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Saletin JM, Koopman-Verhoeff ME, Han G, Barker DH, Carskadon MA, Anders TF, Sheinkopf SJ. Sleep Problems and Autism Impairments in a Large Community Sample of Children and Adolescents. Child Psychiatry Hum Dev 2024; 55:1167-1175. [PMID: 36515855 DOI: 10.1007/s10578-022-01470-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/12/2022] [Indexed: 12/15/2022]
Abstract
Sleep problems are common in individuals with autism spectrum disorder (ASD). How sleep problems reflect specific ASD phenotypes is unclear. We studied whether sleep problems indexed functional impairment in a heterogeneous community sample of individuals with ASD. We analyzed 977 probands (233 females; age = 11.27 ± 4.13 years) from the Rhode Island Consortium for Autism Research and Treatment dataset, a unique public-private-academic collaboration involving all major points of service for families in Rhode Island. We found that individuals with a confirmed diagnosis of ASD were more likely to have sleep problems. However, across the whole sample and above and beyond a formal diagnosis, sleep problems were dimensionally associated with worse social impairment and poorer adaptive functioning. By using a large dataset reflective of the diversity of presentations in the community, this study underscores the importance of considering sleep problems in clinical practice to improve adaptive functioning in individuals with ASD.
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Affiliation(s)
- Jared M Saletin
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.
- Emma Pendleton Bradley Hospital, East Providence, RI, USA.
- Sleep Research Laboratory, Emma Pendleton Bradley Hospital, Providence, RI, USA.
| | - M Elisabeth Koopman-Verhoeff
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
- Emma Pendleton Bradley Hospital, East Providence, RI, USA
- Sleep Research Laboratory, Emma Pendleton Bradley Hospital, Providence, RI, USA
| | - Gloria Han
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
- Department of Anesthesiology, Vanderbilt Medical Center, Nashville, TN, USA
| | - David H Barker
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
- The Bradley Hasbro Children's Research Center, Providence, RI, USA
| | - Mary A Carskadon
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
- Emma Pendleton Bradley Hospital, East Providence, RI, USA
- Sleep Research Laboratory, Emma Pendleton Bradley Hospital, Providence, RI, USA
| | - Thomas F Anders
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
- Emma Pendleton Bradley Hospital, East Providence, RI, USA
| | - Stephen J Sheinkopf
- Brown Center for the Study of Children at Risk, Women & Infants Hospital, Providence, RI, USA
- Thompson Center for Autism and Neurodevelopment, University of Missouri, Columbia, MO, USA
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2
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Harrop C, Tomaszewski B, Putnam O, Klein C, Lamarche E, Klinger L. Are the diagnostic rates of autistic females increasing? An examination of state-wide trends. J Child Psychol Psychiatry 2024; 65:973-983. [PMID: 38181181 PMCID: PMC11161335 DOI: 10.1111/jcpp.13939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/02/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND Autism has been considered a 'male-dominant' condition. However, recent research suggests that autistic females are underdiagnosed, misdiagnosed, and later diagnosed. Females may also have different and more nuanced behavioral profiles. To examine diagnosis rates of females, we used 20 years of state-wide data to characterize historical trends in the diagnosis of autism in females to determine whether the proportion of females diagnosed with autism has changed over time. METHODS Data were drawn from 10,247 participants (males = 8,319, females = 1928) who received an autism diagnosis between 2000 and 2021 from state-wide autism centers associated with the University of North Carolina TEACCH Autism Program. RESULTS The rates of females diagnosed with autism increased at a greater rate compared with males. Age of diagnosis remained consistently higher for females. Late diagnosis (defined as 13+) increased over time across both males and females, however, was more commonly associated with females, particularly those with co-occurring intellectual disability. CONCLUSIONS Our results indicate that the proportion of females diagnosed with autism has increased steadily over a 20-year period, which likely reflects greater societal knowledge of how autism may manifest differentially in females.
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Affiliation(s)
- Clare Harrop
- Department of Health Sciences, University of North Carolina at Chapel Hill, USA
- University of North Carolina TEACCH Autism Program
| | - Brianne Tomaszewski
- University of North Carolina TEACCH Autism Program
- Department of Psychiatry, University of North Carolina at Chapel Hill, USA
| | - Orla Putnam
- Department of Health Sciences, University of North Carolina at Chapel Hill, USA
| | - Claire Klein
- University of North Carolina TEACCH Autism Program
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, USA
| | | | - Laura Klinger
- University of North Carolina TEACCH Autism Program
- Department of Psychiatry, University of North Carolina at Chapel Hill, USA
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3
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McQuaid GA, Ratto AB, Jack A, Khuu A, Smith JV, Duane SC, Clawson A, Lee NR, Verbalis A, Pelphrey KA, Kenworthy L, Wallace GL, Strang JF. Gender, assigned sex at birth, and gender diversity: Windows into diagnostic timing disparities in autism. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024:13623613241243117. [PMID: 38587289 PMCID: PMC11458814 DOI: 10.1177/13623613241243117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
LAY ABSTRACT Later autism diagnosis is associated with risk for mental health problems. Understanding factors related to later autism diagnosis may help reduce mental health risks for autistic people. One characteristic associated with later autism diagnosis is female sex. However, studies often do not distinguish sex assigned at birth and gender identity. Gender diversity may be more common in autistic relative to neurotypical people, and autism is more common in gender-diverse populations. We studied age at autism diagnosis by sex assigned at birth, gender identity, and gender diversity (gender-diverse vs cisgender) status, separately. We studied three separate autistic samples, each of which differed in how they were diagnosed and how they were recruited. The samples included 193 persons (8.0-18.0 years) from a research-recruited academic medical center sample; 1,550 people (1.3-25.4 years) from a clinic-based sample; and 244 people (18.2-30.0 years) from a community-enriched sample. We found significant differences in the clinic-based and community-enriched samples. People assigned female sex at birth were diagnosed with autism significantly later than people assigned male at birth. People of female gender were diagnosed significantly later than people of male gender. Gender-diverse people were diagnosed significantly later than cisgender people. Sex assigned at birth, gender identity, and gender diversity may each show unique relationships with age of autism diagnosis. Differences in how autistic people are diagnosed and recruited are important to consider in studies that examine sex assigned at birth or gender identity. More research into autism diagnosis in adulthood is needed.
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Cuneo N, Floyd S, Goldberg AE. Word meaning is complex: Language-related generalization differences in autistic adults. Cognition 2024; 244:105691. [PMID: 38218051 DOI: 10.1016/j.cognition.2023.105691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 12/02/2023] [Accepted: 12/07/2023] [Indexed: 01/15/2024]
Abstract
The current study marries two important observations. First, there is a growing recognition that word meanings need to be flexibly extended in new ways as new contexts arise. Second, as evidenced primarily within the perceptual domain, autistic individuals tend to find generalization more challenging while showing stronger veridical memory in comparison to their neurotypical peers. Here we report that a group of 80 autistic adults finds it more challenging to flexibly extend the meanings of familiar words in new ways than a group of 80 neurotypical peers, while the autistic individuals outperform the neurotypicals on a novel word-learning task that does not require flexible extension. Results indicate that recognized differences in generalization present an ongoing challenge for autistic adults in the domain of language, separate from social cognition, executive function, or the ability to assign single fixed meanings to new words.
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5
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Bhargava H, Salomon C, Suresh S, Chang A, Kilian R, Stijn DV, Oriol A, Low D, Knebel A, Taraman S. Promises, Pitfalls, and Clinical Applications of Artificial Intelligence in Pediatrics. J Med Internet Res 2024; 26:e49022. [PMID: 38421690 PMCID: PMC10940991 DOI: 10.2196/49022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 09/01/2023] [Accepted: 01/22/2024] [Indexed: 03/02/2024] Open
Abstract
Artificial intelligence (AI) broadly describes a branch of computer science focused on developing machines capable of performing tasks typically associated with human intelligence. Those who connect AI with the world of science fiction may meet its growing rise with hesitancy or outright skepticism. However, AI is becoming increasingly pervasive in our society, from algorithms helping to sift through airline fares to substituting words in emails and SMS text messages based on user choices. Data collection is ongoing and is being leveraged by software platforms to analyze patterns and make predictions across multiple industries. Health care is gradually becoming part of this technological transformation, as advancements in computational power and storage converge with the rapid expansion of digitized medical information. Given the growing and inevitable integration of AI into health care systems, it is our viewpoint that pediatricians urgently require training and orientation to the uses, promises, and pitfalls of AI in medicine. AI is unlikely to solve the full array of complex challenges confronting pediatricians today; however, if used responsibly, it holds great potential to improve many aspects of care for providers, children, and families. Our aim in this viewpoint is to provide clinicians with a targeted introduction to the field of AI in pediatrics, including key promises, pitfalls, and clinical applications, so they can play a more active role in shaping the future impact of AI in medicine.
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Affiliation(s)
- Hansa Bhargava
- Children's Hospital of Atlanta, Atlanta, GA, United States
- School of Medicine, Emory University, Atlanta, GA, United States
- Healio, South New Jersey, NJ, United States
| | | | - Srinivasan Suresh
- Division of Health Informatics, Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, United States
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States
| | - Anthony Chang
- Fowler School of Engineering, Chapman University, Orange, CA, United States
| | | | | | - Albert Oriol
- Rady Children's Hospital, San Diego, CA, United States
| | | | | | - Sharief Taraman
- Cognoa, Inc, Palo Alto, CA, United States
- Children's Hospital of Orange County, Orange, CA, United States
- University of California Irvine School of Medicine, Irvine, CA, United States
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6
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Clarke EB, McCauley JB, Lutz A, Gotelli M, Sheinkopf SJ, Lord C. Understanding profound autism: implications for stigma and supports. Front Psychiatry 2024; 15:1287096. [PMID: 38317766 PMCID: PMC10839016 DOI: 10.3389/fpsyt.2024.1287096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 01/02/2024] [Indexed: 02/07/2024] Open
Abstract
Introduction Societal perceptions and lack of understanding of autism spectrum disorder can be stigmatizing for autistic individuals and their families. This may be particularly the case for individuals who meet criteria for profound autism. Despite the considerable service needs of this marginalized group, there is little data on the prevalence of profound autism, nor on the experiences of those with profound autism and their families. Methods The current study leveraged a mixed-methods approach to address these gaps. First, the prevalence of profound autism was examined in six samples-three from the United States and three from Western Europe. Second, inductive thematic analysis was used to code interviews from 20 caregivers of profoundly autistic adults. Results The prevalence of profound autism varied widely across the six samples-from 11% to 48%. There were also notable differences between samples in prevalence by gender, race, and ethnicity. Two overarching themes were identified via inductive thematic analysis: Community Perceptions of Autism and Family Support Needs and Advocacy Challenges. Though caregivers were not directly asked about stigmatization during interviews, 85% of caregivers reported at least one instance of perceived stigma. Discussion Future research should continue to examine the unique needs and stigmatization experiences of profoundly autistic individuals and their families across the life course.
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Affiliation(s)
- Elaine B. Clarke
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - James B. McCauley
- Department of Psychology, St. Mary’s College of California, Moraga, CA, United States
| | - Amy Lutz
- Department of History and Sociology of Science, University of Pennsylvania, Philadelphia, PA, United States
| | - Marina Gotelli
- Fundación Brincar por un Autismo Feliz, Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas Y Técnicas, Buenos Aires, Argentina
| | - Stephen J. Sheinkopf
- Thompson Center for Autism and Neurodevelopment, University of Missouri, Columbia, MO, United States
| | - Catherine Lord
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
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7
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Brown KA, Donise KR, Cancilliere MK, Aluthge DP, Chen ES. Characterizing Autism Spectrum Disorder and Predicting Suicide Risk for Pediatric Psychiatric Emergency Services Encounters. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2024; 2023:864-873. [PMID: 38222397 PMCID: PMC10785882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
Individuals diagnosed with autism spectrum disorder (ASD) are at a higher risk for mental health concerns including suicidal thoughts and behaviors (STB). Limited studies have focused on suicidal risk factors that are more prevalent or unique to the population with ASD. This study sought to characterize and classify youth presenting to the psychiatric emergency department (ED) for a chief complaint of STB. The results of this study validated that a high number of patients with ASD present to the ED with STB. There were important differences in clinical characteristics to those with ASD versus those without. Clinical features that showed important impact in predicting high suicide risk in the ASD cases include elements of the mental status exam such as affect, trauma symptoms, abuse history, and auditory hallucinations. Focused attention is needed on these unique differences in ASD cases so that suicide risk level can be appropriately and promptly addressed.
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Affiliation(s)
| | - Kathleen R Donise
- Department of Psychiatry and Human Behavior at Alpert Medical School, Brown University, Providence RI
- Department of Child and Adolescent Psychiatry, Hasbro Children's Hospital, Providence RI
| | - Mary Kathryn Cancilliere
- Department of Psychiatry and Human Behavior at Alpert Medical School, Brown University, Providence RI
- Department of Child and Adolescent Psychiatry, Hasbro Children's Hospital, Providence RI
| | - Dilum P Aluthge
- Center for Biomedical Informatics, Brown University, Providence RI
| | - Elizabeth S Chen
- Center for Biomedical Informatics, Brown University, Providence RI
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8
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Lai MC, Amestoy A, Bishop S, Brown HM, Giwa Onaiwu M, Halladay A, Harrop C, Hotez E, Huerta M, Kelly A, Miller D, Nordahl CW, Ratto AB, Saulnier C, Siper PM, Sohl K, Zwaigenbaum L, Goldman S. Improving autism identification and support for individuals assigned female at birth: clinical suggestions and research priorities. THE LANCET. CHILD & ADOLESCENT HEALTH 2023; 7:897-908. [PMID: 37973254 DOI: 10.1016/s2352-4642(23)00221-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 08/11/2023] [Accepted: 08/11/2023] [Indexed: 11/19/2023]
Abstract
Emerging evidence suggests that the higher prevalence of autism in individuals who are assigned male than assigned female at birth results from both biological factors and identification biases. Autistic individuals who are assigned female at birth (AFAB) and those who are gender diverse experience health disparities and clinical inequity, including late or missed diagnosis and inadequate support. In this Viewpoint, an international panel of clinicians, scientists, and community members with lived experiences of autism reviewed the challenges in identifying autism in individuals who are AFAB and proposed clinical and research directions to promote the health, development, and wellbeing of autistic AFAB individuals. The recognition challenges stem from the interplay between cognitive differences and nuanced or different presentations of autism in some AFAB individuals; expectancy, gender-related, and autism-related biases held by clinicians; and social determinants. We recommend that professional development for clinicians be supported by health-care systems, professional societies, and governing bodies to improve equitable access to assessment and earlier identification of autism in AFAB individuals. Autistic AFAB individuals should receive tailored support in education, identity development, health care, and social and professional sense of belonging.
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Affiliation(s)
- Meng-Chuan Lai
- Child and Youth Mental Health Collaborative at the Centre for Addiction and Mental Health and The Hospital for Sick Children, Toronto, ON, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, ON, 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
| | - Anouck Amestoy
- Centre for Autism Spectrum Disorders, Aquitaine Institute for Cognitive and Integrative Neurosciences, Charles Perrens Hospital, University of Bordeaux, Bordeaux, France
| | - Somer Bishop
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Heather M Brown
- Faculty of Education, University of Alberta, Edmonton, AB, Canada
| | - Morénike Giwa Onaiwu
- Autistic Women & Nonbinary Network, Lincoln, NE, USA; Rice University Center for the Study of Women, Gender, and Sexuality, School of Humanities, Houston, TX, USA
| | - Alycia Halladay
- Autism Science Foundation, Scarsdale, NY, USA; Department of Pharmacology and Toxicology, Rutgers University, Piscataway, NJ, USA
| | - Clare Harrop
- Department of Health Sciences and TEACCH Autism Program, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Emily Hotez
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Marisela Huerta
- Felicity House, New York, NY, USA; Weill Cornell Medicine, New York, NY, USA
| | - Amy Kelly
- Devereux Advanced Behavioral Health, Villanova, PA, USA
| | - Dylan Miller
- Auxiliary Enterprises, University of Massachusetts, Amherst, MA, USA
| | - Christine Wu Nordahl
- Department of Psychiatry and Behavioral Sciences and MIND Institute, University of California at Davis, Davis, CA, USA
| | - Allison B Ratto
- Center for Autism Spectrum Disorders, Division of Neuropsychology, Children's National Hospital, Washington, DC, USA
| | - Celine Saulnier
- Neurodevelopmental Assessment and Consulting Services, Decatur, GA, USA
| | - Paige M Siper
- Seaver Autism Center for Research and Treatment, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kristin Sohl
- ECHO Autism Communities, Department of Child Health, University of Missouri School of Medicine, Columbia, MO, USA
| | | | - Sylvie Goldman
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA.
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9
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Kamensek T, Susilo T, Iarocci G, Oruc I. Are people with autism prosopagnosic? Autism Res 2023; 16:2100-2109. [PMID: 37740564 DOI: 10.1002/aur.3030] [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: 03/24/2023] [Accepted: 08/30/2023] [Indexed: 09/24/2023]
Abstract
Difficulties in various face processing tasks have been well documented in autism spectrum disorder (ASD). Several meta-analyses and numerous case-control studies have indicated that this population experiences a moderate degree of impairment, with a small percentage of studies failing to detect any impairment. One possible account of this mixed pattern of findings is heterogeneity in face processing abilities stemming from the presence of a subpopulation of prosopagnosic individuals with ASD alongside those with normal face processing skills. Samples randomly drawn from such a population, especially relatively smaller ones, would vary in the proportion of participants with prosopagnosia, resulting in a wide range of group-level deficits from mild (or none) to severe across studies. We test this prosopagnosic subpopulation hypothesis by examining three groups of participants: adults with ASD, adults with developmental prosopagnosia (DP), and a comparison group. Our results show that the prosopagnosic subpopulation hypothesis does not account for the face impairments in the broader autism spectrum. ASD observers show a continuous and graded, rather than categorical, heterogeneity that span a range of face processing skills including many with mild to moderate deficits, inconsistent with a prosopagnosic subtype account. We suggest that pathogenic origins of face deficits for at least some with ASD differ from those of DP.
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Affiliation(s)
- Todd Kamensek
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, British Columbia, Canada
- Graduate Program in Neuroscience, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tirta Susilo
- School of Psychology, Victoria University of Wellington, Wellington, New Zealand
| | - Grace Iarocci
- Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Ipek Oruc
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, British Columbia, Canada
- Graduate Program in Neuroscience, University of British Columbia, Vancouver, British Columbia, Canada
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10
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Nordahl CW. Why do we need sex-balanced studies of autism? Autism Res 2023; 16:1662-1669. [PMID: 37382167 PMCID: PMC10527473 DOI: 10.1002/aur.2971] [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: 04/28/2023] [Accepted: 06/03/2023] [Indexed: 06/30/2023]
Abstract
Males are diagnosed with autism much more frequently than females, and most research study samples reflect this male predominance. The result is that autistic females are understudied. There is a critical need to increase our understanding of autistic females, both biologically and clinically. The only way to do this is to recruit sex-balanced cohorts in studies so that similarities and differences between males and females can be evaluated in all autism research studies. The purpose of this commentary is to (1) provide historical context about how females came to be under-represented in all research, not just in the field of autism and (2) learn from other areas of health and medicine about the potentially dire consequences of not studying both sexes, and (3) draw attention to the need to recruit sex-balanced cohorts in autism research, particularly in neuroimaging studies.
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Affiliation(s)
- Christine Wu Nordahl
- Department of Psychiatry and Behavioral Sciences, MIND Institute, UC Davis, Sacramento, California, USA
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11
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Bölte S, Neufeld J, Marschik PB, Williams ZJ, Gallagher L, Lai MC. Sex and gender in neurodevelopmental conditions. Nat Rev Neurol 2023; 19:136-159. [PMID: 36747038 PMCID: PMC10154737 DOI: 10.1038/s41582-023-00774-6] [Citation(s) in RCA: 49] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2023] [Indexed: 02/08/2023]
Abstract
Health-related conditions often differ qualitatively or quantitatively between individuals of different birth-assigned sexes and gender identities, and/or with different gendered experiences, requiring tailored care. Studying the moderating and mediating effects of sex-related and gender-related factors on impairment, disability, wellbeing and health is of paramount importance especially for neurodivergent individuals, who are diagnosed with neurodevelopmental conditions with uneven sex/gender distributions. Researchers have become aware of the myriad influences that sex-related and gender-related variables have on the manifestations of neurodevelopmental conditions, and contemporary work has begun to investigate the mechanisms through which these effects are mediated. Here we describe topical concepts of sex and gender science, summarize current knowledge, and discuss research and clinical challenges related to autism, attention-deficit/hyperactivity disorder and other neurodevelopmental conditions. We consider sex and gender in the context of epidemiology, behavioural phenotypes, neurobiology, genetics, endocrinology and neighbouring disciplines. The available evidence supports the view that sex and gender are important contributors to the biological and behavioural variability in neurodevelopmental conditions. Methodological caveats such as frequent conflation of sex and gender constructs, inappropriate measurement of these constructs and under-representation of specific demographic groups (for example, female and gender minority individuals and people with intellectual disabilities) limit the translational potential of research so far. Future research and clinical implementation should integrate sex and gender into next-generation diagnostics, mechanistic investigations and support practices.
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Affiliation(s)
- Sven Bölte
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research; Department of Women's and Children's Health, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.
- Child and Adolescent Psychiatry, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.
- Curtin Autism Research Group, Curtin School of Allied Health, Curtin University, Perth, WA, Australia.
| | - Janina Neufeld
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research; Department of Women's and Children's Health, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Swedish Collegium for Advanced Study (SCAS), Uppsala, Sweden
| | - Peter B Marschik
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research; Department of Women's and Children's Health, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Göttingen and Leibniz ScienceCampus Primate Cognition, Göttingen, Germany
- iDN - interdisciplinary Developmental Neuroscience, Division of Phoniatrics, Medical University of Graz, Graz, Austria
| | - Zachary J Williams
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Brain Institute, Vanderbilt University, Nashville, TN, USA
- Frist Center for Autism and Innovation, Vanderbilt University, Nashville, TN, USA
| | - Louise Gallagher
- Department of Psychiatry, School of Medicine, Trinity College Dublin, Dublin, Ireland
- Child and Youth Mental Health Collaborative at the Centre for Addiction and Mental Health, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, and Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Meng-Chuan Lai
- Child and Youth Mental Health Collaborative at the Centre for Addiction and Mental Health, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, and Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, 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.
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12
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Strang JF, Anthony LG, Song A, Lai MC, Knauss M, Sadikova E, Graham E, Zaks Z, Wimms H, Willing L, Call D, Mancilla M, Shakin S, Vilain E, Kim DY, Maisashvili T, Khawaja A, Kenworthy L. In Addition to Stigma: Cognitive and Autism-Related Predictors of Mental Health in Transgender Adolescents. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2023; 52:212-229. [PMID: 34121545 DOI: 10.1080/15374416.2021.1916940] [Citation(s) in RCA: 37] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Autism spectrum disorder (ASD) is significantly over-represented among transgender adolescents. Independently, ASD and gender diversity are associated with increased mental health risks. Yet, mental health in autistic-transgender adolescents is poorly understood. This study investigates mental health in the largest matched sample to date of autistic-transgender, non-autistic (allistic) transgender, and autistic-cisgender adolescents diagnosed using gold-standard ASD diagnostic procedures. In accordance with advancing understanding of sex/gender-related autism phenotypes, slightly subthreshold autistic diagnostic presentations (common in autistic girls/women) are modeled. METHOD This study includes 93 adolescents aged 13-21, evenly divided between autistic-transgender, autistic-cisgender, and allistic-transgender groups; 13 transgender adolescents were at the margin of ASD diagnosis and included within a larger "broad-ASD" grouping. Psychological and neuropsychological evaluation included assessment of mental health, IQ, LGBT stigma, ASD-related social symptoms, executive functioning (EF), and EF-related barriers to achieving gender-related needs. RESULTS Autistic-transgender adolescents experienced significantly greater internalizing symptoms compared to allistic-transgender and autistic-cisgender groups. In addition to stigma-related associations with mental health, ASD-related cognitive/neurodevelopmental factors (i.e., poorer EF and greater social symptoms) were associated with worse mental health: specifically, social symptoms and EF gender barriers with greater internalizing and EF problems and EF gender barriers with greater suicidality. Comparing across all ASD and gender-related groups, female gender identity was associated with greater suicidality. CONCLUSIONS Parsing the heterogeneity of mental health risks among transgender youth is critical for developing targeted assessments and interventions. This study identifies ASD diagnosis, ASD phenotypic characteristics, and EF-related gender barriers as potential risks for poorer mental health in transgender adolescents.
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Affiliation(s)
- John F Strang
- Gender Development Program, Children's National Hospital
- Center for Autism Spectrum Disorders, Division of Neuropsychology, Children's National Hospital
- Center for Neuroscience, Children's National Research Institute, Children's National Hospital
- Departments of Pediatrics, Psychiatry, and Behavioral Sciences, George Washington University School of Medicine
| | - Laura G Anthony
- Department of Psychiatry, University of Colorado School of Medicine
- Pediatric Mental Health Institute, Children's Hospital of Colorado
| | - Amber Song
- Gender Development Program, Children's National Hospital
- Center for Autism Spectrum Disorders, Division of Neuropsychology, Children's National Hospital
- Center for Neuroscience, Children's National Research Institute, Children's National Hospital
| | - Meng-Chuan Lai
- The Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health, Azrieli Adult Neurodevelopmental Centre, and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health
- Department of Psychiatry, The Hospital for Sick Children
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto
- Autism Research Centre, Department of Psychiatry, University of Cambridge
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine
| | - Megan Knauss
- Center for Autism Spectrum Disorders, Division of Neuropsychology, Children's National Hospital
- Alliance of Community Health Plans
| | | | | | - Zosia Zaks
- Hussman Center for Adults with Autism, Towson University
| | - Harriette Wimms
- Youth Gender Care Services, The Village Family Support Center of Baltimore
| | - Laura Willing
- Gender Development Program, Children's National Hospital
- Departments of Pediatrics, Psychiatry, and Behavioral Sciences, George Washington University School of Medicine
| | - David Call
- Gender Development Program, Children's National Hospital
- Departments of Pediatrics, Psychiatry, and Behavioral Sciences, George Washington University School of Medicine
| | - Michael Mancilla
- Youth Pride Clinic, Adolescent and Young Adult Medicine, Children's National Hospital
| | - Sara Shakin
- Department of Pediatrics, Sinai Hospital of Baltimore
| | - Eric Vilain
- Center for Genetic Medicine Research, Children's National Hospital
- Department of Genomics and Precision Medicine, George Washington University
- Epigenetics, Data, & Politics at Centre National de la Recherche Scientifique
| | - Da-Young Kim
- Center for Autism Spectrum Disorders, Division of Neuropsychology, Children's National Hospital
| | - Tekla Maisashvili
- Center for Autism Spectrum Disorders, Division of Neuropsychology, Children's National Hospital
| | - Ayesha Khawaja
- Center for Autism Spectrum Disorders, Division of Neuropsychology, Children's National Hospital
| | - Lauren Kenworthy
- Center for Autism Spectrum Disorders, Division of Neuropsychology, Children's National Hospital
- Center for Neuroscience, Children's National Research Institute, Children's National Hospital
- Departments of Pediatrics, Psychiatry, and Behavioral Sciences, George Washington University School of Medicine
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13
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Kavanaugh BC, Schremp CA, Jones RN, Best CR, Sheinkopf SJ, Morrow EM. Moderators of Age of Diagnosis in > 20,000 Females with Autism in Two Large US Studies. J Autism Dev Disord 2023; 53:864-869. [PMID: 33961180 DOI: 10.1007/s10803-021-05026-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2021] [Indexed: 10/21/2022]
Abstract
The objective of this study was to determine the clinical features that moderate a later age at ASD diagnosis in females in a large sample of females with ASD. Within two large and independent ASD datasets (> 20,000 females), females were first diagnosed with ASD 14-months later relative to males. This later age at diagnosis was moderated by a mild or atypical presentation, wherein repetitive behaviors were limited, IQ and language were broadly intact, and recognized symptoms emerged later in development. Females are at risk for a later age at ASD diagnosis and treatment implementation, and modification of early childhood ASD screening methods for females may be warranted.
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Affiliation(s)
- Brian C Kavanaugh
- Developmental Disorders Genetics Research Program, Emma Pendleton Bradley Hospital, East Providence, RI, USA.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.,Hassenfeld Child Health Innovation Institute, Brown University, Providence, RI, USA
| | - Christine A Schremp
- Developmental Disorders Genetics Research Program, Emma Pendleton Bradley Hospital, East Providence, RI, USA.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Richard N Jones
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Carrie R Best
- Developmental Disorders Genetics Research Program, Emma Pendleton Bradley Hospital, East Providence, RI, USA.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.,Hassenfeld Child Health Innovation Institute, Brown University, Providence, RI, USA
| | - Stephen J Sheinkopf
- Developmental Disorders Genetics Research Program, Emma Pendleton Bradley Hospital, East Providence, RI, USA.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.,Hassenfeld Child Health Innovation Institute, Brown University, Providence, RI, USA.,Brown Center for the Study of Children at Risk, Women & Infants Hospital, Providence, RI, USA.,Department of Pediatrics, Alpert Medical School of Brown University, Providence, RI, USA
| | - Eric M Morrow
- Developmental Disorders Genetics Research Program, Emma Pendleton Bradley Hospital, East Providence, RI, USA. .,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA. .,Hassenfeld Child Health Innovation Institute, Brown University, Providence, RI, USA. .,Department of Molecular Biology, Cell Biology and Biochemistry, Brown University, Providence, RI, USA. .,Center for Translational Neuroscience, Robert J. and Nancy D. Carney Institute for Brain Science and Brown Institute for Translational Science, Brown University, Providence, RI, USA. .,Laboratories for Molecular Medicine, Brown University, 70 Ship Street, Providence, RI, 02912, USA.
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14
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Reindal L, Nærland T, Weidle B, Lydersen S, Andreassen OA, Sund AM. Structural and Pragmatic Language Impairments in Children Evaluated for Autism Spectrum Disorder (ASD). J Autism Dev Disord 2023; 53:701-719. [PMID: 33515169 PMCID: PMC9944009 DOI: 10.1007/s10803-020-04853-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2020] [Indexed: 12/30/2022]
Abstract
Pragmatic language impairments are common in neurodevelopmental disorders, especially in autism spectrum disorder (ASD). The relationship between structural language skills and pragmatic competence in children with autistic symptoms, however, is largely unknown. We investigated this relationship based on the Children's Communication Checklist-2 and early language delay among children (N = 177, 19% females) clinically evaluated for ASD, differentiated into ASD (n = 148) and non-ASD (n = 29). Structural language deficits were common and associated with reduced pragmatic competence in both groups. Pragmatic language impairments were most profound in children with ASD. Early language delay and structural language deficits were less common in females. Our findings suggest that assessment of structural language skills should be included in the evaluation of children with suspected ASD.
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Affiliation(s)
- Lise Reindal
- Department of Child and Adolescent Psychiatry, Møre og Romsdal Hospital Trust, Volda Hospital, Volda, Norway. .,Department of Mental Health, Faculty of Medicine and Health Sciences, Regional Centre for Child and Youth Mental Health and Child Welfare, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Terje Nærland
- NevSom, Department of Rare Disorders and Disabilities, Oslo University Hospital, Oslo, Norway ,K.G Jebsen Centre for Neurodevelopmental Disorders, University of Oslo, Oslo, Norway
| | - Bernhard Weidle
- Department of Mental Health, Faculty of Medicine and Health Sciences, Regional Centre for Child and Youth Mental Health and Child Welfare, Norwegian University of Science and Technology, Trondheim, Norway ,Department of Child and Adolescent Psychiatry, St. Olavs University Hospital, Trondheim, Norway
| | - Stian Lydersen
- Department of Mental Health, Faculty of Medicine and Health Sciences, Regional Centre for Child and Youth Mental Health and Child Welfare, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ole A. Andreassen
- K.G Jebsen Centre for Neurodevelopmental Disorders, University of Oslo, Oslo, Norway ,NORMENT Centre, University of Oslo, Oslo, Norway ,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Anne Mari Sund
- Department of Mental Health, Faculty of Medicine and Health Sciences, Regional Centre for Child and Youth Mental Health and Child Welfare, Norwegian University of Science and Technology, Trondheim, Norway ,Department of Child and Adolescent Psychiatry, St. Olavs University Hospital, Trondheim, Norway
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15
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Age-Based Tracks: A Method to Tailor Autism Diagnostic Evaluation in Large-Scale Autism Specialty Centers. J Clin Med 2022; 11:jcm11216332. [DOI: 10.3390/jcm11216332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 10/20/2022] [Accepted: 10/24/2022] [Indexed: 11/16/2022] Open
Abstract
This paper describes a proposed model of diagnostic evaluation for autism spectrum disorder (ASD) at a large-scale ASD specialty center. Our center has implemented age-based diagnostic tracks within an interdisciplinary team evaluation approach to assessing ASD. Data were collected as part of a program evaluation and included responses from provider surveys as well as patient medical record reviews. The results from 803 patients were included. The diagnostic outcomes, time for evaluation, and appropriateness of referral were analyzed in patients referred to the Younger (n = 155) and Older (n = 648) diagnostic tracks. In 92.8% of cases referred to the clinic’s standard team evaluation model, the provider teams were able to make a diagnostic decision within the allotted evaluation time. The results from an additional diagnostic pathway, termed the Autism Psych Team (APT), within the older track were also presented. The intake providers had the option to triage older patients to this pathway when they anticipated that the patient might be diagnostically complex. Most patients (45.1%) triaged to the APT were referred due to psychiatric complexity. In 96% of APT cases, the APT providers felt the patient was an appropriate referral. Overall, these results suggest a method to efficiently triage patients to diagnostic models equipped to serve them within a high-volume ASD center.
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16
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LeBeau B, Schabilion K, Assouline SG, Foley Nicpon M, Doobay AF, Mahatmya D. Developmental Milestones as Early Indicators of Twice-Exceptionality. Neurobiol Learn Mem 2022; 194:107671. [PMID: 35908656 DOI: 10.1016/j.nlm.2022.107671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 07/19/2022] [Accepted: 07/24/2022] [Indexed: 11/18/2022]
Abstract
Twice-exceptional individuals are those who have high cognitive ability in one or more areas, but also have a diagnosed disability. The needs of these individuals likely differ from those with high cognitive ability without a disability and those who solely have a disability. Intervening early can offer exceptional benefits for twice-exceptional individuals, but this has proved challenging due to the high cognitive abilities masking disabilities. This study explores if parent-reported developmental milestones can predict the number of disabilities diagnosed for an individual, including Autism Spectrum Disorder (ASD), Attention-Deficit/Hyperactivity Disorder (ADHD), and Specific Learning Disorder (SLD). Using a clinical sample of about 1,300 individuals, we used a Bayesian cumulative logistic model to explore if developmental milestones can predict the number of diagnoses after controlling for IQ and age. Study results showed that when an individual began to count and read informed predictions for the number of future diagnoses in the clinical sample. Implications for future study and practitioners are discussed in further detail.
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17
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Fears NE, Palmer SA, Miller HL. Motor skills predict adaptive behavior in autistic children and adolescents. Autism Res 2022; 15:1083-1089. [PMID: 35322578 PMCID: PMC9167704 DOI: 10.1002/aur.2708] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 02/20/2022] [Accepted: 03/10/2022] [Indexed: 11/10/2022]
Abstract
It is well-documented that intelligence quotient (IQ) is a poor predictor of adaptive behavior scores in autism, with autistic children having lower adaptive behavior scores than would be predicted based on their IQ scores. Differences in motor skills may explain the variability in their adaptive behavior scores. The current study examined how motor skills might explain autistic individuals' low adaptive behavior scores and which individual components of IQ (i.e., verbal comprehension and perceptual reasoning) and motor skills (i.e., manual dexterity, aiming and catching, and balance) may drive this effect. We examined the associations between IQ, motor skills, calibrated severity, and adaptive behavior scores in 45 autistic children and adolescents. Using a t-test, we found a significant difference (p <0.001) between full-scale IQ and adaptive behavior scores, indicating that our participants' adaptive behavior scores were lower than would be expected given their full-scale IQ. Using a linear regression, we investigated whether motor skills predicted adaptive behavior in autistic children and adolescents and found that motor skills scores were associated with adaptive behavior scores (p = 0.022). To further investigate these associations, we used another linear regression to examine how individual components of IQ and motor skills predicted adaptive behavior scores in autistic children and adolescents. Our results indicated that manual dexterity scores were associated with adaptive behavior scores (p = 0.036). These findings clearly illustrate the need for further understanding of autistic individuals' difficulties with adaptive behavior and the potential role of motor skill difficulties that may underlie these difficulties. LAY SUMMARY: Autistic children have lower adaptive behavior scores (e.g., daily living skills, social skills, communication) than intelligence scores (e.g., verbal and perceptual skills) along with difficulties with motor skills. Motor skills may explain the gap between adaptive behavior and intelligence. We found motor skills were associated with adaptive behavior in autistic children and adolescents. In particular, hand coordination was associated with adaptive behavior. We need to better understand how autistic individuals' motor skills impact their adaptive behavior to provide effective supports.
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Affiliation(s)
- Nicholas E Fears
- Department of Physical Therapy, University of North Texas Health Science Center, Fort Worth, Texas, USA.,School of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Haylie L Miller
- Department of Physical Therapy, University of North Texas Health Science Center, Fort Worth, Texas, USA.,School of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA
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18
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Hirota T, Nishimura T, Mikami M, Saito M, Nakamura K. The Role of the Maternal and Child Health Handbook in Developmental Surveillance: The Exploration of Milestone Attainment Trajectories. Front Psychiatry 2022; 13:902158. [PMID: 35782444 PMCID: PMC9247330 DOI: 10.3389/fpsyt.2022.902158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 05/23/2022] [Indexed: 11/13/2022] Open
Abstract
Despite the pivotal role of developmental surveillance in pediatric practice for the early detection of neurodevelopmental disorders (NDDs), there are several barriers, including scarcity of time and staff availability, to its implementation. Additionally, inadequate parental knowledge on what to expect about their child's development contributes to potential delays in the early identification of NDDs. Home-based records (HBRs) are widely used in both high-income and low- and middle-income countries, allowing caregivers to prospectively chart the child's development, including milestone attainment, and thus can be a useful tool for developmental surveillance. Therefore, we analyzed data on milestone attainment from birth to 5 years of age obtained through the home-based records (the Maternal Child Health Handbook: MCHH) in 720 children who attended the Hirosaki Five-year-old children Developmental Health Check-up Study in Hirosaki, Japan to identify trajectory patterns of milestone attainment. Parallel process latent class growth analysis on four milestone domains (motor, social interaction, communication, and self-care) revealed three different trajectories (Class 1: "Consistent milestone attainment" group; 42%, Class 2: "subtle initial delay and catch-up" group; 45%, Class 3: "Consistent failure to attain expected milestones" group; 13%). In Class 3, 90% of children were diagnosed with at least one NDDs at age 5 and approximately 65% of children had autism spectrum disorder and/or intellectual disability, the rate of which was higher than that in the other two classes. Boys and preterm-born children were more likely to be assigned to classes with less favorable trajectories of milestone attainment. Although the use of the MCHH alone does not substitute diagnostic evaluation for NDDs, our study findings suggest the potential utility of the MCHH as a tool to educate parents on what longitudinal patterns of milestone attainment are concerning and require prompt visits to professionals.
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Affiliation(s)
- Tomoya Hirota
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States.,Department of Neuropsychiatry, Graduate School of Medicine, Hirosaki University, Hirosaki, Japan
| | - Tomoko Nishimura
- Research Centre for Child Mental Development, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Misaki Mikami
- Department of Comprehensive Rehabilitation Science, Graduate School of Health Sciences, Hirosaki University, Hirosaki, Japan
| | - Manabu Saito
- Department of Neuropsychiatry, Graduate School of Medicine, Hirosaki University, Hirosaki, Japan.,Department of Comprehensive Rehabilitation Science, Graduate School of Health Sciences, Hirosaki University, Hirosaki, Japan.,Research Center for Child Mental Development, Graduate School of Medicine, Hirosaki University, Hirosaki, Japan
| | - Kazuhiko Nakamura
- Department of Neuropsychiatry, Graduate School of Medicine, Hirosaki University, Hirosaki, Japan.,Research Center for Child Mental Development, Graduate School of Medicine, Hirosaki University, Hirosaki, Japan
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19
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Waterhouse L. Heterogeneity thwarts autism explanatory power: A proposal for endophenotypes. Front Psychiatry 2022; 13:947653. [PMID: 36532199 PMCID: PMC9751779 DOI: 10.3389/fpsyt.2022.947653] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 11/16/2022] [Indexed: 12/03/2022] Open
Abstract
Many researchers now believe that autism heterogeneity is likely to include many disorders, but most research is based on samples defined by the DSM-5 Autism Spectrum Disorder (ASD) criteria. However, individuals diagnosed with autism have complex and varied biological causes for their symptoms. Therefore, autism is not a unitary biological entity. And although autism is significantly different from typical development, autism is not a unitary clinical disorder because diagnosed individuals vary in symptom patterns, comorbidities, biomarkers, and gene variants. The DSM-5 ASD criteria were designed to reduce heterogeneity, and there have been many other efforts to reduce autism heterogeneity including using more stringent clinical criteria, dividing autism into low and high functioning groups, creating subgroups, and by studying larger samples. However, to date these efforts have not been successful. Heterogeneity is extensive and remains unexplained, and no autism pathophysiology has been discovered. Most importantly, heterogeneity has hindered the explanatory power of the autism diagnosis to discover drug regimens and effective behavioral treatments. The paper proposes that possible transdiagnostic endophenotypes may reduce autism heterogeneity. Searching for transdiagnostic endophenotypes requires exploring autism symptoms outside of the framework of the DSM-5 autism diagnosis. This paper proposes that researchers relax diagnostic criteria to increase the range of phenotypes to support the search for transdiagnostic endophenotypes. The paper proposes possible candidates for transdiagnostic endophenotypes. These candidates are taken from DSM-5 ASD criteria, from concepts that have resulted from researched theories, and from symptoms that are the result of subtyping. The paper then sketches a possible basis for a future transdiagnostic endophenotypes screening tool that includes symptoms of autism and other neurodevelopmental disorders.
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Affiliation(s)
- Lynn Waterhouse
- The College of New Jersey, Ewing Township, NJ, United States
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20
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Kavanaugh BC, Gabert T, Jones RN, Sheinkopf SJ, Morrow EM. Parental age and autism severity in the Rhode Island Consortium for Autism Research and Treatment (RI-CART) study. Autism Res 2021; 15:86-92. [PMID: 34866351 DOI: 10.1002/aur.2648] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 10/22/2021] [Accepted: 11/16/2021] [Indexed: 11/10/2022]
Abstract
Advanced parental age at offspring birth has been associated with autism spectrum disorder (ASD). The objective of the current study was to investigate associations between parental age at birth and autism severity. The Rhode Island Consortium for Autism Research and Treatment (RI-CART) study represents a community-based sample with a range of autism severity, including participants with and without ASD. This study involved participants (n = 1178) enrolled in RI-CART with available mother and father ages at birth. Primary data points included the age of mother and father at the participant's birth and results from the Autism Diagnostic Observation Schedule - Second Edition (ADOS-2). Mothers were 1.7 years older at the time of birth of the child with ASD, as compared to mothers of offspring without ASD. Fathers of children with ASD were 1.6 years older at the time of birth than fathers of children without ASD. The age of both parents at offspring birth displayed a positive, statistically significant association with overall ASD severity and the severity of restricted/repetitive behaviors. This finding was driven by the association between parental age and the severity of compulsions or rituals. Intelligence and adaptive functioning did not moderate the relationship between parental age and ASD severity. This study extends prior research to show that advanced parental age at birth is associated with the severity as well as the presence of ASD in offspring.
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Affiliation(s)
- Brian C Kavanaugh
- Developmental Disorders Genetics Research Program, Emma Pendleton Bradley Hospital, East Providence, Rhode Island, USA.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Hassenfeld Child Health Innovation Institute, Brown University, Providence, Rhode Island, USA
| | - Tess Gabert
- Developmental Disorders Genetics Research Program, Emma Pendleton Bradley Hospital, East Providence, Rhode Island, USA
| | | | - Richard N Jones
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Quantitative Sciences Program, Department of Psychiatry and Human Behavior and Department of Neurology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Stephen J Sheinkopf
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Hassenfeld Child Health Innovation Institute, Brown University, Providence, Rhode Island, USA.,Brown Center for the Study of Children at Risk, Women & Infants Hospital, Providence, Rhode Island, USA.,Department of Pediatrics, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Eric M Morrow
- Developmental Disorders Genetics Research Program, Emma Pendleton Bradley Hospital, East Providence, Rhode Island, USA.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Hassenfeld Child Health Innovation Institute, Brown University, Providence, Rhode Island, USA.,Department of Molecular Biology, Cell Biology and Biochemistry, Brown University, Providence, Rhode Island, USA.,Center for Translational Neuroscience, Robert J. and Nancy D. Carney Institute for Brain Science and Brown Institute for Translational Science, Brown University, Providence, Rhode Island, USA
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21
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Sipsock D, Tokadjian H, Righi G, Morrow EM, Sheinkopf SJ. Autism severity aggregates with family psychiatric history in a community-based autism sample. Autism Res 2021; 14:2524-2532. [PMID: 34652072 DOI: 10.1002/aur.2625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 09/01/2021] [Accepted: 09/18/2021] [Indexed: 01/04/2023]
Abstract
The purpose of this study was to examine family psychiatric history in individuals with autism spectrum disorder (ASD) and its association with clinical presentation. Participants were 798 individuals with a clinical diagnosis of ASD, confirmed by the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2), enrolled in Rhode Island Consortium for Autism Research and Treatment, a statewide research registry. Prior research suggests a specific behavioral phenotype in individuals with ASD who have family members with psychiatric diagnoses, including higher IQ and less severe language impairment. However, studies have not specifically investigated autism severity. We hypothesized that increased psychiatric family history would be associated with increased autism severity symptoms. Results show a strong association of increased burden of first-degree family psychiatric history with higher autism symptom severity as measured by Social Responsiveness Scale, Second Edition (SRS-2), but not with ADOS-2 severity scores, IQ, or adaptive functioning. These findings support the importance of investigating the contribution of psychiatric family history toward clinical ASD presentation. LAY SUMMARY: This study explored how family psychiatric history is related to clinical presentation of Autism Spectrum Disorder (ASD). Higher amounts of first-degree family psychiatric history was associated with higher autism symptom severity as measured by the Social Responsiveness Scale, Second Edition (SRS-2). The contribution of psychiatric family history requires ongoing investigation.
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Affiliation(s)
- Danielle Sipsock
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Emma Pendleton Bradley Hospital, East Providence, Rhode Island, USA.,Brown Center for the Study of Children at Risk, Women & Infants Hospital, Providence, Rhode Island, USA
| | - Hasmik Tokadjian
- Brown Center for the Study of Children at Risk, Women & Infants Hospital, Providence, Rhode Island, USA
| | - Giulia Righi
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Emma Pendleton Bradley Hospital, East Providence, Rhode Island, USA.,Brown Center for the Study of Children at Risk, Women & Infants Hospital, Providence, Rhode Island, USA
| | - Eric M Morrow
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Emma Pendleton Bradley Hospital, East Providence, Rhode Island, USA.,Hassenfeld Child Health Innovation Institute, Brown University, Providence, Rhode Island, USA.,Department of Molecular Biology, Cell Biology and Biochemistry, Brown University, Providence, Rhode Island, USA.,Center for Translational Neuroscience, Robert J. and Nancy D. Carney Institute for Brain Science and Brown Institute for Translational Science, Brown University, Providence, Rhode Island, USA
| | - Stephen J Sheinkopf
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Emma Pendleton Bradley Hospital, East Providence, Rhode Island, USA.,Brown Center for the Study of Children at Risk, Women & Infants Hospital, Providence, Rhode Island, USA.,Hassenfeld Child Health Innovation Institute, Brown University, Providence, Rhode Island, USA.,Department of Pediatrics, Alpert Medical School of Brown University, Providence, Rhode Island, USA
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22
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Ronkin E, Tully EC, Branum-Martin L, Cohen LL, Hall C, Dilly L, Tone EB. Sex differences in social communication behaviors in toddlers with suspected autism spectrum disorder as assessed by the ADOS-2 toddler module. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 26:1282-1295. [PMID: 34657471 DOI: 10.1177/13623613211047070] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
LAY ABSTRACT When toddlers are suspected of autism spectrum disorder (ASD), the gold-standard assessment technique is with the Autism Diagnostic Observation Schedule, 2nd edition (ADOS-2) Toddler Module, a behavioral observation system. ASD is a neurodevelopmental condition more frequently diagnosed in toddler boys than in toddler girls. There is some evidence that the ADOS-2 assesses behaviors that are more characteristic of boys with ASD than girls. Thus, it is possible that focusing on these behaviors contributes at least in part to why more boys are diagnosed than girls. Specifically, girls may show more social skills than boys during the ADOS-2 assessment due to their socialization histories, which may lead to missed diagnoses of ASD in toddler girls. The current study examined eight social behaviors assessed by the ADOS-2 in a sample of toddlers with suspected ASD to see if they contributed differently to the total score of those items. Examination of those items suggested that those social communication behaviors work the same for boys and girls with suspected ASD, which was inconsistent with hypotheses. However, examination of particular items raises the possibility of examining creative/imaginative play as an area for future research.
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Brown KA, Sarkar IN, Chen ES. Mental Health Comorbidity Analysis in Pediatric Patients with Autism Spectrum Disorder Using Rhode Island Medical Claims Data. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2021; 2020:263-272. [PMID: 33936398 PMCID: PMC8075466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Identification of comorbidity subgroups linked with Autism Spectrum Disorder (ASD) could provide promising insight into learning more about this disorder. This study sought to use the Rhode Island All-Payer Claims Database to examine mental health conditions linked to ASD. Medical claims data for ASD patients and one or more mental health conditions were analyzed using descriptive statistics, association rule mining (ARM), and sequential pattern mining (SPM). The results indicated that patients with ASD have a higher proportion of mental health diagnoses than the general pediatric population. ARM and SPM methods identified patterns of comorbidities commonly seen among ASD patients. Based on the observed patterns and temporal sequences, suicidal ideation, mood disorders, anxiety, and conduct disorders may need focused attention prospectively. Understanding more about groupings of ASD patients and their comorbidity burden can help bridge gaps in knowledge and make strides toward improved outcomes for patients with ASD.
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Affiliation(s)
- Katherine A Brown
- Brown Center for Biomedical Informatics, Brown University, Providence RI
| | - Indra Neil Sarkar
- Brown Center for Biomedical Informatics, Brown University, Providence RI
- Rhode Island Quality Institute, Providence RI
| | - Elizabeth S Chen
- Brown Center for Biomedical Informatics, Brown University, Providence RI
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Harrop C, Libsack E, Bernier R, Dapretto M, Jack A, McPartland JC, Van Horn JD, Webb SJ, Pelphrey K. Do Biological Sex and Early Developmental Milestones Predict the Age of First Concerns and Eventual Diagnosis in Autism Spectrum Disorder? Autism Res 2021; 14:156-168. [PMID: 33274604 PMCID: PMC8023413 DOI: 10.1002/aur.2446] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 10/26/2020] [Accepted: 11/15/2020] [Indexed: 11/09/2022]
Abstract
Despite advances in early detection, the average age of autism spectrum disorder (ASD) diagnosis exceeds 4 years and is often later in females. In typical development, biological sex predicts inter-individual variation across multiple developmental milestones, with females often exhibiting earlier progression. The goal of this study was to examine sex differences in caregiver-reported developmental milestones (first word, phrase, walking) and their contribution to timing of initial concerns expressed by caregivers and eventual age of diagnosis. 195 (105 males) children and adolescents aged 8 to 17 years with a clinical diagnosis of ASD were recruited to the study (mean IQ = 99.76). While developmental milestones did not predict timing of diagnosis or age parents first expressed concerns, females had earlier first words and phrases than males. There was a marginal difference in the age of diagnosis, with females receiving their diagnosis 1 year later than males. Despite sex differences in developmental milestones and diagnostic variables, IQ was the most significant predictor in the timing of initial concerns and eventual diagnosis, suggesting children with lower IQ, regardless of sex, are identified and diagnosed earlier. Overall, biological sex and developmental milestones did not account for a large proportion of variance for the eventual age of ASD diagnosis, suggesting other factors (such as IQ and the timing of initial concerns) are potentially more influential. LAY SUMMARY: In this study, a later age of diagnosis in females having ASD was confirmed; however, biological sex was not the stronger predictor of age of diagnosis. Parents reported that females learned language more quickly than males, and parents noted their first concerns when females were older than males. In this sample, the strongest predictor of age of diagnosis was the age of first concerns.
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Affiliation(s)
- Clare Harrop
- University of North Carolina at Chapel Hill, Allied Health Sciences, Carr Mill Mall, Carrboro, NC, 27510
| | - Erin Libsack
- Stony Brook University, Department of Psychology, Stony Brook, NY, 11794
| | - Raphael Bernier
- University of Washington Seattle, Department of Psychiatry and Behavioral Sciences, Seattle, WA, 98195
- Seattle Children’s Research Institute, Center on Child Health, Behavior and Development, Seattle, WA, 98121
| | - Mirella Dapretto
- University of California Los Angeles, Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA, 90024
| | - Allison Jack
- George Mason University, Department of Psychology, Fairfax, VA, 22030
| | - James C. McPartland
- Yale School of Medicine, Department of Pediatrics, New Haven, CT, 06520
- Yale School of Medicine, Yale Child Study Center, New Haven, CT, 06519
| | | | - Sara Jane Webb
- University of Washington Seattle, Department of Psychiatry and Behavioral Sciences, Seattle, WA, 98195
- Seattle Children’s Research Institute, Center on Child Health, Behavior and Development, Seattle, WA, 98121
| | - Kevin Pelphrey
- University of Virginia, Department of Neurology, Charlottesville, VA, 22903
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Burton JM, Creaghead NA, Silbert N, Breit-Smith A, Duncan AW, Grether SM. Social Communication and Structural Language of Girls With High-Functioning Autism Spectrum Disorder. Lang Speech Hear Serv Sch 2020; 51:1139-1155. [PMID: 32916076 DOI: 10.1044/2020_lshss-20-00004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Purpose The purpose of this study was to characterize social communication and structural language of school-age girls with high-functioning autism spectrum disorder (HF-ASD) compared to a matched group of girls who are typically developing (TD). Method Participants were 37 girls between 7;5 and 15;2 (years;months)-18 HF-ASD and 19 TD. Children completed the Test of Pragmatic Language-Second Edition (TOPL-2) and Clinical Evaluation of Language Fundamentals-Fifth Edition. Parents completed the Children's Communication Checklist-2 United States Edition (CCC-2) and Receptive and Expressive Communication subdomains of the Vineland Adaptive Behavior Scales-Second Edition. Results In the area of social communication, girls with HF-ASD earned significantly lower scores and were more often classified as having an impairment on the TOPL-2 and the CCC-2. However, 28% and 33% earned average scores on the TOPL-2 and the CCC-2, respectively. In the area of structural language, no significant differences were found between groups on Clinical Evaluation of Language Fundamentals-Fifth Edition indexes. In contrast, girls with HF-ASD earned significantly lower scores and were more often classified as having an impairment on the Vineland Adaptive Behavior Scales-Second Edition. Sixty-one percent and 83% scored below average on the Receptive and Expressive Communication subdomains, respectively. Conclusions It has been argued that girls with HF-ASD, when compared to boys with HF-ASD, may have advantages for social communication and structural language that mask their impairments. However, when compared to girls who are TD, girls with HF-ASD demonstrated impaired social communication and structural language. Clinicians should include and carefully examine multiple sources of information when assessing girls with HF-ASD.
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Affiliation(s)
- Jenny M Burton
- Department of Communication Sciences and Disorders, University of Cincinnati, OH.,Kelly O'Leary Center for Autism Spectrum Disorder, Cincinnati Children's Hospital Medical Center, OH
| | - Nancy A Creaghead
- Department of Communication Sciences and Disorders, University of Cincinnati, OH
| | - Noah Silbert
- Department of Communication Sciences and Disorders, University of Cincinnati, OH
| | | | - Amie W Duncan
- Kelly O'Leary Center for Autism Spectrum Disorder, Cincinnati Children's Hospital Medical Center, OH
| | - Sandra M Grether
- Department of Communication Sciences and Disorders, University of Cincinnati, OH.,Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, OH
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Moreno-De-Luca D, Kavanaugh BC, Best CR, Sheinkopf SJ, Phornphutkul C, Morrow EM. Clinical Genetic Testing in Autism Spectrum Disorder in a Large Community-Based Population Sample. JAMA Psychiatry 2020; 77:979-981. [PMID: 32401282 PMCID: PMC7221847 DOI: 10.1001/jamapsychiatry.2020.0950] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
This study analyzes data from a large, population-based study of people with autism spectrum disorder to evaluate what proportion underwent genetic testing.
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Affiliation(s)
- Daniel Moreno-De-Luca
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island,Hassenfeld Child Health Innovation Institute, Brown University, Providence, Rhode Island,Emma Pendleton Bradley Hospital, East Providence, Rhode Island,Center for Translational Neuroscience, Robert J. and Nancy D. Carney Institute for Brain Science and Brown Institute for Translational Science, Brown University, Providence, Rhode Island
| | - Brian C. Kavanaugh
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island,Hassenfeld Child Health Innovation Institute, Brown University, Providence, Rhode Island,Emma Pendleton Bradley Hospital, East Providence, Rhode Island,Center for Translational Neuroscience, Robert J. and Nancy D. Carney Institute for Brain Science and Brown Institute for Translational Science, Brown University, Providence, Rhode Island
| | - Carrie R. Best
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island,Hassenfeld Child Health Innovation Institute, Brown University, Providence, Rhode Island,Emma Pendleton Bradley Hospital, East Providence, Rhode Island,Center for Translational Neuroscience, Robert J. and Nancy D. Carney Institute for Brain Science and Brown Institute for Translational Science, Brown University, Providence, Rhode Island
| | - Stephen J. Sheinkopf
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island,Hassenfeld Child Health Innovation Institute, Brown University, Providence, Rhode Island,Emma Pendleton Bradley Hospital, East Providence, Rhode Island,Center for Translational Neuroscience, Robert J. and Nancy D. Carney Institute for Brain Science and Brown Institute for Translational Science, Brown University, Providence, Rhode Island,Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, Rhode Island,Brown Center for the Study of Children at Risk, Women and Infants Hospital of Rhode Island, Providence
| | - Chanika Phornphutkul
- Hassenfeld Child Health Innovation Institute, Brown University, Providence, Rhode Island,Center for Translational Neuroscience, Robert J. and Nancy D. Carney Institute for Brain Science and Brown Institute for Translational Science, Brown University, Providence, Rhode Island,Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, Rhode Island,Division of Human Genetics, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence
| | - Eric M. Morrow
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island,Hassenfeld Child Health Innovation Institute, Brown University, Providence, Rhode Island,Emma Pendleton Bradley Hospital, East Providence, Rhode Island,Center for Translational Neuroscience, Robert J. and Nancy D. Carney Institute for Brain Science and Brown Institute for Translational Science, Brown University, Providence, Rhode Island,Department of Molecular Biology, Cell Biology and Biochemistry, Brown University, Providence, Rhode Island
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Abstract
INTRODUCTION While the overall prevalence of autism is 1.7% in the United States of America, research has demonstrated a two- to five-fold increase in CHD. The Cardiac Neurodevelopmental Outcome Collaborative recommends screening for autism from infancy through adolescence. This study investigated the frequency of autism concerns at a single Cardiac Neurodevelopmental Program and examined current clinical practice as a way to improve quality of care. MATERIALS AND METHODS Patients (n = 134; mean age = 9.0 years) included children with high-risk CHD who completed a neurodevelopmental evaluation following a formalised referral to the Cardiac Neurodevelopmental Program between 2018 and 2019. Retrospective chart review included parent report on the Behaviour Assessment System for Children-3 and Adaptive Behaviour Assessment System-3. Descriptive and correlation analyses were completed. RESULTS In this sample, 11.2% presented with autism-related concerns at referral, 2 were diagnosed with autism, 9 were referred to an autism specialist (6 confirmed diagnosis; 3 not completed). Thus, at least 5.9% of the sample were diagnosed with autism following thorough clinical evaluation. Analyses showed atypicality, along with deficient adaptability, leisure, social, and communication skills. Frequency of early intervention, school supports, and relation with comorbidities are reported. DISCUSSION Prior to assessment recommendations by the Cardiac Neurodevelopmental Outcome Collaborative, autism screening may not be completed systematically in clinical care for CHD. The current sample demonstrates a high frequency of autism in the typically referred clinical sample. Commonly used parent-report measures may reveal concerns but will not help diagnosis. Systematic use of an autism screener is essential.
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