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Harstad E, Barbaresi W. Considerations in Early Autism Diagnosis-Reply. JAMA Pediatr 2024; 178:417-418. [PMID: 38315475 DOI: 10.1001/jamapediatrics.2023.6437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Affiliation(s)
- Elizabeth Harstad
- Division of Developmental Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - William Barbaresi
- Division of Developmental Medicine, Boston Children's Hospital, Boston, Massachusetts
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2
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Eigsti IM. The Autism Constellation and Neurodiversity: Long-Term and Adult Outcomes in Autism Spectrum Disorder. Pediatr Clin North Am 2024; 71:327-341. [PMID: 38423724 PMCID: PMC10914322 DOI: 10.1016/j.pcl.2024.01.003] [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] [Indexed: 03/02/2024]
Abstract
Research on autistic adults suggests significant heterogeneity in outcomes. A significant proportion of individuals struggle with intellectual disability and limited communication skills. Of the 67% who have age-appropriate cognitive skills, around half are expected to attain a college education, and 25% are likely to hold a full-time job. Outcomes have been improving over time, in part because of earlier diagnosis and earlier intervention. Indeed, an estimated 10% to 20% are expected to lose all symptoms of autism by adolescence.
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Affiliation(s)
- Inge-Marie Eigsti
- Connecticut Autism and Language Lab (CALL), University of Connecticut; Cognitive Neuroscience of Communication T32 Training Program; Institute for the Brain and Cognitive Sciences; Department of Psychological Sciences, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT 06269, USA.
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3
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Waizbard-Bartov E, Fein D, Lord C, Amaral DG. Autism Severity and its Relationship to Disability. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2024; 22:252-262. [PMID: 38680979 PMCID: PMC11046712 DOI: 10.1176/appi.focus.24022007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
Autism severity is currently defined and measured based exclusively on the severity levels of the two core symptom domains: social-communication and restricted or repetitive patterns of behaviors and interests. Autistic individuals, however, are often diagnosed with other medical, developmental, and psychological co-occurring conditions. These additional challenges such as intellectual disability, limited expressive and/or receptive language, and anxiety disorders, can have a tremendous impact on the day-to-day lives of autistic individuals, for both their adaptive functioning as well as their sense of wellbeing. Furthermore, the initial presentation of core symptoms and their likelihood of changing over time are influenced by the presence of such co-occurring conditions. In order to truly understand how a person's autism impacts their life, both core symptoms as well as other challenges should be considered. This approach was recently taken by The Lancet Commission on the future of care and clinical research in autism, which proposed the term "profound autism" for a subgroup of individuals presenting with high core symptom severity, co-occurring intellectual disability, and little or no language, who require extensive long-term care. Considering other individual factors such as daily living skills, specific support needs and environmental resources would also enhance the evaluation of disability in autistic individuals. As currently employed in the assessment of intellectual disability, a multidimensional approach to autism could provide a more comprehensive system for classification of impairment. At present, however, there is no formal way to designate the combined effect of these different aspects of autism on a person's life. A comprehensive outlook that acknowledges impairments, capabilities, co-occurring conditions, and environmental factors would be useful for identifying subgroups of individuals as well as for determining individual needs and strengths in clinical assessments. Lay Summary: The severity of a person's autism is currently defined based on the severity of their core autism symptoms: impaired social-communication and the presence of restricted or repetitive patterns of behaviors and interests. But autistic people often face additional challenges such as intellectual disability, epilepsy, and anxiety disorder, that considerably impact their everyday life, wellbeing, and the need for support. A more complete view of autism severity, one that includes core symptoms as well as additional challenges, could help identify meaningful sub-groups of autistic individuals and could be useful in clinical care. Appeared originally in Autism Res 2023; 16:685-696.
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Affiliation(s)
- Einat Waizbard-Bartov
- Department of Psychology, University of California Davis, Davis, California, USA (Waizbard-Bartov); The MIND Institute and Department of Psychiatry and Behavioral Sciences, University of California Davis, Davis, California, USA (Waizbard-Bartov, Amaral); Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA; Department of Pediatrics, University of Connecticut, Farmington, Connecticut, USA (Fein); Departments of Psychiatry and Human Development and Psychology, University of California, Los Angeles, California, USA (Lord)
| | - Deborah Fein
- Department of Psychology, University of California Davis, Davis, California, USA (Waizbard-Bartov); The MIND Institute and Department of Psychiatry and Behavioral Sciences, University of California Davis, Davis, California, USA (Waizbard-Bartov, Amaral); Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA; Department of Pediatrics, University of Connecticut, Farmington, Connecticut, USA (Fein); Departments of Psychiatry and Human Development and Psychology, University of California, Los Angeles, California, USA (Lord)
| | - Catherine Lord
- Department of Psychology, University of California Davis, Davis, California, USA (Waizbard-Bartov); The MIND Institute and Department of Psychiatry and Behavioral Sciences, University of California Davis, Davis, California, USA (Waizbard-Bartov, Amaral); Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA; Department of Pediatrics, University of Connecticut, Farmington, Connecticut, USA (Fein); Departments of Psychiatry and Human Development and Psychology, University of California, Los Angeles, California, USA (Lord)
| | - David G Amaral
- Department of Psychology, University of California Davis, Davis, California, USA (Waizbard-Bartov); The MIND Institute and Department of Psychiatry and Behavioral Sciences, University of California Davis, Davis, California, USA (Waizbard-Bartov, Amaral); Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA; Department of Pediatrics, University of Connecticut, Farmington, Connecticut, USA (Fein); Departments of Psychiatry and Human Development and Psychology, University of California, Los Angeles, California, USA (Lord)
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4
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Crutcher J, Butler E, Burke JD, Naigles L, Fein DA, Inge-Marie E. Pragmatic language and associations with externalizing behaviors in autistic individuals and those who have lost the autism diagnosis. RESEARCH IN AUTISM SPECTRUM DISORDERS 2023; 108:102252. [PMID: 38045761 PMCID: PMC10688299 DOI: 10.1016/j.rasd.2023.102252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Background Pragmatic language weaknesses, a core feature of autism spectrum disorder (ASD), are implicated in externalizing behavior disorders (Gremillion & Martel, 2014). Particularly in a clinical setting, these co-occurring externalizing disorders are very common in autism; rates of Attentional Deficit-Hyperactive Disorder (ADHD) and Oppositional Defiant Disorder (ODD) are as high as 83% (ADHD) and 73% (ODD; Joshi et al., 2010). It is possible that pragmatic language weaknesses impact the ability to effectively communicate one's needs, which may lead autistic children to utilize externalizing behaviors in order to achieve a desired outcome (Ketelaars et al., 2010; Rodas et al., 2017). Methods The aim of the current study is to investigate the relationship between pragmatic language, assessed via multiple modalities, and externalizing behaviors, assessed by parent interview, in youth with autistic (n=33) or neurotypical (NT; n=34) developmental histories, along with youth diagnosed with autism, who lost the diagnosis (LAD) by adolescence (n=31). Results The autism group had significantly more pragmatic language difficulties, and more externalizing behaviors and disorders; ADHD symptoms were particularly more prevalent, while LAD and NT groups did not differ. Challenges in pragmatic language abilities were associated with more externalizing symptoms when controlling for other facts that typically influence such symptoms, including nonverbal cognition, structural language, executive functioning, and autistic characteristics, but did not remain when age was included in the model. Conclusions We discuss the mechanisms underlying difficult-to-manage externalizing behaviors and implications for interventions and long-term outcomes for youth with and without a history of autism.
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Affiliation(s)
- Jason Crutcher
- Department of Psychological Sciences, Institute for the Brain and Cognitive Sciences, University of Connecticut, 406 Babbidge Road, U-1020; Storrs, CT 06269; USA
| | - Emilie Butler
- Department of Psychological Sciences, Institute for the Brain and Cognitive Sciences, University of Connecticut, 406 Babbidge Road, U-1020; Storrs, CT 06269; USA
| | - Jeffrey D Burke
- Department of Psychological Sciences, Institute for the Brain and Cognitive Sciences, University of Connecticut, 406 Babbidge Road, U-1020; Storrs, CT 06269; USA
| | - Letitia Naigles
- Department of Psychological Sciences, Institute for the Brain and Cognitive Sciences, University of Connecticut, 406 Babbidge Road, U-1020; Storrs, CT 06269; USA
| | - Deborah A Fein
- Department of Psychological Sciences, Institute for the Brain and Cognitive Sciences, University of Connecticut, 406 Babbidge Road, U-1020; Storrs, CT 06269; USA
| | - Eigsti Inge-Marie
- Department of Psychological Sciences, Institute for the Brain and Cognitive Sciences, University of Connecticut, 406 Babbidge Road, U-1020; Storrs, CT 06269; USA
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5
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Waizbard-Bartov E, Fein D, Lord C, Amaral DG. Autism severity and its relationship to disability. Autism Res 2023; 16:685-696. [PMID: 36786314 PMCID: PMC10500663 DOI: 10.1002/aur.2898] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 01/19/2023] [Indexed: 02/15/2023]
Abstract
Autism severity is currently defined and measured based exclusively on the severity levels of the two core symptom domains: social-communication and restricted or repetitive patterns of behaviors and interests. Autistic individuals, however, are often diagnosed with other medical, developmental, and psychological co-occurring conditions. These additional challenges such as intellectual disability, limited expressive and/or receptive language, and anxiety disorders, can have a tremendous impact on the day-to-day lives of autistic individuals, for both their adaptive functioning as well as their sense of wellbeing. Furthermore, the initial presentation of core symptoms and their likelihood of changing over time are influenced by the presence of such co-occurring conditions. In order to truly understand how a person's autism impacts their life, both core symptoms as well as other challenges should be considered. This approach was recently taken byThe Lancet Commission on the future of care and clinical research in autism, which proposed the term "profound autism" for a subgroup of individuals presenting with high core symptom severity, co-occurring intellectual disability, and little or no language, who require extensive long-term care. Considering other individual factors such as daily living skills, specific support needs and environmental resources would also enhance the evaluation of disability in autistic individuals. As currently employed in the assessment of intellectual disability, a multidimensional approach to autism could provide a more comprehensive system for classification of impairment. At present, however, there is no formal way to designate the combined effect of these different aspects of autism on a person's life. A comprehensive outlook that acknowledges impairments, capabilities, co-occurring conditions, and environmental factors would be useful for identifying subgroups of individuals as well as for determining individual needs and strengths in clinical assessments.
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Affiliation(s)
- Einat Waizbard-Bartov
- Department of Psychology, University of California Davis, Davis, California, USA
- The MIND Institute and Department of Psychiatry and Behavioral Sciences, University of California Davis, Davis, California, USA
| | - Deborah Fein
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA
- Department of Pediatrics, University of Connecticut, Farmington, Connecticut, USA
| | - Catherine Lord
- Departments of Psychiatry and Human Development and Psychology, University of California, Los Angeles, California, USA
| | - David G. Amaral
- The MIND Institute and Department of Psychiatry and Behavioral Sciences, University of California Davis, Davis, California, USA
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6
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Hirata Y, Ozawa E. Characteristics of students who require elementary school counselors' support owing to developmental disorders. Heliyon 2023; 9:e13791. [PMID: 36873511 PMCID: PMC9982625 DOI: 10.1016/j.heliyon.2023.e13791] [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: 12/17/2021] [Revised: 02/02/2023] [Accepted: 02/09/2023] [Indexed: 02/19/2023] Open
Abstract
Awareness and support for developmental disorders are increasing in Japan. In the education field, support from school counselors for students with developmental disorders and their roles and responsibilities in elementary schools are on the rise. However, identifying and addressing specific conditions and developmental disorders that require school counselors' attention are not clearly planned. Therefore, this study explored the characteristics of students who require elementary school counselors' support owing to developmental disorders. The participants included 17 school counselors who were experienced in working at elementary schools. Through semi-structured interviews, 30 cases were discussed, examined, and categorized based on "case characteristics," "classification of the main complaint," "basic information on the diagnosis," and "type of support." The analysis included detailed viewpoints of 13 school counselors, a code frequency table, and contrast tables, focusing on the main complaint and diagnosis. Regarding the children whose main complaint was "school refusal," eight out of nine cases were in the fourth grade or above, with several cases of suspected developmental disorders or autism spectrum disorder. The number of children with comorbid attention-deficit hyperactivity disorder, including suspected cases, seemed to be higher, especially in Grades 3-5. The study highlighted the importance of assessing students' developmental characteristics related to the main complaint in the background of a secondary problem. Furthermore, early detection and interventions should be conducted in the first and second grades.
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Affiliation(s)
- Yutaro Hirata
- Faculty of Law, Economics and the Humanities, Kagoshima University, Korimoto, Kagoshima, Japan
- Corresponding author. Kagoshima University, 1-21-30 Korimoto, 890-8580, Kagoshima, Japan.
| | - Eiji Ozawa
- Faculty of Human-Environment Studies, Kyushu University, Motooka, Nishi-ku, Fukuoka, Japan
- Corresponding author. Kyushu University, 744 Nishiku Motooka, 819-0395, Fukuoka, Japan.
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7
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Pender R, Fearon P, St Pourcain B, Heron J, Mandy W. Developmental trajectories of autistic social traits in the general population. Psychol Med 2023; 53:814-822. [PMID: 34154678 DOI: 10.1017/s0033291721002166] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Autistic people show diverse trajectories of autistic traits over time, a phenomenon labelled 'chronogeneity'. For example, some show a decrease in symptoms, whilst others experience an intensification of difficulties. Autism spectrum disorder (ASD) is a dimensional condition, representing one end of a trait continuum that extends throughout the population. To date, no studies have investigated chronogeneity across the full range of autistic traits. We investigated the nature and clinical significance of autism trait chronogeneity in a large, general population sample. METHODS Autistic social/communication traits (ASTs) were measured in the Avon Longitudinal Study of Parents and Children using the Social and Communication Disorders Checklist (SCDC) at ages 7, 10, 13 and 16 (N = 9744). We used Growth Mixture Modelling (GMM) to identify groups defined by their AST trajectories. Measures of ASD diagnosis, sex, IQ and mental health (internalising and externalising) were used to investigate external validity of the derived trajectory groups. RESULTS The selected GMM model identified four AST trajectory groups: (i) Persistent High (2.3% of sample), (ii) Persistent Low (83.5%), (iii) Increasing (7.3%) and (iv) Decreasing (6.9%) trajectories. The Increasing group, in which females were a slight majority (53.2%), showed dramatic increases in SCDC scores during adolescence, accompanied by escalating internalising and externalising difficulties. Two-thirds (63.6%) of the Decreasing group were male. CONCLUSIONS Clinicians should note that for some young people autism-trait-like social difficulties first emerge during adolescence accompanied by problems with mood, anxiety, conduct and attention. A converse, majority-male group shows decreasing social difficulties during adolescence.
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Affiliation(s)
- Richard Pender
- University College London, Division of Psychiatry, Maple House, 149 Tottenham Court Road, London W1T 7BN, UK
| | - Pasco Fearon
- University College London, Research Department of Clinical, Educational and Health Psychology, 1-19 Torrington Place, London WC1E 7HB, UK
| | - Beate St Pourcain
- Max Planck Institute for Psycholinguistics, Wundtlaan 1, 6525 XD Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, The Netherlands
- MRC Integrative Epidemiology Unit, University of Bristol, UK
| | - Jon Heron
- Bristol Medical School, University of Bristol, Population Health Sciences, Oakfield House, Clifton BS8 2BN, UK
| | - Will Mandy
- University College London, Research Department of Clinical, Educational and Health Psychology, 1-19 Torrington Place, London WC1E 7HB, UK
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8
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Zhang M, Hu X, Jiao J, Yuan D, Li S, Luo T, Wang M, Situ M, Sun X, Huang Y. Brain white matter microstructure abnormalities in children with optimal outcome from autism: a four-year follow-up study. Sci Rep 2022; 12:20151. [PMID: 36418886 PMCID: PMC9684497 DOI: 10.1038/s41598-022-21085-8] [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: 04/15/2022] [Accepted: 09/22/2022] [Indexed: 11/24/2022] Open
Abstract
Autism spectrum disorder (ASD) is a lifelong neurodevelopmental disorder, with only a small proportion of people obtaining optimal outcomes. We do not know if children with ASD exhibit abnormalities in the white matter (WM) microstructure or if this pattern would predict ASD prognosis in a longitudinal study. 182 children with ASD were recruited for MRI and clinical assessment; 111 completed a four-year follow-up visit (30 with optimal outcomes, ASD-; 81 with persistent diagnosis, ASD+). Additionally, 72 typically developing controls (TDC) were recruited. The microstructural integrity of WM fiber tracts was revealed using tract-based spatial statistics (TBSS) and probabilistic tractography analyses. We examined the neuroimaging abnormality associated with ASD and its relationship to ASD with optimal outcome. The ASD+ and TDC groups were propensity score matched to the ASD- group in terms of age, gender, and IQ. TBSS indicated that children with ASD exhibited abnormalities in the superior longitudinal fasciculus (SLF), inferior longitudinal fasciculus (ILF), and extending to the anterior thalamic radiation (ATR) and cingulum; whereas the ASD+ group showed more severe abnormalities than the ASD- group. Probabilistic tractography analysis revealed that ASD+ group exhibited lower Fractional Anisotropy (FA) of the left superior thalamic radiation (STR L) than ASD- group, and that FA value of the STR L was a significant predictor of optimal outcome (EX(B), 6.25; 95% CI 2.50-15.63; p < 0.001). Children with ASD showed significant variations in SLF_L and STR_L, and STR_L was a predictor of 'ASD with optimal outcome'. Our findings may aid in comprehension of the mechanisms of 'ASD with optimal outcome'.
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Affiliation(s)
- Manxue Zhang
- grid.412901.f0000 0004 1770 1022Mental Health Center, West China Hospital of Sichuan University, Chengdu, China ,grid.412461.40000 0004 9334 6536The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiao Hu
- grid.412901.f0000 0004 1770 1022Mental Health Center, West China Hospital of Sichuan University, Chengdu, China ,grid.412901.f0000 0004 1770 1022West China Second Hospital of Sichuan University, Chengdu, China
| | - Jian Jiao
- grid.412901.f0000 0004 1770 1022Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
| | - Danfeng Yuan
- grid.412901.f0000 0004 1770 1022Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
| | - Sixun Li
- grid.412901.f0000 0004 1770 1022Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
| | - Tingting Luo
- grid.412901.f0000 0004 1770 1022Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
| | - Meiwen Wang
- grid.412901.f0000 0004 1770 1022Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
| | - Mingjing Situ
- grid.412901.f0000 0004 1770 1022Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
| | - Xueli Sun
- grid.412901.f0000 0004 1770 1022Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
| | - Yi Huang
- grid.412901.f0000 0004 1770 1022Mental Health Center, West China Hospital of Sichuan University, Chengdu, China ,grid.412901.f0000 0004 1770 1022Brain Research Center, West China Hospital of Sichuan University, Chengdu, China
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9
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Dawson G, Franz L, Brandsen S. At a Crossroads-Reconsidering the Goals of Autism Early Behavioral Intervention From a Neurodiversity Perspective. JAMA Pediatr 2022; 176:839-840. [PMID: 35816341 PMCID: PMC10069446 DOI: 10.1001/jamapediatrics.2022.2299] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Geraldine Dawson
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina
- Duke Center for Autism and Brain Development, Duke University, Durham, North Carolina
| | - Lauren Franz
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina
- Duke Center for Autism and Brain Development, Duke University, Durham, North Carolina
| | - S Brandsen
- Department of Electrical and Computer Engineering, Duke University, Durham, North Carolina
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10
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Larson C, Rivera-Figueroa K, Thomas HR, Fein D, Stevens MC, Eigsti IM. Structural language impairment in Autism Spectrum Disorder versus Loss of Autism Diagnosis: Behavioral and neural characteristics. Neuroimage Clin 2022; 34:103043. [PMID: 35567947 PMCID: PMC9112023 DOI: 10.1016/j.nicl.2022.103043] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 04/14/2022] [Accepted: 05/08/2022] [Indexed: 02/02/2023]
Abstract
This study probed for structural language impairment using behavioral and functional neuroimaging methods in individuals with Autism Spectrum Disorder (ASD) and those diagnosed with ASD in childhood who no longer meet criteria for ASD, referred to as Loss of Autism Diagnosis (LAD1). Participants were drawn from Fein et al. (2013): ASD (n = 35), LAD (n = 31), and Neurotypical (NT; n = 34). Criteria for structural language impairment were: Scores ≤ 82 on Clinical Evaluation of Language Fundamentals-4 (CELF) Core Language, an omnibus measure of language; and scores ≤ 7 on CELF Recalling Sentences, a clinical marker of structural language impairment. Task-based fMRI examined lateralization of significantly activated language-related brain regions in groups with structural language impairment (LI2) versus normal-range language (LN3), collapsed across ASD, LAD1, and NT status. Results showed no ASD versus LAD group differences in the proportion of participants with structural language impairment according to either metric (Recalling Sentences or Core Language). Functional MRI results indicated greater left hemisphere lateralization within significantly activated regions in the LI2 group. Structural language abilities were not meaningfully associated with either social abilities or lifetime ADHD symptoms in LI2 subgroups, further suggesting the presence of structural language impairment. Findings indicate the presence of persistent structural language difficulty even in the absence of ASD symptoms in some individuals within the LAD1 group and unique patterns of language-related neural specialization for language function in LI2 relative to LN3.
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Affiliation(s)
- Caroline Larson
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA,CT Institute for the Brain and Cognitive Sciences, Storrs, CT, USA,Corresponding author at: Department of Psychological Sciences, Unit 1020, 406 Babbidge Rd, Storrs, CT 06269, USA.
| | | | - Hannah R. Thomas
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
| | - Deborah Fein
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA,Department of Pediatrics, University of Connecticut, Farmington, CT, USA
| | - Michael C. Stevens
- Olin Neuropsychiatry Research Center at the Institute of Living, Hartford, CT, USA,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Inge-Marie Eigsti
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA,CT Institute for the Brain and Cognitive Sciences, Storrs, CT, USA
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11
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Colizzi M, Bortoletto R, Costa R, Bhattacharyya S, Balestrieri M. The Autism-Psychosis Continuum Conundrum: Exploring the Role of the Endocannabinoid System. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5616. [PMID: 35565034 PMCID: PMC9105053 DOI: 10.3390/ijerph19095616] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/01/2022] [Accepted: 05/03/2022] [Indexed: 02/07/2023]
Abstract
Evidence indicates shared physiopathological mechanisms between autism and psychosis. In this regard, the endocannabinoid system has been suggested to modulate neural circuits during the early stage of neurodevelopment, with implications for both autism and psychosis. Nevertheless, such potential common markers of disease have been investigated in both autism and psychosis spectrum disorders, without considering the conundrum of differentiating the two groups of conditions in terms of diagnosis and treatment. Here, we systematically review all human and animal studies examining the endocannabinoid system and its biobehavioral correlates in the association between autism and psychosis. Studies indicate overlapping biobehavioral aberrancies between autism and schizophrenia, subject to correction by modulation of the endocannabinoid system. In addition, common cannabinoid-based pharmacological strategies have been identified, exerting epigenetic effects across genes controlling neural mechanisms shared between autism and schizophrenia. Interestingly, a developmental and transgenerational trajectory between autism and schizophrenia is supported by evidence that exogenous alteration of the endocannabinoid system promotes progression to inheritable psychosis phenotypes in the context of biobehavioral autism vulnerability. However, evidence for a diametral association between autism and psychosis is scant. Several clinical implications follow from evidence of a developmental continuum between autism and psychosis as a function of the endocannabinoid system dysregulation.
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Affiliation(s)
- Marco Colizzi
- Unit of Psychiatry, Department of Medicine (DAME), University of Udine, 33100 Udine, Italy;
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AF, UK;
| | - Riccardo Bortoletto
- Child and Adolescent Neuropsychiatry Unit, Maternal-Child Integrated Care Department, Integrated University Hospital of Verona, 37126 Verona, Italy;
| | - Rosalia Costa
- Community Mental Health Team, Friuli Centrale University Health Service (ASUFC), 33057 Palmanova, Italy;
| | - Sagnik Bhattacharyya
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AF, UK;
| | - Matteo Balestrieri
- Unit of Psychiatry, Department of Medicine (DAME), University of Udine, 33100 Udine, Italy;
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12
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Stewart TM, Martin K, Fazi M, Oldridge J, Piper A, Rhodes SM. A systematic review of the rates of depression in autistic children and adolescents without intellectual disability. Psychol Psychother 2022; 95:313-344. [PMID: 34605156 DOI: 10.1111/papt.12366] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 08/12/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Increasing evidence suggests that major depressive disorder (MDD) is highly prevalent in autism spectrum disorder (ASD). The current study is a systematic review of rates of depression in autistic children and adolescents, without intellectual disability. DESIGN Adhering to PRISMA guidelines, a total of 14,557 studies were identified through five databases (MEDLINE, EMBASE, Cinahl, ERIC, PsycINFO, and Web of Science). METHODS Articles were screened for inclusion and exclusion criteria and 10% double coded at each stage. Nineteen studies met criteria and were retained in the review. RESULT The reported rates of depression in autistic children and adolescents varied from 0% to 83.3%. We discuss these findings in relation to method of report (self/informant, interview/questionnaire), recruitment status (clinical/community recruited), and age (pre-pubertal/adolescent). CONCLUSION Rates of depression vary considerably across studies and do not show a particular pattern in relation to methodology, or age. Our research joins a crucial call to action from the research community for future research to improve the identification of depression in autism, which in turn will aid our understanding of the potentially different characterization and manifestation of depression in autism, to ultimately improve assessment and treatment of depression in autistic children and adolescents. PRACTITIONER POINTS Rates of depression in autistic children and adolescents vary and do not show a particular pattern in relation to methodology or age. Our research joins the call to action from the research community for future research to improve the identification of depression in autistic children and adolescents, which in turn will aid understanding of depression in autism, and ultimately improve assessment and treatment of depression in autistic children and young people. The development of new measures of depression, specifically designed with, and for, children and adolescents with autism, is warranted.
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Affiliation(s)
- Tracy M Stewart
- Moray House School of Education and Sport, University of Edinburgh, UK
| | | | | | - Jessica Oldridge
- Child Life and Health, Clinical Brain Sciences, University of Edinburgh, UK
| | - Allan Piper
- Child and Adolescent Mental Health, NHS Lothian, Edinburgh, UK
| | - Sinead M Rhodes
- Child Life and Health, Clinical Brain Sciences, University of Edinburgh, UK
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13
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Eigsti IM, Fein DA. Insights from losing the autism diagnosis: Autism spectrum disorder as a biological entity. Front Psychiatry 2022; 13:972612. [PMID: 36051556 PMCID: PMC9424653 DOI: 10.3389/fpsyt.2022.972612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 07/26/2022] [Indexed: 11/26/2022] Open
Affiliation(s)
- Inge-Marie Eigsti
- Psychological Sciences, University of Connecticut, Storrs, CT, United States
| | - Deborah A Fein
- Psychological Sciences, University of Connecticut, Storrs, CT, United States.,Pediatrics, University of Connecticut, Farmington, CT, United States
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14
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Abstract
Over the past four decades there have been significant advances in our understanding of autism, yet services for autistic adults continue to lag far behind those for children, and prospects for employment and independent living remain poor. Adult outcomes also vary widely and while cognitive and language abilities are important prognostic indicators, the influence of social, emotional, familial and many other factors remains uncertain. For this special issue marking the 40th anniversary of DSM-III, the present paper describes the changing perspectives of autism in adulthood that have occurred over this period, explores individual and wider environmental factors related to outcome, and suggests ways in which services need to be changed to improve the future for adults living with autism.
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Affiliation(s)
- Patricia Howlin
- Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK.
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15
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Patterns of Continuity and Change in the Psychosocial Outcomes of Young Autistic People: a Mixed-Methods Study. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2021; 48:301-313. [PMID: 31797119 DOI: 10.1007/s10802-019-00602-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Long-term longitudinal studies have consistently demonstrated that the outcomes of autistic individuals are highly variable. Yet, these studies have typically focused on aspects of functioning deemed to be critical by non-autistic researchers, rather than autistic people themselves. Here, we uniquely examined the long-term psychosocial outcomes of a group of young autistic people (n = 27; M age = 17 years; 10 months; 2 female) followed from childhood using a combination of approaches, including (1) the standard, normative approach, which examined changes in diagnostic outcomes, autistic features and adaptive functioning over a 9-year period and (2) a qualitative approach, which involved semi-structured interviews to understand young people's own subjective experiences of their current functioning. On average, there was no significant change in young people's diagnostic outcomes and autistic features over the 9-year period, although there was much variability at the individual level. There was far less variability, however, in young people's everyday functioning, with marked declines over the same period. While these often-substantial everyday challenges aligned well with young people's subjective reports, there was no straightforward one-to-one mapping between self-reported experiences of being autistic and standard measures of severity. These findings call for concerted efforts to understand autistic outcomes through the mixing of quantitative and qualitative reports and for sustained and targeted interventions during adolescence in those areas that matter most to young people themselves.
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16
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Pearcey S, Gordon K, Chakrabarti B, Dodd H, Halldorsson B, Creswell C. Research Review: The relationship between social anxiety and social cognition in children and adolescents: a systematic review and meta-analysis. J Child Psychol Psychiatry 2021; 62:805-821. [PMID: 32783234 DOI: 10.1111/jcpp.13310] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/29/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Childhood Social Anxiety Disorder (SAD) is common and impairing. The recommended treatment is a disorder specific form of cognitive behavioural therapy (CBT) that includes social skills training and, whilst they appear to be more effective than more general treatments, it is not clear whether social skills training is the critical component involved in improved outcomes, particularly given that evidence for the relationship between social anxiety and social skills deficits in children is inconsistent. This may be partly due to an overlap in their observable features, and because the nature of the association may vary in different contexts (e.g. according to child age). An alternative approach is to examine the association between social anxiety and the social cognitive capacities that underpin social skills. This paper aims to examine the association between social anxiety and social cognition in children and adolescents, and examine conceptual and methodological moderators of this relationship. METHODS Papers published between 1980 and 2019 were screened systematically. Fifty studies were identified from which an effect size could be calculated for the relationship between social anxiety and social cognition, including 15,411 children and adolescents. RESULTS An overall significant, but moderate effect (r = -.15) was identified, where increased social anxiety was associated with lower social cognitive ability. Moderation analyses revealed specific associations within studies examining social anxiety among participants with and without ASD who were older than 7 years old, and studies assessing the relationship between social anxiety and specific aspects of Theory of Mind (ToM). No significant association was identified between social anxiety and emotion recognition. CONCLUSIONS Significant associations between social anxiety and social cognitive abilities appear to be accounted for by elevated social anxiety among children with ASD, and those with difficulties in specific aspects of ToM but not broader social skills, such as emotion recognition. This reinforces the importance of accurately identifying and treating social anxiety within ASD populations. In addition, treatments for social anxiety among neurotypical populations may benefit from targeting particular aspects of ToM rather than emotion recognition and other broad social skills.
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Affiliation(s)
- Samantha Pearcey
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK.,Department of Experimental Psychology, University of Oxford, Oxford, UK.,Department of Psychiatry, University of Oxford, Oxford, UK
| | - Kate Gordon
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK.,Berkshire Healthcare NHS Foundation Trust, Berkshire, UK
| | - Bhismadev Chakrabarti
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK.,Department of Psychology, Ashoka University, Sonipat, India
| | - Helen Dodd
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Brynjar Halldorsson
- Department of Experimental Psychology, University of Oxford, Oxford, UK.,Department of Psychiatry, University of Oxford, Oxford, UK.,Department of Psychology, Reykjavik University, Reykjavik, Iceland
| | - Cathy Creswell
- Department of Experimental Psychology, University of Oxford, Oxford, UK.,Department of Psychiatry, University of Oxford, Oxford, UK
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17
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Au AHC, Shum KKM, Cheng Y, Tse HMY, Wong RMF, Li J, Au TKF. Autism spectrum disorder screening in preschools. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 25:516-528. [PMID: 33153314 PMCID: PMC7874379 DOI: 10.1177/1362361320967529] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
LAY ABSTRACT With professional training and regular opportunities to observe children interacting with their peers, preschool teachers are in a good position to notice children's autism spectrum disorder symptomatology. Yet even when a preschool teacher suspects that a child may have autism spectrum disorder, fear of false alarm may hold the teacher back from alerting the parents, let alone suggesting them to consider clinical assessment for the child. A valid and convenient screening tool can help preschool teachers make more informed and hence more confident judgment. We set out to develop a screening tool that capitalizes on peer interaction as a naturalistic "stress test" to identify children more likely than their peers to have autism spectrum disorder. A total of 304 3- to 4-year-olds were observed at school with an 84-item preliminary checklist; data-driven item reduction yielded a 13-item Classroom Observation Scale. The Classroom Observation Scale scores correlated significantly with Autism Diagnostic Observation Schedule-2 scores. To validate the scale, another 322 2- to 4-year-olds were screened using the Classroom Observation Scale. The screen-positive children and randomly selected typically developing peers were assessed for autism spectrum disorder 1.5 years later. The Classroom Observation Scale as used by teachers and researchers near preschool onset predicted autism spectrum disorder diagnoses 1.5 years later. This user-friendly 13-item Classroom Observation Scale enables teachers and healthcare workers with little or no clinical training to identify, with reliable and valid results, preschoolers more likely than their peers to have autism spectrum disorder.
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18
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Bottema-Beutel K, Crowley S, Sandbank M, Woynaroski TG. Adverse event reporting in intervention research for young autistic children. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 25:322-335. [PMID: 33076682 PMCID: PMC7870528 DOI: 10.1177/1362361320965331] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
LAY ABSTRACT In this study, we looked at published research on interventions for young autistic children that did not involve administering medication. We were interested in determining how often studies reported on whether adverse events (i.e. physical or psychological distress to the participants) or adverse effects (i.e. adverse events that are thought to be caused by the intervention) had occurred. We found that of the 150 reports we examined, only 11 mentioned adverse events. One of these studies reported adverse events occurred, and three reported that adverse effects occurred. We also reviewed the studies to examine the reasons that were given to explain why any participants dropped out of the intervention (termed "withdrawal"), to determine if any of these reasons could be considered adverse events or adverse effects. Fifty-four studies described reasons for withdrawal, and 10 of these studies had reasons that could be categorized as an adverse event, 8 studies had reasons that could be categorized as an adverse effect, and an additional 12 studies had reasons that were too vaguely described to determine whether they were adverse events or not. We recommend that autism intervention researchers develop more systematic methods of looking for and reporting adverse events and effects, so that professionals and families can be better informed when choosing to enroll their autistic children in interventions.
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Affiliation(s)
| | - Shannon Crowley
- Boston College, Lynch School of Education and Human Development
| | | | - Tiffany G. Woynaroski
- Vanderbilt University Medical Center, Vanderbilt Brain Institute, Vanderbilt Kennedy Center
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19
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A Response to the "Challenging Cases" Article, "Questioning a Previous Autism Spectrum Disorder Diagnosis: Can You 'Lose' the Diagnosis?". J Dev Behav Pediatr 2020; 41:499. [PMID: 32511112 PMCID: PMC7447050 DOI: 10.1097/dbp.0000000000000826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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20
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Zachor DA, Ben-Itzchak E. From Toddlerhood to Adolescence, Trajectories and Predictors of Outcome: Long-Term Follow-Up Study in Autism Spectrum Disorder. Autism Res 2020; 13:1130-1143. [PMID: 32450608 DOI: 10.1002/aur.2313] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 04/20/2020] [Accepted: 04/23/2020] [Indexed: 12/20/2022]
Abstract
This study is one of a very few prospective long-term studies in autism spectrum disorder (ASD). The study compared outcome trajectories in three adolescent groups (T2): "best outcome" (BO, n = 11) did not meet cut-off points for ASD and IQ scores ≥85; high functioning (HF-ASD, n = 14); and lower functioning (LF-ASD, n = 43). Additionally, the study searched for characteristics at toddlerhood (T1) that may predict belonging to the above groups. The study included 68 adolescents (63 males) diagnosed with ASD at toddlerhood (mean age: 13:10 years), mean follow-up time was 11:7 years. Participants underwent comprehensive assessments at T1 and T2. Different trajectories were found for the three defined groups. The BO group improved significantly in cognitive ability, autism severity, and adaptive skills in comparison to no improvement for the LF-ASD group or partial progress for the HF-ASD group. At toddlerhood, better cognition and less severe autism social affect symptoms were generally associated with a better outcome. Early social behaviors including better "pointing," "facial expression directed to others," "showing," and "response to joint attention" were associated with membership in the BO group. In addition, the BO group had the lowest prevalence of significant T2 inattention and anxiety symptoms. No significant differences between the three outcome groups were noted in the birth and prevalence of medical problems. Higher cognitive ability and better T1 showing and pointing behaviors predicted better outcome. The study points to the change in autism severity over time and to the prognostic value of early developmental abilities, social engagement behaviors, and the existence of comorbidities. Autism Res 2020, 13: 1130-1143. © 2020 International Society for Autism Research and Wiley Periodicals LLC. LAY SUMMARY: This long-term study compared characteristics of toddlers diagnosed with autism spectrum disorder (ASD) in three outcome groups in adolescence: best outcome (BO-average IQ/not meeting criteria for ASD), high-functioning ASD, and low-functioning ASD (LF-ASD). At toddlerhood, the BO group displayed less severe autism symptoms, mostly in sharing interests, compared to the LF-ASD group. The BO group had fewer inattention and anxiety symptoms than the two ASD groups. Additionally, early cognitive level and social engagement behaviors predicted outcome in ASD.
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Affiliation(s)
- Ditza A Zachor
- The Autism Center, Department of Pediatrics, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Esther Ben-Itzchak
- Bruckner Center for Research in Autism Spectrum Disorders, Department of Communication Disorders, Ariel University, Ariel, Israel
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21
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Horwitz EH, Schoevers RA, Greaves-Lord K, de Bildt A, Hartman CA. Adult Manifestation of Milder Forms of Autism Spectrum Disorder; Autistic and Non-autistic Psychopathology. J Autism Dev Disord 2020; 50:2973-2986. [PMID: 32052317 PMCID: PMC7374470 DOI: 10.1007/s10803-020-04403-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
We compared the presence of autistic and comorbid psychopathology and functional impairments in young adults who received a clinical diagnosis of Pervasive Developmental Disorders Not Otherwise Specified or Asperger’s Disorder during childhood to that of a referred comparison group. While the Autism Spectrum Disorder group on average scored higher on a dimensional ASD self- and other-report measure than clinical controls, the majority did not exceed the ASD cutoff according to the Autism Diagnostic Observation Schedule. Part of the individuals with an ASD diagnosis in their youth no longer show behaviors that underscribe a clinical ASD diagnosis in adulthood, but have subtle difficulties in social functioning and a vulnerability for a range of other psychiatric disorders.
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Affiliation(s)
- E H Horwitz
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. .,University Medical Center Groningen, University Psychiatric Center, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands. .,GGZ Friesland, Leeuwarden, The Netherlands.
| | - R A Schoevers
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,University Medical Center Groningen, University Psychiatric Center, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | | | - A de Bildt
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,University Medical Center Groningen, University Psychiatric Center, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - C A Hartman
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,University Medical Center Groningen, University Psychiatric Center, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
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22
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Hyman SL, Levy SE, Myers SM. Identification, Evaluation, and Management of Children With Autism Spectrum Disorder. Pediatrics 2020; 145:peds.2019-3447. [PMID: 31843864 DOI: 10.1542/peds.2019-3447] [Citation(s) in RCA: 480] [Impact Index Per Article: 120.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Autism spectrum disorder (ASD) is a common neurodevelopmental disorder with reported prevalence in the United States of 1 in 59 children (approximately 1.7%). Core deficits are identified in 2 domains: social communication/interaction and restrictive, repetitive patterns of behavior. Children and youth with ASD have service needs in behavioral, educational, health, leisure, family support, and other areas. Standardized screening for ASD at 18 and 24 months of age with ongoing developmental surveillance continues to be recommended in primary care (although it may be performed in other settings), because ASD is common, can be diagnosed as young as 18 months of age, and has evidenced-based interventions that may improve function. More accurate and culturally sensitive screening approaches are needed. Primary care providers should be familiar with the diagnostic criteria for ASD, appropriate etiologic evaluation, and co-occurring medical and behavioral conditions (such as disorders of sleep and feeding, gastrointestinal tract symptoms, obesity, seizures, attention-deficit/hyperactivity disorder, anxiety, and wandering) that affect the child's function and quality of life. There is an increasing evidence base to support behavioral and other interventions to address specific skills and symptoms. Shared decision making calls for collaboration with families in evaluation and choice of interventions. This single clinical report updates the 2007 American Academy of Pediatrics clinical reports on the evaluation and treatment of ASD in one publication with an online table of contents and section view available through the American Academy of Pediatrics Gateway to help the reader identify topic areas within the report.
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Affiliation(s)
- Susan L Hyman
- Golisano Children's Hospital, University of Rochester, Rochester, New York;
| | - Susan E Levy
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and
| | - Scott M Myers
- Geisinger Autism & Developmental Medicine Institute, Danville, Pennsylvania
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23
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Briot K, Jean F, Jouni A, Geoffray MM, Ly-Le Moal M, Umbricht D, Chatham C, Murtagh L, Delorme R, Bouvard M, Leboyer M, Amestoy A. Social Anxiety in Children and Adolescents With Autism Spectrum Disorders Contribute to Impairments in Social Communication and Social Motivation. Front Psychiatry 2020; 11:710. [PMID: 32793002 PMCID: PMC7393242 DOI: 10.3389/fpsyt.2020.00710] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 07/06/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Recognition of symptoms of Social anxiety (SA) may be difficult among individuals with Autism Spectrum Disorders (ASD) because of overlap between social anxiety and autistic symptomatology. The main aim of our study was thus to explore the association between symptoms of social anxiety and clinical characteristics of ASD in order to identify individuals experiencing concomitant ASD and social anxiety disorder. We also described the prevalence of SA in a sample of children and adolescents with ASD. METHOD 79 children and adolescents with ASD (with and without intellectual disability) and 28-matched control participants were recruited in two French Expert Centers for ASD, coordinated by the Fundation FondaMental. Psychiatric comorbidities, anxiety disorders and depression were screened with standard tools (Liebowitz social anxiety scale, Hamilton Depression and Anxiety Rating Scale) and correlated to autistic features and social skills assessed with the social responsiveness scale 2 (SRS-2) and the repetitive behavior scale (RBS-R). We performed bivariate analysis between the social anxiety level and the scores measured with different clinical scales. We then adjusted the observed relationships with the alterations of SRS-2 and RBS-R scores. RESULTS After adjustment, the level of social anxiety appeared as significantly associated with alterations in social reciprocity and particularly with the SRS-2 "social communication" and "social motivation" sub-scores, but not with RBS-R score. CONCLUSIONS We confirm previous reports showing that individuals with ASD are at high risk for specific anxiety disorders. In particular, high levels of impairments in social motivation and social communication (SRS-2) are indicative of comorbid disorders namely, social anxiety and ASD. Our findings clearly inform diagnostic assessment in ASD and stress the need to take comorbid anxiety disorders into consideration to improve treatment of ASD. To further clarify the impact of social anxiety on social competences and socio-adaptive handicap, longitudinal studies and cluster analysis will be needed in the future.
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Affiliation(s)
- Kellen Briot
- University of Bordeaux, Medical Sciences Department, Bordeaux, France.,Centre Hospitalier Charles-Perrens, Pôle Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Bordeaux, France
| | - François Jean
- Centre Hospitalier Dr Jean Eric Techer, Pôle de Psychiatrie de l'enfant et de l'adolescent, Calais, France
| | - Ali Jouni
- Centre Hospitalier Charles-Perrens, Pôle Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Bordeaux, France
| | - Marie-Maude Geoffray
- Department of Child and Adolescent Psychiatry, Centre Hospitalier le Vinatier, Bron, France
| | - Myriam Ly-Le Moal
- Institut Roche, Tour Horizons- Bureau 18M3, Boulogne-Billancourt, France
| | - Daniel Umbricht
- Roche Pharma Research and Early Development, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Christopher Chatham
- Roche Pharma Research and Early Development, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Lorraine Murtagh
- Roche Pharma Research and Early Development, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Richard Delorme
- Fondation FondaMental, Créteil, France.,Institut Pasteur, Human Genetics and Cognitive Functions Unit, Paris, France.,Université Paris Est Créteil, AP-HP, DMU IMPACT, Psychiatry and Addictology Department, Mondor University Hospital, Créteil, France
| | - Manuel Bouvard
- University of Bordeaux, Medical Sciences Department, Bordeaux, France.,Centre Hospitalier Charles-Perrens, Pôle Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Bordeaux, France.,Fondation FondaMental, Créteil, France.,Aquitaine Institute for Cognitive and Integrative Neuroscience, INCIA UMR 5287, Bordeaux, France
| | - Marion Leboyer
- Fondation FondaMental, Créteil, France.,Université Paris Est Créteil, AP-HP, DMU IMPACT, Psychiatry and Addictology Department, Mondor University Hospital, Créteil, France.,INSERM, U955, IMRB, Laboratoire de NeuroPsychiatrie translationnelle, Créteil, France
| | - Anouck Amestoy
- University of Bordeaux, Medical Sciences Department, Bordeaux, France.,Centre Hospitalier Charles-Perrens, Pôle Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Bordeaux, France.,Fondation FondaMental, Créteil, France.,Aquitaine Institute for Cognitive and Integrative Neuroscience, INCIA UMR 5287, Bordeaux, France
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24
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Abstract
In most cases, autism spectrum disorder is a life-long condition, often severely affecting the quality of life of the patient and his/her family, but nowadays this diagnosis should not be considered a final sentence without appeal. Although even today the recovery from the autism spectrum is an unlikely possibility, a timely psycho-educational intervention can significantly improve the level of autonomy reached by the individual and therefore favorably modify the outcome. Some predictors of long-term outcome are known, primarily childhood intelligence quotient and early language/communication ability, but today this issue is still open. The lack of studies evaluating the long-term effects of the most important intervention programmes should be filled with adequate research. Community support and social integration may be very important in improving outcomes for individuals with autism spectrum disorder. But a real social integration involves a work activity and this is still a great problem today. An adequate and timely preparation of the working career of these individuals is fundamental for their future, and it should be done by choosing, as far as possible, suitable activities for them. Finally, in creating a dignified future for people with autism, we must never forget to listen to their point of view, whenever possible, in order to meet their particular needs.
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25
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High Functioning Autism Spectrum Disorders in Adults: Consequences for Primary Caregivers Compared to Schizophrenia and Depression. J Autism Dev Disord 2019; 48:1920-1931. [PMID: 29313177 PMCID: PMC5948267 DOI: 10.1007/s10803-017-3445-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Primary caregivers experience consequences from being in close contact to a person with autism spectrum disorder (ASD). This study used the Involvement Evaluation Questionnaire to explore the level of consequences of 104 caregivers involved with adults with High Functioning ASD (HF-ASD) and compared these with the consequences reported by caregivers of patients suffering from depression and schizophrenia. Caregivers involved with adults with an HF-ASD experience overall consequences comparable to those involved with patients with depression or schizophrenia. Worrying was the most reported consequence. More tension was experienced by the caregivers of ASD patients, especially by spouses. More care and attention for spouses of adults with an HF-ASD appears to be needed.
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26
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Menezes M, Robinson L, Sanchez MJ, Cook B. Depression in Youth with Autism Spectrum Disorders: a Systematic Review of Studies Published Between 2012 and 2016. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2018. [DOI: 10.1007/s40489-018-0146-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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27
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Davidsson M, Hult N, Gillberg C, Särneö C, Gillberg C, Billstedt E. Anxiety and depression in adolescents with ADHD and autism spectrum disorders; correlation between parent- and self-reports and with attention and adaptive functioning. Nord J Psychiatry 2017; 71:614-620. [PMID: 28836480 DOI: 10.1080/08039488.2017.1367840] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Adolescents with attention-deficit/hyperactive disorder (ADHD) or autism spectrum disorder (ASD) are at high risk of anxiety and depression. This is important to identify in the clinical assessment to understand its impact. AIMS The aim of this study is to investigate the correlation between parent- and self-reports of anxiety and depression in adolescents with ADHD or ASD, as well as the correlation with adaptive functioning and performance on an attention test. METHOD A total of 65 adolescents with an ADHD diagnosis (n = 24) or an ASD diagnosis (n = 41) filled out Beck Youth Inventories of Emotional and Social Impairment (BYI) to assess depression and anxiety and completed a Continuous Performance Test (QbTest) measuring ADHD symptoms. Parents of the participants completed the internalizing domain in the Five to Fifteen questionnaire (FTF), measuring symptoms of anxiety and depression, and the Vineland Adaptive Behavior Scales (VABS) about the adolescent's adaptive functioning. RESULTS Approximately a third of the study group self-reported substantial internalizing mental symptoms not always recognized by parents, and not always obvious in adaptive function or performance at ADHD test. Correlations between BYI and FTF were low. The BYI depression inventory correlated negatively with VABS and positively with activity level in a subgroup medicated for ADHD. There was a stronger correlation between girls BYI and FTF results as compared with boys. CONCLUSIONS The results highlight the need for identification of anxiety and depression, using both self- and parent report. Present anxiety and depression symptoms do not seem to affect the clinical assessment of ASD and ADHD.
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Affiliation(s)
- Maria Davidsson
- a Gillberg Neuropsychiatry Centre , Institute of Neuroscience & Physiology, Sahlgrenska Academy, University of Gothenburg , Gothenburg, Sweden
| | - Nicklas Hult
- a Gillberg Neuropsychiatry Centre , Institute of Neuroscience & Physiology, Sahlgrenska Academy, University of Gothenburg , Gothenburg, Sweden
| | - Carina Gillberg
- a Gillberg Neuropsychiatry Centre , Institute of Neuroscience & Physiology, Sahlgrenska Academy, University of Gothenburg , Gothenburg, Sweden
| | - Charlotte Särneö
- a Gillberg Neuropsychiatry Centre , Institute of Neuroscience & Physiology, Sahlgrenska Academy, University of Gothenburg , Gothenburg, Sweden
| | - Christopher Gillberg
- a Gillberg Neuropsychiatry Centre , Institute of Neuroscience & Physiology, Sahlgrenska Academy, University of Gothenburg , Gothenburg, Sweden
| | - Eva Billstedt
- a Gillberg Neuropsychiatry Centre , Institute of Neuroscience & Physiology, Sahlgrenska Academy, University of Gothenburg , Gothenburg, Sweden
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Suh J, Orinstein A, Barton M, Chen CM, Eigsti IM, Ramirez-Esparza N, Fein D. Ratings of Broader Autism Phenotype and Personality Traits in Optimal Outcomes from Autism Spectrum Disorder. J Autism Dev Disord 2017; 46:3505-3518. [PMID: 27538964 DOI: 10.1007/s10803-016-2868-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The study examines whether "optimal outcome" (OO) children, despite no longer meeting diagnostic criteria for Autism Spectrum Disorder (ASD), exhibit personality traits often found in those with ASD. Nine zero acquaintance raters evaluated Broader Autism Phenotype (BAP) and Big Five personality traits of 22 OO individuals, 27 high functioning individuals with ASD (HFA), and 23 typically developing (TD) peers. HFA children displayed higher ratings than their peers on all BAP traits. OO were indistinguishable from TD, with the exception of greater extraversion (e.g., increased talkativeness), a potential tendency to be less emotionally stable, and pragmatic language deficits such as getting sidetracked in conversation. Overall, OO individuals are not showing BAP characteristics, but may be subject to other mild ADHD-like characteristics.
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Affiliation(s)
- Joyce Suh
- Department of Psychology, University of Connecticut, Storrs, CT, USA. .,Department of Neuropsychology, Kennedy Krieger Institute/Johns Hopkins School of Medicine, 1750 East Fairmount Avenue, Baltimore, MD, 21231, USA.
| | - Alyssa Orinstein
- Department of Psychology, University of Connecticut, Storrs, CT, USA.,Developmental Medicine Center, Boston Children's Hospital, Boston, MA, USA
| | - Marianne Barton
- Department of Psychology, University of Connecticut, Storrs, CT, USA
| | - Chi-Ming Chen
- Department of Psychology, University of Connecticut, Storrs, CT, USA
| | - Inge-Marie Eigsti
- Department of Psychology, University of Connecticut, Storrs, CT, USA
| | | | - Deborah Fein
- Department of Psychology, University of Connecticut, Storrs, CT, USA.,Department of Pediatrics, University of Connecticut, Farmington, CT, USA
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Resilience and Autism Spectrum Disorder: Applying Developmental Psychopathology to Optimal Outcome. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2017. [DOI: 10.1007/s40489-017-0106-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Mukaddes NM, Mutluer T, Ayik B, Umut A. What happens to children who move off the autism spectrum? Clinical follow-up study. Pediatr Int 2017; 59:416-421. [PMID: 27862704 DOI: 10.1111/ped.13202] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Revised: 09/11/2016] [Accepted: 10/12/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is controversial information on outcome of school age individuals who lose the diagnosis of autism and achieve "optimal outcome" (OO). The present study assessed the autism symptoms and other psychiatric disorders in a group of children with a past history of autism. METHODS The subjects consisted of 26 individuals who had lost the diagnosis of autism 2-8 years previously. Clinical assessment was done with both parents and children. Diagnostic and Statistical Manual of Mental Disorders (5th edn; DSM-V) criteria were used for diagnosis of autism spectrum disorder (ASD). In addition, Childhood Autism Rating Scale and Social Communication Questionnaire (current version) were used. Psychiatric disorders were assessed using the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children Present and Lifetime Version (K-SADS-PL). RESULTS None of the participants met the criteria for ASD. Ninety-two percent had a lifetime diagnosis and 81% had a present psychiatric disorder based on the K-SADS. Attention-deficit hyperactivity disorder, specific phobia and obsessive-compulsive disorder were the most common disorders. CONCLUSIONS Improved status with regard to autism symptomatology is maintained over time, but these individuals are vulnerable to developing other psychiatric disorders. It is crucial to maintain psychiatric follow up of children who move off the autism spectrum.
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Affiliation(s)
| | - Tuba Mutluer
- Child and Adolescent Psychiatry Clinic, Koc University Hospital, Istanbul, Turkey
| | - Basak Ayik
- Department of Child and Adolescent Psychiatry, Bakirkoy Research and Training Hospital for Psychiatric and Neurological Diseases, Istanbul, Turkey
| | - Ayla Umut
- Istanbul Institute of Child and Adolescent Psychiatry, Istanbul, Turkey
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31
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Abstract
PURPOSE OF REVIEW Until recently, there has been little systematic study of adult life among individuals with autism spectrum disorder (ASD) but recognition of the high psychological and social costs of ASD has led to an increase in adult-focused research over the past decade. The aim of this review is to summarize recent empirical findings on outcomes for adults with ASD. RECENT FINDINGS Most research on adult outcomes in ASD indicates very limited social integration, poor job prospects and high rates of mental health problems. However, studies vary widely in their methodology, choice of measures and selection of participants. Thus, estimates of how many adults have significant social and mental health problems are often conflicting. There is little consistent information on the individual, familial or wider social factors that may facilitate more positive social and psychological outcomes. There is a particular dearth of research on older individuals with ASD. SUMMARY The very variable findings reported in this review reflect the problems of conducting research into lifetime outcomes for individuals with a condition as heterogeneous as ASD. Much more systematic research is needed to delineate different patterns of development in adulthood and to determine the factors influencing these trajectories.
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