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Whelan TP, Daly E, Puts NA, Smith P, Allison C, Baron-Cohen S, Malievskaia E, Murphy DGM, McAlonan GM. The 'PSILAUT' protocol: an experimental medicine study of autistic differences in the function of brain serotonin targets of psilocybin. BMC Psychiatry 2024; 24:319. [PMID: 38658877 PMCID: PMC11044362 DOI: 10.1186/s12888-024-05768-2] [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: 12/06/2023] [Accepted: 04/15/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND The underlying neurobiology of the complex autism phenotype remains obscure, although accumulating evidence implicates the serotonin system and especially the 5HT2A receptor. However, previous research has largely relied upon association or correlation studies to link differences in serotonin targets to autism. To directly establish that serotonergic signalling is involved in a candidate brain function our approach is to change it and observe a shift in that function. We will use psilocybin as a pharmacological probe of the serotonin system in vivo. We will directly test the hypothesis that serotonergic targets of psilocybin - principally, but not exclusively, 5HT2A receptor pathways-function differently in autistic and non-autistic adults. METHODS The 'PSILAUT' "shiftability" study is a case-control study autistic and non-autistic adults. How neural responses 'shift' in response to low doses (2 mg and 5 mg) of psilocybin compared to placebo will be examined using multimodal techniques including functional MRI and EEG. Each participant will attend on up to three separate visits with drug or placebo administration in a double-blind and randomized order. RESULTS This study will provide the first direct evidence that the serotonin targets of psilocybin function differently in the autistic and non-autistic brain. We will also examine individual differences in serotonin system function. CONCLUSIONS This work will inform our understanding of the neurobiology of autism as well as decisions about future clinical trials of psilocybin and/or related compounds including stratification approaches. TRIAL REGISTRATION NCT05651126.
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Affiliation(s)
- Tobias P Whelan
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- COMPASS Pathfinder Ltd, London, UK
| | - Eileen Daly
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Nicolaas A Puts
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Medical Research Council Centre for Neurodevelopmental Disorders, King's College London, London, UK
| | - Paula Smith
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Carrie Allison
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Simon Baron-Cohen
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
| | | | - Declan G M Murphy
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Medical Research Council Centre for Neurodevelopmental Disorders, King's College London, London, UK
- NIHR-Maudsley Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and the Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Grainne M McAlonan
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
- Medical Research Council Centre for Neurodevelopmental Disorders, King's College London, London, UK.
- NIHR-Maudsley Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and the Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
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Torenvliet C, Groenman AP, Lever AG, Ridderinkhof KR, Geurts HM. Prepotent response inhibition in autism: Not an inhibitory deficit? Cortex 2023; 166:275-285. [PMID: 37437321 DOI: 10.1016/j.cortex.2023.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 03/16/2023] [Accepted: 05/23/2023] [Indexed: 07/14/2023]
Abstract
Research outcomes on prepotent response inhibition in neurodevelopmental conditions during adulthood seem inconsistent, especially in autism. To gain further insight in these inconsistencies, the current study investigates inhibitory performance, as well as task strategies such as adaptive behavior during inhibitory tasks in autistic adults. As Attention-Deficit/Hyperactivity Disorder (ADHD) is often co-occurring in autism and associated with differences in both inhibition and adaptation, the role of ADHD symptoms is explored. Additionally, prior research is extended to middle- and late-adulthood, and the role of cognitive aging is assessed. Hundred-and-five autistic adults and 139 non-autistic adults (age: 20-80 yrs) were compared on a Go-NoGo task. No significant group differences in inhibitory difficulties (commission errors) or adaptation (post error slowing) were observed, and both did not relate significantly to ADHD symptoms. However, when controlling for reaction time autistic individuals made significantly more inhibitory errors than non-autistic individuals, yet the effect size was modest (Cohen's d = .27). Exploratory analyses showed that adaption significantly related to inhibition in non-autistic individuals only, possibly hinting at altered adaptive behavior during inhibitory tasks in autistic adults. ADHD symptoms related to response variability in the autism group only. Furthermore, task strategy changed with older age in both groups, with slower and more cautious responses at older age. Taken together, although minor differences may exist, autistic and non-autistic people show largely similar patterns of inhibitory behavior throughout adulthood. Differences in task timing and strategy seem relevant for future longitudinal studies on cognitive aging across neurodevelopmental conditions.
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Affiliation(s)
- Carolien Torenvliet
- Dutch Autism & ADHD Research Center, Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands.
| | - Annabeth P Groenman
- Dutch Autism & ADHD Research Center, Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands; Research Institute Child Development and Education, University of Amsterdam, Amsterdam, the Netherlands
| | - Anne G Lever
- Dutch Autism & ADHD Research Center, Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Hilde M Geurts
- Dutch Autism & ADHD Research Center, Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands; Dr. Leo Kannerhuis, Autism Clinic (Youz/Parnassia Group), Amsterdam, the Netherlands
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3
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Villar de Araujo T, Rüesch A, Bankwitz A, Rufer M, Kleim B, Olbrich S. Autism spectrum disorders in adults and the autonomic nervous system: Heart rate variability markers in the diagnostic procedure. J Psychiatr Res 2023; 164:235-242. [PMID: 37385002 DOI: 10.1016/j.jpsychires.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 06/12/2023] [Accepted: 06/15/2023] [Indexed: 07/01/2023]
Abstract
The diagnostic assessment of autism spectrum disorders (ASD) in adults is a challenging and time-consuming procedure. In order to address the lack of specialised health-care professionals and improve the waiting time, we aimed to identify specific electrocardiogram (ECG) derived Heart Rate Variability (HRV) parameters that could be used for diagnostic purposes. 152 patients were diagnosed based on a standardised clinical procedure and assigned to one of three groups: ASD (n = 56), any other psychiatric disorder (OD) (n = 72), and patients with no diagnosis (ND) (n = 24). Groups were compared using ANOVA. Discriminative power of biological parameters and the clinical assessment were compared using receiver operating characteristic curves (ROCs). Patients with ASD showed reduced parasympathetic and increased sympathetic activity compared to ND. The accuracy determined by the area under the curve (AUC) of the biological parameters for discrimination between ASD vs. pooled OD/ND was 0.736 (95% CI = 0.652-0.820), compared to .856 (95% CI = 0.795-0.917) for the extensive clinical assessment. Our results confirmed the dysregulation of the autonomic nervous system in ASD with reduced parasympathetic and increased sympathetic activity as compared to ND. The discriminative power of biological markers including HRV was considerable and could supplement less sophisticated clinical assessments.
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Affiliation(s)
- Tania Villar de Araujo
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich (PUK), University of Zurich, Zurich, Switzerland; Department of Psychology, University of Zurich, Zurich, Switzerland.
| | - Annia Rüesch
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich (PUK), University of Zurich, Zurich, Switzerland; Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Anna Bankwitz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich (PUK), University of Zurich, Zurich, Switzerland; Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Michael Rufer
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich (PUK), University of Zurich, Zurich, Switzerland
| | - Birgit Kleim
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich (PUK), University of Zurich, Zurich, Switzerland; Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Sebastian Olbrich
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich (PUK), University of Zurich, Zurich, Switzerland
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4
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Guastello AD, Lieneman C, Bailey B, Munson M, Barthle-Herrera M, Higham M, Druskin L, McNeil CB. Case report: Co-occurring autism spectrum disorder (Level One) and obsessive-compulsive disorder in a gender-diverse adolescent. Front Psychiatry 2023; 14:1072645. [PMID: 37260756 PMCID: PMC10227521 DOI: 10.3389/fpsyt.2023.1072645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 03/06/2023] [Indexed: 06/02/2023] Open
Abstract
This fictionalized case report captures the common themes and considerations during the diagnostic assessment and behavioral treatment of adolescents demonstrating symptoms of autism spectrum disorder (ASD), obsessive-compulsive disorder (OCD), and attention-deficit/hyperactivity disorder (ADHD), as well as gender-diversity concerns. Our patient was a white, non-Hispanic 17-year-old individual who identified as gender-neutral but had been assigned female at birth. Symptoms presented were social withdrawal, rigid rule-following behavior, unusual repetitive behavior, impairments in social communication skills, sensory sensitivity, body dissatisfaction, self-injury, and anxiety related to contamination, perfectionism, and social interactions. These symptoms contributed to functional impairment with school attendance, school achievement, family relationships, and the activities of daily living. This case report summarizes instruments employed for differential diagnosis concerning cognitive functioning, ASD, OCD, ADHD, depression, anxiety, and commonly co-occurring repetitive behavior. This patient was ultimately diagnosed with ASD, level one for both social communication and restricted, repetitive behaviors, without accompanying intellectual or language impairment; OCD with panic attacks; gender dysphoria; major depressive disorder (single episode and moderate); and ADHD. The subsequent 40-session course of cognitive-behavioral therapy with exposure and response prevention (CBT/ERP) to treat OCD tailored to an individual with ASD and gender diversity concerns is described in detail. Components of family involvement are highlighted. As a result, significant improvements in school attendance, OCD symptoms, depression, social relationships, and adaptive functioning were measured. Lastly, recommendations for clinicians are summarized.
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Affiliation(s)
- Andrea D. Guastello
- Florida Exposure and Anxiety Research (FEAR) Laboratory, Department of Psychiatry, University of Florida, Gainesville, FL, United States
| | - Corey Lieneman
- Department of Psychiatry, University of Nebraska Medical Center, Omaha, NE, United States
| | - Brittany Bailey
- Florida Exposure and Anxiety Research (FEAR) Laboratory, Department of Psychiatry, University of Florida, Gainesville, FL, United States
| | - Melissa Munson
- Florida Exposure and Anxiety Research (FEAR) Laboratory, Department of Psychiatry, University of Florida, Gainesville, FL, United States
| | - Megan Barthle-Herrera
- Florida Exposure and Anxiety Research (FEAR) Laboratory, Department of Psychiatry, University of Florida, Gainesville, FL, United States
| | - Miranda Higham
- Department of School Psychology, University of Florida, Gainesville, FL, United States
| | - Lindsay Druskin
- Department of Psychology, West Virginia University, Morgantown, WV, United States
| | - Cheryl B. McNeil
- Florida Exposure and Anxiety Research (FEAR) Laboratory, Department of Psychiatry, University of Florida, Gainesville, FL, United States
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5
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Torenvliet C, Groenman AP, Radhoe TA, Agelink van Rentergem JA, Van der Putten WJ, Geurts HM. A longitudinal study on cognitive aging in autism. Psychiatry Res 2023; 321:115063. [PMID: 36709700 DOI: 10.1016/j.psychres.2023.115063] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 01/10/2023] [Accepted: 01/14/2023] [Indexed: 01/19/2023]
Abstract
Longitudinal studies on cognitive aging in autism are scarce, and largely underpowered, yet essential to obtain more conclusive results on cognitive changes in autism during adulthood. In the largest longitudinal study on cognition thus far, we aimed to get more insight into cognitive aging in autism. As pre-registered, we computed reliable change indices (RCIs) and multilevel models to estimate cognitive changes in 128 autistic, and 112 non-autistic adults (range: 24-85 yrs.) over two to three timepoints (average interval: 3.5 yrs.). Participants were tested on 15 outcome measures, covering verbal memory, visual (working) memory, prospective memory, theory of mind, fluency, response speed, inhibition, planning, and switching. RCIs showed no significant differences between groups (autism/no-autism) in changes over time. Using multilevel models, most tasks showed sensitivity to cross-sectional age-related effects, and/or longitudinal changes, with worse performance at older age, and later timepoints. However, effects were not significantly different between the autism and no-autism group. This lack of group differences was substantiated by additional Bayesian analyses. In sum, the current study provides evidence for parallel (similar) cognitive aging in autism. Specifically, autistic individuals diagnosed in adulthood, without intellectual disability, do not seem at risk for accelerated cognitive decline.
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Affiliation(s)
- C Torenvliet
- Dutch Autism and ADHD Research Center, Brain and Cognition, Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands.
| | - A P Groenman
- Dutch Autism and ADHD Research Center, Brain and Cognition, Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands; Research Institute Child Development and Education, University of Amsterdam, the Netherlands
| | - T A Radhoe
- Dutch Autism and ADHD Research Center, Brain and Cognition, Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | - J A Agelink van Rentergem
- Dutch Autism and ADHD Research Center, Brain and Cognition, Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | - W J Van der Putten
- Dutch Autism and ADHD Research Center, Brain and Cognition, Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands; Leo Kannerhuis, autism clinic (Youz/Parnassia Group), Amsterdam, the Netherlands
| | - H M Geurts
- Dutch Autism and ADHD Research Center, Brain and Cognition, Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands; Leo Kannerhuis, autism clinic (Youz/Parnassia Group), Amsterdam, the Netherlands
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6
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Fittipaldi S, Armony JL, García AM, Migeot J, Cadaveira M, Ibáñez A, Baez S. Emotional descriptions increase accidental harm punishment and its cortico-limbic signatures during moral judgment in autism. Sci Rep 2023; 13:1745. [PMID: 36720905 PMCID: PMC9889714 DOI: 10.1038/s41598-023-27709-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 01/06/2023] [Indexed: 02/01/2023] Open
Abstract
Individuals with autism spectrum disorder (ASD) present difficulties in integrating mental state information in complex moral tasks. Yet, ASD research has not examined whether this process is influenced by emotions, let alone while capturing its neural bases. We investigated how language-induced emotions modulate intent-based moral judgment in ASD. In a fMRI task, 30 adults with ASD and 27 neurotypical controls read vignettes whose protagonists commit harm either accidentally or intentionally, and then decided how much punishment the protagonist deserved. Emotional content was manipulated across scenarios through the use of graphic language (designed to trigger arousing negative responses) vs. plain (just-the-facts, emotionless) language. Off-line functional connectivity correlates of task performance were also analyzed. In ASD, emotional (graphic) descriptions amplified punishment ratings of accidental harms, associated with increased activity in fronto-temporo-limbic, precentral, and postcentral/supramarginal regions (critical for emotional and empathic processes), and reduced connectivity among the orbitofrontal cortex and the angular gyrus (involved in mentalizing). Language manipulation did not influence intentional harm processing in ASD. In conclusion, in arousing and ambiguous social situations that lack intentionality clues (i.e. graphic accidental harm scenarios), individuals with ASD would misuse their emotional responses as the main source of information to guide their moral decisions. Conversely, in face of explicit harmful intentions, they would be able to compensate their socioemotional alterations and assign punishment through non-emotional pathways. Despite limitations, such as the small sample size and low ecological validity of the task, results of the present study proved reliable and have relevant theoretical and translational implications.
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Affiliation(s)
- Sol Fittipaldi
- Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibáñez, Santiago, Chile
- Global Brain Health Institute (GBHI), University of California San Francisco (UCSF), San Francisco, USA
- Global Brain Health Institute (GBHI), Trinity College Dublin (TCD), Dublin, Ireland
- Cognitive Neuroscience Center (CNC), Universidad de San Andres, Buenos Aires, Argentina
- National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
| | - Jorge L Armony
- Douglas Mental Health University Institute and Dept. of Psychiatry, McGill University, Montreal, Canada
| | - Adolfo M García
- Global Brain Health Institute (GBHI), University of California San Francisco (UCSF), San Francisco, USA
- Cognitive Neuroscience Center (CNC), Universidad de San Andres, Buenos Aires, Argentina
- Departamento de Lingüística y Literatura, Facultad de Humanidades, Universidad de Santiago de Chile, Santiago, Chile
| | - Joaquín Migeot
- Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibáñez, Santiago, Chile
- Center for Social and Cognitive Neuroscience, School of Psychology (CSCN), Universidad Adolfo Ibáñez, Santiago de Chile, Chile
| | | | - Agustín Ibáñez
- Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibáñez, Santiago, Chile
- Global Brain Health Institute (GBHI), University of California San Francisco (UCSF), San Francisco, USA
- Global Brain Health Institute (GBHI), Trinity College Dublin (TCD), Dublin, Ireland
- Cognitive Neuroscience Center (CNC), Universidad de San Andres, Buenos Aires, Argentina
- National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
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Perinelli MG, Cloherty M. Identification of autism in cognitively able adults with epilepsy: A narrative review and discussion of available screening and diagnostic tools. Seizure 2023; 104:6-11. [PMID: 36442428 DOI: 10.1016/j.seizure.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 11/04/2022] [Accepted: 11/06/2022] [Indexed: 11/27/2022] Open
Abstract
The recent NICE epilepsy Guideline (NG217; 2022) recommends that epilepsy professionals need to be alert to autism when considering mental health presentations, behavioural difficulties and as a marker for referral for whole genome sequencing for those patients with epilepsy of unknown cause. However, this relies upon the existence of valid autism screens for people with epilepsy (PWE). We found few studies of autism in cognitively able PWE. This represents an important gap in the literature. We describe different autism screening and diagnostic tools; two screening tools have been used specifically for adult PWE who are cognitively able (AQ, SRS-AS). The AQ is more psychometrically robust, but there may be an overlap between these screening questions and questions relevant to some psychiatric disorders. Formal gold-standard diagnostic tools (module 4 of ADOS-2, ADI-R or 3Di or 3Di-Adult) would benefit from studies of their application to cognitively able PWE. More research is needed to understand the characteristics of autism in cognitively able PWE and to ascertain the appropriate screening and diagnostic tools for this cohort.
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Affiliation(s)
- Martina Giorgia Perinelli
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, Denmark Hill, London SE5 8AF, United Kingdom
| | - Monique Cloherty
- Epilepsy Centre, Clinical Neurosciences Department, Kings College Hospital, 4th Floor Ruskin Wing, Denmark Hill, London SE5 9RS, United Kingdom.
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Torenvliet C, Groenman AP, Radhoe TA, Agelink van Rentergem JA, Geurts HM. One size does not fit all: An individualized approach to understand heterogeneous cognitive performance in autistic adults. Autism Res 2022; 16:734-744. [PMID: 36515294 DOI: 10.1002/aur.2878] [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: 07/08/2022] [Accepted: 12/02/2022] [Indexed: 12/15/2022]
Abstract
Cognitive performances of autistic people vary widely. Therefore, previous group-based comparisons on cognitive aging in autistic adults might have overlooked those autistic adults that are particularly vulnerable for cognitive decline. Multivariate normative comparisons (MNC) statistically assess individual cognitive differences on the entire cognitive profile. Cognitive deviancy as indicated by MNC accurately predicts future cognitive decline, and is therefore sensitive in detecting meaningful cognitive differences. The current study aimed to (1) investigate the applicability of MNC to assess cognitive performance in autism individually, and (2) understand heterogeneous cognitive performance in autistic adults. As pre-registered, we performed MNC in a sample of 254 non-autistic adults, and two independent samples of respectively 118, and 86 autistic adults (20-85 years, mean: 50 years). Cognitive performance was measured on 11 outcomes in six domains (verbal/visual memory, working memory, verbal fluency, Theory of Mind, and psychomotor speed). Using MNC, about twice as many autistic individuals had a deviant cognitive profile (i.e., deviated statistically from the multivariate normspace) as compared to non-autistic individuals. Importantly, most autistic individuals (>80%) did not have a deviant cognitive profile. Having a deviant profile was significantly associated with higher levels of psychological distress in autistic adults specifically, showing the clinical relevance of this method. Therefore, MNC seem a useful tool to individually detect meaningful cognitive differences in autism. These results are consistent with previous cognitive studies suggesting that most autistic adults show fairly similar cognitive profiles to non-autistic adults, yet highlight the necessity for approaches reflecting the heterogeneity observed in autistic people.
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Affiliation(s)
- Carolien Torenvliet
- Department of Psychology, Dutch Autism & ADHD Research Center, Brain & Cognition, University of Amsterdam, Amsterdam, The Netherlands
| | - Annabeth P Groenman
- Department of Psychology, Dutch Autism & ADHD Research Center, Brain & Cognition, University of Amsterdam, Amsterdam, The Netherlands.,Research Institute Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands
| | - Tulsi A Radhoe
- Department of Psychology, Dutch Autism & ADHD Research Center, Brain & Cognition, University of Amsterdam, Amsterdam, The Netherlands
| | - Joost A Agelink van Rentergem
- Department of Psychology, Dutch Autism & ADHD Research Center, Brain & Cognition, University of Amsterdam, Amsterdam, The Netherlands
| | - Hilde M Geurts
- Department of Psychology, Dutch Autism & ADHD Research Center, Brain & Cognition, University of Amsterdam, Amsterdam, The Netherlands.,Leo Kannerhuis, autism clinic (Youz/Parnassia Group), Amsterdam, The Netherlands
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9
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Incidence, prevalence, and global burden of autism spectrum disorder from 1990 to 2019 across 204 countries. Mol Psychiatry 2022; 27:4172-4180. [PMID: 35768640 DOI: 10.1038/s41380-022-01630-7] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 05/07/2022] [Accepted: 05/12/2022] [Indexed: 02/07/2023]
Abstract
Autism spectrum disorder (ASD) substantially contributes to the burden of mental disorders. Improved awareness and changes in diagnostic criteria of ASD may have influenced the diagnostic rates of ASD. However, while data on trends in diagnostic rates in some individual countries have been published, updated estimates of diagnostic rate trends and ASD-related disability at the global level are lacking. Here, we used the Global Burden of Diseases, Injuries, and Risk Factors Study data to address this gap, focusing on changes in prevalence, incidence, and disability-adjusted life years (DALYs) of ASD across the world. From 1990 to 2019, overall age-standardized estimates remained stable globally. Both prevalence and DALYs increased in countries with high socio-demographic index (SDI). However, the age-standardized incidence decreased in some low SDI countries, indicating a need to improve awareness. The male/female ratio decreased between 1990 and 2019, possibly accounted for by increasing clinical attention to ASD in females. Our results suggest that ASD detection in low SDI countries is suboptimal, and that ASD prevention/treatment in countries with high SDI should be improved, considering the increasing prevalence of the disorder. Additionally, growing attention is being paid to ASD diagnosis in females, who might have been left behind by ASD epidemiologic and clinical research previously. ASD burden estimates are underestimated as GBD does not account for mortality in ASD.
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10
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D'Mello AM, Frosch IR, Li CE, Cardinaux AL, Gabrieli JD. Exclusion of females in autism research: Empirical evidence for a "leaky" recruitment-to-research pipeline. Autism Res 2022; 15:1929-1940. [PMID: 36054081 PMCID: PMC9804357 DOI: 10.1002/aur.2795] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 08/05/2022] [Indexed: 01/07/2023]
Abstract
Autism spectrum disorder (ASD) is characterized by challenges in social communication and the presence of repetitive behaviors or restricted interests. Notably, males are four times as likely as females to be diagnosed with autism. Despite efforts to increase representation and characterization of autistic females, research studies consistently enroll small samples of females, or exclude females altogether. Importantly, researchers often rely on standardized measures to confirm diagnosis prior to enrollment in research studies. We retrospectively analyzed the effects of one such measure (Autism Diagnostic Observation Schedule, ADOS) on research inclusion/exclusion rates by sex in autistic adults, all of whom had a preexisting community diagnosis of autism (n = 145, 95 male, 50 female). Using the ADOS as a confirmatory diagnostic measure resulted in the exclusion of autistic females at a rate over 2.5 times higher than that of autistic males. We compared sex ratios in our sample to those in other large, publically available datasets that rely either on community diagnosis (6 datasets, total n = 42,209) or standardized assessments (2 datasets, total n = 214) to determine eligibility of participants for research. Reliance on community diagnosis rather than confirmatory diagnostic assessments resulted in significantly more equal sex ratios. These results provide evidence for a "leaky" recruitment-to-research pipeline for females in autism research. LAY SUMMARY: Despite efforts to increase the representation of autistic females in research, studies consistently enroll small samples of females or exclude females altogether. We find that despite making up almost 50% of the initially recruited sample based upon self-report of community diagnosis, autistic females are disproportonately excluded from research participation as a result of commonly used autism diagnostic measures. In our sample, and several other publically available datasets, reliance on community diagnosis resulted in significantly more equal sex ratios.
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Affiliation(s)
- Anila M. D'Mello
- McGovern Institute for Brain ResearchMassachusetts Institute of TechnologyCambridgeMassachusettsUSA,Present address:
Department of PsychiatryUniversity of Texas Southwestern Medical Center, Dallas, TX; Peter J. O'Donnell Brain Institute, University of Texas Southwestern Medical Center, Dallas, TX; Department of Psychology, University of Texas at DallasCambridgeRichardsonUSA
| | | | - Cindy E. Li
- Hock E. Tan and K. Lisa Yang Center for Autism Research at Massachusetts Institute of TechnologyCambridgeMassachusettsUSA
| | - Annie L. Cardinaux
- McGovern Institute for Brain ResearchMassachusetts Institute of TechnologyCambridgeMassachusettsUSA,Department of Brain and Cognitive SciencesMassachusetts Institute of TechnologyCambridgeMassachusettsUSA
| | - John D.E. Gabrieli
- McGovern Institute for Brain ResearchMassachusetts Institute of TechnologyCambridgeMassachusettsUSA,Department of Brain and Cognitive SciencesMassachusetts Institute of TechnologyCambridgeMassachusettsUSA
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11
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Roestorf A, Howlin P, Bowler DM. Ageing and autism: A longitudinal follow-up study of mental health and quality of life in autistic adults. Front Psychol 2022; 13:741213. [PMID: 36081725 PMCID: PMC9447441 DOI: 10.3389/fpsyg.2022.741213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 06/29/2022] [Indexed: 12/27/2022] Open
Abstract
Background Poor mental health is known to adversely affect functional abilities, social isolation, and quality of life (QoL). It is, therefore, crucial to consider the long-term impacts of mental health conditions as autistic adults grow older. Objectives To explore, in a group of community-based autistic adults, the extent of: (i) autistic traits, co-occurring physical and mental health conditions; (ii) age-related differences in those conditions, and changes over time; and (iii) their impact on everyday living and QoL. Method About Sixty-eight autistic adults (aged 19–80 years) participated in the first study (T1); 49 participants from T1 took part in a follow-up at T2 (mean retest interval 2.4 years). Standardised self-report measures of autistic traits, mental health, and QoL were completed at both time points. Results Over two-thirds (71%) of autistic adult participants experienced at least one co-occurring condition, and over a third (37%) met the criteria for three or more co-occurring conditions. Mental and physical health difficulties were related to autistic traits and difficulties in everyday life and were consistent predictors of poor QoL at T1 and T2. Conclusion Mental health difficulties in autism persisted into older age and did not improve over time. These findings have important implications for mental health provision for autistic adults in older age.
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Affiliation(s)
- Amanda Roestorf
- Autism Research Group (ARG), Department of Psychology, City, University of London, London, United Kingdom
- *Correspondence: Amanda Roestorf,
| | - Patricia Howlin
- Department of Clinical Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Dermot M. Bowler
- Autism Research Group (ARG), Department of Psychology, City, University of London, London, United Kingdom
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12
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Lupindo BM, Maw A, Shabalala N. Late diagnosis of autism: exploring experiences of males diagnosed with autism in adulthood. CURRENT PSYCHOLOGY 2022; 42:1-17. [PMID: 35967496 PMCID: PMC9361958 DOI: 10.1007/s12144-022-03514-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2022] [Indexed: 11/29/2022]
Abstract
Autism Spectrum Disorder (ASD) is a pervasive neurodevelopmental disorder associated with qualitative impairments in social interaction, social communication and restricted, repetitive behaviour (American Psychiatric Association, 2013). Symptoms of ASD are first evident in infancy and childhood. However, individuals presenting with less overt ASD symptomatology may only be diagnosed in adulthood, when the expectation of independence and productivity results in a growing crisis for the individual. This study applied an exploratory qualitative research design to explore first-hand experiences of ten adult males (25 years and above) who were diagnosed with autism during their adulthood. Purposive sampling was used to select participants through the Neurodiversity Centre, Cape Town, South Africa. In-depth one-on-one interviews, guided by a semi-structured interview schedule were conducted. The thematic analysis technique and NVivo 12 qualitative analysis software were used to organise the data and identify themes. Three key themes emerged: failure to diagnose ASD in childhood despite signs and symptoms, ramifications of missed/misdiagnosis in childhood and adulthood on psychological well-being and the impact of receiving a diagnosis of ASD in adulthood. Missed/misdiagnosis had serious implications for psychological well-being throughout childhood and into adulthood. Late diagnosis resulted in missed opportunities for early intervention to address impairments associated with ASD. Receiving a diagnosis provided an explanation for long standing difficulties, offered a way forward in terms of developing coping strategies and allowed for self-acceptance. The implications of these findings for the development of better early screening and assessment for ASD are discussed and future research pathways suggested.
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13
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Peterson BS, Liu J, Dantec L, Newman C, Sawardekar S, Goh S, Bansal R. Using tissue microstructure and multimodal MRI to parse the phenotypic heterogeneity and cellular basis of autism spectrum disorder. J Child Psychol Psychiatry 2022; 63:855-870. [PMID: 34762311 PMCID: PMC9091058 DOI: 10.1111/jcpp.13531] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/08/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND Identifying the brain bases for phenotypic heterogeneity in Autism Spectrum Disorder (ASD) will advance understanding of its pathogenesis and improve its clinical management. METHODS We compared Diffusion Tensor Imaging (DTI) indices and connectome measures between 77 ASD and 88 Typically Developing (TD) control participants. We also assessed voxel-wise associations of DTI indices with measures of regional cerebral blood flow (rCBF) and N-acetylaspartate (NAA) to understand how tissue microstructure associates with cellular metabolism and neuronal density, respectively. RESULTS Autism Spectrum Disorder participants had significantly lower fractional anisotropy (FA) and higher diffusivity values in deep white matter tracts, likely representing ether reduced myelination by oligodendrocytes or a reduced density of myelinated axons. Greater abnormalities in these measures and regions were associated with higher ASD symptom scores. Participant age, sex and IQ significantly moderated these group differences. Path analyses showed that reduced NAA levels accounted significantly for higher diffusivity and higher rCBF values in ASD compared with TD participants. CONCLUSIONS Reduced neuronal density (reduced NAA) likely underlies abnormalities in DTI indices of white matter microstructure in ASD, which in turn are major determinants of elevated blood flow. Together, these findings suggest the presence of reduced axonal density and axonal pathology in ASD white matter. Greater pathology in turn accounts for more severe symptoms, lower intellectual ability, and reduced global efficiency for measures of white matter connectivity in ASD.
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Affiliation(s)
- Bradley S. Peterson
- Institute for the Developing Mind, Children’s Hospital Los Angeles, Los Angeles, CA 90027;,Keck School of Medicine at the University of Southern California, Los Angeles, CA 90033
| | - Jiaqi Liu
- Institute for the Developing Mind, Children’s Hospital Los Angeles, Los Angeles, CA 90027
| | - Louis Dantec
- École Polytechnique Universitaire de Marseille, France
| | | | - Siddhant Sawardekar
- Institute for the Developing Mind, Children’s Hospital Los Angeles, Los Angeles, CA 90027
| | | | - Ravi Bansal
- Institute for the Developing Mind, Children’s Hospital Los Angeles, Los Angeles, CA 90027;,Keck School of Medicine at the University of Southern California, Los Angeles, CA 90033
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14
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Maleval JC. L’émergence des faux autistes. EVOLUTION PSYCHIATRIQUE 2022. [DOI: 10.1016/j.evopsy.2022.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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15
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Jutla A, Foss-Feig J, Veenstra-VanderWeele J. Autism spectrum disorder and schizophrenia: An updated conceptual review. Autism Res 2022; 15:384-412. [PMID: 34967130 PMCID: PMC8931527 DOI: 10.1002/aur.2659] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 11/08/2021] [Accepted: 12/12/2021] [Indexed: 12/19/2022]
Abstract
Autism spectrum disorder (ASD) and schizophrenia (SCZ) are separate disorders, with distinct clinical profiles and natural histories. ASD, typically diagnosed in childhood, is characterized by restricted or repetitive interests or behaviors and impaired social communication, and it tends to have a stable course. SCZ, typically diagnosed in adolescence or adulthood, is characterized by hallucinations and delusions, and tends to be associated with declining function. However, youth with ASD are three to six times more likely to develop SCZ than their neurotypical counterparts, and increasingly, research has shown that ASD and SCZ converge at several levels. We conducted a systematic review of studies since 2013 relevant to understanding this convergence, and present here a narrative synthesis of key findings, which we have organized into four broad categories: symptoms and behavior, perception and cognition, biomarkers, and genetic and environmental risk. We then discuss opportunities for future research into the phenomenology and neurobiology of overlap between ASD and SCZ. Understanding this overlap will allow for researchers, and eventually clinicians, to understand the factors that may make a child with ASD vulnerable to developing SCZ. LAY SUMMARY: Autism spectrum disorder and schizophrenia are distinct diagnoses, but people with autism and people with schizophrena share several characteristics. We review recent studies that have examined these areas of overlap, and discuss the kinds of studies we will need to better understand how these disorders are related. Understanding this will be important to help us identify which autistic children are at risk of developing schizophrenia.
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Affiliation(s)
- Amandeep Jutla
- Columbia University Vagelos College of Physicians and
Surgeons, 630 W 168th St, New York, NY 10032, United States,New York State Psychiatric Institute, 1051 Riverside
Drive, Mail Unit 78, New York, NY 10032, United States
| | - Jennifer Foss-Feig
- Seaver Autism Center for Research and Treatment, Icahn
School of Medicine at Mount Sinai, Department of Psychiatry, 1 Gustave L. Levy
Place, Box 1230, New York, NY 10029, United States
| | - Jeremy Veenstra-VanderWeele
- Columbia University Vagelos College of Physicians and
Surgeons, 630 W 168th St, New York, NY 10032, United States,New York State Psychiatric Institute, 1051 Riverside
Drive, Mail Unit 78, New York, NY 10032, United States,Center for Autism and the Developing Brain, New
York-Presbyterian Westchester Behavioral Health Center, 21 Bloomingdale Road, White
Plains, NY 10605, United States
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16
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Rhodus EK, Barber J, Abner EL, Bardach SH, Gibson A, Jicha GA. Comparison of behaviors characteristic of autism spectrum disorder behaviors and behavioral and psychiatric symptoms of dementia. Aging Ment Health 2022; 26:586-594. [PMID: 33222510 PMCID: PMC8212388 DOI: 10.1080/13607863.2020.1849025] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Similarities exist in behavioral expression of autism spectrum disorder (ASD) and Alzheimer's disease and related dementias (ADRD). The purpose of this study was to assess presence of behavioral and psychiatric symptoms of dementia (BPSD) and ASD-like behaviors in adults with ADRD. METHODS Using a cross-sectional design, data from University of Kentucky Alzheimer's Disease Center participant cohort were used. Hierarchical linear regression was used to assess (1) the relationship between ASD-like behaviors (measured by the Gilliam Autism Rating Scale-Second Edition, GARS-2) and BPSD measured by the Neuropsychiatric Inventory (NPI), and (2) the relationship between ASD-like behaviors and dementia severity (measured by the Clinical Dementia Rating [CDR] sum of boxes), when controlling for BPSD. RESULTS Complete data were available for 142 participants. Using α of 0.05, analyses identified ASD behaviors were significantly associated with BPSD severity ratings (r = 0.47; p < 0.001) and dementia severity (r = 0.46; p < 0.001). GARS-2 explained 6.1% (p < 0.001) of variance in CDR sum of boxes when controlling for NPI and other covariates. DISCUSSION There is significant overlap in behaviors characteristic of ASD and BPSD as assessed by the NPI and GARS-2, despite the use of these instruments in disparate developmental vs. aging settings. ASD behaviors appear to not be solely present in early childhood as a manifestation of ASD but are also present in older adults with neurodegenerative cognitive impairment. Such associations warrant additional research into causation, assessment, and behavioral interventions to further enable new therapeutic approaches targeting ASD behaviors across the lifespan.
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Affiliation(s)
| | - Justin Barber
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY
| | - Erin L. Abner
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY,Department of Epidemiology, University of Kentucky, Lexington, KY
| | - Shoshana H. Bardach
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY,Graduate Center for Gerontology, University of Kentucky, Lexington, KY
| | - Allison Gibson
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY,College of Social Work, University of Kentucky, Lexington, KY
| | - Gregory A. Jicha
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY,Department of Behavioral Science, University of Kentucky, Lexington, KY,Department of Neurology, University of Kentucky, Lexington, KY
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17
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Kato S, Hanawa K, Linh VP, Saito M, Iimura R, Inui K, Nakamura K. Toward mapping pragmatic impairment of autism spectrum disorder individuals through the development of a corpus of spoken Japanese. PLoS One 2022; 17:e0264204. [PMID: 35213580 PMCID: PMC8880787 DOI: 10.1371/journal.pone.0264204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 02/05/2022] [Indexed: 11/19/2022] Open
Abstract
The central symptom of autism spectrum disorder (ASD) is deficiency in social communication, which is generally viewed as being caused by pragmatic impairment (PI). PI is difficulty in using language appropriately in social situations. Studies have confirmed that PI is the result of neurological, cognitive, linguistic, and sensorimotor dysfunctions involving intricately intertwined factors. To elucidate the whole picture of this impairment, an approach from a multifaceted perspective fusing those factors is necessary. To this end, comprehensive PI mapping is a must, since no comprehensive mapping has yet been developed. The aim of this research is to present a model of annotation scheme development and corpus construction to efficiently visualize and quantify for statistical investigation occurrences of PI, which enables comprehensive mapping of PI in the spoken language of Japanese ASD individuals. We constructed system networks (lexicogrammatical option systems speakers make choices from) in the theoretical framework of Systemic Functional Linguistics, from which we developed an annotation scheme to comprehensively cover PI. Since system network covers all possible lexicogrammatical choices in linguistic interaction, it enables a comprehensive view of where and in what lexicogrammar PI occurs. Based on this annotation scheme, we successfully developed the Corpus of ASD + Typically Developed Spoken Language consisting of texts from 1,187 audiotaped tasks performed by 186 ASD and 106 typically developed subjects, accommodating approximately 1.07 million morphemes. Moreover, we were successful in the automatization of the annotation process by machine learning, accomplishing a 90 percent precision rate. We exemplified the mapping procedure with a focus on the spoken use of negotiating particles. Our model corpus is applicable to any language by incorporating our method of constructing the annotation scheme, and would give impetus to defining PI from a cross-linguistic point of view, which is needed because PI of ASD reflects cross-linguistic differences.
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Affiliation(s)
- Sumi Kato
- Department of Neuropsychiatry, Graduate School of Medicine, Hirosaki University, Hirosaki, Japan
- Faculty of Management and Law, Aomori Chuo Gakuin University, Aomori, Japan
| | - Kazuaki Hanawa
- Natural Language Understanding Team, RIKEN Center for Advanced Intelligence Project, Tokyo, Japan
- Natural Language Processing Lab, Graduate School of Information Sciences, Tohoku University, Sendai, Japan
| | - Vo Phuong Linh
- School of Global Studies, University of Sussex, Brighton, United Kingdom
| | - Manabu Saito
- Department of Neuropsychiatry, Graduate School of Medicine, Hirosaki University, Hirosaki, Japan
- Research Center for Child Mental Development, Graduate School of Medicine, Hirosaki University, Hirosaki, Japan
| | - Ryuichi Iimura
- Department of International Management, College of Business Administration, Tamagawa University, Tokyo, Japan
| | - Kentaro Inui
- Natural Language Understanding Team, RIKEN Center for Advanced Intelligence Project, Tokyo, Japan
- Natural Language Processing Lab, Graduate School of Information Sciences, Tohoku University, Sendai, Japan
| | - Kazuhiko Nakamura
- Department of Neuropsychiatry, Graduate School of Medicine, Hirosaki University, Hirosaki, Japan
- Research Center for Child Mental Development, Graduate School of Medicine, Hirosaki University, Hirosaki, Japan
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18
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Bathelt J, Koolschijn PCM, Geurts HM. Atypically slow processing of faces and non-faces in older autistic adults. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 26:1737-1751. [PMID: 34961340 PMCID: PMC9483195 DOI: 10.1177/13623613211065297] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Face recognition is a fundamental function that requires holistic processing. Differences in face processing have been consistently identified in autistic children, but it is unknown whether these differences persist across the adult lifespan. Using event-related functional magnetic resonance imaging, we measured holistic face processing with a rapid Mooney faces task in 50 autistic and 49 non-autistic participants (30–74 years). Behavioral tasks included a self-paced version of the same paradigm and a global–local processing task (Navon). Reduced detection rates for faces, but not non-faces, were found in autistic adults, including slower responses on all conditions. Without time constraints, differences in accuracy disappeared between groups, although reaction times in correctly identifying faces remained higher in autistic adults. The functional magnetic resonance imaging results showed lower activation in the left and right superior frontal gyrus in the autism group but no age-related differences. Overall, our findings point toward slower information processing speed rather than a face recognition deficit in autistic adults. This suggests that face-processing differences are not a core feature of autism across the adult lifespan.
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Affiliation(s)
- Joe Bathelt
- University of Amsterdam, The Netherlands.,Royal Holloway, University of London, UK
| | | | - Hilde M Geurts
- University of Amsterdam, The Netherlands.,Leo Kannerhuis, Youz/Parnassiagroup, The Netherlands
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19
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Torenvliet C, Groenman AP, Radhoe TA, Agelink van Rentergem JA, Van der Putten WJ, Geurts HM. Parallel age-related cognitive effects in autism: A cross-sectional replication study. Autism Res 2021; 15:507-518. [PMID: 34862853 PMCID: PMC9300037 DOI: 10.1002/aur.2650] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 11/04/2021] [Accepted: 11/23/2021] [Indexed: 11/05/2022]
Abstract
Findings on age-related cognitive effects in autism in adulthood are inconsistent across studies. As these studies substantially differ in their methodology, replication studies are needed. In this replication study frequentist (i.e., null-hypothesis significance testing), and Bayesian statistics were used to investigate the hypothesis that in autistic adults compared to non-autistic adults mostly parallel, but also protective age-related cognitive effects can be observed. Participants were 88 autistic adults, and 88 non-autistic matched comparisons (age range: 30-89 years, mean age: 55 years). Cognitive measures were administered on the following six domains: verbal memory, visual memory, working memory, Theory of Mind (ToM), verbal fluency, and processing speed, and self-reported cognitive failures. Non-autistic adults outperformed autistic adults on ToM, verbal fluency, and verbal memory, but only the first two were confirmed with Bayesian replication analyses. Also, more cognitive failures were reported by autistic adults. No interactions between group and age were observed, suggesting a parallel age-related effect on all cognitive domains. In sum, previously observed difficulties in ToM and verbal fluency were replicated which seem to persist at older age. Previously reported parallel age-related cognitive patterns were replicated, yet no evidence for protective age-related patterns was found. LAY SUMMARY: We investigated whether our previous findings on cognitive aging in autism could be confirmed in a new study measuring the cognitive effects of age in autistic and non-autistic adults. As expected, tasks that younger autistic adults had difficulties with (theory of mind, fluency) were also difficult for older autistic adults, and the effect of age itself was similar in autistic and non-autistic adults. Unexpectedly, we observed no protective effects (less cognitive aging) in autism.
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Affiliation(s)
- Carolien Torenvliet
- Dutch Autism & ADHD Research Center, Brain & Cognition, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Annabeth P Groenman
- Dutch Autism & ADHD Research Center, Brain & Cognition, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Tulsi A Radhoe
- Dutch Autism & ADHD Research Center, Brain & Cognition, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Joost A Agelink van Rentergem
- Dutch Autism & ADHD Research Center, Brain & Cognition, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Wikke J Van der Putten
- Dutch Autism & ADHD Research Center, Brain & Cognition, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands.,Leo Kannerhuis, Autism Clinic (Youz/Parnassia Group), Amsterdam, The Netherlands
| | - Hilde M Geurts
- Dutch Autism & ADHD Research Center, Brain & Cognition, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands.,Leo Kannerhuis, Autism Clinic (Youz/Parnassia Group), Amsterdam, The Netherlands
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20
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Parchomiuk M. Old Age in Adults with ASD: Psychosocial Aspects—a Systematic Review. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2021. [DOI: 10.1007/s40489-020-00229-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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21
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Tangviriyapaiboon D, Sirithongthaworn S, Apikomonkon H, Suyakong C, Srikummoon P, Kawilapat S, Traisathit P. Development and psychometric evaluation of a Thai Diagnostic Autism Scale for the early diagnosis of Autism Spectrum Disorder. Autism Res 2021; 15:317-327. [PMID: 34697914 PMCID: PMC9297913 DOI: 10.1002/aur.2631] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 10/04/2021] [Accepted: 10/15/2021] [Indexed: 11/05/2022]
Abstract
The Thai Diagnostic Autism Scale (TDAS) was developed for use as a diagnostic tool for the early diagnosis of Autism Spectrum Disorder (ASD) in Thai children aged 12–48 months old. TDAS consists of 23 items (13 and 17 items in the observational and interview sections, respectively) classified into seven domains (A1–A3 and B1–B4) according to the criteria in the Diagnostic and Statistical Manual of Mental Disorder, fifth edition (DSM‐5). Children with a single score in the A1–A3 domains and at least two of the B1–B4 domains were classified with ASD. The item‐objective congruence (IOC) index, confirmatory factor analysis, and Kappa coefficient were used to evaluate the content, constructs, and inter‐rater validity levels between the evaluators and concurrent validity between TDAS and physicians' diagnoses, respectively. TDAS showed good overall content validity (IOC range 0.71–1.00), suitable construct validity (root‐mean‐squared errors of approximation of 0.076 and 0.067, comparative fit indexes of 0.902 and 0.858, and Tucker‐Lewis indexes of 0.882 and 0.837 for the observation and interview sections, respectively), and excellent diagnostic agreement between TDAS and the evaluators (Kappa = 1.000) as well as between TDAS and the physicians' diagnoses (Kappa = 0.871). The sensitivity and specificity of TDAS were 100% and 82.4%, respectively. In conclusion, TDAS yielded a high level of content validity, concurrent validity, and inter‐rater reliability for the early diagnosis of ASD in Thai children. A large‐scale study using TDAS is needed to determine an appropriate cut‐off point as well as its efficacy. The Thai Diagnostic Autism Scale was developed for use as a diagnostic tool for the early diagnosis of Autism Spectrum Disorder (ASD) among Thai children. It contains 23 items in seven domains for the screening via observations and interviews. The psychometric properties of this diagnostic tool provide its reliability and suitability for the early diagnosis of ASD. A large‐scale study using it is needed to determine an appropriate cut‐off point as well as its efficacy.
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Affiliation(s)
| | | | - Hataichanok Apikomonkon
- Department of Occupational Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Chidawan Suyakong
- Department of Occupational Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Pimwarat Srikummoon
- Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand.,Department of Statistics, Faculty of Science, Data Science Research Center, Chiang Mai University, Chiang Mai, Thailand
| | - Suttipong Kawilapat
- Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
| | - Patrinee Traisathit
- Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand.,Department of Statistics, Faculty of Science, Data Science Research Center, Chiang Mai University, Chiang Mai, Thailand.,Department of Statistics, Faculty of Science, Research Center in Bioresources for Agriculture, Industry and Medicine, Chiang Mai University, Chiang Mai, Thailand
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22
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Jones SL, Johnson M, Alty B, Adamou M. The Effectiveness of RAADS-R as a Screening Tool for Adult ASD Populations. AUTISM RESEARCH AND TREATMENT 2021; 2021:9974791. [PMID: 34552768 PMCID: PMC8452438 DOI: 10.1155/2021/9974791] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 08/31/2021] [Indexed: 11/17/2022]
Abstract
Adult referrals to specialist autism spectrum disorder diagnostic services have increased in recent years, placing strain on existing services. It was proposed that the Ritvo Autism Asperger's Diagnostic Scale could be used as a screening tool, in order to identify and prioritise patients most likely to receive an ASD diagnosis. This study evaluates the validity of the RAADS-R as a screening tool for ASD in an adult population. Retrospective case note analysis was used to evaluate the efficacy of the RAADS-R as a screening tool to predict ASD diagnostic outcomes in 50 service users of a NHS specialist autism service. Results indicate no association between RAADS-R scores and clinical diagnostic outcome, suggesting the RAADS-R is not an effective screening tool for identifying service users most likely to receive an ASD diagnosis. In conclusion, used as a self-report measure pre-full diagnostic assessment, the RAADS-R lacks predictive validity and is not a suitable screening tool for adults awaiting autism assessments. Future research should aim to identify reliable screening tools for this purpose.
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Affiliation(s)
- Sarah L Jones
- South West Yorkshire Partnership NHS Foundation Trust, Wakefield, UK
| | - Maria Johnson
- South West Yorkshire Partnership NHS Foundation Trust, Wakefield, UK
| | - Bronwen Alty
- South West Yorkshire Partnership NHS Foundation Trust, Wakefield, UK
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23
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Vuijk R, Deen M, Arntz A, Geurts HM. First Psychometric Properties of the Dutch Interview for Diagnostic Assessment of Autism Spectrum Disorder in Adult Males Without Intellectual Disability. J Autism Dev Disord 2021; 52:3523-3535. [PMID: 34409554 DOI: 10.1007/s10803-021-05225-z] [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] [Accepted: 07/26/2021] [Indexed: 12/28/2022]
Abstract
For autism spectrum disorder (ASD) in adults there are several diagnostic instruments available with a need for consideration of the psychometric properties. This study aimed to conduct a first psychometric evaluation of a new diagnostic ASD instrument, the NIDA (Dutch Interview for Diagnostic assessment of ASD in adults) in 90 adult males without intellectual disability (age 18-65 years) in the Netherlands: 30 with ASD, 30 with a Personality Disorder and 30 nonpatient controls. The interrater agreement ranged from 0.79 to 1.00, the convergent validity including sensitivity and specificity ranged from 0.76 to 1.00, and we observed an adequate concurrent criterion-related validity. These promising findings can serve as foundation for future psychometric NIDA studies in a more diverse population. TRIAL REGISTRATION: The Netherlands National Trial Register NTR6391. Registered 04 May 2017.
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Affiliation(s)
- Richard Vuijk
- Sarr Autism Rotterdam (Parnassia Psychiatric Institute), Dynamostraat 18, 3083 AK, Rotterdam, The Netherlands.
| | - Mathijs Deen
- Parnassia Psychiatric Institute, Kiwistraat 32, 2552 DH, The Hague, The Netherlands.,Institute of Psychology, Methodology and Statistics Unit, Leiden University, Wassenaarseweg 52, 2333 AK, Leiden, The Netherlands
| | - Arnoud Arntz
- University of Amsterdam, Postbus 15933, 1001 NK, Amsterdam, The Netherlands
| | - Hilde M Geurts
- University of Amsterdam, Postbus 15933, 1001 NK, Amsterdam, The Netherlands.,Dr. Leo Kanner Huis, Youz, Parnassia Psychiatric Institute, Derkinderenstraat 10-18, 1062 DB, Amsterdam, The Netherlands
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24
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Greene RK, Vasile I, Bradbury KR, Olsen A, Duvall SW. Autism Diagnostic Observation Schedule (ADOS-2) elevations in a clinical sample of children and adolescents who do not have autism: Phenotypic profiles of false positives. Clin Neuropsychol 2021; 36:943-959. [PMID: 34294006 DOI: 10.1080/13854046.2021.1942220] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE While the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2) shows high sensitivity for detecting autism spectrum disorder (ASD) when present (i.e. true positives), scores on the ADOS-2 may be falsely elevated for individuals with cognitive impairments or psychological concerns other than ASD (i.e. false positives). This study examined whether demographic, psychological, cognitive, and/or adaptive factors predict ADOS-2 false positives and which psychiatric diagnoses most often result in false positives. METHOD Sensitivity, specificity, false positive, and false negative rates were calculated among 214 5- to 16-year-old patients who completed an ADOS-2 (module 3) as part of an ASD diagnostic evaluation. Additional analyses were conducted with the 101 patients who received clinically elevated ADOS-2 scores (i.e. 56 true positives and 45 false positives). RESULTS Results revealed a 34% false positive rate and a 1% false negative rate. False positives were slightly more likely to be male, have lower restricted and repetitive behavior (RRB) severity scores on the ADOS-2, and demonstrate elevated anxiety during the ADOS-2. Neither IQ, adaptive functioning, nor caregiver-reported emotional functioning was predictive of false positive status. Trauma-related psychiatric diagnoses were more common among false positives. CONCLUSIONS The ADOS-2 should not be used in isolation to assess for ASD, and, in psychiatrically-complex cases, RRB symptom severity may be particularly helpful in differentiating ASD from other psychiatric conditions. Additionally, heightened levels of anxiety, more so than overactivity or disruptive behavior, may lead to non-ASD specific elevations in ADOS-2 scores.
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Affiliation(s)
- Rachel K Greene
- Division of Pediatric Psychology, Department of Pediatrics, Institute on Development and Disability, Oregon Health & Science University and Doernbecher Children's Hospital, Portland, OR, USA
| | - Iulia Vasile
- Division of Pediatric Psychology, Department of Pediatrics, Institute on Development and Disability, Oregon Health & Science University and Doernbecher Children's Hospital, Portland, OR, USA
| | - Kathryn R Bradbury
- Division of Pediatric Psychology, Department of Pediatrics, Institute on Development and Disability, Oregon Health & Science University and Doernbecher Children's Hospital, Portland, OR, USA
| | - Aarika Olsen
- School of Graduate Psychology, Pacific University, Hillsboro, OR, USA
| | - Susanne W Duvall
- Division of Pediatric Psychology, Department of Pediatrics, Institute on Development and Disability, Oregon Health & Science University and Doernbecher Children's Hospital, Portland, OR, USA
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Lodi-Smith J, Rodgers JD, Marquez Luna V, Khan S, Long CJ, Kozlowski KF, Donnelly JP, Lopata C, Thomeer ML. The Relationship of Age with the Autism-Spectrum Quotient Scale in a Large Sample of Adults. AUTISM IN ADULTHOOD 2021; 3:147-156. [PMID: 34169231 DOI: 10.1089/aut.2020.0010] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background: The historical focus on autism as a childhood disorder means that evidence regarding autism in adulthood lags significantly behind research in other age groups. Emerging studies on the relationship of age with autism characteristics do not target older adult samples, which presents a barrier to studying the important variability that exists in life span developmental research. This study aims to further our understanding of the relationship between the Autism-Spectrum Quotient Scale and age in a large adult sample. Methods: The present study examines the relationship of Autism-Spectrum Quotient Scale (AQ) scores with age in 1139 adults, ages 18-97 years. Participants came from three distinct samples-a sample of primarily students, a sample of MTurk participants, and a sample of primarily community dwelling older adults. The majority of the participants did not self-report an autism diagnosis (91%), were female (67%), and identified as White (81%). Participants completed the AQ primarily via online surveys. Researchers scored the AQ following six common scoring practices. Results: Results of preregistered analyses indicate that autism characteristics measured by the AQ are not strongly associated with age (r values from -0.01 to -0.11). Further findings indicate that the measurement of autism characteristics is consistent across age into late life using both multiple groups and local structural equation modeling approaches to measurement invariance (comparative fit indices = 0.82-0.83, root mean square error = 0.06) as well as reliability analysis. Finally, demographic and autism-related variables (sex, race, self-identified autism spectrum disorder diagnosis, and degree of autism characteristics) did not moderate the relationship between age and autism characteristics. Conclusion: These results suggest that self-reports of autism characteristics using the AQ do not vary strongly by age in this large age-representative sample. Findings suggest that the AQ can potentially serve as a useful tool for future research on autism across the life span. Important limitations on what we can learn from these findings point toward critical avenues for future research in this area. Lay summary Why was this study done?: Self-report questionnaires of autism characteristics are a potentially important resource for studying autism in adulthood. This study sought to provide additional information about one of the most commonly used self-report questionnaires, the Autism-Spectrum Quotient Scale (AQ), across adulthood.What was the purpose of this study?: This study intended to determine if there is a relationship between scores on the AQ and age. Researchers also worked to identify which of the multiple different ways of scoring the AQ worked best across adulthood.What did the researchers do?: Researchers collected data from over a thousand participants aged 18-97 years. Participants from three different age groups completed online surveys to self-report their levels of autism characteristics on the AQ. Researchers tested the relationship between AQ scores and age with six different commonly used ways to calculate AQ scores. Researchers used multiple statistical techniques to evaluate various measurement properties of the AQ.What were the results of the study?: The results indicate that autism characteristics measured by the AQ are not strongly associated with age. Along with that, there is evidence that certain approaches to measuring of autism characteristics are consistent across age into late life and do not vary with demographic and autism-related factors.What do these findings add to what was already known?: These results add to the growing evidence that self-reports of autism characteristics using the AQ in general samples are not strongly associated with age across adulthood. These findings also provide guidance about ways of scoring the AQ that work well through late life.What are potential weaknesses in the study?: While the AQ has a degree of relationship with autism diagnoses, this is far from perfect and has not been evaluated in the context of aging research. Therefore, findings from the present research must be carefully interpreted to be about autism characteristics not diagnoses. The sample was also limited in a number of other ways. As in any studies including a broad age range of individuals, the oldest participants are likely quite healthy, engaged individuals. This may particularly be the case given the higher mortality rates and health challenges seen with autism. Similarly, as with any self-report research, this research is limited to those individuals who could answer questions about their autism characteristics. The sample was also predominantly White and nonautistic. Finally, the research was limited to one point in time and so cannot tell us about how autism characteristics may change across adulthood.How will these findings help autistic adults now or in the future?: These findings support the potential for the AQ to be a useful tool for future research on autism in adulthood. For example, researchers can use measures such as the AQ to study how autism characteristics change over time or are associated with aging-related issues such as changes in physical health and memory. Such research may be able to provide a better understanding of how to support autistic individuals across adulthood.
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Affiliation(s)
- Jennifer Lodi-Smith
- Department of Psychology, Institute for Autism Research, Canisius College, Buffalo, New York, USA
| | - Jonathan D Rodgers
- Department of Psychology, Institute for Autism Research, Canisius College, Buffalo, New York, USA
| | - Valeria Marquez Luna
- Department of Psychology, Institute for Autism Research, Canisius College, Buffalo, New York, USA
| | - Sarah Khan
- Department of Psychology, Institute for Autism Research, Canisius College, Buffalo, New York, USA
| | - Caleb J Long
- Department of Psychology, Institute for Autism Research, Canisius College, Buffalo, New York, USA
| | - Karl F Kozlowski
- Department of Kinesiology, Institute for Autism Research, Canisius College, Buffalo, New York, USA
| | - James P Donnelly
- Department of Counseling and Human Services, Institute for Autism Research, Canisius College, Buffalo, New York, USA
| | - Christopher Lopata
- Department of Teacher Education, Institute for Autism Research, Canisius College, Buffalo, New York, USA
| | - Marcus L Thomeer
- Department of Teacher Education, Institute for Autism Research, Canisius College, Buffalo, New York, USA
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Mazza M, Pino MC, Keller R, Vagnetti R, Attanasio M, Filocamo A, Le Donne I, Masedu F, Valenti M. Qualitative Differences in Attribution of Mental States to Other People in Autism and Schizophrenia: What are the Tools for Differential Diagnosis? J Autism Dev Disord 2021; 52:1283-1298. [PMID: 33909212 PMCID: PMC8854268 DOI: 10.1007/s10803-021-05035-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2021] [Indexed: 11/26/2022]
Abstract
The differential diagnosis between schizophrenia spectrum disorders (SSD) and autism spectrum disorders (ASD) remains an important clinical question, because they have overlap in clinical diagnosis. This study explored the differences between ASD (n = 44) and SSD patients (n = 59), compared to typically developing peers (n = 63), in completing an advanced Theory of Mind (ToM) task. The outcome found several differences between groups. The SSD patients showed greater difficulty in understanding social scenarios, while ASD individuals understood the stories, but did not correctly identify the protagonist’s intention. The interesting aspect of the results is that some ToM stories are more informative about the mentalistic reasoning of the two clinical groups, namely, the stories that investigate pretend, persuasion, double bluff and ironic joke constructs.
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Affiliation(s)
- Monica Mazza
- Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, Via Vetoio, Località Coppito, 67100 L’Aquila, Italy
- Reference Centre for Autism of the Abruzzo Region, Local Health Unit ASL 1, L’Aquila, Italy
| | - Maria Chiara Pino
- Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, Via Vetoio, Località Coppito, 67100 L’Aquila, Italy
- Reference Centre for Autism of the Abruzzo Region, Local Health Unit ASL 1, L’Aquila, Italy
| | - Roberto Keller
- Reference Centre for Adult Autism of the Piemonte Region, DSM Local Health Unit ASL Città di Torino, Turin, Italy
| | - Roberto Vagnetti
- Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, Via Vetoio, Località Coppito, 67100 L’Aquila, Italy
| | - Margherita Attanasio
- Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, Via Vetoio, Località Coppito, 67100 L’Aquila, Italy
- Reference Centre for Autism of the Abruzzo Region, Local Health Unit ASL 1, L’Aquila, Italy
| | - Angela Filocamo
- Reference Centre for Autism of the Abruzzo Region, Local Health Unit ASL 1, L’Aquila, Italy
| | - Ilenia Le Donne
- Reference Centre for Autism of the Abruzzo Region, Local Health Unit ASL 1, L’Aquila, Italy
| | - Francesco Masedu
- Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, Via Vetoio, Località Coppito, 67100 L’Aquila, Italy
| | - Marco Valenti
- Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, Via Vetoio, Località Coppito, 67100 L’Aquila, Italy
- Reference Centre for Autism of the Abruzzo Region, Local Health Unit ASL 1, L’Aquila, Italy
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Fombonne E, MacFarlane H, Salem AC. Epidemiological surveys of ASD: advances and remaining challenges. J Autism Dev Disord 2021; 51:4271-4290. [PMID: 33864555 DOI: 10.1007/s10803-021-05005-9] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2021] [Indexed: 12/25/2022]
Abstract
Recent worldwide epidemiological surveys of autism conducted in 37 countries are reviewed; the median prevalence of autism is .97% in 26 high-income countries. Methodological advances and remaining challenges in designing and executing surveys are discussed, including the effects on prevalence of variable case definitions and nosography, of reliance on parental reports only, case ascertainment through mainstream school surveys, innovative approaches to screen school samples more efficiently, and consideration of age in interpreting surveys. Directions for the future of autism epidemiology are discussed, including the need to systematically examine cross-cultural variation in phenotypic expression and developing surveillance programs.
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Affiliation(s)
- Eric Fombonne
- Department of Psychiatry, Oregon Health & Science University, Mail code: GH254 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA.
| | - Heather MacFarlane
- Department of Psychiatry, Oregon Health & Science University, Mail code: GH254 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
| | - Alexandra C Salem
- Department of Psychiatry, Oregon Health & Science University, Mail code: GH254 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
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28
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Dell'Osso L, Carpita B, Cremone IM, Gesi C, D'Ermo A, De Iorio G, Massimetti G, Aguglia E, Bucci P, Carpiniello B, Fagiolini A, Roncone R, Siracusano A, Vita A, Carmassi C, Maj M. Autism spectrum in patients with schizophrenia: correlations with real-life functioning, resilience, and coping styles. CNS Spectr 2021:1-11. [PMID: 33843551 DOI: 10.1017/s1092852921000353] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Previous researches highlighted among patients with schizophrenia spectrum disorders (SSD) a significant presence of autistic traits, which seem to influence clinical and functional outcomes. The aim of this study was to further deepen the investigation, evaluating how patients with SSD with or without autistic traits may differ with respect to levels of functioning, self-esteem, resilience, and coping profiles. METHODS As part of the add-on autism spectrum study of the Italian Network for Research on Psychoses, 164 outpatients with schizophrenia (SCZ) were recruited at eight Italian University psychiatric clinics. Subjects were grouped depending on the presence of significant autistic traits according to the Adult Autism Subthreshold Spectrum (AdAS Spectrum) instrument ("AT group" vs "No AT group"). Other instruments employed were: Autism Spectrum Quotient (AQ), Specific Levels of Functioning (SLOF), Self-Esteem Rating scale (SERS), Resilience Scale for Adults (RSA), and brief-COPE. RESULTS The "AT group" reported significantly higher scores than the "No AT group" on SLOF activities of community living but significantly lower scores on work skills subscale. The same group scored significantly lower also on SERS total score and RSA perception of the self subscale. Higher scores were reported on COPE self-blame, use of emotional support and humor domains in the AT group. Several correlations were found between specific dimensions of the instruments. CONCLUSION Our findings suggest the presence of specific patterns of functioning, resilience, and coping abilities among SSD patients with autistic traits.
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Affiliation(s)
- Liliana Dell'Osso
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Barbara Carpita
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Ivan Mirko Cremone
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Camilla Gesi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Arcangelo D'Ermo
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giovanni De Iorio
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Gabriele Massimetti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Eugenio Aguglia
- Department of Clinical and Molecular Biomedicine, Psychiatry Unit, University of Catania, Catania, Italy
| | - Paola Bucci
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Bernardo Carpiniello
- Section of Psychiatry, Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
| | - Andrea Fagiolini
- Department of Molecular Medicine and Clinical Department of Mental Health, University of Siena, Siena, Italy
| | - Rita Roncone
- Unit of Psychiatry, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Alberto Siracusano
- Department of Systems Medicine, Psychiatry and Clinical Psychology Unit, Tor Vergata University of Rome, Rome, Italy
| | - Antonio Vita
- Psychiatric Unit, School of Medicine, University of Brescia, Brescia, Italy
- Department of Mental Health, Spedali Civili Hospital, Brescia, Italy
| | - Claudia Carmassi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Mario Maj
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
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29
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Finnemann JJS, Plaisted-Grant K, Moore J, Teufel C, Fletcher PC. Low-level, prediction-based sensory and motor processes are unimpaired in Autism. Neuropsychologia 2021; 156:107835. [PMID: 33794277 DOI: 10.1016/j.neuropsychologia.2021.107835] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 03/09/2021] [Accepted: 03/19/2021] [Indexed: 01/08/2023]
Abstract
A new promising account of human brain function suggests that sensory cortices try to optimise information processing via predictions that are based on prior experiences. The brain is thus likened to a probabilistic prediction machine. There has been a growing - though inconsistent - literature to suggest that features of autism spectrum conditions (ASCs) are associated with a deficit in modelling the world through such prediction-based inference. However empirical evidence for differences in low-level sensorimotor predictions in autism is still lacking. One approach to examining predictive processing in the sensorimotor domain is in the context of self-generated (predictable) as opposed to externally-generated (less predictable) effects. We employed two complementary tasks - forcematching and intentional binding - which examine self-versus externally-generated action effects in terms of sensory attenuation and intentional binding respectively in adults with and without autism. The results show that autism was associated with normal levels of sensory attenuation of internally-generated force and with unaltered temporal attraction of voluntary actions and their outcomes. Thus, our results do not support a general deficit in predictive processing in autism.
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Affiliation(s)
- Johanna J S Finnemann
- Department of Psychiatry, University of Cambridge, Cambridge, CB2 8AH, United Kingdom.
| | - Kate Plaisted-Grant
- Department of Psychology, University of Cambridge, Cambridge, CB2 3EB, United Kingdom
| | - James Moore
- Department of Psychology, Goldsmiths, University of London, London, SE14 6NW, United Kingdom
| | - Christoph Teufel
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff University, Cardiff, CF24 4HQ, United Kingdom
| | - Paul C Fletcher
- Department of Psychiatry, University of Cambridge, Cambridge, CB2 8AH, United Kingdom; Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, CB21 5EF, United Kingdom; Wellcome Trust MRC Institute of Metabolic Science, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, United Kingdom
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30
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Takamuku S, Ohta H, Kanai C, de C Hamilton AF, Gomi H. Seeing motion of controlled object improves grip timing in adults with autism spectrum condition: evidence for use of inverse dynamics in motor control. Exp Brain Res 2021; 239:1047-1059. [PMID: 33528597 DOI: 10.1007/s00221-021-06046-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 01/18/2021] [Indexed: 11/28/2022]
Abstract
Previous studies (Haswell et al. in Nat Neurosci 12:970-972, 2009; Marko et al. in Brain J Neurol 138:784-797, 2015) reported that people with autism rely less on vision for learning to reach in a force field. This suggested a possibility that they have difficulties in extracting force information from visual motion signals, a process called inverse dynamics computation. Our recent study (Takamuku et al. in J Int Soc Autism Res 11:1062-1075, 2018) examined the ability of inverse computation with two perceptual tasks and found similar performances in typical and autistic adults. However, this tested the computation only in the context of sensory perception while it was possible that the suspected disability is specific to the motor domain. Here, in order to address the concern, we tested the use of inverse dynamics computation in the context of motor control by measuring changes in grip timing caused by seeing/not seeing a controlled object. The motion of the object was informative of its inertial force and typical participants improved their grip timing based on the visual feedback. Our interest was on whether the autism participants show the same improvement. While some autism participants showed atypical hand slowing when seeing the controlled object, we found no evidence of abnormalities in the inverse computation in our grip timing task or in a replication of the perceptual task. This suggests that the ability of inverse dynamics computation is preserved not only for sensory perception but also for motor control in adults with autism.
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Affiliation(s)
- Shinya Takamuku
- NTT Communication Science Laboratories, Nippon Telegraph and Telephone Corporation, Atsugi, Kanagawa, Japan.
| | - Haruhisa Ohta
- Medical Institute of Developmental Disabilities Research, Showa University, Setagaya-ku, Tokyo, Japan
| | - Chieko Kanai
- Medical Institute of Developmental Disabilities Research, Showa University, Setagaya-ku, Tokyo, Japan.,Department of Child Development and Education, Wayo Women's University, Ichikawa, Chiba, Japan
| | | | - Hiroaki Gomi
- NTT Communication Science Laboratories, Nippon Telegraph and Telephone Corporation, Atsugi, Kanagawa, Japan
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31
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Treise C, Simmons C, Marshall N, Painter M, Perez J. Autism Spectrum Disorder in Early Intervention in Psychosis Services: Implementation and Findings of a 3-step Screening and Diagnostic Protocol. J Psychiatr Pract 2021; 27:23-32. [PMID: 33438864 DOI: 10.1097/pra.0000000000000525] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Evidence indicates that autism spectrum disorder (ASD) is underidentified in populations with psychosis, but that clinical presentations of comorbid ASD and psychosis (ASD-P) and specific treatment needs that may relate to this group are not well understood. In fact, recent studies of ASD in first-episode psychosis suggest that there may be a specific clinical presentation of ASD-P. In response, the Cambridgeshire and Peterborough Early Intervention in Psychosis (EIP) service in the UK implemented and evaluated a 3-step ASD screening and diagnostic protocol, using the Autism Spectrum Disorder in Adults Screening Questionnaire (ASDASQ), case note review, and the Autism Diagnostic Observation Schedule (ADOS-2) and the Childhood Autism Spectrum Test (CAST). As a quality improvement project, the evaluation aimed to (1) establish the prevalence of patients with ASD-P, (2) describe characteristics of the clinical presentation of ASD-P and compare them to those of patients suffering from psychosis but no ASD, and (3) determine any differences in treatment between psychosis patients with and without ASD. Notably, at least 9% of the EIP service caseload met the criteria for a diagnosis of ASD-P, with half identified via the implementation of this protocol. The patients with ASD-P had specific clinical presentations and treatment needs that differed from those of patients with psychosis but no ASD. Thus, the findings from this study supported existing evidence concerning the underdetection of ASD in EIP populations. Our findings also added to emerging evidence for a clinical presentation of ASD-P with specific treatment needs. Our protocol has now been established as routine practice, and its implementation has improved the detection and treatment of patients with ASD-P within our EIP service.
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Adamou M, Jones SL, Wetherhill S. Predicting diagnostic outcome in adult autism spectrum disorder using the autism diagnostic observation schedule, second edition. BMC Psychiatry 2021; 21:24. [PMID: 33423664 PMCID: PMC7798323 DOI: 10.1186/s12888-020-03028-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 12/22/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Autism Diagnostic Observation Schedule, Second Edition (ADOS-2) module four assessment for diagnosing autism spectrum disorder in adults has shown good sensitivity and specificity in research settings. METHOD This study aimed to evaluate the predictive accuracy of the ADOS-2 module four by investigating the components of the assessment, in relation to diagnostic outcome in a clinical setting. Data from 88 service users referred to a Specialist Adult Autism Service was explored. RESULTS ADOS-2 scores failed to predict the diagnostic outcome (overall sensitivity = 92%, specificity = 57%). Interestingly, scores from the 'restricted interests' component of the ADOS-2 have the potential to predict diagnostic outcome, despite this domain not been included in the scoring algorithm. CONCLUSIONS Based on our findings, we recommend clinicians are cautious when interpreting results of the ADOS-2 assessment.
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Affiliation(s)
| | - Sarah L. Jones
- grid.499523.00000 0000 8880 3342South West Yorkshire Partnership NHS Foundation Trust, Wakefield, UK ,Manygates Clinic, Belle Isle Health Park, Portobello Road, Wakefield, WF1 5PN UK
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Nakata Y, Kanahara N, Kimura A, Niitsu T, Komatsu H, Oda Y, Ishikawa M, Hasegawa T, Kamata Y, Yamauchi A, Inazumi K, Kimura H, Iyo M. Autistic traits and cognitive profiles of treatment-resistant schizophrenia. Schizophr Res Cogn 2020; 22:100186. [PMID: 32760657 PMCID: PMC7390750 DOI: 10.1016/j.scog.2020.100186] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 07/10/2020] [Accepted: 07/10/2020] [Indexed: 12/27/2022]
Abstract
The complex pathophysiology of treatment-resistant schizophrenia (TRS) includes severe positive symptoms but also other symptom domains. The overlapping psychological profiles of schizophrenia and autistic spectrum disorder (ASD) are not established. We compared TRS patients (n = 30) with schizophrenia patients in remission (RemSZ, n = 28) and ASD patients (n = 28), focusing on both neurodevelopmental aspects and general and social cognitive impairments. The TRS group performed the worst on general neurocognition (measured by the MATRICS Consensus Cognitive Battery) and social cognition (measured by the theory of mind and emotional expression). The RemSZ group performed the best among the three groups. Regarding autistic traits, all measurements by the Autism-Spectrum Quotient/Autism Screening Questionnaire/Pervasive Developmental Disorder Assessment Rating Scale showed that (1) the ASD patients had the highest autistic traits (2) the TRS patients' scores were less severe than the ASD group's, but (3) the overall trends placed the TRS group between the ASD and the RemSZ group. These findings indicate that TRS patients and remitted patients could have distinctive neurodevelopmental and cognitive profiles. Further, the degrees of social cognitive dysfunction and autistic traits in TRS patients could be close to those of ASD patients, suggesting similarities between TRS and ASD.
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Affiliation(s)
- Yusuke Nakata
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Nobuhisa Kanahara
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan
- Division of Medical Treatment and Rehabilitation, Center for Forensic Mental Health, Chiba University, Chiba, Japan
- Corresponding author at: Division of Medical Treatment and Rehabilitation, Chiba University Center for Forensic Mental Health, 1-8-1 Inohana, Chuou-ku, Chiba-shi, Chiba 260-8670, Japan.
| | - Atsushi Kimura
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Tomihisa Niitsu
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Hideki Komatsu
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yasunori Oda
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Masatomo Ishikawa
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Tadashi Hasegawa
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan
- Palliative Care Center, Chiba University Hospital, Chiba, Japan
| | - Yu Kamata
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Atsushi Yamauchi
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan
- Department of Psychiatry, Chiba Rosai Hospital, Ichihara, Japan
| | - Kazuhiko Inazumi
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Hiroshi Kimura
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan
- Department of Psychiatry, Gakuji-kai Kimura Hospital, Chiba, Japan
| | - Masaomi Iyo
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan
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Russ V, Kovshoff H, Brown T, Abbott P, Hadwin JA. Exploring the Role of Empathy in Understanding the Social-Cognitive Profile for Individuals Referred for Autism Spectrum Disorders Assessment in Adulthood. J Autism Dev Disord 2020; 50:1470-1478. [PMID: 30051187 PMCID: PMC7211188 DOI: 10.1007/s10803-018-3693-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
This study explored the social-cognitive profile of 173 adults referred for an autism assessment. We considered key dimensional traits (autism, empathy and systemising) to understand social cognition in adults diagnosed with an autism spectrum condition compared with those who were referred for, but did not receive a diagnosis. There were no significant social cognitive differences between groups on measures of emotion recognition and social inference. Adults with a confirmed diagnosis, however, reported fewer empathising traits which were positively associated with social-cognitive understanding. Empathising partially mediated the relationship between diagnostic group and social-cognition. Lower empathising traits in individuals diagnosed in adulthood may be important in understanding challenges with social adaptability. The findings have implications for assessment and highlight the role of empathy in developing social understanding in autism.
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Affiliation(s)
- Victoria Russ
- Developmental Laboratory, Department of Psychology, Centre for Innovation in Mental Health, University of Southampton, Southampton, S017 1BJ, UK.
| | - Hanna Kovshoff
- Developmental Laboratory, Department of Psychology, Centre for Innovation in Mental Health, University of Southampton, Southampton, S017 1BJ, UK
| | - Tony Brown
- Autism Diagnostic Research Centre, 9-19 Rose Road, Southampton, SO14 6TE, UK
| | - Patricia Abbott
- Autism Diagnostic Research Centre, 9-19 Rose Road, Southampton, SO14 6TE, UK
| | - Julie A Hadwin
- Developmental Laboratory, Department of Psychology, Centre for Innovation in Mental Health, University of Southampton, Southampton, S017 1BJ, UK
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Sandercock RK, Lamarche EM, Klinger MR, Klinger LG. Assessing the convergence of self-report and informant measures for adults with autism spectrum disorder. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2020; 24:2256-2268. [PMID: 32744068 PMCID: PMC7541713 DOI: 10.1177/1362361320942981] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Self-report measures are widely used for research and clinical assessment of adults with autism spectrum disorder. However, there has been little research examining the convergence of self- and informant-report in this population. This study examined agreement between 40 pairs of adults with autism spectrum disorder and their caregivers on measures of symptom severity, daily living skills, quality of life, and unmet service needs. In addition, this study examined the predictive value of each reporter for objective independent living and employment outcomes. Caregiver and self-report scores were significantly positively correlated on all measures (all r’s >0.50). Results indicated that there were significant differences between reporter ratings of daily living skills, quality of life, and unmet service needs, but no significant differences between ratings of symptom severity. Combining caregiver-report and self-report measures provided significantly higher predictive value of objective outcomes than measures from a single reporter. These findings indicate that both informants provide valuable information and adults with autism spectrum disorder should be included in reporting on their own symptoms and experiences. Given that two reporters together were more predictive of objective outcomes; however, a multi-informant assessment may be the most comprehensive approach for evaluating current functioning and identifying service needs in this population.
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Böhm J, Hermann H, Melchers P, Sappok T. [Validity of the Scale of Pervasive Developmental Disorder in a Clinical Sample of Adults with Intellectual Disability]. PSYCHIATRISCHE PRAXIS 2020; 48:37-43. [PMID: 32659791 DOI: 10.1055/a-1202-2967] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The study assesses the diagnostic validity of the Scale of Pervasive Developmental Disorder in Mentally Retarded Persons (PDD-MRS). METHODS Unblinded conduct of PDD-MRS in a clinical psychiatric sample of adults with intellectual disability (ID; N = 109) and suspect of autism. RESULTS For a cut-off-score of 10, sensitivity was 89 %, specificity 62 % and the Area Under the Curve (AUC) 0.83. The total score was independent of age, gender and level of ID. However the diagnostic validity was better balanced in adults with mild to moderate ID (sensitivity/specificity: 85 %/73 %) compared to those with severe to profound ID (93 %/42 %). The SEAS-M total score was correlated with various ASD screening measures (r = .3-.6), while no correlation was found for scales assessing challenging behavior. CONCLUSION To conclude, the PDD-MRS is a screening instrument for diagnosing autism in adults with mild to moderate ID. Knowledge of the PDD-MRS results within the consensus conference may have led to an overestimation of its diagnostic validity.
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Affiliation(s)
- Julia Böhm
- Ev. Krankenhaus Königin Elisabeth Herzberge, Abteilung für psychische Gesundheit bei intellektuellen Entwicklungsstörungen.,Freie Universität Berlin, Fakultät für Erziehungswissenschaft und Psychologie, Zentrum für seelische Gesundheit
| | - Hauke Hermann
- Ev. Krankenhaus Königin Elisabeth Herzberge, Abteilung für psychische Gesundheit bei intellektuellen Entwicklungsstörungen
| | - Peter Melchers
- Klinikum Oberberg, Kreiskrankenhaus Gummersbach und Klinik Marienheide, Abteilung für Kinder- und Jugendpsychiatrie, Psychotherapie, Psychosomatik
| | - Tanja Sappok
- Ev. Krankenhaus Königin Elisabeth Herzberge, Abteilung für psychische Gesundheit bei intellektuellen Entwicklungsstörungen
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37
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Colombi C, Fish A, Ghaziuddin M. Utility of the ADOS-2 in children with psychiatric disorders. Eur Child Adolesc Psychiatry 2020; 29:989-992. [PMID: 31587085 DOI: 10.1007/s00787-019-01411-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 09/25/2019] [Indexed: 11/24/2022]
Abstract
The Autism Diagnostic Observation Schedule (ADOS-2) is commonly used in the diagnosis of autism spectrum disorder (ASD). Although it has demonstrated good sensitivity and specificity in research settings, relatively little is known about its utility and accuracy in children and adolescents with co-occurring psychiatric disorders. We investigated this topic in children with acute psychiatric disorders. Our sample consisted of 58 patients, aged 9-18 years, admitted to a child and adolescent psychiatric inpatient unit with a suspected diagnosis of ASD. Both Modules 3 and 4 demonstrated low sensitivity (Module 3: 58.3%; Module 4: 55.6%) and specificity (Module 3: 56.5%; Module 4: 59.5%). These findings suggest that the ADOS-2 should be interpreted with caution while screening for autism in children with complex psychiatric disorders.
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Affiliation(s)
- Costanza Colombi
- Department of Psychiatry, University of Michigan, 4250 Plymouth Rd, Ann Arbor, MI, 48109, USA.
| | - Angela Fish
- Department of Psychiatry, University of Michigan, 4250 Plymouth Rd, Ann Arbor, MI, 48109, USA
| | - Mohammad Ghaziuddin
- Department of Psychiatry, University of Michigan, 4250 Plymouth Rd, Ann Arbor, MI, 48109, USA
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Fusar-Poli L, Ciancio A, Gabbiadini A, Meo V, Patania F, Rodolico A, Saitta G, Vozza L, Petralia A, Signorelli MS, Aguglia E. Self-Reported Autistic Traits Using the AQ: A Comparison between Individuals with ASD, Psychosis, and Non-Clinical Controls. Brain Sci 2020; 10:E291. [PMID: 32422885 PMCID: PMC7288044 DOI: 10.3390/brainsci10050291] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 04/29/2020] [Accepted: 05/12/2020] [Indexed: 12/27/2022] Open
Abstract
The term "autism" was originally coined by Eugen Bleuler to describe one of the core symptoms of schizophrenia. Even if autism spectrum disorder (ASD) and schizophrenia spectrum disorders (SSD) are now considered two distinct conditions, they share some clinical features. The present study aimed to investigate self-reported autistic traits in individuals with ASD, SSD, and non-clinical controls (NCC), using the Autism-Spectrum Quotient (AQ), a 50-item questionnaire. The study was conducted in the Psychiatry Unit of Policlinico "G. Rodolico", Catania, Italy. The AQ was administered to 35 adults with ASD, 64 with SSD, and 198 NCC. Overall, our data showed that the ASD sample scored significantly higher than NCC. However, no significant differences were detected between individuals with ASD and SSD. Notably, the three groups scored similarly in the subscale "attention to detail". AQ showed good accuracy in differentiating ASD from NCC (AUC = 0.84), while discriminant ability was poor in the clinical sample (AUC = 0.63). Finally, AQ did not correlate with clinician-rated ADOS-2 scores in the ASD sample. Our study confirms that symptoms are partially overlapping in adults with ASD and psychosis. Moreover, they raise concerns regarding the usefulness of AQ as a screening tool in clinical populations.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Eugenio Aguglia
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy; (L.F.-P.); (A.C.); (A.G.); (V.M.); (F.P.); (A.R.); (G.S.); (L.V.); (A.P.); (M.S.S.)
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Küpper C, Stroth S, Wolff N, Hauck F, Kliewer N, Schad-Hansjosten T, Kamp-Becker I, Poustka L, Roessner V, Schultebraucks K, Roepke S. Identifying predictive features of autism spectrum disorders in a clinical sample of adolescents and adults using machine learning. Sci Rep 2020; 10:4805. [PMID: 32188882 PMCID: PMC7080741 DOI: 10.1038/s41598-020-61607-w] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 02/27/2020] [Indexed: 12/27/2022] Open
Abstract
Diagnosing autism spectrum disorders (ASD) is a complicated, time-consuming process which is particularly challenging in older individuals. One of the most widely used behavioral diagnostic tools is the Autism Diagnostic Observation Schedule (ADOS). Previous work using machine learning techniques suggested that ASD detection in children can be achieved with substantially fewer items than the original ADOS. Here, we expand on this work with a specific focus on adolescents and adults as assessed with the ADOS Module 4. We used a machine learning algorithm (support vector machine) to examine whether ASD detection can be improved by identifying a subset of behavioral features from the ADOS Module 4 in a routine clinical sample of N = 673 high-functioning adolescents and adults with ASD (n = 385) and individuals with suspected ASD but other best-estimate or no psychiatric diagnoses (n = 288). We identified reduced subsets of 5 behavioral features for the whole sample as well as age subgroups (adolescents vs. adults) that showed good specificity and sensitivity and reached performance close to that of the existing ADOS algorithm and the full ADOS, with no significant differences in overall performance. These results may help to improve the complicated diagnostic process of ASD by encouraging future efforts to develop novel diagnostic instruments for ASD detection based on the identified constructs as well as aiding clinicians in the difficult question of differential diagnosis.
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Affiliation(s)
- Charlotte Küpper
- Department of Psychiatry, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany.
| | - Sanna Stroth
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Philipps University, Marburg, Germany
| | - Nicole Wolff
- Department of Child and Adolescent Psychiatry, TU Dresden, Dresden, Germany
| | - Florian Hauck
- Department of Information Systems, Freie Universität Berlin, Berlin, Germany
| | - Natalia Kliewer
- Department of Information Systems, Freie Universität Berlin, Berlin, Germany
| | - Tanja Schad-Hansjosten
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/University of Heidelberg, Mannheim, Germany
| | - Inge Kamp-Becker
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Philipps University, Marburg, Germany
| | - Luise Poustka
- Department of Child and Adolescent Psychiatry, University Medical Center, Göttingen, Germany
| | - Veit Roessner
- Department of Child and Adolescent Psychiatry, TU Dresden, Dresden, Germany
| | - Katharina Schultebraucks
- Department of Psychiatry, New York University School of Medicine, New York, USA.,Vagelos School of Physicians and Surgeons, Department of Emergency Medicine, Columbia University Irving Medical Center, New York, USA
| | - Stefan Roepke
- Department of Psychiatry, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany.
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40
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Social behavioural adaptation in Autism. PLoS Comput Biol 2020; 16:e1007700. [PMID: 32176684 PMCID: PMC7108744 DOI: 10.1371/journal.pcbi.1007700] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 03/31/2020] [Accepted: 01/30/2020] [Indexed: 12/30/2022] Open
Abstract
Autism is still diagnosed on the basis of subjective assessments of elusive notions such as interpersonal contact and social reciprocity. We propose to decompose reciprocal social interactions in their basic computational constituents. Specifically, we test the assumption that autistic individuals disregard information regarding the stakes of social interactions when adapting to others. We compared 24 adult autistic participants to 24 neurotypical (NT) participants engaging in a repeated dyadic competitive game against artificial agents with calibrated reciprocal adaptation capabilities. Critically, participants were framed to believe either that they were competing against somebody else or that they were playing a gambling game. Only the NT participants did alter their adaptation strategy when they held information regarding others' competitive incentives, in which case they outperformed the AS group. Computational analyses of trial-by-trial choice sequences show that the behavioural repertoire of autistic people exhibits subnormal flexibility and mentalizing sophistication, especially when information regarding opponents’ incentives was available. These two computational phenotypes yield 79% diagnosis classification accuracy and explain 62% of the severity of social symptoms in autistic participants. Such computational decomposition of the autistic social phenotype may prove relevant for drawing novel diagnostic boundaries and guiding individualized clinical interventions in autism. Autism or AS is mostly characterized by impairments in a very specific yet intricate skill set, namely: social intelligence. In this work, we focus on "social reciprocity", i.e. the continuous adaptation of one's behaviour that both moulds and appropriately responds to others' behaviour. Our working hypothesis is that social reciprocity deficits in people with AS derive from a basic inability to tune one's adaptation strategy to contextual knowledge about the stakes of social interactions (e.g., others' cooperative or competitive incentives). We ask participants to engage in simple interactive games with AI agents that are endowed with calibrated reciprocal adaptation capabilities. Critically, participants are framed to believe either that they are competing against somebody else (social framing) or that they are playing a gambling game (non-social framing). Only in the social condition do participants know about the (competitive) incentives of their opponents. Computational analyses of action sequences in the games show that, contrary to healthy controls, people with AS do not change their strategy according to whether they hold information regarding their opponents' incentives or not. In addition, these analyses yield 79% diagnosis out-of-sample classification accuracy (AS versus controls) and predict 62% of the severity of social symptoms in people with AS. This demonstrates the feasibility of AI-based quantitative assessments of social cognition and its deficits.
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41
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The Influence of Premorbid Adjustment and Autistic Traits on Social Cognitive Dysfunction in Schizophrenia. J Int Neuropsychol Soc 2020; 26:276-285. [PMID: 31507263 DOI: 10.1017/s1355617719000961] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Premorbid dysfunction during childhood and adolescence is well documented in patients with schizophrenia. Literature pointed out multiple premorbid trajectories leading to different patients' cognitive status, symptomatology, and global functioning after disease onset. This study aimed at identifying groups of premorbid trajectories and disentangling between group differences in clinical and cognitive measures, focusing on theory of mind (ToM) and autistic traits (ATs). METHODS Ninety-seven patients with schizophrenia were recruited and assessed for cognitive and ToM abilities, psychopathology, and ATs. A two-step cluster analysis identified three different groups of patients based on premorbid adjustment during childhood, adolescence, and late adolescence (i.e., stable-good, stable-poor, and "deteriorating"). RESULTS Compared to 66 healthy controls, results showed a widespread impairment in cognitive and ToM abilities among all groups of patients, except for affective ToM and executive functions in the stable-good group. Moreover, the stable-poor group exhibited more pronounced ATs and a more severe ToM impairment, compared to the other two groups of patients. CONCLUSIONS Our findings highlight the existence of a group of patients with poor premorbid adjustment since childhood, more pronounced ATs and a severe ToM impairment affecting those basic mentalizing skills that are usually preserved in schizophrenia. Results might have intriguing implications in identifying underpinning endophenotypes and implementing cutting-edge rehabilitation programs.
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42
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Drimalla H, Scheffer T, Landwehr N, Baskow I, Roepke S, Behnia B, Dziobek I. Towards the automatic detection of social biomarkers in autism spectrum disorder: introducing the simulated interaction task (SIT). NPJ Digit Med 2020; 3:25. [PMID: 32140568 PMCID: PMC7048784 DOI: 10.1038/s41746-020-0227-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 01/17/2020] [Indexed: 12/28/2022] Open
Abstract
Social interaction deficits are evident in many psychiatric conditions and specifically in autism spectrum disorder (ASD), but hard to assess objectively. We present a digital tool to automatically quantify biomarkers of social interaction deficits: the simulated interaction task (SIT), which entails a standardized 7-min simulated dialog via video and the automated analysis of facial expressions, gaze behavior, and voice characteristics. In a study with 37 adults with ASD without intellectual disability and 43 healthy controls, we show the potential of the tool as a diagnostic instrument and for better description of ASD-associated social phenotypes. Using machine-learning tools, we detected individuals with ASD with an accuracy of 73%, sensitivity of 67%, and specificity of 79%, based on their facial expressions and vocal characteristics alone. Especially reduced social smiling and facial mimicry as well as a higher voice fundamental frequency and harmony-to-noise-ratio were characteristic for individuals with ASD. The time-effective and cost-effective computer-based analysis outperformed a majority vote and performed equal to clinical expert ratings.
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Affiliation(s)
- Hanna Drimalla
- Department of Psychology, Humboldt-Universität zu Berlin, Unter den Linden 6, 10099 Berlin, Germany
- Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Unter den Linden 6, 10099 Berlin, Germany
- Digital Health Center, Hasso Plattner Institute, University of Potsdam, Prof.-Dr.-Helmert-Str. 2-3, 14482 Potsdam, Germany
| | - Tobias Scheffer
- Institute of Computer Science, University of Potsdam, Am Neuen Palais 10, 14469 Potsdam, Germany
| | - Niels Landwehr
- Institute of Computer Science, University of Potsdam, Am Neuen Palais 10, 14469 Potsdam, Germany
- Leibniz Institute for Agricultural Engineering and Bioeconomy, Max-Eyth-Allee 100, 14469 Potsdam, Germany
| | - Irina Baskow
- Department of Psychology, Humboldt-Universität zu Berlin, Unter den Linden 6, 10099 Berlin, Germany
- Department of Psychiatry, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Stefan Roepke
- Department of Psychiatry, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Behnoush Behnia
- Department of Psychiatry, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Isabel Dziobek
- Department of Psychology, Humboldt-Universität zu Berlin, Unter den Linden 6, 10099 Berlin, Germany
- Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Unter den Linden 6, 10099 Berlin, Germany
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43
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Boterberg S, Van Coster R, Roeyers H. Characteristics, Early Development and Outcome of Parent-Reported Regression in Autism Spectrum Disorder. J Autism Dev Disord 2020; 49:4603-4625. [PMID: 31463633 DOI: 10.1007/s10803-019-04183-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
This study explored regression patterns in 100 children with ASD (3-11 years) using several approaches to enhance the validity of retrospective parent report. Both early development and outcome were examined in regression groups defined by 36 months age cut-off and two underlying empirical patterns based on type and onset age. Results over regression groups were generally consistent. During early development, children with regression showed a similar amount of social atypicalities and stereotyped behaviour as compared to children without regression. However, parents indicated less communication skills which could be a valuable predictor of regression. Development after regression was characterised by early language delay and more restricted and repetitive behaviour. The findings provide insight into the diagnosis and prognosis of regression in ASD.
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Affiliation(s)
- Sofie Boterberg
- Department of Experimental Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Henri Dunantlaan 2, 9000, Ghent, Belgium.
| | - Rudy Van Coster
- Department of Paediatric Neurology and Metabolism, Faculty of Medicine and Health Sciences, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium
| | - Herbert Roeyers
- Department of Paediatric Neurology and Metabolism, Faculty of Medicine and Health Sciences, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium
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44
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Trevisan DA, Foss-Feig JH, Naples AJ, Srihari V, Anticevic A, McPartland JC. Autism Spectrum Disorder and Schizophrenia Are Better Differentiated by Positive Symptoms Than Negative Symptoms. Front Psychiatry 2020; 11:548. [PMID: 32595540 PMCID: PMC7301837 DOI: 10.3389/fpsyt.2020.00548] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 05/28/2020] [Indexed: 01/01/2023] Open
Abstract
Autism spectrum disorder (ASD) and schizophrenia (SZ) are heterogenous neurodevelopmental disorders that overlap in symptom presentation. The purpose of this study was to specify overlapping symptom domains and to identify symptoms that can reliably differentiate adults with ASD (n = 53), SZ (n = 39), and typical development (TD; n = 40). All participants regardless of diagnosis were administered gold-standard diagnostic assessments of ASD and SZ characteristics including the Autism Diagnostic Observation Schedule (ADOS-2) and the Positive and Negative Syndrome Scale (PANSS). Sensitivity and specificity of the ADOS were assessed using diagnostic cut-off scores. The degree of symptom overlap on these measures between participant groups was analyzed using Analyses of Variance (ANOVAs), Receiver Operating Characteristic (ROC) Curves, and Analyses of Covariance (ANCOVAs) to control for group differences in IQ and sex distributions. The ADOS reliably discriminated ASD and TD adults, but there was a high rate of "false positives" in SZ patients who did not meet the DSM-5 criteria for ASD. To identify the reasons for low specificity in the SZ sample, we categorized ASD and SZ symptoms into 'positive' (presence of atypical behaviors) and 'negative' (absence of typical behaviors) symptoms. ASD and SZ groups overlapped on negative symptoms largely related to the absence of typical social and communicative behaviors, whereas disorder-specific positive symptoms differentiated ASD and SZ. For example, those with ASD scored higher on restricted and repetitive behaviors and stereotyped language, whereas those with SZ scored higher on psychotic symptoms such as delusions and hallucinations. These results suggest that, when making a differential diagnosis between ASD and SZ, clinicians may benefit from focusing on the presence or absence of positive ASD and SZ symptoms. Standardized measures to classify ASD symptoms into positive and negative symptoms have not yet been developed but represent a potentially viable clinical tool.
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Affiliation(s)
- Dominic A Trevisan
- Child Study Center, Yale University School of Medicine, New Haven, CT, United States
| | - Jennifer H Foss-Feig
- Department of Psychiatry, Mount Sinai Icahn School of Medicine, New York, NY, United States.,Seaver Autism Center for Research and Treatment Mount Sinai Icahn School of Medicine, New York, NY, United States
| | - Adam J Naples
- Child Study Center, Yale University School of Medicine, New Haven, CT, United States
| | - Vinod Srihari
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Alan Anticevic
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - James C McPartland
- Child Study Center, Yale University School of Medicine, New Haven, CT, United States
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Bergmann T, Heinrich M, Ziegler M, Dziobek I, Diefenbacher A, Sappok T. Developing a Diagnostic Algorithm for the Music-Based Scale for Autism Diagnostics (MUSAD) Assessing Adults with Intellectual Disability. J Autism Dev Disord 2019; 49:3732-3752. [PMID: 31161304 DOI: 10.1007/s10803-019-04069-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Initial studies have presented the Music-based Scale for Autism Diagnostics (MUSAD) as a promising DSM-5-based observational tool to identify autism spectrum disorder (ASD) in adults with intellectual disability (ID). The current study is the first to address its clinical utility in a new sample of 124 adults with ID (60.5% diagnosed with ASD). The derived diagnostic algorithm differentiated well between individuals with and without ASD (sensitivity 79%, specificity 74%, area under the curve = 0.81). Inter-rater reliability, assessed by the scorings of four independent experts in 22 consensus cases, was excellent (ICC = 0.92). Substantial correlations with scores from other ASD-specific measures indicated convergent validity. The MUSAD yields accurate and reliable scores, supporting comprehensive ASD diagnostics in adults with ID.
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Affiliation(s)
- Thomas Bergmann
- Evangelisches Krankenhaus Königin Elisabeth Herzberge, Herzbergstrasse 79, 10365, Berlin, Germany.
| | - Manuel Heinrich
- Division of Clinical-Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Schwendenerstrasse 27, 14195, Berlin, Germany
| | - Matthias Ziegler
- Faculty of Life Sciences/Department of Psychology, Humboldt-Universität zu Berlin, Unter den Linden 6, 10099, Berlin, Germany
| | - Isabel Dziobek
- Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Unter den Linden 6, 10099, Berlin, Germany
| | - Albert Diefenbacher
- Evangelisches Krankenhaus Königin Elisabeth Herzberge, Herzbergstrasse 79, 10365, Berlin, Germany
| | - Tanja Sappok
- Evangelisches Krankenhaus Königin Elisabeth Herzberge, Herzbergstrasse 79, 10365, Berlin, Germany
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46
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Bechi M, Agostoni G, Buonocore M, Gritti D, Mascia M, Spangaro M, Bianchi L, Cocchi F, Guglielmino C, Bosia M, Cavallaro R. The association of autistic traits with Theory of Mind and its training efficacy in patients with schizophrenia. SCHIZOPHRENIA RESEARCH-COGNITION 2019; 19:100164. [PMID: 31832344 PMCID: PMC6890977 DOI: 10.1016/j.scog.2019.100164] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 09/23/2019] [Accepted: 09/24/2019] [Indexed: 12/27/2022]
Abstract
Literature has recently identified a discrete subgroup of patients affected by schizophrenia that also present autistic traits (ATs), showing a peculiar cognitive, clinical and functional profile. Theory of Mind (ToM) represents a core, impaired feature in both schizophrenia and Autism Spectrum Disorder (ASD), ToM in patients with schizophrenia and ATs has yet to be investigated. Thus, this study aims, on the one hand, to assess differences among patients with and without ATs on clinical, cognitive and ToM abilities as well as in daily functioning; on the other hand, to compare the efficacy on mentalizing abilities of a specific ToM training in these two groups. Ninety-six patients with schizophrenia were enrolled and underwent a broad cognitive, social-cognitive and functional assessment before and after the ToM training. ANOVAs revealed that patients with schizophrenia and ATs are more impaired in cognition, ToM, in premorbid and daily functioning as well as in clinical features, as compared to patients without ATs. This latter group also showed a general improvement in mentalizing abilities after ToM training, while patients with schizophrenia and ATs did not, with a significant time × group interaction on ToM abilities. These data shed new light on the relation among schizophrenia and ATs, highlighting that patients with these traits are highly impaired in ToM abilities. Thus, ATs seem to limit the effectiveness of ToM training, having implications in clinical and rehabilitative practice.
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Affiliation(s)
- Margherita Bechi
- Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giulia Agostoni
- Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Mariachiara Buonocore
- Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Davide Gritti
- School of Psychology, Vita-Salute San Raffaele University, Milan, Italy
| | - Mattia Mascia
- School of Psychology, Vita-Salute San Raffaele University, Milan, Italy
| | - Marco Spangaro
- Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Laura Bianchi
- Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Federica Cocchi
- Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Carmelo Guglielmino
- Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marta Bosia
- Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Roberto Cavallaro
- Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
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[ADI-R and ADOS and the differential diagnosis of autism spectrum disorders: Interests, limits and openings]. Encephale 2019; 45:441-448. [PMID: 31495549 DOI: 10.1016/j.encep.2019.07.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 06/25/2019] [Accepted: 07/18/2019] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Current developments in international public health are leading qualified authorities to release clinical practice guidelines for Autism Spectrum Disorders (ASD) assessment and diagnosis. Such documents incorporate procedures that rely on the Autism Diagnostic Interview-Revised (ADI-R) and the Autism Diagnostic Observation Schedule (ADOS) which are considered to be the "gold standard" assessment measures in the evaluation of ASD. Although these tools do prove their effectiveness in the evaluation of autistic symptomatology, they nevertheless stumble whenever the situation becomes more complex and reveal differential diagnostic issues in infantile and adult autism cases. This differential diagnostic issue remains significant in the clinical practice of daily life and has strong implications for the course of therapeutic treatment. OBJECTIVES Our objective is to underline and nuance the metrological qualities of the ADI-R and the ADOS in the differential diagnosis of autistic disorders by presenting a synthesis of recent studies, thus supporting the interest of maintaining an open debate on diagnostic practices. METHODS Our selective review of the recent literature focuses on studies that confront the ADI-R and the ADOS - used either independently or in a combination - with various differential issues in adulthood and childhood autism in order to highlight their qualities and limits. RESULTS The ADI-R is a semi-structured interview applied by trained examiners and applied to relatives and/or caregivers who collect developmental information about the patient's first years of life on a variety of behaviors and skills. It is therefore relatively dependent on the availability and personal bias of the interviewed third parties. Metric features highlighted by the reviewed studies straightforwardly reveal a certain effectiveness of the tool and a good discrimination of childhood disorders. At the same time, the tool's discriminatory capacity seems insufficient when applied to toddlers, very young children, and adults alike. The latter seems particularly true when it comes to differentiating between autistic and schizophrenic spectrum disorders. The ADOS is a semi-structured standardized observation assessment tool that has experienced several successive developments, such as optimizations concerning the sensitivity of its cutoffs. Many works have contributed to building such a tool with reliable and solid metric qualities which nevertheless retain important biases such as the subjectivity of the caregiver or the evaluator during the scoring process. For assessments of autistic children the tool still has a good diagnostic validity but seems to retain cases of incorrect diagnosis of ASD (false positives). In other words, disorders or developmental disabilities of some children and adolescents could not be distinguished from ASD when relying on this test alone. The ADOS Module 4, designed for the diagnosis of adolescents and adults with fluent speech, has undergone less updating. This revisited algorithm has metrological qualities useful for clinicians and remains one of the few available tools for this population. Unfortunately, its diagnostic accuracy is lower when applied to women, the elderly, people with personality disorders or higher intellectual abilities, or for the discrimination between ASD and schizophrenia. Overall, scores from these two instruments bring strong evidence of their usefulness in the diagnostic process of ASD, provided that they are used with caution and a critical clinical perspective, and only as a secondary technical support. Their use in combination is effective since they are complementary and compensate for each other's limitations. However, their globalized hegemony as "gold-standard" tools constitutes a setback insofar as it constrains the diagnosis of ASD to a set of stereotyped items. The latter in turn sets a normative model of autism that excludes other phenotypic forms, especially in the case of women and the elderly. Finally, the discrimination between autism and psychosis for children seems to remain an insoluble task even for the ADI-R/ADOS combination. CONCLUSIONS The problematics of differential diagnosis remain critical for clinical approaches to autism. Therefore, formalizations of the diagnostic procedures must be able to remain open-minded and accompanied by a creative clinical approach, especially in the case of complex situations that are not soluble by means of conventional diagnostic tools. One possibility may lie in the deepening of the phenomenological approach to autism as an attempt to model the subjective phenomena of autistic subjects and thus operationalize elements that serve the diagnostic process. In the same way, a psychodynamic epistemology could help clinicians to go beyond the consideration of observable behaviors and scores, introducing a psychoanalytic point of view that interfaces objective behaviors with the individual's dynamic intrapsychic functioning. This project could be articulated with projective methodologies - notably the Rorschach test - which respects the needs for standardization and quantification of conventionally used diagnostic tools.
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Rabany L, Brocke S, Calhoun VD, Pittman B, Corbera S, Wexler BE, Bell MD, Pelphrey K, Pearlson GD, Assaf M. Dynamic functional connectivity in schizophrenia and autism spectrum disorder: Convergence, divergence and classification. Neuroimage Clin 2019; 24:101966. [PMID: 31401405 PMCID: PMC6700449 DOI: 10.1016/j.nicl.2019.101966] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 05/15/2019] [Accepted: 07/31/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND Over the recent years there has been a growing debate regarding the extent and nature of the overlap in neuropathology between schizophrenia (SZ) and autism spectrum disorder (ASD). Dynamic functional network connectivity (dFNC) is a recent analysis method that explores temporal patterns of functional connectivity (FC). We compared resting-state dFNC in SZ, ASD and healthy controls (HC), characterized the associations between temporal patterns and symptoms, and performed a three-way classification analysis based on dFNC indices. METHODS Resting-state fMRI was collected from 100 young adults: 33 SZ, 33 ASD, 34 HC. Independent component analysis (ICA) was performed, followed by dFNC analysis (window = 33 s, step = 1TR, k-means clustering). Temporal patterns were compared between groups, correlated with symptoms, and classified via cross-validated three-way discriminant analysis. RESULTS Both clinical groups displayed an increased fraction of time (FT) spent in a state of weak, intra-network connectivity [p < .001] and decreased FT in a highly-connected state [p < .001]. SZ further showed decreased number of transitions between states [p < .001], decreased FT in a widely-connected state [p < .001], increased dwell time (DT) in the weakly-connected state [p < .001], and decreased DT in the highly-connected state [p = .001]. Social behavior scores correlated with DT in the widely-connected state in SZ [r = 0.416, p = .043], but not ASD. Classification correctly identified SZ at high rates (81.8%), while ASD and HC at lower rates. CONCLUSIONS Results indicate a severe and pervasive pattern of temporal aberrations in SZ (specifically, being "stuck" in a state of weak connectivity), that distinguishes SZ participants from both ASD and HC, and is associated with clinical symptoms.
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Affiliation(s)
- Liron Rabany
- Olin Neuropsychiatry Research Center, Institute of Living, Hartford, CT, USA.
| | - Sophy Brocke
- Olin Neuropsychiatry Research Center, Institute of Living, Hartford, CT, USA
| | - Vince D Calhoun
- Mind Research Network, Albuquerque, NM, USA; University of New Mexico, Department of ECE, Albuquerque, NM, USA; Yale University, School of Medicine, Department of Psychiatry, New Haven, CT, USA
| | - Brian Pittman
- Yale University, School of Medicine, Department of Psychiatry, New Haven, CT, USA
| | - Silvia Corbera
- Olin Neuropsychiatry Research Center, Institute of Living, Hartford, CT, USA; Central Connecticut State University, Department of Psychological Science, New Britain, CT, USA
| | - Bruce E Wexler
- Yale University, School of Medicine, Department of Psychiatry, New Haven, CT, USA
| | - Morris D Bell
- Yale University, School of Medicine, Department of Psychiatry, New Haven, CT, USA; VA Connecticut Healthcare System West Haven, CT, USA
| | - Kevin Pelphrey
- Autism and Neurodevelopment Disorders Institute, George Washington University and Children's National Medical Center, DC, USA
| | - Godfrey D Pearlson
- Olin Neuropsychiatry Research Center, Institute of Living, Hartford, CT, USA; Yale University, School of Medicine, Department of Psychiatry, New Haven, CT, USA; Yale University School of Medicine, Department of Neuroscience, New Haven, CT, USA
| | - Michal Assaf
- Olin Neuropsychiatry Research Center, Institute of Living, Hartford, CT, USA; Yale University, School of Medicine, Department of Psychiatry, New Haven, CT, USA
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Walsh MJM, Baxter LC, Smith CJ, Braden BB. Age Group Differences in Executive Network Functional Connectivity and Relationships with Social Behavior in Men with Autism Spectrum Disorder. RESEARCH IN AUTISM SPECTRUM DISORDERS 2019; 63:63-77. [PMID: 32405319 PMCID: PMC7220036 DOI: 10.1016/j.rasd.2019.02.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
BACKGROUND Research suggests adults with autism spectrum disorder (ASD) may use executive functions to compensate for social difficulties. Given hallmark age-related declines in executive functioning and the executive brain network in normal aging, there is concern that older adults with ASD may experience further declines in social functioning as they age. In a male-only sample, we hypothesized: 1) older adults with ASD would demonstrate greater ASD-related social behavior than young adults with ASD, 2) adults with ASD would demonstrate a greater age group reduction in connectivity of the executive brain network than neurotypical (NT) adults, and 3) that behavioral and neural mechanisms of executive functioning would predict ASD-related social difficulties in adults with ASD. METHODS Participants were a cross-sectional sample of non-intellectually disabled young (ages 18-25) and middle-aged (ages 40-70) adult men with ASD and NT development (young adult ASD: n=24; middle-age ASD: n=25; young adult NT: n=15; middle-age NT: n=21). We assessed ASD-related social behavior via the self-report Social Responsiveness Scale-2 (SRS-2) Total Score, with exploratory analyses of the Social Cognition Subscale. We assessed neural executive function via connectivity of the resting-state executive network (EN) as measured by independent component analysis. Correlations were investigated between SRS-2 Total Scores (with exploratory analyses of the Social Cognition Subscale), EN functional connectivity of the dorsolateral prefrontal cortex (dlPFC), and a behavioral measure of executive function, Tower of London (ToL) Total Moves. RESULTS We did not confirm a significant age group difference for adults with ASD on the SRS-2 Total Score; however, exploratory analysis revealed middle-age men with ASD had higher scores on the SRS-2 Social Cognition Subscale than young adult men with ASD. Exacerbated age group reductions in EN functional connectivity were confirmed (left dlPFC) in men with ASD compared to NT, such that older adults with ASD demonstrated the greatest levels of hypoconnectivity. A significant correlation was confirmed between dlPFC connectivity and the SRS-2 Total Score in middle-age men with ASD, but not young adult men with ASD. Furthermore, exploratory analysis revealed a significant correlation with the SRS-2 Social Cognition Subscale for young and middle-aged ASD groups and ToL Total Moves. CONCLUSIONS Our findings suggest that ASD-related difficulties in social cognition and EN hypoconnectivity may get worse with age in men with ASD and is related to executive functioning. Further, exacerbated EN hypoconnectivity associated with older age in ASD may be a mechanism of increased ASD-related social cognition difficulties in older adults with ASD. Given the cross-sectional nature of this sample, longitudinal replication is needed.
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Affiliation(s)
- Melissa J. M. Walsh
- Department of Speech and Hearing Science, Arizona State University, 976 S Forest Mall, Tempe, AZ 85281
| | - Leslie C. Baxter
- Department of Neuroimaging Research, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, 350 W Thomas Rd, Phoenix, AZ 85013
| | - Christopher J. Smith
- Southwest Autism Research & Resource Center, 2225 N 16th Street, Phoenix, AZ 85006
| | - B. Blair Braden
- Department of Speech and Hearing Science, Arizona State University, 976 S Forest Mall, Tempe, AZ 85281
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Theory of Mind (ToM) Performance in High Functioning Autism (HFA) and Schizotypal–Schizoid Personality Disorders (SSPD) Patients. J Autism Dev Disord 2019; 49:3376-3386. [DOI: 10.1007/s10803-019-04058-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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