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Uljarević M, Frazier TW, Chetcuti L. Asperger syndrome and clinical heterogeneity: Reflections on the past, present, and future. Dev Med Child Neurol 2023; 65:1414-1415. [PMID: 37641436 DOI: 10.1111/dmcn.15741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 08/07/2023] [Indexed: 08/31/2023]
Affiliation(s)
- Mirko Uljarević
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, CA, Stanford, USA
| | - Thomas W Frazier
- Department of Psychology, John Carroll University, University Heights, OH, USA
| | - Lacey Chetcuti
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, CA, Stanford, USA
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
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Ahtam B, Braeutigam S, Bailey A. Semantic Processing in Autism Spectrum Disorders Is Associated With the Timing of Language Acquisition: A Magnetoencephalographic Study. Front Hum Neurosci 2020; 14:267. [PMID: 32754020 PMCID: PMC7366733 DOI: 10.3389/fnhum.2020.00267] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 06/15/2020] [Indexed: 12/23/2022] Open
Abstract
Individuals with autism show difficulties in using sentence context to identify the correct meaning of ambiguous words, such as homonyms. In this study, the brain basis of sentence context effects on word understanding during reading was examined in autism spectrum disorder (ASD) and typical development (TD) using magnetoencephalography. The correlates of a history of developmental language delay in ASD were also investigated. Event related field responses at early (150 ms after the onset of a final word) and N400 latencies are reported for three different types of sentence final words: dominant homonyms, subordinate homonyms, and unambiguous words. Clear evidence for semantic access was found at both early and conventional N400 latencies in both TD participants and individuals with ASD with no history of language delay. By contrast, modulation of evoked activity related to semantic access was weak and not significant at early latencies in individuals with ASD with a history of language delay. The reduced sensitivity to semantic context in individuals with ASD and language delay was accompanied by strong right hemisphere lateralization at early and N400 latencies; such strong activity was not observed in TD individuals and individuals with ASD without a history of language delay at either latency. These results provide new evidence and support for differential neural mechanisms underlying semantic processing in ASD, and indicate that delayed language acquisition in ASD is associated with different lateralization and processing of language.
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Affiliation(s)
- Banu Ahtam
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Department of Pediatrics, Division of Newborn Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, United States
| | - Sven Braeutigam
- Oxford Centre for Human Brain Activity, Wellcome Centre for Integrative Neuroimaging, Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Anthony Bailey
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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Recognising autism: a latent transition analysis of parental reports of child autistic spectrum disorder 'red flag' traits before and after age 3. Soc Psychiatry Psychiatr Epidemiol 2019; 54:703-713. [PMID: 30758542 DOI: 10.1007/s00127-019-01664-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 01/21/2019] [Indexed: 01/01/2023]
Abstract
PURPOSE It has been proposed that parents should be educated about child autistic spectrum disorder (ASD) 'red flag' traits to help professionals identify and address concerning behaviours as early as possible. This study aimed to empirically demonstrate that established/recognised 'red flag' traits in the first 3 years of life would reliably predict ASD risk severity in later childhood, associated with established ASD risk correlates and mirroring functioning diagnostic categories. METHODS Using retrospective parental report data from the Mental Health of Children and Young People in Great Britain survey (N = 7977), latent class analysis (LCA) and a quasi -latent transition analysis were used to (1) identify profiles of variation in parent reports of child 'red flag' traits before and after age 3 and (2) model transitions in risk from 3 years and below to ≥ 3 years, respectively, per the 'optimal outcome' model. RESULTS Three distinct classes, each characterised by variation in parent 'red flag' trait reporting were identified for the '≤ 3 years of age' and the '≥ 3 years of age' data. Both LCA class profiles comprised groups of children characterised by low, medium and high ASD risk. Dose-response effects for a number of recognised ASD correlates across the low, moderate and high risk '≥ 3 years of age' classes seemed to validate older classes in terms of ASD relevance. Over 54% of children characterised by the highest levels of ASD 'red flag' trait probability at 3 years and below (2% of sample), also populated the high-risk class evidenced in the '≥ 3 years of age' LCA. CONCLUSIONS Retrospective parental reports of child ASD 'red flag' traits ≤ 3 years of age were reliable indicators of ASD risk in later childhood.
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Bitsika V, Arnold WM, Sharpley CF. Cluster analysis of autism spectrum disorder symptomatology: Qualitatively distinct subtypes or quantitative degrees of severity of a single disorder? RESEARCH IN DEVELOPMENTAL DISABILITIES 2018; 76:65-75. [PMID: 29579688 DOI: 10.1016/j.ridd.2018.03.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Revised: 03/08/2018] [Accepted: 03/12/2018] [Indexed: 06/08/2023]
Abstract
The decision to collapse several related disorders into a single diagnosis of Autism Spectrum Disorder (ASD) generated significant controversy and debate. There has been mixed evidence as to whether various ASD subtypes are qualitatively distinct or if they exist on a spectrum of symptom severity. The present study conducted a two-step cluster analysis of major ASD symptoms in a sample of 147 young males with ASD aged between 6yr and 18yr with IQ > 70. Results indicated that a two-cluster solution (high and low severity of ASD symptomatology) was reliable and valid. Further, the construct of challenging behaviour was not a necessary component of the two-cluster solution, verifying the new conceptualisation of ASD. Further replication of these findings with other subsets of individuals with ASD is needed.
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Affiliation(s)
- Vicki Bitsika
- Centre for Autism Spectrum Disorder, Bond University, Robina, Queensland, 4229, Australia
| | - Wayne M Arnold
- Centre for Autism Spectrum Disorder, Bond University, Robina, Queensland, 4229, Australia
| | - Christopher F Sharpley
- Brain-Behaviour Research Group, University of New England, Armidale, 2351, New South Wales, Australia.
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Barahona-Corrêa JB, Filipe CN. A Concise History of Asperger Syndrome: The Short Reign of a Troublesome Diagnosis. Front Psychol 2016; 6:2024. [PMID: 26834663 PMCID: PMC4725185 DOI: 10.3389/fpsyg.2015.02024] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 12/18/2015] [Indexed: 11/13/2022] Open
Abstract
First described in 1944 by Hans Asperger (1944), it was not before 1994 that Asperger Syndrome (AS) was included in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, only to disappear in the Manual's fifth edition in 2013. During its brief existence as a diagnostic entity, AS aroused immense interest and controversy. Similar to patients with autism, AS patients show deficits in social interaction, inappropriate communication skills, and interest restriction, but also display a rich variety of subtle clinical characteristics that for many distinguish AS from autism. However, difficulties operationalising diagnostic criteria and differentiating AS from autism ultimately led to its merging into the unifying category of Autistic Spectrum Disorders. Here we briefly review the short history of this fascinating condition.
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Affiliation(s)
- J. B. Barahona-Corrêa
- Department of Psychiatry and Mental Health, Nova Medical School/Faculdade de Ciências Médicas - Universidade Nova de LisboaLisbon, Portugal
- Neuropsychiatry Unit, Champalimaud Clinical Centre, Fundação ChampalimaudLisbon, Portugal
- Centro de Apoio ao Desenvolvimento Infantil – CADINCascais, Portugal
- Department of Psychiatry and Mental Health, Centro Hospitalar de Lisboa OcidentalLisbon, Portugal
| | - Carlos N. Filipe
- Department of Physiology, Nova Medical School/Faculdade de Ciências Médicas - Universidade Nova de LisboaLisbon, Portugal
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Abstract
INTRODUCTION For the past two decades, researchers have been using various approaches to investigate the relationship, if any, between autism spectrum disorder (ASD) and violence. The need to clarify that relationship was reinforced by the tragic mass shooting at Sandy Hook Elementary School in Newtown, Connecticut, in December 2012 by an individual diagnosed with Asperger's syndrome. The purpose of this article is (1) to provide an updated review of the literature on the association between ASD and violence, and (2) to examine implications for treating, and for preventing violence by, individuals with ASD. METHOD A review of all published literature regarding ASD and violence from 1943 to 2014 was conducted using electronic and paper searches. RESULTS Although some case reports have suggested an increased violence risk in individuals with ASD compared to the general population, prevalence studies have provided no conclusive evidence to support this suggestion. Among individuals with ASD, however, generative (e.g., comorbid psychopathology, social-cognition deficits, emotion-regulation problems) and associational (e.g., younger age, Asperger's syndrome diagnosis, repetitive behavior) risk factors have been identified or proposed for violent behavior. CONCLUSIONS While no conclusive evidence indicates that individuals with ASD are more violent than those without ASD, specific generative and associational risk factors may increase violence risk among individuals with ASD. Further research would help to clarify or confirm these findings, suggest potential directions for evaluation, treatment, and prevention, and potentially provide compelling empirical support for forensic testimony regarding defendants with ASD charged with violent crimes.
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Affiliation(s)
- David S Im
- From the University of Michigan Medical School and Center for Forensic Psychiatry, Saline, MI
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Lai MC, Lombardo MV, Ecker C, Chakrabarti B, Suckling J, Bullmore ET, Happé F, Murphy DGM, Baron-Cohen S. Neuroanatomy of Individual Differences in Language in Adult Males with Autism. Cereb Cortex 2015; 25:3613-28. [PMID: 25249409 PMCID: PMC4585508 DOI: 10.1093/cercor/bhu211] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
One potential source of heterogeneity within autism spectrum conditions (ASC) is language development and ability. In 80 high-functioning male adults with ASC, we tested if variations in developmental and current structural language are associated with current neuroanatomy. Groups with and without language delay differed behaviorally in early social reciprocity, current language, but not current autistic features. Language delay was associated with larger total gray matter (GM) volume, smaller relative volume at bilateral insula, ventral basal ganglia, and right superior, middle, and polar temporal structures, and larger relative volume at pons and medulla oblongata in adulthood. Despite this heterogeneity, those with and without language delay showed significant commonality in morphometric features when contrasted with matched neurotypical individuals (n = 57). In ASC, better current language was associated with increased GM volume in bilateral temporal pole, superior temporal regions, dorsolateral fronto-parietal and cerebellar structures, and increased white matter volume in distributed frontal and insular regions. Furthermore, current language-neuroanatomy correlation patterns were similar across subgroups with or without language delay. High-functioning adult males with ASC show neuroanatomical variations associated with both developmental and current language characteristics. This underscores the importance of including both developmental and current language as specifiers for ASC, to help clarify heterogeneity.
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Affiliation(s)
- Meng-Chuan Lai
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge CB2 8AH, UK,Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei 10051, Taiwan
| | - Michael V. Lombardo
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge CB2 8AH, UK,Department of Psychology and Center for Applied Neuroscience, University of Cyprus, Nicosia CY 1678, Cyprus
| | - Christine Ecker
- Sackler Institute for Translational Neurodevelopment, Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, King's College London, PO23, Institute of Psychiatry, London SE5 8AF, UK
| | - Bhismadev Chakrabarti
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge CB2 8AH, UK,School of Psychology and Clinical Language Sciences, Centre for Integrative Neuroscience and Neurodynamics, University of Reading, Reading RG6 6AL, UK
| | - John Suckling
- Brain Mapping Unit, Department of Psychiatry, University of Cambridge, Cambridge CB2 0SZ, UK,Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge CB21 5EF, UK
| | - Edward T. Bullmore
- Brain Mapping Unit, Department of Psychiatry, University of Cambridge, Cambridge CB2 0SZ, UK,GlaxoSmithKline, Clinical Unit Cambridge, Addenbrooke's Hospital, Cambridge CB2 2QQ, UK,Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge CB21 5EF, UK
| | - Francesca Happé
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, PO80, Institute of Psychiatry, London SE5 8AF, UK
| | | | - Declan G. M. Murphy
- Sackler Institute for Translational Neurodevelopment, Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, King's College London, PO23, Institute of Psychiatry, London SE5 8AF, UK
| | - Simon Baron-Cohen
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge CB2 8AH, UK,Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge CB21 5EF, UK
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Abstract
The fifth edition of the diagnostic and statistical manual of mental disorders (DSM-5) (APA in diagnostic and statistical manual of mental disorders, Author, Washington, 2013) has decided to merge the subtypes of pervasive developmental disorders into a single category of autism spectrum disorder (ASD) on the assumption that they cannot be reliably differentiated from one another. The purpose of this review is to analyze the basis of this assumption by examining the comparative studies between Asperger's disorder (AsD) and autistic disorder (AD), and between pervasive developmental disorder not otherwise specified (PDDNOS) and AD. In all, 125 studies compared AsD with AD. Of these, 30 studies concluded that AsD and AD were similar conditions while 95 studies found quantitative and qualitative differences between them. Likewise, 37 studies compared PDDNOS with AD. Nine of these concluded that PDDNOS did not differ significantly from AD while 28 reported quantitative and qualitative differences between them. Taken together, these findings do not support the conceptualization of AD, AsD and PDDNOS as a single category of ASD. Irrespective of the changes proposed by the DSM-5, future research and clinical practice will continue to find ways to meaningfully subtype the ASD.
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Abstract
PURPOSE OF REVIEW In the lead up to and following the recent publication of the DSM-5, the diagnostic construct of autism has received intense scrutiny. RECENT FINDINGS This article briefly reviews the history of the diagnosis of autism, the changes that have occurred in the diagnosis over time, and the rationale for change. The most significant changes being introduced with the DSM-5 are highlighted, as well as some of the concerns that will be a focus of attention with respect to the potential impacts going forward. SUMMARY The categorical divisions that characterized the pervasive developmental disorders are now collapsed into a single entity, autism spectrum disorder. The final DSM-5 criteria have yet to be formally compared prospectively against prior criteria, but early indications suggest that the boundaries around the pervasive developmental disorders have not been substantially altered.
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Affiliation(s)
- Bryan H. King
- Seattle Children’s Hospital, Seattle, USA
- University of Washington Psychiatry & Behavioral Sciences, Washington, USA
| | - Noa Navot
- University of Washington Psychiatry & Behavioral Sciences, Washington, USA
| | - Raphael Bernier
- Seattle Children’s Hospital, Seattle, USA
- University of Washington Psychiatry & Behavioral Sciences, Washington, USA
| | - Sara Jane Webb
- Seattle Children’s Hospital, Seattle, USA
- University of Washington Psychiatry & Behavioral Sciences, Washington, USA
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