Formal Thought Disorder and Executive Functioning in Children and Adolescents with Autism Spectrum Disorder: Old Leads and New Avenues

Multiple complex developmental disorder (MCDD): Did we throw the baby out with the bathwater too fast? A systematic review

BACKGROUND

Multiple complex developmental disorder (MCDD) manifests as early-onset impairment across different domains. Although it could appear as a transitional condition between autism and childhood-onset schizophrenia, interest in MCDD has progressively waned. This study attempts to discern MCDD current relevance to avoid "throwing the baby out with the bathwater" too fast.

METHODS

All available studies published up to January 2024 were retrieved and evaluated following on the PRISMA guidelines for systematic reviews using the term "multiple complex developmental disorder" or "MCDD", without any filter for study design nor year of publication.

RESULTS

Only 16 studies were included and analyzed. Overall, a variable heterogeneity was observed in terms of country of investigation, study design, and clinical groups. Most of the included studies explored the construct of MCDD in developmental age, comparing MCDD mostly with autistic patients, and observing how the former group had higher levels of paranoia, illusions, and psychotic thoughts, whereas the latter showed more frequently difficulties in social interactions and stereotypical behaviors.

CONCLUSION

Overall, these results showed how progressive changes in diagnostic criteria over time led MCDD to be abandoned as nosographic construct, leaving perhaps a diagnostic void between autism and psychotic disorders that needs to be further studied. A systematic review on the Multiple Complex Developmental Disorder (MCDD): a forgotten diagnosis between autism and schizophrenia.

The Neurobiology of Formal Thought Disorder

The concept of Formal Thought Disorder (FTD) is an ambiguous and disputed one, even though it has endured as a core psychopathological construct in clinical Psychiatry. FTD can be summarized as a multidimensional construct, reflecting difficulties or idiosyncrasies in thinking, language, and communication in general and is usually subdivided into positive versus negative. In this article, we aim to explore the putative neurobiology of FTD, ranging from changes in neurotransmitter systems to alterations in the functional anatomy of the brain. We also discuss recent critiques of the operationalist view of FTD and how they might fit in its biological underpinnings. We conclude that FTD might be the observable phenotype of many distinct underlying alterations in different proportions.

Executive and motor function in children with autism spectrum disorder

The purpose of this study was to investigate the relationship between executive function, mainly attention and impulse control, and motor function impairment in children with ASD. Fifteen children with ASD (ages 8-14 years) were examined on their executive function using the Conners continuous performance test-3 and motor function using the movement assessment battery for children-2 (MABC-2). It was found that children with ASD were delayed on executive and motor function. This means that those effects were also observed in male children with Autism Spectrum Disorder (ASD) who had similar characteristics as the participants in the study. This study may have practical implications in the relationship between executive function and motor performance in children with ASD and for clinicians and educators working with children with ASD. Furthermore, the findings suggest that variability in reaction time may be a useful predictor of motor skill performance in children with ASD and may reflect underlying difficulties in executive function and future research is suggested.

[Comparison of psychometric and pathopsychological approaches in the assessment of intellectual activity in children and adolescents with progressive forms of schizophrenia]

OBJECTIVE

To study the intellectual activity of children and adolescents with progressive forms of schizophrenia using quantitative and qualitative diagnostic methods.

MATERIAL AND METHODS

An experimental group consisted of 67 children and adolescents (mean age 11.1±2.8 years) with mental pathology of schizophrenia spectrum with varying severity of the disease (malignant, progressive, and low progressive course) and leading clinical syndromes (catatonic, psychopathic, neurosis-like, and hyperkinetic). A control group included 63 children and adolescents (mean age 11.1±3.0 years) without a verified psychiatric diagnosis, secondary schools' students. The Wechsler Intelligence Scale for Children (WISC) was used for assessing intelligence, the Design of objects method was used for assessing the characteristics of thinking.

RESULTS

The relationship between thinking disorders and the parameters of verbal intelligence in patients with schizophrenia was shown (the Information subtest is related to all Object Construction parameters, r=0.401 to r=0.634; verbal IQ score is associated with some Object Construction scores, r=0.541 to r=0.537). In the control group, such a relationship was not noted. A decrease in the level of intelligence and severe thinking disorders is associated with such clinical factors as the malignant course of the disease (mean Full IQ score is 60.1, z-value of the coefficient of standardization in relation to the age norm is -2.1) and catatonic syndrome (mean Full IQ score is 68.1, coefficient of standardization is 60%).

CONCLUSION

The use of psychometric and pathopsychological approaches in the diagnosis of intellectual activity complements each other.

Autistic symptomatology in UHR patients: A preliminary report

Several studies have evaluated the level of autistic symptomatology in schizophrenia patients (SCZ) and ultra-high risk for psychosis (UHR) patients, but the data are not conclusive. Using the PANSS Autism Severity Score (PAUSS) scale, we found that the degree of autistic symptomatology in UHR patients is significantly lower compared to SCZ patients but higher than in patients with a mood disorder. Moreover, we found a significant correlation between autistic symptomatology and the severity of formal thought disorders, confirming Bleuler's hypothesis about autism and association disorders as core features of psychosis.

Reported autism diagnosis is associated with psychotic-like symptoms in the Adolescent Brain Cognitive Development cohort

Although the schizophrenia (SCZ) rate is increased in autism spectrum disorder (ASD), it is difficult to identify which ASD youth will develop psychosis. We explored the relationship between ASD and emerging psychotic-like experiences (PLS) in a sample of 9127 youth aged 9-11 from the Adolescent Brain Cognitive Development (ABCD) cohort. We predicted that parent-reported ASD would be associated with PLS severity, and that ASD youth with PLS (ASD+/PLS+) would differ from ASD youth without PLS (ASD+/PLS-) and youth with PLS but not ASD (ASD-/PLS+) in cognitive function. We fit regression models that included parent-reported ASD, family history of psychosis, lifetime trauma, executive function, processing speed, working memory, age, sex, race, ethnicity, and income-to-needs ratio as predictors of Prodromal Questionnaire-Brief Child (PQ-BC) distress score, a continuous index of PLS severity. We assessed cognitive differences using regression models with ASD/PLS status and relevant covariates as predictors of NIH Toolbox measures. ASD increased raw PQ-BC distress scores by 2.47 points (95% CI 1.33-3.61), an effect at least as large as Black race (1.27 points, 95% CI 0.75-1.78), family history of psychosis (1.05 points, 95% CI 0.56-1.54), and Latinx ethnicity (0.99 points, 95% CI 0.53-1.45. We did not identify differences in cognition for ASD+/PLS+ youth relative to other groups. Our finding of association between ASD and PLS in youth is consistent with previous literature and adds new information in suggesting that ASD may be a strong risk factor for PLS even compared to established SCZ risk factors.

Autism spectrum disorder and schizophrenia: An updated conceptual review

Autism spectrum disorder (ASD) and schizophrenia (SCZ) are separate disorders, with distinct clinical profiles and natural histories. ASD, typically diagnosed in childhood, is characterized by restricted or repetitive interests or behaviors and impaired social communication, and it tends to have a stable course. SCZ, typically diagnosed in adolescence or adulthood, is characterized by hallucinations and delusions, and tends to be associated with declining function. However, youth with ASD are three to six times more likely to develop SCZ than their neurotypical counterparts, and increasingly, research has shown that ASD and SCZ converge at several levels. We conducted a systematic review of studies since 2013 relevant to understanding this convergence, and present here a narrative synthesis of key findings, which we have organized into four broad categories: symptoms and behavior, perception and cognition, biomarkers, and genetic and environmental risk. We then discuss opportunities for future research into the phenomenology and neurobiology of overlap between ASD and SCZ. Understanding this overlap will allow for researchers, and eventually clinicians, to understand the factors that may make a child with ASD vulnerable to developing SCZ. LAY SUMMARY: Autism spectrum disorder and schizophrenia are distinct diagnoses, but people with autism and people with schizophrena share several characteristics. We review recent studies that have examined these areas of overlap, and discuss the kinds of studies we will need to better understand how these disorders are related. Understanding this will be important to help us identify which autistic children are at risk of developing schizophrenia.

Autistic traits in psychotic disorders: prevalence, familial risk, and impact on social functioning

BACKGROUND

Prevalence estimates of autistic traits in individuals with psychotic disorders (PD) vary greatly and it is unclear whether individuals with a familial risk (FR) for psychosis have an increased propensity to display autistic traits. Furthermore, it is unknown whether the presence of comorbid autism traits disproportionally affects the cognitive and behavioral aspects of social functioning in PD.

METHODS

In total, 504 individuals with PD, 587 unaffected siblings with FR, and 337 typical comparison (TC) individuals (16-50 years) were included. Autistic and psychotic traits were measured with the Autism Spectrum Quotient (AQ) and the Community Assessment of Psychic Experiences (CAPE). Social cognition was assessed with the Picture Sequencing Task (PST) and social behavior with the Social Functioning Scale (SFS).

RESULTS

For PD 6.5% scored above AQ clinical cut-off (⩾32), 1.0% for FR, and 1.2% for TC. After accounting for age, sex, and IQ, the PD group showed significantly more autistic traits and alterations in social behavior and cognition, while FR and TC only displayed marginal differences. Within the PD group autistic traits were a robust predictor of social behavior and there were no interactions with positive psychotic symptoms.

CONCLUSIONS

Levels of autistic traits are substantially elevated in PD and have a profoundly negative association with social functioning. In contrast, autistic traits above the clinical cut-off are not elevated in those with FR, and only marginally on a dimensional level. These findings warrant specific clinical guidelines for psychotic patients who present themselves with autistic comorbidity to help address their social needs.

Autism Symptoms, Executive Functioning and Academic Progress in Higher Education Students

Many students with autism spectrum disorders (ASDs) attending higher education drop out prematurely. The predictive value of self-reported daily executive functioning (EF) and (cognitive) performance-based EF (mental flexibility and working memory) for academic progress was evaluated in 54 young adults with ASD (M_age = 22.5, SD = 2.4, 72% male). Regression analyses showed that autism symptom severity explained 12% of variance in academic progress, which was raised to 36% by adding self-reported daily EF, and to 25% by adding performance-based EF. It is suggested that EF is a candidate marker for academic progress in higher education students with ASD and a candidate target for early intervention.

Assessing Youth with Psychotic Experiences: A Phenomenological Approach

Psychotic experiences may be part of normal development or indicate a wide range of mental disorders. This article shows how a systematic, domain-based, phenomenological approach to assessing psychotic symptoms in youth facilitates the gathering of the nuanced clinical information necessary to understand a child's specific experience. Mapping this information onto a narrative timeline, while understanding the evolution and developmental context of psychotic experiences, is essential in making an accurate diagnostic formulation and appropriate treatment plan for youth presenting with psychotic experiences.

The Attenuated Psychosis Syndrome and Facial Affect Processing in Adolescents With and Without Autism

BACKGROUND

Autism and schizophrenia spectrum disorders both represent severely disabling neurodevelopmental disorders with marked impairments in social functioning. Despite an increased incidence of psychosis in autism, and substantial overlap in symptoms and cognitive markers, it is unclear whether such phenotypes are specifically related to risk for psychosis or perhaps reflect more general, idiosyncratic autism traits. The attenuated psychosis syndrome (APS) is primarily defined by the presence of attenuated psychotic symptoms, which currently constitute the best and most-replicated clinical predictors of psychosis, and are common in clinical youth with and without autism. The aims of this study were to test the hypothesis that facial affect processing is impaired in adolescents with APS and to explore whether such deficits are more indicative of psychotic or autistic phenotypes on a categorical and dimensional level.

MATERIALS AND METHOD

Fifty-three adolescents with APS and 81 typically developing controls (aged 12-18) were included. The APS group consisted of adolescents with (n = 21) and without (n = 32) a diagnosis of autism spectrum disorder. Facial affect recognition was assessed with the Amsterdam Neuropsychological Tasks using a cascade model of cognitive processing, in which disturbances in "lower-level" cognitive abilities (pattern recognition), affect "higher-level" cognitive processes (face recognition and facial affect recognition). For associations with schizotypal and autistic-like traits the Schizotypal Personality Questionnaire and Social Communication Questionnaire were used in a confirmatory item factor analysis framework.

RESULTS

Contrary to expectation, APS in adolescents was not associated with impairments in pattern, face, or facial affect recognition. However, the APS group with autism spectrum disorder showed a general latency in response time to social and non-social stimuli. Dimensionally assessed schizotypal and autistic-like traits did not predict the accuracy or the speed of face or facial affect recognition.

CONCLUSION

Facial affect processing performance was not associated with APS in adolescence and represents an unlikely early vulnerability marker for psychosis. APS individuals with a more autistic-like profile were characterized by slower responses to social- and non-social stimuli, suggesting that the combined effect of APS and autism spectrum disorder on cognition is larger than for APS alone.

Impairments in cognitive empathy and alexithymia occur independently of executive functioning in college students with autism

Reduced empathy and alexithymic traits are common across the autism spectrum, but it is unknown whether this is also true for intellectually advanced adults with autism spectrum disorder. The aim of this study was to examine whether college students with autism spectrum disorder experience difficulties with empathy and alexithymia, and whether this is associated with their cognitive levels of executive functioning. In total, 53 college students with autism spectrum disorder were compared to a gender-matched group of 29 neurotypical students on cognitive and affective dimensions of empathy and alexithymia. In addition, cognitive performance on executive functioning was measured with computerized and paper-and-pencil tasks. The autism spectrum disorder group scored significantly lower on cognitive empathy and higher on cognitive alexithymia (both d = 0.65). The difference on cognitive empathy also remained significant after controlling for levels of cognitive alexithymia. There were no group differences on affective empathy and alexithymia. No significant relations between executive functioning and cognitive alexithymia or cognitive empathy were detected. Together, these findings suggest that intellectually advanced individuals with autism spectrum disorder experience serious impairments in the cognitive processing of social–emotional information. However, these impairments cannot be attributed to individual levels of cognitive executive functioning.