Broad Cognitive Profile in Children and Adolescents with HF-ASD and in Their Siblings: Widespread Underperformance and its Clinical and Adaptive Correlates

Autistic traits as a mediator between visual working memory capacity and enhanced performance in visual-perceptual tasks in children with ASD

The present study aimed to identify autistic traits as a mediator between visual working memory capacity and enhanced performance in visual-perceptual tasks in children with ASD. One hundred-forty children, ages 4-6 years, participated in this study (mean age = 5.34 ± 4.11, 98 males). They were recruited from Taiba Specialized Centers for the Care of People with Special Needs in Saudi Arabia. A correlational design was used to identify the mediating role of autistic traits in the relationship between visual working memory capacity and enhanced performance in visual-perceptual tasks in children with ASD. The present study developed a theoretical model that incorporated autistic traits as a mediator between visual working memory capacity and enhanced performance in visual-perceptual tasks in children with ASD. The study findings indicate that: (1) A significant positive correlation exists between autistic traits and visual working memory capacity; (2) A significant positive correlation exists between autistic traits and enhanced performance in visual-perceptual tasks; (3) The relationship between visual working memory capacity and enhanced performance is mediated by autistic traits.

Neurocognitive and self-reported psychosocial and behavioral functioning in siblings of individuals with neurodevelopmental conditions: a study using remote self-administered testing

OBJECTIVE

This study compared and explored the neurocognitive profiles of siblings of persons with and without neurodevelopmental conditions (NDCs) and associations between objective test performance and self-reported psychosocial functioning.

METHODS

Siblings of persons with and without NDCs (64 NDC and 64 control siblings; mean age 19.88 years, range 11-27 years, 73.44% female, 75.78% White Caucasian) completed self-report questionnaires and self-administered computerized neurocognitive tests of executive functioning (EF). Using Bayesian analyses, we examined cross-sectional associations between self-reported psychosocial functioning and cognitive test performance, and predictors of EF over 15 months.

RESULTS

NDC siblings had poorer working memory, inhibition, attention, and shifting compared to controls, as measured by experimental paradigms on the backward Corsi span, N-Back 2-back task, Stop Signal Task, Sustained Attention to Response Task, and the Wisconsin Card Sorting Test (effect size δ ranging 0.49 to 0.64). Bayesian cross-sectional networks revealed negative emotion reactivity and working memory difficulties were central to the NDC sibling network. Over 15 months, poorer EF (k low test scores) was predicted by negative emotion reactivity, sleep problems, and anxiety, over and above effects of age and subclinical autistic and ADHD traits. Siblings of autistic individuals and persons with fetal alcohol spectrum disorder had higher rates of neurocognitive and psychiatric difficulties than other NDCs and controls (Bayes factors >20).

CONCLUSIONS

Neurocognitive difficulties were associated with transdiagnostic vulnerability to poorer wellbeing in NDC siblings. These findings demonstrate the feasibility of remote online cognitive testing and highlight the importance of individualized prevention and intervention for NDC siblings.

Individual-Level Risk and Resilience Factors Associated with Mental Health in Siblings of Individuals with Neurodevelopmental Conditions: A Network Analysis

Siblings of individuals with neurodevelopmental conditions (NDCs) are exposed to unique family environments and experience a range of psychosocial risk and resilience factors. Networks of self-reported risk, resilience, and neuropsychiatric variables were estimated for siblings of individuals with (n = 235) and without (n = 480) NDCs (N = 715, mean age 22.40 years, 76% female, 74% White Caucasian). The NDC group reported more depressive (g = 0.39) and anxious (g = 0.43) symptoms than controls, and 71.5% of the NDC group reported at least one neuropsychiatric diagnosis compared to 36.9% of controls. Self-reported sleep and post-traumatic stress disorders were high amongst NDC siblings. Everyday executive functioning difficulties (cognitive inflexibility, hyperactivity/impulsivity) and emotion dysregulation were the most influential transdiagnostic risk factors for poorer functioning within the NDC group network.

Timing of therapy and neurodevelopmental outcomes in 18 families with pyridoxine-dependent epilepsy

BACKGROUND

Seventy-five percent of patients with pyridoxine-dependent epilepsy due to α-aminoadipic semialdehyde dehydrogenase deficiency (PDE-ALDH7A1) suffer intellectual developmental disability despite pyridoxine treatment. Adjunct lysine reduction therapies (LRT), aimed at lowering putative neurotoxic metabolites, are associated with improved cognitive outcomes. However, possibly due to timing of treatment, not all patients have normal intellectual function.

METHODS

This retrospective, multi-center cohort study evaluated the effect of timing of pyridoxine monotherapy and pyridoxine with adjunct LRT on neurodevelopmental outcome. Patients with confirmed PDE-ALDH7A1 with at least one sibling with PDE-ALDH7A1 and a difference in age at treatment initiation were eligible and identified via the international PDE registry, resulting in thirty-seven patients of 18 families. Treatment regimen was pyridoxine monotherapy in ten families and pyridoxine with adjunct LRT in the other eight. Primary endpoints were standardized and clinically assessed neurodevelopmental outcomes. Clinical neurodevelopmental status was subjectively assessed over seven domains: overall neurodevelopment, speech/language, cognition, fine and gross motor skills, activities of daily living and behavioral/psychiatric abnormalities.

RESULTS

The majority of early treated siblings on pyridoxine monotherapy performed better than their late treated siblings on the clinically assessed domain of fine motor skills. For siblings on pyridoxine and adjunct LRT, the majority of early treated siblings performed better on clinically assessed overall neurodevelopment, cognition, and behavior/psychiatry. Fourteen percent of the total cohort was assessed as normal on all domains.

CONCLUSION

Early treatment with pyridoxine and adjunct LRT may be beneficial for neurodevelopmental outcome. When evaluating a more extensive neurodevelopmental assessment, the actual impairment rate may be higher than the 75% reported in literature.

TAKE- HOME MESSAGE

Early initiation of lysine reduction therapies adjunct to pyridoxine treatment in patients with PDE-ALDH7A1 may result in an improved neurodevelopmental outcome.

Atypical Neural Responses of Cognitive Flexibility in Parents of Children With Autism Spectrum Disorder

Impaired cognitive flexibility has been repeatedly demonstrated in autism spectrum disorder (ASD). There is strong evidence for genetic involvement in ASD. First-degree relatives of individuals with ASD may show mild deficits in cognitive inflexibility. The present study investigated cognitive flexibility and its neuroelectrophysiological mechanisms in first-degree relatives of individuals with ASD to assess its potential familiality. Forty-five biological parents of individuals/children with ASD (pASD) and thirty-one biological parents of typically developing individuals/children (pTD), matched by gender, age, and IQ, were enrolled. The broad autism phenotype questionnaire (BAPQ) and cognitive flexibility inventory (CFI) were used to quantitatively assess autistic traits and cognitive flexibility in daily life, respectively. The task-switching paradigm was used to evaluate the behavioral flexibility in a structured assessment situation. Event-related potentials (ERPs) induced by this paradigm were also collected. Results showed that compared with the pTD group, the pASD group had lower CFI scores (t = −2.756, p < 0.01), while both groups showed an equivalent “switch cost” in the task-switching task (p > 0.05). Compared with the pTD group, the pASD group induced greater N2 amplitude at F3, F4, Fz, and C4 (F = 3.223, p < 0.05), while P3 amplitude and latency did not differ between the two groups. In addition, there was a significant negative correlation between the CFI total scores and BAPQ total scores in the pASD group (r = −0.734, p < 0.01). After controlling for age and IQ, the N2 amplitude in the frontal lobe of pASD was negatively correlated with the CFI total scores under the repetition sequence (r = −0.304, p = 0.053). These results indicated that pASD had deficit in cognitive flexibility at the self-reported and neurological levels. The cognitive flexibility difficulties of parents of children with ASD were related to autistic traits. These findings support that cognitive flexibility is most likely a neurocognitive endophenotype of ASD, which is worthy of further investigation.

Intelligence profiles and adaptive behaviors of high-functioning autism spectrum disorder and developmental speech and language disorders

OBJECTIVE

The present study was aimed at investigating the intelligence profiles and adaptive behaviors of children with high-functioning autism spectrum disorder (HFASD) and developmental speech and language disorders (DSLDs). We compared the similarities and differences of cognitive capabilities and adaptive functions and explored their correlations in the HFASD and DSLDs groups.

METHODS

128 patients with HFASD, 111 patients with DSLDs and 114 typically developing (TD) children were enrolled into our study. Wechsler Intelligence Scale for Children-IV (WISC-IV) and Adaptive Behavior Assessment System-II (ABAS-II) were respectively applied to evaluate intelligence profiles and adaptive behaviors. Intelligence quotient (IQ) scores and adaptive functioning scores among the HFASD, DSLDs and TD groups were compared through one-way ANOVA. Pearson correlation coefficient was applied to examine the relationships between WISC indices and ABAS domains.

RESULTS

Outcomes showed significantly poorer intelligence profiles and adaptive behaviors in HFASD and DSLDs groups. Both children with HFASD and DSLDs demonstrated impairments in verbal comprehension and executive functions. Processing speed and working memory were the predominant defects of children with HFASD and DSLDs in the field of executive functions, respectively. Whereas perceptual reasoning was a relative strength for them. Children with DSLDs had balanced scores of all the domains in ABAS-II; nevertheless, HFASD individuals demonstrated striking impairments in Social domain. Correlation analysis showed IQs of children with HFASD were positively correlated with all the domains and General Adaptive Composite (GAC) of ABAS-II. Additionally, IQs were positively correlated with Conceptual domain and GAC for children with DSLDs. Compared with DSLDs group, intelligence displayed stronger correlations with adaptive behaviors in HFASD group.

CONCLUSION

Our study expanded insights regarding intelligence profiles and adaptive behaviors of children with HFASD and DSLDs. Moreover, this study made breakthroughs in discovering positive correlations between IQs and adaptive functions in the two neurodevelopmental disorders.

Executive functions in youths with autism spectrum disorder and their unaffected siblings

BACKGROUND

Executive dysfunction is one of the main cognitive theories of autism spectrum disorder (ASD). Despite evidence of deficits in executive functions in individuals with ASD, little is known about executive dysfunctions as candidate cognitive endophenotypes for ASD. In this study, we investigated executive functions in youths with ASD, their unaffected siblings and typically developing controls (TDC).

METHODS

We recruited 240 youths with a clinical diagnosis of ASD (aged 6-18 years), 147 unaffected siblings of ASD youths, and 240 TDC youths. TDC youths were recruited based on the age and sex distribution of the ASD youths. Participants were assessed using the verbal Digit Span test and four executive function tasks from the Cambridge Neuropsychological Test Automated Battery, including Intra-dimensional/Extra-dimensional Shift (I/ED), Spatial Span (SSP), Spatial Working Memory (SWM), and Stocking of Cambridge (SoC).

RESULTS

ASD youths, relative to TDC, performed significantly worse in executive function tasks assessing verbal working memory (forward and backward digit span), set-shifting (I/ED), visuospatial working memory (SSP, SWM), and planning/problem solving (SoC). Furthermore, unaffected siblings, relative to TDC, performed worse in forward and backward digit recalls and made more errors in SWM. These results were independent of the effects of age, sex, IQ, and symptoms of attention-deficit/hyperactivity disorder.

CONCLUSIONS

Our findings support impaired executive functions in youths with ASD. However, unaffected siblings were mostly unimpaired except in the areas of verbal and spatial working memory, which may be potential cognitive endophenotypes for ASD.

The Episodic Memory Profile in Autism Spectrum Disorder: A Bayesian Meta-Analysis

Although autism spectrum disorders (ASD) are commonly characterized by diminished episodic memory, the literature in this area is mixed. We address these inconsistent findings by employing multilevel Bayesian meta-analysis to quantify episodic memory differences between individuals with ASD and typically developing (TD) controls. We used meta-regression to evaluate the effects of test modality (e.g., word list, story recall), delay interval (immediate vs. delayed), retrieval demands (recognition vs. recall), and sensory modality (auditory vs. visual) on episodic memory in ASD. A total of 338 effect sizes from 113 empirical articles, including 5,632 unique participants (ASD = 2,777, TD = 2,855), were included. Results show that the memory deficits associated with ASD were larger for recall (g = -0.52, se = 0.04, 95% CrI [-0.60, -0.43]) compared to recognition (g = -0.25, se = 0.05, 95% CrI [-0.35, -0.14]) and differed based on the testing modality. For example, effect sizes were smallest for words (g = -0.28, se = 0.05, 95% CrI [-0.38, -0.18]), pictures (g = -0.38, se = 0.07, 95% CrI [-0.52, -0.24]), and figure reproduction (g = -0.49, se = 0.11, 95% CrI [-0.70, -0.27]). However, effect sizes for sentences (g = -0.59, se = 0.20, 95% CrI [-1.00, -0.21]), stories (Hedges' g = -0.54, se = 0.08, 95% CrI [-0.69, -0.38]) and staged events (g = -0.75, se = 0.10, 95% CrI [-0.95, -0.55]) were much larger. These findings suggest that ASD is associated with a small to medium reduction in scores on episodic memory tests relative to TD controls.

Brief Report: Associations Between Cognitive Control Processes and Traits of Autism Spectrum Disorder (ASD), attention-Deficit/Hyperactivity Disorder (ADHD) and Anxiety in Children at Elevated and Typical Familial Likelihood for ASD

Shared difficulties with cognitive control may play a role in co-occurring mental health problems frequently observed in autistic children. We investigated how different cognitive control processes (inhibitory control, conflict resolution, cognitive flexibility) associated with traits of autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD) and anxiety in 7-year-old children at elevated (n = 44) and typical (n = 37) familial likelihood for ASD. Poor inhibitory control was associated with higher ADHD traits. Better inhibitory control and poorer cognitive flexibility predicted higher anxiety traits. Cognitive control processes were not associated dimensionally with autistic traits, though better conflict resolution predicted greater likelihood of meeting diagnostic criteria for ASD in categorical analysis. These findings suggest that different cognitive control alterations are associated with ASD, ADHD and anxiety.

Exploring the spatial working memory and visual perception in children with autism spectrum disorder and general population with high autism-like traits

The aim of the study is to compare the spatial working memory and visual perception between children with autism spectrum disorder (ASD) and typically developing control (TDC). Furthermore, this study validated whether this impairment was a feature of autism in general population with different autism-like traits (ALTs). This study contains two parts: case-control study and community population study. The ASD group and the control group were enlisted voluntarily (ASD group, n = 52; control group, n = 32). In the population study, we recruited 2994 children. Based on the scores of Autism Spectrum Quotient (AQ), children were divided into two groups (higher ALTs n = 122, lower ALTs n = 122). The participants completed the cognition tasks focusing on spatial working memory, visual-motor integration, and Intelligence. Analysis of covariance (ANCOVA) was conducted, with potential confounders IQ, age, and gender were controlled. Pearson correlations were computed by controlling the IQ and age as covariate to better understand the relations between visual perception, spatial working memory, and autism-like traits. In the case-control study, the results of cognition tasks focusing on the spatial working memory and visual perception indicated underperformance in children with ASD. In the community population study, we found that individuals with higher ALTs performed worse than children with lower ALTs in spatial working memory. Pearson correlation analysis suggested that a correlation between SWM total errors and visual perception was identified both in the children with ASD and in community population (ASD group, r = -0.592, p<0.001; general population, r = -0.201, p = 0.003). It suggested that spatial working memory deficit was a characteristic of autism, and may be distributed across the general population. Furthermore, we speculated a correlation between spatial working memory and visual perception in children with ASD and in general population.

Greater Individual Variability in Functional Brain Activity during Working Memory Performance in young people with Autism and Executive Function Impairment

BACKGROUND

Individuals with autism spectrum disorder (ASD) often present with executive functioning (EF) deficits, including spatial working memory (SWM) impairment, which impedes real-world functioning. The present study examined task-related brain activity, connectivity and individual variability in fMRI-measured neural response during an SWM task in older youth and young adults with autism and clinically significant EF impairment.

METHODS

Neuroimaging was analyzed in 29 individuals with ASD without intellectual disability who had clinically significant EF impairment on the Behavior Rating Inventory of Executive Function, and 20 typically developing controls (participant age range=16-34). An SWM N-Back task was performed during fMRI. SWM activity (2-Back vs. 0-Back) and task-related dorsolateral prefrontal cortex (DLPFC) connectivity was examined within and between groups. Variability of neural response during SWM was also examined.

RESULTS

During SWM performance both groups activated the expected networks, and no group differences in network activation or task-related DLPFC-connectivity were found. However, greater individual variability in the pattern of SWM activity was found in the ASD versus the typically developing control group.

CONCLUSIONS

While there were no group differences in SWM task-evoked activity or connectivity, fronto-parietal network engagement was found to be more variable/idiosyncratic in ASD. Our results suggest that the fronto-parietal network may be shifted or sub-optimally engaged during SWM performance in participants with ASD with clinically significant EF impairment, with implications for developing targeted interventions for this subgroup.

Treatment of Executive Function Deficits in autism spectrum disorder with repetitive transcranial magnetic stimulation: A double-blind, sham-controlled, pilot trial

Background:

In youth and young adults with autism spectrum disorder (ASD), executive function (EF) deficits may be a promising treatment target with potential impact on everyday functioning.

Objective:

To conduct a pilot randomized, double-blind, parallel, controlled trial evaluating repetitive transcranial magnetic stimulation (rTMS) for EF deficits in ASD.

Method:

In Toronto, Ontario (November 2014 to June 2017), a 20-session, 4-week course of 20 Hz rTMS targeting dorsolateral prefrontal cortex (DLPFC) (90%RMT) was compared to sham stimulation in 16—35 year-olds with ASD (28 male/12 female), without intellectual disability, who had impaired everyday EF performance (n = 20 active/n = 20 sham). Outcome measures evaluated protocol feasibility and clinical effects of active vs. sham rTMS on EF performance. The moderating effect of baseline functioning was explored.

Results:

Of eligible participants, 95% were enrolled and 95% of randomized participants completed the protocol. Adverse events across treatment arms were mild-to-moderate. There was no significant difference between active vs. sham rTMS on EF performance. Baseline adaptive functioning moderated the effect of rTMS, such that participants with lower baseline functioning experienced significant EF improvement in the active vs. sham group.

Conclusions:

Our pilot RCT demonstrated the feasibility and acceptability of using high frequency rTMS targeting DLPFC in youth and young adults with autism. No evidence for efficacy of active versus sham rTMS on EF performance was found. However, we found promising preliminary evidence of EF performance improvement following active versus sham rTMS in participants with ASD with more severe adaptive functioning deficits. Future work could focus on examining efficacy of rTMS in this higher-need population.

Clinical trial registration:

Repetitive Transcranial Magnetic Stimulation (rTMS) for Executive Function Deficits in Autism Spectrum Disorder and Effects on Brain Structure: A Pilot Study; https://clinicaltrials.gov/ct2/show/NCT02311751?term=ameis&rank=1; NCT02311751. The trial was funded by: an American Academy of Child and Adolescent Psychiatry (AACAP) Pilot Research Award, the Innovation Fund from the Alternate Funding Plan of the Academic Health Sciences Centres of Ontario, and an Ontario Mental Health Foundation (OMHF) Project A Grant and New Investigator Fellowship.