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Zhou D, Hua T, Tang H, Yang R, Huang L, Gong Y, Zhang L, Tang G. Gender and age related brain structural and functional alterations in children with autism spectrum disorder. Cereb Cortex 2024; 34:bhae283. [PMID: 38997211 DOI: 10.1093/cercor/bhae283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 06/10/2024] [Indexed: 07/14/2024] Open
Abstract
To explore the effects of age and gender on the brain in children with autism spectrum disorder using magnetic resonance imaging. 185 patients with autism spectrum disorder and 110 typically developing children were enrolled. In terms of gender, boys with autism spectrum disorder had increased gray matter volumes in the insula and superior frontal gyrus and decreased gray matter volumes in the inferior frontal gyrus and thalamus. The brain regions with functional alterations are mainly distributed in the cerebellum, anterior cingulate gyrus, postcentral gyrus, and putamen. Girls with autism spectrum disorder only had increased gray matter volumes in the right cuneus and showed higher amplitude of low-frequency fluctuation in the paracentral lobule, higher regional homogeneity and degree centrality in the calcarine fissure, and greater right frontoparietal network-default mode network connectivity. In terms of age, preschool-aged children with autism spectrum disorder exhibited hypo-connectivity between and within auditory network, somatomotor network, and visual network. School-aged children with autism spectrum disorder showed increased gray matter volumes in the rectus gyrus, superior temporal gyrus, insula, and suboccipital gyrus, as well as increased amplitude of low-frequency fluctuation and regional homogeneity in the calcarine fissure and precentral gyrus and decreased in the cerebellum and anterior cingulate gyrus. The hyper-connectivity between somatomotor network and left frontoparietal network and within visual network was found. It is essential to consider the impact of age and gender on the neurophysiological alterations in autism spectrum disorder children when analyzing changes in brain structure and function.
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Affiliation(s)
- Di Zhou
- Department of Radiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Ting Hua
- Department of Radiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Huan Tang
- Department of Radiology, Huadong Hospital of Fudan University, Shanghai 200040, China
| | - Rong Yang
- Department of Pediatrics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Linsheng Huang
- Department of Pediatrics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Yujiao Gong
- Department of Pediatrics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Lin Zhang
- Department of Radiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Guangyu Tang
- Department of Radiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
- Department of Radiology, Shanghai Stomatological Hospital & School of Stomatology, Fudan University, Shanghai 201103, China
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Harrop C, Tomaszewski B, Putnam O, Klein C, Lamarche E, Klinger L. Are the diagnostic rates of autistic females increasing? An examination of state-wide trends. J Child Psychol Psychiatry 2024; 65:973-983. [PMID: 38181181 PMCID: PMC11161335 DOI: 10.1111/jcpp.13939] [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] [Accepted: 11/02/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND Autism has been considered a 'male-dominant' condition. However, recent research suggests that autistic females are underdiagnosed, misdiagnosed, and later diagnosed. Females may also have different and more nuanced behavioral profiles. To examine diagnosis rates of females, we used 20 years of state-wide data to characterize historical trends in the diagnosis of autism in females to determine whether the proportion of females diagnosed with autism has changed over time. METHODS Data were drawn from 10,247 participants (males = 8,319, females = 1928) who received an autism diagnosis between 2000 and 2021 from state-wide autism centers associated with the University of North Carolina TEACCH Autism Program. RESULTS The rates of females diagnosed with autism increased at a greater rate compared with males. Age of diagnosis remained consistently higher for females. Late diagnosis (defined as 13+) increased over time across both males and females, however, was more commonly associated with females, particularly those with co-occurring intellectual disability. CONCLUSIONS Our results indicate that the proportion of females diagnosed with autism has increased steadily over a 20-year period, which likely reflects greater societal knowledge of how autism may manifest differentially in females.
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Affiliation(s)
- Clare Harrop
- Department of Health Sciences, University of North Carolina at Chapel Hill, USA
- University of North Carolina TEACCH Autism Program
| | - Brianne Tomaszewski
- University of North Carolina TEACCH Autism Program
- Department of Psychiatry, University of North Carolina at Chapel Hill, USA
| | - Orla Putnam
- Department of Health Sciences, University of North Carolina at Chapel Hill, USA
| | - Claire Klein
- University of North Carolina TEACCH Autism Program
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, USA
| | | | - Laura Klinger
- University of North Carolina TEACCH Autism Program
- Department of Psychiatry, University of North Carolina at Chapel Hill, USA
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Nagda R, Le T, Lin B, Tanbonliong T. Oral hygiene practice and home-care challenges in children with autism spectrum disorder in San Francisco: Cross-sectional study. SPECIAL CARE IN DENTISTRY 2024; 44:837-844. [PMID: 37700541 DOI: 10.1111/scd.12922] [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: 06/08/2023] [Revised: 08/28/2023] [Accepted: 09/02/2023] [Indexed: 09/14/2023]
Abstract
INTRODUCTION Autism spectrum disorder (ASD) is characterized by challenges in social interaction, communication, and stereotypical patterns of behavior. They are more likely to have tooth brushing issues and need help with routine dental care. Children with ASD could face difficulty in accessing dental care as the parents have a challenging task in finding a dentist that would treat the child with special needs. As a result, dental care is often neglected. The aims of this study are to evaluate oral hygiene practices and challenges in children with ASD and compare it with typically developing peers (TDP). METHOD The sample size of the study was 60. Parents of children aged 3-10 were recruited and divided in 2 groups with 30 in each group. Age and gender of children were matched. ASD group included children with medical diagnosis of ASD only and no other co-morbidities. Children in TDP group had no diagnosis of ASD, and reported no disability, or any other diagnosis. Parents were asked to complete the questionnaire which asked about their demographic information, child's oral care regimens, and their knowledge about dental care. Chi-squared tests and t-test were used for statistical analysis. A p-value of .05 was used for determining statistical significance. RESULTS Many children with ASD (47%) had to travel more than 20 miles for their dental home compared to 13% with TDP (p < .05). Only 60% of children with ASD brushed twice a day with 70% of parents reporting that it is difficult to brush their child's teeth compared to TDP with 93% of children brush twice daily (p < .05). Significantly a smaller number of children with ASD (47%) allowed their parent to brush their teeth as compared to 93% of TSD children (p < .001). CONCLUSION Parents of children with autism spectrum disorder travel longer distance to find a dental home and face more difficulty in maintaining their child's daily oral hygiene.
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Affiliation(s)
- Rahul Nagda
- San Francisco School of Dentistry, University of California, San Francisco, California, USA
| | - Thuan Le
- San Francisco School of Dentistry, University of California, San Francisco, California, USA
| | - Brent Lin
- San Francisco School of Dentistry, University of California, San Francisco, California, USA
| | - Thomas Tanbonliong
- San Francisco School of Dentistry, University of California, San Francisco, California, USA
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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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Tsirgiotis JM, Young RL, Weber N. A comparison of the presentations of males and females with autism spectrum disorder and those narrowly below the diagnostic threshold. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:1029-1044. [PMID: 37606218 PMCID: PMC10981200 DOI: 10.1177/13623613231190682] [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] [Indexed: 08/23/2023]
Abstract
LAY ABSTRACT Most research about autism spectrum disorder (ASD) in females has looked at autistic features in people who have already received diagnoses. Because our understanding of ASD has been shaped by the difficulties of males, females may experience different difficulties and may not meet the criteria for diagnosis because of a skewed concept of ASD. We extracted detailed information from the assessment reports of 222 children who were either diagnosed with ASD (156 children) or not diagnosed despite many ASD traits (78 children). Females were less likely to have restricted interests, especially females who did not receive an ASD diagnosis. Females who did not receive an ASD diagnosis tended to show more ability in social and emotional reciprocity than what would qualify them for a diagnosis. We also found sex-/gender-specific profiles of body use and speech mannerisms. Many behaviours were more closely linked with an ASD diagnosis for males and others for females, suggesting that behaviours may be interpreted differently depending on the child's sex/gender. We discuss implications for assessing females for ASD in the context of this evidence.
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Brunt S, Nevill R, Mazurek MO. Associations Among Autism Symptom Domains and Facets of Caregiver Strain. J Autism Dev Disord 2024; 54:1507-1516. [PMID: 36637596 PMCID: PMC10931534 DOI: 10.1007/s10803-022-05885-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2022] [Indexed: 01/14/2023]
Abstract
Parents of children with autism spectrum disorder (ASD) often experience elevated levels of caregiver strain (CGS). Few studies have examined the relationship between core ASD symptoms and each facet of CGS: objective, subjective internalized, and subjective externalized strain. The predictive effect of core and associated features of ASD on CGS facets were investigated, while also exploring the moderating effect of age. Atypical behaviors and behavior problems were the strongest predictors of all types of caregiver strain. For younger children, more repetitive behaviors predicted higher externalized strain, yet the opposite was true for parents of adolescents. Given that caregiver strain impacts parents' service utilization patterns, future research should focus on strategies to support parents in reducing caregiver strain.
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Affiliation(s)
- Sophie Brunt
- University of Virginia, 417 Emmet St. South, 22903, Charlottesville, VA, USA.
| | - Rose Nevill
- University of Virginia, 417 Emmet St. South, 22903, Charlottesville, VA, USA
| | - Micah O Mazurek
- University of Virginia, 417 Emmet St. South, 22903, Charlottesville, VA, USA
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Taylor SC, Gehringer BN, Dow HC, Langer A, Rawot E, Smernoff Z, Steeman S, Almasy L, Rader DJ, Bučan M, Brodkin ES. Contrasting Views of Autism Spectrum Traits in Adults, Especially in Self-Reports vs. Informant-Reports for Women High in Autism Spectrum Traits. J Autism Dev Disord 2024; 54:1088-1100. [PMID: 36484966 PMCID: PMC9734875 DOI: 10.1007/s10803-022-05822-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2022] [Indexed: 12/13/2022]
Abstract
There is uncertainty among researchers and clinicians about how to best measure autism spectrum dimensional traits in adults. In a sample of adults with high levels of autism spectrum traits and without intellectual disability (probands, n = 103) and their family members (n = 96), we sought to compare self vs. informant reports of autism spectrum-related traits and possible effects of sex on discrepancies. Using correlational analysis, we found poor agreement between self- and informant-report measures for probands, yet moderate agreement for family members. We found reporting discrepancy was greatest for female probands, often self-reporting more autism-related behaviors. Our findings suggest that autism spectrum traits are often underrecognized by informants, making self-report data important to collect in clinical and research settings.
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Affiliation(s)
- Sara C Taylor
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Suite 3080, Philadelphia, PA, 19104-3309, USA
- Department of Genetics, Perelman School of Medicine, Clinical Research Building, 415 Curie Boulevard, University of Pennsylvania, Philadelphia, PA, 19104-6145, USA
- Neuroscience Graduate Group, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Brielle N Gehringer
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Suite 3080, Philadelphia, PA, 19104-3309, USA
- Department of Genetics, Perelman School of Medicine, Clinical Research Building, 415 Curie Boulevard, University of Pennsylvania, Philadelphia, PA, 19104-6145, USA
| | - Holly C Dow
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Suite 3080, Philadelphia, PA, 19104-3309, USA
- Department of Genetics, Perelman School of Medicine, Clinical Research Building, 415 Curie Boulevard, University of Pennsylvania, Philadelphia, PA, 19104-6145, USA
| | - Allison Langer
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Suite 3080, Philadelphia, PA, 19104-3309, USA
- Department of Genetics, Perelman School of Medicine, Clinical Research Building, 415 Curie Boulevard, University of Pennsylvania, Philadelphia, PA, 19104-6145, USA
| | - Eric Rawot
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Suite 3080, Philadelphia, PA, 19104-3309, USA
- Department of Genetics, Perelman School of Medicine, Clinical Research Building, 415 Curie Boulevard, University of Pennsylvania, Philadelphia, PA, 19104-6145, USA
| | - Zoe Smernoff
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Suite 3080, Philadelphia, PA, 19104-3309, USA
- Department of Genetics, Perelman School of Medicine, Clinical Research Building, 415 Curie Boulevard, University of Pennsylvania, Philadelphia, PA, 19104-6145, USA
| | - Samantha Steeman
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Suite 3080, Philadelphia, PA, 19104-3309, USA
- Department of Genetics, Perelman School of Medicine, Clinical Research Building, 415 Curie Boulevard, University of Pennsylvania, Philadelphia, PA, 19104-6145, USA
| | - Laura Almasy
- Department of Genetics, Perelman School of Medicine, Clinical Research Building, 415 Curie Boulevard, University of Pennsylvania, Philadelphia, PA, 19104-6145, USA
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Lifespan Brain Institute, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Daniel J Rader
- Department of Genetics, Perelman School of Medicine, Clinical Research Building, 415 Curie Boulevard, University of Pennsylvania, Philadelphia, PA, 19104-6145, USA
| | - Maja Bučan
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Suite 3080, Philadelphia, PA, 19104-3309, USA
- Department of Genetics, Perelman School of Medicine, Clinical Research Building, 415 Curie Boulevard, University of Pennsylvania, Philadelphia, PA, 19104-6145, USA
| | - Edward S Brodkin
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Suite 3080, Philadelphia, PA, 19104-3309, USA.
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Boerner KE, Keogh E, Inkster AM, Nahman-Averbuch H, Oberlander TF. A developmental framework for understanding the influence of sex and gender on health: Pediatric pain as an exemplar. Neurosci Biobehav Rev 2024; 158:105546. [PMID: 38272336 DOI: 10.1016/j.neubiorev.2024.105546] [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: 12/12/2022] [Revised: 07/07/2023] [Accepted: 11/06/2023] [Indexed: 01/27/2024]
Abstract
Sex differences are a robust finding in many areas of adult health, including cardiovascular disease, psychiatric disorders, and chronic pain. However, many sex differences are not consistently observed until after the onset of puberty. This has led to the hypothesis that hormones are primary contributors to sex differences in health outcomes, largely ignoring the relative contributions of early developmental influences, emerging psychosocial factors, gender, and the interaction between these variables. In this paper, we argue that a comprehensive understanding of sex and gender contributions to health outcomes should start as early as conception and take an iterative biopsychosocial-developmental perspective that considers intersecting social positions. We present a conceptual framework, informed by a review of the literature in basic, clinical, and social science that captures how critical developmental stages for both sex and gender can affect children's health and longer-term outcomes. The literature on pediatric chronic pain is used as a worked example of how the framework can be applied to understanding different chronic conditions.
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Affiliation(s)
- Katelynn E Boerner
- Department of Pediatrics, University of British Columbia, and BC Children's Hospital Research Institute, Vancouver, BC, Canada.
| | - Edmund Keogh
- Department of Psychology & Centre for Pain Research, University of Bath, Bath, United Kingdom
| | - Amy M Inkster
- Department of Medical Genetics, University of British Columbia, and BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Hadas Nahman-Averbuch
- Department of Anesthesiology, Washington University in St. Louis, St. Louis, MO, USA
| | - Tim F Oberlander
- Department of Pediatrics, University of British Columbia, and BC Children's Hospital Research Institute, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, and BC Children's Hospital Research Institute, Vancouver, BC, Canada
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Huntjens A, Landlust A, Wissenburg S, van der Gaag M. The Prevalence of Suicidal Behavior in Autism Spectrum Disorder. CRISIS 2024; 45:144-153. [PMID: 37668055 DOI: 10.1027/0227-5910/a000922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Abstract
Background: Suicidal ideation (SI) and suicide attempts (SA) are common in autistic individuals, but prevalence rates have not yet been estimated with meta-analysis. Aims: This meta-analysis aims to estimate SI and SA prevalence rates in autistic individuals and identify subgroup differences based on sample characteristics and study quality. Methods: A systematic search identified 52 studies with 88,509 autistic participants reporting SI and SA. Pooled prevalence estimates were calculated using a random-effects model. Results: Pooled prevalence estimates of lifetime SI and SA were 37.2% [95% CI 25.3-50.8] and 15.3% [95% CI 9.5-23.6], respectively. For 12-month prevalence, this was 25.4% [95% CI 19.0-33.2] and 14.1% [95% CI 7.4-25.2], respectively. Subgroup analyses revealed significant differences based on age (SI), region (SI), data collection (SI), measurement scales used to define autism and suicidality (SA), and representation of the study sample (SI and SA). Heterogeneity measures were high for all outcomes (I2 = 60.3-99.1%). Limitations: The heterogeneity of the included studies may limit the generalizability of our findings. Conclusion: The high rates of suicidal problems in autistic individuals call for a systematic evaluation of suicidality in clinical practice and adequate therapeutic interventions to improve this condition.
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Affiliation(s)
- Anne Huntjens
- Department of Clinical Psychology, VU University and Amsterdam Public Health Research, Amsterdam, The Netherlands
- Department of Psychosis Research, Parnassia Academy, The Hague, The Netherlands
| | - Annemiek Landlust
- Autism Team Northern-Netherlands, Jonx, Department of (Youth) Mental Health and Autism, Lentis Psychiatric Institute, Groningen, The Netherlands
- Department of Genetics, University Medical Center Groningen, The Netherlands
| | - Sophie Wissenburg
- Department of Clinical Psychology, VU University and Amsterdam Public Health Research, Amsterdam, The Netherlands
- Department of Psychosis Research, Parnassia Academy, The Hague, The Netherlands
| | - Mark van der Gaag
- Department of Clinical Psychology, VU University and Amsterdam Public Health Research, Amsterdam, The Netherlands
- Department of Psychosis Research, Parnassia Academy, The Hague, The Netherlands
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Di Vara S, Guerrera S, Menghini D, Scibelli F, Lupi E, Valeri G, Vicari S. Characterizing individual differences in children and adolescents with autism spectrum disorder: a descriptive study. Front Psychol 2024; 15:1323787. [PMID: 38476386 PMCID: PMC10927760 DOI: 10.3389/fpsyg.2024.1323787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 02/05/2024] [Indexed: 03/14/2024] Open
Abstract
Introduction Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by a higher prevalence in male than in female participants. Recent studies have hypothesized the presence of different phenotypes in male and female participants with ASD. The present study aims to assess possible sex differences in cognitive and adaptive functioning, symptomatology of ASD, and psychopathological comorbidities in a large sample of children and adolescents with ASD. Methods The study included a total of 2,146 children and adolescents diagnosed with ASD, comprising 1785 boys (mean age 7.12 ± 3.69 years) and 361 girls (mean age 6.25 ± 3.30 years). The age of the participants ranged from 1.35 to 19.05 years (mean age 9.98 ± 3.64). The study sought to include all children and adolescents diagnosed with Autism or ASD. Results Present results showed that girls with ASD had lower IQs than boys but similar adaptive functioning. The severity of symptoms of ASD was greater in boys than in girls, as were scores on psychopathological measures. With increasing age, boys with ASD showed greater impairment in social communication skills than girls and increased psychopathological comorbidities. Older girls showed fewer restricted and repetitive behaviors. Discussion Exploring phenotypic differences in children and adolescents with ASD fosters an understanding of subtle diagnostic facets that may go unrecognized, allowing for increasingly individualized and tailored interventions.
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Affiliation(s)
- S. Di Vara
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - S. Guerrera
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - D. Menghini
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - F. Scibelli
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - E. Lupi
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - G. Valeri
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - S. Vicari
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
- Department of Life Sciences and Public Health, Catholic University, Rome, Italy
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Goikolea-Vives A, Fernandes C, Thomas MSC, Thornton C, Stolp HB. Sex-specific behavioural deficits in adulthood following acute activation of the GABAA receptor in the neonatal mouse. Dev Neurosci 2024:000536641. [PMID: 38325353 DOI: 10.1159/000536641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 01/26/2024] [Indexed: 02/09/2024] Open
Abstract
INTRODUCTION Sex differences exist in the prevalence of neurodevelopmental disorders (NDDs). Part of the aetiology of NDDs has been proposed to be alterations in the balance between excitatory and inhibitory neurotransmission, leading to the question of whether males and females respond differently to altered neurotransmitter balance. We investigated whether pharmacological alteration of GABAA signalling in early development results in sex-dependent changes in adult behaviours associated with NDDs. METHODS Male and female C57BL/6J mice received intraperitoneal injections of 0.5mg/kg muscimol or saline on postnatal days (P) 3-5 and were subjected to behavioural testing, specifically open field, light dark box, marble burying, sucralose preference, social interaction and olfactory habituation/dishabituation tests between P60-90. RESULTS Early postnatal administration of muscimol resulted in reduced anxiety in the light dark box test in both male and female adult mice. Muscimol reduced sucralose preference in males, but not females, whereas female mice showed reduced social behaviours. Regional alterations in cortical thickness were observed in the weeks following GABAA receptor activation, pointing to an evolving structural difference in the brain underlying adult behaviour. CONCLUSIONS We conclude that activation of the GABAA receptor in the first week of life resulted in long-lasting changes in a range of behaviours in adulthood following altered neurodevelopment. Sex of the individual affected the nature and severity of these abnormalities, explaining part of the varied pathophysiology and neurodevelopmental diagnosis that derive from excitatory/inhibitory imbalance.
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Li B, Heyne D, Scheeren A, Blijd-Hoogewys E, Rieffe C. School participation of autistic youths: The influence of youth, family and school factors. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024:13623613231225490. [PMID: 38311864 DOI: 10.1177/13623613231225490] [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: 02/06/2024]
Abstract
LAY ABSTRACT School-aged youths have a basic human right to participate in educational and recreational activities at school. Yet, autistic youths are at high risk of being excluded from school and from school-based activities. It is important to understand how this occurs, to ensure that all autistic youths have opportunities to participate in school activities that are equal to the opportunities of their non-autistic peers. The present study investigated multiple influences on the school participation of autistic youths, including youth factors (age and autistic traits), family factors (parent education level and parental self-efficacy for supporting their child's schoolwork) and school factors (the impact of problems autistic youths experienced with the physical and social environments of school). Using an online survey, we gathered the views and experiences of the parents of 200 autistic youths aged between 4 and 16 years, in the Netherlands. We found that among the factors, only the impact of problems that autistic youths experienced with the physical environment of school was associated with their school participation. In particular, autistic youths who experienced greater difficulties with the physical environment of school had lower levels of school participation. Our findings highlight the pressing need to modify school environments to better accommodate the needs of autistic youths so that they can participate easily and comfortably.
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Affiliation(s)
- Boya Li
- Leiden University, The Netherlands
- Delft University of Technology, The Netherlands
| | | | | | | | - Carolien Rieffe
- Leiden University, The Netherlands
- University of Twente, The Netherlands
- University College London, UK
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Oztan O, Del Rosso LA, Simmons SM, Nguyen DKK, Talbot CF, Capitanio JP, Garner JP, Parker KJ. Naturally occurring low sociality in female rhesus monkeys: A tractable model for autism or not? Mol Autism 2024; 15:8. [PMID: 38291493 PMCID: PMC10829375 DOI: 10.1186/s13229-024-00588-3] [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: 08/29/2023] [Accepted: 01/22/2024] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Autism spectrum disorder (ASD) is characterized by persistent social interaction impairments and is male-biased in prevalence. We have established naturally occurring low sociality in male rhesus monkeys as a model for the social features of ASD. Low-social male monkeys exhibit reduced social interactions and increased autistic-like trait burden, with both measures highly correlated and strongly linked to low cerebrospinal fluid (CSF) arginine vasopressin (AVP) concentration. Little is known, however, about the behavioral and neurochemical profiles of female rhesus monkeys, and whether low sociality in females is a tractable model for ASD. METHODS Social behavior assessments (ethological observations; a reverse-translated autistic trait measurement scale, the macaque Social Responsiveness Scale-Revised [mSRS-R]) were completed on N = 88 outdoor-housed female rhesus monkeys during the non-breeding season. CSF and blood samples were collected from a subset of N = 16 monkeys across the frequency distribution of non-social behavior, and AVP and oxytocin (OXT) concentrations were quantified. Data were analyzed using general linear models. RESULTS Non-social behavior frequency and mSRS-R scores were continuously distributed across the general female monkey population, as previously found for male monkeys. However, dominance rank significantly predicted mSRS-R scores in females, with higher-ranking individuals showing fewer autistic-like traits, a relationship not previously observed in males from this colony. Females differed from males in several other respects: Social behavior frequencies were unrelated to mSRS-R scores, and AVP concentration was unrelated to any social behavior measure. Blood and CSF concentrations of AVP were positively correlated in females; no significant relationship involving any OXT measure was found. LIMITATIONS This study sample was small, and did not consider genetic, environmental, or other neurochemical measures that may be related to female mSRS-R scores. CONCLUSIONS Dominance rank is the most significant predictor of autistic-like traits in female rhesus monkeys, and CSF neuropeptide concentrations are unrelated to measures of female social functioning (in contrast to prior CSF AVP findings in male rhesus monkeys and male and female autistic children). Although preliminary, this evidence suggests that the strong matrilineal organization of this species may limit the usefulness of low sociality in female rhesus monkeys as a tractable model for ASD.
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Affiliation(s)
- Ozge Oztan
- Department of Psychiatry and Behavioral Sciences, Stanford University, 1201 Welch Rd., MSLS P-104, Stanford, CA, 94305, USA
| | - Laura A Del Rosso
- California National Primate Research Center, 1 Shields Ave., Davis, CA, 95616, USA
| | - Sierra M Simmons
- California National Primate Research Center, 1 Shields Ave., Davis, CA, 95616, USA
| | - Duyen K K Nguyen
- Department of Psychiatry and Behavioral Sciences, Stanford University, 1201 Welch Rd., MSLS P-104, Stanford, CA, 94305, USA
| | - Catherine F Talbot
- California National Primate Research Center, 1 Shields Ave., Davis, CA, 95616, USA
- School of Psychology, Florida Institute of Technology, 150 W. University Blvd., Melbourne, FL, 32901, USA
| | - John P Capitanio
- California National Primate Research Center, 1 Shields Ave., Davis, CA, 95616, USA
- Department of Psychology, University of California, 1 Shields Ave., Davis, 95616, USA
| | - Joseph P Garner
- Department of Psychiatry and Behavioral Sciences, Stanford University, 1201 Welch Rd., MSLS P-104, Stanford, CA, 94305, USA
- Department of Comparative Medicine, Stanford University, 300 Pasteur Dr., Edwards R348, Stanford, CA, 94305, USA
| | - Karen J Parker
- Department of Psychiatry and Behavioral Sciences, Stanford University, 1201 Welch Rd., MSLS P-104, Stanford, CA, 94305, USA.
- Department of Comparative Medicine, Stanford University, 300 Pasteur Dr., Edwards R348, Stanford, CA, 94305, USA.
- California National Primate Research Center, 1 Shields Ave., Davis, CA, 95616, USA.
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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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Wilkes BJ, Archer DB, Farmer AL, Bass C, Korah H, Vaillancourt DE, Lewis MH. Cortico-basal ganglia white matter microstructure is linked to restricted repetitive behavior in autism spectrum disorder. Mol Autism 2024; 15:6. [PMID: 38254158 PMCID: PMC10804694 DOI: 10.1186/s13229-023-00581-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 12/23/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Restricted repetitive behavior (RRB) is one of two behavioral domains required for the diagnosis of autism spectrum disorder (ASD). Neuroimaging is widely used to study brain alterations associated with ASD and the domain of social and communication deficits, but there has been less work regarding brain alterations linked to RRB. METHODS We utilized neuroimaging data from the National Institute of Mental Health Data Archive to assess basal ganglia and cerebellum structure in a cohort of children and adolescents with ASD compared to typically developing (TD) controls. We evaluated regional gray matter volumes from T1-weighted anatomical scans and assessed diffusion-weighted scans to quantify white matter microstructure with free-water imaging. We also investigated the interaction of biological sex and ASD diagnosis on these measures, and their correlation with clinical scales of RRB. RESULTS Individuals with ASD had significantly lower free-water corrected fractional anisotropy (FAT) and higher free-water (FW) in cortico-basal ganglia white matter tracts. These microstructural differences did not interact with biological sex. Moreover, both FAT and FW in basal ganglia white matter tracts significantly correlated with measures of RRB. In contrast, we found no significant difference in basal ganglia or cerebellar gray matter volumes. LIMITATIONS The basal ganglia and cerebellar regions in this study were selected due to their hypothesized relevance to RRB. Differences between ASD and TD individuals that may occur outside the basal ganglia and cerebellum, and their potential relationship to RRB, were not evaluated. CONCLUSIONS These new findings demonstrate that cortico-basal ganglia white matter microstructure is altered in ASD and linked to RRB. FW in cortico-basal ganglia and intra-basal ganglia white matter was more sensitive to group differences in ASD, whereas cortico-basal ganglia FAT was more closely linked to RRB. In contrast, basal ganglia and cerebellar volumes did not differ in ASD. There was no interaction between ASD diagnosis and sex-related differences in brain structure. Future diffusion imaging investigations in ASD may benefit from free-water estimation and correction in order to better understand how white matter is affected in ASD, and how such measures are linked to RRB.
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Affiliation(s)
- Bradley J Wilkes
- Department of Applied Physiology and Kinesiology, University of Florida, P.O. Box 118205, Gainesville, FL, 32611, USA.
| | - Derek B Archer
- Vanderbilt Memory and Alzheimer's Center, Department of Neurology, Vanderbilt School of Medicine, Nashville, TN, USA
- Department of Neurology, Vanderbilt Genetics Institute, Vanderbilt School of Medicine, Nashville, TN, USA
| | - Anna L Farmer
- Department of Psychology, University of Florida, Gainesville, FL, USA
| | - Carly Bass
- Department of Psychiatry, University of Florida, Gainesville, FL, USA
| | - Hannah Korah
- Department of Pharmacology, College of Medicine, University of Arizona, Tucson, AZ, USA
| | - David E Vaillancourt
- Department of Applied Physiology and Kinesiology, University of Florida, P.O. Box 118205, Gainesville, FL, 32611, USA
- Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA
- Department of Neurology, Fixel Center for Neurological Diseases, Program in Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL, USA
| | - Mark H Lewis
- Department of Psychology, University of Florida, Gainesville, FL, USA
- Department of Psychiatry, University of Florida, Gainesville, FL, USA
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Cage E, Botha M, McDevitt L, King KN, Biscoe L, Tucker K, Pearson A. Diagnosis as a new beginning not an end: A participatory photovoice study on navigating an autism diagnosis in adulthood. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024:13623613231220418. [PMID: 38230649 DOI: 10.1177/13623613231220418] [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: 01/18/2024]
Abstract
LAY ABSTRACT Lots of people seek an autism diagnosis as an adult, and they often say that being diagnosed can be positively life-changing, but the experience of getting a diagnosis can be difficult. We often do not hear the views of people currently looking for a diagnosis, or talk to them about how diagnosis relates to their identity. In our study, we looked at experiences of people currently seeking an autism diagnosis in the UK. We used participatory methods, where six people seeking diagnosis were included as collaborators in the research. They took part in four different sessions, where they helped to shape the research, took part in interviews about their experiences and helped to analyse the patterns in all the interviews. We also used something called photovoice during the interviews, where they could use photos to show how they felt about navigating a diagnosis. We identified four common themes: (1) everyone had experienced some form of crisis before seeking diagnosis; (2) when they realised they were autistic, they felt seen; (3) the diagnostic process and criteria were not working, and they felt judged by clinicians and (4) there was limited support available after diagnosis. In another session, we identified actions that need to be taken which have implications for policy and practice, including improving the diagnostic process and criteria with autistic people, autistic people being listened to more by people like general practitioners and clinicians and diagnosis services needing to be more flexible and appreciate different aspects of someone's identity and neurodivergence.
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17
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Vuijk R, Turner W, Zimmerman D, Walker H, Dandachi-FitzGerald B. Schema therapy in adults with autism spectrum disorder: A scoping review. Clin Psychol Psychother 2024. [PMID: 38214936 DOI: 10.1002/cpp.2949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 12/13/2023] [Accepted: 12/15/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND Schema therapy (ST) in adults with autism spectrum disorder (ASD) have gained increasing interest in clinical practice and research. However, to date, there has been no synthesis of the literature on ST as treatment for adults with ASD. Through a scoping review, we aim to summarize the emerging research and literature on ST for adults with ASD. METHODS A comprehensive literature search of three electronic databases was conducted using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. Publications were included that examined ST in adults with ASD and non-clinical adults with autistic traits. RESULTS Systematic searches identified a total of 11 publications, all published since 2014, with the majority being conducted by Dutch and Japanese researchers. Of the 11 publications, 1 described an ST-informed social interaction training, 1 was an ST protocol, 2 described conceptual ST models, 2 were case examples, 2 examined early maladaptive schemas (EMSs) and 3 investigated the effectiveness of ST interventions. In summary, the theoretical exploration, practical examples of the application of ST and research findings with preliminary evidence of ST, EMSs and schema modes (SMs) in adults with ASD point towards the potential of ST for the treatment of adults with ASD. DISCUSSION The current scoping review highlights preliminary research findings and offers valuable suggestions for clinicians treating adults with ASD. This review underscores the need for development of and research in specialized ST protocols and programmes tailored to adults with ASD with chronic mental conditions, such as personality disorders (PDs).
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Affiliation(s)
- Richard Vuijk
- Sarr Autism Rotterdam (Parnassia Psychiatric Institute), Rotterdam, The Netherlands
| | - Wesley Turner
- Minds & Hearts, Stones Corner, Queensland, Australia
- University of Queensland, Brisbane, Queensland, Australia
| | - David Zimmerman
- Minds & Hearts, Stones Corner, Queensland, Australia
- University of Queensland, Brisbane, Queensland, Australia
| | - Hugh Walker
- Minds & Hearts, Stones Corner, Queensland, Australia
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18
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Collignon A, Dion-Albert L, Ménard C, Coelho-Santos V. Sex, hormones and cerebrovascular function: from development to disorder. Fluids Barriers CNS 2024; 21:2. [PMID: 38178239 PMCID: PMC10768274 DOI: 10.1186/s12987-023-00496-3] [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: 08/11/2023] [Accepted: 11/29/2023] [Indexed: 01/06/2024] Open
Abstract
Proper cerebrovascular development and neurogliovascular unit assembly are essential for brain growth and function throughout life, ensuring the continuous supply of nutrients and oxygen. This involves crucial events during pre- and postnatal stages through key pathways, including vascular endothelial growth factor (VEGF) and Wnt signaling. These pathways are pivotal for brain vascular growth, expansion, and blood-brain barrier (BBB) maturation. Interestingly, during fetal and neonatal life, cerebrovascular formation coincides with the early peak activity of the hypothalamic-pituitary-gonadal axis, supporting the idea of sex hormonal influence on cerebrovascular development and barriergenesis.Sex hormonal dysregulation in early development has been implicated in neurodevelopmental disorders with highly sexually dimorphic features, such as autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD). Both disorders show higher prevalence in men, with varying symptoms between sexes, with boys exhibiting more externalizing behaviors, such as aggressivity or hyperactivity, and girls displaying higher internalizing behaviors, including anxiety, depression, or attention disorders. Indeed, ASD and ADHD are linked to high prenatal testosterone exposure and reduced aromatase expression, potentially explaining sex differences in prevalence and symptomatology. In line with this, high estrogen levels seem to attenuate ADHD symptoms. At the cerebrovascular level, sex- and region-specific variations of cerebral blood flow perfusion have been reported in both conditions, indicating an impact of gonadal hormones on the brain vascular system, disrupting its ability to respond to neuronal demands.This review aims to provide an overview of the existing knowledge concerning the impact of sex hormones on cerebrovascular formation and maturation, as well as the onset of neurodevelopmental disorders. Here, we explore the concept of gonadal hormone interactions with brain vascular and BBB development to function, with a particular focus on the modulation of VEGF and Wnt signaling. We outline how these pathways may be involved in the underpinnings of ASD and ADHD. Outstanding questions and potential avenues for future research are highlighted, as uncovering sex-specific physiological and pathological aspects of brain vascular development might lead to innovative therapeutic approaches in the context of ASD, ADHD and beyond.
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Affiliation(s)
- Adeline Collignon
- Department of Psychiatry & Neuroscience and CERVO Brain Research Center, Universite Laval, Quebec City, Canada
| | - Laurence Dion-Albert
- Department of Psychiatry & Neuroscience and CERVO Brain Research Center, Universite Laval, Quebec City, Canada
| | - Caroline Ménard
- Department of Psychiatry & Neuroscience and CERVO Brain Research Center, Universite Laval, Quebec City, Canada
| | - Vanessa Coelho-Santos
- Institute for Nuclear Sciences Applied to Health (ICNAS), University of Coimbra, Coimbra, Portugal.
- University of Coimbra, Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), Coimbra, Portugal.
- Faculty of Medicine, University of Coimbra, Institute of Physiology, Coimbra, Portugal.
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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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20
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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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Dunn ZD, Gowda A, Horsfall Turner IC. The viability of a proposed psychoeducational neurodiversity approach in children services: The PANDA (the Portsmouth alliance's neuro-diversity approach). Clin Child Psychol Psychiatry 2024; 29:198-212. [PMID: 37311174 DOI: 10.1177/13591045231184121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
People with Neurodevelopmental (ND) conditions are often unfairly stereotyped by society, without fully appreciating their strengths. As a result, their advantageous behaviours may be overlooked or ignored. Despite wide psychoeducation on ND in society there is a push from the scientific and ND community to move from a binary diagnostic system to an approach that encompasses the spectrum experienced by individuals. In view of this, we have developed the Portsmouth Alliance Neuro-Diversity Approach (PANDA), a coproduced method which helps facilitate understanding, communication and early support for individuals who may be Neuro-Diverse. 51 young people, their parents and attached professionals participated in the approach's feasibility to improve wellbeing and symptom management measured by quantitative and qualitative means. Results showed a significant improvement in the child's wellbeing, but not symptom management. Overall, this indicates the PANDA could facilitate a more holistic approach for referrals, information gathering, psychoeducation and cross-system relationship building to be used in conjunction with a traditional pathway. Though, this study is limited in scope, its main purpose is to inform future development of the approach. Additionally, more research investigating the specific narrative, and separate structure of the PANDA would be required to highlight the strengths and limitations of implementation.
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Affiliation(s)
- Zach D Dunn
- Children and Adolescent Mental Health Service, Solent NHS Trust, Portsmouth, UK
| | - Asha Gowda
- Children and Adolescent Mental Health Service, Solent NHS Trust, Portsmouth, UK
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22
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Price JR, Biebesheimer EC, Chen K. Examining gender effects in autistic written language skills: A small sample exploratory study. AUTISM & DEVELOPMENTAL LANGUAGE IMPAIRMENTS 2024; 9:23969415241227071. [PMID: 38348411 PMCID: PMC10860466 DOI: 10.1177/23969415241227071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
Background and aims Gender differences in the written language of autistic individuals are an overlooked but important area of research. We contend that the gender differences in spoken language of autistic individuals may extend to written language, mirroring the gender differences of writing in the general population and reflecting the shared dimensionality of oral and written language. Our research question was: Do autistic adolescent females demonstrate written language characteristics, across persuasive, expository, and narrative genres, that are distinct from those of autistic adolescent males and non-autistic (NA) adolescent females? Methods We performed a secondary, exploratory analysis on writing samples collected from 18 participants (11 autistic males, three autistic females, and four NA females) from a larger investigation of autistic adolescents' writing skills. Each participant completed three writing samples-one persuasive, one expository, and one narrative (for a total of 54 writing samples). We compared sample length (total number of words), writing productivity (words written per minute), syntactic length (mean length of T-unit in words), vocabulary diversity (type-token ratio), and macrostructure of autistic females' samples to autistic males' and NA females' samples. Results Based on non-parametric analyses using variable medians, autistic males, but not autistic females, wrote significantly shorter expository samples than NA females. Autistic males' writing productivity was significantly lower in the persuasive and expository genres than both autistic females and NA females. Several other comparisons of sample length, productivity, vocabulary diversity, and persuasive and narrative macrostructure yielded large effect sizes but were not statistically significant. Conclusions Though our small sample sizes prevent us from drawing generalizable conclusions, we observed that some gender-specific findings of the current study differ from previous findings based on a single autistic group (females and males combined). Combining data of autistic females with autistic males may cloud the distinct written language characteristics of each group. Implications Our findings, especially when situated in the context of relevant literature, suggest that larger-scale investigation of gender differences in written language is essential in order to more fully describe the unique characteristics of autistic females. Clinicians should be prepared to support autistic writers' needs for producing written language to meet their developmental, academic, social, and employment-related goals.
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Affiliation(s)
- Johanna R Price
- Department of Communication Sciences and Disorders, Western Carolina University, Cullowhee, NC, USA
| | - Emily C Biebesheimer
- Department of Communication Sciences and Disorders, Western Carolina University, Cullowhee, NC, USA
| | - Kong Chen
- Coulter Faculty Commons, Western Carolina University, Cullowhee, NC, USA
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Carpita B, Nardi B, Pronestì C, Parri F, Giovannoni F, Cremone IM, Pini S, Dell’Osso L. May Female Autism Spectrum Be Masked by Eating Disorders, Borderline Personality Disorder, or Complex PTSD Symptoms? A Case Series. Brain Sci 2023; 14:37. [PMID: 38248252 PMCID: PMC10813290 DOI: 10.3390/brainsci14010037] [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: 11/16/2023] [Revised: 12/15/2023] [Accepted: 12/28/2023] [Indexed: 01/23/2024] Open
Abstract
Introduction: The prevalence of Autism Spectrum Disorder (ASD) is four times higher in males than females; however, females are significantly more likely to go undiagnosed due to the existence of a "female autistic phenotype", a manifestation unique to females that conflicts with conventional, masculine conceptualizations of ASD. Furthermore, subthreshold autistic traits, which exert a significantly negative impact on quality of life and represent a vulnerability factor for the development of other psychopathological conditions, may remain even more under-recognized. Subsequently, many women with ASD may never receive a diagnosis or any resulting care, with serious consequences for their health. Aims: We aimed to describe two brief cases in order to confirm the diagnostic difficulties that ASD female undergo during their clinical evaluation and the possible alternative phenotype that they can manifest. Methods: We reported the cases of two young women on the autism spectrum that came to clinical attention only after the development of severe symptomatology attributed to other mental disorders, overlooking the presence of underlying autism spectrum features and a brief résumé of the literature on this topic. Results: These cases confirm the need for a timely and proper identification of females on the autism spectrum in order to prevent complications and improve the outcome. Conclusions: Research on gender differences could lead to a reexamination of the sex ratio in the prevalence of ASD and provide a better understanding of several psychiatric conditions that are frequently diagnosed in women, supporting the neurodevelopmental approach to psychopathology.
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Affiliation(s)
| | - Benedetta Nardi
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (B.C.); (C.P.); (F.P.); (F.G.); (S.P.); (L.D.)
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24
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Francis S, Tseng A, Rawls E, Conelea C, Grissom N, Kummerfeld E, Ma S, Jacob S. Integrating Causal Discovery and Clinically-Relevant Insights to Explore Directional Relationships between Autistic Features, Sex at Birth, and Cognitive Abilities. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.12.21.23300348. [PMID: 38196591 PMCID: PMC10775686 DOI: 10.1101/2023.12.21.23300348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
Prevalence in autism spectrum disorder (ASD) diagnosis has long been strongly male-biased. Yet, consensus has not been reached on mechanisms and clinical features that underlie sex-based discrepancies. Whereas females may be under-diagnosed because of inconsistencies in diagnostic/ascertainment procedures (sex-biased criteria, social camouflaging), diagnosed males may have exhibited more overt behaviors (e.g., hyperactivity, aggression) that prompted clinical evaluation. Applying a novel network-theory-based approach, we extracted data-driven, clinically-relevant insights from a large, well-characterized sample (Simons Simplex Collection) of 2175 autistic males (Ages = 8.9±3.5 years) and 334 autistic females (Ages = 9.2±3.7 years). Exploratory factor analysis (EFA) and expert clinical review reduced data dimensionality to 15 factors of interest. To offset inherent confounds of an imbalanced sample, we identified a subset of males (N=331) matched to females on key variables (Age, IQ) and applied data-driven CDA using Greedy Fast Causal Inference (GFCI) for three groups (All Females, All Males, and Matched Males). Structural equation modeling (SEM) extracted measures of model fit and effect sizes for causal relationships between sex, age, and, IQ on EFA-selected factors capturing phenotypic representations of autism across sensory, social, and restricted and repetitive behavior domains. Our methodology unveiled sex-specific directional relationships to inform developmental outcomes and targeted interventions.
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Groen Y, Ebert WM, Dittner FM, Stapert AF, Henning D, Greaves-Lord K, Davids RCD(L, Castelein S, Baron Cohen S, Allison C, Van Balkom IDC, Piening S. Measuring the Autistic Women's Experience (AWE). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7148. [PMID: 38131700 PMCID: PMC10742621 DOI: 10.3390/ijerph20247148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/01/2023] [Accepted: 12/04/2023] [Indexed: 12/23/2023]
Abstract
We developed a Dutch questionnaire called the Autistic Women's Experience (AWE) and compared its psychometric properties to the Autism Spectrum Quotient (AQ). Whilst attenuated gender differences on the AQ have been widely replicated, this instrument may not fully capture the unique experience of autistic women. The AWE was co-developed with autistic women to include items that reflect autistic women's experience. We investigated the AWE (49 items) and compared it with the AQ (50 items) in Dutch autistic individuals (N = 153, n = 85 women) and in the general population (N = 489, n = 246 women) aged 16+. Both the AQ and AWE had excellent internal consistency and were highly and equally predictive of autism in both women and men. Whilst there was a gender difference on the AQ among non-autistic people (men > women), there was no gender difference among autistic people, confirming all earlier studies. No gender differences were detected on the AWE overall scale, yet subtle gender differences were observed on the subscales. We conclude that the AQ is valid for both genders, but the AWE provides an additional useful perspective on the characteristics of autistic women. The AWE needs further validation in independent samples using techniques that allow for testing gender biases, as well as a confirmatory factor analysis in a larger sample.
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Affiliation(s)
- Yvonne Groen
- Clinical and Developmental Neuropsychology, University of Groningen, 9712 TS Groningen, The Netherlands
| | - W. Miro Ebert
- Institute for Sport Sciences, University of Regensburg, D-93053 Regensburg, Germany
| | - Francien M. Dittner
- Clinical and Developmental Neuropsychology, University of Groningen, 9712 TS Groningen, The Netherlands
| | - Anne Fleur Stapert
- Autism Team Northern-Netherlands, Jonx, Department of (Youth) Mental Health and Autism of Lentis Psychiatric Institute, 9728 JR Groningen, The Netherlands; (A.F.S.); (I.D.C.V.B.); (S.P.)
| | - Daria Henning
- Lentis Psychiatric Institute, Outpatient Clinic for the Elderly, 9725 AG Groningen, The Netherlands;
| | - Kirstin Greaves-Lord
- Autism Team Northern-Netherlands, Jonx, Department of (Youth) Mental Health and Autism of Lentis Psychiatric Institute, 9728 JR Groningen, The Netherlands; (A.F.S.); (I.D.C.V.B.); (S.P.)
- Clinical Psychology and Experimental Psychopathology, University of Groningen, 9712 TS Groningen, The Netherlands
| | | | - Stynke Castelein
- Clinical Psychology and Experimental Psychopathology, University of Groningen, 9712 TS Groningen, The Netherlands
- Lentis Research, Lentis Psychiatric Institute, 9725 AG Groningen, The Netherlands
| | - Simon Baron Cohen
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge CB2 8AH, UK
| | - Carrie Allison
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge CB2 8AH, UK
| | - Ingrid D. C. Van Balkom
- Autism Team Northern-Netherlands, Jonx, Department of (Youth) Mental Health and Autism of Lentis Psychiatric Institute, 9728 JR Groningen, The Netherlands; (A.F.S.); (I.D.C.V.B.); (S.P.)
| | - Sigrid Piening
- Autism Team Northern-Netherlands, Jonx, Department of (Youth) Mental Health and Autism of Lentis Psychiatric Institute, 9728 JR Groningen, The Netherlands; (A.F.S.); (I.D.C.V.B.); (S.P.)
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26
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Mosconi MW, Stevens CJ, Unruh KE, Shafer R, Elison JT. Endophenotype trait domains for advancing gene discovery in autism spectrum disorder. J Neurodev Disord 2023; 15:41. [PMID: 37993779 PMCID: PMC10664534 DOI: 10.1186/s11689-023-09511-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 11/09/2023] [Indexed: 11/24/2023] Open
Abstract
Autism spectrum disorder (ASD) is associated with a diverse range of etiological processes, including both genetic and non-genetic causes. For a plurality of individuals with ASD, it is likely that the primary causes involve multiple common inherited variants that individually account for only small levels of variation in phenotypic outcomes. This genetic landscape creates a major challenge for detecting small but important pathogenic effects associated with ASD. To address similar challenges, separate fields of medicine have identified endophenotypes, or discrete, quantitative traits that reflect genetic likelihood for a particular clinical condition and leveraged the study of these traits to map polygenic mechanisms and advance more personalized therapeutic strategies for complex diseases. Endophenotypes represent a distinct class of biomarkers useful for understanding genetic contributions to psychiatric and developmental disorders because they are embedded within the causal chain between genotype and clinical phenotype, and they are more proximal to the action of the gene(s) than behavioral traits. Despite their demonstrated power for guiding new understanding of complex genetic structures of clinical conditions, few endophenotypes associated with ASD have been identified and integrated into family genetic studies. In this review, we argue that advancing knowledge of the complex pathogenic processes that contribute to ASD can be accelerated by refocusing attention toward identifying endophenotypic traits reflective of inherited mechanisms. This pivot requires renewed emphasis on study designs with measurement of familial co-variation including infant sibling studies, family trio and quad designs, and analysis of monozygotic and dizygotic twin concordance for select trait dimensions. We also emphasize that clarification of endophenotypic traits necessarily will involve integration of transdiagnostic approaches as candidate traits likely reflect liability for multiple clinical conditions and often are agnostic to diagnostic boundaries. Multiple candidate endophenotypes associated with ASD likelihood are described, and we propose a new focus on the analysis of "endophenotype trait domains" (ETDs), or traits measured across multiple levels (e.g., molecular, cellular, neural system, neuropsychological) along the causal pathway from genes to behavior. To inform our central argument for research efforts toward ETD discovery, we first provide a brief review of the concept of endophenotypes and their application to psychiatry. Next, we highlight key criteria for determining the value of candidate endophenotypes, including unique considerations for the study of ASD. Descriptions of different study designs for assessing endophenotypes in ASD research then are offered, including analysis of how select patterns of results may help prioritize candidate traits in future research. We also present multiple candidate ETDs that collectively cover a breadth of clinical phenomena associated with ASD, including social, language/communication, cognitive control, and sensorimotor processes. These ETDs are described because they represent promising targets for gene discovery related to clinical autistic traits, and they serve as models for analysis of separate candidate domains that may inform understanding of inherited etiological processes associated with ASD as well as overlapping neurodevelopmental disorders.
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Affiliation(s)
- Matthew W Mosconi
- Schiefelbusch Institute for Life Span Studies and Kansas Center for Autism Research and Training (K-CART), University of Kansas, Lawrence, KS, USA.
- Clinical Child Psychology Program, University of Kansas, Lawrence, KS, USA.
| | - Cassandra J Stevens
- Schiefelbusch Institute for Life Span Studies and Kansas Center for Autism Research and Training (K-CART), University of Kansas, Lawrence, KS, USA
- Clinical Child Psychology Program, University of Kansas, Lawrence, KS, USA
| | - Kathryn E Unruh
- Schiefelbusch Institute for Life Span Studies and Kansas Center for Autism Research and Training (K-CART), University of Kansas, Lawrence, KS, USA
| | - Robin Shafer
- Schiefelbusch Institute for Life Span Studies and Kansas Center for Autism Research and Training (K-CART), University of Kansas, Lawrence, KS, USA
| | - Jed T Elison
- Institute of Child Development, University of Minnesota, Minneapolis, MN, USA
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
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Zeng WX, Liu H, Hao Y, Qian KY, Tian FM, Li L, Yu B, Zeng XT, Gao S, Hu Z, Tong XJ. CaMKII mediates sexually dimorphic synaptic transmission at neuromuscular junctions in C. elegans. J Cell Biol 2023; 222:e202301117. [PMID: 37624117 PMCID: PMC10457463 DOI: 10.1083/jcb.202301117] [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: 01/27/2023] [Revised: 06/20/2023] [Accepted: 08/14/2023] [Indexed: 08/26/2023] Open
Abstract
Sexually dimorphic behaviors are ubiquitous throughout the animal kingdom. Although both sex-specific and sex-shared neurons have been functionally implicated in these diverse behaviors, less is known about the roles of sex-shared neurons. Here, we discovered sexually dimorphic cholinergic synaptic transmission in C. elegans occurring at neuromuscular junctions (NMJs), with males exhibiting increased release frequencies, which result in sexually dimorphic locomotion behaviors. Scanning electron microscopy revealed that males have significantly more synaptic vesicles (SVs) at their cholinergic synapses than hermaphrodites. Analysis of previously published transcriptome identified the male-enriched transcripts and focused our attention on UNC-43/CaMKII. We ultimately show that differential accumulation of UNC-43 at cholinergic neurons controls axonal SV abundance and synaptic transmission. Finally, we demonstrate that sex reversal of all neurons in hermaphrodites generates male-like cholinergic transmission and locomotion behaviors. Thus, beyond demonstrating UNC-43/CaMKII as an essential mediator of sex-specific synaptic transmission, our study provides molecular and cellular insights into how sex-shared neurons can generate sexually dimorphic locomotion behaviors.
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Affiliation(s)
- Wan-Xin Zeng
- School of Life Science and Technology, ShanghaiTech University, Shanghai, China
- Institute of Neuroscience, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Haowen Liu
- Queensland Brain Institute, Clem Jones Centre for Ageing Dementia Research (CJCADR), The University of Queensland, Brisbane, Australia
| | - Yue Hao
- School of Life Science and Technology, ShanghaiTech University, Shanghai, China
- Institute of Neuroscience, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Kang-Ying Qian
- School of Life Science and Technology, ShanghaiTech University, Shanghai, China
- Institute of Neuroscience, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Fu-Min Tian
- School of Life Science and Technology, ShanghaiTech University, Shanghai, China
| | - Lei Li
- Queensland Brain Institute, Clem Jones Centre for Ageing Dementia Research (CJCADR), The University of Queensland, Brisbane, Australia
| | - Bin Yu
- College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, China
| | - Xian-Ting Zeng
- School of Life Science and Technology, ShanghaiTech University, Shanghai, China
| | - Shangbang Gao
- College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, China
| | - Zhitao Hu
- Queensland Brain Institute, Clem Jones Centre for Ageing Dementia Research (CJCADR), The University of Queensland, Brisbane, Australia
- Department of Neuroscience, City University of Hong Kong, Kowloon, China
| | - Xia-Jing Tong
- School of Life Science and Technology, ShanghaiTech University, Shanghai, China
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Cary E, Rao A, Matsuba ESM, Russo N. Barriers to an Autistic Identity: How RRBs may Contribute to the Underdiagnosis of Females. RESEARCH IN AUTISM SPECTRUM DISORDERS 2023; 109:102275. [PMID: 38187508 PMCID: PMC10768999 DOI: 10.1016/j.rasd.2023.102275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
Background Autistic females are frequently underdiagnosed, misdiagnosed, and/or diagnosed later in life. Restricted and Repetitive Behaviors (RRBs) are increasingly critical for diagnosis and yet are commonly rated lower in females. Whether this reflects genuinely lower levels of these traits, or if female-typical RRBs have a different phenotypic presentation that may not register on current quantitative measurement tools is unclear. Methods Twenty-one autistic females and 21 autistic males matched on chronological age and FSIQ completed the AQ, ADOS-2, and ADI-R. Items from the ADOS-2 and ADI-R were selected that were relevant to the four areas of restricted and repetitive behavior in the DSM-5 diagnostic criteria of autism. Using a mixed-methods analytical approach, scores and comments on these measures were compared between sexes to better characterize RRBs in autistic females. Results There were no sex differences on the AQ, which broadly assesses autistic traits. When analyzed by the four DSM-5 RRB criteria, there were no sex differences on the ADI-R when using traditional algorithm scoring that narrows questions down to those that are more sensitive and specific in capturing autism in research samples with a high proportion of males. When incorporating additional items relevant to the DSM-5 to identify sex changes in a broader pool of items, females scored higher on stereotyped movements and speech. Females also engaged in more sensory behaviors during the ADOS-2. Qualitative analyses indicated that females were more likely to engage in stereotyped body rocking and spinning, stereotyped behaviors when anxious, to show major reactions to changes, repetitive language including listing and counting, and sensory behaviors, especially in the tactile domain. Conclusion Exploratory findings highlight sex differences in RRBs that may help enhance diagnostic clarity for females. Higher tactile sensory behaviors in females suggests there may be increased diagnostic sensitivity for females with the updated DSM-5 that now includes sensory components as part of the diagnostic criteria.
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Affiliation(s)
- Emily Cary
- Department of Psychology, Syracuse University, 430 Huntington Hall, Syracuse, NY 13244 2340
| | - Aparajita Rao
- Department of Psychology, Syracuse University, 430 Huntington Hall, Syracuse, NY 13244 2340
| | | | - Natalie Russo
- Department of Psychology, Syracuse University, 430 Huntington Hall, Syracuse, NY 13244 2340
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29
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Eldeeb SY, Ludwig NN, Wieckowski AT, Dieckhaus MFS, Algur Y, Ryan V, Dufek S, Stahmer A, Robins DL. Sex differences in early autism screening using the Modified Checklist for Autism in Toddlers, Revised, with Follow-Up (M-CHAT-R/F). AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:2112-2123. [PMID: 36786236 PMCID: PMC10423742 DOI: 10.1177/13623613231154728] [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] [Indexed: 02/15/2023]
Abstract
LAY ABSTRACT This study examined a widely used autism screening tool, the Modified Checklist for Autism in Toddlers, Revised, with Follow-Up to identify differences in screening for autism between toddler males and females. Examining sex differences in screening for autism in toddlerhood is important as it determines who will be referred for evaluations and receive diagnoses, which is critical for access to autism-specific early intervention. This study found that females were less likely to screen positive and be invited for evaluations compared with males. Females at high likelihood for autism were less likely to be diagnosed with autism, which decreases confidence in the screener's results. Importantly, the Modified Checklist for Autism in Toddlers, Revised, with Follow-Up accurately identified both males and females with autism. Future research should examine ways to improve accuracy in screening results for females.
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Affiliation(s)
| | - Natasha N. Ludwig
- Kennedy Krieger Institute, John Hopkins School of Medicine, Baltimore, MD
| | | | | | - Yasemin Algur
- Department of Epidemiology & Biostatistics, Drexel University, Philadelphia, PA
| | - Victoria Ryan
- Department of Epidemiology & Biostatistics, Drexel University, Philadelphia, PA
| | - Sarah Dufek
- Department of Psychiatry and Behavioral Sciences, University of California, Davis MIND Institute, Sacramento, CA
| | - Aubyn Stahmer
- Department of Psychiatry and Behavioral Sciences, University of California, Davis MIND Institute, Sacramento, CA
| | - Diana L. Robins
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, PA
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Torske T, Nærland T, Quintana DS, Hypher RE, Kaale A, Høyland AL, Hope S, Johannessen J, Øie MG, Andreassen OA. Sex as a Moderator Between Parent Ratings of Executive Dysfunction and Social Difficulties in Children and Adolescents with Autism Spectrum Disorder. J Autism Dev Disord 2023; 53:3847-3859. [PMID: 35838825 PMCID: PMC10499744 DOI: 10.1007/s10803-022-05629-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2022] [Indexed: 11/25/2022]
Abstract
Girls and boys might differ in autistic symptoms and associated cognitive difficulties such as executive function (EF). We investigated sex differences in the relationship between parent rated EF and autistic symptoms in 116 children and adolescents (25 girls) aged 5-19 years with an intelligence quotient above 70 and an autism spectrum disorder (ASD) diagnosis. They were rated with the behavior rating inventory of executive function (BRIEF) and the autism diagnostic interview revised (ADI-R). We found a positive association between EF and the ADI-R domains of reciprocal social interaction (p < 0.001) and communication (p = 0.001) in girls, while these relationships were small and non-significant in boys. Our results provide a greater understanding of the sex-specific characteristics of children and adolescents with ASD.
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Affiliation(s)
- Tonje Torske
- Division of Mental Health and Addiction, Vestre Viken Hospital Trust, Postboks 800, 3004, Drammen, Norway.
- Department of Psychology, University of Oslo, Oslo, Norway.
| | - Terje Nærland
- NevSom Department of Rare Disorders and Disabilities, Oslo University Hospital, Oslo, Norway
- K.G. Jebsen Center for Neurodevelopmental Disorders, University of Oslo, Oslo, Norway
| | - Daniel S Quintana
- Department of Psychology, University of Oslo, Oslo, Norway
- NevSom Department of Rare Disorders and Disabilities, Oslo University Hospital, Oslo, Norway
- K.G. Jebsen Center for Neurodevelopmental Disorders, University of Oslo, Oslo, Norway
- NORMENT, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Ruth Elizabeth Hypher
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Division of Pediatric and Adolescent Medicine, Department of Clinical Neurosciences for Children, Oslo University Hospital, Oslo, Norway
| | - Anett Kaale
- NevSom Department of Rare Disorders and Disabilities, Oslo University Hospital, Oslo, Norway
- Department of Special Needs Education, University of Oslo, Oslo, Norway
| | - Anne Lise Høyland
- Faculty of Medicine and Health Sciences, Department of Mental Health, Regional Centre for Child and Youth Mental Health and Child Welfare, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Pediatrics, St. Olav Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Sigrun Hope
- NORMENT, University of Oslo and Oslo University Hospital, Oslo, Norway
- Department of Neurohabilitation, Oslo University Hospital, Oslo, Norway
| | - Jarle Johannessen
- NevSom Department of Rare Disorders and Disabilities, Oslo University Hospital, Oslo, Norway
- Department of Medicine, University of Oslo, Oslo, Norway
| | - Merete G Øie
- Department of Psychology, University of Oslo, Oslo, Norway
- Research Department, Innlandet Hospital Trust, Lillehammer, Norway
| | - Ole A Andreassen
- K.G. Jebsen Center for Neurodevelopmental Disorders, University of Oslo, Oslo, Norway
- NORMENT, University of Oslo and Oslo University Hospital, Oslo, Norway
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Rutten AX, Vermeiren RRJM, Bongers IL, Van Nieuwenhuizen C. Likelihood of identifying autistic traits with the autism spectrum quotient (AQ) in male juveniles with autism spectrum disorder (ASD) and severe behavioral problems (SBPs). BMC Psychiatry 2023; 23:694. [PMID: 37749505 PMCID: PMC10521445 DOI: 10.1186/s12888-023-05200-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 09/18/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND When screening for autism spectrum disorders (ASD), the Autism Spectrum Quotient (AQ) is generally considered to be useful. Whether the AQ is also a suitable screener for ASD in juveniles with severe behavioral problems (SBPs) is unknown. Due to the overlap of symptoms between ASD and SBPs, particularly in juveniles low on empathy, the screening capacity of the AQ might be constrained. The aim of the present study was to investigate whether (comorbid) SBPs affect the screening capacity of the AQ. The hypothesis is that male juveniles with SBPs - but without a diagnosis of ASD - will score higher than male juveniles without both SBPs and ASD. METHOD The AQ was completed by 216 male juveniles aged 15-18 years treated at an outpatient department of child and adolescent psychiatry. The 216 participants were categorized into four groups according to a clinical diagnosis of ASD and SBPs (defined as disruptive behavior disorder and/or delinquent behavior). Using multinomial logistic regression, we investigated whether the four identified groups, based on a diagnosis of ASD and SBPs, scored differently for the total score and subscales of the AQ. RESULTS Participants in the group with ASD (ASD+) but without SBPs (SBP-) were more likely to report higher levels of autistic traits than the reference group without both ASD and SBPs (ASD-SBP-), except for the subscale on attention to detail (ASD+SBP- OR = 1.04; 95%CI = 0.98-1.11). Participants in the group with both ASD and SBPs were more likely to report higher levels for the total AQ score (ASD+SBP+ OR = 1.03; 95%CI = 1.00-1.05) and the communication subscale of the AQ (ASD+SBP+ OR = 1.18; 95%CI = 1.07-1.31) than the reference group without both ASD and SBPs. CONCLUSION In outpatient male juveniles, SBPs do not affect the screening capacity of the AQ for autistic traits. In spite of the well-known overlap of symptoms between ASD and SBPs, male juveniles with SBPs but without a diagnosis of ASD do not score higher on the AQ than male juveniles without SBPs and without a diagnosis of ASD.
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Affiliation(s)
- Alexa X Rutten
- Centre for Child and Adolescent Psychiatry, GGzE, P.O. Box 909, Eindhoven, DP, 8001, 5600 AX, The Netherlands.
- Scientific Center for Care and Wellbeing, Tilburg University, Tranzo, Tilburg, The Netherlands.
| | - Robert R J M Vermeiren
- Department of Child and Adolescent Psychiatry, LUMC-Curium, Leiden University Medical Center, Leiden, The Netherlands
- Youz, Parnassia Group, The Hague, The Netherlands
| | - Ilja L Bongers
- Centre for Child and Adolescent Psychiatry, GGzE, P.O. Box 909, Eindhoven, DP, 8001, 5600 AX, The Netherlands
- Scientific Center for Care and Wellbeing, Tilburg University, Tranzo, Tilburg, The Netherlands
| | - Chijs Van Nieuwenhuizen
- Centre for Child and Adolescent Psychiatry, GGzE, P.O. Box 909, Eindhoven, DP, 8001, 5600 AX, The Netherlands
- Scientific Center for Care and Wellbeing, Tilburg University, Tranzo, Tilburg, The Netherlands
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32
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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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Cuppens T, Shatto J, Mangnier L, Kumar AA, Ng ACH, Kaur M, Bui TA, Leclercq M, Droit A, Dunham I, Bolduc FV. Sex difference contributes to phenotypic diversity in individuals with neurodevelopmental disorders. Front Pediatr 2023; 11:1172154. [PMID: 37609366 PMCID: PMC10441218 DOI: 10.3389/fped.2023.1172154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 07/20/2023] [Indexed: 08/24/2023] Open
Abstract
Objective Gain a better understanding of sex-specific differences in individuals with global developmental delay (GDD), with a focus on phenotypes and genotypes. Methods Using the Deciphering Developmental Disorders (DDD) dataset, we extracted phenotypic information from 6,588 individuals with GDD and then identified statistically significant variations in phenotypes and genotypes based on sex. We compared genes with pathogenic variants between sex and then performed gene network and molecular function enrichment analysis and gene expression profiling between sex. Finally, we contrasted individuals with autism as an associated condition. Results We identified significantly differentially expressed phenotypes in males vs. females individuals with GDD. Autism and macrocephaly were significantly more common in males whereas microcephaly and stereotypies were more common in females. Importantly, 66% of GDD genes with pathogenic variants overlapped between both sexes. In the cohort, males presented with only slightly increased X-linked genes (9% vs. 8%, respectively). Individuals from both sexes harbored a similar number of pathogenic variants overall (3) but females presented with a significantly higher load for GDD genes with high intolerance to loss of function. Sex difference in gene expression correlated with genes identified in a sex specific manner. While we identified sex-specific GDD gene mutations, their pathways overlapped. Interestingly, individuals with GDD but also co-morbid autism phenotypes, we observed distinct mutation load, pathways and phenotypic presentation. Conclusion Our study shows for the first time that males and females with GDD present with significantly different phenotypes. Moreover, while most GDD genes overlapped, some genes were found uniquely in each sex. Surprisingly they shared similar molecular functions. Sorting genes by predicted tolerance to loss of function (pLI) led to identifying an increased mutation load in females with GDD, suggesting potentially a tolerance to GDD genes of higher pLI compared to overall GDD genes. Finally, we show that considering associated conditions (for instance autism) may influence the genomic underpinning found in individuals with GDD and highlight the importance of comprehensive phenotyping.
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Affiliation(s)
- Tania Cuppens
- Centre de Recherche du CHU de Québec-Université Laval, Département de Médecine Moléculaire de L'Université Laval, Québec, QC, Canada
| | - Julie Shatto
- Department of Pediatric Neurology, University of Alberta, Edmonton, AB, Canada
| | - Loïc Mangnier
- Centre de Recherche du CHU de Québec-Université Laval, Département de Médecine Moléculaire de L'Université Laval, Québec, QC, Canada
| | - Ajay A. Kumar
- European Molecular Biology Laboratory, European Bioinformatics Institute (EMBL-EBI); Wellcome Genome Campus, Cambridgeshire, United Kingdom
| | - Andy Cheuk-Him Ng
- Department of Pediatric Neurology, University of Alberta, Edmonton, AB, Canada
| | - Manpreet Kaur
- Department of Pediatric Neurology, University of Alberta, Edmonton, AB, Canada
| | - Truong An Bui
- Department of Pediatric Neurology, University of Alberta, Edmonton, AB, Canada
| | - Mickael Leclercq
- Centre de Recherche du CHU de Québec-Université Laval, Département de Médecine Moléculaire de L'Université Laval, Québec, QC, Canada
| | - Arnaud Droit
- Centre de Recherche du CHU de Québec-Université Laval, Département de Médecine Moléculaire de L'Université Laval, Québec, QC, Canada
| | - Ian Dunham
- European Molecular Biology Laboratory, European Bioinformatics Institute (EMBL-EBI); Wellcome Genome Campus, Cambridgeshire, United Kingdom
| | - Francois V. Bolduc
- Department of Pediatric Neurology, University of Alberta, Edmonton, AB, Canada
- Department of Medical Genetics, University of Alberta, Edmonton, AB, Canada
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
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Must A, Eliasziw M, Stanish H, Curtin C, Bandini LG, Bowling A. Passive and social screen time in children with autism and in association with obesity. Front Pediatr 2023; 11:1198033. [PMID: 37492602 PMCID: PMC10364473 DOI: 10.3389/fped.2023.1198033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/29/2023] [Indexed: 07/27/2023] Open
Abstract
Background Screen time has been identified as a risk factor for childhood obesity, but the media landscape has evolved rapidly. Children with autism tend to be heavy users of screens and have an elevated prevalence of obesity. We know little about screen use patterns among children with autism vs. typically developing (TD) peers and in association with obesity. Methods Baseline data from 10,842 participants in the Adolescent Brain Cognition Development Study was used to characterize time spent with child-reported passive screen use (television/movies/watching videos), playing video games, and using social media. Duration of screen time by autism status and gender was summarized as mean time per day; obesity was defined using CDC/WHO criteria. A propensity score analysis was used to create a matched dataset for analysis. Results Overall, 1.7% of children were was identified as having autism. Significant mean differences were observed by autism status and gender for both passive viewing and playing video games. Compared to TD children, boys with autism spent more time (2.9 vs. 2.3 h, p < 0.001) watching TV, movies or videos, as did girls (3.0 vs. 2.0 h, p = 0.002). Compared to TD peers, boys with autism reported more video game time (102.7 vs. 77.5 min, p = 0.001), as did girls with autism (64.4 vs. 37.9 min, p = 0.03); girls with autism also spent more time on social media sites or video chat (45.5 vs. 21.9 min, p = 0.04). Overall, obesity prevalence increased with increasing screen time duration, significantly for passive screen time (p-value = 0.002) and texting (p-value = 0.02). Associations between obesity and screen time duration did not differ by autism status. Discussion Children with autism spend more time playing video games and on passive and social screen activities than their TD peers, with some variations by gender. High rates of social media use among girls with autism and multiplayer video game use among both boys and girls with autism may challenge the notion that the high levels of screen time reflect social isolation in the group. Given potential positive aspects of screen time in children with autism movement to focus on content and context is appropriate.
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Affiliation(s)
- Aviva Must
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, United States
| | - Misha Eliasziw
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, United States
| | - Heidi Stanish
- Department of Exercise and Health Sciences, Manning College of Nursing and Health Sciences, University of Massachusetts-Boston, Boston, MA, United States
| | - Carol Curtin
- E.K. Shriver Center, UMASS Chan Medical School, Worcester, MA, United States
| | - Linda G. Bandini
- E.K. Shriver Center, UMASS Chan Medical School, Worcester, MA, United States
| | - April Bowling
- E.K. Shriver Center, UMASS Chan Medical School, Worcester, MA, United States
- Department of Nursing and Health Sciences, Merrimack College, Andover, MA, United States
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Abstract
The sex difference in the prevalence of autism spectrum disorder (ASD) may be magnified by sex differences on diagnostic measures. The current study compared autistic males and females on items on the gold-standard diagnostic measure, the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2). In a sample of 8-to-17-year old autistic individuals from research (n = 229) and clinical settings (n = 238), females were less likely to show atypicalities on most items related to social-communication behaviors and on total and subscale scores. When controlling for overall intensity of symptomatology, no sex differences survived statistical corrections. Diagnostic criteria and/or gold-standard assessments may be less sensitive to female presentations of ASD and/or autistic females may exhibit fewer or less intense behaviors characteristic of ASD.
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Affiliation(s)
- Hannah M Rea
- Psychiatry & Behavioral Science Department, University of Washington, Seattle, WA, 98195, USA
| | - Roald A Øien
- UiT-The Arctic University of Norway, PB 6060, 9037, Tromsø, Norway
- Child Study Center, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Frederick Shic
- Center On Child Health, Behavior & Development, Seattle Children's Research Institute, Seattle, WA, 98105, USA
- Department of Pediatrics, University of Washington, Seattle, WA, 98195, USA
| | - Sara Jane Webb
- Psychiatry & Behavioral Science Department, University of Washington, Seattle, WA, 98195, USA
- Center On Child Health, Behavior & Development, Seattle Children's Research Institute, Seattle, WA, 98105, USA
| | - Allison B Ratto
- Children's National Medical Center, 15245 Shady Grove Road, Suite 350, Rockville, MD, 20850, USA.
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Scaffei E, Mazziotti R, Conti E, Costanzo V, Calderoni S, Stoccoro A, Carmassi C, Tancredi R, Baroncelli L, Battini R. A Potential Biomarker of Brain Activity in Autism Spectrum Disorders: A Pilot fNIRS Study in Female Preschoolers. Brain Sci 2023; 13:951. [PMID: 37371429 DOI: 10.3390/brainsci13060951] [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: 05/07/2023] [Revised: 05/29/2023] [Accepted: 06/10/2023] [Indexed: 06/29/2023] Open
Abstract
Autism spectrum disorder (ASD) refers to a neurodevelopmental condition whose detection still remains challenging in young females due to the heterogeneity of the behavioral phenotype and the capacity of camouflage. The availability of quantitative biomarkers to assess brain function may support in the assessment of ASD. Functional Near-infrared Spectroscopy (fNIRS) is a non-invasive and flexible tool that quantifies cortical hemodynamic responses (HDR) that can be easily employed to describe brain activity. Since the study of the visual phenotype is a paradigmatic model to evaluate cerebral processing in many neurodevelopmental conditions, we hypothesized that visually-evoked HDR (vHDR) might represent a potential biomarker in ASD females. We performed a case-control study comparing vHDR in a cohort of high-functioning preschooler females with ASD (fASD) and sex/age matched peers. We demonstrated the feasibility of visual fNIRS measurements in fASD, and the possibility to discriminate between fASD and typical subjects using different signal features, such as the amplitude and lateralization of vHDR. Moreover, the level of response lateralization was correlated to the severity of autistic traits. These results corroborate the cruciality of sensory symptoms in ASD, paving the way for the validation of the fNIRS analytical tool for diagnosis and treatment outcome monitoring in the ASD population.
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Affiliation(s)
- Elena Scaffei
- Department of Neuroscience, Psychology, Drug Research and Child Health NEUROFARBA, University of Florence, 50135 Florence, Italy
- IRCCS Stella Maris Foundation, Viale del Tirreno, 56128 Pisa, Italy
| | - Raffaele Mazziotti
- IRCCS Stella Maris Foundation, Viale del Tirreno, 56128 Pisa, Italy
- Institute of Neuroscience, National Research Council, Via Moruzzi 1, 56124 Pisa, Italy
| | - Eugenia Conti
- IRCCS Stella Maris Foundation, Viale del Tirreno, 56128 Pisa, Italy
| | - Valeria Costanzo
- IRCCS Stella Maris Foundation, Viale del Tirreno, 56128 Pisa, Italy
| | - Sara Calderoni
- IRCCS Stella Maris Foundation, Viale del Tirreno, 56128 Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56126 Pisa, Italy
| | - Andrea Stoccoro
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, 56100 Pisa, Italy
| | - Claudia Carmassi
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56126 Pisa, Italy
| | | | - Laura Baroncelli
- Institute of Neuroscience, National Research Council, Via Moruzzi 1, 56124 Pisa, Italy
| | - Roberta Battini
- IRCCS Stella Maris Foundation, Viale del Tirreno, 56128 Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56126 Pisa, Italy
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Ruffing S, Ullrich C, Flotats-Bastardas M, Poryo M, Meyer S. [Assessment of the importance of neuropediatric diagnostics in the initial clarification of autism]. Wien Med Wochenschr 2023:10.1007/s10354-023-01012-w. [PMID: 37133629 DOI: 10.1007/s10354-023-01012-w] [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: 09/20/2022] [Accepted: 03/08/2023] [Indexed: 05/04/2023]
Abstract
BACKGROUND The diagnostics of autism spectrum disorder is complex due to missing biological markers and numerous comorbidities. The aim was to assess the role of neuropediatric diagnostics and to develop a standard operating procedure for a targeted assessment. METHOD All patients presenting to the neuropediatric outpatient clinic at Saarland University Hospital between April 2014 and December 2017 with ICD code F84 pervasive developmental disorders were included. RESULTS A total of 82 patients were included (male 78%, female 22%; mean age 5.9 ± 2.9 years, range 2-16 years). The most frequent examination was electroencephalography (EEG) (74/82; 90.2%) with pathological findings in 33.8% (25/74). Based on the history and/or EEG epilepsy was diagnosed in 19.5% (16/82). Magnetic resonance imaging (MRI) was performed in 49/82 (59.8%) patients, 22/49 (44.9%) showed at least 1 cerebral abnormality and definite pathologies could be detected in 63.6% (14/22). A metabolic diagnostic work-up was performed in 44/82 (53.7%) cases and in 5/44 (11.4%) it resulted in a diagnosis or suspicion of a metabolic disease. Genetic testing results were available in 29/82 (35.4%) children and 12/29 (41.4%) showed abnormal results. Delay in motor development was more frequently associated with comorbidities, EEG abnormalities, epilepsy and abnormalities in metabolic and genetic testing. CONCLUSION Neuropediatric examination in cases of suspected autism should include a detailed history, a thorough neurological examination and an EEG. An MRI, comprehensive metabolic and genetic testing are only recommended if clinically indicated.
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Affiliation(s)
- Sarah Ruffing
- Pädiatrische Kardiologie, Universität des Saarlandes, Kirrberger Str., Geb. 9, 66421, Homburg/Saar, Deutschland.
| | - Christine Ullrich
- Klinik für Allgemeine Pädiatrie und Neonatologie, Universität des Saarlandes, Homburg/Saar, Deutschland
| | - Marina Flotats-Bastardas
- Klinik für Allgemeine Pädiatrie und Neonatologie, Universität des Saarlandes, Homburg/Saar, Deutschland
| | - Martin Poryo
- Pädiatrische Kardiologie, Universität des Saarlandes, Kirrberger Str., Geb. 9, 66421, Homburg/Saar, Deutschland
| | - Sascha Meyer
- Klinik für Allgemeine Pädiatrie und Neonatologie, Universität des Saarlandes, Homburg/Saar, Deutschland
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38
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Carrick A, Hamilton CJ. Heated Behaviour in the Classroom for Children with FASD: The Relationship between Characteristics Associated with ADHD, ODD and ASD, Hot Executive Function and Classroom Based Reward Systems. CHILDREN 2023; 10:children10040685. [PMID: 37189934 DOI: 10.3390/children10040685] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 03/17/2023] [Accepted: 03/30/2023] [Indexed: 04/07/2023]
Abstract
Possession of characteristics related to Attention Deficit Hyperactive Disorder, Oppositional Defiance Disorder, and Autism Spectrum Disorder in children prenatally exposed to alcohol contributes to challenges within the diagnostic pathway for Foetal Alcohol Spectrum Disorder (FASD). The presentation of these characteristics, though problematic for the children affected, may not result in referral for diagnosis; focusing on diagnostic thresholds masks the dimensional nature of these characteristics. Children with traits which are undiagnosed may not receive effective support and are often identified as exhibiting challenging behaviour. In the UK, children with undiagnosed Special Educational Needs (SEN) are more likely to experience school exclusion. Common across each condition are challenges to executive function associated with emotional regulation (hot-executive function). This study explored the relationship between characteristics of Attention Deficit Hyperactive Disorder, Oppositional Defiance Disorder, Autistic-Like Traits, and hot executive functions on the helpfulness of reward-based interventions for children with suspected or diagnosed FASD. Data were collected online using caregiver referral questionnaire screeners for each measure (Child Autism Quotient Questionnaire, Vanderbilt ADHD Parental Rating Scale and The Childhood Executive Functioning Inventory) for children aged 6–12 years with suspected or diagnosed FASD (n = 121). Between-group comparisons showed no significant difference in the reporting of Attention Deficit Hyperactive Disorder characteristics, Oppositional Defiance Disorder characteristics, Autistic-Like Traits, and executive function, regardless of diagnostic state. Multiple regression analyses indicated that these personality characteristics and executive functions were associated with the perception of the reward system helpfulness. However, this pattern was qualified by both the type of hot executive function challenged (significant for Regulation not Inhibition) and whether the child had an FASD diagnosis. Thus, a dimensional approach may strengthen our understanding of the child’s classroom experience and help overcome barriers to effective intervention and support.
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Affiliation(s)
- Andrea Carrick
- Department of Psychology, Northumbria University, Newcastle upon Tyne NE1 8ST, UK
| | - Colin J. Hamilton
- Department of Psychology, Northumbria University, Newcastle upon Tyne NE1 8ST, UK
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39
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Dillon EF, Kanne S, Landa RJ, Annett R, Bernier R, Bradley C, Carpenter L, Kim SH, Parish-Morris J, Schultz R, Wodka EL. Sex Differences in Autism: Examining Intrinsic and Extrinsic Factors in Children and Adolescents Enrolled in a National ASD Cohort. J Autism Dev Disord 2023; 53:1305-1318. [PMID: 34859339 PMCID: PMC9181723 DOI: 10.1007/s10803-021-05385-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2021] [Indexed: 12/20/2022]
Abstract
Discernment of possible sex-based variations in presentations of autism spectrum disorder (ASD) symptoms is limited by smaller female samples with ASD and confounds with ASD ascertainment. A large national cohort of individuals with autism, SPARK, allowed parent report data to be leveraged to examine whether intrinsic child characteristics and extrinsic factors differentially impact males and females with ASD. Small but consistent sex differences in individuals with ASD emerged related to both intrinsic and extrinsic factors, with different markers for males and females. Language concerns in males may make discernment of ASD more straightforward, while early motor concerns in females may hamper diagnosis as such delays are not identified within traditional ASD diagnostic criteria.
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Affiliation(s)
- Emily F Dillon
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, MD, USA
- Autism Assessment Research Training and Service (AARTS), Center at RUSH University, Chicago, IL, USA
| | - Stephen Kanne
- Thompson Center of Neurodevelopmental Disorders, University of Missouri, Columbia, MO, USA
- Cornell University, New York City, NY, USA
| | - Rebecca J Landa
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Robert Annett
- Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS, USA
| | - Raphael Bernier
- Department of Psychiatry, University of Washington, Seattle, WA, USA
| | - Catherine Bradley
- Developmental-Behavioral Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - Laura Carpenter
- Developmental-Behavioral Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - So Hyun Kim
- Weill Cornell Medicine, Clinical Psychiatry, New York, NY, USA
| | - Julia Parish-Morris
- Center for Autism and Children's Hospital of Philadelphia, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Robert's Center for Pediatric Research, Philadelphia, PA, USA
| | - Robert Schultz
- Center for Autism and Children's Hospital of Philadelphia, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Ericka L Wodka
- Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, MD, USA.
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40
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Kopp S, Asztély KS, Landberg S, Waern M, Bergman S, Gillberg C. Girls With Social and/or Attention Deficit Re-Examined in Young Adulthood: Prospective Study of Diagnostic Stability, Daily Life Functioning and Social Situation. J Atten Disord 2023; 27:830-846. [PMID: 36915033 DOI: 10.1177/10870547231158751] [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] [Indexed: 03/16/2023]
Abstract
OBJECTIVE Investigate diagnostic stability, daily life functioning and social situation in women diagnosed with ADHD and/or ASD in childhood. METHODS Prospective 17 to 20-year follow-up study of 100 girls of whom 92 diagnosed in childhood with main DSM-IV ADHD or ASD, and 60 comparison girls. Ninety and 54 of these women were examined (M = 27, 4 years old) with semi-structured interviews and questionnaires, close relatives were interviewed. RESULTS At follow-up, 89% of women with ADHD or ASD in childhood still met the criteria for either of these diagnoses. Very few women were "in remission." In 34% the main diagnosis shifted from ADHD to ASD. Women with ADHD and ASD had significantly more disability and unfavorable social situation than comparison women. CONCLUSION Women with ADHD and/or ASD in childhood had impairing problems 17 to 20 years later. Early ADHD changed to ASD in adulthood in some cases. Nearly all with ASD met criteria for ADHD as adults.
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Affiliation(s)
- Svenny Kopp
- University of Gothenburg Institute of Neuroscience and Physiology, Göteborg, Sweden
| | | | - Sara Landberg
- University of Gothenburg Institute of Neuroscience and Physiology, Göteborg, Sweden
| | - Margda Waern
- University of Gothenburg Institute of Neuroscience and Physiology, Göteborg, Sweden
| | - Stefan Bergman
- University of Gothenburg Institute of Medicine, Göteborg, VG Region, Sweden
| | - Christopher Gillberg
- University of Gothenburg Institute of Neuroscience and Physiology, Göteborg, Sweden
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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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42
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Ferguson CJ, Preece DA, Schweitzer RD. Alexithymia in autism spectrum disorder. AUSTRALIAN PSYCHOLOGIST 2023. [DOI: 10.1080/00050067.2023.2174409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Affiliation(s)
- Cassie J. Ferguson
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, Australia
| | - David A. Preece
- Curtin enAble Institute and School of Population Health, Curtin University, Perth, Australia
- School of Psychological Science, University of Western Australia, Perth, Australia
| | - Robert D. Schweitzer
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, Australia
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Abstract
Relative to males, women with autism spectrum disorder (ASD) have neurobiological and clinical presentation differences. Recent research suggests that the male/female ASD prevalence gap is smaller than previously reported. Sex differences in symptom presentation as well as the male bias of ASD account for delayed/missed diagnosis among women. Investigating ASD and providing psychological evaluation referrals for women who are struggling socially and present with complex mental health conditions (e.g., ADHD, depression), even when they do not show typical autistic characteristics, is important. Accurate diagnosis facilitates understanding of challenges, increases access to treatments, and alleviates the burden of ASD.
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Affiliation(s)
- Cesar Ochoa-Lubinoff
- Rush University Medical Center, 1725 West Harrison Street, Suite 710, Chicago, IL 60612, USA.
| | - Bridget A Makol
- Rush University Medical Center, 1653 West Congress Parkway, 12 Kellogg, Chicago, IL 60612, USA
| | - Emily F Dillon
- Rush University Medical Center, 1645 West Jackson Boulevard, Chicago, IL 60612, USA
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Stephenson KG, Norris M, Butter EM. Sex-Based Differences in Autism Symptoms in a Large, Clinically-Referred Sample of Preschool-Aged Children with ASD. J Autism Dev Disord 2023; 53:624-632. [PMID: 33459916 DOI: 10.1007/s10803-020-04836-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2020] [Indexed: 11/26/2022]
Abstract
Previous research has identified possible sex-based differences in restricted and repetitive behaviors in autism spectrum disorder (ASD). However, this finding is mixed, particularly among preschool-aged children. We investigated the presence of sex-based differences in parent-rated ASD symptomatology, using the Autism Spectrum Rating Scale (ASRS). Participants consisted of a large (n = 481,100 female), clinically-referred sample of preschoolers (ages 2-5) diagnosed with ASD (NVIQ: M = 67.11, SD = 21.79). Females had less severe symptoms on the Total, Unusual Behaviors, DSM-5, and Stereotypy scales on the ASRS. The effects were small-to-medium, but statistically significant. There was evidence of differential relationships between nonverbal IQ and ASRS scores among males and females. This study provides additional evidence of sex-based differences in ASD symptoms present from an early age.
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Affiliation(s)
- Kevin G Stephenson
- Child Development Center, Nationwide Children's Hospital, Columbus, OH, USA.
- Departments of Pediatrics and Psychology, The Ohio State University, Columbus, OH, USA.
| | - Megan Norris
- Child Development Center, Nationwide Children's Hospital, Columbus, OH, USA
- Departments of Pediatrics and Psychology, The Ohio State University, Columbus, OH, USA
| | - Eric M Butter
- Child Development Center, Nationwide Children's Hospital, Columbus, OH, USA
- Departments of Pediatrics and Psychology, The Ohio State University, Columbus, OH, USA
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45
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Xu B, Ho Y, Fasolino M, Medina J, O’Brien WT, Lamonica JM, Nugent E, Brodkin ES, Fuccillo MV, Bucan M, Zhou Z. Allelic contribution of Nrxn1α to autism-relevant behavioral phenotypes in mice. PLoS Genet 2023; 19:e1010659. [PMID: 36848371 PMCID: PMC9997995 DOI: 10.1371/journal.pgen.1010659] [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: 12/12/2022] [Revised: 03/09/2023] [Accepted: 02/08/2023] [Indexed: 03/01/2023] Open
Abstract
Copy number variations (CNVs) in the Neurexin 1 (NRXN1) gene, which encodes a presynaptic protein involved in neurotransmitter release, are some of the most frequently observed single-gene variants associated with autism spectrum disorder (ASD). To address the functional contribution of NRXN1 CNVs to behavioral phenotypes relevant to ASD, we carried out systematic behavioral phenotyping of an allelic series of Nrxn1 mouse models: one carrying promoter and exon 1 deletion abolishing Nrxn1α transcription, one carrying exon 9 deletion disrupting Nrxn1α protein translation, and one carrying an intronic deletion with no observable effect on Nrxn1α expression. We found that homozygous loss of Nrxn1α resulted in enhanced aggression in males, reduced affiliative social behaviors in females, and significantly altered circadian activities in both sexes. Heterozygous or homozygous loss of Nrxn1α affected the preference for social novelty in male mice, and notably, enhanced repetitive motor skills and motor coordination in both sexes. In contrast, mice bearing an intronic deletion of Nrxn1 did not display alterations in any of the behaviors assessed. These findings demonstrate the importance of Nrxn1α gene dosage in regulating social, circadian, and motor functions, and the variables of sex and genomic positioning of CNVs in the expression of autism-related phenotypes. Importantly, mice with heterozygous loss of Nrxn1, as found in numerous autistic individuals, show an elevated propensity to manifest autism-related phenotypes, supporting the use of models with this genomic architecture to study ASD etiology and assess additional genetic variants associated with autism.
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Affiliation(s)
- Bing Xu
- Department of Genetics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
- Autism Spectrum Program of Excellence (ASPE), University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
- Department of Urology, The First Affiliated Hospital of Shandong First Medical University & Shandong Province Qianfoshan Hospital, Shandong Medicine and Health Key Laboratory of Organ Transplantation and Nephrosis, Shandong Institute of Nephrology, Jinan, Shandong, China
| | - Yugong Ho
- Department of Genetics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
- Autism Spectrum Program of Excellence (ASPE), University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Maria Fasolino
- Department of Genetics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
- Autism Spectrum Program of Excellence (ASPE), University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Joanna Medina
- Department of Genetics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
- Autism Spectrum Program of Excellence (ASPE), University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - William Timothy O’Brien
- Preclinical Models Core, Intellectual and Developmental Disability Research Center (IDDRC) Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Janine M. Lamonica
- Department of Genetics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
- Autism Spectrum Program of Excellence (ASPE), University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Erin Nugent
- Department of Genetics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
- Autism Spectrum Program of Excellence (ASPE), University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Edward S. Brodkin
- Autism Spectrum Program of Excellence (ASPE), University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Marc V. Fuccillo
- Autism Spectrum Program of Excellence (ASPE), University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
- Department of Neuroscience, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Maja Bucan
- Department of Genetics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
- Autism Spectrum Program of Excellence (ASPE), University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Zhaolan Zhou
- Department of Genetics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
- Autism Spectrum Program of Excellence (ASPE), University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
- Preclinical Models Core, Intellectual and Developmental Disability Research Center (IDDRC) Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Department of Neuroscience, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
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46
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Kavanaugh BC, Schremp CA, Jones RN, Best CR, Sheinkopf SJ, Morrow EM. Moderators of Age of Diagnosis in > 20,000 Females with Autism in Two Large US Studies. J Autism Dev Disord 2023; 53:864-869. [PMID: 33961180 DOI: 10.1007/s10803-021-05026-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2021] [Indexed: 10/21/2022]
Abstract
The objective of this study was to determine the clinical features that moderate a later age at ASD diagnosis in females in a large sample of females with ASD. Within two large and independent ASD datasets (> 20,000 females), females were first diagnosed with ASD 14-months later relative to males. This later age at diagnosis was moderated by a mild or atypical presentation, wherein repetitive behaviors were limited, IQ and language were broadly intact, and recognized symptoms emerged later in development. Females are at risk for a later age at ASD diagnosis and treatment implementation, and modification of early childhood ASD screening methods for females may be warranted.
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Affiliation(s)
- Brian C Kavanaugh
- Developmental Disorders Genetics Research Program, Emma Pendleton Bradley Hospital, East Providence, RI, USA.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.,Hassenfeld Child Health Innovation Institute, Brown University, Providence, RI, USA
| | - Christine A Schremp
- Developmental Disorders Genetics Research Program, Emma Pendleton Bradley Hospital, East Providence, RI, USA.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Richard N Jones
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Carrie R Best
- Developmental Disorders Genetics Research Program, Emma Pendleton Bradley Hospital, East Providence, RI, USA.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.,Hassenfeld Child Health Innovation Institute, Brown University, Providence, RI, USA
| | - Stephen J Sheinkopf
- Developmental Disorders Genetics Research Program, Emma Pendleton Bradley Hospital, East Providence, RI, USA.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.,Hassenfeld Child Health Innovation Institute, Brown University, Providence, RI, USA.,Brown Center for the Study of Children at Risk, Women & Infants Hospital, Providence, RI, USA.,Department of Pediatrics, Alpert Medical School of Brown University, Providence, RI, USA
| | - Eric M Morrow
- Developmental Disorders Genetics Research Program, Emma Pendleton Bradley Hospital, East Providence, RI, USA. .,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA. .,Hassenfeld Child Health Innovation Institute, Brown University, Providence, RI, USA. .,Department of Molecular Biology, Cell Biology and Biochemistry, Brown University, Providence, RI, USA. .,Center for Translational Neuroscience, Robert J. and Nancy D. Carney Institute for Brain Science and Brown Institute for Translational Science, Brown University, Providence, RI, USA. .,Laboratories for Molecular Medicine, Brown University, 70 Ship Street, Providence, RI, 02912, USA.
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47
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Putnam OC, Sasson N, Parish-Morris J, Harrop C. Effects of social complexity and gender on social and non-social attention in male and female autistic children: A comparison of four eye-tracking paradigms. Autism Res 2023; 16:315-326. [PMID: 36408851 DOI: 10.1002/aur.2851] [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: 12/03/2021] [Accepted: 10/31/2022] [Indexed: 11/22/2022]
Abstract
Eye tracking has long been used to characterize differences in social attention between autistic and non-autistic children, but recent work has shown that these patterns may vary widely according to the biological sex of the participants and the social complexity and gender-typicality of the eye tracking stimuli (e.g., barbies vs. transformers). To better understand effects of sex, social complexity, and object gender-typicality on social and non-social gaze behavior in autism, we compared the visual attention patterns of 67 autistic (ASD) and non-autistic (NA) males (M) and females (F) (ASD M = 21; ASD F = 18; NA M = 14; NA F = 14) across four eye tracking paradigms varying in social complexity and object gender-typicality. We found consistency across paradigms in terms of overall attention and attention to social stimuli, but attention to objects varied when paradigms considered gender in their stimulus design. Children attended more to gendered objects, particularly when the gender-typicality of the object matched their assigned sex. These results demonstrate that visual social attention in autism is affected by interactions between a child's biological sex, social scene complexity, and object gender-typicality and have broad implications for the design and interpretation of eye tracking studies.
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Affiliation(s)
- Orla C Putnam
- Division of Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Noah Sasson
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, Texas, USA
| | - Julia Parish-Morris
- Department of Child and Adolescent Psychiatry, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Clare Harrop
- Division of Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,TEACCH Autism Program, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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48
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Sun F, Chen Y, Huang Y, Yan J, Chen Y. Relationship between gray matter structure and age in children and adolescents with high-functioning autism spectrum disorder. Front Hum Neurosci 2023; 16:1039590. [PMID: 36684838 PMCID: PMC9853167 DOI: 10.3389/fnhum.2022.1039590] [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: 09/08/2022] [Accepted: 12/15/2022] [Indexed: 01/08/2023] Open
Abstract
Objective The present study used magnetic resonance imaging to investigate the difference in the relationship between gray matter structure and age in children and adolescents with autism spectrum disorder (ASD) and typically developing (TD) subjects. Methods After screening T1 structural images from the Autism Brain Imaging Data Exchange (ABIDE) database, 111 children and adolescents (7-18 years old) with high-functioning ASD and 151 TD subjects matched for age, sex and full IQ were included in the current study. By using the voxel-based morphological analysis method, gray matter volume/density (GMV/GMD) maps were obtained for each participant. Then, a multiple regression analysis was performed for ASD and TD groups, respectively to estimate the relationship between GMV/GMD and age with gender, education, site, and IQ scores as covariates. Furthermore, a z-test was used to compare such relationship difference between the groups. Results Results showed that compared with TD, the GMD of ASD showed stronger positive correlations with age in the prefrontal cortex, and a stronger negative correlation in the left inferior parietal lobule, and a weaker positive correlation in the right inferior parietal lobule. The GMV of ASD displayed stronger positive correlations with age in the prefrontal cortex and cerebellum. Conclusion These findings may provide evidence to support that the brain structure abnormalities underlying ASD during childhood and adolescence may differ from each other.
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Affiliation(s)
- Fenfen Sun
- Center for Brain, Mind, and Education, Shaoxing University, Shaoxing, China,Department of Psychology, Shaoxing University, Shaoxing, China
| | - Yue Chen
- Center for Brain, Mind, and Education, Shaoxing University, Shaoxing, China,Department of Psychology, Shaoxing University, Shaoxing, China
| | - Yingwen Huang
- Center for Brain, Mind, and Education, Shaoxing University, Shaoxing, China,Department of Psychology, Shaoxing University, Shaoxing, China
| | - Jing Yan
- Center for Brain, Mind, and Education, Shaoxing University, Shaoxing, China,Department of Psychology, Shaoxing University, Shaoxing, China
| | - Yihong Chen
- Department of Otorhinolaryngology, The First People’s Hospital of Xiaoshan, Hangzhou, China,*Correspondence: Yihong Chen,
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49
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Zhong NH, Grimm RP, Kanne SM, Mazurek MO. Measurement invariance of the Autism Impact Measure (AIM) across sex in children with autism spectrum disorder. Autism Res 2023; 16:154-163. [PMID: 36341720 PMCID: PMC10099563 DOI: 10.1002/aur.2845] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 10/25/2022] [Indexed: 11/09/2022]
Abstract
Measurement invariance, or the degree to which an instrument measures constructs consistently across subgroups, is critical for appropriate interpretations of measures. Given sex differences in the phenotypic and clinical presentation of autism spectrum disorder (ASD), it is particularly important to examine measurement invariance in autism instruments to ensure that ASD measures are not biased toward the more common male ASD phenotype. This study represents an important preliminary investigation evaluating the measurement equivalence of the Autism Impact Measure (AIM) across children and adolescents with ASD. The results indicated that the AIM demonstrated measurement invariance at the configural, metric, and scalar levels across sex in all five domains, including Repetitive Behavior, Communication, Atypical Behavior, Social Reciprocity, and Peer Interaction. These results suggest that ASD core symptoms assessed by the AIM were similar among male and female groups. In addition, the latent means for all five factors were not statistically significantly different across sex groups, revealing no systematic differences on any of the AIM subscales for males and females. Overall, this study showed that the AIM detects core ASD symptoms across all five areas equivalently in males and females and is not biased toward males with ASD.
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Affiliation(s)
- Nicole H Zhong
- School of Education and Human Development, University of Virginia, Charlottesville, Virginia, USA
| | | | - Stephen M Kanne
- Weill Cornell Medical College and New York-Presbyterian Hospital, New York, USA
| | - Micah O Mazurek
- School of Education and Human Development, University of Virginia, Charlottesville, Virginia, USA
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50
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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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