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Hong J, DaWalt LS, Taylor JL, Haider A, Mailick M. Autism through midlife: trajectories of symptoms, behavioral functioning, and health. J Neurodev Disord 2023; 15:36. [PMID: 37919643 PMCID: PMC10623813 DOI: 10.1186/s11689-023-09505-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 10/17/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND This study describes change in autism symptoms, behavioral functioning, and health measured prospectively over 22 years. Most studies tracking developmental trajectories have focused on autism during childhood, although adulthood is the longest stage of the life course. A robust understanding of how autistic people change through midlife and into older age has yet to be obtained. METHODS Using an accelerated longitudinal design with 9 waves of data, developmental trajectories were estimated from adolescence through midlife and into early old age in a community-based cohort (n = 406). The overall aim was to determine whether there were age-related increases or decreases, whether the change was linear or curvilinear, and whether these trajectories differed between those who have ID and those who have average or above-average intellectual functioning. Subsequently, the slopes of the trajectories were evaluated to determine if they differed depending on age when the study began, with the goal of identifying possible cohort effects. RESULTS There were significant trajectories of age-related change for all but one of the measures, although different measures manifested different patterns. Most autism symptoms improved through adulthood, while health worsened. An inverted U-shaped curve best described change for repetitive behavior symptoms, activities of daily living, maladaptive behaviors, and social interaction. For these measures, improved functioning was evident from adolescence until midlife. Then change leveled off, with worsening functioning from later midlife into early older age. Additionally, differences between autistic individuals with and without ID were evident. Although those who have ID had poorer levels of functioning, there were some indications that those without ID had accelerating challenges in their aging years that were not evident in those with ID - increases in medications for physical health problems and worsening repetitive behaviors. CONCLUSIONS Meeting the needs of the increasingly large population of autistic adults in midlife and old age requires a nuanced understanding of life course trajectories across the long stretch of adulthood and across multiple domains. Given the heterogeneity of autism, it will be important not to generalize across sub-groups, for example those who are minimally verbal and those who have above-average intellectual functioning.
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Affiliation(s)
- Jinkuk Hong
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Ave, Madison, WI, 53705, USA.
| | - Leann Smith DaWalt
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Ave, Madison, WI, 53705, USA
| | - Julie Lounds Taylor
- Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN, 37232, USA
| | - Aasma Haider
- Lawrence University, 711 E. Boldt Way, Appleton, WI, 54911, USA
| | - Marsha Mailick
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Ave, Madison, WI, 53705, USA
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2
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Hu Y, Li M, Shen Y, Wang T, Liu Q, Lu Z, Wang H, Luo X, Yang L. Case report: A novel frameshift mutation in BRSK2 causes autism in a 16-year old Chinese boy. Front Psychiatry 2023; 14:1205204. [PMID: 37671287 PMCID: PMC10476520 DOI: 10.3389/fpsyt.2023.1205204] [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: 04/13/2023] [Accepted: 06/26/2023] [Indexed: 09/07/2023] Open
Abstract
Serine/threonine protein kinases are involved in axon formation and neuronal polarization and have recently been implicated in autism spectrum disorder (ASD) and neurodevelopmental disorders (NDD). Here, we focus on BRSK2, which encodes brain-specific serine/threonine protein kinase 2. Although previous studies have reported 19 unrelated patients with BRSK2 pathogenic variation, only 15 of 19 patients have detailed clinical data. Therefore, more case reports are needed to enrich the phenotype associated with BRSK2 mutations. In this study, we report a novel de novo frameshift variant (c.442del, p.L148Cfs*39) identified by exome sequencing in a 16 year-old Chinese boy with ASD. The proband presented with attention-deficit, auditory hallucinations, limb tremor, and abnormal brain electrical activity mapping. This study expands the phenotypic spectrum of BRSK2-related cases and reveals the highly variable severity of disorders associated with BRSK2.
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Affiliation(s)
- Yu Hu
- The Brain Cognition and Brain Disease Institute, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
- Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institutions, Shenzhen, China
| | - Miao Li
- The Brain Cognition and Brain Disease Institute, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
- Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institutions, Shenzhen, China
| | - Yanmei Shen
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Tianyun Wang
- Department of Medical Genetics, Center for Medical Genetics, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China
- Neuroscience Research Institute, Peking University, Beijing, China
- Key Laboratory for Neuroscience, Ministry of Education of China and National Health Commission of China, Beijing, China
- Autism Research Center, Peking University Health Science Center, Beijing, China
| | - Qiwei Liu
- The Brain Cognition and Brain Disease Institute, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
- Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institutions, Shenzhen, China
- State Key Laboratory of Primate Biomedical Research, Institute of Primate Translational Medicine, Kunming University of Science and Technology, Kunming, China
| | - Zhonghua Lu
- The Brain Cognition and Brain Disease Institute, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
- Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institutions, Shenzhen, China
| | - Hong Wang
- The Brain Cognition and Brain Disease Institute, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
- Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institutions, Shenzhen, China
| | - Xuerong Luo
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Lixin Yang
- The Brain Cognition and Brain Disease Institute, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
- Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institutions, Shenzhen, China
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3
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Hotez E, Rava J, Russ S, Ware A, Halfon N. Using a life course health development framework to combat stigma-related health disparities for individuals with intellectual and/or developmental disability (I/DD). Curr Probl Pediatr Adolesc Health Care 2023; 53:101433. [PMID: 37867057 DOI: 10.1016/j.cppeds.2023.101433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
In the U.S., 1 in 6 children has an intellectual and/or developmental disability (I/DD). This population experiences a multitude of negative health outcomes across the life course, relative to the general population. Stigma-the social devaluation of individuals with certain characteristics, identities, or statuses within interpersonal, educational, healthcare, and policy contexts-is a potentially preventable contributor to health disparities. To date, existing approaches for addressing and preventing stigma are limited to discrete and siloed interventions that often fail to address the lifelong, cumulative impacts of the specific types of stigma experienced by the I/DD population. In the current paper, we describe three elements of Life Course Health Development (LCHD)-a novel translational framework that draws on evidence from biology, sociology, epidemiology, and psychology-that healthcare providers can use to prevent stigma-related health disparities and improve outcomes for individuals with I//DDs. We discuss the utility of targeting prevention to sensitive periods; prioritizing interventions for the most damaging types of stigmas; and leveraging supports from multiple service systems and sectors. By incorporating evidence from life course science into efforts to address stigma-related health disparities, providers can more effectively and strategically prevent and combat stigma-related health disparities for the I/DD population in childhood and across the life course.
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Affiliation(s)
- Emily Hotez
- University of California, Los Angeles (UCLA), David Geffen School of Medicine, Department of General Internal Medicine / Health Services Research, 911 Broxton Ave, Los Angeles, CA, 90095, United States; University of California, Los Angeles (UCLA), David Geffen School of Medicine, Department of Pediatrics, Center for Healthier Children, Families, & Communities, 10960 Wilshire Blvd., Suite 960, Los Angeles, CA 90024-3913, United States.
| | - Julianna Rava
- University of California, Los Angeles (UCLA), David Geffen School of Medicine, Department of General Internal Medicine / Health Services Research, 911 Broxton Ave, Los Angeles, CA, 90095, United States; University of California, Los Angeles (UCLA), David Geffen School of Medicine, Department of Pediatrics, Center for Healthier Children, Families, & Communities, 10960 Wilshire Blvd., Suite 960, Los Angeles, CA 90024-3913, United States
| | - Shirley Russ
- University of California, Los Angeles (UCLA), David Geffen School of Medicine, Department of General Internal Medicine / Health Services Research, 911 Broxton Ave, Los Angeles, CA, 90095, United States; University of California, Los Angeles (UCLA), David Geffen School of Medicine, Department of Pediatrics, Center for Healthier Children, Families, & Communities, 10960 Wilshire Blvd., Suite 960, Los Angeles, CA 90024-3913, United States
| | - Allysa Ware
- Family Voices, 110 Hartwell Avenue, Lexington, MA, 02421, United States
| | - Neal Halfon
- University of California, Los Angeles (UCLA), David Geffen School of Medicine, Department of Pediatrics, Center for Healthier Children, Families, & Communities, 10960 Wilshire Blvd., Suite 960, Los Angeles, CA 90024-3913, United States; Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, United States; Department of Public Policy, UCLA Luskin School of Public Affairs, Los Angeles, CA, United States
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4
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McFayden TC, Putnam O, Grzadzinski R, Harrop C. Sex Differences in the Developmental Trajectories of Autism Spectrum Disorder. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2023; 10:80-91. [PMID: 37635854 PMCID: PMC10457022 DOI: 10.1007/s40474-023-00270-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2023] [Indexed: 01/28/2023]
Abstract
Purpose of Review Females and males are disproportionately diagnosed with autism, a sex difference that has historically represented this neurodevelopmental condition. The current review examines lifespan developmental trajectories of autism based on sex to elucidate behavioral phenotypic differences that may contribute to differential rates of diagnosis. Recent Findings We review sex differences in diagnostic criteria: social communication and restricted interests/repetitive behaviors (RRBs). Results suggest RRBs are more indicative of a diagnosis in males, whereas social differences are more indicative of a diagnosis in females. Factors contributing to a later diagnosis in females include social strengths (camouflaging) and diagnostic overshadowing. Summary Sex differences in diagnostic criteria may contribute to differential rates of identification in males and females. Sex differences are most pronounced when assessing naturalistic social communication instead of reliance on standardized measure. Numerous future directions are identified including increasing samples of sub-threshold autistic females and evaluating longitudinal sex differences.
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Affiliation(s)
- Tyler C. McFayden
- Carolina Institute for Developmental Disabilities, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Orla Putnam
- Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Rebecca Grzadzinski
- Carolina Institute for Developmental Disabilities, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Clare Harrop
- Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, USA
- TEACCH Autism Program, University of North Carolina at Chapel Hill, Chapel Hill, USA
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Abstract
Relative to males, women with autism spectrum disorder (ASD) have neurobiological and clinical presentation differences. Recent research suggests that the male/female ASD prevalence gap is smaller than previously reported. Sex differences in symptom presentation as well as the male bias of ASD account for delayed/missed diagnosis among women. Investigating ASD and providing psychological evaluation referrals for women who are struggling socially and present with complex mental health conditions (e.g., ADHD, depression), even when they do not show typical autistic characteristics, is important. Accurate diagnosis facilitates understanding of challenges, increases access to treatments, and alleviates the burden of ASD.
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Affiliation(s)
- Cesar Ochoa-Lubinoff
- Rush University Medical Center, 1725 West Harrison Street, Suite 710, Chicago, IL 60612, USA.
| | - Bridget A Makol
- Rush University Medical Center, 1653 West Congress Parkway, 12 Kellogg, Chicago, IL 60612, USA
| | - Emily F Dillon
- Rush University Medical Center, 1645 West Jackson Boulevard, Chicago, IL 60612, USA
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6
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Davies C, Moosa M, McKenna K, Mittal J, Memis I, Mittal R, Eshraghi AA. Quality of Life, Neurosensory Disorders and Co-Occurring Medical Conditions in Individuals on the Spectrum, with a Special Focus on Females Diagnosed with Autism: A Systematic Review. J Clin Med 2023; 12:jcm12030927. [PMID: 36769575 PMCID: PMC9917678 DOI: 10.3390/jcm12030927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/12/2023] [Accepted: 01/16/2023] [Indexed: 01/26/2023] Open
Abstract
Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder that has a high prevalence and a significant economic impact. Our knowledge regarding neurosensory disorders and co-occurring medical conditions in the ASD population is limited, particularly for autistic women. Most of the studies include male participants or do not make comparisons with their female counterparts. The objective of this systematic review article is to explore the quality of life as well as the prevalence of neurosensory disorders and co-occurring medical conditions in individuals on the spectrum, with a special focus on autistic females. The literature search was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. A protocol of this systematic review was designed a priori and was registered in the PROSPERO database (registration number: CRD42022330368). We concluded that numerous medical areas were of concern. Autistic females are more likely than their male counterparts with ASD to suffer from psychiatric conditions such as post-traumatic stress syndrome, depression, and eating disorders. They are also more likely to report GI-related disturbances and chronic pain. Further investigations are warranted to determine quality of life, as well as the prevalence and severity of neurosensory disorders in individuals with ASD, specifically studies comparing autistic females with their male counterparts. The information derived from these studies will help develop better support systems for individuals with autism, particularly females on the spectrum, in pursuit of improving their quality of life.
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Affiliation(s)
- Camron Davies
- Hearing Research and Communication Disorders Laboratory, Department of Otolaryngology, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA
| | - Moeed Moosa
- Hearing Research and Communication Disorders Laboratory, Department of Otolaryngology, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - Keelin McKenna
- Hearing Research and Communication Disorders Laboratory, Department of Otolaryngology, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA
| | - Jeenu Mittal
- Hearing Research and Communication Disorders Laboratory, Department of Otolaryngology, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - Idil Memis
- Hearing Research and Communication Disorders Laboratory, Department of Otolaryngology, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - Rahul Mittal
- Hearing Research and Communication Disorders Laboratory, Department of Otolaryngology, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - Adrien A. Eshraghi
- Hearing Research and Communication Disorders Laboratory, Department of Otolaryngology, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
- Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
- Department of Pediatrics, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
- Correspondence:
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7
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Tint A, Chung H, Lai MC, Balogh R, Lin E, Durbin A, Lunsky Y. Health conditions and service use of autistic women and men: A retrospective population-based case-control study. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023:13623613221144353. [PMID: 36588296 PMCID: PMC10374994 DOI: 10.1177/13623613221144353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
LAY ABSTRACT This study used administrative data from Ontario, Canada to compare the health conditions and service use of autistic women and men with adults with other developmental disabilities and with adults without developmental disabilities. Autistic women and men were more likely to have physical and mental health conditions compared to adults without developmental disabilities. Rates of health conditions were similar or lower among autistic adults compared to adults with other developmental disabilities, except more autistic adults had psychiatric conditions. Autistic women and men used higher rates of psychiatric services compared to all other groups. When comparing autistic women with same aged autistic men, sex differences were found for specific physical (Crohn's disease/colitis, rheumatoid arthritis) and psychiatric conditions (psychotic disorders, non-psychotic disorders), as well differences in service use (emergency department visits, hospitalizations, family doctor and neurologist visits). These results further highlight the high health needs and service use of autistic women and men, as well as adults with other developmental disabilities. It is critical for future research to focus on mental health support for autistic adults and to better understand how to tailor supports to best serve autistic women.
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Affiliation(s)
- Ami Tint
- Centre for Addiction and Mental Health, Canada
| | | | - Meng-Chuan Lai
- Centre for Addiction and Mental Health, Canada.,University of Toronto, Canada.,The Hospital for Sick Children, Canada.,University of Cambridge, United Kingdom.,National Taiwan University Hospital, Taiwan
| | | | - Elizabeth Lin
- Centre for Addiction and Mental Health, Canada.,University of Toronto, Canada
| | - Anna Durbin
- ICES, Canada.,University of Toronto, Canada.,Unity Health, Canada
| | - Yona Lunsky
- Centre for Addiction and Mental Health, Canada.,ICES, Canada.,University of Toronto, Canada
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8
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Grove R, Clapham H, Moodie T, Gurrin S, Hall G. 'Living in a world that's not about us': The impact of everyday life on the health and wellbeing of autistic women and gender diverse people. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057231189542. [PMID: 37727115 PMCID: PMC10515546 DOI: 10.1177/17455057231189542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 05/26/2023] [Accepted: 07/04/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Autistic women and gender diverse people have specific needs related to their physical and mental health. They also experience more barriers to accessing services. While there are autobiographical accounts of the 'invisible' challenges that autistic women and gender diverse people face day-to-day, there has been limited research that explores how these experiences impact health and wellbeing. OBJECTIVES This study aimed to understand the everyday experiences of autistic women and gender diverse people, and their impact on health and wellbeing. DESIGN Qualitative methods were used to elicit rich information about the unique experiences of autistic women and gender diverse people. METHODS We conducted semi-structured interviews with 31 autistic adults. The data were analysed using reflexive thematic analysis. RESULTS We identified 3 themes and 10 subthemes. Our first theme described 'all the stuff that you have to do to get through life', including managing domestic tasks, parenting, unique health needs and co-occurring physical conditions. The second theme outlined the impact of 'living in a world that's not about us', describing how navigating the neurotypical world, managing gender role expectations and trying to fit impacts on mental health. Our third theme outlined the positive impacts of 'shedding all the layers and being myself', including the importance of formal identification, exploring autistic identity and community, and including autistic people in research to support them to 'have a good life on their own terms'. CONCLUSION This study emphasized the importance of shifting the responsibility of health and wellbeing from the individual, and the importance of interpersonal, community, cultural, policy and societal factors in ensuring positive health outcomes for autistic women and gender diverse people. It also highlighted areas that enable autistic women and gender diverse people to flourish, including autistic community connectedness, positive relationships and autistic-affirming support from health professionals.
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Affiliation(s)
- Rachel Grove
- School of Public Health, Faculty of Health, University of Technology Sydney, NSW, Australia
| | - Hayley Clapham
- Autistic Advisory Group, School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Tess Moodie
- Autistic Advisory Group, School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Sarah Gurrin
- Autistic Advisory Group, School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Gabrielle Hall
- School of Public Health, Faculty of Health, University of Technology Sydney, NSW, Australia
- Autistic Advisory Group, School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
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9
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Vidriales-Fernández R, Plaza-Sanz M, Hernández-Layna C, Verde-Cagiao M, Benito-Ruiz G, Carvajal-Molina F. Characterizing the physical and mental health profile of children, adolescents and adults with autism spectrum disorder in Spain. Front Psychiatry 2023; 14:1088727. [PMID: 36970262 PMCID: PMC10031816 DOI: 10.3389/fpsyt.2023.1088727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 02/14/2023] [Indexed: 03/29/2023] Open
Abstract
Introduction Autistic men and women are more likely to experience health issues than the general population, although the available epidemiological studies addressing co-occurrence conditions are limited. This is the first Spanish epidemiologic study addressing the health profile and poor-health exacerbating factors in individuals of all ages with autism spectrum disorder (ASD). Methods We analyzed 2,629 registries extracted from Autism Spain's sociodemographic registry (November 2017-May 2020). A descriptive health data analysis was conducted to assess the prevalence of other conditions associated to ASD in the Spanish population. Nervous system disorders (12.9%), mental health diagnoses (17.8%), and other comorbidities (25.4%) were reported. Men-to-women ratio was 4:1. Results Women, elder individuals and those with intellectual disability (ID) were at an increased risk of health comorbidities and psychopharmacological exposure. Women were also more prone to severe intellectual and functional impairment. Nearly all individuals had difficulties in their adaptative functioning, especially those with ID (50% of the population). Almost half of the sample received psychopharmacological treatments starting from infancy and early childhood, mostly antipsychotics and anticonvulsants. Discussion This study represents an important first approach to the health status of autistic people in Spain and can contribute to the development of public policies and innovative health strategies.
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Affiliation(s)
| | | | | | | | - Guillermo Benito-Ruiz
- Confederación Autismo España, Madrid, Spain
- Facultad de Ciencias de la Salud, Universidad Isabel I, Burgos, Spain
- *Correspondence: Guillermo Benito-Ruiz,
| | - Fernando Carvajal-Molina
- Facultad de Psicología, Departamento de Psicología Biológica y de la Salud, Universidad Autónoma de Madrid, Madrid, Spain
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10
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Williams ZJ, Cascio CJ, Woynaroski TG. Measuring subjective quality of life in autistic adults with the PROMIS global-10: Psychometric study and development of an autism-specific scoring method. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:145-157. [PMID: 35403453 PMCID: PMC9550880 DOI: 10.1177/13623613221085364] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
LAY ABSTRACT Quality of Life an outcome that both researchers and autistic advocates agree is extremely important to consider when implementing services, interventions, and supports for autistic people. However, there has been little research on the topic of how quality of life can best be measured in autistic people or whether existing quality of life questionnaires are appropriate for use in the autistic population. This study aimed to validate an established quality of life measure, the Patient-Reported Outcomes Measurement Information System Global-10, in a large sample of autistic adults recruited online. We created a new way to score the Patient-Reported Outcomes Measurement Information System Global-10 scale and generate a "General quality of life" score specific to autistic adults. This new score performed very well in this sample, showing very little measurement error and relating in expected ways to similar constructs, such as physical health and emotional distress. Exploratory analyses found that lower quality of life was associated with female sex and self-identification as a sexual or gender minority (i.e. LGBTQ + identity). These findings suggest that the new Patient-Reported Outcomes Measurement Information System Global-10 quality of life score is a reliable and valid measure of quality of life in autistic adults, although additional studies are necessary to further explore its measurement properties in other subsets of the autistic population, such as individuals with intellectual disabilities. This measure is freely available for use as an outcome in both research and clinical practice, and an online score calculator is available to support the use of this measure in real-world applications.
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Affiliation(s)
- Zachary J. Williams
- Medical Scientist Training Program, Vanderbilt University School of Medicine, Nashville, TN
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN
- Vanderbilt Brain Institute, Vanderbilt University, Nashville, TN
- Frist Center for Autism and Innovation, Vanderbilt University, Nashville, TN
- Vanderbilt Kennedy Center, Vanderbilt University Medical Center, Nashville, TN
| | - Carissa J. Cascio
- Vanderbilt Brain Institute, Vanderbilt University, Nashville, TN
- Frist Center for Autism and Innovation, Vanderbilt University, Nashville, TN
- Vanderbilt Kennedy Center, Vanderbilt University Medical Center, Nashville, TN
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Tiffany G. Woynaroski
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN
- Vanderbilt Brain Institute, Vanderbilt University, 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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11
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Redquest B, Tint A, St. John L, Hutton S, Palmer P, Lunsky Y. Virtual group-based mindfulness program for autistic women: A feasibility study. WOMEN'S HEALTH (LONDON, ENGLAND) 2022; 18:17455057221142369. [PMID: 36560924 PMCID: PMC9793023 DOI: 10.1177/17455057221142369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Autistic women experience life differently than autistic men. For example, autistic women tend to be diagnosed significantly later than autistic men, they experience a higher number of traumas, and are at increased risk for mental health conditions. Given gender-specific life experiences, autistic women may benefit from gender-specific group-based supports. Virtual mindfulness has been shown to be helpful in improving well-being among autistic adults; however, limited research has explored the impact of virtual mindfulness when it is delivered to a group of autistic women only. OBJECTIVES The aim of this article is to describe a preliminary evaluation of a virtual mindfulness group piloted for autistic women. Five key areas of feasibility were assessed in the current study: demand, implementation, acceptability, practicality, and limited efficacy testing. METHODS Twenty-eight women participated in a 6-week virtual autism-informed mindfulness program and were asked to complete measures assessing psychological distress, self-compassion, and mindfulness at pre and post. Participants were also asked to complete a satisfaction survey after the program. RESULTS Results showed that the program was feasible in terms of demand, implementation, practicality, and acceptability. While quantitative results showed there were no changes in psychological distress, self-compassion, and mindfulness from pre- to post-program, qualitative results showed some benefits. CONCLUSION Given the unique challenges that some autistic women experience, offering groups to autistic women may have some value and it would be important to continue exploring this topic area.
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Affiliation(s)
- Brianne Redquest
- School and Applied Child Psychology,
Werklund School of Education, University of Calgary, Calgary, AB, Canada,Alberta Children’s Hospital Research
Institute, University of Calgary, Calgary, AB, Canada,Azrieli Adult Neurodevelopmental
Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and
Mental Health, Toronto, ON, Canada
| | - Ami Tint
- Azrieli Adult Neurodevelopmental
Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and
Mental Health, Toronto, ON, Canada
| | - Laura St. John
- Azrieli Adult Neurodevelopmental
Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and
Mental Health, Toronto, ON, Canada
| | - Sue Hutton
- Azrieli Adult Neurodevelopmental
Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and
Mental Health, Toronto, ON, Canada
| | - Pamela Palmer
- Azrieli Adult Neurodevelopmental
Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and
Mental Health, Toronto, ON, Canada
| | - Yona Lunsky
- Azrieli Adult Neurodevelopmental
Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and
Mental Health, Toronto, ON, Canada,Department of Psychiatry, Temerty
Faculty of Medicine, University of Toronto, Toronto, ON, Canada,Yona Lunsky, Azrieli Adult
Neurodevelopmental Centre, Centre for Addiction and Mental Health, 1025 Queen
Street West, Toronto M6J 1H4, Ontario, Canada.
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12
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Barriers to healthcare and their relationship to well-being and social support for autistic adults during COVID-19. Prim Health Care Res Dev 2022; 23:e79. [PMID: 36515013 PMCID: PMC9817085 DOI: 10.1017/s1463423622000755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
AIM The present study aimed to investigate barriers to healthcare and their relationships to social and emotional well-being and intersectional inequalities for autistic adults during COVID-19 restrictions in the UK. BACKGROUND Autistic adults experience severe health inequalities and report more barriers to accessing health services compared to other both disabled and non-disabled populations. The COVID-19 pandemic has impacted many areas of society that may have increased vulnerability of autistic people to social and health inequalities, including delivery of healthcare from in-person to remote methods. METHOD One hundred twenty-eight autistic adults who lived in the UK took part in an online survey. Measures included the Barriers to Healthcare Checklist (Short Form) and PROMIS outcome measure bank to assess emotional well-being and social support. Participants rated their agreement with items, retrospectively considering three different points of the trajectory of COVID-19 restrictions: before COVID-19, during the first lockdown in spring 2020, and in the month prior to taking the survey during autumn 2020. They completed a follow-up survey six months later to continue to assess change as restrictions in the UK were eased. FINDINGS The average number of barriers to healthcare showed no significant change between all four time points. However, the nature of barriers to healthcare changed at the point of lockdown and persisted beyond the easing of COVID-19 restrictions. Barriers to healthcare were associated with some social and emotional well-being variables and demographic groups including gender, education and presence of additional disabilities. The findings may help to identify areas to target to improve access to both remote and in-person health systems for autistic people as modes of delivery continue to change over time.
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Smith JA, Eikenberry SA, Scott KA, Baumer-Harrison C, de Lartigue G, de Kloet AD, Krause EG. Oxytocin and cardiometabolic interoception: Knowing oneself affects ingestive and social behaviors. Appetite 2022; 175:106054. [PMID: 35447163 DOI: 10.1016/j.appet.2022.106054] [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] [Received: 01/03/2022] [Revised: 03/22/2022] [Accepted: 04/14/2022] [Indexed: 01/22/2023]
Abstract
Maintaining homeostasis while navigating one's environment involves accurately assessing and interacting with external stimuli while remaining consciously in tune with internal signals such as hunger and thirst. Both atypical social interactions and unhealthy eating patterns emerge as a result of dysregulation in factors that mediate the prioritization and attention to salient stimuli. Oxytocin is an evolutionarily conserved peptide that regulates attention to exteroceptive and interoceptive stimuli in a social environment by functioning in the brain as a modulatory neuropeptide to control social behavior, but also in the periphery as a hormone acting at oxytocin receptors (Oxtr) expressed in the heart, gut, and peripheral ganglia. Specialized sensory afferent nerve endings of Oxtr-expressing nodose ganglia cells transmit cardiometabolic signals via the Vagus nerve to integrative regions in the brain that also express Oxtr(s). These brain regions are influenced by vagal sensory pathways and coordinate with external events such as those demanding attention to social stimuli, thus the sensations related to cardiometabolic function and social interactions are influenced by oxytocin signaling. This review investigates the literature supporting the idea that oxytocin mediates the interoception of cardiovascular and gastrointestinal systems, and that the modulation of this awareness likewise influences social cognition. These concepts are then considered in relation to Autism Spectrum Disorder, exploring how atypical social behavior is comorbid with cardiometabolic dysfunction.
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Affiliation(s)
- Justin A Smith
- Department of Pharmacodynamics, College of Pharmacy, University of Florida, Gainesville, FL, USA; Center for Integrative Cardiovascular and Metabolic Diseases, University of Florida, Gainesville, FL, USA; Evelyn F. and William L. McKnight Brain Institute, University of Florida, Gainesville, FL, USA
| | - Sophia A Eikenberry
- Center for Integrative Cardiovascular and Metabolic Diseases, University of Florida, Gainesville, FL, USA; Department of Physiology and Functional Genomics, College of Medicine, University of Florida, Gainesville, FL, USA; Evelyn F. and William L. McKnight Brain Institute, University of Florida, Gainesville, FL, USA
| | - Karen A Scott
- Department of Pharmacodynamics, College of Pharmacy, University of Florida, Gainesville, FL, USA; Center for Integrative Cardiovascular and Metabolic Diseases, University of Florida, Gainesville, FL, USA; Evelyn F. and William L. McKnight Brain Institute, University of Florida, Gainesville, FL, USA
| | - Caitlin Baumer-Harrison
- Center for Integrative Cardiovascular and Metabolic Diseases, University of Florida, Gainesville, FL, USA; Department of Physiology and Functional Genomics, College of Medicine, University of Florida, Gainesville, FL, USA; Evelyn F. and William L. McKnight Brain Institute, University of Florida, Gainesville, FL, USA
| | - Guillaume de Lartigue
- Department of Pharmacodynamics, College of Pharmacy, University of Florida, Gainesville, FL, USA; Center for Integrative Cardiovascular and Metabolic Diseases, University of Florida, Gainesville, FL, USA
| | - Annette D de Kloet
- Center for Integrative Cardiovascular and Metabolic Diseases, University of Florida, Gainesville, FL, USA; Department of Physiology and Functional Genomics, College of Medicine, University of Florida, Gainesville, FL, USA; Evelyn F. and William L. McKnight Brain Institute, University of Florida, Gainesville, FL, USA
| | - Eric G Krause
- Department of Pharmacodynamics, College of Pharmacy, University of Florida, Gainesville, FL, USA; Center for Integrative Cardiovascular and Metabolic Diseases, University of Florida, Gainesville, FL, USA; Evelyn F. and William L. McKnight Brain Institute, University of Florida, Gainesville, FL, USA.
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14
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Towards equitable diagnoses for autism and attention-deficit/hyperactivity disorder across sexes and genders. Curr Opin Psychiatry 2022; 35:90-100. [PMID: 35084380 DOI: 10.1097/yco.0000000000000770] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Sex/gender-related factors contribute to contextual issues influencing the recognition of autism and attention-deficit/hyperactivity disorder (ADHD), and modulate how neurodevelopmental characteristics are manifested. This review summarizes the empirical literature to provide directions for improving clinical diagnostic practices. RECENT FINDINGS Timing of autism and/or ADHD diagnosis, particularly in girls/women, is related to the individual's developmental characteristics and co-occurring diagnoses, and expectancy, alongside gender stereotype biases, of referral sources and clinicians. This is further compounded by sex and gender modulations of behavioural presentations. The emerging 'female autism phenotype' concept may serve as a helpful illustration of nuanced autism phenotypes, but should not be viewed as essential features of autism in a particular sex or gender. These nuanced phenotypes that can present across sexes and genders include heightened attention to socially salient stimuli, friendship and social groups, richness in language expression, and more reciprocal behaviours. The nuanced female-predominant ADHD phenotypes are characterized by subtle expressions in hyperactivity-impulsivity (e.g., hyper-verbal behaviours). Optimizing neurodevelopmental diagnoses across sexes and genders also requires an understanding of sex-related and gender-related variations in developmental trajectories, including compensation/masking efforts, and the influences of co-occurring conditions on clinical presentations. SUMMARY Equitable diagnoses across sexes and genders for autism and ADHD require understanding of the nuanced presentations and the Gestalt clinical-developmental profiles, and addressing contextual biases that influence diagnostic practices.
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Hidalgo PM, Martínez MM, González AG, Petisco LG, Forcadell CA, D'Agostino CI, de la Varga LP. Self-Perceived Quality of Life in Spanish-Speaking Women with Autism Spectrum Disorders. J Autism Dev Disord 2021; 52:5428-5439. [PMID: 34953140 PMCID: PMC9637056 DOI: 10.1007/s10803-021-05400-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2021] [Indexed: 12/03/2022]
Abstract
Perceived personal wellbeing tends to be lower in individuals with autism spectrum disorders (ASD), especially in the case of women. To develop the present study, the Personal Wellbeing Index (PWI-A) was administered to a Spanish-speaking sample of women with ASD (N = 401) and self-diagnosed ASD (N = 343), women without ASD (N = 373) and men with ASD (N = 65) to compare their self-perceptions. Women with ASD showed significantly lower wellbeing rates than women in the control group for the total PWI-A and across all the domains, and there were no significant differences when compared with self-diagnosed women with ASD and men with ASD. Autism explained between 24 and 26% of the decline in the PWI-A total score, with life achievement, future security, safety and relationships being the domains most highly correlated with the total. These findings are an effective contribution to improving diagnosis and professional intervention in women with ASD.
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Affiliation(s)
- Paula Morales Hidalgo
- Research Group on Nutrition and Mental Health (NUTRISAM), Research Center for Behavioral Assessment (CRAMC), Department of Psychology, University Rovira i Virgili, Tarragona, Spain.
- Asperger- ASD Association of Camp de Tarragona, Tarragona, Spain.
- Spanish Association of Autism Professionals (AETAPI), Cadiz, Spain.
| | - María Merino Martínez
- Science of Education Department, Specific Didactics Department, Universidad de Burgos, Burgos, Spain
- Burgos Autism Association, Burgos, Spain
- Spanish Association of Autism Professionals (AETAPI), Cadiz, Spain
| | - Angélica Gutiérrez González
- Department of Social Anthropology, Basic Psychology Public Health, Universidad Pablo de Olavide, Sevilla, Spain
- Sevilla Autism Association, Sevilla, Spain
- Spanish Association of Autism Professionals (AETAPI), Cadiz, Spain
| | - Lola Garrote Petisco
- Centro de Evaluación, Diagnóstico e Intervención (CEDIN), Valencia, Spain
- Spanish Association of Autism Professionals (AETAPI), Cadiz, Spain
| | - Carol Amat Forcadell
- Maresme Health Consortium, Mataró Hospital, Mataró, Spain
- Gabinet d'Especialitats Mèdiques Associades Mataró (GEMASI), Mataró, Spain
- Spanish Association of Autism Professionals (AETAPI), Cadiz, Spain
| | - Cynthia I D'Agostino
- Department of Psychology and Pedagogical Sciences, Universidad CAECE, Buenos Aires, Argentina
- Pediatrics Service, Hospital de Clinicas José T. San Martín, Buenos Aires, Argentina
- Spanish Association of Autism Professionals (AETAPI), Cadiz, Spain
| | - Laura Pérez de la Varga
- Science of Education Department, Universidad de Burgos, Burgos, Spain
- Spanish Association of Autism Professionals (AETAPI), Cadiz, Spain
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