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Carbone A, Dell’Aquila A. The Diagnosis of "Pervasive Developmental Disorder Not Otherwise Specified": A Systematic Literature Review. CHILDREN (BASEL, SWITZERLAND) 2023; 10:844. [PMID: 37238392 PMCID: PMC10217468 DOI: 10.3390/children10050844] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 05/01/2023] [Accepted: 05/04/2023] [Indexed: 05/28/2023]
Abstract
(1) Background: The study deepens the diagnosis of "pervasive developmental disorder not otherwise specified" (PDD-NOS), a subthreshold diagnosis introduced in DSM-IV and then absorbed into the broader spectrum disorder of autism in DSM 5. The presence of people still attributed with a diagnosis of PDD-NOS can cause confusion in the understanding of this disorder, which is no longer present in the current diagnostic system. This review aims to gain a deeper understanding of the characteristics and boundaries of diagnosis, its use within the scientific community, and the long-term stability of that diagnosis. (2) Methods: The Prisma method was used to carry out the literature review; the scientific papers were selected using scientific search engines, including SCOPUS, PUBMED, and PsychINFO. Twenty-three articles were finally selected, and a meticulous reading was carried out in relation to the research questions. (3) Results: Four cross-cutting categories were identified: (1) diagnosis; (2) differential diagnosis; (3) prognosis; and (4) comorbidity. (4) Conclusions: Limits have emerged regarding the consistency, sensitivity, and the stability of PDD-NOS. The inclusion of this diagnosis within the broader autism spectrum disorder category coined in DSM-5 appears applicable.
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Affiliation(s)
- Agostino Carbone
- Department of Developmental and Social Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, 00185 Roma, Italy
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2
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Rosello R, Berenguer C, Martinez-Raga J, Miranda A, Cortese S. Subgroups of Children with Autism Spectrum Disorder without Intellectual Disability: A Longitudinal Examination of Executive and Socio-Adaptive Behaviors in Adolescence. J Clin Med 2021; 10:2220. [PMID: 34065583 PMCID: PMC8160732 DOI: 10.3390/jcm10102220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 01/10/2023] Open
Abstract
Within the autistic spectrum, there is remarkable variability in the etiology, presentation, and treatment response. This prospective study was designed to identify, through cluster analysis, subgroups of individuals with ASD without intellectual disability (ID) based on the severity of the core symptoms in childhood. The secondary aim was to explore whether these subgroups and a group with typical development (TD) differ in cognitive, adaptive, and social aspects measured in adolescence. The sample at baseline was comprised of 52 children with ASD without ID and 37 children with TD, aged 7-11. Among the ASD group, three clusters were identified. Cluster 1 (40%), 'high severity', presented high symptom severity on the DSM-5 criteria and the Social Communication Questionnaire. Cluster 2 (34%) showed 'moderate severity' on most of the scores. Cluster 3 (25%) corresponded to 'low severity', showing moderate social impairment and low restrictive, repetitive patterns of behavior, interests and activities. At 5-year follow-up, 45 adolescents with ASD without ID and 27 adolescents with TD were assessed. All clusters had significantly more difficulties in EF, ToM, socialization and adaptive behavior compared to TD. Social and adaptive trajectories between the ASD subgroups were relatively different; Cluster 3 showed poorer socialization and daily living skills than the other two subgroups. These findings highlight the importance of fully assessing social, cognitive, and adaptive profiles to develop care plans tailored to specific needs.
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Affiliation(s)
- Rocio Rosello
- Division of Psychiatry, Imperial College London, London W12 0NN, UK
- Division of Psychiatry, University Hospital Doctor Peset of Valencia, 46017 Valencia, Spain;
| | - Carmen Berenguer
- Division of Developmental and Educational Psychology, University of Valencia, 46010 Valencia, Spain; (C.B.); (A.M.)
| | - Jose Martinez-Raga
- Division of Psychiatry, University Hospital Doctor Peset of Valencia, 46017 Valencia, Spain;
- Division of Psychiatry, University of Valencia, 46010 Valencia, Spain
| | - Ana Miranda
- Division of Developmental and Educational Psychology, University of Valencia, 46010 Valencia, Spain; (C.B.); (A.M.)
| | - Samuele Cortese
- Hassenfeld Children’s Hospital at NYU Langone, New York University Child Study Center, New York, NY 10016, USA;
- Child and Adolescent Mental Health Service, Solent NHS Trust, Southampton SO19 6DR, UK
- Centre for Innovation in Mental Health (CIMH), School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton SO17 1BJ, UK
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK
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Agelink van Rentergem JA, Deserno MK, Geurts HM. Validation strategies for subtypes in psychiatry: A systematic review of research on autism spectrum disorder. Clin Psychol Rev 2021; 87:102033. [PMID: 33962352 DOI: 10.1016/j.cpr.2021.102033] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 02/14/2021] [Accepted: 04/14/2021] [Indexed: 12/11/2022]
Abstract
Heterogeneity within autism spectrum disorder (ASD) is recognized as a challenge to both biological and psychological research, as well as clinical practice. To reduce unexplained heterogeneity, subtyping techniques are often used to establish more homogeneous subtypes based on metrics of similarity and dissimilarity between people. We review the ASD literature to create a systematic overview of the subtyping procedures and subtype validation techniques that are used in this field. We conducted a systematic review of 156 articles (2001-June 2020) that subtyped participants (range N of studies = 17-20,658), of which some or all had an ASD diagnosis. We found a large diversity in (parametric and non-parametric) methods and (biological, psychological, demographic) variables used to establish subtypes. The majority of studies validated their subtype results using variables that were measured concurrently, but were not included in the subtyping procedure. Other investigations into subtypes' validity were rarer. In order to advance clinical research and the theoretical and clinical usefulness of identified subtypes, we propose a structured approach and present the SUbtyping VAlidation Checklist (SUVAC), a checklist for validating subtyping results.
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Affiliation(s)
- Joost A Agelink van Rentergem
- Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands; Dutch Autism & ADHD Research Center, the Netherlands.
| | - Marie K Deserno
- Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands; Dutch Autism & ADHD Research Center, the Netherlands
| | - Hilde M Geurts
- Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands; Dutch Autism & ADHD Research Center, the Netherlands; Dr. Leo Kannerhuis, the Netherlands
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Ward A, Boan AD, Carpenter LA, Bradley CC. Evaluating the rate of Social (Pragmatic) Communication Disorder in children at risk for Autism Spectrum Disorder. CHILDRENS HEALTH CARE 2020. [DOI: 10.1080/02739615.2020.1803072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Audrey Ward
- College of Medicine, Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - Andrea D. Boan
- College of Medicine, Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - Laura A. Carpenter
- College of Medicine, Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - Catherine C. Bradley
- College of Medicine, Pediatrics, Medical University of South Carolina, Charleston, SC, USA
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Syriopoulou- Delli CK, Papaefstathiou E. Review of cluster analysis of phenotypic data in Autism Spectrum Disorders: distinct subtypes or a severity gradient model? INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2019; 66:13-21. [PMID: 34141364 PMCID: PMC8115451 DOI: 10.1080/20473869.2018.1542561] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 09/09/2018] [Accepted: 10/26/2018] [Indexed: 06/12/2023]
Abstract
Background: Individuals with autism spectrum disorder (ASD) form a heterogeneous group, posing a challenge for clinical definition. Additional problems regarding the diverse clinical presentation arise from changes in diagnostic criteria according to the latest Diagnostic and Statistical Manual of Mental Disorders (DSM-5), with exclusion of individuals who met earlier criteria or inclusion of more than previously. Objectives: To investigate studies that have attempted to reduce the heterogeneity of ASD based on cluster analysis of phenotypic data and to clarify whether ASD should be interpreted as 'a unitary spectrum,' with a severity gradient, or defined by distinct subtypes. This will allow better understanding of the disorder with implications for its treatment and prognosis. Methods: A literature search was made through PubMed, Researchgate and Google Scholar for studies of ASD populations. In addition, reference lists from identified studies were reviewed. Results: Only 10 studies were found that dealt with the heterogeneity of ASD and its different subtypes, based on the review prerequisites. Most of the studies appear to support the existence of subtypes within ASD, but it remains unclear whether these are considered as different specific subtypes with characteristic profiles of symptoms or as a part of a severity gradient across symptom domains. Conclusions: Drawing definitive conclusions from the published studies about the nature of ASD is difficult, due to the fundamental methodological differences among the studies and their inconsistent findings. This review shed light on a number of discrepancies regarding the current classification of ASD. However, future research will be necessary to provide a more definite answer on the question of a definition based on separate diagnostic subtypes or on a severity gradient by including larger samples that are followed longitudinal and by applying better diagnostic system and choosing the appropriate variables.
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Affiliation(s)
| | - Elpis Papaefstathiou
- Department of Educational and Social Policy, University of Macedonia, Thessaloniki, Greece
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Medical Conditions in the First Years of Life Associated with Future Diagnosis of ASD in Children. J Autism Dev Disord 2018; 47:2067-2079. [PMID: 28434058 PMCID: PMC5487747 DOI: 10.1007/s10803-017-3130-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This study examines medical conditions diagnosed prior to the diagnosis of autism spectrum disorder (ASD). Using a matched case control design with 3911 ASD cases and 38,609 controls, we found that 38 out of 79 medical conditions were associated with increased ASD risk. Developmental delay, mental health, and neurology conditions had the strongest associations (ORs 2.0–23.3). Moderately strong associations were observed for nutrition, genetic, ear nose and throat, and sleep conditions (ORs 2.1–3.2). Using machine learning methods, we clustered children based on their medical conditions prior to ASD diagnosis and demonstrated ASD risk stratification. Our findings provide new evidence indicating that children with ASD have a disproportionate burden of certain medical conditions preceding ASD diagnosis.
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Cohen S, Fulcher BD, Rajaratnam SMW, Conduit R, Sullivan JP, Hilaire MAS, Phillips AJ, Loddenkemper T, Kothare SV, McConnell K, Ahearn W, Braga-Kenyon P, Shlesinger A, Potter J, Bird F, Cornish KM, Lockley SW. Behaviorally-determined sleep phenotypes are robustly associated with adaptive functioning in individuals with low functioning autism. Sci Rep 2017; 7:14228. [PMID: 29079761 PMCID: PMC5660229 DOI: 10.1038/s41598-017-14611-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 10/11/2017] [Indexed: 01/08/2023] Open
Abstract
Despite sleep disturbance being a common complaint in individuals with autism, specific sleep phenotypes and their relationship to adaptive functioning have yet to be identified. This study used cluster analysis to find distinct sleep patterns and relate them to independent measures of adaptive functioning in individuals with autism. Approximately 50,000 nights of care-giver sleep/wake logs were collected on school-days for 106 individuals with low functioning autism (87 boys, 14.77 ± 3.11 years) for 0.5-6 years (2.2 ± 1.5 years) from two residential schools. Using hierarchical cluster analysis, performed on summary statistics of each individual across their recording duration, two clusters of individuals with clearly distinguishable sleep phenotypes were found. The groups were summarized as 'unstable' sleepers (cluster 1, n = 41) and 'stable' sleepers (cluster 2, n = 65), with the former exhibiting reduced sleep duration, earlier sleep offset, and less stability in sleep timing. The sleep clusters displayed significant differences in properties that were not used for clustering, such as intellectual functioning, communication, and socialization, demonstrating that sleep phenotypes are associated with symptom severity in individuals with autism. This study provides foundational evidence for profiling and targeting sleep as a standard part of therapeutic intervention in individuals with autism.
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Affiliation(s)
- Simonne Cohen
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Ben D Fulcher
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Shantha M W Rajaratnam
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Melbourne, Australia
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, USA
| | - Russell Conduit
- School of Health Sciences, Royal Melbourne Institute of Technology, Melbourne, Australia
| | - Jason P Sullivan
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, USA
| | - Melissa A St Hilaire
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, USA
| | - Andrew J Phillips
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, USA
| | - Tobias Loddenkemper
- Division of Sleep Medicine, Harvard Medical School, Boston, USA
- Boston Children's Hospital, Boston, USA
| | - Sanjeev V Kothare
- Division of Sleep Medicine, Harvard Medical School, Boston, USA
- Boston Children's Hospital, Boston, USA
- New York University Langone Medical School, New York, USA
| | | | | | - Paula Braga-Kenyon
- New England Center for Children, Southborough, USA
- Melmark New England, Andover, USA
| | | | | | | | - Kim M Cornish
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Steven W Lockley
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Melbourne, Australia.
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, USA.
- Division of Sleep Medicine, Harvard Medical School, Boston, USA.
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Abstract
To reduce phenotypic heterogeneity of Autism spectrum disorders (ASD) and add to the current diagnostic discussion this study aimed at identifying clinically meaningful ASD subgroups. Cluster analyses were used to describe empirically derived groups based on the Autism Diagnostic Interview-revised (ADI-R) in a large sample of n = 463 individuals with ASD aged 3-21. Three clusters were observed. Most severely affected individuals regarding all core symptoms were allocated to cluster 2. Cluster 3 comprised moderate symptom severity of social communication impairments (SCI) and less stereotyped repetitive behavior (RRB). Minor SCI and relatively more RRB characterized cluster 1. This study offers support for both, a symptom profile, and a gradient model of ASD within the spectrum due to the sample included.
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Abstract
Early autism research focused on behavior and cognition. In recent decades, the pace of research has accelerated, and advances in imaging and genetics have allowed the accumulation of biological data. Nevertheless, a coherent picture of the syndrome at either phenotypic or biological level has not emerged. We see two fundamental obstacles to progress in basic understanding of autism. First, the two defining features (impairment in social interactions and communication, and restricted, repetitive behaviors and interests) are historically seen as integrally related. Others hold that these two major traits are fractionable and must be studied independently, casting doubt on autism as a coherent syndrome. Second, despite much recent research on brain structure and function, environmental factors, and genetics/genomics, findings on the biological level have not generally aligned well with those on the phenotypic level. In the first two sections, we explore these challenges, and in the third section, we review approaches that may facilitate progress, such as (1) including in studies all individuals defined by social impairment without regard to repetitive behaviors, (2) forming narrowly defined subtypes by thorough characterization on specific features, both diagnostic and non-diagnostic, (3) focusing on characteristics that may be relatively robust to environmental influence, (4) studying children as early as possible, minimizing environmental influence, and including longitudinal course as an important part of the phenotype, (5) subtyping by environmental risk factors, (6) distinguishing between what participants can do and what they typically do, and (7) aggregating large data sets across sites. (JINS, 2017, 23, 903-915).
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Jashar DT, Brennan LA, Barton ML, Fein D. Cognitive and Adaptive Skills in Toddlers Who Meet Criteria for Autism in DSM-IV but not DSM-5. J Autism Dev Disord 2017; 46:3667-3677. [PMID: 27628939 DOI: 10.1007/s10803-016-2901-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The current study compared adaptive and cognitive skills, and autism severity of toddlers with an autism spectrum disorder (ASD) diagnosis under DSM-IV but not DSM-5 criteria (DSM-IV only group) to those who met autism criteria under both diagnostic systems (DSM-5 group) and to those without ASD (non-ASD group). The toddlers in the DSM-IV only group were less delayed on various domains of adaptive (Communication, Socialization) and cognitive (Expressive and Receptive language, Fine Motor, Visual Reception) skills, and had less severe symptoms of ASD than the DSM-5 group. Thus, they might have the best potential for successful intervention. The DSM-IV only group did not differ from the non-ASD group in any adaptive or cognitive skills except for socialization skills, the hallmark of ASD.
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Affiliation(s)
- Dasal Tenzin Jashar
- Department of Psychology, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT, 06269, USA.
| | - Laura A Brennan
- Department of Psychology, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT, 06269, USA
| | - Marianne L Barton
- Department of Psychology, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT, 06269, USA
| | - Deborah Fein
- Department of Psychology, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT, 06269, USA
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Foley-Nicpon M, L. Fosenburg S, G. Wurster K, Assouline SG. Identifying High Ability Children with DSM-5 Autism Spectrum or Social Communication Disorder: Performance on Autism Diagnostic Instruments. J Autism Dev Disord 2016; 47:460-471. [DOI: 10.1007/s10803-016-2973-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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12
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Abstract
Abstract
ASD research is at an important crossroads. The ASD diagnosis is important for assigning a child to early behavioral intervention and explaining a child’s condition. But ASD research has not provided a diagnosis-specific medical treatment, or a consistent early predictor, or a unified life course. If the ASD diagnosis also lacks biological and construct validity, a shift away from studying ASD-defined samples would be warranted. Consequently, this paper reviews recent findings for the neurobiological validity of ASD, the construct validity of ASD diagnostic criteria, and the construct validity of ASD spectrum features. The findings reviewed indicate that the ASD diagnosis lacks biological and construct validity. The paper concludes with proposals for research going forward.
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