1
|
Schwartzman JM, Antezana L, Conner CM. The relationship between distress tolerance and behavioral activation on anxiety and depression symptomatology in autistic youth: Leveraging self and caregiver perspectives. Autism Res 2024. [PMID: 39105310 DOI: 10.1002/aur.3208] [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: 03/29/2024] [Accepted: 07/22/2024] [Indexed: 08/07/2024]
Abstract
Anxiety and depression are prevalent among autistic adolescents and may be difficult to accurately diagnose and treat given various factors (e.g., diagnostic overshadowing, heterogeneity). Therefore, efforts to examine transdiagnostic factors (i.e., distress tolerance, behavioral activation) may afford more parsimonious means for assessment and treatment. To our knowledge, there has been little research on distress tolerance, behavioral activation, and depressive and anxiety symptoms in autistic adolescents to guide diagnostic practices and treatment planning. In the current study, we examined the interrelationships between these transdiagnostic factors and depressive and anxiety symptoms using ratings from 100 verbally fluent autistic adolescents without intellectual disability (Mage = 13.70, SDage = 2.23, Range: 11:00-17:11 years) and 100 of their caregivers. Many adolescents reported male sex assigned at birth (61%), cisgender (87%), not Hispanic/Latinx (90%), and White (80%) identities. A series of correlational analyses were employed to examine associations between these constructs from youth and caregiver perspectives, and multiple linear regression analyses were conducted to explore the mediating roles of distress tolerance and behavioral activation. Preliminary results show that low distress tolerance and behavioral activation were associated with more severe internalizing symptoms per self- and caregiver-report. Some differences by rater emerged, which highlight the importance of multi-informant ratings in autism. Results from mediation analyses may show that behavioral activation may be more salient to assessments and treatment planning for depression than distress tolerance, while distress tolerance may be important for both anxiety and depression; however, findings are preliminary given the cross-sectional nature of the data. Findings suggest that these transdiagnostic concepts may be important to individualizing treatment approaches, including the timing of certain approaches, for anxiety and/or depression in autistic adolescents.
Collapse
Affiliation(s)
- Jessica M Schwartzman
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Pediatrics, University of Southern California, Los Angeles, California, USA
| | - Ligia Antezana
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Caitlin M Conner
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
2
|
Corbett BA, Muscatello RA, Cyperski M, Sadikova E, Edmiston EK, McGonigle TW, Calvosa R, Vandekar S. Gender diversity in autistic and neurotypical youth over adolescence and puberty: A longitudinal study. Autism Res 2024; 17:1450-1463. [PMID: 38661056 DOI: 10.1002/aur.3141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 04/12/2024] [Indexed: 04/26/2024]
Abstract
Recent research in autism spectrum disorder (ASD) has suggested a higher prevalence of gender diversity in individuals diagnosed with ASD. Adolescence is a critical period for the consolidation of gender identity, yet the extent to which the experience of gender diversity is stable over adolescence and puberty in autistic youth is poorly understood. The aim of the study was to examine the consistency of gender diversity using the gender diversity screening questionnaire for self- and parent-report of youth (GDSQ-S, GDSQ-P) over a four-year longitudinal study of pubertal development in youth with ASD (N = 140, 36 assigned-female-at birth (AFAB)) and typical development (TD, N = 104, 58 assigned-male-at-birth [AMAB]) and their parents. The extent to which diagnosis (ASD vs. TD), assigned sex (AFAB vs. AMAB) and developmental level (age, puberty) predict GDSQ trajectory over time was explored. There was a significant diagnosis by sex-assigned-at-birth by age interaction for GDSQ-S Gender Diversity, p = 0.002, showing higher scores in autistic AFAB youth over adolescence, and TD AFAB showing initially lower, then increasing levels over adolescence. For GDSQ-P, Gender Incongruence was significantly different between the groups, p = 0.032, showing higher incongruence for autistic AFAB around age 10, decreasing between age 12-14 before increasing again, while TD AFAB evidence the inverse trend. AMAB trends were stable. The significant diagnostic, developmental and sex-based differences indicate AFAB youth experience greater gender diversity that evolves over development. Findings suggest gender identity formation is nuanced and may be influenced by pubertal progression, hormonal patterns, and psychosocial factors. Results underscore the need for enhanced understanding of the unique, dynamic profiles of females-assigned-at-birth.
Collapse
Affiliation(s)
- Blythe A Corbett
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Vanderbilt Kennedy Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Psychology, Vanderbilt University, Nashville, Tennessee, USA
| | - Rachael A Muscatello
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Vanderbilt Kennedy Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Melissa Cyperski
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Eleonora Sadikova
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - E Kale Edmiston
- Department of Psychiatry, University of Massachusetts Chan School of Medicine, Worcester, Massachusetts, USA
| | - Trey William McGonigle
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Rachel Calvosa
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Simon Vandekar
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| |
Collapse
|
3
|
Corbett BA, Muscatello RA, McGonigle T, Vandekar S, Burroughs C, Sparks S. Trajectory of depressive symptoms over adolescence in autistic and neurotypical youth. Mol Autism 2024; 15:18. [PMID: 38698474 PMCID: PMC11064411 DOI: 10.1186/s13229-024-00600-w] [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: 11/29/2023] [Accepted: 04/25/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Adolescence coincides with a dramatic rise in the onset of psychiatric conditions including depression. Depression symptoms may be particularly prevalent and impairing for youth with autism spectrum disorder (ASD). While prior research suggests adolescence is associated with worsening depression symptoms for typically developing (TD) and autistic youth, it is unclear if they follow a similar course. METHOD The study examined the trajectory of depressive symptoms in autistic and neurotypical youth over a 4-year longitudinal study using linear and logistic mixed effects models. In youth with clinically relevant depressive scores (t-score > 65), moderating factors (i.e., diagnosis, age, puberty, sex) were explored. During Year 1, the sample included 244 youth 10-to-13 years: 140 in the ASD group (36 females) and 104 in the TD group (46 females). RESULTS Autistic youth had elevated depression scores compared to TD peers (p < 0.001) and females were higher than males in both groups (p = 0.001). There was significant diagnosis by age (p < 0.001) and diagnosis by pubertal stage (p < 0.05) interactions. In the ASD group, elevated depressive scores presented in early adolescence and decreased during middle adolescence and puberty, whereas the TD group showed the opposite trend with an increase in depression symptoms with advancing development. LIMITATIONS Limitations include an unequal sex distribution (fewer females), non-representative autistic sample (e.g., cognition and race/ethnicity), and potential confound of the COVID-19 pandemic. CONCLUSIONS Autistic youth present with higher rates of depressive symptoms early in development; yet, approaching middle adolescence and puberty, the symptom trajectory in the autistic youth declines coinciding with an increase in the TD youth. While group trajectories are divergent, they lead to similar levels of depression in late adolescence with higher symptoms in females. Findings suggest a period of quiescence in depressive symptomology influenced by biopsychosocial factors impacting affective profiles.
Collapse
Affiliation(s)
- Blythe A Corbett
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, 1500 21st Avenue South, Nashville, TN, 37212, USA.
- Vanderbilt Kennedy Center, Vanderbilt University Medical Center, Nashville, TN, USA.
- Department of Psychology, Vanderbilt University, Nashville, TN, USA.
| | - Rachael A Muscatello
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, 1500 21st Avenue South, Nashville, TN, 37212, USA
- Vanderbilt Kennedy Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Trey McGonigle
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Simon Vandekar
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Christina Burroughs
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, 1500 21st Avenue South, Nashville, TN, 37212, USA
| | - Sloane Sparks
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, 1500 21st Avenue South, Nashville, TN, 37212, USA
| |
Collapse
|
4
|
Rosenthal EA, Hinshaw SP. Pubertal timing in adolescents with ADHD: extension and replication in an all-female sample. Eur Child Adolesc Psychiatry 2024; 33:1133-1141. [PMID: 37245161 PMCID: PMC11032289 DOI: 10.1007/s00787-023-02239-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 05/17/2023] [Indexed: 05/29/2023]
Abstract
Pubertal timing predicts a miscellany of negative mental and physical health outcomes. Prior work examining pubertal timing in youth with attention-deficit hyperactivity disorder (ADHD) has failed to investigate potential sex specificity of results. Therefore, we aim to extend past findings in a sample of female adolescents with ADHD. We compare pubertal timing (1) between females with and without carefully diagnosed ADHD and (2) between females with ADHD who do vs. do not have a history of stimulant medication use during childhood. We examine 127 adolescent females with childhood-diagnosed ADHD and 82 matched neurotypical peers (Mage: 14.2 years, range: 11.3-18.2) from the Berkeley Girls with ADHD Longitudinal Study (Wave 2). We measured pubertal timing using self-reported Tanner staging and age at menarche. Three strategies compared pubertal timing across groups: (1)χ 2 tests of Tanner Stages, (2) t tests of residuals of pubertal status regressed on age, and (3) t tests of age at menarche. Pubertal timing of girls with and without ADHD did not differ significantly across methods and measures. Yet females with ADHD who had received stimulant medication during childhood menstruated later than those without a stimulant history, potentially related to differences in BMI across groups. On the other hand, no significant differences between medicated vs. non-medicated participants emerged for the two Tanner staging indicators. Our findings extend prior work, suggesting that females with ADHD are developing physically at a similar time as their peers, which parallels findings from previous mixed-sex samples that did not examine effects separately by sex.
Collapse
Affiliation(s)
- Emily A Rosenthal
- Department of Psychology, University of California, Berkeley, 2121 Berkeley Way, Berkeley, CA, 94720-1650, USA.
| | - Stephen P Hinshaw
- Department of Psychology, University of California, Berkeley, 2121 Berkeley Way, Berkeley, CA, 94720-1650, USA
- Department of Psychiatry and Behavioral Sciences, UCSF Weill Institute for Neurosciences, University of California, San Francisco, 675 18th Street, San Francisco, CA, 94107, USA
| |
Collapse
|
5
|
Rynkiewicz A, Zheng S, Lacroix A. Special considerations for assessing and caring for autism in girls and women. Curr Opin Psychiatry 2024; 37:71-77. [PMID: 38085884 DOI: 10.1097/yco.0000000000000913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
PURPOSE OF REVIEW As the specificities of autistic women are increasingly recognized, this review aims to highlight emerging areas of research. These areas primarily focus on measurement bias of diagnostic tools, the physical and mental health of autistic women, and the unique aspects of the lives of autistic women, both personally and professionally across all life stages. RECENT FINDINGS Conventional diagnostic tools struggle to capture the specificities of autism in females, but more sensitive instruments like the GQ-ASC (Girls' Questionnaire for Autism Spectrum Conditions), later also referred to as Q-ASC (Questionnaire for Autism Spectrum Conditions) in the scientific literature, show better performances. Autistic women face particular challenges, including an increased risk of physical and mental health problems throughout their lives as women (puberty, motherhood, menopause). Autistic women also encounter specific difficulties in their employment that require greater consideration. SUMMARY The findings of this review identify research areas that need to be developed to better understand and support autistic girls and women and to enhance clinical practice for them.
Collapse
Affiliation(s)
- Agnieszka Rynkiewicz
- Department of Psychiatry, College of Medical Sciences, University of Rzeszow, Rzeszow
- Center for Diagnosis, Therapy and Education SPECTRUM ASC-MED, Gdansk, Poland
| | - Shuting Zheng
- Department of Psychiatry and Behavioral Sciences, University of California, California, San Francisco, USA
| | - Adeline Lacroix
- Univ. Grenoble Alpes, Univ. Savoie Mont Blanc, CNRS, LPNC, Grenoble, France
| |
Collapse
|
6
|
Zhuang W, Jia H, Liu Y, Cong J, Chen K, Yao D, Kang X, Xu P, Zhang T. Identification and analysis of autism spectrum disorder via large-scale dynamic functional network connectivity. Autism Res 2023; 16:1512-1526. [PMID: 37365978 DOI: 10.1002/aur.2974] [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: 11/08/2022] [Accepted: 06/08/2023] [Indexed: 06/28/2023]
Abstract
Autism spectrum disorder (ASD) is a prevalent neurodevelopmental disorder with severe cognitive impairment. Several studies have reported that brain functional network connectivity (FNC) has great potential for identifying ASD from healthy control (HC) and revealing the relationships between the brain and behaviors of ASD. However, few studies have explored dynamic large-scale FNC as a feature to identify individuals with ASD. This study used a time-sliding window method to study the dynamic FNC (dFNC) on the resting-state fMRI. To avoid arbitrarily determining the window length, we set a window length range of 10-75 TRs (TR = 2 s). We constructed linear support vector machine classifiers for all window length conditions. Using a nested 10-fold cross-validation framework, we obtained a grand average accuracy of 94.88% across window length conditions, which is higher than those reported in previous studies. In addition, we determined the optimal window length using the highest classification accuracy of 97.77%. Based on the optimal window length, we found that the dFNCs were located mainly in dorsal and ventral attention networks (DAN and VAN) and exhibited the highest weight in classification. Specifically, we found that the dFNC between DAN and temporal orbitofrontal network (TOFN) was significantly negatively correlated with social scores of ASD. Finally, using the dFNCs with high classification weights as features, we construct a model to predict the clinical score of ASD. Overall, our findings demonstrated that the dFNC could be a potential biomarker to identify ASD and provide new perspectives to detect cognitive changes in ASD.
Collapse
Affiliation(s)
- Wenwen Zhuang
- Mental Health Education Center and School of Science, Xihua University, Chengdu, China
| | - Hai Jia
- Mental Health Education Center and School of Science, Xihua University, Chengdu, China
| | - Yunhong Liu
- Mental Health Education Center and School of Science, Xihua University, Chengdu, China
| | - Jing Cong
- Mental Health Education Center and School of Science, Xihua University, Chengdu, China
| | - Kai Chen
- Mental Health Education Center and School of Science, Xihua University, Chengdu, China
| | - Dezhong Yao
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China
| | - Xiaodong Kang
- The Department of Sichuan 81 Rehabilitation Center, Chengdu University of TCM, Chengdu, China
| | - Peng Xu
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China
| | - Tao Zhang
- Mental Health Education Center and School of Science, Xihua University, Chengdu, China
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China
| |
Collapse
|
7
|
Muscatello RA, Rafatjoo E, Mirpuri KK, Kim A, Vandekar S, Corbett BA. Salivary testosterone in male and female youth with and without autism spectrum disorder: considerations of development, sex, and diagnosis. Mol Autism 2022; 13:37. [PMID: 36123716 PMCID: PMC9484057 DOI: 10.1186/s13229-022-00515-4] [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] [Received: 07/21/2022] [Accepted: 09/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Puberty is characterized by significant physical, hormonal, and psychological changes, which may be especially challenging for individuals with autism spectrum disorder (ASD). Although the etiology of ASD remains uncertain, studies suggest imbalances in hormones, such as testosterone, may modulate the autism phenotype. While differences in fetal and postnatal testosterone have been reported, there is limited literature regarding testosterone variations during adolescence in ASD. We investigated morning salivary testosterone levels in youth with ASD and typical development (TD) to explore hypothesized differences, expecting elevated hormonal levels in ASD compared to TD. METHODS Youth with ASD (n = 140) and TD (n = 104), ages 10 to 13 years, were enrolled as part of a longitudinal study on pubertal development. Pubertal stage was determined by gold standard physical examination, and salivary testosterone was collected in the morning immediately upon waking and 30 min after waking and averaged across 3 days. Diagnostic (ASD/TD) and sex (male/female) differences, as well as interactions with age and puberty, were examined using robust linear mixed effect models. RESULTS Youth with ASD showed significantly elevated testosterone concentrations compared to same-age TD peers. After the inclusion of natural cubic splines to account for nonlinearity in age, a significant age-by-sex interaction emerged with distinct developmental slopes for males and females. At younger ages, females had higher testosterone, until about 11.5 years of age, when levels began to plateau, while male testosterone concentrations continued to rapidly increase and surpass females. As expected, more advanced pubertal development was associated with elevated testosterone. In contrast, no significant effect of parent-reported social communication symptoms was observed. LIMITATIONS Limitations include an unequal sex distribution, non-representative sample (e.g., cognition and race/ethnicity), and inability to examine afternoon/evening testosterone due to detection limits. CONCLUSIONS Testosterone may play a unique role in the presentation of ASD, especially during periods of dynamic hormonal changes including puberty. Inherent developmental (age, puberty) and sex-based (male, female) factors play a more prominent role in changes in testosterone levels during adolescence. Even so, future research is warranted to determine the differential expression and impact of exposure to excess testosterone during the pubertal transition for youth with ASD.
Collapse
Affiliation(s)
- Rachael A Muscatello
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, 1500 21st Avenue South, Nashville, TN, 37212, USA
| | | | | | - Ahra Kim
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Simon Vandekar
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Blythe A Corbett
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, 1500 21st Avenue South, Nashville, TN, 37212, USA.
- Vanderbilt Kennedy Center, Vanderbilt University Medical Center, Nashville, TN, USA.
- Department of Psychology, Vanderbilt University, Nashville, TN, USA.
| |
Collapse
|