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Croom K, Rumschlag JA, Molinaro G, Erickson MA, Binder DK, Huber KM, Razak KA. Developmental trajectory and sex differences in auditory processing in a PTEN-deletion model of autism spectrum disorders. Neurobiol Dis 2024; 200:106628. [PMID: 39111703 DOI: 10.1016/j.nbd.2024.106628] [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: 04/01/2024] [Revised: 07/31/2024] [Accepted: 08/02/2024] [Indexed: 08/16/2024] Open
Abstract
Autism Spectrum Disorders (ASD) encompass a wide array of debilitating symptoms, including severe sensory deficits and abnormal language development. Sensory deficits early in development may lead to broader symptomatology in adolescents and adults. The mechanistic links between ASD risk genes, sensory processing and language impairment are unclear. There is also a sex bias in ASD diagnosis and symptomatology. The current study aims to identify the developmental trajectory and genotype- and sex-dependent differences in auditory sensitivity and temporal processing in a Pten-deletion (phosphatase and tensin homolog missing on chromosome 10) mouse model of ASD. Auditory temporal processing is crucial for speech recognition and language development and deficits will cause language impairments. However, very little is known about the development of temporal processing in ASD animal models, and if there are sex differences. To address this major gap, we recorded epidural electroencephalography (EEG) signals from the frontal (FC) and auditory (AC) cortex in developing and adult Nse-cre PTEN mice, in which Pten is deleted in specific cortical layers (layers III-V) (PTEN conditional knock-out (cKO). We quantified resting EEG spectral power distribution, auditory event related potentials (ERP) and temporal processing from awake and freely moving male and female mice. Temporal processing is measured using a gap-in-noise-ASSR (auditory steady state response) stimulus paradigm. The experimental manipulation of gap duration and modulation depth allows us to measure cortical entrainment to rapid gaps in sounds. Temporal processing was quantified using inter-trial phase clustering (ITPC) values that account for phase consistency across trials. The results show genotype differences in resting power distribution in PTEN cKO mice throughout development. Male and female cKO mice have significantly increased beta power but decreased high frequency oscillations in the AC and FC. Both male and female PTEN cKO mice show diminished ITPC in their gap-ASSR responses in the AC and FC compared to control mice. Overall, deficits become more prominent in adult (p60) mice, with cKO mice having significantly increased sound evoked power and decreased ITPC compared to controls. While both male and female cKO mice demonstrated severe temporal processing deficits across development, female cKO mice showed increased hypersensitivity compared to males, reflected as increased N1 and P2 amplitudes. These data identify a number of novel sensory processing deficits in a PTEN-ASD mouse model that are present from an early age. Abnormal temporal processing and hypersensitive responses may contribute to abnormal development of language function in ASD.
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Affiliation(s)
- Katilynne Croom
- Graduate Neuroscience Program, University of California, Riverside, United States of America
| | - Jeffrey A Rumschlag
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, United States of America
| | - Gemma Molinaro
- Department of Neuroscience, O'Donnell Brain Institute, UT Southwestern Medical Center, Dallas, TX, United States of America
| | - Michael A Erickson
- Psychology Department, University of California, Riverside, United States of America
| | - Devin K Binder
- Graduate Neuroscience Program, University of California, Riverside, United States of America; Biomedical Sciences, School of Medicine, University of California, Riverside, United States of America
| | - Kimberly M Huber
- Department of Neuroscience, O'Donnell Brain Institute, UT Southwestern Medical Center, Dallas, TX, United States of America
| | - Khaleel A Razak
- Graduate Neuroscience Program, University of California, Riverside, United States of America; Psychology Department, University of California, Riverside, United States of America.
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Yeung TS, Greene RK, Dick CC, Duvall SW. Females evaluated for autism: characteristics and co-occurring and differential DSM-5 diagnoses. Clin Neuropsychol 2024; 38:1481-1500. [PMID: 38037328 DOI: 10.1080/13854046.2023.2281709] [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: 06/27/2023] [Accepted: 11/03/2023] [Indexed: 12/02/2023]
Abstract
Objective: While sex differences in autism spectrum disorder (ASD) have been identified in areas such as neurocognitive functioning, behavior patterns, and diagnostic criteria, less work has focused on differences within females referred for ASD evaluation, including those who did not go on to receive a diagnosis. This study examined psychological and behavioral characteristics and co-occurring and differential DSM-5 diagnoses between pediatric female participants who received an ASD diagnosis (ASD+) and those who did not (ASD-). Method: Data on cognitive functioning, adaptive functioning, internalizing symptoms, externalizing symptoms, and ADOS-2 scores were analyzed among 137 3- to 20-year-old patients. The sample was divided into two age groups (ages 3-8 and ages 9-20) for analyses of between-group differences (ASD+ vs. ASD-) and predictors of group membership. Results: Females in the ASD+ group were significantly younger, had lower cognitive scores, lower internalizing and externalizing symptoms, and had higher Autism Diagnostic Observation Schedule-2 (ADOS-2) scores than those in the ASD- group. ADOS-2 scores were also the only significant predictor of ASD group membership across age groups. The ASD+ group had a higher percentage of intellectual disability while the ASD- group had higher percentages of anxiety disorder, attention-deficit/hyperactivity disorder, and disruptive behavior disorders. Conclusions: Psychological and behavioral presentations among females referred for ASD evaluation varied with age and ASD diagnostic groups. These results highlight potential female differences in ASD referrals and identification of ASD and the need to improve care for females in consideration of demographic factors.
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Affiliation(s)
- Tat Shing Yeung
- Division of Pediatric Psychology, Department of Pediatrics, Institute on Development and Disability, Oregon Health & Science University and Doernbecher Children's Hospital, Portland, OR, USA
| | - 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
| | - Catherine C Dick
- Division of Pediatric Psychology, Department of Pediatrics, Institute on Development and Disability, Oregon Health & Science University and Doernbecher Children's Hospital, Portland, 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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Uglik-Marucha N, Mason D, Belcher H, Happé F, Vitoratou S. Protocol for a systematic review evaluating psychometric properties and gender-related measurement (non)invariance of self-report assessment tools for autism in adults. Syst Rev 2024; 13:188. [PMID: 39030636 PMCID: PMC11264752 DOI: 10.1186/s13643-024-02604-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 07/07/2024] [Indexed: 07/21/2024] Open
Abstract
BACKGROUND Given the recent evidence on gender differences in the presentation of autism, there is an increasing concern that current tools for autism do not adequately capture traits more often found in women. If tools for autism measure autistic traits differently based on gender alone, their validity may be compromised as they may not be measuring the same construct across genders. Measurement invariance investigations of autism measures can help assess the validity of autism constructs for different genders. The aim of this systematic review is to identify and critically appraise the psychometric properties of all self-report tools for autism in adults that meet two criteria: (a) they have been published since or included in the NICE (2014) recommendations, and (b) they have undergone gender-related measurement invariance investigations as part of their validation process. METHODS A search of electronic databases will be conducted from 2014 until the present using MEDLINE, Embase, and PsycINFO using predefined search terms to identify eligible studies. The search for grey literature will include sources such as OpenGrey, APA PsycEXTRA, and Scopus. Two reviewers will independently screen titles, abstracts, and full texts for eligibility. The references of included studies will be searched for additional records. The methodological quality of the studies will be evaluated using the COSMIN Risk of Bias checklist, while psychometric quality of findings will be assessed based on criteria for good measurement properties and ConPsy checklist. The quality of the total body of evidence will be appraised using the approach outlined in the modified GRADE guidelines. DISCUSSION This systematic review will be among the first to assess the psychometric properties and gender-related measurement invariance of self-reported measures for autism in adults that were published since (or included in) NICE (2014) guidelines. The review will provide recommendations for the most suitable tool to assess for autism without gender bias. If no such measure is found, it will identify existing tools with promising psychometric properties that require further testing, or suggest developing a new measure. SYSTEMATIC REVIEW REGISTRATION The protocol has been registered at the International Prospective Register of Systematic Reviews (PROSPERO). The registration number is CRD42023429350.
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Affiliation(s)
- Nora Uglik-Marucha
- Psychometrics and Measurement Lab, Biostatistics and Health Informatics Department, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, SE5 8AF, UK.
| | - David Mason
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, SE5 8AF, UK
| | - Hannah Belcher
- Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, SE5 8AF, UK
| | - Francesca Happé
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, SE5 8AF, UK
| | - Silia Vitoratou
- Psychometrics and Measurement Lab, Biostatistics and Health Informatics Department, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, SE5 8AF, UK
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Arutiunian V, Santhosh M, Neuhaus E, Sullivan CAW, Bernier RA, Bookheimer SY, Dapretto M, Geschwind DH, Jack A, McPartland JC, Van Horn JD, Pelphrey KA, Gupta AR, Webb SJ. A common genetic variant in the Neurexin family member CNTNAP2 is related to language but not communication skills in youth with Autism Spectrum Disorder. Autism Res 2024. [PMID: 38984666 DOI: 10.1002/aur.3193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 06/23/2024] [Indexed: 07/11/2024]
Abstract
One of the candidate genes related to language variability in individuals with Autism Spectrum Disorder (ASD) is the contactin-associated protein-like 2 gene (CNTNAP2), a member of the Neurexin family. However, due to the different assessment tools used, it is unknown whether the polymorphisms of the CNTNAP2 gene are linked to structural language skills or more general communication abilities. A total of 302 youth aged 7 to 18 years participated in the present study: 131 verbal youth with ASD (62 female), 130 typically developing (TD) youth (64 female), and 41 unaffected siblings (US) of youth with ASD (25 female). Blood samples were collected to obtain genomic DNA and processed by the Rutgers University Cell and Data Repository or using standard protocols (Gentra Puregene Blood DNA extraction kit; Qiagen). Language and verbal communication skills were screened with the Clinical Evaluation of Language Fundamental-4 (CELF-4) and Vineland-II Communication domain, subsequently. The results showed that the polymorphism of CNTNAP2 (SNP rs2710102) was related to structural language abilities, such that participants carrying the A-allele had lower language skills in comparison to the G-allele homozygotes. No relationship was found between the polymorphism of CNTNAP2 and more general communication abilities. Although the study revealed genetic mechanisms that are associated with CELF-4 measures but not Vineland-II in youth with ASD, follow-up studies are needed that will include measures of language and communication that are less correlated to each other as well as will include a group of minimally and/or non-verbal individuals with ASD.
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Affiliation(s)
- Vardan Arutiunian
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Megha Santhosh
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Emily Neuhaus
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA
- Department of Psychiatry and Behavioral Science, University of Washington, Seattle, Washington, USA
| | | | - Raphael A Bernier
- Department of Psychiatry and Behavioral Science, University of Washington, Seattle, Washington, USA
| | - Susan Y Bookheimer
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
- Center for Autism Research and Treatment, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Mirella Dapretto
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
- Center for Autism Research and Treatment, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Daniel H Geschwind
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
- Center for Autism Research and Treatment, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
- Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
- Department of Human Genetics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Allison Jack
- Department of Psychology, George Mason University, Fairfax, Virginia, USA
| | - James C McPartland
- Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut, USA
| | - John D Van Horn
- Department of Psychology, University of Virginia, Charlottesville, Virginia, USA
- School of Data Science, University of Virginia, Charlottesville, Virginia, USA
| | - Kevin A Pelphrey
- Department of Neurology, School of Medicine, University of Virginia, Virginia, USA
| | - Abha R Gupta
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut, USA
- Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Neuroscience, Yale School of Medicine, New Haven, Connecticut, USA
| | - Sara Jane Webb
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA
- Department of Psychiatry and Behavioral Science, University of Washington, Seattle, Washington, USA
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Liu C, Guo Z, Pang J, Zhang Y, Yang Z, Cao J, Zhang T. Administration of Atosiban, an oxytocin receptor antagonist, ameliorates autistic-like behaviors in a female rat model of valproic acid-induced autism. Behav Brain Res 2024; 469:115052. [PMID: 38782096 DOI: 10.1016/j.bbr.2024.115052] [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: 12/24/2023] [Revised: 05/08/2024] [Accepted: 05/16/2024] [Indexed: 05/25/2024]
Abstract
Autism spectrum disorder (ASD) is a pervasive developmental disorder with gender differences. Oxytocin (OXT) is currently an important candidate drug for autism, but the lack of data on female autism is a big issue. It has been reported that the effect of OXT is likely to be different between male and female ASD patients. In the study, we specifically explored the role of the OXT signaling pathway in a VPA-induced female rat's model of autism. The data showed that there was an increase of either oxytocin or its receptor expressions in both the hippocampus and the prefrontal cortex of VPA-induced female offspring. To determine if the excess of OXT signaling contributed to autism symptoms in female rats, exogenous oxytocin and oxytocin receptor antagonists Atosiban were used in the experiment. It was found that exogenous oxytocin triggered autism-like behaviors in wild-type female rats by intranasal administration. More interestingly, several autism-like deficits including social interaction, anxiety, and repeat stereotypical sexual behavior in the VPA female offspring were significantly attenuated by oxytocin receptor antagonists Atosiban. Moreover, Atosiban also effectively improved the synaptic plasticity impairment induced by VPA in female offspring. Our results suggest that oxytocin receptor antagonists significantly improve autistic-like behaviors in a female rat model of valproic acid-induced autism.
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Affiliation(s)
- Chunhua Liu
- School of Medicine, Nankai University, Tianjin 300071, PR China
| | - Zhengyang Guo
- College of Life Sciences and Key Laboratory of Bioactive Materials Ministry of Education, Nankai University, Tianjin 300071, PR China
| | - Jiyi Pang
- College of Life Sciences and Key Laboratory of Bioactive Materials Ministry of Education, Nankai University, Tianjin 300071, PR China
| | - Yuying Zhang
- College of Life Sciences and Key Laboratory of Bioactive Materials Ministry of Education, Nankai University, Tianjin 300071, PR China
| | - Zhuo Yang
- School of Medicine, Nankai University, Tianjin 300071, PR China
| | - Jianting Cao
- Graduate School of Engineering, Saitama Institute of Technology, Fukaya 369-0217, Japan
| | - Tao Zhang
- College of Life Sciences and Key Laboratory of Bioactive Materials Ministry of Education, Nankai University, Tianjin 300071, PR China.
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Kirkovski M, Singh M, Dhollander T, Fuelscher I, Hyde C, Albein-Urios N, Donaldson PH, Enticott PG. An Investigation of Age-related Neuropathophysiology in Autism Spectrum Disorder Using Fixel-based Analysis of Corpus Callosum White Matter Micro- and Macrostructure. J Autism Dev Disord 2024; 54:2198-2210. [PMID: 37079181 PMCID: PMC11143064 DOI: 10.1007/s10803-023-05980-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2023] [Indexed: 04/21/2023]
Abstract
Fixel-based analysis was used to probe age-related changes in white matter micro- and macrostructure of the corpus callosum between participants with (N = 54) and without (N = 50) autism spectrum disorder (ASD). Data were obtained from the Autism Brain Imaging Data Exchange-II (ABIDE-II). Compared to age-matched controls, young adolescents with ASD (11.19 ± 7.54 years) showed reduced macroscopic fiber cross-section (logFC) and combined fiber-density and cross-section (FDC). Reduced fiber-density (FD) and FDC was noted in a marginally older (13.87 ± 3.15 years) ASD cohort. Among the oldest ASD cohort (17.07 ± 3.56 years), a non-significant trend indicative of reduced FD was noted. White matter aberration appears greatest and most widespread among younger ASD cohorts. This supports the suggestion that some early neuropathophysiological indicators in ASD may dissipate with age.
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Affiliation(s)
- Melissa Kirkovski
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, VIC, Australia.
- Institute for Health and Sport, Victoria University, Melbourne, VIC, Australia.
| | - Mervyn Singh
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, VIC, Australia
| | - Thijs Dhollander
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Ian Fuelscher
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, VIC, Australia
| | - Christian Hyde
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, VIC, Australia
| | - Natalia Albein-Urios
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, VIC, Australia
| | - Peter H Donaldson
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, VIC, Australia
| | - Peter G Enticott
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, VIC, Australia
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7
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Latrèche K, Godel M, Franchini M, Journal F, Kojovic N, Schaer M. Early trajectories and moderators of autistic language profiles: A longitudinal study in preschoolers. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024:13623613241253015. [PMID: 38770974 DOI: 10.1177/13623613241253015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
LAY ABSTRACT Language development can greatly vary among autistic children. Children who struggle with language acquisition often face many challenges and experience lower quality of life. However, little is known about the early language trajectories of autistic preschoolers and their moderators. Autistic language can be stratified into three profiles. Language unimpaired experience little to no language difficulties; language impaired show significant difficulties in language; minimally verbal never develop functional language. In this study, we used a longitudinal sample of preschoolers with autism and with typical development (aged 1.5-5.7 years). We replicated the three language profiles through a data-driven approach. We also found that different factors modulated the language outcome within each group. For instance, non-verbal cognition at age 2.4 moderated the participants' attribution to each language profile. Moreover, early intervention moderated verbal outcome in the language impaired profile. In conclusion, we provided a detailed description of how autistic preschoolers acquire language, and what factors might influence their trajectories. Our findings could inspire more personalized intervention for early autistic language difficulties.
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Smith JV, McQuaid GA, Wallace GL, Neuhaus E, Lopez A, Ratto AB, Jack A, Khuu A, Webb SJ, Verbalis A, Pelphrey KA, Kenworthy L. Time is of the essence: Age at autism diagnosis, sex assigned at birth, and psychopathology. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024:13623613241249878. [PMID: 38725306 DOI: 10.1177/13623613241249878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
LAY ABSTRACT Previous research has shown that girls/women are diagnosed later than boys/men with autism. Individuals who are diagnosed later in life, especially girls/women, have greater anxious and depressive symptoms. Previous research has been limited due to narrow inclusionary criteria for enrollment in studies. The present study uses two samples-one clinic-based, large "real-world" sample and another research-based sample with strict criteria for autism diagnosis-to understand the relationships between diagnostic age, sex assigned at birth, and symptoms of anxiety/depression. In both samples, those who were diagnosed later had greater anxious/depressive symptoms, and anxiety was not predicted by sex. In the clinic-based but not research-based sample, those assigned female at birth were diagnosed later than those assigned male at birth. In the clinic-based sample only, individuals assigned female at birth and who were later diagnosed experienced greater symptoms of anxiety/depression compared to those assigned male who benefited from earlier diagnostic timing. Within the research-based sample, those assigned female at birth had greater depressive symptoms than those assigned male. These findings highlight the importance of timely identification of autism, especially for girls/women who are often diagnosed later. Community-based samples are needed to better understand real-world sex-based and diagnostic age-based disparities in mental health.
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Affiliation(s)
- Jessica V Smith
- Children's Research Institute, Children's National Hospital, USA
| | | | - Gregory L Wallace
- Department of Speech, Language, and Hearing Sciences, The George Washington University, USA
| | - Emily Neuhaus
- Center on Child Health, Behavior, and Development, Seattle Children's Research Institute, USA
| | - Andrea Lopez
- Children's Research Institute, Children's National Hospital, USA
| | - Allison B Ratto
- Children's Research Institute, Children's National Hospital, USA
| | - Allison Jack
- Department of Psychology, George Mason University, USA
| | - Alexis Khuu
- Children's Research Institute, Children's National Hospital, USA
| | - Sara J Webb
- Center on Child Health, Behavior, and Development, Seattle Children's Research Institute, USA
| | - Alyssa Verbalis
- Children's Research Institute, Children's National Hospital, USA
| | | | - Lauren Kenworthy
- Children's Research Institute, Children's National Hospital, USA
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López Resa P, Moraleda Sepúlveda E. Developmental Profile in Children Aged 3-6 Years: Down Syndrome vs. Autism Spectrum Disorder. Behav Sci (Basel) 2024; 14:380. [PMID: 38785871 PMCID: PMC11117480 DOI: 10.3390/bs14050380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 04/26/2024] [Accepted: 04/29/2024] [Indexed: 05/25/2024] Open
Abstract
This research aims to compare the developmental profiles of children with autism spectrum disorder (ASD) and children with Down Syndrome (DS) between the ages of 3 and 6 years. The study examines whether these developmental disorders share common developmental milestones or exhibit distinctive characteristics. A total of 43 children, 23 with DS and 20 with ASD, participated in the study. Cognitive and language skills were assessed using standardized tools, including the Battelle Developmental Inventory, Reynell Developmental Language Scales III, and NEPSY-II battery. The results indicated that children with ASD outperformed children with DS in the areas of fine motor skills, gross motor skills, and communication. Additionally, children with ASD demonstrated higher scores in language comprehension and expressive language, compared to children with DS. Significant correlations were found between motor skills and communication abilities. Neuropsychological evaluations revealed significant differences between the two groups in various tasks, such as the comprehension of instructions, body part naming and identification, and recognition of emotions. These findings contribute to our understanding of the similarities and differences between ASD and DS, shedding light on the dissociation between cognition and language and its impact on adaptive functioning in these populations.
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Affiliation(s)
- Patricia López Resa
- Departamento de Psicología, Facultad de Ciencias de la Salud, Universidad de Castilla La Mancha, 45600 Talavera de la Reina, Spain
| | - Esther Moraleda Sepúlveda
- Departamento de Psicología Experimental, Procesos Cognitivos y Logopedia, Facultad de Psicología y Logopedia, Universidad Complutense de Madrid, 28040 Madrid, Spain;
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10
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Bourson L, Prevost C. Characteristics of restricted interests in girls with ASD compared to boys: a systematic review of the literature. Eur Child Adolesc Psychiatry 2024; 33:987-1004. [PMID: 35644857 DOI: 10.1007/s00787-022-01998-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 04/23/2022] [Indexed: 11/03/2022]
Abstract
The existence of a female phenotype profile in autistic spectrum disorder is one of the current hypotheses to explain the diagnostic discrepancy between men and women. In this context, an international literature review was carried out to evidence and describe the characteristics of restricted interests found in girls with autistic spectrum disorder. A documentary search was conducted on PubMed and a systematic literature review was carried out based on the PRISMA methodology. We selected studies with a population of boys and girls diagnosed as autistic according to the DSM-IV or the DSM-5, in which quantitative and descriptive comparisons of restricted interests, according to gender were carried out. Nineteen studies were found to be relevant. Fifteen enabled a refining of the characteristics of restricted interests among females: fewer restricted interests were identified in comparison with boys, and the autistic girls' interests seem to be closer to those of neurotypical girls than to those of autistic boys, which thus led to more complex screening. Age and Intelligence quotient seem to be two factors that trigger variations in restricted interests differently according to gender. Representations among professionals also have an impact on diagnoses among girls. For future research, one of the perspectives could be a comparison between girls with autism and neurotypical girls to limit gender bias. The present results contribute to potentially extending knowledge of a female phenotypical profile in autism and show the need to improve the general population's awareness, to improve health professionals' training and possibly to revise the diagnostic tools.
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Affiliation(s)
| | - Camille Prevost
- Université Paris Saclay - CESP INSERM U1178, CCU-AH at the Centre Hospitalier Fondation Vallée, Gentilly, France
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11
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Boettcher J, Orm S, Fjermestad KW. Autism traits, social withdrawal, and behavioral and emotional problems in a Norwegian cohort of adolescents with rare genetic disorders. RESEARCH IN DEVELOPMENTAL DISABILITIES 2024; 147:104699. [PMID: 38367299 DOI: 10.1016/j.ridd.2024.104699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 02/13/2024] [Accepted: 02/14/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND Adolescents with rare genetic disorders represent a population that can be at risk in psychosocial terms. Despite its importance, the association of autism traits and social withdrawal in behavioral and emotional problems in adolescents with rare genetic disorders remains understudied. AIM The study aimed to empirically examine the clinical characteristics of adolescents with rare genetic disorders with a behavior theory-driven approach. METHOD We investigated the behavioral and emotional problems and current and lifetime autistic traits in a sample of 93 Norwegian adolescents (Mage = 13.2 years, SDage = 2.4, rangeage 10-17, 62.4% females, 37.6% males) with various rare genetic disorders. The adolescents were investigated cross-sectionally utilizing standardized psychometric questionnaires rated by their parents. RESULTS More current and lifetime autistic traits and social withdrawal were all associated with more internalizing problems. Further analyses demonstrated that social withdrawal partially mediated the positive association between current autistic traits and internalizing problems. In contrast, social withdrawal fully mediated the positive association between lifetime autistic traits and internalizing problems. CONCLUSION AND IMPLICATIONS Our results demonstrate important characteristics of adolescents with rare genetic disorders that may guide clinicians and future interventions. Social withdrawal may be prodromal to internalizing problems such as anxiety and depression. Thus, clinically addressing social withdrawal can represent a means to prevent internalizing problems in adolescents with rare genetic disorders and autistic traits.
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Affiliation(s)
- Johannes Boettcher
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg, Eppendorf, Germany.
| | - Stian Orm
- Division Mental Health Care, Innlandet Hospital Trust, Norway; Department of Psychology, Inland Norway University of Applied Sciences, Norway
| | - Krister Westlye Fjermestad
- Frambu Resource Centre for Rare Disorders, Siggerud, Norway; Department of Psychology, University of Oslo, Norway
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12
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Simmons GL, Corbett BA, Lerner MD, Wofford K, White SW. Social competence in autism: A structural equation modeling approach. Autism Res 2024; 17:761-774. [PMID: 38481386 DOI: 10.1002/aur.3108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 01/25/2024] [Indexed: 04/13/2024]
Abstract
Autistic individuals present with difficulties in social competence (e.g., navigating social interactions and fostering relationships). Clinical interventions widely target social cognition and social behavior, but there is inconsistent understanding of the underlying components of social competence. The present study used structural equation modeling to examine social cognition and social behavior and explore the relationship between these latent constructs. Autistic youth (ages 10-17; n = 219) and their caregivers participated in this study. Constructs of social cognition and social behavior were captured using caregiver-report and self-report rating scales, as well as observational measures and direct clinical assessments (e.g., NEPSY-II). Measurement models of social cognition and social behavior demonstrated adequate to good fit. Correlational models demonstrated adequate to poor fit, indicating latent constructs of social cognition and social behavior are not closely related in autistic youth. Exploratory examination of a subsample of male youth (n = 157) evidenced improved model fit of social behavior, specifically. Findings tease apart social cognition and social behavior as cohesive and separable constructs; results do not support a structural relationship between social cognition and social behavior. Noted treatment implications include consideration of how targeting social cognition and social behavior together or separately may support autistic youth's progress toward reaching their identified therapeutic goals and supporting their self-directed social development.
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Affiliation(s)
- G L Simmons
- TEACCH Autism Program, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Center for Youth Development and Intervention, Department of Psychology, The University of Alabama, Tuscaloosa, Alabama, USA
| | - B A Corbett
- Department of Psychiatry & Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - M D Lerner
- Department of Psychology, Stony Brook University, Stony Brook, New York, USA
- AJ Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania, USA
| | - K Wofford
- Department of Psychology, University of South Florida, Tampa, Florida, USA
| | - S W White
- Center for Youth Development and Intervention, Department of Psychology, The University of Alabama, Tuscaloosa, Alabama, USA
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13
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Feller C, Ilen L, Eliez S, Schneider M. Social skills in neurodevelopmental disorders: a study using role-plays to assess adolescents and young adults with 22q11.2 deletion syndrome and autism spectrum disorders. J Neurodev Disord 2024; 16:11. [PMID: 38500028 PMCID: PMC11064408 DOI: 10.1186/s11689-024-09527-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 03/08/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUNDS Social skills are frequently impaired in neurodevelopmental disorders and genetic conditions, including 22q11.2 deletion syndrome (22q11DS) and autism spectrum disorders (ASD). Although often assessed with questionnaires, direct assessment provides a more valid estimate of the constructs. Role-plays (i.e., simulates situational settings) therefore appear to be an appropriate indicator of social skills in daily life. METHODS This co-registered study involved 53 individuals with 22q11DS, 34 individuals with ASD, and 64 typically developing (TD) peers aged 12-30 years. All participants were assessed with role-plays as well as parent-reported questionnaires and clinical interviews focusing on social skills, functioning and anxiety. RESULTS Both clinical groups showed impaired social skills compared to TD, but distinct social profiles emerged between the groups. Individuals with 22q11DS displayed higher social appropriateness and clarity of speech but weaker general argumentation and negotiation skills, with the opposite pattern observed in participants with ASD. No association was found between social skills measured by direct observation and caregiver reports. Social anxiety, although higher in clinical groups than in TD, was not associated with role-plays. CONCLUSIONS This study highlights the need to train social skills through tailored interventions to target the specific difficulties of each clinical population. It also highlights the importance of combining measures as they do not necessarily provide the same outcome.
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Affiliation(s)
- Clémence Feller
- Department of Psychology and Educational Sciences, Clinical Psychology Unit for Intellectual and Developmental Disabilities, Faculty of Psychology and Educational Sciences, University of Geneva, 40, Boulevard du Pont-d'Arve, 1205, Geneva, Switzerland.
| | - Laura Ilen
- Department of Psychology and Educational Sciences, Clinical Psychology Unit for Intellectual and Developmental Disabilities, Faculty of Psychology and Educational Sciences, University of Geneva, 40, Boulevard du Pont-d'Arve, 1205, Geneva, Switzerland
| | - Stephan Eliez
- Developmental Imaging and Psychopathology Lab Research Unit, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Department of Genetic Medicine and Development, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Maude Schneider
- Department of Psychology and Educational Sciences, Clinical Psychology Unit for Intellectual and Developmental Disabilities, Faculty of Psychology and Educational Sciences, University of Geneva, 40, Boulevard du Pont-d'Arve, 1205, Geneva, Switzerland
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14
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Cruz S, Zubizarreta SCP, Costa AD, Araújo R, Martinho J, Tubío-Fungueiriño M, Sampaio A, Cruz R, Carracedo A, Fernández-Prieto M. Is There a Bias Towards Males in the Diagnosis of Autism? A Systematic Review and Meta-Analysis. Neuropsychol Rev 2024:10.1007/s11065-023-09630-2. [PMID: 38285291 DOI: 10.1007/s11065-023-09630-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 12/11/2023] [Indexed: 01/30/2024]
Abstract
Autism is more frequently diagnosed in males, with evidence suggesting that females are more likely to be misdiagnosed or underdiagnosed. Possibly, the male/female ratio imbalance relates to phenotypic and camouflaging differences between genders. Here, we performed a comprehensive approach to phenotypic and camouflaging research in autism addressed in two studies. First (Study 1 - Phenotypic Differences in Autism), we conducted a systematic review and meta-analysis of gender differences in autism phenotype. The electronic datasets Pubmed, Scopus, Web of Science, and PsychInfo were searched. We included 67 articles that compared females and males in autism core symptoms, and in cognitive, socioemotional, and behavioural phenotypes. Autistic males exhibited more severe symptoms and social interaction difficulties on standard clinical measures than females, who, in turn, exhibited more cognitive and behavioural difficulties. Considering the hypothesis of camouflaging possibly underlying these differences, we then conducted a meta-analysis of gender differences in camouflaging (Study 2 - Camouflaging Differences in Autism). The same datasets as the first study were searched. Ten studies were included. Females used more compensation and masking camouflage strategies than males. The results support the argument of a bias in clinical procedures towards males and the importance of considering a 'female autism phenotype'-potentially involving camouflaging-in the diagnostic process.
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Affiliation(s)
- Sara Cruz
- Psychology of Development Research Center, Lusiada University of Porto, Porto, Portugal.
- Department of Psychology, School of Philosophy, Psychology & Language Sciences, University of Edinburgh, Edinburgh, UK.
| | - Sabela Conde-Pumpido Zubizarreta
- Genomics and Bioinformatics Group, Center for Research in Molecular Medicine and Chronic Diseases (CiMUS), University of Santiago de Compostela (USC), Santiago de Compostela, Spain
| | - Ana Daniela Costa
- Psychological Neuroscience Laboratory (PNL), Research Center in Psychology (CIPsi), School of Psychology, University of Minho, Braga, Portugal
| | - Rita Araújo
- Psychological Neuroscience Laboratory (PNL), Research Center in Psychology (CIPsi), School of Psychology, University of Minho, Braga, Portugal
| | | | - María Tubío-Fungueiriño
- Genomics and Bioinformatics Group, Center for Research in Molecular Medicine and Chronic Diseases (CiMUS), University of Santiago de Compostela (USC), Santiago de Compostela, Spain
- Fundación Instituto de Investigación Sanitaria de Santiago de Compostela (FIDIS), Santiago de Compostela, Spain
- Genetics Group, GC05, Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, Spain
- Grupo de Medicina Xenómica, U-711, Centro de Investigación en Red de Enfermedades Raras (CIBERER), University of Santiago de Compostela (USC), Santiago de Compostela, Spain
| | - Adriana Sampaio
- Psychological Neuroscience Laboratory (PNL), Research Center in Psychology (CIPsi), School of Psychology, University of Minho, Braga, Portugal
| | - Raquel Cruz
- Genomics and Bioinformatics Group, Center for Research in Molecular Medicine and Chronic Diseases (CiMUS), University of Santiago de Compostela (USC), Santiago de Compostela, Spain
- Grupo de Medicina Xenómica, U-711, Centro de Investigación en Red de Enfermedades Raras (CIBERER), University of Santiago de Compostela (USC), Santiago de Compostela, Spain
| | - Angel Carracedo
- Genomics and Bioinformatics Group, Center for Research in Molecular Medicine and Chronic Diseases (CiMUS), University of Santiago de Compostela (USC), Santiago de Compostela, Spain
- Genetics Group, GC05, Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, Spain
- Grupo de Medicina Xenómica, U-711, Centro de Investigación en Red de Enfermedades Raras (CIBERER), University of Santiago de Compostela (USC), Santiago de Compostela, Spain
- Fundación Pública Galega de Medicina Xenómica, Servicio Galego de Saúde (SERGAS), Santiago de Compostela, Spain
| | - Montse Fernández-Prieto
- Genomics and Bioinformatics Group, Center for Research in Molecular Medicine and Chronic Diseases (CiMUS), University of Santiago de Compostela (USC), Santiago de Compostela, Spain
- Fundación Instituto de Investigación Sanitaria de Santiago de Compostela (FIDIS), Santiago de Compostela, Spain
- Genetics Group, GC05, Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, Spain
- Grupo de Medicina Xenómica, U-711, Centro de Investigación en Red de Enfermedades Raras (CIBERER), University of Santiago de Compostela (USC), Santiago de Compostela, Spain
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15
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Zaccarelli-Magalhães J, Manes M, Féba LS, Abreu GR, Flório JC, Ricci EL, Felício LF, Spinosa HS. Do Autistic and Depressed Rats Express the Same Type of Maternal Care? Neuroscience 2024; 536:72-78. [PMID: 38000546 DOI: 10.1016/j.neuroscience.2023.11.024] [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: 08/18/2023] [Revised: 11/17/2023] [Accepted: 11/20/2023] [Indexed: 11/26/2023]
Abstract
Autism is a neurodevelopmental disorder that is more frequently diagnosed in men. Nevertheless, through current diagnostic tools, women have also been found to be affected by this disorder, but in different ways. Few studies have been conducted regarding unique periods of life, such as motherhood. Yet, extant literature has already described the existence of a comorbidity between autism and postpartum depression. Thus, this study aimed to compare the maternal care sphere between two animal models of these diseases. Lactating rats were subdivided into three groups (n = 8 animals/group): 1) control dams; 2) maternal separation (MS) dams, separated from their litter for 3 h daily from lactating day (LD) 2-12 for postpartum depression induction; and 3) valproic acid (VPA) dams, which were the pups of dams treated with 400 mg/kg of VPA (i.p.) on gestational day 12.5 for autism induction. Maternal care tests were performed during lactation and, after weaning, dams were euthanized for the analysis of dopaminergic system on the prefrontal cortex. The results showed an impairment of maternal care of MS dams and an improvement of VPA dams, as well as alterations on dopaminergic system that corroborates the behavior data. These findings indicate that VPA dams express better maternal care, even with cognitive and socialization difficulties. This is probably due to a hyper-focus, as opposed to MS dams, which mimic the maternal care dysfunction expressed by women with postpartum depression.
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Affiliation(s)
- J Zaccarelli-Magalhães
- Department of Pathology, School of Veterinary Medicine and Animal Science, University of São Paulo, Avenida Professor Doutor Orlando Marques de Paiva, 87, 05508-270 São Paulo, Brazil.
| | - M Manes
- Department of Pathology, School of Veterinary Medicine and Animal Science, University of São Paulo, Avenida Professor Doutor Orlando Marques de Paiva, 87, 05508-270 São Paulo, Brazil
| | - L S Féba
- Health Science Institute, Presbyterian Mackenzie University, Rua da Consolação, 930, 01302-907 São Paulo, Brazil
| | - G R Abreu
- Department of Pathology, School of Veterinary Medicine and Animal Science, University of São Paulo, Avenida Professor Doutor Orlando Marques de Paiva, 87, 05508-270 São Paulo, Brazil
| | - J C Flório
- Department of Pathology, School of Veterinary Medicine and Animal Science, University of São Paulo, Avenida Professor Doutor Orlando Marques de Paiva, 87, 05508-270 São Paulo, Brazil
| | - E L Ricci
- Department of Pathology, School of Veterinary Medicine and Animal Science, University of São Paulo, Avenida Professor Doutor Orlando Marques de Paiva, 87, 05508-270 São Paulo, Brazil; Health Science Institute, Presbyterian Mackenzie University, Rua da Consolação, 930, 01302-907 São Paulo, Brazil; School of Health Sciences IGESP, Rua da Consolação, 1025, 01301-000 São Paulo, Brazil
| | - L F Felício
- Department of Pathology, School of Veterinary Medicine and Animal Science, University of São Paulo, Avenida Professor Doutor Orlando Marques de Paiva, 87, 05508-270 São Paulo, Brazil
| | - H S Spinosa
- Department of Pathology, School of Veterinary Medicine and Animal Science, University of São Paulo, Avenida Professor Doutor Orlando Marques de Paiva, 87, 05508-270 São Paulo, Brazil
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16
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Kim JI, Yoo HJ. Diagnosis and Assessment of Autism Spectrum Disorder in South Korea. Soa Chongsonyon Chongsin Uihak 2024; 35:15-21. [PMID: 38204740 PMCID: PMC10774553 DOI: 10.5765/jkacap.230009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 08/08/2023] [Accepted: 09/13/2023] [Indexed: 01/12/2024] Open
Abstract
Autism spectrum disorder (ASD) is diagnosed by the clinical decision of a trained professional based on the Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition or International Classification of Diseases 11th Revision diagnostic criteria. To obtain information for diagnostic formulation, professionals should explore detailed developmental history, and can use structured or semi-structured assessment tools to observe interaction between the child and parents or strangers. Diagnostic assessment should include a profile of the strength and weaknesses of the individual and should be conducted using an optimal approach by a multidisciplinary team with appropriate techniques and experience. Assessment of language, cognitive, neuropsychological, and adaptive functioning should be conducted in ASD individuals prior to establishing an individualized treatment plan. Genetic testing, brain magnetic resonance imaging or electroencephalogram testing can be considered for identification of underlying causes.
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Affiliation(s)
| | - Hee Jeong Yoo
- Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
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17
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Edwards H, Wright S, Sargeant C, Cortese S, Wood-Downie H. Research Review: A systematic review and meta-analysis of sex differences in narrow constructs of restricted and repetitive behaviours and interests in autistic children, adolescents, and adults. J Child Psychol Psychiatry 2024; 65:4-17. [PMID: 37485556 DOI: 10.1111/jcpp.13855] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/13/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Evidence that autism often manifests differently between males and females is growing, particularly in terms of social interaction and communication, but it is unclear if there are sex differences in restricted and repetitive behaviours and interests (RRBIs) when rigorously focusing on the narrow construct level (i.e., stereotyped behaviour, restricted interests, insistence on sameness, and/or sensory experiences). METHODS We conducted a systematic review and four random effects meta-analyses investigating sex differences in narrow construct measures of RRBIs in autistic children, adolescents, and adults (Prospero registration ID: CRD42021254221). Study quality was appraised using the Newcastle-Ottawa Quality Assessment Scale. RESULTS Forty-six studies were narratively synthesised and 25 of these were included in four random effects meta-analyses. Results found that autistic males had significantly higher levels of stereotyped behaviours (SMD = 0.21, 95% confidence interval (CI) [0.09, 0.33], p < .001) and restricted interests (SMD = 0.18, 95% CI [0.07, 0.29], p < .001) compared to autistic females. In contrast, there were no significant sex differences for sensory experiences (SMD = -0.09, 95% CI [-0.27, 0.09], p = .32) and insistence on sameness (SMD = 0.01, 95% CI [-0.03, 0.05], p = .68). The findings from the narrative synthesis were generally consistent with those from the meta-analyses and also found qualitative sex differences in the way RRBIs manifest. CONCLUSIONS Our findings show significant differences in narrowly defined RRBIs in males and females. Practitioners need to be aware of such differences, which could be contributing to the under-recognition of autism in females and may not be captured by current diagnostic instruments.
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Affiliation(s)
- Hannah Edwards
- Doctorate in Educational Psychology, University of Southampton, Southampton, UK
- Hampshire and Isle of Wight Educational Psychology Service (HIEP), Havant, UK
| | - Sarah Wright
- Doctorate in Educational Psychology, University of Southampton, Southampton, UK
| | - Cora Sargeant
- Doctorate in Educational Psychology, University of Southampton, Southampton, UK
| | - Samuele Cortese
- Centre for Innovation in Mental Health - Developmental Lab, School of Psychology, University of Southampton, Southampton, UK
- Solent NHS Trust, Southampton, UK
- New York University Child Study Center, New York, NY, USA
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Henry Wood-Downie
- Doctorate in Educational Psychology, University of Southampton, Southampton, UK
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18
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Villegas-Lirola F. Prevalence of Autism Spectrum Disorder in Children in Andalusia (Spain). J Autism Dev Disord 2023; 53:4438-4456. [PMID: 36076115 DOI: 10.1007/s10803-022-05728-3] [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] [Accepted: 08/20/2022] [Indexed: 10/14/2022]
Abstract
Autism Spectrum Disorder (ASD) is socially relevant because of its number and the intensity of the medical and socio-educational response it requires. In Andalusia, one in 70 children will be diagnosed with ASD in 2021. It is much more frequent in boys than in girls, being 5.91 times more likely to present it as a boy than as a girl. The age of diagnosis is increasingly younger, standing at 4.4 years. In more than half of primary schools and more than 75% of secondary schools there are an average of three students with ASD per school. It is necessary to develop a network of preferential care centers for students with ASD to generalize specialized care in ordinary modalities.
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Affiliation(s)
- Francisco Villegas-Lirola
- HUM782 Research Group University of Almeria: Diversity, Disability and Special Educational Needs, Universidad de Almería, 04120, Almería, Spain.
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19
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Fithall K, Gray IE, Linardon J, Phillipou A, Donaldson PH, Albein-Urios N, Enticott PG, Fuller-Tyszkiewicz M, Kirkovski M. Exploring the role of autistic traits and eating disorder psychopathology on mentalising ability in the general population. BMC Psychol 2023; 11:269. [PMID: 37674242 PMCID: PMC10483798 DOI: 10.1186/s40359-023-01306-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 09/04/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND This study evaluated the role of overlapping traits and characteristics related to autism spectrum disorder (autism) and anorexia nervosa (AN) in the general population, and the impact of these traits on mentalising ability. METHODS A sample of young adults (N = 306), aged 18-25 years, was recruited to complete an online study that consisted of 4 measures: the Autism-Spectrum Quotient, Eating Disorder Examination Questionnaire, the Mentalization Scale, and the Reading the Mind in the Eyes task. RESULTS Higher levels of autistic traits, particularly difficulty with attention switching, were associated with increased eating disorder psychopathology. Overall, autistic traits and eating disorder psychopathology were related among females, but not males. Difficulty with attention switching, however, was related to eating disorder psychopathology among both females and males. Autistic traits also appear to have a greater role in mentalising ability than does eating disorder psychopathology. CONCLUSION The role of attention switching in overlapping traits of autism and eating disorder psychopathology needs to be more comprehensively evaluated by future research, as does the role of biological sex. Expanded knowledge in this field will help to better understand and evaluate symptoms at presentation, leading to clearer diagnoses and potentially better treatment outcomes.
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Affiliation(s)
- Kate Fithall
- School of Psychology, Deakin University, Geelong, Australia
| | - Indigo E Gray
- School of Psychology, Deakin University, Geelong, Australia
| | - Jake Linardon
- School of Psychology, Deakin University, Geelong, Australia
| | - Andrea Phillipou
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
- Orygen, Melbourne, VIC, Australia
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, VIC, Australia
- Department of Mental Health, St Vincent's Hospital, Melbourne, VIC, Australia
- Department of Mental Health, Austin Hospital, Melbourne, VIC, Australia
| | | | | | | | | | - Melissa Kirkovski
- School of Psychology, Deakin University, Geelong, Australia.
- Institute for Health and Sport, Victoria University, Melbourne, VIC, Australia.
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20
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Breddemann A, Schilbach L, Kunerl E, Witzmann M, Schuwerk T. [Gender Differences in Autism Diagnostics]. PSYCHIATRISCHE PRAXIS 2023; 50:299-307. [PMID: 37146640 DOI: 10.1055/a-2043-9812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Autism spectrum condition (ASC) is predominantly diagnosed in boys and men. There is evidence that this is also because girls and women with ASC don't receive a diagnosis, or, if they do, only later in life. This study investigates gender differences in diagnosis, support needs, mental health, and life satisfaction among individuals with autism spectrum condition (ASC) in Germany. Data of an online questionnaire study with 659 persons with ASC from 3-67 years of age living in Bavaria, Germany, were analyzed (215 thereof were female). It was found that women with ASC are diagnosed 7-11 years later than men and are more likely to receive at least one misdiagnosis. They are more likely than men to have unmet educational support needs and comorbid internalizing psychiatric disorders. The results of this study point towards a strong gender bias in clinical diagnosis of ASC in Germany and need for improvements in the case of women.
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Affiliation(s)
- Alina Breddemann
- MUNIK - Münchner Universitäres Institut für Kinder- und Jugendlichenpsychotherapie, Ludwig-Maximilians-Universität München
| | - Leonhard Schilbach
- Munich Center for Neurosciences, Ludwig-Maximilians-Universität München
- Psychiatrie, LVR-Klinikum Düsseldorf - Kliniken der Heinrich-Heine-Universität Düsseldorf
| | - Eva Kunerl
- Pädagogik, Ludwig-Maximilians-Universität München
| | - Markus Witzmann
- Fakultät für angewandte Sozialwissenschaften, Hochschule München
| | - Tobias Schuwerk
- MUNIK - Münchner Universitäres Institut für Kinder- und Jugendlichenpsychotherapie, Ludwig-Maximilians-Universität München
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21
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Fertan E, Wong AA, Montbrun TSGD, Purdon MK, Roddick KM, Yamamoto T, Brown RE. Early postnatal development of the MDGA2 +/- mouse model of synaptic dysfunction. Behav Brain Res 2023; 452:114590. [PMID: 37499910 DOI: 10.1016/j.bbr.2023.114590] [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: 05/05/2023] [Revised: 06/13/2023] [Accepted: 07/19/2023] [Indexed: 07/29/2023]
Abstract
Synaptic dysfunction underlies many neurodevelopmental disorders (NDDs). The membrane-associated mucin domain-containing glycosylphosphatidylinositol anchor proteins (MDGAs) regulate synaptic development by modulating neurexin-neuroligin complex formation. Since understanding the neurodevelopmental profile and the sex-based differences in the manifestation of the symptoms of NDDs is important for their early diagnosis, we tested a mouse model haploinsufficient for MDGA2 (MDGA2+/-) on a neurodevelopmental test battery, containing sensory, motor, and cognitive measures, as well as ultrasonic vocalizations. When male and female MDGA2+/- and wildtype (WT) C57BL/6 J mice were examined from 2 to 23 days of age using this test battery, genotype and sex differences in body weight, sensory-motor processes, and ultrasonic vocalizations were observed. The auditory startle reflex appeared earlier in the MDGA2+/- than in WT mice and the MDGA2+/- mice produced fewer ultrasonic vocalizations. The MDGA2+/- mice showed reduced locomotion and rearing than WT mice in the open field after 17 days of age and spent less time investigating a novel object than WT mice at 21 days of age. Female MDGA2+/- mice weighed less than WT females and showed lower grip strength, indicating a delay in sensory-motor development in MDGA2+/- mice, which appears to be more pronounced in females than males. The behavioural phenotypes resulting from MDGA2 haploinsufficiency suggests that it shows delayed development of motor behaviour, grip strength and exploratory behaviour, non-social phenotypes of NDDs.
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Affiliation(s)
- Emre Fertan
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Aimée A Wong
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | | | - Michaela K Purdon
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Kyle M Roddick
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Tohru Yamamoto
- Department of Molecular Neurobiology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kagawa 761-0793, Japan
| | - Richard E Brown
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS B3H 4R2, Canada.
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22
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Brickhill R, Atherton G, Piovesan A, Cross L. Autism, thy name is man: Exploring implicit and explicit gender bias in autism perceptions. PLoS One 2023; 18:e0284013. [PMID: 37611041 PMCID: PMC10446214 DOI: 10.1371/journal.pone.0284013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 03/18/2023] [Indexed: 08/25/2023] Open
Abstract
Males are around three times more likely to possess an autism diagnosis than females. For years this was explained by accounts that considered the male gender more compatible with the autistic phenotype. However, new research suggests that a lack of understanding and recognition of the female autistic phenotype, and a predisposition to associate males with autistic traits, could lead to structural inequalities that hinder the identification of autistic females. To explore how autism and gender are more widely perceived, the present study tested implicit and explicit associations between autism and binary gender using the Implicit Association Test (IAT) and the Autism Quotient (AQ) presented alongside a male or female vignette. A significant association was found on the IAT, identifying an implicit bias towards males and autistic traits. The vignette AQ pairing also revealed some specific items perceived as explicitly male traits, while only reverse-scored items were perceived as female. These findings suggest that current perceptions and even metrics of autism are skewed towards males, which may hinder the identification and understanding of the female autistic phenotype.
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Affiliation(s)
- Rae Brickhill
- Department of Psychology, Edge Hill University, Liverpool, United Kingdom
| | - Gray Atherton
- Department of Psychology, Edge Hill University, Liverpool, United Kingdom
| | - Andrea Piovesan
- Department of Psychology, Edge Hill University, Liverpool, United Kingdom
| | - Liam Cross
- Department of Psychology, Edge Hill University, Liverpool, United Kingdom
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Mutiso VN, Ndetei DM, Muia EN, Masake M, Alietsi RK, Onsinyo L, Musyimi C, Mamah D. Risk of autism spectrum disorder and association of its symptoms with psychiatric and substance use disorders in non-clinical student sample in Kenya: cross-sectional study. BJPsych Open 2023; 9:e160. [PMID: 37605834 PMCID: PMC10486240 DOI: 10.1192/bjo.2023.503] [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: 05/28/2021] [Revised: 01/12/2023] [Accepted: 01/20/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND The prevalence and patterns of autism spectrum disorder (ASD) symptoms/traits and the associations of ASD with psychiatric and substance use disorders has not been documented in non-clinical students in Sub-Saharan Africa, and Kenya in particular. AIMS To document the risk level of ASD and its traits in a Kenyan student population (high school, college and university) using the Autism-Spectrum Quotient (AQ); and to determine the associations between ASD and other psychiatric and substance use disorders. METHOD This was a cross-sectional study among students (n = 9626). We used instruments with sufficient psychometric properties and good discriminative validity to collect data. A cut-off score of ≥32 on the AQ was used to identify those at high risk of ASD. We conducted the following statistical tests: (a) basic descriptive statistics; (b) chi-squared tests and Fisher's exact tests to analyse associations between categorical variables and ASD; (c) independent t-tests to examine two-group comparisons with ASD; (d) one-way analysis of variance to make comparisons between categorical variables with three or more groups and ASD; (e) statistically significant (P < 0.05) variables fitted into an ordinal logistic regression model to identify determinants of ASD; (f) Pearson's correlation and reliability analysis. RESULTS Of the total sample, 54 (0.56%) were at high risk of ASD. Sociodemographic differences were found in the mean scores for the various traits, and statistically significant (P < 0.05) associations we found between ASD and various psychiatric and substance use disorders. CONCLUSIONS Risk of ASD, gender characteristics and associations with psychiatric and substance use disorders are similar in this Kenyan sample to those found in Western settings in non-clinical populations.
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Affiliation(s)
| | - David M. Ndetei
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya; Department of Psychiatry, University of Nairobi, Nairobi, Kenya; and World Psychiatric Association Collaborating Centre for Research and Training, Nairobi, Kenya
| | - Esther N. Muia
- Department of Public and Community Health, Machakos University, Machakos, Kenya
| | - Monicah Masake
- Department of Public and Community Health, Machakos University, Machakos, Kenya
| | - Rita K. Alietsi
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - Lydia Onsinyo
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - Christine Musyimi
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - Daniel Mamah
- Department of Psychiatry, Washington University Medical School, St Louis, Missouri, USA
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24
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Fleet BG, Elliott A, Orwin M, Spencer M, Sedda L. Autism trends in a medium size coastal town of England. PLoS One 2023; 18:e0287808. [PMID: 37390060 PMCID: PMC10313016 DOI: 10.1371/journal.pone.0287808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 06/13/2023] [Indexed: 07/02/2023] Open
Abstract
Autism spectrum disorder (ASD) is a complex set of neurodevelopmental conditions which affects just under 1% of the global population. This study aims to investigate the trends in ASD diagnoses in a typical English deprived coastal community over the last two decades. ASD information for patients registered at Fleetwood GP practices were provided for the period between July 1952 to March 2022. The incidence and prevalence were calculated and Poisson regression modelling was employed to estimate the effects of age and sex on the number of ASD diagnoses over time. The study shows that there has been an upward trend in the number of ASD diagnoses over the past two decades. Model's results showed that sex differences in ASD diagnoses are less pronounced when accounting for time trends. The study findings show that Fleetwood has experienced a similar rise in ASD cases as the rest of the UK, most likely due to increased awareness that may explain the time effects over gender differences. However, due to the small sample size of the study, confirmation of the gender results and identification of the factors determining the temporal trends are needed in order to determine the gender effects in ASD diagnosis.
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Affiliation(s)
- Benjamin G. Fleet
- Faculty of Health and Medicine, Medicine and Surgery MBChB Student at Lancaster Medical School, Lancaster University, Lancaster, United Kingdom
| | - Alicia Elliott
- NHS Midlands and Lancashire Commissioning Support Unit, Lancashire Business Park, Leyland, United Kingdom
| | - Margaret Orwin
- NHS Midlands and Lancashire Commissioning Support Unit, Lancashire Business Park, Leyland, United Kingdom
| | - Mark Spencer
- Healthier Fleetwood, Health & Wellbeing Centre, Fleetwood, United Kingdom
| | - Luigi Sedda
- Faculty of Health and Medicine, Lancaster Ecology and Epidemiology Group, Lancaster Medical School, Lancaster University, Lancaster, United Kingdom
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Cano S, Díaz-Arancibia J, Arango-López J, Libreros JE, García M. Design Path for a Social Robot for Emotional Communication for Children with Autism Spectrum Disorder (ASD). SENSORS (BASEL, SWITZERLAND) 2023; 23:s23115291. [PMID: 37300017 DOI: 10.3390/s23115291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 05/29/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023]
Abstract
Children with autism spectrum disorder (ASD) have deficits in social interaction and expressing and understanding emotions. Based on this, robots for children with ASD have been proposed. However, few studies have been conducted about how to design a social robot for children with ASD. Non-experimental studies have been carried out to evaluate social robots; however, the general methodology that should be used to design a social robot is not clear. This study proposes a design path for a social robot for emotional communication for children with ASD following a user-centered design approach. This design path was applied to a case study and evaluated by a group of experts in psychology, human-robot interaction, and human-computer interaction from Chile and Colombia, as well as parents of children with ASD. Our results show that following the proposed design path for a social robot to communicate emotions for children with ASD is favorable.
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Affiliation(s)
- Sandra Cano
- School of Computer Engineering, Pontificia Universidad Católica de Valparaíso, Valparaíso 2340000, Chile
| | - Jaime Díaz-Arancibia
- Departamento de Ciencias de la Computación e Informática, Universidad de la Frontera, Temuco 4811230, Chile
| | - Jeferson Arango-López
- Departamento de Sistemas e Informática, Universidad de Caldas, Manizales 170004, Colombia
| | - Julia Elena Libreros
- Facultad de Psicología, Universidad Cooperativa de Colombia, Cali 760035, Colombia
| | - Matías García
- School of Computer Engineering, Pontificia Universidad Católica de Valparaíso, Valparaíso 2340000, Chile
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26
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Lewis N, Miller R, Gazula H, Calhoun V. Fine temporal brain network structure modularizes and localizes differently in men and women: insights from a novel explainability framework. Cereb Cortex 2023; 33:5817-5828. [PMID: 36843049 PMCID: PMC10183744 DOI: 10.1093/cercor/bhac462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 10/05/2022] [Accepted: 10/06/2022] [Indexed: 02/28/2023] Open
Abstract
Deep learning has become an effective tool for classifying biological sex based on functional magnetic resonance imaging (fMRI). However, research on what features within the brain are most relevant to this classification is still lacking. Model interpretability has become a powerful way to understand "black box" deep-learning models, and select features within the input data that are most relevant to the correct classification. However, very little work has been done employing these methods to understand the relationship between the temporal dimension of functional imaging signals and the classification of biological sex. Consequently, less attention has been paid to rectifying problems and limitations associated with feature explanation models, e.g. underspecification and instability. In this work, we first provide a methodology to limit the impact of underspecification on the stability of the measured feature importance. Then, using intrinsic connectivity networks from fMRI data, we provide a deep exploration of sex differences among functional brain networks. We report numerous conclusions, including activity differences in the visual and cognitive domains and major connectivity differences.
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Affiliation(s)
- Noah Lewis
- Computational Science and Engineering, Georgia Institute of Technology, North Ave, 30332, GA, United States
| | - Robyn Miller
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), 55 Park Pl NE, 30303, GA, United States
- Georgia State University, 33 Gilmer St SE, 30303, GA, United States
| | - Harshvardhan Gazula
- Athinoula A. Martinos Center for Biomedical Imaging, 149 13th Street, 02129, MA, United States
- Harvard Medical School, 25 Shattuck St, 02115, MA, United States
| | - Vince Calhoun
- Computational Science and Engineering, Georgia Institute of Technology, North Ave, 30332, GA, United States
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), 55 Park Pl NE, 30303, GA, United States
- Georgia State University, 33 Gilmer St SE, 30303, GA, United States
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27
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Das S, Zomorrodi R, Mirjalili M, Kirkovski M, Blumberger DM, Rajji TK, Desarkar P. Machine learning approaches for electroencephalography and magnetoencephalography analyses in autism spectrum disorder: A systematic review. Prog Neuropsychopharmacol Biol Psychiatry 2023; 123:110705. [PMID: 36574922 DOI: 10.1016/j.pnpbp.2022.110705] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 12/04/2022] [Accepted: 12/21/2022] [Indexed: 12/26/2022]
Abstract
There are growing application of machine learning models to study the intricacies of non-linear and non-stationary characteristics of electroencephalography (EEG) and magnetoencephalography (MEG) data in neurobiologically complex and heterogeneous conditions such as autism spectrum disorder (ASD). Such tools have potential diagnostic applications, and given the highly heterogeneous presentation of ASD, might prove fruitful in early detection and therefore could facilitate very early intervention. We conducted a systematic review (PROSPERO ID#CRD42021257438) by searching PubMed, EMBASE, and PsychINFO for machine learning approaches for EEG and MEG analyses in ASD. Thirty-nine studies were identified, of which the majority (18) used support vector machines for classification; other successful methods included deep learning. Thirty-seven studies were found to employ EEG and two were found to employ MEG. This systematic review indicate that machine learning methods can be used to classify ASD, predict ASD diagnosis in high-risk infants as early as 3 months of age, predict ASD symptom severity, and classify states of cognition in ASD with high accuracy. Replication studies testing validity, reproducibility and generalizability in tandem with randomized controlled trials in ASD populations will likely benefit the field.
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Affiliation(s)
- Sushmit Das
- Centre for Addiction and Mental Health, Toronto, Canada; Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Reza Zomorrodi
- Centre for Addiction and Mental Health, Toronto, Canada; Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Mina Mirjalili
- Centre for Addiction and Mental Health, Toronto, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Adult Neurodevelopmental and Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Vector Institute for Artificial Intelligence, Toronto, ON, Canada
| | - Melissa Kirkovski
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, Australia; Insitute for Health and Sport, Victoria University, Melbourne, Australia
| | - Daniel M Blumberger
- Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Tarek K Rajji
- Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Pushpal Desarkar
- Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada; Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada.
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28
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Freeman NC, Grigoriadis A. A survey of assessment practices among health professionals diagnosing females with autism. RESEARCH IN DEVELOPMENTAL DISABILITIES 2023; 135:104445. [PMID: 36746026 DOI: 10.1016/j.ridd.2023.104445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 01/19/2023] [Accepted: 01/24/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Emerging research suggests there may be a distinct female autism phenotype, although females are still diagnosed at a much lower rate than males. To date, no research has examined the assessment practices of health professionals when assessing females for autism. AIMS This study aimed to identify the training received, level of confidence, and assessment practices specific to assessing females for autism. METHODS AND PROCEDURE An online survey was completed by 126 health professionals (34 paediatricians, 40 psychologists and 52 speech pathologists) working across Australia. OUTCOMES AND RESULTS The majority of health professionals received no training that addressed gender differences when assessing for autism, even when controlling for number of years since they completed their studies. Most health professionals reported using similar assessment practices when assessing and diagnosing males and females for autism; only 18.2 % reported using female-specific assessment measures. CONCLUSIONS AND IMPLICATIONS Suggestions for the lack of difference in assessment measures used across genders are discussed. Potential for including measures that may be more sensitive to the presentation of autism in females in health professional's assessment practices is identified. The high proportion of health professionals engaging in professional development following their clinical training highlights the importance of training opportunities to enhance practitioner understanding and confidence when undertaking assessments for autism in females.
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Affiliation(s)
- Nerelie C Freeman
- School of Educational Psychology and Counselling, Faculty of Education, Monash University, Victoria 3800, Australia.
| | - Ashley Grigoriadis
- School of Educational Psychology and Counselling, Faculty of Education, Monash University, Victoria 3800, Australia.
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29
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Measuring Social Camouflaging in Individuals with High Functioning Autism: A Literature Review. Brain Sci 2023; 13:brainsci13030469. [PMID: 36979279 PMCID: PMC10046375 DOI: 10.3390/brainsci13030469] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 03/06/2023] [Accepted: 03/08/2023] [Indexed: 03/12/2023] Open
Abstract
In the recent years, growing attention has been paid to the use of camouflaging strategies by adult populations suffering from autism spectrum disorder (ASD) with milder manifestations and without intellectual impairment, which may lead to a delay in diagnosis or even a misdiagnosis. In fact, high-functioning ASD individuals were reported to be more aware of their communication difficulties and were more likely make considerable efforts to adjust their behavior to conventional rules of non-autistic individuals, learning to imitate other non-ASD individuals. Moreover, females reported a higher frequency of camouflaging strategies, suggesting a role of camouflaging in the gender gap of the ASD diagnosis. Although camouflaging strategies can sometimes grant a better level of adjustment, even resulting in a hyper-adaptive behavior, they are also often correlated with negative mental health consequences due to the long-term stress associated with continuous attempts to adapt in day-to-day life. In this framework, the aim of the present work was to review the available studies that assessed the presence and correlates of camouflaging strategies in individuals with ASD. Although the literature available on the topic is still scarce, some interesting correlations between camouflaging and anxious and depressive symptoms, as well as suicidality, were highlighted. In particular, the controversial and sometime opposite thoughts and results about camouflaging may be clarified and integrated in light of a dimensional approach to psychopathology.
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30
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Co-Occurring Autism Spectrum and Borderline Personality Disorder: An Emerging Clinical Challenge Seeking Informed Interventions. Harv Rev Psychiatry 2023; 31:83-91. [PMID: 36884039 PMCID: PMC9997622 DOI: 10.1097/hrp.0000000000000361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
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31
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“I Always Knew I Was Different”: Experiences of Receiving a Diagnosis of Autistic Spectrum Disorder in Adulthood—a Meta-Ethnographic Systematic Review. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2023. [DOI: 10.1007/s40489-023-00356-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
AbstractA broadening of diagnostic criteria and increased awareness of autism has led to a large number of individuals whose difficulties remained undetected until adulthood. This systematic review aimed to synthesise empirical evidence of the experience of individuals who received their diagnosis of autism in adulthood. Eight studies met the inclusion criteria. A meta-ethnographic approach was used to synthesise the findings. Analysis revealed two meta-themes: feeling “like an alien” and the “not guilty” verdict, each with three associated subthemes. The findings indicate the need for timely diagnosis and provision of post-diagnostic support to alleviate the mental health implications of not having a framework to understand one’s experiences and to support the process of adjustment to the diagnosis.
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32
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EEG Features in Autism Spectrum Disorder: A Retrospective Analysis in a Cohort of Preschool Children. Brain Sci 2023; 13:brainsci13020345. [PMID: 36831889 PMCID: PMC9954463 DOI: 10.3390/brainsci13020345] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/14/2023] [Accepted: 02/15/2023] [Indexed: 02/22/2023] Open
Abstract
Autism Spectrum Disorder (ASD) is a complex neurodevelopmental disorder that can be associated with intellectual disability (ID) and epilepsy (E). The etiology and the pathogenesis of this disorder is in most cases still to be clarified. Several studies have underlined that the EEG recordings in children with these clinical pictures are abnormal, however the precise frequency of these abnormalities and their relationship with the pathogenic mechanisms and in particular with epileptic seizures are still unknown. We retrospectively reviewed 292 routine polysomnographic EEG tracings of preschool children (age < 6 years) who had received a first multidisciplinary diagnosis of ASD according to DSM-5 clinical criteria. Children (mean age: 34.6 months) were diagnosed at IRCCS E. Medea (Bosisio Parini, Italy). We evaluated: the background activity during wakefulness and sleep, the presence and the characteristics (focal or diffuse) of the slow-waves abnormalities and the interictal epileptiform discharges. In 78.0% of cases the EEG recordings were found to be abnormal, particularly during sleep. Paroxysmal slowing and epileptiform abnormalities were found in the 28.4% of the subjects, confirming the high percentage of abnormal polysomnographic EEG recordings in children with ASD. These alterations seem to be more correlated with the characteristics of the underlying pathology than with intellectual disability and epilepsy. In particular, we underline the possible significance of the prevalence of EEG abnormalities during sleep. Moreover, we analyzed the possibility that EEG data reduces the ASD clinical heterogeneity and suggests the exams to be carried out to clarify the etiology of the disorder.
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Davies C, Moosa M, McKenna K, Mittal J, Memis I, Mittal R, Eshraghi AA. Quality of Life, Neurosensory Disorders and Co-Occurring Medical Conditions in Individuals on the Spectrum, with a Special Focus on Females Diagnosed with Autism: A Systematic Review. J Clin Med 2023; 12:jcm12030927. [PMID: 36769575 PMCID: PMC9917678 DOI: 10.3390/jcm12030927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/12/2023] [Accepted: 01/16/2023] [Indexed: 01/26/2023] Open
Abstract
Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder that has a high prevalence and a significant economic impact. Our knowledge regarding neurosensory disorders and co-occurring medical conditions in the ASD population is limited, particularly for autistic women. Most of the studies include male participants or do not make comparisons with their female counterparts. The objective of this systematic review article is to explore the quality of life as well as the prevalence of neurosensory disorders and co-occurring medical conditions in individuals on the spectrum, with a special focus on autistic females. The literature search was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. A protocol of this systematic review was designed a priori and was registered in the PROSPERO database (registration number: CRD42022330368). We concluded that numerous medical areas were of concern. Autistic females are more likely than their male counterparts with ASD to suffer from psychiatric conditions such as post-traumatic stress syndrome, depression, and eating disorders. They are also more likely to report GI-related disturbances and chronic pain. Further investigations are warranted to determine quality of life, as well as the prevalence and severity of neurosensory disorders in individuals with ASD, specifically studies comparing autistic females with their male counterparts. The information derived from these studies will help develop better support systems for individuals with autism, particularly females on the spectrum, in pursuit of improving their quality of life.
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Affiliation(s)
- Camron Davies
- Hearing Research and Communication Disorders Laboratory, Department of Otolaryngology, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA
| | - Moeed Moosa
- Hearing Research and Communication Disorders Laboratory, Department of Otolaryngology, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - Keelin McKenna
- Hearing Research and Communication Disorders Laboratory, Department of Otolaryngology, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA
| | - Jeenu Mittal
- Hearing Research and Communication Disorders Laboratory, Department of Otolaryngology, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - Idil Memis
- Hearing Research and Communication Disorders Laboratory, Department of Otolaryngology, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - Rahul Mittal
- Hearing Research and Communication Disorders Laboratory, Department of Otolaryngology, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - Adrien A. Eshraghi
- Hearing Research and Communication Disorders Laboratory, Department of Otolaryngology, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
- Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
- Department of Pediatrics, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
- Correspondence:
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Saure E, Castrén M, Mikkola K, Salmi J. Intellectual disabilities moderate sex/gender differences in autism spectrum disorder: a systematic review and meta-analysis. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2023; 67:1-34. [PMID: 36444668 DOI: 10.1111/jir.12989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 10/19/2022] [Accepted: 10/19/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Girls/women with autism spectrum disorder (ASD) are suggested to exhibit different symptom profiles than boys/men with ASD. Accumulating evidence suggests that intellectual disability (ID) may affect sex/gender differences in ASD. However, a systematic review and meta-analysis on this topic is missing. METHODS Two databases (MEDLINE and PsycINFO) were used to search for studies reporting sex/gender differences (girls/women versus boys/men) in social communication and interaction, restrictive and repetitive behaviour and interests (RRBIs), sensory processing, and linguistic and motor abilities in ASD. The final sample consisted of 79 studies. The meta-analysis was performed with Review Manager using a random-effects model. Participants with ASD without and with ID were analysed as separate subgroups, and the effects in these two subgroups were also compared with each other. RESULTS Girls/women with ASD without ID displayed fewer RRBIs, more sensory symptoms and less problems in linguistic abilities than their boys/men counterparts. In contrast, girls/women with ASD with ID displayed more social difficulties and RRBIs, poorer linguistic abilities and more motor problems than boys/men with ASD with ID. Comparisons of groups of participants with ASD without ID versus participants with ASD with ID confirmed differences in sex/gender effects on social difficulties, sensory processing, linguistic abilities and motor abilities. CONCLUSIONS Our results clearly suggest that the female phenotype of ASD is moderated by ID. Among individuals with ASD with ID, girls/women seem to be more severely affected than boys/men, whereas among individuals with ASD without ID, girls/women with ASD may have less symptoms than boys/men. Such phenotypic differences could be a potential cause of underrecognition of girls/women with ASD, and it is also possible that observed phenotypic differences may reflect underdiagnosing of girls/women with ASD.
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Affiliation(s)
- E Saure
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- BABA Center and Department of Clinical Neurophysiology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - M Castrén
- Department of Physiology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - K Mikkola
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - J Salmi
- Department of Neuroscience and Biomedical Engineering, Aalto University, Espoo, Finland
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Mallipeddi NV, VanDaalen RA. Intersectionality Within Critical Autism Studies: A Narrative Review. AUTISM IN ADULTHOOD 2022; 4:281-289. [PMID: 36777375 PMCID: PMC9908281 DOI: 10.1089/aut.2021.0014] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The aim of this narrative review was to examine intersectionality within critical autism studies. A growing body of evidence has demonstrated the importance of intersectional frameworks in highlighting the diverse experiences of marginalized communities. Many disability studies researchers investigated intersectionality to elucidate the impact of race, gender, sexuality, class, and other constructs on disability identification. Within critical autism studies, a field that emerged to challenge the deficit-laden, pathologizing autism discourses favored by the medical community, intersectionality has started to become an integral component of the literature. This review highlights intersectional frameworks utilized to explore autism in both academic and nonacademic contexts, to provide a foundation for future study. Upon analysis, we found overarching themes regarding the explicit, implicit, and descriptive approaches to intersectionality, racial and gender biases within critical autism studies, and the multidisciplinary nature of intersectionality and critical autism studies. We finish the review with recommendations for how to more fully address the experiences of all autistic people-particularly of racial, gender, and sexual minority individuals-in future study. Our recommendations include utilizing intersectionality as an analytical lens for describing previously overlooked phenomena and questioning central tenets of methodology and processes, including developing research questions, analyzing data, and writing results.
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Affiliation(s)
| | - Rachel A. VanDaalen
- Department of Psychology, University of Maryland, College Park, Maryland, USA
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36
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Freeman NC, Paradis P. Parent experiences of obtaining an autism diagnosis for their daughter: An interpretative phenomenological analysis. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 27:1068-1078. [PMID: 36221957 DOI: 10.1177/13623613221129830] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
LAY ABSTRACT Autistic females are often diagnosed later than males and are also more likely to be misdiagnosed with other conditions. Co-occurring conditions may also be diagnosed at the time of the assessment but their autism diagnosis is missed. The majority of research examining the parent experience of obtaining an autism diagnosis for their child has included predominantly or exclusively male children in their samples. This study examines the experiences of parents in obtaining an autism diagnosis for their daughters in Australia through interview data which allowed for an exploration of their lived experiences. Several of the parents reported positive feelings of excitement or curiosity in relation to the assessment process which are emotions that have not been reported in earlier studies. While recent research advances have improved our understanding of gender differences in autistic behaviours, the findings of this study suggest that some practitioners have obsolete knowledge which may lead to misdiagnosis or missed diagnosis in some females. Although the extent that these experiences are representative of parents in the wider community is unknown, the fact that they are still being reported in the present day suggests that a proportion of health professionals continue to practice with outdated conceptualisations of autism.
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Kamikubo R, Wang L, Marte C, Mahmood A, Kacorri H. Data Representativeness in Accessibility Datasets: A Meta-Analysis. ASSETS. ANNUAL ACM CONFERENCE ON ASSISTIVE TECHNOLOGIES 2022; 2022:8. [PMID: 36939417 PMCID: PMC10024595 DOI: 10.1145/3517428.3544826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
As data-driven systems are increasingly deployed at scale, ethical concerns have arisen around unfair and discriminatory outcomes for historically marginalized groups that are underrepresented in training data. In response, work around AI fairness and inclusion has called for datasets that are representative of various demographic groups. In this paper, we contribute an analysis of the representativeness of age, gender, and race & ethnicity in accessibility datasets-datasets sourced from people with disabilities and older adults-that can potentially play an important role in mitigating bias for inclusive AI-infused applications. We examine the current state of representation within datasets sourced by people with disabilities by reviewing publicly-available information of 190 datasets, we call these accessibility datasets. We find that accessibility datasets represent diverse ages, but have gender and race representation gaps. Additionally, we investigate how the sensitive and complex nature of demographic variables makes classification difficult and inconsistent (e.g., gender, race & ethnicity), with the source of labeling often unknown. By reflecting on the current challenges and opportunities for representation of disabled data contributors, we hope our effort expands the space of possibility for greater inclusion of marginalized communities in AI-infused systems.
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Affiliation(s)
- Rie Kamikubo
- College of Information Studies, University of Maryland, College Park, United States
| | - Lining Wang
- Department of Computer Science, University of Maryland, College Park, United States
| | - Crystal Marte
- College of Information Studies, University of Maryland, College Park, United States
| | - Amnah Mahmood
- Department of Mathematics, University of Maryland, College Park, United States
| | - Hernisa Kacorri
- College of Information Studies, University of Maryland, College Park, United States
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Wechsler Intelligence Scale for Adults - Fourth Edition profiles of adults with autism spectrum disorder. Epidemiol Psychiatr Sci 2022; 31:e67. [PMID: 36148868 PMCID: PMC9531589 DOI: 10.1017/s2045796022000506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
AIM In this study, we have compared 229 Wechsler Adults Intelligence Scale - Fourth Edition (WAIS-IV) cognitive profiles of different severity adults with autism spectrum disorder to verify the impact of several variables including sex, age, level of education and autism severity level in an Italian sample. Moreover, we wanted to find out the optimal cut points for the major intelligence quotients in order to discriminate autism severity levels. METHODS Participants were recruited from two National Health System Center in two different Italian regions and were assessed with gold-standard instruments as a part of their clinical evaluation. According to DSM-5, cognitive domains were also measured with multi-componential tests. We used the Italian adaptation of WAIS-IV. We checked our hypotheses using linear regression models and receiver operating characteristics (ROC) curves. RESULTS Our results showed that age and level of education have a strong impact on Verbal Comprehension (VCI) and Working Memory Indexes (WMI). Gender differences are relevant when considering the VCI and Processing Speed index (PSI) in which women obtained the best performance. These differences are still relevant when considering cut points of ROC because 69 resulted to be the optimal cut point for women, 65 for men. CONCLUSIONS Few conclusions can be assumed only examining Full Scale Intelligence Quotient (FSIQ) scores as it includes many different information about broader cognitive abilities. Looking deeper at main indexes and their subtests findings are consistent with previous research on the disorder (moderate correlations of FSIQ, Perceptual Reasoning index, WMI and PSI with the participants' age), while other results are unforeseen (no effect of sex found on FSIQ score) or novel (significant effect of education on VCI and WMI). Using an algorithm predicting optimal cut point for discriminating through autism severity levels can help clinicians to better label and quantify the required help a person may need, a test cannot replace diagnostic and clinical evaluation by experienced clinicians.
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Murphy S, Flower RL, Jellett R. Women seeking an autism diagnosis in Australia: A qualitative exploration of factors that help and hinder. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 27:808-821. [PMID: 35978525 DOI: 10.1177/13623613221117911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
LAY ABSTRACT An autism diagnosis can have a big impact on women and make it possible to access support. This study explored women's experiences of being diagnosed with autism as an adult in Australia, to try to understand what was helpful (facilitators) and unhelpful (barriers) for them during this process. We interviewed 10 autistic women who had been diagnosed in the last 5 years. Framework analysis was used to understand the data. We wanted to understand barriers and facilitators relating to the individual participants, the professionals they saw and the system they went through for their diagnostic assessment. Women reported that being able to recognise they were autistic, being motivated, preparing for the assessment, having social support and unmasking to be themselves were helpful during the diagnostic process. They reported that having a knowledgeable diagnostician who made accommodations for their needs assisted them during the assessment process. When providers dismissed the participants when they first raised the possibility they were autistic, it delayed them in seeking an assessment. At the system level, the women in this study found some aspects of the healthcare system difficult to navigate, particularly costs and long waitlists. Some found the assessment tools used were not well suited to them. The experiences of the women in this study highlight improvements that could be made to accessing an adulthood autism diagnosis in Australia. These include improving provider knowledge of the varied presentation of autism and the development of resources to help autistic women prepare for their diagnostic assessment.
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Chellew T, Barbaro J, Freeman NC. The Early Childhood Signs of Autism in Females: a Systematic Review. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2022. [DOI: 10.1007/s40489-022-00337-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
AbstractCompared to males, females are at a much greater likelihood of receiving a later diagnosis of autism, which impacts their opportunity to receive early support. To assist with early identification, this systematic literature review aimed to ascertain whether females differ from males in the early childhood signs of autism. The small number of heterogeneous studies made it difficult to draw conclusions, although it appears that females and males under 6 years of age are more similar than different in terms of their expression of autistic behaviours. Given the discrepant sex/gender ratio in autism, these findings highlight the importance of exploring whether there are different and/or specific, not yet identified, early signs of autism in females and males.
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Diemer MC, Gerstein ED, Regester A. Autism presentation in female and Black populations: Examining the roles of identity, theory, and systemic inequalities. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 26:1931-1946. [PMID: 35899909 DOI: 10.1177/13623613221113501] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
LAY ABSTRACT Although the prevalence of autism has been rising in recent years, disparities in diagnosis still remain. Female and Black populations in the United States are diagnosed later, are more likely to have an intellectual disability, and are excluded from research as well as services designed for autistic individuals. Autistic Black girls are effectively invisible in the current scientific literature. Intersectional theory, which looks at a person as a whole, examines models that are inclusive toward diverse gender, ability, and racial/ethnic backgrounds. This theory may be a useful approach to clinical and research work with autism so that practitioners may be most effective for the whole population of autistic people. The authors recommend research focusing on inclusion of autistic populations with intellectual disability and research studies that include evaluations as part of the procedure. Clinically, the authors recommend a focus on screening all young children for autism and improving provider knowledge in working with diverse autistic populations.
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Frigaux A, Vacant C, Evrard R. Le devenir autiste au féminin : difficultés diagnostiques et ressources subjectives. Une revue de littérature. EVOLUTION PSYCHIATRIQUE 2022. [DOI: 10.1016/j.evopsy.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Cross-frequency coupling in psychiatric disorders: A systematic review. Neurosci Biobehav Rev 2022; 138:104690. [PMID: 35569580 DOI: 10.1016/j.neubiorev.2022.104690] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 05/02/2022] [Accepted: 05/08/2022] [Indexed: 11/21/2022]
Abstract
Cross-frequency coupling (CFC), an electrophysiologically derived measure of oscillatory coupling in the brain, is believed to play a critical role in neuronal computation, learning and communication. It has received much recent attention in the study of both health and disease. We searched for literature that studied CFC during resting state and task-related activities during electroencephalography and magnetoencephalography in psychiatric disorders. Thirty-eight studies were identified, which included attention-deficit hyperactivity disorder, Alzheimer's dementia, autism spectrum disorder, bipolar disorder, depression, obsessive compulsive disorder, social anxiety disorder and schizophrenia. The systematic review was registered with PROSPERO (ID#CRD42021224188). The current review indicates measurable differences exist between CFC in disease states vs. healthy controls. There was variance in CFC at different regions of the brain within the same psychiatric disorders, perhaps this could be explained by the mechanisms and functionality of CFC. There was heterogeneity in methodologies used, which may lead to spurious CFC analyses. Going forward, standardized methodologies need to be established and utilized in further research to understand the neuropathophysiology associated with psychiatric disorders.
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Russell G, Stapley S, Newlove-Delgado T, Salmon A, White R, Warren F, Pearson A, Ford T. Time trends in autism diagnosis over 20 years: a UK population-based cohort study. J Child Psychol Psychiatry 2022; 63:674-682. [PMID: 34414570 DOI: 10.1111/jcpp.13505] [Citation(s) in RCA: 76] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/30/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Autism spectrum disorder is a diagnosis that is increasingly applied; however, previous studies have conflicting findings whether rates of diagnosis rates continue to grow in the UK. This study tested whether the proportion of people receiving a new autism diagnosis has been increasing over a twenty-year period, both overall and by subgroups. METHOD Population-based study utilizing the Clinical Practice Research Datalink (CPRD) primary care database, which contains patients registered with practices contributing data to the CPRD between 1998 and 2018 (N = 6,786,212 in 1998 to N = 9,594,598 in 2018). 65,665 patients had a diagnosis of autism recorded in 2018. Time trend of new (incident) cases of autism diagnosis was plotted for all, and stratified by gender, diagnostic subtypes, and developmental stage: infancy and preschool, 0-5 years old; childhood, 6-11 years old; adolescence, 12-19 years old; adults, over 19 years old. RESULTS There was a 787%, exponential increase in recorded incidence of autism diagnoses between 1998 and 2018; R2 = 0.98, exponentiated coefficient = 1.07, 95% CI [1.06, 1.08], p < .001. The increase in diagnoses was greater for females than males (exponentiated interaction coefficient = 1.02, 95% CI [1.01, 1.03], p < .001) and moderated by age band, with the greatest rises in diagnostic incidence among adults (exponentiated interaction coefficient = 1.06, 95% CI [1.04, 1.07], p < .001). CONCLUSIONS Increases could be due to growth in prevalence or, more likely, increased reporting and application of diagnosis. Rising diagnosis among adults, females and higher functioning individuals suggest augmented recognition underpins these changes.
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Affiliation(s)
- Ginny Russell
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Sal Stapley
- College of Medicine and Health, University of Exeter, Exeter, UK
| | | | - Andrew Salmon
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Rhianna White
- Department of Psychology, University of Bath, Bath, UK
| | - Fiona Warren
- College of Medicine and Health, University of Exeter, Exeter, UK
| | | | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, Cambridge, UK
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Riddiford JA, Enticott PG, Lavale A, Gurvich C. Gaze and social functioning associations in autism spectrum disorder: A systematic review and meta-analysis. Autism Res 2022; 15:1380-1446. [PMID: 35593039 PMCID: PMC9543973 DOI: 10.1002/aur.2729] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 03/08/2022] [Accepted: 03/28/2022] [Indexed: 12/11/2022]
Abstract
Autism spectrum disorder (ASD) is characterized by significant social functioning impairments, including (but not limited to) emotion recognition, mentalizing, and joint attention. Despite extensive investigation into the correlates of social functioning in ASD, only recently has there been focus on the role of low‐level sensory input, particularly visual processing. Extensive gaze deficits have been described in ASD, from basic saccadic function through to social attention and the processing of complex biological motion. Given that social functioning often relies on accurately processing visual information, inefficient visual processing may contribute to the emergence and sustainment of social functioning difficulties in ASD. To explore the association between measures of gaze and social functioning in ASD, a systematic review and meta‐analysis was conducted. A total of 95 studies were identified from a search of CINAHL Plus, Embase, OVID Medline, and psycINFO databases in July 2021. Findings support associations between increased gaze to the face/head and eye regions with improved social functioning and reduced autism symptom severity. However, gaze allocation to the mouth appears dependent on social and emotional content of scenes and the cognitive profile of participants. This review supports the investigation of gaze variables as potential biomarkers of ASD, although future longitudinal studies are required to investigate the developmental progression of this relationship and to explore the influence of heterogeneity in ASD clinical characteristics.
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Affiliation(s)
- Jacqueline A Riddiford
- Department of Psychiatry, Central Clinical School, Monash University, Melbourne, Victoria
| | - Peter G Enticott
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, Australia
| | - Alex Lavale
- Department of Psychiatry, Central Clinical School, Monash University, Melbourne, Victoria
| | - Caroline Gurvich
- Department of Psychiatry, Central Clinical School, Monash University, Melbourne, Victoria
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Stroth S, Tauscher J, Wolff N, Küpper C, Poustka L, Roepke S, Roessner V, Heider D, Kamp-Becker I. Phenotypic differences between female and male individuals with suspicion of autism spectrum disorder. Mol Autism 2022; 13:11. [PMID: 35255969 PMCID: PMC8900413 DOI: 10.1186/s13229-022-00491-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 02/22/2022] [Indexed: 11/16/2022] Open
Abstract
Background Although autism spectrum disorder (ASD) is a common developmental disorder, our knowledge about a behavioral and neurobiological female phenotype is still scarce. As the conceptualization and understanding of ASD are mainly based on the investigation of male individuals, females with ASD may not be adequately identified by routine clinical diagnostics. The present machine learning approach aimed to identify diagnostic information from the Autism Diagnostic Observation Schedule (ADOS) that discriminates best between ASD and non-ASD in females and males. Methods Random forests (RF) were used to discover patterns of symptoms in diagnostic data from the ADOS (modules 3 and 4) in 1057 participants with ASD (18.1% female) and 1230 participants with non-ASD (17.9% % female). Predictive performances of reduced feature models were explored and compared between females and males without intellectual disabilities. Results Reduced feature models relied on considerably fewer features from the ADOS in females compared to males, while still yielding similar classification performance (e.g., sensitivity, specificity). Limitations As in previous studies, the current sample of females with ASD is smaller than the male sample and thus, females may still be underrepresented, limiting the statistical power to detect small to moderate effects. Conclusion Our results do not suggest the need for new or altered diagnostic algorithms for females with ASD. Although we identified some phenotypic differences between females and males, the existing diagnostic tools seem to sufficiently capture the core autistic features in both groups. Supplementary Information The online version contains supplementary material available at 10.1186/s13229-022-00491-9.
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Harmens M, Sedgewick F, Hobson H. The Quest for Acceptance: A Blog-Based Study of Autistic Women's Experiences and Well-Being During Autism Identification and Diagnosis. AUTISM IN ADULTHOOD 2022; 4:42-51. [PMID: 36605564 PMCID: PMC8992923 DOI: 10.1089/aut.2021.0016] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background Although studies have found that autism is underdiagnosed in women and that autistic women have poorer well-being outcomes than men, less is known about autistic women's experiences with self-identification or diagnosis or how they feel such experiences affect their mental health. Methods We explored autistic women's experiences of coming to recognize and understand themselves as autistic. We used data collected from blogs written by autistic women about their diagnostic or self-identification experiences. We were particularly interested in well-being, and how this contributed to, was affected by, and interacted with the identification and diagnostic process. We used thematic analysis to explore and document experiences described in blogs from 20 blogsites (representing the views of 23 autistic women). Results Acceptance was a central issue. We developed themes of self-understanding and self-acceptance, being understood and accepted by others (including peers, clinicians, and others in the autism community), and the exhaustion resulting from trying to be accepted and be understood. These issues arose both when going through the diagnostic process, and after receiving a formal diagnosis. Conclusions Diagnosis and identification may have both positive and negative effects on autistic women's well-being, with women often describing difficulties after diagnosis as stemming from facing male stereotypes of autism. We consider the implications of our findings for clinicians, researchers, and those who work with autistic women.
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Affiliation(s)
- Miriam Harmens
- Department of Psychology, University of York, Heslington, York, United Kingdom
| | | | - Hannah Hobson
- Department of Psychology, University of York, Heslington, York, United Kingdom.,Address correspondence to: Hannah Hobson, DPhil, Department of Psychology, University of York, YO10 5DD York, United Kingdom
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Rujeedawa T, Zaman SH. The Diagnosis and Management of Autism Spectrum Disorder (ASD) in Adult Females in the Presence or Absence of an Intellectual Disability. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:1315. [PMID: 35162336 PMCID: PMC8835194 DOI: 10.3390/ijerph19031315] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/14/2022] [Accepted: 01/20/2022] [Indexed: 01/04/2023]
Abstract
We review the reasons for the greater male predominance in the diagnosis of autism spectrum disorder in the non-intellectual disabled population and compare it to autism diagnosed in intellectually disabled individuals. Accurate and timely diagnosis is important, as it reduces health inequalities. Females often present later for the diagnosis. The differences are in core features, such as in social reciprocal interaction through 'camouflaging' and restricted repetitive behaviours, that are less noticeable in females and are potentially explained by the biological differences (female protective effect theory) and/or differences in presentation between the two sexes (female autism phenotype theory). Females more often present with internalising co-occurring conditions than males. We review these theories, highlighting the key differences and the impact of a diagnosis on females. We review methods to potentially improve diagnosis in females along with current and future management strategies.
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Affiliation(s)
| | - Shahid H. Zaman
- Cambridge Intellectual & Developmental Disabilities Research Group, Department of Psychiatry, University of Cambridge, Cambridge CB2 8AH, UK;
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Calderoni S. Sex/gender differences in children with autism spectrum disorder: A brief overview on epidemiology, symptom profile, and neuroanatomy. J Neurosci Res 2022; 101:739-750. [PMID: 35043482 DOI: 10.1002/jnr.25000] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 11/01/2021] [Accepted: 12/03/2021] [Indexed: 12/11/2022]
Abstract
Autism spectrum disorders (ASD) are a heterogeneous group of neurodevelopmental conditions whose shared core features are impairments in social interaction and communication as well as restricted patterns of behavior, interests, and activities. The significant and consistent male preponderance in ASD prevalence has historically affected the scientific knowledge of autism in females as regards, inter alia, the clinical presentation, the genetic architecture, and the structural brain underpinnings. Indeed, females with ASD are under-investigated as samples recruited for clinical research typically reflect the strong male bias of the disorder. In the last years, the study of the various aspects of sex/gender (s/g) differences in ASD is gaining increased clinical and research interest resulting in a growing number of investigations on this topic. Here, I review and discuss evidence emerged from epidemiological, clinical, and neuroimaging studies in the last decade focusing on s/g differences in children with ASD. These studies are the prerequisites for the development of assessment and treatment practices which take into consideration s/g differences in ASD. Ultimately, a better understanding of s/g differences aims at improving healthcare for both ASD males and females.
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Affiliation(s)
- Sara Calderoni
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy.,Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Cola M, Yankowitz LD, Tena K, Russell A, Bateman L, Knox A, Plate S, Cubit LS, Zampella CJ, Pandey J, Schultz RT, Parish-Morris J. Friend matters: sex differences in social language during autism diagnostic interviews. Mol Autism 2022; 13:5. [PMID: 35012645 PMCID: PMC8751321 DOI: 10.1186/s13229-021-00483-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 12/21/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Autistic individuals frequently experience social communication challenges. Girls are diagnosed with autism less often than boys even when their symptoms are equally severe, which may be due to insufficient understanding of the way autism manifests in girls. Differences in the behavioral presentation of autism, including how people talk about social topics, could contribute to these persistent problems with identification. Despite a growing body of research suggesting that autistic girls and boys present distinct symptom profiles in a variety of domains, including social attention, friendships, social motivation, and language, differences in the way that autistic boys and girls communicate verbally are not yet well understood. Closely analyzing boys' and girls' socially-focused language during semi-structured clinical assessments could shed light on potential sex differences in the behavioral presentation of autistic individuals that may prove useful for identifying and effectively supporting autistic girls. Here, we compare social word use in verbally fluent autistic girls and boys during the interview sections of the ADOS-2 Module 3 and measure associations with clinical phenotype. METHODS School-aged girls and boys with autism (N = 101, 25 females; aged 6-15) were matched on age, IQ, and parent/clinician ratings of autism symptom severity. Our primary analysis compared the number of social words produced by autistic boys and girls (normalized to account for differences in total word production). Social words are words that make reference to other people, including friends and family. RESULTS There was a significant main effect of sex on social word production, such that autistic girls used more social words than autistic boys. To identify the specific types of words driving this effect, additional subcategories of friend and family words were analyzed. There was a significant effect of sex on friend words, with girls using significantly more friend words than boys. However, there was no significant main effect of sex on family words, suggesting that sex differences in social word production may be driven by girls talking more about friends compared to boys, not family. To assess relationships between word use and clinical phenotype, we modeled ADOS-2 Social Affect (SA) scores as a function of social word production. In the overall sample, social word use correlated significantly with ADOS-2 SA scores, indicating that participants who used more social words were rated as less socially impaired by clinicians. However, when examined in each sex separately, this result only held for boys. LIMITATIONS This study cannot speak to the ways in which social word use may differ for younger children, adults, or individuals who are not verbally fluent; in addition, there were more autistic boys than girls in our sample, making it difficult to detect small effects. CONCLUSIONS Autistic girls used significantly more social words than boys during a diagnostic assessment-despite being matched on age, IQ, and both parent- and clinician-rated autism symptom severity. Sex differences in linguistic markers of social phenotype in autism are especially important in light of the late or missed diagnoses that disproportionately affect autistic girls. Specifically, heightened talk about social topics could complicate autism referral and diagnosis when non-clinician observers expect a male-typical pattern of reduced social focus, which autistic girls may not always exhibit.
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Affiliation(s)
- Meredith Cola
- Center for Autism Research, Children’s Hospital of Philadelphia, 2716 South St, Philadelphia, PA 19104 USA
- Department of Psychology, La Salle University, 1900 West Olney Ave, Philadelphia, PA 19141 USA
| | - Lisa D. Yankowitz
- Center for Autism Research, Children’s Hospital of Philadelphia, 2716 South St, Philadelphia, PA 19104 USA
- Department of Psychology, University of Pennsylvania, 3720 Walnut St, Philadelphia, PA 19104 USA
| | - Kimberly Tena
- Center for Autism Research, Children’s Hospital of Philadelphia, 2716 South St, Philadelphia, PA 19104 USA
| | - Alison Russell
- Center for Autism Research, Children’s Hospital of Philadelphia, 2716 South St, Philadelphia, PA 19104 USA
| | - Leila Bateman
- Center for Autism Research, Children’s Hospital of Philadelphia, 2716 South St, Philadelphia, PA 19104 USA
| | - Azia Knox
- Center for Autism Research, Children’s Hospital of Philadelphia, 2716 South St, Philadelphia, PA 19104 USA
| | - Samantha Plate
- Department of Psychology, University of Pittsburgh, 210 S. Bouquet St, Pittsburgh, PA 15213 USA
| | - Laura S. Cubit
- Center for Autism Research, Children’s Hospital of Philadelphia, 2716 South St, Philadelphia, PA 19104 USA
| | - Casey J. Zampella
- Center for Autism Research, Children’s Hospital of Philadelphia, 2716 South St, Philadelphia, PA 19104 USA
| | - Juhi Pandey
- Center for Autism Research, Children’s Hospital of Philadelphia, 2716 South St, Philadelphia, PA 19104 USA
- Department of Psychiatry, Perelman School of Medicine of the University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104 USA
| | - Robert T. Schultz
- Center for Autism Research, Children’s Hospital of Philadelphia, 2716 South St, Philadelphia, PA 19104 USA
- Department of Pediatrics, Perelman School of Medicine of the University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104 USA
| | - Julia Parish-Morris
- Center for Autism Research, Children’s Hospital of Philadelphia, 2716 South St, Philadelphia, PA 19104 USA
- Department of Psychiatry, Perelman School of Medicine of the University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104 USA
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