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Moore HL, Cassidy S, Rodgers J. Exploring the mediating effect of camouflaging and the moderating effect of autistic identity on the relationship between autistic traits and mental wellbeing. Autism Res 2024; 17:1391-1406. [PMID: 38108621 DOI: 10.1002/aur.3073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 11/27/2023] [Indexed: 12/19/2023]
Abstract
Mental health difficulties are prevalent among autistic adults. Camouflaging (behaving differently to fit in) may be a mechanism by which autistic traits and mental health difficulties relate to each other, but little research has considered the role of different facets of camouflaging. Additionally, autistic identity might buffer against camouflaging and mental health difficulties. This research aims to explore the mediating effects of camouflaging behaviours on the relationship between autistic traits and both positive and negative mental wellbeing, as well as how autistic identity might moderate the relationship between autistic traits and camouflaging, and also mental health. Data were available for 627 autistic adults, recruited through volunteer databases and social media. Participants completed measures of autistic traits, anxiety, depression, positive wellbeing, camouflaging behaviours (compensating for difficulties, masking, and assimilating/putting on an act) and autistic identity. Mediation and moderated mediation models were tested, applying 95% bootstrapped CIs (10,000 resamples) and including age, gender and diagnosis as covariates. There were no significant direct effects between autistic traits and mental wellbeing. Assimilation was a significant mediator of all mental wellbeing measures, and compensation was a significant mediator of positive wellbeing only. Autistic identity was not a significant moderator. Assimilation and compensation should be considered when offering psychological interventions to support mental wellbeing of autistic people. Additional research into external drivers of camouflaging (e.g. stigma) and mechanisms by which camouflaging impacts mental wellbeing, such as autonomy, authenticity, skill mastery and community, may identify other areas of support. Concurrently, societal change is necessary to reduce the need to camouflage.
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Affiliation(s)
| | - Sarah Cassidy
- School of Psychology, University of Nottingham, University Park, Nottingham, UK
| | - Jacqui Rodgers
- Population Health Sciences Institute, Newcastle University, Sir James Spence Institute, Royal Victoria Infirmary, Newcastle Upon Tyne, UK
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2
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Riis K, Samulski B, Neely KA, Laverdure P. Physical Activity for Anxiety for Autistic People: A Systematic Review. J Autism Dev Disord 2024:10.1007/s10803-024-06356-9. [PMID: 38755488 DOI: 10.1007/s10803-024-06356-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2024] [Indexed: 05/18/2024]
Abstract
Clinical anxiety is a common comorbidity in autistic people. Due to the prevalence of anxiety in the autism population and the adverse effects it causes, there is a critical need to develop effective interventions which address anxiety symptoms for autistic people. Therefore, the purpose of this systematic review was to examine the effectiveness of the use of physical activity as an intervention to reduce anxiety in autistic people. Three databases PubMed, PsychInfo, and Cochrane RCTs, were searched utilizing key terms. PRISMA systematic search procedures identified 44 studies meeting predetermined inclusion criteria. Participant characteristics, the type of physical activity performed, the nature of the physical activity program/delivery, anxiety-related outcomes, and research methodology was evaluated for each study. Each paper included was appraised and scored for risk of bias using Cochrane Handbook for Systematic Reviews of Interventions risk of bias tool. Titles and abstracts of 44 articles were reviewed and 8 articles met inclusion criteria which evaluated interventions. Evidence from 8 studies suggests that yoga, a community-based football program, an app-assisted walking program, group exercise programs, and horseback riding interventions reduced anxiety for autistic people. The studies included in this systematic review provide strong-to-moderate evidence that physical activity can reduce anxiety for autistic children and adults. However, additional research is needed to identify which mode of physical activity is most beneficial for anxiety reduction. Further, future research should evaluate frequency, duration, and intensity and their effects on anxiety for autistic people.
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Affiliation(s)
- Kathryn Riis
- Department of Kinesiology, Auburn University, 301 Wire Rd, Auburn, AL, 36830, USA.
| | - Brittany Samulski
- Department of Kinesiology and Rehabilitation, Old Dominion University, Norfolk, VA, USA
| | - Kristina A Neely
- Department of Kinesiology, Auburn University, 301 Wire Rd, Auburn, AL, 36830, USA
| | - Patricia Laverdure
- Department of Rehabilitation Sciences, Old Dominion University, Norfolk, VA, USA
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3
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Moore HL, Freeston M, Rodgers J, Cassidy S. A Measurement Invariance Analysis of the Anxiety Scale for Autism-Adults in a Sample of Autistic and Non-Autistic Men and Women. J Autism Dev Disord 2024:10.1007/s10803-024-06260-2. [PMID: 38740697 DOI: 10.1007/s10803-024-06260-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2024] [Indexed: 05/16/2024]
Abstract
The Anxiety Scale for Autism-Adults (ASA-A) captures the autistic anxiety experience, but we do not know whether it is structurally equivalent for men and women, or non-autistic people. Measurement invariance analysis considered gender and diagnostic status (342 cis-gender autistic men (N = 105) and women (N = 237), 316 cis-gender non-autistic men (N = 104) and women (N = 212)). Strict invariance was achieved between autistic men and women and between non-autistic men and women, but the ASA-A structure is quantitatively different in autistic compared to non-autistic adults. Therefore, this tool cannot be used to directly compare anxiety between these groups. Autistic women scored significantly higher on the ASA-A than autistic men and Uncertainty was the highest scoring factor for autistic participants. Future research should include alternative gender identities.
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Affiliation(s)
- Heather L Moore
- School of Psychology, Dame Margaret Barbour Building, Wallace Street, Newcastle upon Tyne, NE2 4DR, UK.
| | - Mark Freeston
- School of Psychology, Dame Margaret Barbour Building, Wallace Street, Newcastle upon Tyne, NE2 4DR, UK
| | - Jacqui Rodgers
- Population Health Sciences Institute, Sir James Spence Institute, Newcastle University, Royal Victoria Infirmary, Level 3, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK
| | - Sarah Cassidy
- School of Psychology, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
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4
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Pezzimenti F, Durrani E, Zheng S, Adams RE, Bishop SL, Taylor JL. Perspectives on Employer-Initiated Terminations Among Young Adults on the Autism Spectrum. J Autism Dev Disord 2024; 54:1332-1343. [PMID: 36626010 PMCID: PMC9838300 DOI: 10.1007/s10803-022-05884-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2022] [Indexed: 01/11/2023]
Abstract
Job instability is high among autistic adults, with employer-initiated terminations a common reason for job loss. The current study used qualitative methods to code reasons that autistic adults identified for their employer-initiated termination. From 315 autistic individuals ages 18-35 who completed an online survey, 93 (29.5%) reported having been terminated from a job. These individuals were asked about the reasons for their termination and responses were coded into thematic categories. Common reasons included work performance, social difficulties, attendance, and mental health challenges. Adults were more likely to attribute terminations to internal causes (related to the individual) than to external causes (environment-related). A good fit between workplace, individual preferences, skills, and abilities is likely key to promoting job continuity for autistic adults.
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Affiliation(s)
- Florencia Pezzimenti
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Eman Durrani
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Shuting Zheng
- Weill Institute for Neurosciences, Department of Psychiatry and Behavior Sciences, University of California, San Francisco, CA, USA
| | - Ryan E Adams
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Somer L Bishop
- Weill Institute for Neurosciences, Department of Psychiatry and Behavior Sciences, University of California, San Francisco, CA, USA
| | - Julie Lounds Taylor
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA.
- Vanderbilt Kennedy Center, Vanderbilt University Medical Center, Nashville, TN, USA.
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Riedelbauch S, Gaigg SB, Thiel T, Roessner V, Ring M. Examining a model of anxiety in autistic adults. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:565-579. [PMID: 37329157 PMCID: PMC10913331 DOI: 10.1177/13623613231177777] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
ABSTRACT Anxiety disorders commonly occur in autism. Existing studies implicate intolerance of uncertainty, alexithymia, sensory processing differences and emotion regulation difficulties as influencing factors of anxiety in autism. To date, a few studies have considered the combination of these factors within the same sample. This study used structural equation modelling to test the prediction that intolerance of uncertainty and emotion regulation constitute more direct causes of anxiety in autism that mediate the influences of sensory processing difference and alexithymia as more sequential contributing factors. Autistic (n = 86) and non-autistic adults (n = 100) completed a battery of self-report questionnaires. Only when applied to each group separately, the broad predictions of the model were confirmed for the autistic group following data-driven additions of paths between sensory processing difference and anxiety and alexithymia implying that sensory processing difference contribute indirectly as well as directly to individual differences in anxiety. For the non-autistic group, model fit could only be achieved after removing autism-related traits and sensory processing differences as predictors of anxiety. These results suggest that aetiology and expression of anxiety in autism partially overlap with what is observed in the general population except that sensory processing differences appear to play a relatively unique role in the context of autism.
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Affiliation(s)
- Saskia Riedelbauch
- Klinik und Poliklinik für Kinder- und Jugendpsychiatrie und –psychotherapie, Medizinische Fakultät, Technische Universität Dresden, Dresden, Germany
| | | | - Tobias Thiel
- Klinik und Poliklinik für Kinder- und Jugendpsychiatrie und –psychotherapie, Medizinische Fakultät, Technische Universität Dresden, Dresden, Germany
| | - Veit Roessner
- Klinik und Poliklinik für Kinder- und Jugendpsychiatrie und –psychotherapie, Medizinische Fakultät, Technische Universität Dresden, Dresden, Germany
| | - Melanie Ring
- Klinik und Poliklinik für Kinder- und Jugendpsychiatrie und –psychotherapie, Medizinische Fakultät, Technische Universität Dresden, Dresden, Germany
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Gupta N, Gupta M. Off-label psychopharmacological interventions for autism spectrum disorders: strategic pathways for clinicians. CNS Spectr 2024; 29:10-25. [PMID: 37539695 DOI: 10.1017/s1092852923002389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
The prevalence of autism spectrum disorder (ASD) continues to see a trend upward with a noticeable increase to 1 in 36 children less than 8 years of age in the recent MMWR. There are many factors linked to the substantially increased burden of seeking mental health services, and clinically these individuals are likely to present for impairments associated with co-occurring conditions. The advances in cutting-edge research and the understanding of co-occurring conditions in addition to psychosocial interventions have provided a window of opportunity for psychopharmacological interventions given the limited availability of therapeutics for core symptomatology. The off-label psychopharmacological treatments for these co-occurring conditions are central to clinical practice. However, the scattered evidence remains an impediment for practitioners to systematically utilize these options. The review collates the crucial scientific literature to provide stepwise treatment alternatives for individuals with ASD; with an aim to lead practitioners in making informed and shared decisions. There are many questions about the safety and tolerability of off-label medications; however, it is considered the best practice to utilize the available empirical data in providing psychoeducation for patients, families, and caregivers. The review also covers experimental medications and theoretical underpinnings to enhance further experimental studies. In summary, amidst the growing clinical needs for individuals with ASD and the lack of approved clinical treatments, the review addresses these gaps with a practical guide to appraise the risk and benefits of off-label medications.
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Affiliation(s)
| | - Mayank Gupta
- Southwood Psychiatric Hospital, Pittsburgh, PA, USA
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Rai D, Webb D, Lewis A, Cotton L, Norris JE, Alexander R, Baldwin DS, Brugha T, Cochrane M, Del Piccolo MC, Glasson EJ, Hatch KK, Kessler D, Langdon PE, Leonard H, MacNeill SJ, Mills N, Morales MV, Morgan Z, Mukherjee R, Realpe AX, Russell A, Starkstein S, Taylor J, Turner N, Thorn J, Welch J, Wiles N. Sertraline for anxiety in adults with a diagnosis of autism (STRATA): study protocol for a pragmatic, multicentre, double-blind, placebo-controlled randomised controlled trial. Trials 2024; 25:37. [PMID: 38212784 PMCID: PMC10782796 DOI: 10.1186/s13063-023-07847-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 11/30/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed to manage anxiety in adults with an autism diagnosis. However, their effectiveness and adverse effect profile in the autistic population are not well known. This trial aims to determine the effectiveness and cost-effectiveness of the SSRI sertraline in reducing symptoms of anxiety and improving quality of life in adults with a diagnosis of autism compared with placebo and to quantify any adverse effects. METHODS STRATA is a two-parallel group, multi-centre, pragmatic, double-blind, randomised placebo-controlled trial with allocation at the level of the individual. It will be delivered through recruiting sites with autism services in 4 regional centres in the United Kingdom (UK) and 1 in Australia. Adults with an autism diagnosis and a Generalised Anxiety Disorder Assessment (GAD-7) score ≥ 10 at screening will be randomised 1:1 to either 25 mg sertraline or placebo, with subsequent flexible dose titration up to 200 mg. The primary outcome is GAD-7 scores at 16 weeks post-randomisation. Secondary outcomes include adverse effects, proportionate change in GAD-7 scores including 50% reduction, social anxiety, obsessive-compulsive symptoms, panic attacks, repetitive behaviours, meltdowns, depressive symptoms, composite depression and anxiety, functioning and disability and quality of life. Carer burden will be assessed in a linked carer sub-study. Outcome data will be collected using online/paper methods via video call, face-to-face or telephone according to participant preference at 16, 24 and 52 weeks post-randomisation, with brief safety checks and data collection at 1-2, 4, 8, 12 and 36 weeks. An economic evaluation to study the cost-effectiveness of sertraline vs placebo and a QuinteT Recruitment Intervention (QRI) to optimise recruitment and informed consent are embedded within the trial. Qualitative interviews at various times during the study will explore experiences of participating and taking the trial medication. DISCUSSION Results from this study should help autistic adults and their clinicians make evidence-based decisions on the use of sertraline for managing anxiety in this population. TRIAL REGISTRATION ISRCTN, ISRCTN15984604 . Registered on 08 February 2021. EudraCT 2019-004312-66. ANZCTR ACTRN12621000801819. Registered on 07 April 2021.
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Affiliation(s)
- Dheeraj Rai
- Population Health Sciences, University of Bristol, Bristol, UK.
- NIHR Bristol Biomedical Research Centre, Bristol, UK.
- Avon & Wiltshire Partnership Mental Health NHS Trust, Bath, UK.
| | - Doug Webb
- Population Health Sciences, University of Bristol, Bristol, UK
- Bristol Trials Centre, University of Bristol, Bristol, UK
| | - Amanda Lewis
- Population Health Sciences, University of Bristol, Bristol, UK
- Bristol Trials Centre, University of Bristol, Bristol, UK
| | - Leonora Cotton
- Population Health Sciences, University of Bristol, Bristol, UK
- Bristol Trials Centre, University of Bristol, Bristol, UK
| | - Jade Eloise Norris
- Population Health Sciences, University of Bristol, Bristol, UK
- Bristol Trials Centre, University of Bristol, Bristol, UK
| | - Regi Alexander
- Hertfordshire Partnership NHS Foundation Trust, Hatfield, UK
| | - David S Baldwin
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | | | - Madeleine Cochrane
- Population Health Sciences, University of Bristol, Bristol, UK
- Bristol Trials Centre, University of Bristol, Bristol, UK
| | | | - Emma J Glasson
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
- Discipline of Psychiatry, Medical School, The University of Western Australia, Perth, Australia
| | - Katherine K Hatch
- Discipline of Psychiatry, Medical School, The University of Western Australia, Perth, Australia
| | - David Kessler
- Population Health Sciences, University of Bristol, Bristol, UK
- NIHR Bristol Biomedical Research Centre, Bristol, UK
| | - Peter E Langdon
- Centre for Research in Intellectual and Developmental Disabilities, University of Warwick, Coventry, UK
- Coventry and Warwickshire Partnership NHS Trust, Coventry, UK
| | - Helen Leonard
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
- Discipline of Psychiatry, Medical School, The University of Western Australia, Perth, Australia
| | - Stephanie J MacNeill
- Population Health Sciences, University of Bristol, Bristol, UK
- NIHR Bristol Biomedical Research Centre, Bristol, UK
- Bristol Trials Centre, University of Bristol, Bristol, UK
| | - Nicola Mills
- Population Health Sciences, University of Bristol, Bristol, UK
- NIHR Bristol Biomedical Research Centre, Bristol, UK
| | - Maximiliano Vazquez Morales
- Population Health Sciences, University of Bristol, Bristol, UK
- Bristol Trials Centre, University of Bristol, Bristol, UK
| | | | - Raja Mukherjee
- Surrey and Borders Partnership NHS Foundation Trust, Leatherhead, UK
| | - Alba X Realpe
- Population Health Sciences, University of Bristol, Bristol, UK
- NIHR Bristol Biomedical Research Centre, Bristol, UK
- Bristol Trials Centre, University of Bristol, Bristol, UK
| | - Ailsa Russell
- Centre for Applied Autism Research, Department of Psychology, University of Bath, Bath, UK
| | - Sergio Starkstein
- Discipline of Psychiatry, Medical School, The University of Western Australia, Perth, Australia
| | - Jodi Taylor
- Population Health Sciences, University of Bristol, Bristol, UK
- Bristol Trials Centre, University of Bristol, Bristol, UK
| | - Nicholas Turner
- Population Health Sciences, University of Bristol, Bristol, UK
- Bristol Trials Centre, University of Bristol, Bristol, UK
| | - Joanna Thorn
- Population Health Sciences, University of Bristol, Bristol, UK
- Bristol Trials Centre, University of Bristol, Bristol, UK
| | - Jack Welch
- Dorset County Hospital NHS Foundation Trust, Dorchester, UK
| | - Nicola Wiles
- Population Health Sciences, University of Bristol, Bristol, UK
- NIHR Bristol Biomedical Research Centre, Bristol, UK
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8
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Zhang B, Zhang X, Omorou M, Zhao K, Ruan Y, Luan H. Disco interacting protein 2 homolog A (DIP2A): A key component in the regulation of brain disorders. Biomed Pharmacother 2023; 168:115771. [PMID: 37897975 DOI: 10.1016/j.biopha.2023.115771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 10/08/2023] [Accepted: 10/18/2023] [Indexed: 10/30/2023] Open
Abstract
Disco Interacting Protein 2 Homolog A (DIP2A) is expressed throughout the body and abundantly expressed in the brain tissue. It is activated by Follistatin-like 1 (FSTL1). Activated DIP2A interacts with several pathways, such as AMPK/mTOR and AKT pathways, to contribute to many biological processes, such as oxidative stress, transcriptional regulation, and apoptosis. Dysregulated DIP2A activation has been implicated in numerous processes in the brain. If the upstream pathways of DIP2A remain globally unexplored, many proteins, including cortactin, AMPK, and AKT, have been identified as its downstream targets in the literature. Recent studies have linked DIP2A to a variety of mechanisms in many types of brain disorders, suggesting that regulation of DIP2A could provide novel diagnostic and therapeutic approaches for brain disorders. In this review, we comprehensively summarized and discussed the current research on DIP2A in various brain disorders, such as stroke, autism spectrum disorders (ASD), Alzheimer's disease (AD), dyslexia, and glioma.
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Affiliation(s)
- Baoyuan Zhang
- Department of Physiology, School of Basic Medicine, Jiamusi University, Jiamusi 154000, Heilongjiang, China; Key laboratory of Microecology-immune Regulatory Network and Related Diseases, School of Basic Medicine, Jiamusi University, Jiamusi 154000, Heilongjiang, China
| | - Xuesong Zhang
- First Affiliated Hospital, Jiamusi University, Jiamusi, Heilongjiang, China
| | - Moussa Omorou
- Key laboratory of Microecology-immune Regulatory Network and Related Diseases, School of Basic Medicine, Jiamusi University, Jiamusi 154000, Heilongjiang, China; Department of Biochemistry and Molecular Biology, School of Basic Medicine, Jiamusi University, Jiamusi 154000, Heilongjiang, China
| | - Kai Zhao
- Department of Physiology, School of Basic Medicine, Jiamusi University, Jiamusi 154000, Heilongjiang, China; Key laboratory of Microecology-immune Regulatory Network and Related Diseases, School of Basic Medicine, Jiamusi University, Jiamusi 154000, Heilongjiang, China
| | - Yang Ruan
- The Central Hospital of Jiamusi City, Jiamusi, Heilongjiang, China.
| | - Haiyan Luan
- Department of Physiology, School of Basic Medicine, Jiamusi University, Jiamusi 154000, Heilongjiang, China; Key laboratory of Microecology-immune Regulatory Network and Related Diseases, School of Basic Medicine, Jiamusi University, Jiamusi 154000, Heilongjiang, China.
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9
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Sappok T, Bayer M, Tarasova D, Kaiser H, Bergmann T. [Autism Spectrum Disorders in Adulthood: Empirical Findings on Comorbidities, Differential Diagnoses, and the Clinical Utility of the AQ]. PSYCHIATRISCHE PRAXIS 2023; 50:370-374. [PMID: 37160157 DOI: 10.1055/a-2044-8540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
AUTISM: spectrum disorders (ASD) often remain undiagnosed until adulthood. The aim of this study is to report differential diagnoses (DDX) and comorbidities of adults without intellectual impairment suspected of having an ASD and to test the self-assessment questionnaire Autism Quotient (AQ) for its suitability for screening. METHODS DDX and comorbidities were recorded with standardized scales in an autism outpatient clinic in 106 individuals. The AQ was tested against the expert judgment of an interdisciplinary case conference using ROC analysis. RESULTS Affective disorders were common in both groups (48%); other DDX were phobias (33%) and personality disorders (22%). The AQ showed an AUC of 0,527 with sensitivity/specificity of 70%/35%. CONCLUSIONS Adults suspected of having autism are highly burdened by DDX and comorbidities. An interdisciplinary diagnostic procedure based on standardized scales is useful, whereas the AQ hardly differentiates between persons with and without ASD.
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Affiliation(s)
- Tanja Sappok
- Universitätsklinik für Inklusive Medizin, Krankenhaus Mara gGmbh, Universitätsklinikum OWL der Universität Bielefeld
| | - Mareike Bayer
- Klinische Psychologie Sozialer Interaktion, Institut für Psychologie, Humboldt-Universität zu Berlin
| | - Daria Tarasova
- Behandlungszentrum für psychische Gesundheit bei Entwicklungsstörungen, Evangelisches Krankenhaus Königin Elisabeth Herzberge gGmbH, Berlin
| | - Heika Kaiser
- Behandlungszentrum für psychische Gesundheit bei Entwicklungsstörungen, Evangelisches Krankenhaus Königin Elisabeth Herzberge gGmbH, Berlin
| | - Thomas Bergmann
- Behandlungszentrum für psychische Gesundheit bei Entwicklungsstörungen, Evangelisches Krankenhaus Königin Elisabeth Herzberge gGmbH, Berlin
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10
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Underwood JFG, DelPozo-Banos M, Frizzati A, Rai D, John A, Hall J. Neurological and psychiatric disorders among autistic adults: a population healthcare record study. Psychol Med 2023; 53:5663-5673. [PMID: 36189783 PMCID: PMC10482712 DOI: 10.1017/s0033291722002884] [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] [Received: 01/07/2022] [Revised: 07/29/2022] [Accepted: 08/22/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Co-occurring psychiatric disorders are common in autism, with previous studies suggesting 54-94% of autistic individuals develop a mental health condition in their lifetime. Most studies have looked at clinically-recruited cohorts, or paediatric cohorts followed into adulthood, with less known about the autistic community at a population level. We therefore studied the prevalence of co-occurring psychiatric and neurological conditions in autistic individuals in a national sample. METHODS This retrospective case-control study utilised the SAIL Databank to examine anonymised whole population electronic health record data from 2001 to 2016 in Wales, UK (N = 3.6 million). We investigated the prevalence of co-occurring psychiatric and selected neurological diagnoses in autistic adults' records during the study period using International Classification of Diseases-10 and Read v2 clinical codes compared to general population controls matched for age, sex and deprivation. RESULTS All psychiatric conditions examined were more common amongst adults with autism after adjusting for age, sex and deprivation. Prevalence of attention-deficit hyperactivity disorder (7.00%), bipolar disorder (2.50%), obsessive-compulsive disorder (3.02%), psychosis (18.30%) and schizophrenia (5.20%) were markedly elevated in those with autism, with corresponding odds ratios 8.24-10.74 times the general population. Depression (25.90%) and anxiety (22.40%) were also more prevalent, with epilepsy 9.21 times more common in autism. CONCLUSIONS We found that a range of psychiatric conditions were more frequently recorded in autistic individuals. We add to understanding of under-reporting and diagnostic overshadowing in autism. With increasing awareness of autism, services should be cognisant of the psychiatric conditions that frequently co-occur in this population.
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Affiliation(s)
- Jack F. G. Underwood
- Division of Psychological Medicine and Clinical Neurosciences, Neuroscience and Mental Health Innovation Institute, Cardiff University, Cardiff, UK
| | | | - Aura Frizzati
- Cedar Healthcare Technology Research Centre, Cardiff & Vale University Health Board, Cardiff, UK
| | - Dheeraj Rai
- Bristol Medical School, Bristol Population Health Science Institute, Bristol, UK
| | - Ann John
- Population Data Science, Medical School, Swansea University, Swansea, UK
| | - Jeremy Hall
- Division of Psychological Medicine and Clinical Neurosciences, Neuroscience and Mental Health Innovation Institute, Cardiff University, Cardiff, UK
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Taheri F, Esmaeilpour K, Sepehri G, Sheibani V, Shekari MA. Amelioration of cognition impairments in the valproic acid-induced animal model of autism by ciproxifan, a histamine H3-receptor antagonist. Behav Pharmacol 2023; 34:179-196. [PMID: 37171458 DOI: 10.1097/fbp.0000000000000720] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Autism spectrum disorder is a neurodevelopmental disorder characterized by deficits in social communication and repetitive behavior. Many studies show that the number of cognitive impairmentscan be reduced by antagonists of the histamine H3 receptor (H3R). In this study, the effects of ciproxifan (CPX) (1 and 3 mg/kg, intraperitoneally) on cognitive impairments in rat pups exposed to valproic acid (VPA) (600 mg/kg, intraperitoneally) wereexamined on postnatal day 48-50 (PND 48-50) using marble-burying task (MBT), open field, novel object recognition (NOR), and Passive avoidance tasks. Famotidine (FAM) (10, 20, and 40 mg/kg, intraperitoneally) was also used to determine whether histaminergic neurotransmission exerts its procognitive effects via H2 receptors (H2Rs). Furthermore, a histological investigation was conducted to assess the degree of degeneration of hippocampal neurons. The results revealed that repetitive behaviors increased in VPA-exposed rat offspring in the MBT. In addition, VPA-exposed rat offspring exhibited more anxiety-like behaviors in the open field than saline-treated rats. It was found that VPA-exposed rat offspring showed memory deficits in NOR and Passive avoidance tasks. Our results indicated that 3 mg/kg CPX improved cognitive impairments induced by VPA, while 20 mg/kg FAM attenuated them. We concluded that 3 mg/kg CPX improved VPA-induced cognitive impairments through H3Rs. The histological assessment showed that the number of CA1 neurons decreased in the VPA-exposed rat offspring compared to the saline-exposed rat offspring, but this decrease was not significant. The histological assessment also revealed no significant differences in CA1 neurons in VPA-exposed rat offspring compared to saline-exposed rat offspring. However, CPX3 increased the number of CA1 neurons in the VPA + CPX3 group compared to the VPA + Saline group, but this increase was not significant. This study showed that rats prenatally exposed to VPA exhibit cognitive impairments in the MBT, open field, NOR, and Passive avoidance tests, which are ameliorated by CPX treatment on PND 48-50. In addition, morphological investigations showed that VPA treatment did not lead to neuronal degeneration in the CA1 subfield of the hippocampus in rat pups.
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Affiliation(s)
- Farahnaz Taheri
- Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Khadijeh Esmaeilpour
- Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
- Physics and Astronomy Department, University of Waterloo, Waterloo, Ontario, Canada
| | - Gholamreza Sepehri
- Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Vahid Sheibani
- Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Majid Asadi Shekari
- Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
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12
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Sandhu TR, Xiao B, Lawson RP. Transdiagnostic computations of uncertainty: towards a new lens on intolerance of uncertainty. Neurosci Biobehav Rev 2023; 148:105123. [PMID: 36914079 DOI: 10.1016/j.neubiorev.2023.105123] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 02/21/2023] [Accepted: 03/08/2023] [Indexed: 03/13/2023]
Abstract
People radically differ in how they cope with uncertainty. Clinical researchers describe a dispositional characteristic known as "intolerance of uncertainty", a tendency to find uncertainty aversive, reported to be elevated across psychiatric and neurodevelopmental conditions. Concurrently, recent research in computational psychiatry has leveraged theoretical work to characterise individual differences in uncertainty processing. Under this framework, differences in how people estimate different forms of uncertainty can contribute to mental health difficulties. In this review, we briefly outline the concept of intolerance of uncertainty within its clinical context, and we argue that the mechanisms underlying this construct may be further elucidated through modelling how individuals make inferences about uncertainty. We will review the evidence linking psychopathology to different computationally specified forms of uncertainty and consider how these findings might suggest distinct mechanistic routes towards intolerance of uncertainty. We also discuss the implications of this computational approach for behavioural and pharmacological interventions, as well as the importance of different cognitive domains and subjective experiences in studying uncertainty processing.
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Affiliation(s)
- Timothy R Sandhu
- Department of Psychology, Downing Place, University of Cambridge, CB2 3EB, UK; MRC Cognition and Brain Sciences Unit, 15 Chaucer Road, CB2 7EF, UK.
| | - Bowen Xiao
- Department of Psychology, Downing Place, University of Cambridge, CB2 3EB, UK
| | - Rebecca P Lawson
- Department of Psychology, Downing Place, University of Cambridge, CB2 3EB, UK; MRC Cognition and Brain Sciences Unit, 15 Chaucer Road, CB2 7EF, UK
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13
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Yamada K, Kimura T, Cui M, Tanaka E, Kubota Y, Ikehara S, Iso H. Maternal autistic traits and antenatal pain by cross-sectional analysis of the Japan Environment and Children's Study. Sci Rep 2023; 13:6068. [PMID: 37055438 PMCID: PMC10101964 DOI: 10.1038/s41598-023-32945-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 04/05/2023] [Indexed: 04/15/2023] Open
Abstract
The aim of cross-sectional study was to investigate whether the presence of autistic traits in pregnant women was positively associated with the prevalence and severity of antenatal pain. We analyzed 89,068 pregnant women from a Japanese national birth cohort cross-sectionally. Autistic traits were assessed using the Japanese version of the Autism-Spectrum Quotient short form (AQ-10-J). Antenatal pain was measured using the SF-8 bodily pain item (SF-8-Pain). Antenatal pain in the second to third trimester during pregnancy was categorized into three groups: without pain, mild pain, and moderate-to-severe pain. Participants were divided into eight groups by AQ-10-J score: seven consecutive scoring groups (scores 0-6), and those above the cut-off (≥ 7) for probable autistic spectrum disorders. Odds ratios (OR) for the prevalence of mild and moderate-to-severe pain were calculated for each AQ-10-J scoring group (reference: without pain group) using multinominal logistic regression analysis. Autistic traits were positively associated with mild and moderate-to-severe pain in a dose-response manner, but the association with moderate-to-severe pain was strongest. Fully-adjusted ORs (95% confidence intervals) for moderate-to-severe pain were: 1.01 (0.91-1.13) for 1 point, 1.13 (1.02-1.25) for 2 points, 1.16 (1.04-1.29) for 3 points, 1.20 (1.07-1.34) for 4 points, 1.23 (1.09-1.40) for 5 points, 1.27 (1.10-1.47) for 6 points, and 1.24 (1.05-1.46) for ≥ 7 points (AQ-10-J cut-off). We identified an association between maternal autistic traits and antenatal pain. Maternal autistic traits may need to be considered when addressing antenatal pain during healthcare for expectant mothers.
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Affiliation(s)
- Keiko Yamada
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
- Pain Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
- Department of Anesthesiology and Pain Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan.
| | - Takashi Kimura
- Department of Public Health, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Meishan Cui
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Eizaburo Tanaka
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
- Hyogo Institute for Traumatic Stress, Kobe, Hyogo, Japan
| | - Yasuhiko Kubota
- Osaka Center for Cancer and Cardiovascular Diseases Prevention, Osaka, Japan
| | - Satoyo Ikehara
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Hiroyasu Iso
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
- Department of Public Health Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
- Institute for Global Health Policy Research (iGHP), Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan
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Sharghi S, Flunkert S, Daurer M, Rabl R, Chagnaud BP, Leopoldo M, Lacivita E, Hutter-Paier B, Prokesch M. Evaluating the effect of R-Baclofen and LP-211 on autistic behavior of the BTBR and Fmr1-KO mouse models. Front Neurosci 2023; 17:1087788. [PMID: 37065917 PMCID: PMC10097904 DOI: 10.3389/fnins.2023.1087788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 03/07/2023] [Indexed: 03/31/2023] Open
Abstract
IntroductionAutism spectrum disorder (ASD) is a persistent neurodevelopmental condition characterized by two core behavioral symptoms: impaired social communication and interaction, as well as stereotypic, repetitive behavior. No distinct cause of ASD is known so far; however, excitatory/inhibitory imbalance and a disturbed serotoninergic transmission have been identified as prominent candidates responsible for ASD etiology.MethodsThe GABAB receptor agonist R-Baclofen and the selective agonist for the 5HT7 serotonin receptor LP-211 have been reported to correct social deficits and repetitive behaviors in mouse models of ASD. To evaluate the efficacy of these compounds in more details, we treated BTBR T+ Itpr3tf/J and B6.129P2-Fmr1tm1Cgr/J mice acutely with R-Baclofen or LP-211 and evaluated the behavior of animals in a series of tests.ResultsBTBR mice showed motor deficits, elevated anxiety, and highly repetitive behavior of self-grooming. Fmr1-KO mice exhibited decreased anxiety and hyperactivity. Additionally, Fmr1-KO mice’s ultrasonic vocalizations were impaired suggesting a reduced social interest and communication of this strain. Acute LP-211 administration did not affect the behavioral abnormalities observed in BTBR mice but improved repetitive behavior in Fmr1-KO mice and showed a trend to change anxiety of this strain. Acute R-Baclofen treatment improved repetitive behavior only in Fmr1-KO mice.ConclusionOur results add value to the current available data on these mouse models and the respective compounds. Yet, additional studies are needed to further test R-Baclofen and LP-211 as potential treatments for ASD therapy.
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Affiliation(s)
- Shirin Sharghi
- Department of Neuropharmacology, QPS Austria GmbH, Grambach, Austria
- Institute for Biology, Karl-Franzens-Universität Graz, Graz, Austria
- *Correspondence: Shirin Sharghi,
| | - Stefanie Flunkert
- Department of Neuropharmacology, QPS Austria GmbH, Grambach, Austria
| | - Magdalena Daurer
- Department of Neuropharmacology, QPS Austria GmbH, Grambach, Austria
| | - Roland Rabl
- Department of Neuropharmacology, QPS Austria GmbH, Grambach, Austria
| | | | - Marcello Leopoldo
- Department of Pharmacy-Drug Sciences, University of Bari Aldo Moro, Bari, Italy
| | - Enza Lacivita
- Department of Pharmacy-Drug Sciences, University of Bari Aldo Moro, Bari, Italy
| | | | - Manuela Prokesch
- Department of Neuropharmacology, QPS Austria GmbH, Grambach, Austria
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15
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Cole RH, Elmalem MS, Petrochilos P. Prevalence of autistic traits in functional neurological disorder and relationship to alexithymia and psychiatric comorbidity. J Neurol Sci 2023; 446:120585. [PMID: 36807974 DOI: 10.1016/j.jns.2023.120585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 02/06/2023] [Accepted: 02/09/2023] [Indexed: 02/14/2023]
Abstract
INTRODUCTION In a cohort of adults with Functional Neurological Disorder (FND), we aim to: METHODS: 91 patients participating in a FND 5-week outpatient program completed baseline self-report questionnaires for total phobia, somatic symptom severity, attention deficit hyperactivity disorder (ADHD) and dyslexia. Patients were grouped by Autism Spectrum Quotient (AQ-10) score of <6 or ≥ 6 and compared for significant differences in tested variables. This analysis was repeated with patients grouped by alexithymia status. Simple effects were tested using pairwise comparisons. Multistep regression models tested direct relationships between autistic traits and psychiatric comorbidity scores, and mediation by alexithymia. RESULTS 36 patients (40%) were AQ-10 positive (scoring ≥6 on AQ-10). A further 36 patients (across AQ-10 positive and AQ-10 negative groups) (40%) screened positive for alexithymia. AQ-10 positive patients scored significantly higher for alexithymia, depression, generalised anxiety, social phobia, ADHD, and dyslexia. Alexithymia positive patients scored significantly higher for generalised anxiety, depression, somatic symptoms severity, social phobia, and dyslexia. Alexithymia score was found to mediate the relationship between autistic trait and depression scores. CONCLUSION We demonstrate a high proportion of autistic and alexithymic traits, in adults with FND. A higher prevalence of autistic traits may highlight a need for specialised communication approaches in FND management. Mechanistic conclusions are limited. Future research could explore links with interoceptive data.
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Affiliation(s)
| | - Michael S Elmalem
- Department of Clinical and Movement Neurosciences, National Hospital for Neurology and Neurosurgery, UCL Queen Square Institute of Neurology, Queen Square, Box 95, London WC1N 3BG, UK; High-Dimensional Neurology, UCL IoN, Queen Square, Box 19, London WC1N 3BG, UK.
| | - Panayiota Petrochilos
- Department of Neuropsychiatry, National Hospital for Neurology and Neurosurgery, Queen Square, Box 19, London WC1N 3BG, UK.
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16
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The relationship between fear of COVID-19 and depression, anxiety and stress in persons with disabilities: A cross-sectional study. Arch Psychiatr Nurs 2023; 43:15-21. [PMID: 37032008 PMCID: PMC9810547 DOI: 10.1016/j.apnu.2022.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 09/28/2022] [Accepted: 12/27/2022] [Indexed: 01/05/2023]
Abstract
AIM This study aimed to determine the relationship between the fear of COVID-19 and the depression, anxiety and stress in persons with disabilities. METHODS In this cross-sectional study, the data were collected using an online survey from 178 persons with disabilities using the Personal Information Form, Depression Anxiety Stress Scales-21 (DASS-21) and the Fear of COVID-19 Scale (FCV-19S). RESULTS The mean age of the participants was 34.08 ± 11.8 years. The disability types that participants had were related to vision (47.2 %), hearing (25.8 %), mobility (24.7 %), cognitive (8.4 %), and chronic disease (10.1 %). It has been determined that 73.6 % of the participants stated that their access to healthcare services was restricted due to the COVID-19 pandemic. The mean DASS-21 was 10.24 ± 8.25 and the mean FCV-19S was 17.71 ± 5.05. A positive correlation was found between DASS-21 and FCV-19S. CONCLUSION The pandemic has created a need to provide appropriate interventions to improve the psychosocial health of persons with disabilities.
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Sánchez-Cueva MS, Alcantud Marín F, Alonso-Esteban Y. Ansiedad y trastornos del espectro del autismo: notas para la intervención psicoeducativa. SIGLO CERO REVISTA ESPAÑOLA SOBRE DISCAPACIDAD INTELECTUAL 2022. [DOI: 10.14201/scero2022534930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Se analizan de forma narrativa las relaciones entre comportamiento sensorial atípico, intolerancia a la incertidumbre y regulación emocional como generadores de los trastornos de ansiedad en niños y niñas autistas. El objetivo es estudiar el origen de la ansiedad en los niños y niñas autistas con la finalidad de determinar cuál o cuáles pueden ser los procedimientos de intervención más adecuados. Se han revisado algunos de los programas de intervención cognitivo-conductuales más utilizados en niños y niñas autistas y las adaptaciones realizadas a los mismos. Se observa un divorcio entre los programas psicoeducativos escolares y los programas clínicos de intervención para el tratamiento de la ansiedad. Como conclusión, se recomienda que en los programas psicoeducativos escolares se incorporen acciones proactivas en forma de programas de intervención cognitivo-conductuales para evitar o aminorar los efectos negativos de la ansiedad en el aprendizaje e inclusión escolar de los niños y las niñas autistas.
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Rinaldi A, Martins MCM, Maioli M, Rinaldi S, Fontani V. REAC Noninvasive Neurobiological Stimulation in Autism Spectrum Disorder for Alleviating Stress Impact. ADVANCES IN NEURODEVELOPMENTAL DISORDERS 2022; 7:244-251. [PMID: 36213521 PMCID: PMC9525921 DOI: 10.1007/s41252-022-00293-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/23/2022] [Indexed: 05/05/2023]
Abstract
Objectives Autism spectrum disorder (ASD) symptoms can become more evident because of different factors. Among these, depression, anxiety, and stress play an important role. Additionally, several studies have revealed the impact of the COVID-19 pandemic on participants with ASD. In previous studies, two noninvasive neurobiological stimulation treatments with radio electric asymmetric conveyer (REAC) technology, called neuropostural optimization (NPO) and neuropsychophysical optimization (NPPO), were shown to be effective in improving the subjective response to environmental stressors in the general population and in ASD population. Based on the proven efficacy of REAC NPO and NPPOs treatments in alleviating anxiety, stress, and depression, the purpose of this study is to verify how these treatments can reduce the severity of ASD symptoms expression, which is aggravated by depression, anxiety, and stress. The treatments' effects were perceived by caregivers and assessed by the Autism Treatment Evaluation Checklist (ATEC). Methods This study involved 46 children with a previous diagnosis of ASD made using the Autism Diagnostic Observation Schedule and Autism Diagnostic Interview-Revised. The participants received one session of NPO treatment and one NPPOs treatment cycle of 18 sessions, administered within approximately 3 weeks. The Autism Treatment Evaluation Checklist (ATEC) was used to evaluate the efficacy of the REAC treatments. ATEC allows to evaluate four clusters (speech or language communication; sociability; sensory or cognitive awareness; and health/physical/behavior) through a numerical scale that measures increasing levels of ASD severity. Results The comparison between the scores of the ATEC administered pre- and post-REAC treatments highlighted an improvement of ASD symptoms in each of the four clusters of ATEC. Conclusions The results confirm the usefulness of REAC treatments to optimize the individual response to environmental stressors and reduce the symptomatic expression and deficits present in ASD.
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Affiliation(s)
- Arianna Rinaldi
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
- Department of Adaptive Neuro Psycho Physio Pathology and Neuro Psycho Physical Optimization, Rinaldi Fontani Institute, Florence, Italy
| | - Márcia C. Marins Martins
- International Scientific Society of Neuro Psycho Physical Optimization With REAC Technology, Brazilian Branch, São Paulo, Brazil
| | - Margherita Maioli
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Salvatore Rinaldi
- Department of Adaptive Neuro Psycho Physio Pathology and Neuro Psycho Physical Optimization, Rinaldi Fontani Institute, Florence, Italy
- Research Department, Rinaldi Fontani Foundation, Florence, Italy
| | - Vania Fontani
- Department of Adaptive Neuro Psycho Physio Pathology and Neuro Psycho Physical Optimization, Rinaldi Fontani Institute, Florence, Italy
- Research Department, Rinaldi Fontani Foundation, Florence, Italy
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Kilanko A, Obi-Azuike C, Adaralegbe N, Eze-Njoku C, Urhi A, Agbor C, Ayisire OE, Eche VC, Soomro F, Kaur G, Babalola F, Oyeleye-Adegbite OC, Aladum B, Popoola HA, Anugwom GO. The Correlation Between Autistic Childhood Disorders and the Development of Anxiety and Depression in Adults: A Systematic Review. Cureus 2022; 14:e30093. [PMID: 36381917 PMCID: PMC9642317 DOI: 10.7759/cureus.30093] [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] [Accepted: 10/08/2022] [Indexed: 06/16/2023] Open
Abstract
Children with autism spectrum disorder significantly suffer from other mental conditions, including anxiety and depression, compared to the general population. This continues to have a significant effect till adulthood. This study aimed at determining if there is a correlation between autism disorder in childhood and the development of anxiety and depression in adulthood and if behavioral therapy for children with this disorder reduces the likelihood of developing anxiety and depression as an adult. Three major databases were searched: EMBASE, Google Scholar, and PubMed, using specific search terms. Studies were selected according to population, exposure, comparison, condition or outcome(s) of interest, study design, and context. Overall, there are five articles relevant to this systematic review synthesis; all were observational studies. Our study shows psychiatric disorders like anxiety and depression could be related to autism spectrum disorder and early behavioral intervention could be beneficial and reduce the need for anxiety and depression medication.
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Affiliation(s)
| | - Crystal Obi-Azuike
- Psychiatry and Behavioral Sciences, University of Medicine and Health Sciences, New York City, USA
| | - Ngozi Adaralegbe
- Psychiatry and Behavioral Sciences, University of Connecticut, Waterbury, USA
| | - Chioma Eze-Njoku
- Pediatrics, Atrium Health Navicient the Medical Center, Macon, USA
| | | | - Chukwudi Agbor
- Psychiatry, Tees, Esk and Wear Valleys NHS Trust, Scarborough, GBR
| | | | - Victor C Eche
- Psychiatry, University of Port Harcourt, Port Harcourt, NGA
| | - Fareena Soomro
- Psychiatry and Behavioral Sciences, Isra University, Sindh, PAK
| | - Garima Kaur
- Psychiatry, All Indian Institute of Medical Sciences Rishikesh, Rishikesh, IND
| | - Funmilola Babalola
- Epidemiology and Public Health, Texas Department of State Health Services, San Antonio, USA
| | | | - Bialo Aladum
- Psychiatry, Ascension Borgess Hospital, Kalamazoo, USA
| | - Hakeem A Popoola
- Internal Medicine, Windsor University School of Medicine, Bassettere, KNA
| | - Gibson O Anugwom
- Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, USA
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20
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Verhulst I, MacLennan K, Haffey A, Tavassoli T. The Perceived Causal Relations Between Sensory Reactivity Differences and Anxiety Symptoms in Autistic Adults. AUTISM IN ADULTHOOD 2022; 4:183-192. [PMID: 36606154 PMCID: PMC9648696 DOI: 10.1089/aut.2022.0018] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background Rates of anxiety are inordinately high in autistic adults. Sensory reactivity differences, such as hyperreactivity (e.g., strong reactions to sound), hyporeactivity (e.g., no, or slower reactions to pain), and seeking (e.g., fascination with spinning objects), are a diagnostic criterion of autism and have been linked with anxiety. Understanding how individuals perceive these to be causally related can impact the assessment and treatment of anxiety. Therefore, we examined the perceived causal relations (PCR) between sensory reactivity differences and anxiety in autistic adults. Method Two hundred forty-six autistic adults aged 18-76 years took part in an online study. They completed self-report assessments of sensory reactivity differences, and anxiety, followed by the PCR scale, indicating whether they perceived their sensory reactivity differences to be more of a cause or an effect of their anxiety symptoms. Results We found sensory reactivity hyperreactivity, hyporeactivity, and seeking to be significantly correlated with anxiety. Further, we found total sensory hyperreactivity, and visual, auditory, and olfactory hyperreactivity, to be perceived as significantly more of a cause of anxiety than an effect, and total sensory seeking, and tactile and vestibular seeking, to be perceived as significantly more of an effect of anxiety than a cause. Conclusion Future individualized approaches to treating anxiety in autistic individuals may benefit from differentiating between potential sensory causes of anxiety (e.g. hypersensitivities) vs. potential sensory effects of anxiety (e.g. sensory seeking behaviors).
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Affiliation(s)
- Isabelle Verhulst
- Department of Psychology, Royal Holloway, University of London, Egham, United Kingdom
| | - Keren MacLennan
- School of Psychology and Clinical Language Sciences, The University of Reading, Berkshire, United Kingdom
| | - Anthony Haffey
- School of Psychology and Clinical Language Sciences, The University of Reading, Berkshire, United Kingdom
| | - Teresa Tavassoli
- School of Psychology and Clinical Language Sciences, The University of Reading, Berkshire, United Kingdom
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21
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Stogiannos N, Carlier S, Harvey-Lloyd JM, Brammer A, Nugent B, Cleaver K, McNulty JP, dos Reis CS, Malamateniou C. A systematic review of person-centred adjustments to facilitate magnetic resonance imaging for autistic patients without the use of sedation or anaesthesia. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 26:782-797. [PMID: 34961364 PMCID: PMC9008560 DOI: 10.1177/13623613211065542] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
LAY ABSTRACT Autistic patients often undergo magnetic resonance imaging examinations. Within this environment, it is usual to feel anxious and overwhelmed by noises, lights or other people. The narrow scanners, the loud noises and the long examination time can easily cause panic attacks. This review aims to identify any adaptations for autistic individuals to have a magnetic resonance imaging scan without sedation or anaesthesia. Out of 4442 articles screened, 53 more relevant were evaluated and 21 were finally included in this study. Customising communication, different techniques to improve the environment, using technology for familiarisation and distraction have been used in previous studies. The results of this study can be used to make suggestions on how to improve magnetic resonance imaging practice and the autistic patient experience. They can also be used to create training for the healthcare professionals using the magnetic resonance imaging scanners.
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Affiliation(s)
| | - Sarah Carlier
- University of Applied Sciences and Arts Western Switzerland (HES-SO), Switzerland
- University of Lausanne, Switzerland
| | | | | | - Barbara Nugent
- City, University of London, UK
- MRI Safety Matters® Organisation, UK
- NHS National Education for Scotland, UK
| | | | | | - Cláudia Sá dos Reis
- University of Applied Sciences and Arts Western Switzerland (HES-SO), Switzerland
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22
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Alves ALC, de Paula JJ, de Miranda DM, Romano-Silva MA. The Autism Spectrum Quotient in a sample of Brazilian adults: analyses of normative data and performance. Dement Neuropsychol 2022; 16:244-248. [PMID: 35720649 PMCID: PMC9173798 DOI: 10.1590/1980-5764-dn-2021-0081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 11/26/2021] [Accepted: 12/11/2021] [Indexed: 11/21/2022] Open
Abstract
Autism spectrum disorder (ASD) is characterized by difficulties in social interaction and inflexible behaviors/interests. To quantify ASD traits in adults with preserved intelligence, the Autism Spectrum Quotient (AQ) was developed, which is a self-report instrument and one of the most used and recommended tools.
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Affiliation(s)
- Ana Luíza Costa Alves
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Programa de Pós-Graduação em Medicina Molecular, Belo Horizonte MG, Brazil
| | - Jonas Jardim de Paula
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Programa de Pós-Graduação em Medicina Molecular, Belo Horizonte MG, Brazil
| | - Débora Marques de Miranda
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Programa de Pós-Graduação em Medicina Molecular, Belo Horizonte MG, Brazil
| | - Marco Aurélio Romano-Silva
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Programa de Pós-Graduação em Medicina Molecular, Belo Horizonte MG, Brazil
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Kuo AA, Hotez E, Rosenau KA, Gragnani C, Fernandes P, Haley M, Rudolph D, Croen LA, Massolo ML, Holmes LG, Shattuck P, Shea L, Wilson R, Martinez-Agosto JA, Brown HM, Dwyer PSR, Gassner DL, Onaiwu MG, Kapp SK, Ne'eman A, Ryan JG, Waisman TC, Williams ZJ, DiBari JN, Foney DM, Ramos LR, Kogan MD. The Autism Intervention Research Network on Physical Health (AIR-P) Research Agenda. Pediatrics 2022; 149:e2020049437D. [PMID: 35363290 DOI: 10.1542/peds.2020-049437d] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/09/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES In the United States, autistic individuals experience disproportionate physical and mental health challenges relative to non-autistic individuals, including higher rates of co-occurring and chronic conditions and lower physical, social, and psychological health-related quality of life. The Autism Intervention Research Network on Physical Health (AIR-P) is an interdisciplinary, multicenter research network for scientific collaboration and infrastructure that aims to increase the life expectancy and quality of life for autistic individuals, with a focus on underserved or vulnerable populations. The current paper describes the development of the AIR-P Research Agenda. METHODS Development of the research agenda involved an iterative and collaborative process between the AIR-P Advisory Board, Steering Committee, and Autistic Researcher Review Board. The methodology consisted of 3 phases: (1) ideation and design, (2) literature review and synthesis; and (3) network engagement. RESULTS Six core research priorities related to the health of autistic individuals were identified: (1) primary care services and quality, (2) community-based lifestyle interventions, (3) health systems and services, (4) gender, sexuality, and reproductive health, (5) neurology, and (6) genetics. Specific topics within each of these priorities were identified. Four cross-cutting research priorities were also identified: (1) neurodiversity-oriented care, (2) facilitating developmental transitions, (3) methodologically rigorous intervention studies, and (4) addressing health disparities. CONCLUSIONS The AIR-P Research Agenda represents an important step forward for enacting large-scale health-promotion efforts for autistic individuals across the lifespan. This agenda will catalyze autism research in historically underrepresented topic areas while adopting a neurodiversity-oriented approach to health-promotion.
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Affiliation(s)
- Alice A Kuo
- Departments of Medicine and
- Pediatrics
- Graduate School of Education and Information Studies, University of California, Los Angeles, Los Angeles, California
| | | | - Kashia A Rosenau
- Graduate School of Education and Information Studies, University of California, Los Angeles, Los Angeles, California
| | | | | | | | - Dawn Rudolph
- Association of University Centers on Disabilities, Silver Spring, Maryland
| | - Lisa A Croen
- Kaiser Permanente Northern California, Los Angeles, California
| | - Maria L Massolo
- Kaiser Permanente Northern California, Los Angeles, California
| | | | | | - Lindsay Shea
- AJ Drexel Autism Institute, Philadelphia, Pennsylvania
| | | | | | | | - Patrick S R Dwyer
- Center for Mind and Brain
- Department of Psychology, University of California Davis, Davis, California
| | - Dena L Gassner
- School of Social Work, Adelphi University, Garden City, New York
- Department of Health Sciences, Towson University, Towson, Maryland
| | | | - Steven K Kapp
- Department of Psychology, University of Portsmouth, Portsmouth, United Kingdom
| | - Ari Ne'eman
- Harvard University, Cambridge, Massachusetts
| | - Jacalyn G Ryan
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - T C Waisman
- University of Calgary, Calgary, Alberta, Canada
| | - Zachary J Williams
- Medical Scientist Training Program, Vanderbilt University School of Medicine, Nashville, Tennessee
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
- Vanderbilt Brain Institute
- Frist Center for Autism and Innovation, Vanderbilt University, Nashville, Tennessee
| | - Jessica N DiBari
- Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, Maryland
| | - Dana M Foney
- Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, Maryland
| | | | - Michael D Kogan
- Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, Maryland
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24
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OUP accepted manuscript. Cereb Cortex 2022; 32:4619-4639. [DOI: 10.1093/cercor/bhab506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 12/07/2021] [Accepted: 12/08/2021] [Indexed: 11/13/2022] Open
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25
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Normansell-Mossa KM, Top DN, Russell N, Freeston M, Rodgers J, South M. Sensory Sensitivity and Intolerance of Uncertainty Influence Anxiety in Autistic Adults. Front Psychol 2021; 12:731753. [PMID: 34867612 PMCID: PMC8635111 DOI: 10.3389/fpsyg.2021.731753] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 10/15/2021] [Indexed: 01/02/2023] Open
Abstract
Several models of anxiety in autistic adults have focused on the role of intolerance of uncertainty which has biological and evolutionary bases, as a cognitive explanation for the high prevalence of anxiety in autism. This framework suggests that all people are born with a healthy level of intolerance of uncertainty, and as we develop, this intolerance is lessened as we learn when situations are safe and begin to understand and manage the uncertainty. This process of learning about managing uncertainty does not happen in the same way in those who are high in autistic traits, which could be the reason for the high levels of anxiety symptoms commonly seen in this population. We examined archival data of 199 non-autistic and 55 autistic adults from prior studies in which we collected self-report measures of autistic traits, intolerance of uncertainty, sensory processing, and anxiety. We conducted two path analyses to examine the role of intolerance of uncertainty in anxiety in autistic adults. The first model tested the idea that intolerance of uncertainty, an evolutionary phenomenon common for all people, could explain some of the cognitive aspects of anxiety in autism. The second model suggests that primary neurodevelopmental differences associated with autistic traits underlie the sensory sensitivity and sensory seeking behaviors, which in turn increase intolerance of uncertainty and subsequent anxiety. We found that the “neurodevelopmental” model had better model fit than the “evolutionary stress” model, suggesting that the neurodevelopmental impact of higher levels of autistic traits could moderate a non-autistic trajectory of learning to manage uncertainty as children develop and understand that uncertainty is common and acceptable.
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Affiliation(s)
| | - D Nicholas Top
- Student Health Services, Utah Valley University, Orem, UT, United States
| | - Nicholas Russell
- Department of Psychology, Brigham Young University, Provo, UT, United States
| | - Mark Freeston
- School of Psychology, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Jacqui Rodgers
- Population Health Sciences Institute, Sir James Spence Institute, Newcastle upon Tyne, United Kingdom
| | - Mikle South
- Department of Psychology, Brigham Young University, Provo, UT, United States.,Neuroscience Center, Brigham Young University, Provo, UT, United States
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26
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Tung R, Reiter MA, Linke A, Kohli JS, Kinnear MK, Müller RA, Carper RA. Functional connectivity within an anxiety network and associations with anxiety symptom severity in middle-aged adults with and without autism. Autism Res 2021; 14:2100-2112. [PMID: 34264028 DOI: 10.1002/aur.2579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 12/20/2022]
Abstract
Anxiety is highly prevalent in autism spectrum disorders (ASDs). However, few functional magnetic resonance imaging (fMRI) studies of ASDs have focused on anxiety (and fewer still on anxiety in middle-aged adults). Thus, relationships between atypical connectivity and anxiety in this population are poorly understood. The current study contrasted functional connectivity within anxiety network regions across adults (40-64 years) with and without autism, and tested for group by functional connectivity interactions on anxiety. Twenty-two adults with ASDs (16 males) and 26 typical control (TC) adults (22 males) completed the Beck Anxiety Inventory and a resting-state fMRI scan. An anxiety network consisting of 12 regions of interest was defined, based on a meta-analysis in TC individuals and two studies on anxiety in ASDs. We tested for main effects of group and group by anxiety interactions on connectivity within this anxiety network, controlling for head motion using ANCOVA. Results are reported at an FDR adjusted threshold of q < 0.1 (corrected) and p < 0.05 (uncorrected). Adults with ASDs showed higher anxiety and underconnectivity within the anxiety network, mostly involving bilateral insula. Connectivity within the anxiety network in the ASD group showed distinct relationships with anxiety symptoms that did not relate to ASD symptom severity. Functional connectivity involving the bilateral posterior insula was positively correlated with anxiety in the ASD (but not the TC) group. Increased anxiety in middle-aged adults with ASD is associated with atypical functional connectivity, predominantly involving bilateral insula. Results were not related to ASD symptom severity suggesting independence of anxiety-related effects. LAY SUMMARY: Anxiety is very common in adults with autism but the brain basis of this difference is not well understood. We compared functional connectivity between anxiety-related brain regions in middle-aged adults with and without autism. Adults with autism were more anxious and showed weaker functional connections between these regions. Some relationships between functional connectivity and higher anxiety were specific to the autism group. Results suggest that anxiety functions differently in autism.
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Affiliation(s)
- Ryan Tung
- Brain Development Imaging Laboratories, Department of Psychology, San Diego State University, San Diego, California, USA.,Center for Autism and Development Disorders, Department of Psychology, San Diego State University, San Diego, California, USA
| | - Maya A Reiter
- Brain Development Imaging Laboratories, Department of Psychology, San Diego State University, San Diego, California, USA.,Center for Autism and Development Disorders, Department of Psychology, San Diego State University, San Diego, California, USA.,San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, California, USA
| | - Annika Linke
- Brain Development Imaging Laboratories, Department of Psychology, San Diego State University, San Diego, California, USA.,Center for Autism and Development Disorders, Department of Psychology, San Diego State University, San Diego, California, USA
| | - Jiwandeep S Kohli
- Brain Development Imaging Laboratories, Department of Psychology, San Diego State University, San Diego, California, USA.,Center for Autism and Development Disorders, Department of Psychology, San Diego State University, San Diego, California, USA.,San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, California, USA
| | - Mikaela K Kinnear
- Brain Development Imaging Laboratories, Department of Psychology, San Diego State University, San Diego, California, USA.,Center for Autism and Development Disorders, Department of Psychology, San Diego State University, San Diego, California, USA
| | - Ralph-Axel Müller
- Brain Development Imaging Laboratories, Department of Psychology, San Diego State University, San Diego, California, USA.,Center for Autism and Development Disorders, Department of Psychology, San Diego State University, San Diego, California, USA.,San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, California, USA
| | - Ruth A Carper
- Brain Development Imaging Laboratories, Department of Psychology, San Diego State University, San Diego, California, USA.,Center for Autism and Development Disorders, Department of Psychology, San Diego State University, San Diego, California, USA.,San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, California, USA
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Nadeem MS, Murtaza BN, Al-Ghamdi MA, Ali A, Zamzami MA, Khan JA, Ahmad A, Rehman MU, Kazmi I. Autism - A Comprehensive Array of Prominent Signs and Symptoms. Curr Pharm Des 2021; 27:1418-1433. [PMID: 33494665 DOI: 10.2174/1381612827666210120095829] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 12/06/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Autism Spectrum Disorder (ASD) is a multifaceted neurodevelopmental condition characterized by multiple psychological and physiological impairments in young children. According to the recent reports, 1 out of every 58 newly-born children is suffering from autism. The aetiology of the disorder is complex and poorly understood, hindering the adaptation of targeted and effective therapies. There are no well- established diagnostic biomarkers for autism. Hence the analysis of symptoms by the pediatricians plays a critical role in the early intervention. METHODS In the present report, we have emphasized 24 behavioral, psychological and clinical symptoms of autism. RESULTS Impaired social interaction, restrictive and narrow interests, anxiety, depression; aggressive, repetitive, rigid and self-injurious behavior, lack of consistency, short attention span, fear, shyness and phobias, hypersensitivity and rapid mood alterations, high level of food and toy selectivity; inability to establish friendships or follow the instructions; fascination by round spinning objects and eating non-food materials are common psychological characteristics of autism. Speech or hearing impairments, poor cognitive function, gastrointestinal problems, weak immunity, disturbed sleep and circadian rhythms, weak motor neuromuscular interaction, lower level of serotonin and neurotransmitters, headache and body pain are common physiological symptoms. CONCLUSION A variable qualitative and quantitative impact of this wide range of symptoms is perceived in each autistic individual, making him/her distinct, incomparable and exceptional. Selection and application of highly personalized medical and psychological therapies are therefore recommended for the management and treatment of autism.
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Affiliation(s)
- Muhammad Shahid Nadeem
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Bibi Nazia Murtaza
- Department of Zoology, Abbottabad University of Science and Technology (AUST), Abbottabad, Pakistan
| | - Maryam A Al-Ghamdi
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Akbar Ali
- College of Pharmacy, Northern Border University Rafha 1321, Saudi Arabia
| | - Mazin A Zamzami
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Jalaluddin A Khan
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Aftab Ahmad
- College of Pharmacy, Northern Border University Rafha 1321, Saudi Arabia
| | - Mujaddad Ur Rehman
- Department of Zoology, Abbottabad University of Science and Technology (AUST), Abbottabad, Pakistan
| | - Imran Kazmi
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah 21589, Saudi Arabia
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28
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McMillion A, Van Herwegen J, Johnson A, Monteiro J, Cronin AJ, Remington A. Dental experiences of a group of autistic adults based in the United Kingdom. SPECIAL CARE IN DENTISTRY 2021; 41:474-488. [PMID: 33682191 DOI: 10.1111/scd.12583] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 01/27/2021] [Accepted: 02/18/2021] [Indexed: 11/28/2022]
Abstract
AIMS Previous international research has shown that autistic people have difficulty accessing dental care due to sensory processing, anxiety and communication issues. However, it is not known whether autistic adults in the United Kingdom are experiencing similar dental care barriers. The current study investigated autistic adults' dental experiences in the United Kingdom. METHODS AND RESULTS A mixed methods survey was given to self-selecting autistic (n = 37) and non-autistic adults (n = 43) to compare whether autistic individuals had more negative experiences than non-autistic individuals. Closed questions asked about anxiety, patient-practitioner communication, satisfaction and the dental environment. Open questions asked about autism-specific dental challenges, what works well at the dentist, and improving autistic individuals' experiences. Responses were analyzed using thematic analysis. Overall, results demonstrated that autistic adults in the United Kingdom have more negative dental experiences than non-autistic adults. These predominantly related to interactions with dental practitioners, a challenging sensory environment, anxiety, pain, and disclosure. Participants recommended sensory environment adaptations, ways to increase preparedness, longer appointments, and individual accommodations. CONCLUSION This study offers best-practice strategies for working with autistic patients and highlights the importance of dentists working with autistic individuals to maximize the quality of care and outcomes for this underserved population.
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Affiliation(s)
- Audrey McMillion
- Department of Psychology and Human Development, UCL Institute of Education, London, UK
| | - Jo Van Herwegen
- Department of Psychology and Human Development, UCL Institute of Education, London, UK
| | - Adele Johnson
- Paediatric Dentistry, Royal National ENT & Eastman Dental Hospital, London, UK
| | - Joana Monteiro
- Dental and Maxillofacial Surgery Department, Great Ormond Street Hospital, London, UK
| | - Aaron J Cronin
- Department of Oral and Maxillofacial Surgery, Royal London Hospital, London, UK
| | - Anna Remington
- Department of Psychology and Human Development, UCL Institute of Education, London, UK
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29
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Gandhi T, Lee CC. Neural Mechanisms Underlying Repetitive Behaviors in Rodent Models of Autism Spectrum Disorders. Front Cell Neurosci 2021; 14:592710. [PMID: 33519379 PMCID: PMC7840495 DOI: 10.3389/fncel.2020.592710] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 12/09/2020] [Indexed: 12/15/2022] Open
Abstract
Autism spectrum disorder (ASD) is comprised of several conditions characterized by alterations in social interaction, communication, and repetitive behaviors. Genetic and environmental factors contribute to the heterogeneous development of ASD behaviors. Several rodent models display ASD-like phenotypes, including repetitive behaviors. In this review article, we discuss the potential neural mechanisms involved in repetitive behaviors in rodent models of ASD and related neuropsychiatric disorders. We review signaling pathways, neural circuits, and anatomical alterations in rodent models that display robust stereotypic behaviors. Understanding the mechanisms and circuit alterations underlying repetitive behaviors in rodent models of ASD will inform translational research and provide useful insight into therapeutic strategies for the treatment of repetitive behaviors in ASD and other neuropsychiatric disorders.
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Affiliation(s)
- Tanya Gandhi
- Department of Comparative Biomedical Sciences, Louisiana State University School of Veterinary Medicine, Baton Rouge, LA, United States
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30
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Kildahl AN, Bakken TL, Matre EAW, Hellerud JMA, Engebretsen MH, Helverschou SB. Case study: identification of anxiety and subsequent intervention in an adolescent male with autism, severe intellectual disability and self-injurious behaviour. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2020; 67:327-338. [PMID: 34552728 PMCID: PMC8451636 DOI: 10.1080/20473869.2020.1850160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 11/07/2020] [Accepted: 11/07/2020] [Indexed: 05/12/2023]
Abstract
Introduction: Anxiety disorders are highly prevalent in individuals with autism spectrum disorder (ASD), but knowledge is limited regarding identification and treatment of these disorders in individuals with ASD and more severe levels of intellectual disability (ID). The current case study aims to explore and describe the inpatient, psychiatric assessment in an adolescent male with ASD, severe ID and self-injurious behaviour (SIB) who was diagnosed with a co-occurring anxiety disorder. The study further aims to explore the implications of this diagnosis for subsequent intervention and care, including management of SIB. Materials and methods: Case study including multimodal, psychiatric assessment and subsequent intervention. Results: Following changes in care strategies attempting to incorporate the understanding of anxiety/trauma as contributing to SIB, a reduction of SIB was observed, and this reduced frequency was maintained when the patient was discharged from the inpatient setting. Conclusions: Though no causal inferences are possible, these experiences indicate that further research is needed regarding possible associations between SIB and anxiety in individuals with ASD, including implications for treatment. Experiences from the current case further indicate that it is possible to recognize and diagnose anxiety disorder in complex cases involving ASD, severe ID, limited verbal language skills, and severe SIB.
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Affiliation(s)
- Arvid Nikolai Kildahl
- Regional Section Mental Health, Intellectual Disabilities/Autism, Oslo University Hospital, Oslo, Norway
- NevSom Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnias, Oslo University Hospital, Oslo, Norway
| | - Trine Lise Bakken
- Regional Section Mental Health, Intellectual Disabilities/Autism, Oslo University Hospital, Oslo, Norway
| | | | | | - Maria Hagen Engebretsen
- Regional Section Mental Health, Intellectual Disabilities/Autism, Oslo University Hospital, Oslo, Norway
| | - Sissel Berge Helverschou
- NevSom Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnias, Oslo University Hospital, Oslo, Norway
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31
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Clin E, Maes P, Stercq F, Kissine M. No preference for direct versus averted gaze in autistic adults: a reinforced preferential looking paradigm. Mol Autism 2020; 11:91. [PMID: 33208193 PMCID: PMC7672906 DOI: 10.1186/s13229-020-00398-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 11/06/2020] [Indexed: 12/27/2022] Open
Abstract
Background With the overarching objective to gain better insights into social attention in autistic adults, the present study addresses three outstanding issues about face processing in autism. First, do autistic adults display a preference for mouths over eyes; second, do they avoid direct gaze; third, is atypical visual exploration of faces in autism mediated by gender, social anxiety or alexithymia? Methods We used a novel reinforced preferential looking paradigm with a group of autistic adults (n = 43, 23 women) pairwise matched on age with neurotypical participants (n = 43, 21 women). Participants watched 28 different pairs of 5 s video recordings of a speaking person: the two videos, simultaneously displayed on the screen, were identical except that gaze was directed at the camera in one video and averted in the other. After a 680 ms transition phase, a short reinforcement animation appeared on the side that had displayed the direct gaze. Results None of the groups showed a preference for mouths over eyes. However, neurotypical participants fixated significantly more the stimuli with direct gaze, while no such preference emerged in autistic participants. As the experiment progressed, neurotypical participants also increasingly anticipated the appearance of the reinforcement, based on the location of the stimulus with the direct gaze, while no such anticipation emerged in autistic participants. Limitations Our autistic participants scored higher on the social anxiety and alexithymia questionnaires than neurotypicals. Future studies should match neurotypical and autistic participants on social anxiety and alexithymia and complement questionnaires with physiological measures of anxiety. Conclusions The absence of preference for direct versus averted gaze in the autistic group is probably due to difficulties in distinguishing eye gaze direction, potentially linked to a reduced spontaneous exploration or avoidance of the eye region. Social attention and preference for direct versus averted gaze correlated with alexithymia and social anxiety scores, but not gender.
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Affiliation(s)
- Elise Clin
- ACTE at LaDisco and ULB Neuroscience Institute, Université libre de Bruxelles, Avenue F. D. Roosevelt, 50/175, 1050, Brussels, Belgium.
| | - Pauline Maes
- ACTE at LaDisco and ULB Neuroscience Institute, Université libre de Bruxelles, Avenue F. D. Roosevelt, 50/175, 1050, Brussels, Belgium
| | - Fanny Stercq
- ACTE at LaDisco and ULB Neuroscience Institute, Université libre de Bruxelles, Avenue F. D. Roosevelt, 50/175, 1050, Brussels, Belgium
| | - Mikhail Kissine
- ACTE at LaDisco and ULB Neuroscience Institute, Université libre de Bruxelles, Avenue F. D. Roosevelt, 50/175, 1050, Brussels, Belgium
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32
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Appelqvist-Schmidlechner K, Lämsä R, Tuulio-Henriksson A. Factors associated with positive mental health in young adults with a neurodevelopmental disorder. RESEARCH IN DEVELOPMENTAL DISABILITIES 2020; 106:103780. [PMID: 32950021 DOI: 10.1016/j.ridd.2020.103780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 08/26/2020] [Accepted: 09/02/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Positive dimension of mental health has gained less attention in previous research on individuals with neurodevelopmenal disorders. However, knowledge on factors associated with mental well-being is crucial for planning effective interventions for this target group. AIMS The aim of the study was to investigate the determinants of positive mental health among young adults with neurodevelopmental disorders. METHODS AND PROCEDURES The study sample consisted of 171 young adults (18-35 years, mean age 25 years, SD 4.35) with a diagnosis of Autism Spectrum Disorder (ASD) or ADHD/ADD. The data were collected with questionnaires. RESULTS The mean score of SWEMWBS was 20.98 (n = 168, ranging 14.75-35.00, SD = 3.55). Provisions of social relationships, functional capacity and self-rated state of health associated independently with positive mental health. CONCLUSION AND IMPLICATIONS The level of positive mental health of study participants was relatively low compared with previous studies in other clinical settings or general populations. Promotion of social competence and social relationship should be included in rehabilitation programmes targeted at individuals with neurodevelopmental disorder. This may be beneficial in reaching also other goals set for the rehabilitation, such as increasing capacity to work or study.
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Affiliation(s)
| | - Riikka Lämsä
- National Institute for Health and Welfare, Equality and Inclusion Unit, P.O. Box 30, FI-00271, Helsinki, Finland; University of Helsinki, Faculty of Medicine, Department of Public Health, P.0. Box 20, 00014, Finland.
| | - Annamari Tuulio-Henriksson
- University of Helsinki, Faculty of Medicine, Department of Psychology and Logopedics, P.0. Box 21, 00014, Finland.
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33
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Failla MD, Gerdes MB, Williams ZJ, Moore DJ, Cascio CJ. Increased pain sensitivity and pain-related anxiety in individuals with autism. Pain Rep 2020; 5:e861. [PMID: 33235944 PMCID: PMC7676593 DOI: 10.1097/pr9.0000000000000861] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 08/14/2020] [Accepted: 09/02/2020] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Individuals with autism spectrum disorder (ASD) often exhibit differences in pain responsivity. This altered responsivity could be related to ASD-related social communication difficulties, sensory differences, or altered processing of pain stimuli. Previous neuroimaging work suggests altered pain evaluation could contribute to pain-related anxiety in ASD. OBJECTIVES We hypothesized that individuals with ASD would report increased pain sensitivity and endorse more pain-related anxiety, compared to typically developing controls. METHODS We recruited 43 adults (ASD, n = 24; typically developing, n = 19) for 3 heat pain tasks (applied to the calf). We measured heat pain thresholds using a method of limits approach, a pain-rating curve (7 temperatures between 40 and 48°C, 5 seconds, 5 trials each), and a sustained heat pain task with alternating low (42°C) and high (46°C) temperatures (21 seconds, 6 trials each). Individual differences in pain-related anxiety, fear of pain, situational pain catastrophizing, depressive symptoms, and autism-related social communication were assessed by self-report. RESULTS There were no group differences in pain thresholds. For suprathreshold tasks, mean pain ratings were higher in ASD across both the pain-rating curve and the sustained heat pain tasks, but responses in the ASD group were more varied. Pain anxiety (PASS-Total) and pain-related fear (FOP-III-Total) were higher in the ASD group and were positively associated with pain ratings. CONCLUSIONS Our results suggest that both sensory and cognitive experiences of pain are heightened and interact reciprocally in adults with ASD. Future studies are needed to evaluate the impact of pain-related anxiety on treatment-seeking and pain behaviors, given higher levels of pain-related anxiety in ASD.
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Affiliation(s)
- Michelle D. Failla
- Department of Psychiatry and Behavioral Science, Vanderbilt University, Nashville, TN, USA
| | - Madison B. Gerdes
- Department of Psychiatry and Behavioral Science, Vanderbilt University, Nashville, TN, USA
| | - Zachary J. Williams
- Medical Scientist Training Program, Vanderbilt University, Nashville, TN, USA
- Vanderbilt Brain Institute, Vanderbilt University School of Medicine, Vanderbilt University, Nashville, TN, USA
- Frist Center for Autism and Innovation, Vanderbilt University, Nashville, TN, USA
| | - David J. Moore
- Department of Psychology, Liverpool John Moores University, Liverpool, United Kingdom
| | - Carissa J. Cascio
- Department of Psychiatry and Behavioral Science, Vanderbilt University, Nashville, TN, USA
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34
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Park SH, Song YJC, Demetriou EA, Pepper KL, Thomas EE, Hickie IB, Guastella AJ. Validation of the 21-item Depression, Anxiety, and Stress Scales (DASS-21) in individuals with autism spectrum disorder. Psychiatry Res 2020; 291:113300. [PMID: 32763554 DOI: 10.1016/j.psychres.2020.113300] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 07/07/2020] [Accepted: 07/12/2020] [Indexed: 12/16/2022]
Abstract
The purpose of the study was to examine the internal consistency and validity of the 21-item Depression Anxiety Stress Scale (DASS-21) in individuals with Autism Spectrum Disorder (ASD) and without intellectual disability (IQ >= 70). Participants (NN = 123) were consecutively recruited from the Brain and Mind Centre in New South Wales, Australia. Internal consistency was determined using Cronbach's alpha. Item-total correlations were evaluated by Pearson's product-moment correlation coefficient. The convergent validity of the DASS-21 was examined by measuring its associations with quality of life and other measures of depression and anxiety. Factorial validity was assessed using confirmatory factor analysis. The DASS-21 demonstrated good internal consistency, adequate convergent validity, and all items exhibited satisfactory item-total correlations. Considering fit indices and factor loadings, the confirmatory factor analysis results provided support for the original 3-factor oblique model consisting of depression, anxiety, and stress factors. The model fit could be further improved with some modifications. Overall, the results indicate that the DASS-21 is a viable self-report screening measure for depression, anxiety, and stress in individuals with ASD and without intellectual disability.
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Affiliation(s)
- Shin Ho Park
- Autism Clinic for Translational Research, Child Development and Mental Health Team, Brain and Mind Centre, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, 2050, Australia
| | - Yun Ju C Song
- Autism Clinic for Translational Research, Child Development and Mental Health Team, Brain and Mind Centre, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, 2050, Australia
| | - Eleni A Demetriou
- Autism Clinic for Translational Research, Child Development and Mental Health Team, Brain and Mind Centre, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, 2050, Australia
| | - Karen L Pepper
- Autism Clinic for Translational Research, Child Development and Mental Health Team, Brain and Mind Centre, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, 2050, Australia
| | - Emma E Thomas
- Autism Clinic for Translational Research, Child Development and Mental Health Team, Brain and Mind Centre, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, 2050, Australia
| | - Ian B Hickie
- Autism Clinic for Translational Research, Child Development and Mental Health Team, Brain and Mind Centre, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, 2050, Australia; Clinical Research Unit, Brain and Mind Centre, University of Sydney, Camperdown, NSW 2050, Australia
| | - Adam J Guastella
- Autism Clinic for Translational Research, Child Development and Mental Health Team, Brain and Mind Centre, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, 2050, Australia.
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Pehlivanidis A, Papanikolaou K, Mantas V, Kalantzi E, Korobili K, Xenaki LA, Vassiliou G, Papageorgiou C. Lifetime co-occurring psychiatric disorders in newly diagnosed adults with attention deficit hyperactivity disorder (ADHD) or/and autism spectrum disorder (ASD). BMC Psychiatry 2020; 20:423. [PMID: 32847520 PMCID: PMC7449076 DOI: 10.1186/s12888-020-02828-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 08/19/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Co-occurring psychiatric disorders in adults with Attention Deficit Hyperactivity Disorder (ADHD) and/or Autism Spectrum Disorder (ASD) contribute to the burden of the healthcare and possibly to the delay of diagnosis. Aim of the study was to clinically assess the prevalence and compare lifetime co-occurring psychopathology in a sample of newly diagnosed ADHD and/or ASD adults and discuss the diagnostic challenges they pose. METHODS The lifetime prevalence rates of ten of the most frequently co-occurring psychiatric diagnoses was registered in 336 adults of normal intelligence who underwent a thorough clinical evaluation for the diagnosis of ADHD and/or ASD for the first time in their lives. Four study groups were formed: the ADHD (n = 151), the ASD (n = 58), the ADHD+ASD (n = 28) and the nonADHD/nonASD (NN) (n = 88) group. RESULTS At least one co-occurring psychopathology was found in 72.8% of the ADHD group, in 50% of the ASD group, in 72.4% of the ADHD+ASD group and in 76.1% of the NN group (p = 0.004). In all groups the most frequent psychiatric disorder was depressive disorder. The only significant difference regarding the patterns of psychiatric co-occurrence between the ADHD and the nonADHD groups (ASD and NN groups) was found for SUD (p = 0.001). Also, the proportion of subjects with Bipolar Disorder was significantly greater in the NN group as compared to those with ASD (p = 0.025). CONCLUSIONS Our results support the high prevalence of co-occurring psychiatric disorders in adults with ADHD and/or ASD with the ASD group presenting the lowest rate. The most marked difference between the ADHD and the nonADHD groups was found for SUD. Moreover, our findings highlight the need for a thorough clinical assessment of all referred patients both in the presence and absence of ADHD and/or ASD.
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Affiliation(s)
- Artemios Pehlivanidis
- 1st Department of Psychiatry, National and Kapodistrian University of Athens, Medical School, "Eginition" Hospital, 72-74 Vas. Sofias Ave, 11528, Athens, Greece.
| | - Katerina Papanikolaou
- Department of Child Psychiatry, National and Kapodistrian University of Athens, Medical School, “Agia Sophia” Children’s Hospital, 11527 Athens, Greece
| | - Vasilios Mantas
- grid.5216.00000 0001 2155 08001st Department of Psychiatry, National and Kapodistrian University of Athens, Medical School, “Eginition” Hospital, 72-74 Vas. Sofias Ave, 11528 Athens, Greece
| | - Eva Kalantzi
- grid.5216.00000 0001 2155 08001st Department of Psychiatry, National and Kapodistrian University of Athens, Medical School, “Eginition” Hospital, 72-74 Vas. Sofias Ave, 11528 Athens, Greece
| | - Kalliopi Korobili
- grid.5216.00000 0001 2155 08001st Department of Psychiatry, National and Kapodistrian University of Athens, Medical School, “Eginition” Hospital, 72-74 Vas. Sofias Ave, 11528 Athens, Greece
| | - Lida-Alkisti Xenaki
- grid.5216.00000 0001 2155 08001st Department of Psychiatry, National and Kapodistrian University of Athens, Medical School, “Eginition” Hospital, 72-74 Vas. Sofias Ave, 11528 Athens, Greece
| | - Georgia Vassiliou
- grid.5216.00000 0001 2155 08001st Department of Psychiatry, National and Kapodistrian University of Athens, Medical School, “Eginition” Hospital, 72-74 Vas. Sofias Ave, 11528 Athens, Greece
| | - Charalambos Papageorgiou
- grid.5216.00000 0001 2155 08001st Department of Psychiatry, National and Kapodistrian University of Athens, Medical School, “Eginition” Hospital, 72-74 Vas. Sofias Ave, 11528 Athens, Greece
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Failla MD, Schwartz KL, Chaganti S, Cutting LE, Landman BA, Cascio CJ. Using phecode analysis to characterize co-occurring medical conditions in autism spectrum disorder. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2020; 25:800-811. [PMID: 32662293 DOI: 10.1177/1362361320934561] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
LAY ABSTRACT People with autism spectrum disorder often have a number of other medical conditions in addition to autism. These can range from constipation to epilepsy. This study uses medical record data to understand how frequently and how long people with autism have to be seen by a medical professional for these other medical conditions. This study confirmed that people with autism often have a number of other medical conditions and that they have to go see a medical professional about those conditions often. We also looked to see if children diagnosed with autism after age 5 years might have different medical conditions compared to children diagnosed earlier. Children diagnosed later had more conditions like asthma, hearing loss, and mood disorders. This work describes how much medical care people with autism get for different medical conditions and the burden of seeking additional medical care for people with autism and their families.
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Affiliation(s)
| | | | | | | | - Bennett A Landman
- Vanderbilt University Medical Center, USA.,Vanderbilt University, USA
| | - Carissa J Cascio
- Vanderbilt University Medical Center, USA.,Vanderbilt University, USA
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