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Alkire D, Warnell KR, Kirby LA, Moraczewski D, Redcay E. Explaining Variance in Social Symptoms of Children with Autism Spectrum Disorder. J Autism Dev Disord 2021; 51:1249-1265. [PMID: 32676827 PMCID: PMC7854817 DOI: 10.1007/s10803-020-04598-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The social symptoms of autism spectrum disorder are likely influenced by multiple psychological processes, yet most previous studies have focused on a single social domain. In school-aged autistic children (n = 49), we compared the amount of variance in social symptoms uniquely explained by theory of mind (ToM), biological motion perception, empathy, social reward, and social anxiety. Parent-reported emotional contagion-the aspect of empathy in which one shares another's emotion-emerged as the most important predictor, explaining 11-14% of the variance in social symptoms, with higher levels of emotional contagion predicting lower social symptom severity. Our findings highlight the role of mutual emotional experiences in social-interactive success, as well as the limitations of standard measures of ToM and social processing in general.
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Affiliation(s)
- Diana Alkire
- Department of Psychology, University of Maryland, College Park, MD, 20742, USA.
- Neuroscience and Cognitive Science Program, University of Maryland, College Park, MD, 20742, USA.
| | - Katherine Rice Warnell
- Department of Psychology, University of Maryland, College Park, MD, 20742, USA
- Department of Psychology, Texas State University, San Marcos, TX, 78666, USA
| | - Laura Anderson Kirby
- Department of Psychology, University of Maryland, College Park, MD, 20742, USA
- Yale Child Study Center, Yale School of Medicine, New Haven, CT, 06519, USA
| | - Dustin Moraczewski
- Department of Psychology, University of Maryland, College Park, MD, 20742, USA
- Neuroscience and Cognitive Science Program, University of Maryland, College Park, MD, 20742, USA
- Computation and Mathematics for Biological Networks, University of Maryland, College Park, MD, 20742, USA
- Data Science and Sharing Team, National Institute of Mental Health, Bethesda, MD, 20892, USA
| | - Elizabeth Redcay
- Department of Psychology, University of Maryland, College Park, MD, 20742, USA
- Neuroscience and Cognitive Science Program, University of Maryland, College Park, MD, 20742, USA
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Pehlivanidis A, Papanikolaou K, Korobili K, Kalantzi E, Mantas V, Pappa D, Papageorgiou C. Trait-Based Dimensions Discriminating Adults with Attention Deficit Hyperactivity Disorder (ADHD), Autism Spectrum Disorder (ASD) and, Co-occurring ADHD/ASD. Brain Sci 2020; 11:E18. [PMID: 33375278 PMCID: PMC7824158 DOI: 10.3390/brainsci11010018] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/20/2020] [Accepted: 12/22/2020] [Indexed: 11/16/2022] Open
Abstract
This study assessed the co-occurrence of attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) in newly diagnosed adults of normal intelligence and the contribution of trait-based dimensions deriving from the Barkley Adult ADHD Rating Scale-IV (BAARS-IV), the Autism-Spectrum Quotient (AQ), and the Empathy Quotient (EQ) to the differentiation of patients with ADHD, ASD, and ADHD/ASD. A total of 16.1% of patients with ADHD received a co-occurring ASD diagnosis, while 33.3% of patients with ASD received an ADHD diagnosis. Subjects with ADHD or ADHD/ASD had higher scores in all ADHD traits compared to ASD subjects. Compared to the ADHD group, the ASD group had AQ scores that were significantly greater, except for attention to detail. ADHD/ASD co-occurrence significantly increased the score of attention to detail. The total EQ score was greater in the ADHD group. In the stepwise logistic regression analyses, past hyperactivity, current inattention and impulsivity, attention switching, communication, imagination, and total EQ score discriminated ADHD patients from ASD patients. Attention to detail, imagination, and total EQ score discriminated ADHD cases from ADHD/ASD cases, while past hyperactivity and current impulsivity discriminated ASD subjects from ADHD/ASD subjects. Our findings highlight the importance of particular trait-based dimensions when discriminating adults with ADHD, ASD, and co-occurring ADHD/ASD.
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Affiliation(s)
- Artemios Pehlivanidis
- 1st Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, “Eginition” Hospital, 72-74 Vas. Sofias Ave, 11528 Athens, Greece; (K.K.); (E.K.); (V.M.); (D.P.); (C.P.)
| | - Katerina Papanikolaou
- Department of Child Psychiatry, Medical School, National and Kapodistrian University of Athens, “Agia Sophia” Children’s Hospital, 11527 Athens, Greece;
| | - Kalliopi Korobili
- 1st Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, “Eginition” Hospital, 72-74 Vas. Sofias Ave, 11528 Athens, Greece; (K.K.); (E.K.); (V.M.); (D.P.); (C.P.)
| | - Eva Kalantzi
- 1st Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, “Eginition” Hospital, 72-74 Vas. Sofias Ave, 11528 Athens, Greece; (K.K.); (E.K.); (V.M.); (D.P.); (C.P.)
| | - Vasileios Mantas
- 1st Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, “Eginition” Hospital, 72-74 Vas. Sofias Ave, 11528 Athens, Greece; (K.K.); (E.K.); (V.M.); (D.P.); (C.P.)
| | - Dimitra Pappa
- 1st Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, “Eginition” Hospital, 72-74 Vas. Sofias Ave, 11528 Athens, Greece; (K.K.); (E.K.); (V.M.); (D.P.); (C.P.)
| | - Charalambos Papageorgiou
- 1st Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, “Eginition” Hospital, 72-74 Vas. Sofias Ave, 11528 Athens, Greece; (K.K.); (E.K.); (V.M.); (D.P.); (C.P.)
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Beresford B, Mukherjee S, Mayhew E, Heavey E, Park AL, Stuttard L, Allgar V, Knapp M. Evaluating specialist autism teams’ provision of care and support for autistic adults without learning disabilities: the SHAPE mixed-methods study. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08480] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
The National Institute for Health and Care Excellence recommends that every locality has a ‘Specialist Autism Team’: an specialist autism, community-based, multidisciplinary service that is responsible for developing, co-ordinating and delivering care and support. The National Institute for Health and Care Excellence recommended that this novel delivery model was evaluated.
Objectives
The objectives were to identify services fulfilling the National Institute for Health and Care Excellence’s description of a Specialist Autism Team; to describe practitioner and user experiences; to investigate outcomes; to identify factors associated with these outcomes; and to estimate costs and investigate cost-effectiveness of these services.
Design
During stage 1, desk-based research and a survey to identify Specialist Autism Teams were carried out. Stage 2 comprised a mixed-methods observational study of a cohort of Specialist Autism Team users, which was followed for up to 2 years from the assessment appointment. The cohort comprised users of a Specialist Autism Team not previously diagnosed with autism (the ‘Diagnosis and Support’ group) and those already diagnosed (the ‘Support-Only’ group). Stage 2 also involved a nested qualitative study of senior practitioners and an exploratory comparison of the Diagnosis and Support group with a cohort who accessed a service which only provided autism diagnostic assessments (‘Diagnosis-Only’ cohort).
Setting
The setting in stage 2 was nine Specialist Autism Teams; three also provided a regional diagnostic assessment service (used to recruit the Diagnosis-Only cohort).
Participants
There were 252 participants in the Specialist Autism Team cohort (Diagnosis and Support, n = 164; Support Only, n = 88) and 56 participants in the Diagnosis-Only cohort. Thirty-eight participants (across both cohorts) were recruited to the qualitative evaluation and 11 practitioners to the nested qualitative study.
Main outcome measures
The World Health Organization Quality of Life assessment, abbreviated version (psychological domain) and the General Health Questionnaire (12-item version).
Data sources
Self-reported outcomes, qualitative interviews with users and focus groups with practitioners.
Results
A total of 18 Specialist Autism Teams were identified, all for autistic adults without learning disabilities. Services varied in their characteristics. The resources available, commissioner specifications and clinical opinion determined service design. Practitioners working in Specialist Autism Teams recruited to stage 2 reported year-on-year increases in referral rates without commensurate increases in funding. They called for an expansion of Specialist Autism Teams’ consultation/supervision function and resources for low-intensity, ongoing support. For the Specialist Autism Team cohort, there was evidence of prevention of deterioration in outcomes and positive benefit for the Diagnosis and Support group at the 1-year follow-up (T3). Users of services with more professions involved were likely to experience better outcomes; however, such services may not be considered cost-effective. Some service characteristics were not associated with outcomes, suggesting that different structural/organisational models are acceptable. Findings suggest that one-to-one work for mental health problems was cost-effective and an episodic approach to delivering care plans was more cost-effective than managed care. Qualitative findings generally align with quantitative findings; however, users consistently connected a managed-care approach to supporting improvement in outcomes. Among the Diagnosis-Only cohort, no changes in mental health outcomes at T3 were observed. Findings from the interviews with individuals in the Diagnosis and Support group and Diagnosis-Only cohort suggest that extended psychoeducation post diagnosis has an impact on immediate and longer-term adjustment.
Limitations
Sample size prohibited an investigation of the associations between some service characteristics and outcomes. Comparison of the Diagnosis-Only cohort and the Diagnosis and Support group was underpowered. The economic evaluation was limited by incomplete costs data.
Conclusions
The study provides first evidence on the implementation of Specialist Autism Teams. There is some evidence of benefit for this model of care. Service characteristics that may affect outcomes, costs and cost-effectiveness were identified. Finding suggest that extended psychoeducation post diagnosis is a critical element of Specialist Autism Team provision.
Future work
We recommend a comparative evaluation of Specialist Autism Teams with diagnosis-only provision, and an evaluation of models of providing consultation/supervision and low-intensity support.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 48. See the NIHR Journals Library website for further project information.
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Affiliation(s)
| | | | - Emese Mayhew
- Social Policy Research Unit, University of York, York, UK
| | - Emily Heavey
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - A-La Park
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Lucy Stuttard
- Social Policy Research Unit, University of York, York, UK
| | | | - Martin Knapp
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK
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Abstract
It has been proposed that atypical empathy in autism spectrum disorder (ASD) is due to co-occurring alexithymia. However, difficulties measuring empathy and statistical issues in previous research raise questions about the role of alexithymia in empathic processing in ASD. Addressing these issues, we compared the associations of trait alexithymia and autism with empathy in large samples from the general population. Multiple regression analyses showed that both trait autism and alexithymia were uniquely associated with atypical empathy, but dominance analysis found that trait autism, compared to alexithymia, was a more important predictor of atypical cognitive, affective, and overall empathy. Together, these findings indicate that atypical empathy in ASD is not simply due to co-occurring alexithymia.
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Rubinstein K. Psychological Diagnosis of Adults with Autism Spectrum Disorder. AUTISM IN ADULTHOOD 2019. [DOI: 10.1007/978-3-030-28833-4_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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