Face and emotion recognition in MCDD versus PDD-NOS

Multiple complex developmental disorder (MCDD): Did we throw the baby out with the bathwater too fast? A systematic review

BACKGROUND

Multiple complex developmental disorder (MCDD) manifests as early-onset impairment across different domains. Although it could appear as a transitional condition between autism and childhood-onset schizophrenia, interest in MCDD has progressively waned. This study attempts to discern MCDD current relevance to avoid "throwing the baby out with the bathwater" too fast.

METHODS

All available studies published up to January 2024 were retrieved and evaluated following on the PRISMA guidelines for systematic reviews using the term "multiple complex developmental disorder" or "MCDD", without any filter for study design nor year of publication.

RESULTS

Only 16 studies were included and analyzed. Overall, a variable heterogeneity was observed in terms of country of investigation, study design, and clinical groups. Most of the included studies explored the construct of MCDD in developmental age, comparing MCDD mostly with autistic patients, and observing how the former group had higher levels of paranoia, illusions, and psychotic thoughts, whereas the latter showed more frequently difficulties in social interactions and stereotypical behaviors.

CONCLUSION

Overall, these results showed how progressive changes in diagnostic criteria over time led MCDD to be abandoned as nosographic construct, leaving perhaps a diagnostic void between autism and psychotic disorders that needs to be further studied. A systematic review on the Multiple Complex Developmental Disorder (MCDD): a forgotten diagnosis between autism and schizophrenia.

Whatever happened to multiple complex developmental disorder?

Multiple complex developmental disorder is characterized by early-onset combined impairment in the regulation of affective states, in the social behavior, and in the thought processes. First described in the Eighties, so far multiple complex developmental disorder has so far not found recognition as an autonomous nosographic entity in international classifiers. In the past, the most common diagnosis for patients presenting with this clinical picture was that of 'pervasive developmental disorder not otherwise specified,' due to the early-onset impairment in various development areas, including the social functioning, with pervasive characteristics. Over recent years, based on literature data, the interest in multiple complex developmental disorder has seemed to decline. Yet, several clinical and neurobiological findings emerging from the literature seem to support the nosographic autonomy of multiple complex developmental disorder. The correct recognition of this clinical picture appears to be of considerable importance because children who are affected seem to be predisposed to develop a schizophrenia spectrum disorder during their lifetime. Multiple complex developmental disorder could be a very interesting entity, being a possible kind of "bridge" condition between autism spectrum disorder and childhood-onset schizophrenia. However, there is a lack of findings of the real recurrence, neurobiologic background, and course of this clinical picture.

The Attenuated Psychosis Syndrome and Facial Affect Processing in Adolescents With and Without Autism

BACKGROUND

Autism and schizophrenia spectrum disorders both represent severely disabling neurodevelopmental disorders with marked impairments in social functioning. Despite an increased incidence of psychosis in autism, and substantial overlap in symptoms and cognitive markers, it is unclear whether such phenotypes are specifically related to risk for psychosis or perhaps reflect more general, idiosyncratic autism traits. The attenuated psychosis syndrome (APS) is primarily defined by the presence of attenuated psychotic symptoms, which currently constitute the best and most-replicated clinical predictors of psychosis, and are common in clinical youth with and without autism. The aims of this study were to test the hypothesis that facial affect processing is impaired in adolescents with APS and to explore whether such deficits are more indicative of psychotic or autistic phenotypes on a categorical and dimensional level.

MATERIALS AND METHOD

Fifty-three adolescents with APS and 81 typically developing controls (aged 12-18) were included. The APS group consisted of adolescents with (n = 21) and without (n = 32) a diagnosis of autism spectrum disorder. Facial affect recognition was assessed with the Amsterdam Neuropsychological Tasks using a cascade model of cognitive processing, in which disturbances in "lower-level" cognitive abilities (pattern recognition), affect "higher-level" cognitive processes (face recognition and facial affect recognition). For associations with schizotypal and autistic-like traits the Schizotypal Personality Questionnaire and Social Communication Questionnaire were used in a confirmatory item factor analysis framework.

RESULTS

Contrary to expectation, APS in adolescents was not associated with impairments in pattern, face, or facial affect recognition. However, the APS group with autism spectrum disorder showed a general latency in response time to social and non-social stimuli. Dimensionally assessed schizotypal and autistic-like traits did not predict the accuracy or the speed of face or facial affect recognition.

CONCLUSION

Facial affect processing performance was not associated with APS in adolescence and represents an unlikely early vulnerability marker for psychosis. APS individuals with a more autistic-like profile were characterized by slower responses to social- and non-social stimuli, suggesting that the combined effect of APS and autism spectrum disorder on cognition is larger than for APS alone.

The role of COMT and plasma proline in the variable penetrance of autistic spectrum symptoms in 22q11.2 deletion syndrome

This paper examines how COMT¹⁵⁸ genotypes and plasma proline levels are associated with variable penetrance of social behavioural and social cognitive problems in 22q11.2 deletion syndrome (22q11DS). Severity of autistic spectrum symptoms of 45 participants with 22q11DS was assessed using the Autism Diagnostic Interview Revised. Face and facial emotion recognition was evaluated using standardized computer-based test-paradigms. Associations with COMT¹⁵⁸ genotypes and proline levels were examined. High proline levels and poor face recognition in individuals with the COMT^MET allele, and poor facial emotion recognition, explained almost 50% of the variance in severity of autism symptomatology in individuals with 22q11DS. High proline levels and a decreased capacity to break down dopamine as a result of the COMT^MET variant are both relevant in the expression of the social phenotype in patients. This epistatic interaction effect between the COMT¹⁵⁸ genotype and proline on the expression of social deficits in 22q11DS shows how factors other than the direct effects of the deletion itself can modulate the penetrance of associated cognitive and behavioural outcomes. These findings are not only relevant to our insight into 22q11DS, but also provide a model to better understand the phenomenon of variable penetrance in other pathogenic genetic variants.

Processing of facial and nonsocial information is differentially associated with severity of symptoms in patients with multiepisode schizophrenia

Patients with schizophrenia show impairments in social cognitive abilities, such as recognizing facial emotions. However, the relation to symptoms remains unclear. The goal of this study was to explore whether facial emotion recognition and face identity recognition are associated with severity of symptoms and to which extent associations with symptoms differ for processing of social versus nonsocial information. Facial emotion recognition, face recognition, and abstract pattern recognition were evaluated in 98 patients with multiepisode schizophrenia. Severity of symptoms was measured using a five-factor model of the Positive and Negative Syndrome Scale. Results show that facial emotion recognition and, to a lesser extent, face recognition were predominantly associated with severity of disorganization symptoms. In contrast, recognition of nonsocial patterns was associated with negative symptoms, excitement, and emotional distress. Reaction time rather than accuracy of social cognition explained variance in symptomatology. These results lead to the conclusion that facial emotion processing in schizophrenia appears to be associated with severity of symptoms, especially disorganization.

Executive function in MCDD and PDD-NOS: a study of inhibitory control, attention regulation and behavioral adaptivity

A proportion of children within the autism spectrum is at risk for severe deregulation of thought, emotion and behaviour resulting in (symptoms of) psychotic disorders over the course of development. In an attempt to identify this subgroup, children with PDD-NOS, subtype MCDD (n = 24) were compared to children with PDD-NOS (n = 23) on executive function (EF) skills. Significant differences emerged, always to the disadvantage of the children with PDD-NOS, subtype MCDD on various EF measures. The findings suggest compromised attention regulation and impaired inhibitory control in children with MCDD, which may help explain high levels of thought problems which are frequently observed in these children. Our findings provide evidence for recognizing a PDD subcategory of MCDD that is of specific interest with regard to long-term developmental risks involved.

"Autism-plus" spectrum disorders: intersection with psychosis and the schizophrenia spectrum

Patients are often encountered clinically who have autism spectrum disorders (ASD) and also have symptoms suggestive of a comorbid psychotic disorder. A careful assessment for the presence of comorbid disorders is important. However, the core deficits seen in ASD, in social reciprocity, communication, and restricted behaviors and interests, can be mistaken for psychosis. Also, there is a subset of patients who present with a complex neurodevelopmental disorder with impairments that cross diagnostic categories. This article reviews the connections between ASD and psychosis, and highlights the key points to consider in patients who present with these "autism-plus" disorders.

Geschlechts- und Altersunterschiede in der Emotionserkennung von Kindern und Jugendlichen

In dieser Arbeit werden zwei Studien präsentiert, welche Alters- und Geschlechtsunterschiede beim Erkennen von Emotionen im Gesichtsausdruck von Kindern und Jugendlichen untersuchten. Dabei kam eine neu entwickelte Bilderserie zum Einsatz. Die Bilder zeichnen sich dadurch aus, dass die mimischen Affektausdrücke in authentischen, interaktiven Situationen gefilmt wurden und die Auswahl der Einzelbilder auf der Basis objektiver Kodierungen mit den Facial Action Coding System (FACS) getroffen wurde. In der ersten Studie schätzten 275 Kinder und Jugendliche im Alter von 8 bis 14 Jahren (M = 10.46, SD = 1.45) 24 Bilder ein, auf welchen die Basisemotionen Freude, Ärger, Trauer, Überraschung, Angst und Ekel in jeweils vier Varianten abgebildet waren. 55.4 % der Bilder wurden dabei richtig erkannt, wobei Mädchen signifikant bessere Leistungen zeigten als Jungen. Am besten erkannt wurde Freude vor Ekel, gefolgt von Überraschung, Trauer, Ärger und Angst. Altersunterschiede waren nicht feststellbar. Die zweite Studie untersuchte die Emotionserkennungsfähigkeit bei Kindergartenkindern. Dazu wurden 62 Kindern zwischen 3 und 6 Jahren (M = 4.84, SD = 0.93) jeweils zwei Bilder pro Basisemotion vorgelegt. Die Erkennungsleistung lag hier bei 41.4 %, wobei Freude, wie auch bereits in der ersten Studie, am besten erkannt wurde, gefolgt von Trauer, Überraschung und Ärger sowie von Ekel und Angst. In Studie 2 zeigten sich Altersunterschiede dahingehend, dass ältere Kinder (5 – 6 Jahre) Emotionen insgesamt besser erkannten als die jüngeren Kinder (3 – 4 Jahre), insbesondere Überraschung und Trauer. Geschlechtsunterschiede wurden keine gefunden.

[The concept of «multiple complex developmental disorder» - a disorder of social interaction, paranoid thinking and social anxiety in a 17-year-old boy]

OBJECTIVES

Multiple complex developmental disorder (MCDD) is a little-known disorder characterized by disturbances in the regulation of emotions, social interactions and thought disorders. Neither the classification system of ICD-10 nor the DSM-IV lists MCDD as an independent disorder.

METHODS

The study presents an overview on diagnostic criteria, current research and illustration by a case report of a 17-year-old adolescent.

RESULTS

MCDD, autistic disorders and schizophrenic disorders partially overlap. A clear classification or differentiation is currently not clearly possible.

CONCLUSIONS

Many open questions remain, and further research is needed.

Social information processing in children and adolescents with neurofibromatosis type 1

AIM

To examine social information processing in children and adolescents with neurofibromatosis type 1 (NF1).

METHOD

Thirty-two children with NF1 (12 males, 20 females; mean age 12y 4mo, SD 4y) and 32 comparison children (12 males, 20 females; mean age 13y 1mo, SD 3y 11mo) completed face recognition, identification of facial emotions (IFE), and matching facial emotions (MFE) tasks. A series of general linear model analyses of variance were used to compare performance between children with NF1 and comparison children.

RESULTS

Children with NF1 performed less accurately than comparison children in the face recognition task when faces were presented 'in profile' (p=0.05), when fearful expressions had to be identified in IFE (p=0.017), and across conditions in MFE (p=0.009). When quality of cognitive control (i.e. mean standardized scores on tasks measuring working memory and inhibitory control) was introduced to the analyses, differences in face recognition were no longer significant and differences in MFE were largely reduced (p=0.048). Differences in IFE between the comparison group and children with NF1 remained largely intact (fear: p=0.047).

INTERPRETATION

Children with NF1 have problems in social information processing, which, in part, appear to be caused by cognitive control deficits. Some of the deficits, however, appear to be caused by deficient bottom-up processing of social signals (e.g. fear recognition).

Further evidence that the rs1858830 C variant in the promoter region of the MET gene is associated with autistic disorder

Previous studies in three independent cohorts have shown that the rs1858830 C allele variant in the promoter region of the MET gene on chromosome 7q31 is associated with autism. Another study has found correlations between other alterations in the MET gene and autism in two unrelated cohorts. This study screened two cohorts, an Autistic Disorder cohort from South Carolina and a Pervasive Developmental Disorder (PDD) cohort from Italy, for the presence of the C allele variant in rs1858830. A significant increase in the C allele variant frequency was found in the South Carolina Autistic Disorder patients as compared to South Carolina Controls (chi(2)=5.8, df=1, P=0.02). In the South Carolina cohort, a significant association with Autistic Disorder was found when comparing the CC and CG genotypes to the GG genotype (odds ratio (OR)=1.64; 95% confidence interval (CI)=1.12-2.40; chi(2)=6.5, df=1, P=0.01) in cases and controls. In the Italian cohort, no significant association with PDD was found when comparing the CC or CG genotype to the GG genotype (OR=1.20; 95% CI=0.56-2.56; chi(2)=0.2, df=1, P=0.64). This study is the third independent study to find the rs1858830 C variant in the MET gene promoter to be associated with autism.