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Norton B, Sheen J, Burns L, Enticott PG, Fuller-Tyszkiewicz M, Kirkovski M. Overlap of eating disorders and neurodivergence: the role of inhibitory control. BMC Psychiatry 2024; 24:454. [PMID: 38890597 PMCID: PMC11186180 DOI: 10.1186/s12888-024-05837-6] [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] [Received: 01/09/2024] [Accepted: 05/10/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Difficulties with inhibitory control have been identified in eating disorders (EDs) and neurodevelopmental disorders (NDs; including attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder), and there appear to be parallels between the expression of these impairments. It is theorised that impairments in inhibitory control within NDs may represent a unique vulnerability for eating disorders (EDs), and this same mechanism may contribute to poorer treatment outcomes. This review seeks to determine the state of the literature concerning the role of inhibitory control in the overlap of EDs and neurodivergence. METHOD A scoping review was conducted to summarise extant research, and to identify gaps in the existing knowledge base. Scopus, Medline, PsycInfo, Embase, and ProQuest were systematically searched. Studies were included if the study measured traits of ADHD or autism, and symptoms of ED, and required participants to complete a performance task measure of inhibitory control. Where studies included a cohort with both an ND and ED, these results had to be reported separately from cohorts with a singular diagnosis. Studies were required to be published in English, within the last 10 years. RESULTS No studies explored the relationship between autism and EDs using behavioural measures of inhibitory control. Four studies exploring the relationship between ADHD and EDs using behavioural measures of inhibitory control met selection criteria. These studies showed a multifaceted relationship between these conditions, with differences emerging between domains of inhibitory control. ADHD symptoms predicted poorer performance on measures of response inhibition in a non-clinical sample; this was not replicated in clinical samples, nor was there a significant association with EDs. Both ADHD and ED symptoms are associated with poor performance on attentional control measures; where these diagnoses were combined, performance was worse than for those with a singular diagnosis of ADHD. This was not replicated when compared to those with only ED diagnoses. CONCLUSION Impairments in attentional control may represent a unique vulnerability for the development of an ED and contribute to poor treatment outcomes. Further research is needed to explore the role of inhibitory control in EDs, ADHD and autism, including the use of both self-report and behavioural measures to capture the domains of inhibitory control.
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Affiliation(s)
- Bethany Norton
- School of Psychology, Deakin University, Geelong, Australia.
| | - Jade Sheen
- School of Psychology, Deakin University, Geelong, Australia
| | - Lewis Burns
- School of Psychology, Deakin University, Geelong, Australia
| | | | | | - Melissa Kirkovski
- School of Psychology, Deakin University, Geelong, Australia.
- Institute for Health and Sport, Victoria University, Melbourne, VIC, Australia.
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Di Vara S, Guerrera S, Menghini D, Scibelli F, Lupi E, Valeri G, Vicari S. Characterizing individual differences in children and adolescents with autism spectrum disorder: a descriptive study. Front Psychol 2024; 15:1323787. [PMID: 38476386 PMCID: PMC10927760 DOI: 10.3389/fpsyg.2024.1323787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 02/05/2024] [Indexed: 03/14/2024] Open
Abstract
Introduction Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by a higher prevalence in male than in female participants. Recent studies have hypothesized the presence of different phenotypes in male and female participants with ASD. The present study aims to assess possible sex differences in cognitive and adaptive functioning, symptomatology of ASD, and psychopathological comorbidities in a large sample of children and adolescents with ASD. Methods The study included a total of 2,146 children and adolescents diagnosed with ASD, comprising 1785 boys (mean age 7.12 ± 3.69 years) and 361 girls (mean age 6.25 ± 3.30 years). The age of the participants ranged from 1.35 to 19.05 years (mean age 9.98 ± 3.64). The study sought to include all children and adolescents diagnosed with Autism or ASD. Results Present results showed that girls with ASD had lower IQs than boys but similar adaptive functioning. The severity of symptoms of ASD was greater in boys than in girls, as were scores on psychopathological measures. With increasing age, boys with ASD showed greater impairment in social communication skills than girls and increased psychopathological comorbidities. Older girls showed fewer restricted and repetitive behaviors. Discussion Exploring phenotypic differences in children and adolescents with ASD fosters an understanding of subtle diagnostic facets that may go unrecognized, allowing for increasingly individualized and tailored interventions.
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Affiliation(s)
- S. Di Vara
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - S. Guerrera
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - D. Menghini
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - F. Scibelli
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - E. Lupi
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - G. Valeri
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - S. Vicari
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
- Department of Life Sciences and Public Health, Catholic University, Rome, Italy
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Torske T, Nærland T, Quintana DS, Hypher RE, Kaale A, Høyland AL, Hope S, Johannessen J, Øie MG, Andreassen OA. Sex as a Moderator Between Parent Ratings of Executive Dysfunction and Social Difficulties in Children and Adolescents with Autism Spectrum Disorder. J Autism Dev Disord 2023; 53:3847-3859. [PMID: 35838825 PMCID: PMC10499744 DOI: 10.1007/s10803-022-05629-5] [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] [Accepted: 05/27/2022] [Indexed: 11/25/2022]
Abstract
Girls and boys might differ in autistic symptoms and associated cognitive difficulties such as executive function (EF). We investigated sex differences in the relationship between parent rated EF and autistic symptoms in 116 children and adolescents (25 girls) aged 5-19 years with an intelligence quotient above 70 and an autism spectrum disorder (ASD) diagnosis. They were rated with the behavior rating inventory of executive function (BRIEF) and the autism diagnostic interview revised (ADI-R). We found a positive association between EF and the ADI-R domains of reciprocal social interaction (p < 0.001) and communication (p = 0.001) in girls, while these relationships were small and non-significant in boys. Our results provide a greater understanding of the sex-specific characteristics of children and adolescents with ASD.
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Affiliation(s)
- Tonje Torske
- Division of Mental Health and Addiction, Vestre Viken Hospital Trust, Postboks 800, 3004, Drammen, Norway.
- Department of Psychology, University of Oslo, Oslo, Norway.
| | - Terje Nærland
- NevSom Department of Rare Disorders and Disabilities, Oslo University Hospital, Oslo, Norway
- K.G. Jebsen Center for Neurodevelopmental Disorders, University of Oslo, Oslo, Norway
| | - Daniel S Quintana
- Department of Psychology, University of Oslo, Oslo, Norway
- NevSom Department of Rare Disorders and Disabilities, Oslo University Hospital, Oslo, Norway
- K.G. Jebsen Center for Neurodevelopmental Disorders, University of Oslo, Oslo, Norway
- NORMENT, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Ruth Elizabeth Hypher
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Division of Pediatric and Adolescent Medicine, Department of Clinical Neurosciences for Children, Oslo University Hospital, Oslo, Norway
| | - Anett Kaale
- NevSom Department of Rare Disorders and Disabilities, Oslo University Hospital, Oslo, Norway
- Department of Special Needs Education, University of Oslo, Oslo, Norway
| | - Anne Lise Høyland
- Faculty of Medicine and Health Sciences, Department of Mental Health, Regional Centre for Child and Youth Mental Health and Child Welfare, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Pediatrics, St. Olav Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Sigrun Hope
- NORMENT, University of Oslo and Oslo University Hospital, Oslo, Norway
- Department of Neurohabilitation, Oslo University Hospital, Oslo, Norway
| | - Jarle Johannessen
- NevSom Department of Rare Disorders and Disabilities, Oslo University Hospital, Oslo, Norway
- Department of Medicine, University of Oslo, Oslo, Norway
| | - Merete G Øie
- Department of Psychology, University of Oslo, Oslo, Norway
- Research Department, Innlandet Hospital Trust, Lillehammer, Norway
| | - Ole A Andreassen
- K.G. Jebsen Center for Neurodevelopmental Disorders, University of Oslo, Oslo, Norway
- NORMENT, University of Oslo and Oslo University Hospital, Oslo, Norway
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Hunt E, Hogan A, Will EA, Roberts JE. ADHD and ASD symptoms in young males with fragile X syndrome: associations with early trajectories of inhibitory control. Child Neuropsychol 2023; 29:760-786. [PMID: 36082630 PMCID: PMC9995619 DOI: 10.1080/09297049.2022.2120605] [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] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 08/29/2022] [Indexed: 10/14/2022]
Abstract
Inhibitory control (IC), the ability to suppress inappropriate responses, emerges late in the first year of life and improves across typical development, concurrent with brain maturation. The development of IC is critical to various social-emotional and behavioral functions, with IC difficulties being linked to numerous neurodevelopmental disorders, including attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). Fragile X syndrome (FXS) is a single-gene disorder characterized by IC difficulties, and elevated rates of ADHD and ASD, making it a useful model for understanding the early development and consequences of IC. In this longitudinal study, we characterized IC trajectories across multiple time points between 16 and 71 months of age in young males with FXS (n = 79) relative to neurotypical (NT) controls (n=49). To explore the association between behavioral outcomes and IC, we identified a subsample of 50 children with longitudinal IC data and an outcome assessment for ADHD and ASD symptoms at age 5 (FXS: n = 26, NT: n = 24). Results indicated that, compared to their NT peers, young males with FXS exhibit differences in IC as early as 24 months, with group differences increasing through age 5. Additionally, we determined that lower IC levels at 24 months were associated with later ADHD symptoms and a decreasing slope in IC over time was associated with later ASD symptoms in male children with FXS. These findings help refine early developmental phenotypes of FXS and highlight IC as a potential target for early detection and intervention of ASD and ADHD symptoms in male children with FXS.
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Affiliation(s)
- Erin Hunt
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Abigail Hogan
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Elizabeth A Will
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Jane E Roberts
- Department of Psychology, University of South Carolina, Columbia, SC, USA
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5
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Navarro-Pardo E, Alonso-Esteban Y, Alcantud-Marin F, Murphy M. Do Savant Syndrome and Autism Spectrum Disorders Share Sex Differences? A Comprehensive Review. Soa Chongsonyon Chongsin Uihak 2023; 34:117-124. [PMID: 37035793 PMCID: PMC10080262 DOI: 10.5765/jkacap.230008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/17/2023] [Accepted: 03/24/2023] [Indexed: 04/08/2023] Open
Abstract
Savant syndrome was described before autism. However, they soon became closely associated, as many of their symptoms (intellectual disability, repetitive behaviors, alterations in social communication, and islets of abilities) overlap. Only a few women with autism have been diagnosed with savant syndrome. The theories or hypotheses that attempt to explain savant syndrome, which are common in autism, present differential treatment according to sex. We postulate that savant syndrome associated with autism as well as autism in general is underdiagnosed in women.
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Affiliation(s)
- Esperanza Navarro-Pardo
- Department of Developmental and Educational Psychology, University of Valencia, Valencia, Spain
| | | | | | - Mike Murphy
- School of Applied Psychology, University College Cork, Cork, Ireland
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6
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Mali I, Payne M, King C, Maze TR, Davison T, Challans B, Bossmann SH, Plakke B. Adolescent female valproic acid rats have impaired extra-dimensional shifts of attention and enlarged anterior cingulate cortices. Brain Res 2023; 1800:148199. [PMID: 36509128 PMCID: PMC9835202 DOI: 10.1016/j.brainres.2022.148199] [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: 03/15/2022] [Revised: 12/05/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022]
Abstract
In order to develop better treatments for autism spectrum disorder (ASD) it is critical to understand the developmental trajectory of the disorder and the accompanying brain changes. This study used the valproic acid (VPA) model to induce ASD-like symptoms in rodents. Prior studies have demonstrated that VPA animals are impaired on executive function tasks, paralleling results in humans with ASD. Here, VPA adolescent female rats were impaired on a set-shifting task and had enlarged frontal cortices compared to control females. The deficits observed in the VPA female rats mirrors results in females with ASD. In addition, adolescent VPA females with enlarged frontal cortices performed the worst across the entire task. These brain changes in adolescence are also found in adolescent humans with ASD. These novel findings highlight the importance of studying the brain at different developmental stages.
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Affiliation(s)
- Ivina Mali
- Department of Chemistry, Kansas State University, Manhattan, KS, USA
| | - Macy Payne
- Department of Chemistry, Kansas State University, Manhattan, KS, USA
| | - Cole King
- Department of Psychological Sciences, Kansas State University, Manhattan, KS, USA
| | - Tessa R Maze
- Department of Psychological Sciences, Kansas State University, Manhattan, KS, USA
| | - Taylor Davison
- Department of Psychological Sciences, Kansas State University, Manhattan, KS, USA
| | - Brandon Challans
- Department of Psychological Sciences, Kansas State University, Manhattan, KS, USA
| | - Stefan H Bossmann
- Department of Chemistry, Kansas State University, Manhattan, KS, USA
| | - Bethany Plakke
- Department of Psychological Sciences, Kansas State University, Manhattan, KS, USA.
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7
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Cissne MN, Bellesheim KR, Christ SE. Inhibitory Control in Male and Female Adolescents with Autism Spectrum Disorder (ASD). Dev Neuropsychol 2022; 47:369-383. [PMID: 36537866 DOI: 10.1080/87565641.2022.2154770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The present study examined potential sex- and age-related differences in inhibitory control in adolescents with and without ASD. A computerized flanker visual filtering task and a go/no-go task were used to assess the ability to resist interference from visual distractors (RIVD) and prepotent response inhibition, respectively. Overall, the ASD and non-ASD groups performed comparably on both tasks and no sex-related differences or interactions (group-by-sex) were apparent. Consistent with past research, however, we did observe a significant age-related improvement in RIVD performance among the ASD group (but not the non-ASD group).
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Affiliation(s)
- Mackenzie N Cissne
- Department of Psychological Sciences, University of Missouri, Columbia, Missouri, USA
| | - Katherine R Bellesheim
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Shawn E Christ
- Department of Psychological Sciences, University of Missouri, Columbia, Missouri, USA
- Thompson Center for Autism & Neurodevelopmental Disorders, University of Missouri, Columbia, Missouri, USA
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8
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Han YMY, Chan MC, Chan MMY, Yeung MK, Chan AS. Effects of working memory load on frontal connectivity in children with autism spectrum disorder: a fNIRS study. Sci Rep 2022; 12:1522. [PMID: 35087126 PMCID: PMC8795357 DOI: 10.1038/s41598-022-05432-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 01/12/2022] [Indexed: 01/29/2023] Open
Abstract
Individuals with autism spectrum disorder (ASD) perform poorly in working memory (WM) tasks, with some literature suggesting that their impaired performance is modulated by WM load. While some neuroimaging and neurophysiological studies have reported altered functional connectivity during WM processing in individuals with autism, it remains largely unclear whether such alterations are moderated by WM load. The present study aimed to examine the effect of WM load on functional connectivity within the prefrontal cortex (PFC) in ASD using functional near-infrared spectroscopy (fNIRS). Twenty-two children with high-functioning ASD aged 8-12 years and 24 age-, intelligent quotient (IQ)-, sex- and handedness-matched typically developing (TD) children performed a number n-back task with three WM loads (0-back, 1-back, and 2-back). Hemodynamic changes in the bilateral lateral and medial PFC during task performance were monitored using a multichannel NIRS device. Children with ASD demonstrated slower reaction times, specifically during the "low load" condition, than TD children. In addition, the ASD and TD groups exhibited differential load-dependent functional connectivity changes in the lateral and medial PFC of the right but not the left hemisphere. These findings indicate that WM impairment in high-functioning ASD is paralleled by load-dependent alterations in right, but not left, intrahemispheric connectivity during WM processing in children with ASD. A disruption of functional neural connections that support different cognitive processes may underlie poor performance in WM tasks in ASD.
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Affiliation(s)
- Yvonne M Y Han
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, People's Republic of China.
- University Research Facility in Behavioral and Systems Neuroscience (UBSN), The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, People's Republic of China.
| | - Ming-Chung Chan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, People's Republic of China
| | - Melody M Y Chan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, People's Republic of China
| | - Michael K Yeung
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, People's Republic of China
- University Research Facility in Behavioral and Systems Neuroscience (UBSN), The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, People's Republic of China
| | - Agnes S Chan
- Department of Psychology, The Chinese University of Hong Kong, Kowloon, Hong Kong SAR, People's Republic of China
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9
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Tonizzi I, Giofrè D, Usai MC. Inhibitory Control in Autism Spectrum Disorders: Meta-analyses on Indirect and Direct Measures. J Autism Dev Disord 2021; 52:4949-4965. [PMID: 34816341 DOI: 10.1007/s10803-021-05353-6] [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] [Accepted: 11/01/2021] [Indexed: 11/25/2022]
Abstract
This manuscript aimed to advance our understanding of inhibitory control (IC) in autism spectrum disorders (ASD), adopting a meta-analytic multilevel approach. The first meta-analysis, on 164 studies adopting direct measures, indicated a significant small-to-medium (g = 0.484) deficit in the group with ASD (n = 5140) compared with controls (n = 6075). Similar effect sizes between response inhibition and interference control were found, but they were differentially affected by intellectual functioning and age. The second meta-analysis, on 24 studies using indirect measures, revealed a large deficit (g = 1.334) in the group with ASD (n = 985) compared with controls (n = 1300). Presentation format, intellectual functioning, and age were significant moderators. The effect of comorbidity with ADHD was not statistically significant. Implications are discussed for IC research and practice in autism.
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Affiliation(s)
- Irene Tonizzi
- Department of Educational Sciences, University of Genoa, Corso Podestà 2, 16128, Genoa, Italy
| | - David Giofrè
- Department of Educational Sciences, University of Genoa, Corso Podestà 2, 16128, Genoa, Italy
| | - Maria Carmen Usai
- Department of Educational Sciences, University of Genoa, Corso Podestà 2, 16128, Genoa, Italy.
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10
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Payne M, Mali I, McKinnell ZE, Vangsness L, Shrestha TB, Bossmann SH, Plakke B. Increased volumes of lobule VI in a valproic acid model of autism are associated with worse set-shifting performance in male Long-Evan rats. Brain Res 2021; 1765:147495. [PMID: 33894224 PMCID: PMC8205983 DOI: 10.1016/j.brainres.2021.147495] [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: 02/09/2021] [Revised: 04/15/2021] [Accepted: 04/17/2021] [Indexed: 11/27/2022]
Abstract
Autism spectrum disorder (ASD) is a neurodevelopmental disorder with a skewed sex-based diagnostic ratio. While males are at a higher risk for ASD, it is critical to understand the neurobiology of the disorder to develop better treatments for both males and females. Our prior work has demonstrated that VPA (valproic acid) treated offspring had impaired performance on an attentional set-shifting task. The current study used MRI and regions of interest analyses to measure the volumes of cerebellar subregions in VPA and controls rats that had participated in the attentional set-shifting task. VPA males had significantly more volume in lobule VI compared to male controls. VPA female rats had significantly less volume in lobules I, IV and X compared to female controls. In addition, it was revealed that decreases in volume for VPA females was associated with worse performance. Males with increases in lobule VI were also impaired on the set-shifting task. Similar volumetric differences within the cerebellum have been observed in humans with ASD, which suggests that the VPA model is capturing some of the same brain changes observed in humans with ASD, and that these changes in volume may be impacting cognition.
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Affiliation(s)
- Macy Payne
- Department of Chemistry, Kansas State University, Manhattan, KS, USA
| | - Ivina Mali
- Department of Chemistry, Kansas State University, Manhattan, KS, USA
| | - Zach E McKinnell
- Department of Psychological Sciences, Kansas State University, Manhattan, KS, USA
| | - Lisa Vangsness
- Department of Psychology, Wichita State University, Wichita, KS, USA
| | - Tej B Shrestha
- Department of Anatomy & Physiology, Nanotechnology Innovation Center of Kansas State-NICKS, KS, USA
| | - Stefan H Bossmann
- Department of Chemistry, Kansas State University, Manhattan, KS, USA
| | - Bethany Plakke
- Department of Psychological Sciences, Kansas State University, Manhattan, KS, USA.
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Demetriou EA, Pepper KL, Park SH, Pellicano L, Song YJC, Naismith SL, Hickie IB, Thomas EE, Guastella AJ. Autism spectrum disorder: An examination of sex differences in neuropsychological and self-report measures of executive and non-executive cognitive function. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 25:2223-2237. [PMID: 34169770 DOI: 10.1177/13623613211014991] [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] [Indexed: 11/15/2022]
Abstract
LAY ABSTRACT Research comparing females and males with a diagnosis of autism suggests that there are sex differences in some characteristics such as behaviour regulation. One area not studied in detail is whether females and males with autism perform differently in tests of cognitive ability. The results of previous research are quite mixed. One explanation may be that some research comparing females and males with autism did not include a neurotypical control group for comparison. As a result, it is not clear whether the sex differences in cognitive ability observed in people with autism are similar to differences between neurotypical males and females. To better understand whether there are unique differences between males and females with autism, it is important to also compare them with neurotypical males and females. In our research, we included a neurotypical group and compared males and females with and without a diagnosis of autism. We found that the sex differences in autism are similar to what we observe in males and females without autism. Our study showed that compared with males, females (with and without autism) do better in assessments of processing speed, cognitive flexibility, verbal learning and memory and semantic fluency. Our results suggest that although females show different cognitive performance to males, these sex differences were not specific to the group with a diagnosis of autism.
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12
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Saha S, Chatterjee M, Sinha S, Mukhopadhyay K. A pioneering study indicate role of GABRQ rs3810651 in ASD severity of Indo-Caucasoid female probands. Sci Rep 2021; 11:7010. [PMID: 33772085 PMCID: PMC7997895 DOI: 10.1038/s41598-021-86496-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 03/16/2021] [Indexed: 11/24/2022] Open
Abstract
Alteration in gamma aminobutyric acid (GABA), the principal inhibitory neurotransmitter, is speculated to be a potential risk factor for Autism Spectrum Disorder (ASD) due to an altered expression in the brain. Sensory, social, and emotional deficits of subjects with ASD were reported to be caused by an imbalance between excitatory and inhibitory neurotransmission as well as GABAergic dysfunction caused by inadequate receptor function. We for the first time studied association between ASD and a missense coding variant rs3810651 (I478F) in the GABRQ gene, encoding for one of the subunits of GABAA receptors. Stratified analysis on families with ASD probands (N = 251) and ethnically matched control subjects (N = 250) revealed marginally higher frequency of "A" allele and "AA" genotype in female ASD probands as compared to gender matched controls. Female probands demonstrated higher severity for Verbal communication (χ2 = 5.75, P = 0.01), Activity level (χ2 = 7.26, P = 0.007), as well as Level and consistency of intellectual response (χ2 = 7.83 P = 0.005) in presence of "A/AA" warranting further in-depth investigation on the role of rs3810651 in ASD.
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Affiliation(s)
- Sharmistha Saha
- Manovikas Biomedical Research and Diagnostic Centre, Manovikas Kendra, 482 Madudah, Plot I-24, Sector J, EM Bypass, Kolkata, West Bengal, 700107, India
| | - Mahasweta Chatterjee
- Manovikas Biomedical Research and Diagnostic Centre, Manovikas Kendra, 482 Madudah, Plot I-24, Sector J, EM Bypass, Kolkata, West Bengal, 700107, India
| | - Swagata Sinha
- Manovikas Biomedical Research and Diagnostic Centre, Manovikas Kendra, 482 Madudah, Plot I-24, Sector J, EM Bypass, Kolkata, West Bengal, 700107, India
| | - Kanchan Mukhopadhyay
- Manovikas Biomedical Research and Diagnostic Centre, Manovikas Kendra, 482 Madudah, Plot I-24, Sector J, EM Bypass, Kolkata, West Bengal, 700107, India.
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Kelly SE, Schmitt LM, Sweeney JA, Mosconi MW. Reduced Proactive Control Processes Associated With Behavioral Response Inhibition Deficits in Autism Spectrum Disorder. Autism Res 2021; 14:389-399. [PMID: 33111461 PMCID: PMC7878417 DOI: 10.1002/aur.2415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 06/13/2020] [Accepted: 09/27/2020] [Indexed: 11/08/2022]
Abstract
Impairments in inhibitory control are common in individuals with autism spectrum disorder (ASD) and associated with multiple clinical issues. Proactive (i.e., delaying response onset) and reactive control mechanisms (i.e., stopping quickly) contribute to successful inhibitory control in typically developing individuals and may be compromised in ASD. We assessed inhibitory control in 58 individuals with ASD and 63 typically developing controls aged 5-29 years using an oculomotor stop-signal task during which participants made rapid eye movements (i.e., saccades) toward peripheral targets (i.e., GO trials) or inhibited saccades (i.e., STOP trials). Individuals with ASD exhibited reduced ability to inhibit saccades, reduced reaction time slowing (GO RT slowing), and faster stop-signal reaction times (SSRT) compared to controls. Across participants, stopping accuracy was positively related to GO RT slowing, and increased age was associated with higher stopping accuracy and GO RT slowing. Our results indicate that failures to proactively delay prepotent responses in ASD underpin deficits of inhibitory control and may contribute to difficulties modifying their behavior according to changes in contextual demands. These findings implicate frontostriatal brain networks in inhibitory control and core symptoms of ASD. LAY SUMMARY: Difficulties stopping actions are common in individuals with autism spectrum disorder (ASD) and are related to repetitive behaviors. This study compared the ability to stop eye movements in individuals with ASD and healthy peers. We found that individuals with ASD were less able to stop eye movements and that this difficulty was related to a reduced ability to delay their eye movements before seeing the cue to stop, not their ability to react quickly to this cue.
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Affiliation(s)
- Shannon E. Kelly
- Clinical Child Psychology Program, University of Kansas, Lawrence, KS; Life Span Institute, University of Kansas, Lawrence, KS; Kansas Center for Autism Research and Training (KCART), University of Kansas, Lawrence, KS
| | - Lauren M. Schmitt
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH
| | - John A. Sweeney
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Matthew W. Mosconi
- Clinical Child Psychology Program, University of Kansas, Lawrence, KS; Life Span Institute, University of Kansas, Lawrence, KS; Kansas Center for Autism Research and Training (KCART), University of Kansas, Lawrence, KS
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14
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McKinnell ZE, Maze T, Ramos A, Challans B, Plakke B. Valproic acid treated female Long-Evans rats are impaired on attentional set-shifting. Behav Brain Res 2020; 397:112966. [PMID: 33053383 DOI: 10.1016/j.bbr.2020.112966] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 08/26/2020] [Accepted: 10/07/2020] [Indexed: 01/14/2023]
Abstract
Autism spectrum disorder (ASD), is a neurodevelopmental disorder characterized by social deficits, communication impairments, restrictive behaviors, and cognitive flexibility deficits. The valproic acid (VPA) model of autism has been widely used to examine changes in rodent behavior and neurobiology to better understand ASD. This study examined social and anxiety behavior as well as cognitive flexibility in VPA and control offspring. Results for social behavior were consistent with prior studies showing reduced sociability in VPA rats and increased self-grooming, which may be viewed as a repetitive behavior. VPA rats also had deficits in performing the set-shifting task, with female VPA rats demonstrating greater impairment compared to female control rats and male VPA rats. These results support the hypothesis that females diagnosed with ASD may suffer from different symptoms and present a unique behavioral profile compared to males with ASD. Female VPA rats were also less likely to form an attentional set; offering evidence that the VPA model of autism is encompassing executive function deficits similar to those observed in humans with ASD.
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Affiliation(s)
- Zach E McKinnell
- Department of Psychological Sciences, Kansas State University, Manhattan, KS, 66506, USA
| | - Tessa Maze
- Department of Psychological Sciences, Kansas State University, Manhattan, KS, 66506, USA
| | - Alejandro Ramos
- Department of Psychological Sciences, Kansas State University, Manhattan, KS, 66506, USA
| | - Brandon Challans
- Department of Psychological Sciences, Kansas State University, Manhattan, KS, 66506, USA
| | - Bethany Plakke
- Department of Psychological Sciences, Kansas State University, Manhattan, KS, 66506, USA.
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15
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Chen MT, Chang YP, Marraccini ME, Cho MC, Guo NW. Comprehensive attention training system (CATS): A computerized executive-functioning training for school-aged children with autism spectrum disorder. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2020; 68:528-537. [PMID: 35937171 PMCID: PMC9351557 DOI: 10.1080/20473869.2020.1827673] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 09/19/2020] [Accepted: 09/20/2020] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Theory suggests that impaired executive functioning (EF) might explain several symptoms of autism spectrum disorder (ASD) in children. However, only a few studies have examined the efficacy of EF training for the children using randomized control trial designs, and only two of them found significant benefits of the training. METHOD We designed Comprehensive Attention Training System (CATS), and tested this new EF intervention for children with ASD in a small-sampled randomized controlled trial. Twenty-five children with ASD aged six to twelve were randomly assigned to either the CATS or the control training and were assessed pre- and post-training. RESULTS Relative to the control group, the CATS group improved on EF as measured by the trail-making test, avoiding perseverative errors, and forming conceptual responses in the Wisconsin Card Sorting Task. There were also indications that CATS contributed to long-term communication skills as measured by the Vineland adaptive behavior scales. CONCLUSIONS We report preliminary evidence that the CATS intervention may improve the EF of school-aged children with ASD compared to a control intervention. We discuss the results in terms of their generalizability to other developmental disorders.
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Affiliation(s)
- Meng-Ting Chen
- Department of Child and Family Studies, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Yen-Ping Chang
- Department of Educational Psychology and Counseling, National Tsing Hua University, Hsinchu City, Taiwan
| | - Marisa E. Marraccini
- School of Education, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Miao-Chun Cho
- Department of Child and Adolescent Psychiatry, Chang Gung Memorial Hospital Kaohsiung Branch, Kaohsiung City, Taiwan
| | - Nai-Wen Guo
- Institute of Behavioral Medicine, National Cheng Kung University, Tainan City, Taiwan
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16
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Albajara Sáenz A, Septier M, Van Schuerbeek P, Baijot S, Deconinck N, Defresne P, Delvenne V, Passeri G, Raeymaekers H, Salvesen L, Victoor L, Villemonteix T, Willaye E, Peigneux P, Massat I. ADHD and ASD: distinct brain patterns of inhibition-related activation? Transl Psychiatry 2020; 10:24. [PMID: 32066671 PMCID: PMC7026183 DOI: 10.1038/s41398-020-0707-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 11/20/2019] [Accepted: 11/27/2019] [Indexed: 12/13/2022] Open
Abstract
Attention-deficit/hyperactivity (ADHD) and autism spectrum (ASD) disorders often co-occur. In both cases, response inhibition deficits and inhibition-related atypical brain activation have been reported, although less consistently in ASD. Research exploring the overlap/distinctiveness between ADHD and ASD has significantly increased in recent years, but direct comparison of the inhibition-related neuronal correlates between these disorders are scarce in the literature. This study aimed at disentangling the shared and specific inhibitory brain dysfunctions in ASD and ADHD. Using functional magnetic resonance imaging (fMRI), brain activity was compared between children with ADHD, ASD and typically developing (TD) children aged 8-12 years during an inhibition stop-signal task, using stringent inclusion criteria. At the behavioural level, only children with ADHD exhibited inhibition deficits when compared with the TD group. Distinct patterns of brain activity were observed during successful inhibition. In children with ADHD, motor inhibition was associated with right inferior parietal activation, whereas right frontal regions were activated in children with ASD. Between-group comparisons disclosed higher middle frontal activation in the ASD group compared with the ADHD and the TD groups. Our results evidence different patterns of activation during inhibition in these two disorders, recruiting different regions of the fronto-parietal network associated to inhibition. Besides brain activity differences, behavioural inhibition deficits found only in children with ADHD further suggest that reactive inhibition is one of the core deficits in ADHD, but not in ASD. Our findings provide further evidence contributing to disentangle the shared and specific inhibitory dysfunctions in ASD and ADHD.
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Affiliation(s)
- Ariadna Albajara Sáenz
- Neuropsychology and Functional Neuroimaging Research Group (UR2NF) at the Centre for Research in Cognition and Neurosciences (CRCN), Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Mathilde Septier
- Hôpital Universitaire Robert Debré, Paris, France
- Institut de Psychiatrie et de Neurosciences de Paris Inserm U894 Team 1, Paris, France
| | - Peter Van Schuerbeek
- Department of Radiology, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Simon Baijot
- Neuropsychology and Functional Neuroimaging Research Group (UR2NF) at the Centre for Research in Cognition and Neurosciences (CRCN), Université Libre de Bruxelles (ULB), Brussels, Belgium
- Hôpital Universitaire des Enfants Reine Fabiola (HUDERF), Brussels, Belgium
| | - Nicolas Deconinck
- Hôpital Universitaire des Enfants Reine Fabiola (HUDERF), Brussels, Belgium
| | - Pierre Defresne
- Service Universitaire Spécialisé pour personnes avec Autisme (SUSA)-Université de Mons, Mons, Belgium
| | - Véronique Delvenne
- Hôpital Universitaire des Enfants Reine Fabiola (HUDERF), Brussels, Belgium
| | - Gianfranco Passeri
- Hôpital Universitaire des Enfants Reine Fabiola (HUDERF), Brussels, Belgium
| | - Hubert Raeymaekers
- Department of Radiology, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Leila Salvesen
- Neuropsychology and Functional Neuroimaging Research Group (UR2NF) at the Centre for Research in Cognition and Neurosciences (CRCN), Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Laurent Victoor
- PsyPluriel, Centre Européen de Psychologie Médicale, Brussels, Belgium
| | - Thomas Villemonteix
- Neuropsychology and Functional Neuroimaging Research Group (UR2NF) at the Centre for Research in Cognition and Neurosciences (CRCN), Université Libre de Bruxelles (ULB), Brussels, Belgium
- Paris 8 Vincennes - St Denis University, Laboratoire de Psychopathologie et Neuropsychologie, Saint Denis, France
| | - Eric Willaye
- Service Universitaire Spécialisé pour personnes avec Autisme (SUSA)-Université de Mons, Mons, Belgium
| | - Philippe Peigneux
- Neuropsychology and Functional Neuroimaging Research Group (UR2NF) at the Centre for Research in Cognition and Neurosciences (CRCN), Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Isabelle Massat
- Neuropsychology and Functional Neuroimaging Research Group (UR2NF) at the Centre for Research in Cognition and Neurosciences (CRCN), Université Libre de Bruxelles (ULB), Brussels, Belgium.
- Laboratory of Experimental Neurology, ULB, Brussels, Belgium.
- National Fund of Scientific Research (FNRS), Brussels, Belgium.
- Department of Neurology, Erasme Hospital, Brussels, Belgium.
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17
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Shi L, Zhou H, Shen Y, Wang Y, Fang Y, He Y, Ou J, Luo X, Cheung EFC, Chan RCK. Differential profiles of response inhibition deficit between male children with autism spectrum disorders and schizophrenia. Autism Res 2019; 13:591-602. [PMID: 31657124 DOI: 10.1002/aur.2231] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 08/31/2019] [Accepted: 09/28/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Li‐juan Shi
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health Institute of Psychology, Chinese Academy of Sciences Beijing China
- School of Education Hunan University of Science and Technology Xiangtan Hunan China
| | - Han‐yu Zhou
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health Institute of Psychology, Chinese Academy of Sciences Beijing China
- Department of Psychology University of Chinese Academy of Sciences Beijing China
| | - Yan‐mei Shen
- Mental Health Institute, The Second Xiangya Hospital, Central South University Changsha Hunan China
| | - Ya Wang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health Institute of Psychology, Chinese Academy of Sciences Beijing China
- Department of Psychology University of Chinese Academy of Sciences Beijing China
| | - Yu‐min Fang
- Mental Health Institute, The Second Xiangya Hospital, Central South University Changsha Hunan China
| | - Yu‐qiong He
- Mental Health Institute, The Second Xiangya Hospital, Central South University Changsha Hunan China
| | - Jian‐jun Ou
- Mental Health Institute, The Second Xiangya Hospital, Central South University Changsha Hunan China
| | - Xue‐rong Luo
- Mental Health Institute, The Second Xiangya Hospital, Central South University Changsha Hunan China
| | | | - Raymond C. K. Chan
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health Institute of Psychology, Chinese Academy of Sciences Beijing China
- Department of Psychology University of Chinese Academy of Sciences Beijing China
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18
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Uratani M, Ota T, Iida J, Okazaki K, Yamamuro K, Nakanishi Y, Kishimoto N, Kishimoto T. Reduced prefrontal hemodynamic response in pediatric autism spectrum disorder measured with near-infrared spectroscopy. Child Adolesc Psychiatry Ment Health 2019; 13:29. [PMID: 31297147 PMCID: PMC6599245 DOI: 10.1186/s13034-019-0289-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Accepted: 06/22/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Functional neuroimaging studies suggest that prefrontal cortex dysfunction is present in people with autism spectrum disorder (ASD). Near-infrared spectroscopy is a noninvasive optical tool for examining oxygenation and hemodynamic changes in the cerebral cortex by measuring changes in oxygenated hemoglobin. METHODS Twelve drug-naïve male participants, aged 7-15 years and diagnosed with ASD according to DSM-5 criteria, and 12 age- and intelligence quotient (IQ)-matched healthy control males participated in the present study after giving informed consent. Relative concentrations of oxyhemoglobin were measured with frontal probes every 0.1 s during the Stroop color-word task, using 24-channel near-infrared spectroscopy. RESULTS Oxyhemoglobin changes during the Stroop color-word task in the ASD group were significantly smaller than those in the control group at channels 12 and 13, located over the dorsolateral prefrontal cortex (FDR-corrected P: 0.0021-0.0063). CONCLUSION The results suggest that male children with ASD have reduced prefrontal hemodynamic responses, measured with near-infrared spectroscopy.
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Affiliation(s)
| | - Toyosaku Ota
- 0000 0004 0372 782Xgrid.410814.8Department of Psychiatry, Nara Medical University, 840 Shijyo-cho, Kashihara, Nara 634-8522 Japan
| | - Junzo Iida
- 0000 0004 0372 782Xgrid.410814.8Faculty of Nursing, Nara Medical University, Kashihara, Japan
| | - Kosuke Okazaki
- 0000 0004 0372 782Xgrid.410814.8Department of Psychiatry, Nara Medical University, 840 Shijyo-cho, Kashihara, Nara 634-8522 Japan
| | - Kazuhiko Yamamuro
- 0000 0004 0372 782Xgrid.410814.8Department of Psychiatry, Nara Medical University, 840 Shijyo-cho, Kashihara, Nara 634-8522 Japan
| | - Yoko Nakanishi
- 0000 0004 0372 782Xgrid.410814.8Department of Psychiatry, Nara Medical University, 840 Shijyo-cho, Kashihara, Nara 634-8522 Japan
| | - Naoko Kishimoto
- 0000 0004 0372 782Xgrid.410814.8Department of Psychiatry, Nara Medical University, 840 Shijyo-cho, Kashihara, Nara 634-8522 Japan
| | - Toshifumi Kishimoto
- 0000 0004 0372 782Xgrid.410814.8Department of Psychiatry, Nara Medical University, 840 Shijyo-cho, Kashihara, Nara 634-8522 Japan
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19
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Pallayova M, Brandeburova A, Tokarova D. Update on Sexual Dimorphism in Brain Structure–Function Interrelationships: A Literature Review. Appl Psychophysiol Biofeedback 2019; 44:271-284. [DOI: 10.1007/s10484-019-09443-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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20
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Gooskens B, Bos DJ, Mensen VT, Shook DA, Bruchhage MMK, Naaijen J, Wolf I, Brandeis D, Williams SCR, Buitelaar JK, Oranje B, Durston S. No evidence of differences in cognitive control in children with autism spectrum disorder or obsessive-compulsive disorder: An fMRI study. Dev Cogn Neurosci 2019; 36:100602. [PMID: 30559053 PMCID: PMC6969278 DOI: 10.1016/j.dcn.2018.11.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 10/05/2018] [Accepted: 11/26/2018] [Indexed: 12/27/2022] Open
Abstract
Repetitive behaviors are among the core symptoms of both Autism Spectrum Disorder (ASD) and Obsessive-Compulsive Disorder (OCD) and are thought to be associated with impairments in cognitive control. However, it is still unknown how deficits in cognitive control and associated neural circuitry relate to the quality or severity of repetitive behavior in children with these disorders. Therefore, we investigated the behavioral and neural correlates of cognitive control using a modified stop-signal task in a multicenter study of children (aged 8-12 years) with ASD, OCD and typically developing (TD) children (N = 95). As both ASD and OCD have high levels of comorbidity with Attention Deficit/Hyperactivity Disorder (ADHD), we did an exploratory analysis addressing ADHD-symptoms. We found that children with ASD and OCD did not show deficits in cognitive control or changes in brain activity in task-relevant neural networks when compared to TD children. However, increased activity in prefrontal brain areas was associated with increased symptoms of comorbid ADHD. As such, this study does not support differences in cognitive control or associated neural circuitry in children with ASD and OCD, but rather suggests that changes in cognitive control in these disorders may be related to symptoms of comorbid ADHD.
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Affiliation(s)
- Bram Gooskens
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
| | - Dienke J Bos
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Vincent T Mensen
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Devon A Shook
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Muriel M K Bruchhage
- Department of Neuroimaging, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Jilly Naaijen
- Department of Cognitive Neuroscience, Donders Institute of Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Isabella Wolf
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty, Mannheim/Heidelberg University, Mannheim, Germany
| | - Daniel Brandeis
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty, Mannheim/Heidelberg University, Mannheim, Germany; Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, Zurich, Switzerland; Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland; Neuroscience Center Zurich, University of Zurich, Zurich, Switzerland; ETH Zurich, Zurich, Switzerland
| | - Steven C R Williams
- Department of Neuroimaging, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Jan K Buitelaar
- Department of Cognitive Neuroscience, Donders Institute of Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands; Karakter Child and Adolescent Psychiatry University Center, Nijmegen, the Netherlands
| | - Bob Oranje
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Sarah Durston
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
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21
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Vogan VM, Leung RC, Safar K, Martinussen R, Smith ML, Taylor MJ. Longitudinal Examination of Everyday Executive Functioning in Children With ASD: Relations With Social, Emotional, and Behavioral Functioning Over Time. Front Psychol 2018; 9:1774. [PMID: 30364134 PMCID: PMC6191468 DOI: 10.3389/fpsyg.2018.01774] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 09/03/2018] [Indexed: 11/13/2022] Open
Abstract
Executive functioning (EF) deficits are well-documented in Autism Spectrum Disorder (ASD), yet little is known about the longitudinal trajectory of "everyday" EF and links to social, emotional and behavioral outcomes in ASD. This study examined the profile of everyday EF utilizing parent-reported measures over 2 years, and explored whether prior estimates of EF were related to later co-morbid psychopathology and social functioning in 39 children with ASD and 34 typically developing (TD) children (ages 7-14 years). According to parent reports, children with ASD had impaired scores of EF in all domains at both time points, and showed no significant improvement across 2 years, compared to controls. Regression analyses showed that prior estimates of behavior regulation difficulties at time 1 uniquely predicted later emotional (i.e., symptoms of anxiety/depression) and behavioral (i.e., oppositionality/aggressiveness) problems in children with ASD 2 years later. Furthermore, an improvement of metacognitive skills predicted a reduction of social difficulties over 2 years in ASD. These results imply that EF may be a potential target of intervention for preventing and reducing co-morbid psychopathology and promoting social competence in youth with ASD. Furthermore, the findings that EF related to behavior is more critical for later emotional and behavioral functioning, whereas EF related to cognition is more critical for social functioning, indicates that it may be beneficial to tailor treatment. Future studies investigating the effectiveness of EF-based interventions in improving the cognitive, psychological and social outcomes in ASD are of high priority.
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Affiliation(s)
- Vanessa M Vogan
- Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Applied Psychology and Human Development, Ontario Institute for Studies in Education, Toronto, ON, Canada
| | - Rachel C Leung
- Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Psychology, University of Toronto, Toronto, ON, Canada
| | - Kristina Safar
- Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada
| | - Rhonda Martinussen
- Institute of Child Study, Ontario Institute for Studies in Education, University of Toronto, Toronto, ON, Canada
| | - Mary Lou Smith
- Department of Psychology, University of Toronto, Toronto, ON, Canada
| | - Margot J Taylor
- Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Psychology, University of Toronto, Toronto, ON, Canada
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22
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Øien RA, Schjølberg S, Volkmar FR, Shic F, Cicchetti DV, Nordahl-Hansen A, Stenberg N, Hornig M, Havdahl A, Øyen AS, Ventola P, Susser ES, Eisemann MR, Chawarska K. Clinical Features of Children With Autism Who Passed 18-Month Screening. Pediatrics 2018; 141:e20173596. [PMID: 29784756 DOI: 10.1542/peds.2017-3596] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/05/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES We compared sex-stratified developmental and temperamental profiles at 18 months in children screening negative for autism spectrum disorder (ASD) on the Modified Checklist for Autism in Toddlers (M-CHAT) but later receiving diagnoses of ASD (false-negative group) versus those without later ASD diagnoses (true-negative group). METHODS We included 68 197 screen-negative cases from the Norwegian Mother and Child Cohort Study (49.1% girls). Children were screened by using the 6 critical items of the M-CHAT at 18 months. Groups were compared on domains of the Ages and Stages Questionnaire and the Emotionality Activity Sociability Temperament Survey. RESULTS Despite passing M-CHAT screening at 18 months, children in the false-negative group exhibited delays in social, communication, and motor skills compared with the true-negative group. Differences were more pronounced in girls. However, with regard to shyness, boys in the false-negative group were rated as more shy than their true-negative counterparts, but girls in the false-negative group were rated as less shy than their counterparts in the true-negative group. CONCLUSIONS This is the first study to reveal that children who pass M-CHAT screening at 18 months and are later diagnosed with ASD exhibit delays in core social and communication areas as well as fine motor skills at 18 months. Differences appeared to be more pronounced in girls. With these findings, we underscore the need to enhance the understanding of early markers of ASD in boys and girls, as well as factors affecting parental report on early delays and abnormalities, to improve the sensitivity of screening instruments.
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Affiliation(s)
- Roald A Øien
- Department of Psychology, University of Tromsø - The Arctic University of Norway, Tromsø, Norway;
- Child Study Center, School of Medicine, Yale University, New Haven, Connecticut
| | - Synnve Schjølberg
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Fred R Volkmar
- Child Study Center, School of Medicine, Yale University, New Haven, Connecticut
| | - Frederick Shic
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington
| | - Domenic V Cicchetti
- Child Study Center, School of Medicine, Yale University, New Haven, Connecticut
| | | | - Nina Stenberg
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Mady Hornig
- Department of Epidemiology, and
- Center for Infection and Immunity, Mailman School of Public Health, Columbia University, New York, New York
| | - Alexandra Havdahl
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
- Medical Research Council Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Anne-Siri Øyen
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
- Nic Waals Institute, Lovisenberg Hospital, Oslo, Norway; and
| | - Pamela Ventola
- Child Study Center, School of Medicine, Yale University, New Haven, Connecticut
| | - Ezra S Susser
- Department of Epidemiology, and
- New York State Psychiatric Institute, New York, New York
| | - Martin R Eisemann
- Department of Psychology, University of Tromsø - The Arctic University of Norway, Tromsø, Norway
| | - Katarzyna Chawarska
- Child Study Center, School of Medicine, Yale University, New Haven, Connecticut
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23
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Moseley RL, Hitchiner R, Kirkby JA. Self-reported sex differences in high-functioning adults with autism: a meta-analysis. Mol Autism 2018; 9:33. [PMID: 29796237 PMCID: PMC5960195 DOI: 10.1186/s13229-018-0216-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 04/30/2018] [Indexed: 12/21/2022] Open
Abstract
Background Sex differences in autistic symptomatology are believed to contribute to the mis- and missed diagnosis of many girls and women with an autism spectrum condition (ASC). Whilst recent years have seen the emergence of clinical and empirical reports delineating the profile of young autistic girls, recognition of sex differences in symptomatology in adulthood is far more limited. Methods We chose here to focus on symptomatology as reported using a screening instrument, the Ritvo Autism Asperger Diagnostic Scale-Revised (RAADS-R). In a meta-analysis, we pooled and analysed RAADS-R data from a number of experimental groups. Analysis of variance (ANOVA) searched for the presence of main effects of Sex and Diagnosis and for interactions between these factors in our sample of autistic and non-autistic adults. Results In social relatedness and circumscribed interests, main effects of Diagnosis revealed that as expected, autistic adults reported significantly greater lifetime prevalence of symptoms in these domains; an effect of Sex, in circumscribed interests, also suggested that males generally reported more prevalent symptoms than females. An interaction of Sex and Diagnosis in language symptomatology revealed that a normative sex difference in language difficulties was attenuated in autism. An interaction of Sex and Diagnosis in the sensorimotor domain revealed the opposite picture: a lack of sex differences between typically developing men and women and a greater prevalence of sensorimotor symptoms in autistic women than autistic men. Conclusions We discuss the literature on childhood sex differences in relation to those which emerged in our adult sample. Where childhood sex differences fail to persist in adulthood, several interpretations exist, and we discuss, for example, an inherent sampling bias that may mean that only autistic women most similar to the male presentation are diagnosed. The finding that sensorimotor symptomatology is more highly reported by autistic women is a finding requiring objective confirmation, given its potential importance in diagnosis. Electronic supplementary material The online version of this article (10.1186/s13229-018-0216-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- R L Moseley
- Department of Psychology, Bournemouth University, Fern Barrow, Poole, Dorset, BH12 5BB UK
| | - R Hitchiner
- Department of Psychology, Bournemouth University, Fern Barrow, Poole, Dorset, BH12 5BB UK
| | - J A Kirkby
- Department of Psychology, Bournemouth University, Fern Barrow, Poole, Dorset, BH12 5BB UK
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24
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Schmitt LM, White SP, Cook EH, Sweeney JA, Mosconi MW. Cognitive mechanisms of inhibitory control deficits in autism spectrum disorder. J Child Psychol Psychiatry 2018; 59:586-595. [PMID: 29052841 PMCID: PMC5906199 DOI: 10.1111/jcpp.12837] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/20/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Inhibitory control deficits are common in autism spectrum disorder (ASD) and associated with more severe repetitive behaviors. Inhibitory control deficits may reflect slower execution of stopping processes, or a reduced ability to delay the onset of behavioral responses in contexts of uncertainty. Previous studies have documented relatively spared stopping processes in ASD, but whether inhibitory control deficits in ASD reflect failures to delay response onset has not been systematically assessed. Further, while improvements in stopping abilities and response slowing are seen through adolescence/early adulthood in health, their development in ASD is less clear. METHODS A stop-signal test (SST) was administered to 121 individuals with ASD and 76 age and IQ-matched healthy controls (ages 5-28). This test included 'GO trials' in which participants pressed a button when a peripheral target appeared and interleaved 'STOP trials' in which they were cued to inhibit button-presses when a stop-signal appeared at variable times following the GO cue. STOP trial accuracy, RT of the stopping process (SSRT), and reaction time (RT) slowing during GO trials were examined. RESULTS Relative to controls, individuals with ASD had reduced accuracy on STOP trials. SSRTs were similar across control and ASD participants, but RT slowing was reduced in patients compared to controls. Age-related increases in stopping ability and RT slowing were attenuated in ASD. Reduced stopping accuracy and RT slowing were associated with more severe repetitive behaviors in ASD. DISCUSSION Our findings show that inhibitory control deficits in ASD involve failures to strategically delay behavioral response onset. These results suggest that reduced preparatory behavioral control may underpin inhibitory control deficits as well as repetitive behaviors in ASD. Typical age-related improvements in inhibitory control during late childhood/early adolescence are reduced in ASD, highlighting an important developmental window during which treatments may mitigate cognitive alterations contributing to repetitive behaviors.
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Affiliation(s)
- Lauren M. Schmitt
- Schiefelbusch Institute for Life Span Studies and Clinical Child Psychology Program, University of Kansas,Kansas Center for Autism Research and Training (KCART), University of Kansas Medical School,Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati
| | - Stormi P. White
- Center for Autism and Developmental Disabilities, University of Texas Southwestern Medical Center
| | - Edwin H. Cook
- Institute for Juvenile Research, University of Illinois at Chicago
| | - John A. Sweeney
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati
| | - Matthew W. Mosconi
- Schiefelbusch Institute for Life Span Studies and Clinical Child Psychology Program, University of Kansas,Kansas Center for Autism Research and Training (KCART), University of Kansas Medical School
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25
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Torske T, Nærland T, Øie MG, Stenberg N, Andreassen OA. Metacognitive Aspects of Executive Function Are Highly Associated with Social Functioning on Parent-Rated Measures in Children with Autism Spectrum Disorder. Front Behav Neurosci 2018; 11:258. [PMID: 29375332 PMCID: PMC5767603 DOI: 10.3389/fnbeh.2017.00258] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 12/19/2017] [Indexed: 12/27/2022] Open
Abstract
Autism Spectrum Disorder (ASD) is characterized by social dysfunction. Even though executive dysfunction has been recognized as important in understanding ASD, the findings are inconsistent. This might be due to different definitions of executive function (EF), which part of EF that has been studied, structured vs. unstructured tasks, inclusion of different moderators (age, IQ, sex) and different diagnostic categories within the spectrum. The main finding is that people with ASD have more EF difficulties than normal controls and more difficulties on open-end tasks than on structured cognitive tasks. Since some EF difficulties may not be observable in a laboratory setting, informant measures might have higher ecological validity than neuropsychological tests. Evidence suggests that executive dysfunctions are associated with social impairments, but few studies have investigated the details of this relationship, and it remains unclear what types of EF deficits are relevant for the social problems of individuals with ASD. Here we investigated which EF domains were associated with various domains of social function on parent-rated measures. A total of 86 children and adolescents with a diagnosis of ASD were included and tested for general cognitive abilities. Parents completed the Behavior Rating Inventory of Executive Function (BRIEF) and the Social Responsiveness Scale (SRS). Multiple regression analysis revealed significant associations between SRS scores and age, sex, total IQ and the BRIEF indexes. The Metacognition Index from the BRIEF added significantly to the prediction of the SRS total score and the subscales Social Communication, Social Motivation and Autistic Mannerisms. The findings suggest that metacognitive aspects of EF are of particular importance for social abilities in children and adolescents with ASD. Earlier research has shown that typically developing (TD) children have a different relationship between EF and social function than children with ASD. They found that in TD children the EF domain related to behavioral regulation was most important to social function. The results from the current study may have implications for understanding the cognitive components of the social problems that define ASD, and may be relevant in developing more targeted clinical EF interventions related to core ASD dysfunctions.
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Affiliation(s)
- Tonje Torske
- Division of Mental Health and Addiction, Vestre Viken Hospital Trust, Drammen, Norway
| | - Terje Nærland
- NevSom Department of Rare Disorders and Disabilities, Oslo University Hospital, Oslo, Norway.,NORMENT, KG Jebsen Centre for Psychosis Research, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Merete G Øie
- Department of Psychology, University of Oslo, Oslo, Norway.,Research Department, Innlandet Hospital Trust, Lillehammer, Norway
| | - Nina Stenberg
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Ole A Andreassen
- NORMENT, KG Jebsen Centre for Psychosis Research, University of Oslo and Oslo University Hospital, Oslo, Norway
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26
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Hull L, Mandy W. Protective effect or missed diagnosis? Females with autism spectrum disorder. FUTURE NEUROLOGY 2017. [DOI: 10.2217/fnl-2017-0006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Autism spectrum disorder (ASD) has historically been diagnosed more frequently in males than females. One explanation for this is the ‘female protective effect’: that there is something inherent in being female that makes girls and women less susceptible to ASD. Another possibility is that ASD is under-diagnosed in girls and women, due to the existence of a ‘female autism phenotype’, which is not well captured by current, male-biased diagnostic criteria. To evaluate the ‘female protective effect’ and ‘female autism phenotype’ hypotheses, this narrative review describes recent developments exploring the genetic underpinning and behavioral expression of ASD in females. We then look at the ways to better identify females with ASD who may be missed under the current diagnostic criteria.
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Affiliation(s)
- Laura Hull
- Department of Psychology, University College London, 26 Bedford Way, London WC1H 0AP, UK
| | - William Mandy
- Department of Psychology, University College London, 26 Bedford Way, London WC1H 0AP, UK
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27
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White EI, Wallace GL, Bascom J, Armour AC, Register-Brown K, Popal HS, Ratto AB, Martin A, Kenworthy L. Sex differences in parent-reported executive functioning and adaptive behavior in children and young adults with autism spectrum disorder. Autism Res 2017; 10:1653-1662. [PMID: 28568910 DOI: 10.1002/aur.1811] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 04/14/2017] [Accepted: 04/28/2017] [Indexed: 01/28/2023]
Abstract
This study is the largest to date examining executive function and adaptive skills in females with autism spectrum disorder (ASD). Its primary aim was to utilize parent ratings of real-world executive functioning and adaptive behavior to better understand whether females with ASD differ from males with ASD in these areas of everyday functioning. We compared 79 females with ASD to 158 males with ASD (ages 7-18) who were statistically matched on age, IQ, and level of ADHD or ASD traits. All participants were assessed using the Behavior Rating Inventory of Executive Function (BRIEF) and a subset (56 females and 130 males) also received the Vineland Adaptive Behavior Scales (VABS). Females were rated by parents as having greater problems with executive function on the BRIEF. Parents also rated females as exhibiting more difficulties than males on the Daily Living Skills domain of the VABS. There was a correlation between increased global EF difficulty and decreased adaptive ability in both males and females. Our results indicate relative weaknesses for females compared to males diagnosed with ASD on executive function and daily living skills. These differences occur in the absence of sex differences in our sample in age, IQ, clinician ratings of core ASD symptomatology, parent ratings of ADHD symptoms, and parent-reported social and communication adaptive skills on the VABS. These findings indicate specific liabilities in real world EF and daily living skills for females with ASD and have important implications for targeting their treatments. Autism Res 2017, 10: 1653-1662. © 2017 International Society for Autism Research, Wiley Periodicals, Inc.
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Affiliation(s)
- Emily I White
- Laboratory of Brain and Cognition, National Institute of Mental Health, Bethesda, MD
| | - Gregory L Wallace
- Deparment of Speech and Hearing Sciences, The George Washington University, Washington, DC
| | | | - Anna C Armour
- Center for Autism Spectrum Disorders, Children's National Health System, Washington, DC
| | | | - Haroon S Popal
- Laboratory of Brain and Cognition, National Institute of Mental Health, Bethesda, MD
| | - Allison B Ratto
- Center for Autism Spectrum Disorders, Children's National Health System, Washington, DC.,Children's Research Institute, Children's National Health System, Washington, DC
| | - Alex Martin
- Laboratory of Brain and Cognition, National Institute of Mental Health, Bethesda, MD
| | - Lauren Kenworthy
- Center for Autism Spectrum Disorders, Children's National Health System, Washington, DC.,Children's Research Institute, Children's National Health System, Washington, DC
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28
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Freeman LM, Locke J, Rotheram-Fuller E, Mandell D. Brief Report: Examining Executive and Social Functioning in Elementary-Aged Children with Autism. J Autism Dev Disord 2017; 47:1890-1895. [PMID: 28260182 PMCID: PMC5536167 DOI: 10.1007/s10803-017-3079-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
There is a paucity of literature examining the relationship between executive and social functioning in children with autism spectrum disorder (ASD). Twenty-three school-aged children with ASD participated. Executive functioning was measured using the Developmental Neuropsychological Assessment, Second Edition and Differential Ability Scales, Second Edition, and the teacher-rated Behavior Rating of Inventory of Executive Function. Independent assessors observed children's social functioning on the playground while children with ASD and their peers completed a survey to measure peer friendships and rejections. Overall, poorer executive functioning was associated with increased playground isolation and less engagement with peers. This suggests that metacognitive skills such as initiation, working memory, and planning and organization are associated with children's social functioning.
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Affiliation(s)
| | - Jill Locke
- University of Washington, Seattle, WA, USA.
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29
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Hull L, Mandy W, Petrides KV. Behavioural and cognitive sex/gender differences in autism spectrum condition and typically developing males and females. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2016; 21:706-727. [PMID: 28749232 DOI: 10.1177/1362361316669087] [Citation(s) in RCA: 116] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Studies assessing sex/gender differences in autism spectrum conditions often fail to include typically developing control groups. It is, therefore, unclear whether observed sex/gender differences reflect those found in the general population or are particular to autism spectrum conditions. A systematic search identified articles comparing behavioural and cognitive characteristics in males and females with and without an autism spectrum condition diagnosis. A total of 13 studies were included in meta-analyses of sex/gender differences in core autism spectrum condition symptoms (social/communication impairments and restricted/repetitive behaviours and interests) and intelligence quotient. A total of 20 studies were included in a qualitative review of sex/gender differences in additional autism spectrum condition symptoms. For core traits and intelligence quotient, sex/gender differences were comparable in autism spectrum conditions and typical samples. Some additional autism spectrum condition symptoms displayed different patterns of sex/gender differences in autism spectrum conditions and typically developing groups, including measures of executive function, empathising and systemising traits, internalising and externalising problems and play behaviours. Individuals with autism spectrum conditions display typical sex/gender differences in core autism spectrum condition traits, suggesting that diagnostic criteria based on these symptoms should take into account typical sex/gender differences. However, awareness of associated autism spectrum condition symptoms should include the possibility of different male and female phenotypes, to ensure those who do not fit the 'typical' autism spectrum condition presentation are not missed.
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30
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Lai MC, Lerch JP, Floris DL, Ruigrok AN, Pohl A, Lombardo MV, Baron-Cohen S. Imaging sex/gender and autism in the brain: Etiological implications. J Neurosci Res 2016; 95:380-397. [DOI: 10.1002/jnr.23948] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 09/04/2016] [Accepted: 09/06/2016] [Indexed: 12/22/2022]
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, Department of Psychiatry; University of Toronto; Toronto Ontario Canada
- Autism Research Centre, Department of Psychiatry; University of Cambridge; Cambridge United Kingdom
- Department of Psychiatry; National Taiwan University Hospital and College of Medicine; Taipei Taiwan
| | - Jason P. Lerch
- Mouse Imaging Centre, Hospital for Sick Children; Toronto Ontario Canada
- Department of Medical Biophysics; University of Toronto; Toronto Ontario Canada
| | - Dorothea L. Floris
- Autism Research Centre, Department of Psychiatry; University of Cambridge; Cambridge United Kingdom
- New York University Child Study Center; New York New York USA
| | - Amber N.V. Ruigrok
- Autism Research Centre, Department of Psychiatry; University of Cambridge; Cambridge United Kingdom
| | - Alexa Pohl
- Autism Research Centre, Department of Psychiatry; University of Cambridge; Cambridge United Kingdom
| | - Michael V. Lombardo
- Autism Research Centre, Department of Psychiatry; University of Cambridge; Cambridge United Kingdom
- Department of Psychology and Center of Applied Neuroscience; University of Cyprus; Nicosia Cyprus
| | - Simon Baron-Cohen
- Autism Research Centre, Department of Psychiatry; University of Cambridge; Cambridge United Kingdom
- CLASS Clinic, Cambridgeshire and Peterborough NHS Foundation Trust; Cambridge United Kingdom
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31
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Lehnhardt FG, Falter CM, Gawronski A, Pfeiffer K, Tepest R, Franklin J, Vogeley K. Sex-Related Cognitive Profile in Autism Spectrum Disorders Diagnosed Late in Life: Implications for the Female Autistic Phenotype. J Autism Dev Disord 2016; 46:139-154. [PMID: 26319250 DOI: 10.1007/s10803-015-2558-7] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Females with high-functioning ASD are known to camouflage their autistic symptoms better than their male counterparts, making them prone to being under-ascertained and delayed in diagnostic assessment. Thus far the underlying cognitive processes that enable such successful socio-communicative adaptation are not well understood. The current results show sex-related differences in the cognitive profile of ASD individuals, which were diagnosed late in life exclusively. Higher verbal abilities were found in males (n = 69) as opposed to higher processing speed and better executive functions in females with ASD (n = 38). Since both sexes remained unidentified during childhood and adolescence, these results are suggestive for sex-distinctive cognitive strategies as an alternative to typically-developed reciprocal social behavior and social mimicry in high functioning ASD.
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Affiliation(s)
- Fritz-Georg Lehnhardt
- Department of Psychiatry and Psychotherapy, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
| | - Christine Michaela Falter
- Department of Psychiatry and Psychotherapy, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Astrid Gawronski
- Department of Psychiatry and Psychotherapy, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Kathleen Pfeiffer
- Department of Psychiatry and Psychotherapy, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Ralf Tepest
- Department of Psychiatry and Psychotherapy, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Jeremy Franklin
- Institute of Medical Statistics, Computer Science and Epidemiology (IMSIE), University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Kai Vogeley
- Department of Psychiatry and Psychotherapy, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.,Institute of Neuroscience and Medicine - Cognitive Neurosciences (INM-3), Research Center Juelich, 52425, Juelich, Germany
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32
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May T, Cornish K, Rinehart NJ. Gender Profiles of Behavioral Attention in Children With Autism Spectrum Disorder. J Atten Disord 2016; 20:627-35. [PMID: 22912506 DOI: 10.1177/1087054712455502] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The attention profile of girls with autism spectrum disorder (ASD) is unclear compared with boys with ASD and typical children. This study aimed to investigate parent-reported ASD and ADHD symptoms in a large sample of boys and girls with and without ASD. METHOD A total of 124 normally intelligent children, half of them girls, 64 with autistic disorder or Asperger's disorder, and 60 age- and gender-matched typically developing, aged 7 to 12 years, were recruited. Parents completed questionnaires regarding autistic and ADHD symptoms. RESULTS No gender differences in social difficulties but more repetitive motor movements, communication difficulties, and inattention were reported in males, regardless of group. Younger boys with ASD had more elevated levels of hyperactivity-impulsivity than younger girls with ASD. CONCLUSION Gender differences in autistic symptoms and inattention in ASD reflected gender differences in typical children. More pronounced hyperactivity in younger boys with ASD could contribute to higher rates of clinical referral than girls.
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Affiliation(s)
- Tamara May
- School of Psychology & Psychiatry, Monash University, Victoria, Australia Centre for Developmental Psychiatry & Psychology, Monash University, Victoria, Australia
| | - Kim Cornish
- School of Psychology & Psychiatry, Monash University, Victoria, Australia
| | - Nicole J Rinehart
- School of Psychology & Psychiatry, Monash University, Victoria, Australia Centre for Developmental Psychiatry & Psychology, Monash University, Victoria, Australia
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33
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Kuiper MWM, Verhoeven EWM, Geurts HM. The role of interstimulus interval and "Stimulus-type" in prepotent response inhibition abilities in people with ASD: A quantitative and qualitative review. Autism Res 2016; 9:1124-1141. [PMID: 27091394 DOI: 10.1002/aur.1631] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 02/24/2016] [Accepted: 03/19/2016] [Indexed: 11/08/2022]
Abstract
Autism spectrum disorders (ASD) are associated with prepotent response inhibition difficulties. However, the large variation between studies suggests that understudied factors, such as interstimulus interval (ISI) and "stimulus-type" (both hypothesized proxies of stressors influencing arousal), might influence the inhibitory abilities of people with ASD. Using meta-analysis, we tested whether differences in prepotent response inhibition between people with and without ASD was influenced by ISI. There was not enough variation in "stimulus-type" between the studies to include it as a moderator. Thirty-seven studies met inclusion criteria, with a combined sample size of 950 people with ASD and 966 typically developing controls. Additionally, a qualitative review including studies comparing a neutral and an arousing condition in one experiment was performed to examine whether fast ISI or specific arousing stimuli directly influence prepotent response inhibition. The meta-analysis indicated that ISI was not a relevant moderator. The qualitative review showed that ISI and "stimulus-type" had the same effect for both groups. Although all studies regarding ISI indicated that fast ISI worsened performance, different types of stimuli had either a positive or a negative influence. This could suggest that distinctive stimuli might affect arousal differently. While we replicated the inhibition difficulties in people with ASD (g = .51), our results do not show strong ASD-specific effects of ISI or "stimulus-type" on inhibition. Nonetheless, ISI and "stimulus-type" do seem to influence performance. Future research focusing on potential underlying factors (e.g., baseline physiological arousal) is needed to examine why this is the case. Autism Res 2016, 9: 1124-1141. © 2016 International Society for Autism Research, Wiley Periodicals, Inc.
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Affiliation(s)
- Marieke W M Kuiper
- Dr. Leo Kannerhuis, Houtsniplaan 1, 6865 XZ, Doorwerth, The Netherlands.,University van Amsterdam Faculty of Social and Behavioural Sciences, Programme group Brain and Cognition, Weesperplein 4, 1018 XA, Amsterdam, The Netherlands
| | | | - Hilde M Geurts
- Dr. Leo Kannerhuis, Houtsniplaan 1, 6865 XZ, Doorwerth, The Netherlands.,University van Amsterdam Faculty of Social and Behavioural Sciences, Programme group Brain and Cognition, Weesperplein 4, 1018 XA, Amsterdam, The Netherlands
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34
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Wilson CE, Murphy CM, McAlonan G, Robertson DM, Spain D, Hayward H, Woodhouse E, Deeley PQ, Gillan N, Ohlsen JC, Zinkstok J, Stoencheva V, Faulkner J, Yildiran H, Bell V, Hammond N, Craig MC, Murphy DG. Does sex influence the diagnostic evaluation of autism spectrum disorder in adults? AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2016; 20:808-19. [PMID: 26802113 PMCID: PMC5363500 DOI: 10.1177/1362361315611381] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
It is unknown whether sex influences the diagnostic evaluation of autism spectrum disorder, or whether male and female adults within the spectrum have different symptom profiles. This study reports sex differences in clinical outcomes for 1244 adults (935 males and 309 females) referred for autism spectrum disorder assessment. Significantly, more males (72%) than females (66%) were diagnosed with an autism spectrum disorder of any subtype (x(2) = 4.09; p = 0.04). In high-functioning autism spectrum disorder adults (IQ > 70; N = 827), there were no significant sex differences in severity of socio-communicative domain symptoms. Males had significantly more repetitive behaviours/restricted interests than females (p = 0.001, d = 0.3). A multivariate analysis of variance indicated a significant interaction between autism spectrum disorder subtype (full-autism spectrum disorder/partial-autism spectrum disorder) and sex: in full-autism spectrum disorder, males had more severe socio-communicative symptoms than females; for partial-autism spectrum disorder, the reverse was true. There were no sex differences in prevalence of co-morbid psychopathologies. Sex influenced diagnostic evaluation in a clinical sample of adults with suspected autism spectrum disorder. The sexes may present with different manifestations of the autism spectrum disorder phenotype and differences vary by diagnostic subtype. Understanding and awareness of adult female repetitive behaviours/restricted interests warrant attention and sex-specific diagnostic assessment tools may need to be considered.
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Affiliation(s)
- C Ellie Wilson
- King's College London, UK South London and Maudsley NHS Foundation Trust, UK University of Seville, Spain
| | - Clodagh M Murphy
- King's College London, UK South London and Maudsley NHS Foundation Trust, UK
| | - Grainne McAlonan
- King's College London, UK South London and Maudsley NHS Foundation Trust, UK
| | - Dene M Robertson
- King's College London, UK South London and Maudsley NHS Foundation Trust, UK
| | - Debbie Spain
- King's College London, UK South London and Maudsley NHS Foundation Trust, UK
| | - Hannah Hayward
- King's College London, UK South London and Maudsley NHS Foundation Trust, UK
| | - Emma Woodhouse
- King's College London, UK South London and Maudsley NHS Foundation Trust, UK
| | - P Quinton Deeley
- King's College London, UK South London and Maudsley NHS Foundation Trust, UK Bethlem Royal Hospital, UK
| | - Nicola Gillan
- South London and Maudsley NHS Foundation Trust, UK Bristol Autism Spectrum Service, UK University of Bristol, UK
| | | | - Janneke Zinkstok
- King's College London, UK South London and Maudsley NHS Foundation Trust, UK
| | | | - Jessica Faulkner
- King's College London, UK South London and Maudsley NHS Foundation Trust, UK
| | | | - Vaughan Bell
- South London and Maudsley NHS Foundation Trust, UK University College London, UK
| | - Neil Hammond
- South London and Maudsley NHS Foundation Trust, UK
| | - Michael C Craig
- King's College London, UK South London and Maudsley NHS Foundation Trust, UK Bethlem Royal Hospital, UK
| | - Declan Gm Murphy
- King's College London, UK South London and Maudsley NHS Foundation Trust, UK
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35
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Developmental neurotoxicity of inhaled ambient ultrafine particle air pollution: Parallels with neuropathological and behavioral features of autism and other neurodevelopmental disorders. Neurotoxicology 2015; 59:140-154. [PMID: 26721665 DOI: 10.1016/j.neuro.2015.12.014] [Citation(s) in RCA: 153] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 12/18/2015] [Accepted: 12/18/2015] [Indexed: 12/25/2022]
Abstract
Accumulating evidence from both human and animal studies show that brain is a target of air pollution. Multiple epidemiological studies have now linked components of air pollution to diagnosis of autism spectrum disorder (ASD), a linkage with plausibility based on the shared mechanisms of inflammation. Additional plausibility appears to be provided by findings from our studies in mice of exposures from postnatal day (PND) 4-7 and 10-13 (human 3rd trimester equivalent), to concentrated ambient ultrafine (UFP) particles, considered the most reactive component of air pollution, at levels consistent with high traffic areas of major U.S. cities and thus highly relevant to human exposures. These exposures, occurring during a period of marked neuro- and gliogenesis, unexpectedly produced a pattern of developmental neurotoxicity notably similar to multiple hypothesized mechanistic underpinnings of ASD, including its greater impact in males. UFP exposures induced inflammation/microglial activation, reductions in size of the corpus callosum (CC) and associated hypomyelination, aberrant white matter development and/or structural integrity with ventriculomegaly (VM), elevated glutamate and excitatory/inhibitory imbalance, increased amygdala astrocytic activation, and repetitive and impulsive behaviors. Collectively, these findings suggest the human 3rd trimester equivalent as a period of potential vulnerability to neurodevelopmental toxicity to UFP, particularly in males, and point to the possibility that UFP air pollution exposure during periods of rapid neuro- and gliogenesis may be a risk factor not only for ASD, but also for other neurodevelopmental disorders that share features with ASD, such as schizophrenia, attention deficit disorder, and periventricular leukomalacia.
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Van Eylen L, Boets B, Steyaert J, Wagemans J, Noens I. Executive functioning in autism spectrum disorders: influence of task and sample characteristics and relation to symptom severity. Eur Child Adolesc Psychiatry 2015; 24:1399-417. [PMID: 25697266 DOI: 10.1007/s00787-015-0689-1] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 01/28/2015] [Indexed: 01/17/2023]
Abstract
Impaired executive functioning (EF) has been proposed to underlie symptoms of autism spectrum disorders (ASD). However, insight in the EF profile of ASD individuals is hampered due to task impurity and inconsistent findings. To elucidate these inconsistencies, we investigated the influence of task and sample characteristics on EF in ASD, with an extended test battery designed to reduce task impurity. Additionally, we studied the relation between EF and ASD symptoms. EF (inhibition, cognitive flexibility, generativity, working memory and planning) was measured in open-ended versus structured assessment situations, while controlling for possible confounding EF and non-EF variables. The performance of 50 individuals with ASD was compared with that of 50 age, gender and IQ matched typically developing (TD) individuals. The effects of group (ASD versus TD), age (children versus adolescents) and gender were examined, as well as the correlation between age, IQ, ASD symptoms and EF. Individuals with ASD showed impairments in all EF domains, but deficits were more pronounced in open-ended compared to structured settings. Group differences did not depend on gender and only occasionally on participants' age. This suggests that inconsistencies between studies largely result from differences in task characteristics and less from differences in the investigated sample features. However, age and IQ strongly correlated with EF, indicating that group differences in these factors should be controlled for when studying EF. Finally, EF correlated with both social and non-social ASD symptoms, but further research is needed to clarify the nature of this relationship.
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Affiliation(s)
- Lien Van Eylen
- Parenting and Special Education Research Unit, KU Leuven, Leopold Vanderkelenstraat 32, Box 3765, 3000, Leuven, Belgium. .,Leuven Autism Research (LAuRes), KU Leuven, Leuven, Belgium.
| | - Bart Boets
- Leuven Autism Research (LAuRes), KU Leuven, Leuven, Belgium.,Department of Child Psychiatry, UPC-KU Leuven, Leuven, Belgium
| | - Jean Steyaert
- Leuven Autism Research (LAuRes), KU Leuven, Leuven, Belgium.,Department of Child Psychiatry, UPC-KU Leuven, Leuven, Belgium.,Department of Clinical Genetics, University Hospital Maastricht, Maastricht, The Netherlands
| | - Johan Wagemans
- Leuven Autism Research (LAuRes), KU Leuven, Leuven, Belgium.,Laboratory of Experimental Psychology, KU Leuven, Leuven, Belgium
| | - Ilse Noens
- Parenting and Special Education Research Unit, KU Leuven, Leopold Vanderkelenstraat 32, Box 3765, 3000, Leuven, Belgium.,Leuven Autism Research (LAuRes), KU Leuven, Leuven, Belgium.,Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, USA
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Blijd-Hoogewys EMA, Bezemer ML, van Geert PLC. Executive functioning in children with ASD: an analysis of the BRIEF. J Autism Dev Disord 2015; 44:3089-100. [PMID: 24996868 DOI: 10.1007/s10803-014-2176-9] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The Behavior Rating Inventory of Executive Functions (BRIEF) screens for executive function deficits in 5- to 18-year-olds. Data of three autism subgroups, according to DSM-IV-TR criteria (N = 35 Autistic Disorder, N = 27 Asperger's Disorder and N = 65 PDD-NOS), were analyzed. The total group has elevated scores on almost all BRIEF scales. The Shift scale is clinically elevated, reflecting a deficit in cognitive flexibility. The BRIEF scales are not found to discriminate among the autism spectrum disorder (ASD) subgroups. The relation between BRIEF and IQ is complex. Possible influencing factors are discussed. Finally, it is recommended to omit the Negativity scale as a validity index in children with ASD and to consider a high score on this index as a unique characteristic of their BRIEF profile, reflecting rigidity problems.
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Affiliation(s)
- E M A Blijd-Hoogewys
- Autism Team and Infant Team, INTER-PSY, Verlengde Meeuwerderweg 7, 9723 ZM, Groningen, The Netherlands,
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Farahmand Z, Tehrani-Doost M, Amini H, Mohammadi A, Mirzaei M, Mohamadzadeh A. Working Memory and Response Inhibition in Patients With Bipolar I Disorder During Euthymic Period. IRANIAN JOURNAL OF PSYCHIATRY AND BEHAVIORAL SCIENCES 2015; 9:e209. [PMID: 26251656 PMCID: PMC4525445 DOI: 10.17795/ijpbs209] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 12/05/2014] [Accepted: 01/20/2015] [Indexed: 11/25/2022]
Abstract
Background: Several cognitive domains, including attention, memory, and executive functions are impaired in bipolar disorder. Objectives: This study aimed to investigate two executive functions (working memory and response inhibition) in patients with bipolar I disorder during remission of the symptoms. Patients and Methods: In this case-control design, 30 bipolar I patients (18 to 45 years old) were matched with 30 ones in the control group in terms of age, gender, and education. The patients were selected from Roozbeh Psychiatric Hospital (a hospital affiliated to Tehran University of Medical Sciences) from May to October 2013. They were evaluated and contrasted using working memory (Spatial Span and Spatial Working Memory (SSP and SWM)) and response inhibition (Stop Signal Task (SST)) tests. Results: We used independent t-tests for comparing and contrasting 2 groups on total and sub-scales scores of these 3 tests. In terms of SWM test there was a significant difference in between-group error between the two groups (P = 0.05); there was also a meaningful difference between the strategies used by two groups (P = 0.05). In SSP test, a significant difference appeared between averages of span length of the two groups. In the first and last item delays, there was also a clear difference, but the total error index was not noticeably different. In SST test, the direction error indicator in start-stop trials indicated a major difference, while in successful stops ratio, the case group had a lower ratio. In addition, reaction time to stop signs in bipolar group was meaningfully lower than the control group. Conclusion: In conclusion, even during remission phase, executive dysfunction is detectable at least in some areas in patients with bipolar disorder.
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Affiliation(s)
- Zahra Farahmand
- Department of Clinical Psychology, Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Mehdi Tehrani-Doost
- Department of Psychiatry, Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Homayoun Amini
- Department of Psychiatry, Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Abolfazl Mohammadi
- Department of Clinical Psychology, Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Mosleh Mirzaei
- Mental Health Research Centre, Tehran Psychiatric Institute, Faculty of Behavioral Science and Mental Health, Iran University of Medical Sciences, Tehran, IR Iran
| | - Azar Mohamadzadeh
- Department of Psychiatry, Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, Tehran, IR Iran
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Rubenstein E, Wiggins LD, Lee LC. A Review of the Differences in Developmental, Psychiatric, and Medical Endophenotypes Between Males and Females with Autism Spectrum Disorder. JOURNAL OF DEVELOPMENTAL AND PHYSICAL DISABILITIES 2015; 27:119-139. [PMID: 26146472 PMCID: PMC4490156 DOI: 10.1007/s10882-014-9397-x] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Autism spectrum disorder (ASD) is over four times more prevalent in males compared to females. Increased understanding of sex differences in ASD endophenotypes could add insight into possible etiologies and the assessment and management of the disorder. Consequently, the purpose of this review is to describe current literature regarding sex differences in the developmental, psychiatric, and medical endophenotypes of ASD in order to illustrate current knowledge and areas in need of further research. Our review found that repetitive behaviors and restricted interests are more common in males than females with ASD. Intellectual disability is more common in females than males with ASD. Attention to detail may be more common in males than females with ASD and epilepsy may be more common in females than males with ASD, although limited research in these areas prevent definitive conclusions from being drawn. There does not appear to be a sex difference in other developmental, psychiatric, and medical symptoms associated with ASD, or the research was contradictory or too sparse to establish a sex difference. Our review is unique in that it offers detailed discussion of sex differences in three major endophenotypes of ASD. Further research is needed to better understand why sex differences exist in certain ASD traits and to evaluate whether phenotypic sex differences are related to different pathways of development, assessment, and treatment of the disorder.
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Affiliation(s)
- Eric Rubenstein
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room E6032, Baltimore, MD 21205, USA
| | - Lisa D. Wiggins
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 1600 Clifton Rd. MS E-86, Atlanta 30333 GA, USA
| | - Li-Ching Lee
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room E6032, Baltimore, MD 21205, USA
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Lai MC, Lombardo MV, Auyeung B, Chakrabarti B, Baron-Cohen S. Sex/gender differences and autism: setting the scene for future research. J Am Acad Child Adolesc Psychiatry 2015; 54:11-24. [PMID: 25524786 PMCID: PMC4284309 DOI: 10.1016/j.jaac.2014.10.003] [Citation(s) in RCA: 556] [Impact Index Per Article: 61.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 10/10/2014] [Accepted: 10/13/2014] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The relationship between sex/gender differences and autism has attracted a variety of research ranging from clinical and neurobiological to etiological, stimulated by the male bias in autism prevalence. Findings are complex and do not always relate to each other in a straightforward manner. Distinct but interlinked questions on the relationship between sex/gender differences and autism remain underaddressed. To better understand the implications from existing research and to help design future studies, we propose a 4-level conceptual framework to clarify the embedded themes. METHOD We searched PubMed for publications before September 2014 using search terms "'sex OR gender OR females' AND autism." A total of 1,906 articles were screened for relevance, along with publications identified via additional literature reviews, resulting in 329 articles that were reviewed. RESULTS Level 1, "Nosological and diagnostic challenges," concerns the question, "How should autism be defined and diagnosed in males and females?" Level 2, "Sex/gender-independent and sex/gender-dependent characteristics," addresses the question, "What are the similarities and differences between males and females with autism?" Level 3, "General models of etiology: liability and threshold," asks the question, "How is the liability for developing autism linked to sex/gender?" Level 4, "Specific etiological-developmental mechanisms," focuses on the question, "What etiological-developmental mechanisms of autism are implicated by sex/gender and/or sexual/gender differentiation?" CONCLUSIONS Using this conceptual framework, findings can be more clearly summarized, and the implications of the links between findings from different levels can become clearer. Based on this 4-level framework, we suggest future research directions, methodology, and specific topics in sex/gender differences and autism.
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Affiliation(s)
- Meng-Chuan Lai
- National Taiwan University Hospital and College of Medicine, Taipei, Taiwan and the Autism Research Centre, University of Cambridge, Cambridge, UK.
| | - Michael V Lombardo
- University of Cyprus, Nicosia, Cyprus and the Autism Research Centre, University of Cambridge
| | - Bonnie Auyeung
- University of Edinburgh and the Autism Research Centre, University of Cambridge
| | - Bhismadev Chakrabarti
- Centre for Integrative Neuroscience and Neurodynamics, School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK and the Autism Research Centre, University of Cambridge
| | - Simon Baron-Cohen
- Cambridge Lifespan Asperger Syndrome Service (CLASS) Clinic, Cambridgeshire and Peterborough National Health Service Foundation Trust, Cambridge, and the Autism Research Centre, University of Cambridge
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Mileva-Seitz VR, Ghassabian A, Bakermans-Kranenburg MJ, van den Brink JD, Linting M, Jaddoe VWV, Hofman A, Verhulst FC, Tiemeier H, van IJzendoorn MH. Are boys more sensitive to sensitivity? Parenting and executive function in preschoolers. J Exp Child Psychol 2014; 130:193-208. [PMID: 25462041 DOI: 10.1016/j.jecp.2014.08.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 08/25/2014] [Accepted: 08/25/2014] [Indexed: 10/24/2022]
Abstract
During early childhood, girls outperform boys on key dimensions of cognitive functions, including inhibitory control, sustained attention, and working memory. The role of parenting in these sex differences is unknown despite evidence that boys are more sensitive to the effects of the early environment. In this study, we measured parental sensitivity at 14 and 36 months of age, and children's cognitive and executive functions (sustained attention, inhibitory control, and forward/backward memory) at 52 months of age, in a longitudinal cohort (N=752). Boys scored significantly lower than girls on inhibitory control (more Go/NoGo "commission errors") and short-term memory (forward color recall task), but boys did not differ from girls on attention (Go/NoGo "omission errors") or working memory (backward color recall task). In stratified analyses, parental sensitivity at 36 months of age was negatively associated with number of errors of commission (p=.05) and omission (p=.02) in boys, whereas child's age was the only significant predictor of commission and omission errors in girls. A combined analysis of both sexes confirmed an interaction between sex and parenting for omission errors (p=.03). The results indicate that sex differences in cognitive functions are evident in preschoolers, although not across all dimensions we assessed. Boys appear to be more vulnerable to early parenting effects, but only in association with omission errors (attention) and not with the other cognitive function dimensions.
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Affiliation(s)
- Viara R Mileva-Seitz
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, 3000 CB Rotterdam, The Netherlands; Center for Child and Family Studies, Leiden University, 2300 RB Leiden, The Netherlands.
| | - Akhgar Ghassabian
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, 3000 CB Rotterdam, The Netherlands; Generation R Study Group, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands
| | | | - Jessica D van den Brink
- Generation R Study Group, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands
| | - Marielle Linting
- Center for Child and Family Studies, Leiden University, 2300 RB Leiden, The Netherlands
| | - Vincent W V Jaddoe
- Generation R Study Group, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Department of Epidemiology, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Department of Pediatrics, Erasmus University Medical Center, 3000 CB Rotterdam, The Netherlands
| | - Albert Hofman
- Department of Epidemiology, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands
| | - Frank C Verhulst
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, 3000 CB Rotterdam, The Netherlands
| | - Henning Tiemeier
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, 3000 CB Rotterdam, The Netherlands; Department of Epidemiology, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands; Department of Psychiatry, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands
| | - Marinus H van IJzendoorn
- Center for Child and Family Studies, Leiden University, 2300 RB Leiden, The Netherlands; School of Pedagogical and Educational Sciences, Erasmus University Rotterdam, 3000 DR Rotterdam, The Netherlands
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Kirkovski M, Enticott PG, Fitzgerald PB. A review of the role of female gender in autism spectrum disorders. J Autism Dev Disord 2014; 43:2584-603. [PMID: 23525974 DOI: 10.1007/s10803-013-1811-1] [Citation(s) in RCA: 208] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This paper reviews the literature exploring gender differences associated with the clinical presentation of autism spectrum disorders (ASD). The potentially mediating effect of comorbid psychopathology, biological and neurodevelopmental implications on these gender differences is also discussed. A vastly heterogeneous condition, while females on the lower-functioning end of the spectrum appear to be more severely affected, an altered clinical manifestation of the disorder among high-functioning females may consequently result in many being un- or mis-diagnosed. To date, there is strong bias in the literature towards the clinical presentation of ASD in males. It is imperative that future research explores gender differences across the autism spectrum, in order to improve researchers', clinicians' and the public's understanding of this debilitating disorder.
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Affiliation(s)
- Melissa Kirkovski
- Monash Alfred Psychiatry Research Centre, The Alfred and Central Clinical School, Monash University, Level 4, 607 St Kilda Rd, Melbourne, VIC, 3004, Australia,
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Baron-Cohen S, Cassidy S, Auyeung B, Allison C, Achoukhi M, Robertson S, Pohl A, Lai MC. Attenuation of typical sex differences in 800 adults with autism vs. 3,900 controls. PLoS One 2014; 9:e102251. [PMID: 25029203 PMCID: PMC4100876 DOI: 10.1371/journal.pone.0102251] [Citation(s) in RCA: 110] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Accepted: 06/13/2014] [Indexed: 12/27/2022] Open
Abstract
Sex differences have been reported in autistic traits and systemizing (male advantage), and empathizing (female advantage) among typically developing individuals. In individuals with autism, these cognitive-behavioural profiles correspond to predictions from the "extreme male brain" (EMB) theory of autism (extreme scores on autistic traits and systemizing, below average on empathizing). Sex differences within autism, however, have been under-investigated. Here we show in 811 adults (454 females) with autism and 3,906 age-matched typical control adults (2,562 females) who completed the Empathy Quotient (EQ), the Systemizing Quotient-Revised (SQ-R), and the Autism Spectrum Quotient (AQ), that typical females on average scored higher on the EQ, typical males scored higher on the SQ-R and AQ, and both males and females with autism showed a shift toward the extreme of the "male profile" on these measures and in the distribution of "brain types" (the discrepancy between standardized EQ and SQ-R scores). Further, normative sex differences are attenuated but not abolished in adults with autism. The findings provide strong support for the EMB theory of autism, and highlight differences between males and females with autism.
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Affiliation(s)
- Simon Baron-Cohen
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Cambridge Lifespan Asperger Syndrome Service (CLASS) Clinic, Cambridgeshire and Peterborough National Health Service Foundation Trust, Cambridge, United Kingdom
| | - Sarah Cassidy
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Bonnie Auyeung
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Department of Psychology, University of Edinburgh, Edinburgh, United Kingdom
| | - Carrie Allison
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Maryam Achoukhi
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Sarah Robertson
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Alexa Pohl
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Meng-Chuan Lai
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Cambridge Lifespan Asperger Syndrome Service (CLASS) Clinic, Cambridgeshire and Peterborough National Health Service Foundation Trust, Cambridge, United Kingdom
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
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de Vries M, Geurts HM. Beyond individual differences: are working memory and inhibition informative specifiers within ASD? J Neural Transm (Vienna) 2014; 121:1183-98. [DOI: 10.1007/s00702-014-1225-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Accepted: 04/15/2014] [Indexed: 01/26/2023]
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Geurts HM, van den Bergh SFWM, Ruzzano L. Prepotent response inhibition and interference control in autism spectrum disorders: two meta-analyses. Autism Res 2014; 7:407-20. [PMID: 24596300 DOI: 10.1002/aur.1369] [Citation(s) in RCA: 140] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 02/02/2014] [Indexed: 11/11/2022]
Abstract
There is a substantial amount of data providing evidence for, but also against the hypothesis that individuals with autism spectrum disorders (ASD) encounter inhibitory control deficits. ASD is often associated with interference control deficits rather than prepotent response inhibition. Moreover, the developmental trajectory for these inhibitory control processes is hypothesized to differ in ASD as compared to typical development. In efforts to gain a more comprehensive perspective of inhibition in ASD, separate quantitative analysis for prepotent response inhibition studies and interference control studies were conducted. Together, these two meta-analyses included 41 studies with a combined sample size of 1,091 people with ASD (M age 14.8 years), and 1,306 typically developing (TD) controls (M age 13.8 years).The meta-analyses indicated that individuals with ASD show increased difficulties in prepotent response inhibition (effect size 0.55) and in interference control (effect size 0.31). In addition, age was a relevant moderator for prepotent response inhibition but not for interference control. Exploratory analyses revealed that when IQ was taken into account, heterogeneity considerably decreased among interference control studies but not among prepotent response inhibition. In contrast to the general belief, both prepotent response inhibition and interference control problems were observed in individuals with ASD. However, a large variation between studies was also found. Therefore, there remain factors beyond inhibition type, age, or IQ that significantly influence inhibitory control performance among individuals with ASD.
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Affiliation(s)
- Hilde M Geurts
- Department of Psychology, Brain & Cognition, University of Amsterdam, Amsterdam, The Netherlands; Research & Development, Dr Leo Kannerhuis, Center for Autism, Amsterdam, The Netherlands; Dutch Autism and ADHD Research Center (d'Arc), Amsterdam, The Netherlands; Cognitive Science Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
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Frazier TW, Georgiades S, Bishop SL, Hardan AY. Behavioral and cognitive characteristics of females and males with autism in the Simons Simplex Collection. J Am Acad Child Adolesc Psychiatry 2014; 53:329-40.e1-3. [PMID: 24565360 PMCID: PMC3935179 DOI: 10.1016/j.jaac.2013.12.004] [Citation(s) in RCA: 249] [Impact Index Per Article: 24.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 12/12/2013] [Accepted: 12/18/2013] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To examine differences in behavioral symptoms and cognitive functioning between males and females with autism spectrum disorder (ASD). METHOD We analyzed data from 2,418 probands with autism (304 females and 2,114 males) included in the Simons Simplex Collection. Sex differences were evaluated across measures of autism symptoms, cognitive and motor functioning, adaptive behavior, and associated behavior problems. Measurement bias was examined using latent variable models of symptoms. Unadjusted and propensity-adjusted analyses were computed to ensure that sex differences were not due to unbalanced sampling. Moderator and mediator analyses evaluated whether sex differences were modified by clinical characteristics or were driven by cognitive ability. RESULTS Females with ASD had greater social communication impairment, lower levels of restricted interests, lower cognitive ability, weaker adaptive skills, and greater externalizing problems relative to males. Symptom differences could not be accounted for by measurement differences, indicating that diagnostic instruments captured autism similarly in males and females. IQ reductions mediated greater social impairment and reduced adaptive behavior in females with ASD, but did not mediate reductions in restricted interests or increases in irritability. CONCLUSIONS A specific female ASD phenotype is emerging that cannot be accounted for by differential symptom measurement. The present data suggest that the relatively low proportion of high-functioning females may reflect the effect of protective biological factors or may be due to under-identification. Additional carefully accrued samples are needed to confirm the present pattern and to evaluate whether observed sex ratios in high-functioning cases are reduced if female-specific indicators of restricted interests are included.
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Affiliation(s)
- Thomas W Frazier
- Center for Pediatric Behavioral Health and Center for Autism, Cleveland Clinic.
| | | | - Somer L Bishop
- Center for Autism and the Developing Brain, Weill Cornell Medical College
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Memari AH, Ziaee V, Shayestehfar M, Ghanouni P, Mansournia MA, Moshayedi P. Cognitive flexibility impairments in children with autism spectrum disorders: links to age, gender and child outcomes. RESEARCH IN DEVELOPMENTAL DISABILITIES 2013; 34:3218-3225. [PMID: 23886763 DOI: 10.1016/j.ridd.2013.06.033] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 06/22/2013] [Accepted: 06/25/2013] [Indexed: 06/02/2023]
Abstract
There are still many questions about the cognitive flexibility in autism spectrum disorder (ASD) that remain unanswered. The goal of current study was to evaluate cognitive flexibility patterns and their demographic, clinical and behavioral correlates in large sample of children with ASD. A total of 123 children (94 boys and 29 girls) with ASD aged 7-14 years were assessed on the Wisconsin card sorting test (WCST). Findings showed that gender but not age was associated with the cognitive flexibility performance in ASD. Individuals who had more parent-reported language deficits, lower level of intelligence and education, and showed lower daily sleep time or more engagement in solitary instead of social daily activities were more likely to demonstrate perseveration. Findings provide tentative evidence of a link between cognitive flexibility deficits and sociodemographic or clinical child outcomes in ASD.
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Affiliation(s)
- Amir Hossein Memari
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
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48
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Lai MC, Lombardo MV, Suckling J, Ruigrok ANV, Chakrabarti B, Ecker C, Deoni SCL, Craig MC, Murphy DGM, Bullmore ET, Baron-Cohen S. Biological sex affects the neurobiology of autism. Brain 2013; 136:2799-815. [PMID: 23935125 PMCID: PMC3754459 DOI: 10.1093/brain/awt216] [Citation(s) in RCA: 197] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
In autism, heterogeneity is the rule rather than the exception. One obvious source of heterogeneity is biological sex. Since autism was first recognized, males with autism have disproportionately skewed research. Females with autism have thus been relatively overlooked, and have generally been assumed to have the same underlying neurobiology as males with autism. Growing evidence, however, suggests that this is an oversimplification that risks obscuring the biological base of autism. This study seeks to answer two questions about how autism is modulated by biological sex at the level of the brain: (i) is the neuroanatomy of autism different in males and females? and (ii) does the neuroanatomy of autism fit predictions from the ‘extreme male brain’ theory of autism, in males and/or in females? Neuroanatomical features derived from voxel-based morphometry were compared in a sample of equal-sized high-functioning male and female adults with and without autism (n = 120, n = 30/group). The first question was investigated using a 2 × 2 factorial design, and by spatial overlap analyses of the neuroanatomy of autism in males and females. The second question was tested through spatial overlap analyses of specific patterns predicted by the extreme male brain theory. We found that the neuroanatomy of autism differed between adult males and females, evidenced by minimal spatial overlap (not different from that occurred under random condition) in both grey and white matter, and substantially large white matter regions showing significant sex × diagnosis interactions in the 2 × 2 factorial design. These suggest that autism manifests differently by biological sex. Furthermore, atypical brain areas in females with autism substantially and non-randomly (P < 0.001) overlapped with areas that were sexually dimorphic in neurotypical controls, in both grey and white matter, suggesting neural ‘masculinization’. This was not seen in males with autism. How differences in neuroanatomy relate to the similarities in cognition between males and females with autism remains to be understood. Future research should stratify by biological sex to reduce heterogeneity and to provide greater insight into the neurobiology of autism.
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Affiliation(s)
- Meng-Chuan Lai
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Douglas House, 18B, Trumpington Road, Cambridge CB2 8AH, UK.
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Schneider K, Regenbogen C, Pauly KD, Gossen A, Schneider DA, Mevissen L, Michel TM, Gur RC, Habel U, Schneider F. Evidence for gender-specific endophenotypes in high-functioning autism spectrum disorder during empathy. Autism Res 2013; 6:506-21. [PMID: 23868876 DOI: 10.1002/aur.1310] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Despite remarkable behavioral gender differences in patients with autism spectrum disorder (ASD), and growing evidence for a diminished male : female ratio for the putative "male disorder" ASD, aspects of gender are not addressed accordingly in ASD research. Our study aims at filling this gap by exploring empathy abilities in a group of 28 patients with high-functioning ASD and 28 gender-, age- and education-matched non-autistic subjects, for the first time by means of functional neuroimaging (fMRI). In an event-related fMRI paradigm, emotional ("E") and neutral ("N") video clips presented actors telling self-related short stories. After each clip, participants were asked to indicate their own emotion and its intensity as well as the emotion and intensity perceived for the actor. Behaviorally, we found significantly less empathic responses in the overall ASD group compared with non-autistic subjects, and inadequate emotion recognition for the neutral clips in the female ASD group compared with healthy women. Neurally, increased activation of the bilateral medial frontal gyrus was found in male patients compared with female patients, a pattern which was not present in the non-autistic group. Additionally, autistic women exhibited decreased activation of midbrain and limbic regions compared with non-autistic women, whereas there was no significant difference within the male group. While we did not find a fundamental empathic deficit in autistic patients, our data propose different ways of processing empathy in autistic men and women, suggesting stronger impairments in cognitive aspects of empathy/theory of mind for men, and alterations of social reciprocity for women.
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Affiliation(s)
- Karla Schneider
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Medical School, RWTH Aachen University, Aachen; JARA-Translational Brain Medicine, Aachen-Jülich
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May T, Rinehart N, Wilding J, Cornish K. The Role of Attention in the Academic Attainment of Children with Autism Spectrum Disorder. J Autism Dev Disord 2013; 43:2147-58. [DOI: 10.1007/s10803-013-1766-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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