recherche Médicale, INSERM Unit 1000 “Neuroimaging & Psychiatry”, Service Hospitalier Frédéric Joliot, Orsay, France,University Paris-Sud 11, Orsay, France,University Paris Descartes - Sorbonne Paris Cité, Paris, France,AP-HP, Department of Adolescent Psychopathology and Medicine, Maison de Solenn, Cochin Hospital, Paris, France
| | - F Nees
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | | | - T Paus
- Rotman Research Institute, Baycrest, Toronto, ON, Canada,Child Mind Institute, New York, NY, USA,Department of Psychology, University of Toronto, Toronto, ON, Canada,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - L Poustka
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany,Department of Child and Adolescent Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - M N Smolka
- Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany
| | - H Walter
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité, Universitätsmedizin Berlin, Berlin, Germany
| | - R Whelan
- Department of Psychology, University College Dublin, Dublin, Ireland
| | - G Schumann
- Medical Research Council - Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - A Stringaris
- Department of Child and Adolescent Psychiatry, King's CollegeLondon, Institute of Psychiatry, Psychology & Neuroscience, London, UK
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Accordino RE, Kidd C, Politte LC, Henry CA, McDougle CJ. Psychopharmacological interventions in autism spectrum disorder. Expert Opin Pharmacother 2016; 17:937-52. [PMID: 26891879 DOI: 10.1517/14656566.2016.1154536] [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] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Individuals with autism spectrum disorder (ASD) commonly present for treatment of emotional and behavioral disturbances associated with ASD's "core" symptoms. Psychotropic medications are widely utilized in alleviating associated emotional and behavioral symptoms. AREAS COVERED Emotional and behavioral disturbances associated with ASD include irritability/severely disruptive behavior, which comprises the heaviest symptom burden; hyperactivity and other Attention-Deficit-Hyperactivity-Disorder (ADHD)-type symptoms; repetitive/stereotyped behaviors; and social withdrawal. Existing evidence for medications for each of these symptom clusters will be examined in this review. EXPERT OPINION Psychopharmacological treatment of core and associated symptoms in ASD is challenging, in large part because of the heterogeneity in the presentation of ASD. Furthermore, children and adolescents with ASD are more vulnerable to the side effects of psychopharmacological intervention than their age-matched, typically developing counterparts. Currently, risperidone and aripiprazole are the only medications that have been (relatively) reliably shown to help treat certain symptom clusters associated with ASD, namely severely disruptive behavior and hyperactivity. Recent studies have begun to look at medications with mechanisms that are novel in the treatment of ASD and that may address underlying pathophysiology and/or core symptoms such as glutamate-modulating agents. Overall, randomized, placebo-controlled studies of medications for the treatment of ASD are scarce.
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Affiliation(s)
- Robert E Accordino
- a Massachusetts General Hospital & McLean Hospital, Child & Adolescent Psychiatry Service , Yawkey Outpatient Care Center , Boston , MA , USA
| | - Christen Kidd
- b Payne-Whitney Clinic , New York-Presbyterian Hospital/Weill-Cornell Medical Center , New York , NY , USA
| | - Laura C Politte
- c Carolina Institute for Developmental Disabilities , University of North Carolina School of Medicine , Carrboro , NC , USA
| | - Charles A Henry
- d Massachusetts General Hospital, Harvard Medical School, Child & Adolescent Psychiatry Service , Yawkey Outpatient Care Center , Boston , MA , USA
| | - Christopher J McDougle
- e Lurie Center for Autism, Massachusetts General Hospital , Harvard Medical School , Lexington , MA , USA
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Nuske HJ, Vivanti G, Dissanayake C. No Evidence of Emotional Dysregulation or Aversion to Mutual Gaze in Preschoolers with Autism Spectrum Disorder: An Eye-Tracking Pupillometry Study. J Autism Dev Disord 2015; 45:3433-45. [DOI: 10.1007/s10803-015-2479-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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17
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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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Kerns CM, Kendall PC, Zickgraf H, Franklin ME, Miller J, Herrington J. Not to be overshadowed or overlooked: functional impairments associated with comorbid anxiety disorders in youth with ASD. Behav Ther 2015; 46:29-39. [PMID: 25526833 DOI: 10.1016/j.beth.2014.03.005] [Citation(s) in RCA: 110] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Revised: 02/21/2014] [Accepted: 03/11/2014] [Indexed: 12/28/2022]
Abstract
This study's objective was to examine associations between comorbid anxiety disorders and difficulties commonly attributed to both anxiety and ASD (autism spectrum disorder) including self-injury, depressive symptoms, functional communication, social skill deficits and parent stress, in a well-characterized sample of youth with ASD. Fifty-nine verbally fluent participants (7-17 years; 93% Caucasian) diagnosed with ASD and their parents completed semistructured diagnostic interviews to confirm ASD diagnosis and assess for anxiety disorders. Parents completed questionnaires on child behavior and social skill as well as parental stress. Co-occurring anxiety disorders were associated with more parent-reported self-injurious behavior, depressive symptoms, and parental stress in youth with ASD, after controlling for other influential variables (e.g., ASD severity, cognitive ability, medication status). In contrast, youth with co-occurring anxiety disorders appeared to have significantly stronger parent-reported functional communication than youth with ASD alone as well as a comparable ability, according to parents, to initiate social interaction and develop relationships. Findings support a profile of challenges and relative strengths associated with the presence of anxiety disorders in youth with ASD. Though more research is needed to determine the direction of these associations, results provide further rationale for improving recognition and targeted treatment of this comorbidity in clinical practice.
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Affiliation(s)
| | | | | | | | - Judith Miller
- Children's Hospital of Philadelphia, Center for Autism Research
| | - John Herrington
- Children's Hospital of Philadelphia, Center for Autism Research
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Zainal H, Magiati I, Tan JWL, Sung M, Fung DSS, Howlin P. A preliminary investigation of the Spence Children's Anxiety Parent Scale as a screening tool for anxiety in young people with autism spectrum disorders. J Autism Dev Disord 2014; 44:1982-94. [PMID: 24573336 DOI: 10.1007/s10803-014-2075-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Despite high rates of clinically elevated anxiety difficulties in children and adolescents with autism spectrum disorders (ASDs), very few studies have systematically examined the usefulness of commonly used caregiver report anxiety screening tools with this population. This study investigated the use of the Spence Children's Anxiety Scale-Parent version (SCAS-P) as a screening tool for anxiety disorders when compared to a standardized DSM-IV-TR-based clinical interview, the Kiddie-Schedule for Schizophrenia and Affective Disorders-Present and Lifetime version (K-SADS-PL). Thirty-two caregivers of youth with a clinical diagnosis of ASD (mean age 10.3 years) attending a specialist autism school participated in this study. They first completed the SCAS-P, a measure of adaptive functioning and a checklist of other emotional and behavioral difficulties. They were then interviewed with the K-SADS-PL. Internal consistency for the SCAS Total score was .88, but Cronbach's alphas were <.70 in three of the six SCAS-P subscales. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the SCAS-P against K-SADS diagnosis were .75, .71, .27, and .95, respectively. All values were >.70, except for the PPV. Evidence of convergent validity between the SCAS-P, K-SADS-PL and DBC anxiety subscale was also found. The high false positive rates notwithstanding, the preliminary data of acceptable to excellent sensitivity, specificity and NPV values tentatively suggest that the SCAS-P may be useful for screening non-help seeking young people with ASD for elevated anxiety symptoms. Further replication in larger studies is needed and ways in which the SCAS-P could be further developed and investigated for use with youth with ASD are discussed.
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Affiliation(s)
- Hani Zainal
- Department of Psychology, National University of Singapore (NUS), AS4, 9 Arts Link, Singapore, 117570, Singapore
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Henry CA, Nowinski L, Koesterer K, Ferrone C, Spybrook J, Bauman M. Low rates of depressed mood and depression diagnoses in a clinic review of children and adolescents with autistic disorder. J Child Adolesc Psychopharmacol 2014; 24:403-6. [PMID: 25198799 DOI: 10.1089/cap.2014.0024] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES The purpose of this study was to investigate the prevalence of depression diagnoses and related clinical data in an outpatient sample of youth with autistic disorder. METHODS Records of 123 psychiatrically referred children and adolescents with a Diagnostic and Statistical Manual of Mental Disorders, 4th ed., Text Revision (DSM-IV-TR) diagnosis of autistic disorder were examined. Mood disorder diagnoses and chief complaints along with family mood disorder history were the primary variables analyzed. RESULTS Four subjects (3%) presented with depressed mood. Irritability complaints were frequent (n=78, 63%). Six subjects (5%) received a mood disorder diagnosis; all with mood disorder, not otherwise specified. No subjects received a depressive disorder diagnosis. Family history of mood disorders was common. CONCLUSIONS Findings raise questions about the appropriate characterization and potential misdiagnoses of depression in youth with autistic disorder.
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Affiliation(s)
- Charles A Henry
- 1 Department of Psychiatry, Massachusetts General Hospital , Boston, Massachusetts
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21
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Wu X, Bai Y, Tan T, Li H, Xia S, Chang X, Zhou Z, Zhou W, Li T, Wang YT, Dong Z. Lithium ameliorates autistic-like behaviors induced by neonatal isolation in rats. Front Behav Neurosci 2014; 8:234. [PMID: 25018711 PMCID: PMC4071979 DOI: 10.3389/fnbeh.2014.00234] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 06/13/2014] [Indexed: 11/21/2022] Open
Abstract
Neonatal isolation is a widely accepted model to study the long-term behavioral changes produced by the early life events. However, it remains unknown whether neonatal isolation can induce autistic-like behaviors, and if so, whether pharmacological treatment can overcome it. Here, we reported that newborn rats subjected to individual isolations from their mother and nest for 1 h per day from postnatal days 1–9 displayed apparent autistic-like symptoms including social deficits, excessive repetitive self-grooming behavior, and increased anxiety- and depressive-like behaviors tested in young adult (postnatal days 42–56) compared to normal reared controls. Furthermore, these behavioral changes were accompanied by impaired adult hippocampal neurogenesis and reduced the ratio of excitatory/inhibitory synaptic transmissions, as reflected by an increase in spontaneous inhibitory postsynaptic current (sIPSC) and normal spontaneous excitatory postsynaptic current (sEPSC) in the hippocampal CA1 pyramidal neuron. More importantly, chronic administration of lithium, a clinically used mood stabilizer, completely overcame neonatal isolation-induced autistic-like behaviors, and restored adult hippocampal neurogenesis as well as the balance between excitatory and inhibitory activities to physiological levels. These findings indicate that neonatal isolation may produce autistic-like behaviors, and lithium may be a potential therapeutic agent against autism spectrum disorders (ASD) during development.
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Affiliation(s)
- Xiaoyan Wu
- Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University Chongqing, China ; Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Children's Hospital of Chongqing Medical University Chongqing, China
| | - Yanrui Bai
- Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University Chongqing, China ; Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Children's Hospital of Chongqing Medical University Chongqing, China
| | - Tao Tan
- Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University Chongqing, China ; Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Children's Hospital of Chongqing Medical University Chongqing, China
| | - Hongjie Li
- Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University Chongqing, China ; Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Children's Hospital of Chongqing Medical University Chongqing, China
| | - Shuting Xia
- Ministry of Education Key Laboratory of Developmental Genes and Human Disease, Institute of Life Sciences, Southeast University Nanjing, China
| | - Xinxia Chang
- Ministry of Education Key Laboratory of Developmental Genes and Human Disease, Institute of Life Sciences, Southeast University Nanjing, China
| | - Zikai Zhou
- Ministry of Education Key Laboratory of Developmental Genes and Human Disease, Institute of Life Sciences, Southeast University Nanjing, China
| | - Weihui Zhou
- Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University Chongqing, China ; Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Children's Hospital of Chongqing Medical University Chongqing, China
| | - Tingyu Li
- Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University Chongqing, China ; Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Children's Hospital of Chongqing Medical University Chongqing, China
| | - Yu Tian Wang
- Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University Chongqing, China ; Brain Research Centre, University of British Columbia Vancouver, BC, Canada
| | - Zhifang Dong
- Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University Chongqing, China ; Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Children's Hospital of Chongqing Medical University Chongqing, China
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Gotham K, Unruh K, Lord C. Depression and its measurement in verbal adolescents and adults with autism spectrum disorder. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2014; 19:491-504. [PMID: 24916450 DOI: 10.1177/1362361314536625] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In a sample of 50 verbally fluent adolescents and adults with autism spectrum disorders (age: 16-31 years; verbal IQ: 72-140), we examined the pattern of response and associations between scores on common measures of depressive symptoms, participant characteristics, and clinical diagnosis of depressive disorders. Beck Depression Inventory-Second Edition item descriptives in this autism spectrum disorder sample were compared to previously published data from a large typically developing sample, with results suggesting that cognitive-attributional symptoms of depression may be particularly prevalent in autism spectrum disorder. Scores on a variety of self- and parent-report depression measures were not associated with chronological age or verbal IQ, and were relatively highly correlated with each other and with clinical diagnosis of a mood disorder. The Beck Depression Inventory-Second Edition and the Adult Self-Report "Depressive" scale best identified both depressed and non-depressed participants in this sample, though neither was particularly strong. Validation studies of depression measures in the autism spectrum disorder population are necessary to advance research into this prevalent and impairing comorbidity.
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Gotham K, Bishop SL, Brunwasser S, Lord C. Rumination and perceived impairment associated with depressive symptoms in a verbal adolescent-adult ASD sample. Autism Res 2014; 7:381-91. [PMID: 24802136 DOI: 10.1002/aur.1377] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 03/19/2014] [Indexed: 11/06/2022]
Abstract
The aim of this study was to examine the association between depressive symptoms and several psychosocial constructs (insight into autism symptoms, rumination, desire for social interaction, and satisfaction with social support) that may play a role in the development or maintenance of depression in verbally fluent adolescents and adults with ASD. Participants included 50 individuals with ASD and verbal IQ ≥ 70, aged 16-35 (sample size varied by measure). Elevated depressive symptoms on the Beck Depression Inventory, 2nd edition (BDI-II), were associated with greater self-perceived, autism-related impairments (n = 48), greater rumination (n = 21), and lower perceived social support (n = 37). Rumination tended to moderate the association between self-perceived autism symptoms and BDI-II scores (n = 21), and was significantly associated with ASD-related insistence on sameness behaviors (n = 18). An unexpected relationship between depressive features and social participation and motivation will need to be clarified by longitudinal research. These and similar findings contribute to our understanding of the phenomenology of depression in ASD, which is critical to the development of practical prevention and treatment.
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Affiliation(s)
- Katherine Gotham
- Department of Psychiatry, Vanderbilt University School of Medicine, Nashville, Tennessee
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24
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Hollocks MJ, Jones CRG, Pickles A, Baird G, Happé F, Charman T, Simonoff E. The association between social cognition and executive functioning and symptoms of anxiety and depression in adolescents with autism spectrum disorders. Autism Res 2014; 7:216-28. [PMID: 24737743 DOI: 10.1002/aur.1361] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 01/12/2014] [Indexed: 12/28/2022]
Abstract
While high levels of anxiety and depression are now recognized as major co-occurring problems in children and young people with an autism spectrum disorder (ASD), research examining possible associations with individual differences in neurocognitive functioning has been limited. This study included 90 adolescents with an ASD aged 14-16 years with a full-scale IQ > 50. Using structural equation modeling, we examined the independent relationships between multiple measures of executive functioning and social cognition on severity of anxiety or depressive symptoms. Results indicated a significant association between poorer executive functioning and higher levels of anxiety, but not depression. In contrast, social cognition ability was not associated with either anxiety or depression. This study is the first to report significant associations between executive functions and anxiety in ASD. This may suggest that poor executive functioning is one factor associated with the high prevalence of anxiety disorder in children and adolescents with ASD.
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Affiliation(s)
- Matthew J Hollocks
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, King's College London, London, United Kingdom
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25
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Abstract
After participating in this educational activity, the physician should be better able to1. Prescribe the appropriate psychotropic medication to treat symptoms of ASD.2. Identify the side effects of the psychotropic medications used to treat ASD.Autism spectrum disorders (ASDs) are characterized by core deficits in social communication and language, and restrictive and repetitive behaviors that cause significant functional impairment and distress for affected individuals and their caregivers. The increasing prevalence of ASD, most recently estimated as 1 in 88 children, presents an ever-increasing burden on families, schools, medical systems, and society at large. Individuals with ASD commonly present for treatment of associated emotional and behavioral disturbances that include anxiety, symptoms of ADHD, compulsions and other repetitive behaviors, mood lability, irritability, aggression, and sleep disturbance. Psychotropic medications are widely utilized in alleviating these symptoms, though rigorous clinical trials in ASD are lacking for most areas of impairment. Strong evidence from randomized, placebo-controlled trials supports the use of atypical antipsychotics, particularly risperidone and aripiprazole, for managing severe irritability and aggression in ASD. Serotonin reuptake inhibitors are commonly used to treat anxiety and compulsions, though reports of efficacy in the literature are mixed, and behavioral side effects in children are common. Minimal evidence supports the utility of anticonvulsants and traditional mood stabilizers in managing mood lability and aggression. Stimulant and nonstimulant ADHD medications can be effective for reducing hyperactivity, inattention, and impulsivity, though to a lesser degree than in ADHD populations without ASD and with greater risk of adverse effects. Psychopharmacological interventions in development for core symptoms of autism include those that target the glutamatergic and GABAergic neurotransmitter systems and the neuropeptide oxytocin. Further research is needed to establish evidence-based interventions in ASD populations.
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26
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Babri S, Doosti MH, Salari AA. Strain-dependent effects of prenatal maternal immune activation on anxiety- and depression-like behaviors in offspring. Brain Behav Immun 2014; 37:164-76. [PMID: 24326014 DOI: 10.1016/j.bbi.2013.12.003] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 11/25/2013] [Accepted: 12/02/2013] [Indexed: 12/20/2022] Open
Abstract
There is converging evidence that prenatal maternal infection can increase the risk of occurrence of neuropsychiatric disorders like schizophrenia, autism, anxiety and depression in later life. Experimental studies have shown conflicting effects of prenatal maternal immune activation on anxiety-like behavior and hypothalamic-pituitary-adrenal (HPA) axis development in offspring. We investigated the effects of maternal immune activation during pregnancy on anxiety- and depression-like behaviors in pregnant mice and their offspring to determine whether these effects are dependent on strain. NMRI and C57BL/6 pregnant mice were treated with either saline or lipopolysaccharide on gestational day 17 and then interleukin (IL)-6 and corticosterone (COR) levels; anxiety or depression in the pregnant mice and their offspring were evaluated. The results indicate that maternal inflammation increased the levels of COR and anxiety-like behavior in NMRI pregnant mice, but not in C57BL/6 dams. Our data also demonstrate that maternal inflammation elevated the levels of anxiety-and depression-like behaviors in NMRI offspring on the elevated plus-maze, elevated zero-maze, tail suspension test and forced swimming test respectively, but not in the open field and light-dark box. In addition, we did not find any significant change in anxiety- and depression-like behaviors of adult C57BL/6 offspring. Our findings suggest that prenatal maternal immune activation can alter the HPA axis activity, anxiety- and depression-like behaviors in a strain- and task-dependent manner in offspring and further comprehensive studies are needed to prove the causal relationship between the findings found here and to validate their relevance to neuropsychiatric disorders in humans.
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Affiliation(s)
- Shirin Babri
- Laboratory of Physiology, Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad-Hossein Doosti
- Laboratory of Immunology, Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali-Akbar Salari
- Laboratory of Physiology, Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; Laboratory of Immunology, Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
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27
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Abstract
The purpose of this article is to describe emotion regulation, and how emotion regulation may be compromised in patients with autism spectrum disorder (ASD). This information may be useful for clinicians working with children with ASD who exhibit behavioral problems. Suggestions for practice are provided.
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Affiliation(s)
- Carla A. Mazefsky
- Assistant Professor, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
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Sharma S, Woolfson LM, Hunter SC. Maladaptive cognitive appraisals in children with high-functioning autism: associations with fear, anxiety and theory of mind. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2013; 18:244-54. [PMID: 24092841 DOI: 10.1177/1362361312472556] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Despite the well-documented success of cognitive restructuring techniques in the treatment of anxiety disorders, there is still little clarity on which cognitions underpin fear and anxiety in children with high-functioning autism spectrum disorder. This study examined whether certain cognitive appraisals, known to be associated with fear and anxiety in typically developing groups, may help explain these emotions in children with high-functioning autism spectrum disorder. It also investigated relations between these cognitive appraisals and theory of mind. Appraisals, fear and anxiety were assessed using a vignette approach in 22 children with high-functioning autism spectrum disorders and 22 typically developing children. The two groups differed significantly on all four appraisal types. Anxiety was negatively correlated with future expectancy and positively with problem-focused coping potential in the high-functioning autism spectrum disorder group but was not correlated with appraisals in the typically developing group. The two appraisals associated with fear were emotion-focused coping potential (in the high-functioning autism spectrum disorder group only) and self-accountability (in the typically developing group only). Linear regression analysis found that appraisals of emotion-focused coping potential, problem-focused coping potential and future expectancy were significant predictors of theory-of-mind ability in the high-functioning autism spectrum disorders group. These findings indicate that specific, problematic patterns of appraisal may characterise children with high-functioning autism spectrum disorders.
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Berthoz S, Lalanne C, Crane L, Hill EL. Investigating emotional impairments in adults with autism spectrum disorders and the broader autism phenotype. Psychiatry Res 2013; 208:257-64. [PMID: 23747233 DOI: 10.1016/j.psychres.2013.05.014] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Revised: 02/11/2013] [Accepted: 05/09/2013] [Indexed: 01/24/2023]
Abstract
There is an increasing interest in the socio-affective atypicalities observed in adults with autism spectrum disorder (ASD). The aim of this study was to further explore emotional responsiveness in adults with ASD using well-validated self-reports of alexithymia and to determine whether anhedonic features are part of a broader autism phenotype (BAP). Participants comprised 38 adults with ASD, 87 parents of ASD individuals and 47 typical controls. All participants completed the Autism Spectrum Quotient (AQ), the 20-item Toronto Alexithymia Scale, and the Bermond-Vorst Alexithymia Questionnaire, as well as the Chapman Physical and Social Anhedonia Scales. The ASD group differed from controls and parents on most measures, with the exception of physical and social anhedonia, relative to parents. Parents differed from controls on social anhedonia, and a higher proportion of parents were classed as alexithymic, relative to controls. Cluster analysis revealed that some parents share more similarities with ASD participants than with controls. The results suggest that socio-affective impairments characteristic of ASD are part of the BAP.
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Affiliation(s)
- Sylvie Berthoz
- Institut National de la Santé et de la Recherche Médicale (INSERM U669), Maison de Solenn-Cochin, Paris, France
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30
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Conner CM, Maddox BB, White SW. Parents' state and trait anxiety: relationships with anxiety severity and treatment response in adolescents with autism spectrum disorders. J Autism Dev Disord 2013; 43:1811-8. [PMID: 23224592 PMCID: PMC11097144 DOI: 10.1007/s10803-012-1728-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Comorbid anxiety is common among children with Autism Spectrum Disorder (ASD), and parents of children with ASD are more likely to have anxiety disorders. This study investigated the relationship between parents' state and trait anxiety and parent-reported internalizing and externalizing symptoms among adolescents (n = 30) with ASD, as well as the relationship of parents' anxiety symptoms and adolescent treatment response in the context of a randomized controlled trial. Parental state anxiety correlated with severity of adolescent anxiety, and trait anxiety in parents correlated with parent-reported adolescent internalizing and externalizing symptoms. Also, parents of adolescent treatment responders experienced a decrease in their own trait anxiety. Findings highlight the importance of considering parental anxiety when targeting anxiety among youth with ASD.
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Affiliation(s)
- Caitlin M Conner
- Department of Psychology, Virginia Polytechnic Institute and State University, 109 Williams Hall (0436), Blacksburg, VA 24061, USA.
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31
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Kerns CM, Kendall PC. The presentation and classification of anxiety in autism spectrum disorder. ACTA ACUST UNITED AC 2012. [DOI: 10.1111/cpsp.12009] [Citation(s) in RCA: 137] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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32
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Simonoff E, Jones CRG, Pickles A, Happé F, Baird G, Charman T. Severe mood problems in adolescents with autism spectrum disorder. J Child Psychol Psychiatry 2012; 53:1157-66. [PMID: 22909395 DOI: 10.1111/j.1469-7610.2012.02600.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Severe mood dysregulation and problems (SMP) in otherwise typically developing youth are recognized as an important mental health problem with a distinct set of clinical features, family history and neurocognitive characteristics. SMP in people with autism spectrum disorders (ASDs) have not previously been explored. METHOD We studied a longitudinal, population-based cohort of adolescents with ASD in which we collected parent-reported symptoms of SMP that included rage, low and labile mood and depressive thoughts. Ninety-one adolescents with ASD provided data at age 16 years, of whom 79 had additional data from age 12. We studied whether SMP have similar correlates to those seen in typically developing youth. RESULTS Severe mood problems were associated with current (parent-rated) and earlier (parent- and teacher-rated) emotional problems. The number of prior psychiatric diagnoses increased the risk of subsequent SMP. Intellectual ability and adaptive functioning did not predict to SMP. Maternal mental health problems rated at 12 and 16 years were associated with SMP. Autism severity as rated by parents was associated with SMP, but the relationship did not hold for clinician ratings of autistic symptoms or diagnosis. SMP were associated with difficulty in identifying the facial expression of surprise, but not with performance recognizing other emotions. Relationships between SMP and tests of executive function (card sort and trail making) were not significant after controlling for IQ. CONCLUSIONS This is the first study of the behavioural and cognitive correlates of severe mood problems in ASD. As in typically developing youth, SMP in adolescents with ASD are related to other affective symptoms and maternal mental health problems. Previously reported links to deficits in emotion recognition and cognitive flexibility were not found in the current sample. Further research is warranted using categorical and validated measures of SMP.
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Affiliation(s)
- Emily Simonoff
- Department of Child and Adolescent Psychiatry, King's College London, Institute of Psychiatry and NIHR Biomedical Research Centre for Mental Health, De Crespigny Park, London, UK.
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Lohr WD, Le JF. An 11-year-old boy with tantrums and head banging. Pediatr Ann 2012; 41:1-3. [PMID: 23052136 DOI: 10.3928/00904481-20120924-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- W David Lohr
- University of Louisville School of Medicine, Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Louisville, KY, USA
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34
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Ozinci Z, Kahn T, Antar LN. Depression in Patients with Autism Spectrum Disorder. Psychiatr Ann 2012. [DOI: 10.3928/00485713-20120806-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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35
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Solomon M, Miller M, Taylor SL, Hinshaw SP, Carter CS. Autism symptoms and internalizing psychopathology in girls and boys with autism spectrum disorders. J Autism Dev Disord 2012; 42:48-59. [PMID: 21442362 PMCID: PMC3244604 DOI: 10.1007/s10803-011-1215-z] [Citation(s) in RCA: 172] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Findings regarding phenotypic differences between boys and girls with ASD are mixed. We compared autism and internalizing symptoms in a sample of 8-18 year-old girls (n = 20) and boys (n = 20) with ASD and typically developing (TYP) girls (n = 19) and boys (n = 17). Girls with ASD were more impaired than TYP girls but did not differ from boys with ASD in autism symptoms. In adolescence, girls with ASD had higher internalizing symptoms than boys with ASD and TYP girls, and higher symptoms of depression than TYP girls. Girls ages 8-18 with ASD resemble boys with ASD and not TYP girls, and appear to be at increased risk for affective symptoms in the teen years.
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Affiliation(s)
- Marjorie Solomon
- Department of Psychiatry & Behavioral Sciences, University of California, Davis, Davis, CA, USA.
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Brito MC, Misquiatti ARN. Iniciativas de comunicação na interação entre crianças com distúrbios do espectro autístico e suas mães: análise pragmática. REVISTA CEFAC 2011. [DOI: 10.1590/s1516-18462011005000052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJETIVOS: investigar as iniciativas de comunicação na interação entre crianças com distúrbios do espectro autístico (DEA) e suas mães, por meio de uma análise pragmática. MÉTODO: cinco crianças com DEA, de ambos os gêneros, idades entre cinco e 12 anos juntamente com suas mães. O grupo controle constou de cinco crianças com desenvolvimento normal, pareadas com as crianças com DEA de acordo com gênero e idade e suas respectivas mães, totalizando 20 participantes. Para a caracterização da amostra foram utilizadas uma Ficha informativa e a Escala de Avaliação de Traços Autísticos. Cada díade foi filmada por 30 minutos durante as interações lúdicas, analisadas a partir do Protocolo de Pragmática. Este instrumento avalia as iniciativas de comunicação, meios e funções comunicativas expressas. Os dados foram tratados estatisticamente (p < 0,05; foram utilizados os testes não-paramétricos de Wilcoxon e de Mann-Whitney). RESULTADOS: foram observadas diferenças estatisticamente significantes entre as iniciativas comunicativas das crianças com DEA e suas mães, quando comparadas ao grupo controle. As díades que envolveram crianças com DEA iniciaram menos a comunicação e utilizaram predominantemente gestos e vocalizações menos interativas. CONCLUSÕES: estes dados possibilitaram descrever aspectos fundamentais para compreensão das manifestações clínicas da população estudada e para a elaboração de programas de intervenção que visem melhorar a qualidade de vida da criança e sua família.
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