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O’Hearn K, Lynn A. Age differences and brain maturation provide insight into heterogeneous results in autism spectrum disorder. Front Hum Neurosci 2023; 16:957375. [PMID: 36819297 PMCID: PMC9934814 DOI: 10.3389/fnhum.2022.957375] [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: 05/31/2022] [Accepted: 11/07/2022] [Indexed: 02/05/2023] Open
Abstract
Studies comparing individuals with autism spectrum disorder (ASD) to typically developing (TD) individuals have yielded inconsistent results. These inconsistencies reflect, in part, atypical trajectories of development in children and young adults with ASD compared to TD peers. These different trajectories alter group differences between children with and without ASD as they age. This paper first summarizes the disparate trajectories evident in our studies and, upon further investigation, laboratories using the same recruiting source. These studies indicated that cognition improves into adulthood typically, and is associated with the maturation of striatal, frontal, and temporal lobes, but these age-related improvements did not emerge in the young adults with ASD. This pattern - of improvement into adulthood in the TD group but not in the group with ASD - occurred in both social and non-social tasks. However, the difference between TD and ASD trajectories was most robust on a social task, face recognition. While tempting to ascribe this uneven deficit to the social differences in ASD, it may also reflect the prolonged typical development of social cognitive tasks such as face recognition into adulthood. This paper then reviews the evidence on age-related and developmental changes from other studies on ASD. The broader literature also suggests that individuals with ASD do not exhibit the typical improvements during adolescence on skills important for navigating the transition to adulthood. These skills include execution function, social cognition and communication, and emotional recognition and self-awareness. Relatedly, neuroimaging studies indicate arrested or atypical brain maturation in striatal, frontal, and temporal regions during adolescence in ASD. This review not only highlights the importance of a developmental framework and explicit consideration of age and/or stage when studying ASD, but also the potential importance of adolescence on outcomes in ASD.
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Affiliation(s)
- Kirsten O’Hearn
- Department of Physiology and Pharmacology, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, United States,*Correspondence: Kirsten O’Hearn,
| | - Andrew Lynn
- Department of Special Education, Vanderbilt University, Nashville, TN, United States
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2
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Bylemans T, Heleven E, Baetens K, Deroost N, Baeken C, Van Overwalle F. A narrative sequencing and mentalizing training for adults with autism: A pilot study. Front Behav Neurosci 2022; 16:941272. [PMID: 36062258 PMCID: PMC9433774 DOI: 10.3389/fnbeh.2022.941272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 08/01/2022] [Indexed: 12/24/2022] Open
Abstract
Adults diagnosed with autism experience difficulties with understanding the mental states of others, or themselves (mentalizing) and with adequately sequencing personal stories (narrative coherence). Given that the posterior cerebellum is implicated in both skills, as well as in the etiology of autism, we developed a narrative sequencing and mentalizing training for autistic adults. Participants with an official autism diagnosis were randomly assigned to a Training group (n = 17) or a waiting-list Control group (n = 15). The Training group took part in six weekly sessions in groups of three participants lasting each about 60 min. During training, participants had to (re)tell stories from the perspective of the original storyteller and answer questions that required mentalizing. We found significant improvements in mentalizing about others’ beliefs and in narrative coherence for the Training group compared to the Control group immediately after the training compared to before the training. Almost all participants from the Training group expressed beneficial effects of the training on their mood and half of the participants reported positive effects on their self-confidence in social situations. All participants recommended the current training to others. Results are discussed in light of cerebellar theories on sequencing of social actions during mentalizing. Further improvements to the program are suggested. Our results highlight the potential clinical utility of adopting a neuroscience-informed approach to developing novel therapeutic interventions for autistic populations.
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Affiliation(s)
- Tom Bylemans
- Brain Body and Cognition, Department of Psychology, Center for Neuroscience, Vrije Universiteit Brussels, Brussels, Belgium
- *Correspondence: Tom Bylemans,
| | - Elien Heleven
- Brain Body and Cognition, Department of Psychology, Center for Neuroscience, Vrije Universiteit Brussels, Brussels, Belgium
| | - Kris Baetens
- Brain Body and Cognition, Department of Psychology, Center for Neuroscience, Vrije Universiteit Brussels, Brussels, Belgium
| | - Natacha Deroost
- Brain Body and Cognition, Department of Psychology, Center for Neuroscience, Vrije Universiteit Brussels, Brussels, Belgium
| | - Chris Baeken
- Ghent Experimental Psychiatry (GHEP) Lab, Department of Head and Skin (UZGent), Ghent University, Ghent, Belgium
- Department of Psychiatry, University Hospital (UZ Brussel), Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Frank Van Overwalle
- Brain Body and Cognition, Department of Psychology, Center for Neuroscience, Vrije Universiteit Brussels, Brussels, Belgium
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Tully J, Frey A, Fotiadou M, Kolla NJ, Eisenbarth H. Psychopathy in women: insights from neuroscience and ways forward for research. CNS Spectr 2021; 28:1-13. [PMID: 34906266 DOI: 10.1017/s1092852921001085] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Psychopathy is a severe form of personality disturbance, resulting in a detrimental impact on individuals, healthcare systems, and society as a whole. Until relatively recently, most research in psychopathy has focused on male samples, not least because of its link with criminal behavior and the large proportion of violent crime committed by men. However, psychopathy in women also leads to considerable problems at an individual and societal level, including substance misuse, poor treatment outcomes, and contribution to ever-increasing numbers of female prisoners. Despite this, due to relative neglect, most research into adult female psychopathy is underpowered and outdated. We argue that the field needs revitalizing, with a focus on the developmental nature of the condition and neurocognitive research. Recent work international consortia into conduct disorder in female youth-a precursor of psychopathy in female adults-gives cause for optimism. Here, we outline key strategies for enriching research in this important field with contemporary approaches to other psychiatric conditions.
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Affiliation(s)
- John Tully
- Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Annalena Frey
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, United Kingdom
| | | | - Nathan J Kolla
- Department of Psychiatry, University of Toronto, Ontario, Canada and Research and Academics, Waypoint Centre for Mental Health Care, Penetanguishene, Ontario, Canada
| | - Hedwig Eisenbarth
- School of Psychology, Victoria University of Wellington, Wellington, New Zealand
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Brief Report: Specificity of Interpersonal Synchrony Deficits to Autism Spectrum Disorder and Its Potential for Digitally Assisted Diagnostics. J Autism Dev Disord 2021; 52:3718-3726. [PMID: 34331629 PMCID: PMC9296396 DOI: 10.1007/s10803-021-05194-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2021] [Indexed: 11/18/2022]
Abstract
Reliably diagnosing autism spectrum disorders (ASD) in adulthood poses a challenge to clinicians due to the absence of specific diagnostic markers. This study investigated the potential of interpersonal synchrony (IPS), which has been found to be reduced in ASD, to augment the diagnostic process. IPS was objectively assessed in videos of diagnostic interviews in a representative referral population from two specialized autism outpatient clinics. In contrast to the current screening tools that could not reliably differentiate, we found a significant reduction of IPS in interactions with individuals later diagnosed with ASD (n = 16) as opposed to those not receiving a diagnosis (n = 23). While these findings need to be validated in larger samples, they nevertheless underline the potential of digitally-enhanced diagnostic processes for ASD.
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Kamp-Becker I, Stroth S, Stehr T, Weber L. Segen oder Fluch? Das Internet als Informationsquelle über Autismus und Asperger-Syndrom. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2020; 48:133-143. [DOI: 10.1024/1422-4917/a000693] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Zusammenfassung. Fragestellung: Sehr viele Menschen informieren sich heutzutage über gesundheitsrelevante Themen im Internet, wobei die Qualität dieser Informationen fraglich ist. In der vorliegenden Studie soll beispielhaft für ein psychisches Störungsbild (Autismus-Spektrum-Störung) die Qualität der Informationsquelle Internet sowie die sich daraus ergebenden Implikationen diskutiert werden. Methodik: Es wurde eine systematische Auswertung von 96 deutschsprachigen Internetseiten durchgeführt mit dem Ziel, neben konkreten Charakteristika der Internetseiten auch die Zuverlässigkeit der Publikationen, die Informationsdarstellung sowie die Gesamtqualität der Internetseiten zu bewerten und die sich aus der Darstellung ergebenden klinischen Implikationen zu analysieren. Ergebnisse: Nur bei 39 % der Internetseiten ließen sich Referenzen für wissenschaftlich fundierte Informationen feststellen, Werbung war hingegen auf 53 % der Internetseiten vorhanden. Die meisten falschen Informationen wurden im Bereich der „Behandlung“ (17 %) verbreitet. Bei 75 % der Internetseiten traf die Vollständigkeit nicht zu. Lediglich 10 % der Internetseiten thematisierte die Beeinträchtigung bzw. Belastung der Familien. Die Qualität der Seiten wurde bei 30 % als ungenügend, bei 41 % als mangelhaft und nur bei 6 % als gut beurteilt. Schlussfolgerungen: Ähnlich wie durch die bereits vorliegenden Analysen zu englischsprachigen Internetseiten festgestellt, können für viele der deutschsprachigen Seiten deutliche Qualitätsmängel konstatiert werden. Die Implikationen in Bezug auf Bestätigungsfehler, Stigmatisierung, Überidentifikation, Ingroup-Outgroup-Effekte, Kontrast- und Schneeballeffekte werden diskutiert.
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Affiliation(s)
- Inge Kamp-Becker
- Klinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, Philipps-Universität Marburg
| | - Sanna Stroth
- Klinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, Philipps-Universität Marburg
| | - Thomas Stehr
- Klinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, Philipps-Universität Marburg
| | - Lisa Weber
- Klinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, Philipps-Universität Marburg
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Georgescu AL, Koehler JC, Weiske J, Vogeley K, Koutsouleris N, Falter-Wagner C. Machine Learning to Study Social Interaction Difficulties in ASD. Front Robot AI 2019; 6:132. [PMID: 33501147 PMCID: PMC7805744 DOI: 10.3389/frobt.2019.00132] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 11/13/2019] [Indexed: 11/27/2022] Open
Abstract
Autism Spectrum Disorder (ASD) is a spectrum of neurodevelopmental conditions characterized by difficulties in social communication and social interaction as well as repetitive behaviors and restricted interests. Prevalence rates have been rising, and existing diagnostic methods are both extremely time and labor consuming. There is an urgent need for more economic and objective automatized diagnostic tools that are independent of language and experience of the diagnostician and that can help deal with the complexity of the autistic phenotype. Technological advancements in machine learning are offering a potential solution, and several studies have employed computational approaches to classify ASD based on phenomenological, behavioral or neuroimaging data. Despite of being at the core of ASD diagnosis and having the potential to be used as a behavioral marker for machine learning algorithms, only recently have movement parameters been used as features in machine learning classification approaches. In a proof-of-principle analysis of data from a social interaction study we trained a classification algorithm on intrapersonal synchrony as an automatically and objectively measured phenotypic feature from 29 autistic and 29 typically developed individuals to differentiate those individuals with ASD from those without ASD. Parameters included nonverbal motion energy values from 116 videos of social interactions. As opposed to previous studies to date, our classification approach has been applied to non-verbal behavior objectively captured during naturalistic and complex interactions with a real human interaction partner assuring high external validity. A machine learning approach lends itself particularly for capturing heterogeneous and complex behavior in real social interactions and will be essential in developing automatized and objective classification methods in ASD.
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Affiliation(s)
- Alexandra Livia Georgescu
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,Department of Psychiatry and Psychotherapy, University Hospital of Cologne, Cologne, Germany
| | - Jana Christina Koehler
- Department of Psychiatry and Psychotherapy, Medical Faculty, LMU Munich, Munich, Germany
| | - Johanna Weiske
- Department of Psychiatry and Psychotherapy, Medical Faculty, LMU Munich, Munich, Germany
| | - Kai Vogeley
- Department of Psychiatry and Psychotherapy, University Hospital of Cologne, Cologne, Germany.,Institute of Neuroscience and Medicine, Cognitive Neuroscience (INM-3), Research Center Juelich, Jülich, Germany
| | - Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Medical Faculty, LMU Munich, Munich, Germany
| | - Christine Falter-Wagner
- Department of Psychiatry and Psychotherapy, Medical Faculty, LMU Munich, Munich, Germany.,Institute of Medical Psychology, Medical Faculty, LMU Munich, Munich, Germany
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Abstract
Autism is associated with a range of costs. This paper reviews the literature on estimating the economic costs of autism spectrum disorder (ASD). More or less 50 papers covering multiple countries (US, UK, Australia, Canada, Sweden, the Netherlands, etc.) were analysed. Six types of costs are discussed in depth: (i) medical and healthcare service costs, (ii) therapeutic costs, (iii) (special) education costs, (iv) costs of production loss for adults with ASD, (v) costs of informal care and lost productivity for family/caregivers, and (vi) costs of accommodation, respite care, and out-of-pocket expenses. A general finding is that individuals with ASD and families with children with ASD have higher costs. Education costs appear to be a major cost component for parents with children with ASD.
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Höfer J, Hoffmann F, Kamp-Becker I, Poustka L, Roessner V, Stroth S, Wolff N, Bachmann CJ. Pathways to a diagnosis of autism spectrum disorder in Germany: a survey of parents. Child Adolesc Psychiatry Ment Health 2019; 13:16. [PMID: 30949235 PMCID: PMC6429704 DOI: 10.1186/s13034-019-0276-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 03/12/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Early identification of autism spectrum disorders (ASD) is a prerequisite for access to early interventions. Although parents often note developmental atypicalities during the first 2 years of life, many children with ASD are not diagnosed until school age. For parents, the long period between first parental concerns and diagnosis is often frustrating and accompanied by uncertainty and worry. METHODS This study retrospectively explored the trajectories of children with a confirmed ASD diagnosis during the diagnostic process, from first parental concerns about their child's development until the definite diagnosis. A survey concerning the diagnostic process was distributed to parents or legal guardians of children with ASD from three specialized ASD outpatient clinics in Germany. RESULTS The response rate was 36.9%, and the final sample consisted of carers of 207 affected children (83.6% male, mean age 12.9 years). The children had been diagnosed with childhood autism (55.6%), Asperger syndrome (24.2%), or atypical autism (20.3%). On average, parents had first concerns when their child was 23.4 months old, and an ASD diagnosis was established at a mean age of 78.5 months. Children with atypical autism or Asperger syndrome were diagnosed significantly later (83.9 and 98.1 months, respectively) than children with childhood autism (68.1 months). Children with an IQ < 85 were diagnosed much earlier than those with an IQ ≥ 85. On average, parents visited 3.4 different health professionals (SD = 2.4, range 1-20, median: 3.0) until their child received a definite ASD diagnosis. Overall, 38.5% of carers were satisfied with the diagnostic process. CONCLUSIONS In this sample of children with ASD in Germany, the time to diagnosis was higher than in the majority of other comparable studies. These results flag the need for improved forms of service provision and delivery for suspected cases of ASD in Germany.
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Affiliation(s)
- Juliana Höfer
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, Ammerländer Heerstr. 140, 26129 Oldenburg, Germany
| | - Falk Hoffmann
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, Ammerländer Heerstr. 140, 26129 Oldenburg, Germany
| | - Inge Kamp-Becker
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Philipps University Marburg, Hans-Sachs-Str. 4, 35039 Marburg, Germany
| | - Luise Poustka
- Department of Child and Adolescent Psychiatry, University Medical Center Göttingen, Von-Siebold-Str. 5, 37075 Göttingen, Germany
| | - Veit Roessner
- Department of Child and Adolescent Psychiatry, Medical Faculty of the Technical University Dresden, Fetscherstr. 74, 01307 Dresden, Germany
| | - Sanna Stroth
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Philipps University Marburg, Hans-Sachs-Str. 4, 35039 Marburg, Germany
| | - Nicole Wolff
- Department of Child and Adolescent Psychiatry, Medical Faculty of the Technical University Dresden, Fetscherstr. 74, 01307 Dresden, Germany
| | - Christian J. Bachmann
- Department of Child and Adolescent Psychiatry, LVR-Klinikum Düsseldorf/Heinrich-Heine University Düsseldorf, Bergische Landstr. 2, 40629 Düsseldorf, Germany
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Murphy D, Glaser K, Hayward H, Eklund H, Cadman T, Findon J, Woodhouse E, Ashwood K, Beecham J, Bolton P, McEwen F, Wilson E, Ecker C, Wong I, Simonoff E, Russell A, McCarthy J, Chaplin E, Young S, Asherson P. Crossing the divide: a longitudinal study of effective treatments for people with autism and attention deficit hyperactivity disorder across the lifespan. PROGRAMME GRANTS FOR APPLIED RESEARCH 2018. [DOI: 10.3310/pgfar06020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BackgroundAutism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) frequently persist into adolescence and young adulthood. However, there are few clinical services that support those with these disorders through adulthood.ObjectiveOur aim was to determine if clinical services meet the needs of people with ASD and ADHD, who are ‘at transition’ from childhood to adulthood.DesignA longitudinal study of individuals with ASD and ADHD, the impact of services and treatments.MethodsOur research methods included (1) interviewing > 180 affected individuals (and their families) with a confirmed diagnosis of ASD and/or ADHD, (2) screening for ASD and ADHD in approximately 1600 patients and (3) surveying general practitioner prescribing to 5651 ASD individuals across the UK. In addition, we tested the effectiveness of (1) new ASD diagnostic interview measures in 169 twins, 145 familes and 150 non-twins, (2) a magnetic resonance imaging-based diagnostic aid in 40 ASD individuals, (3) psychological treatments in 46 ASD individuals and (4) the feasability of e-learning in 28 clinicians.SettingNHS clinical services and prisons.ParticipantsFocus – young people with ASD and ADHD as they ‘transition’ from childhood and adolescence into early adulthood.InterventionsTesting the utility of diagnostic measures and services, web-based learning interventions, pharmacological prescribing and cognitive–behavioural treatments.Main outcome measuresSymptom severity, service provision and met/unmet need.ResultsPeople with ASD and ADHD have very significant unmet needs as they transition through adolescence and young adulthood. A major contributor to this is the presence of associated mental health symptoms. However, these are mostly undiagnosed (and untreated) by clinical services. Furthermore, the largest determinant of service provision was age and not severity of symptoms. We provide new tools to help diagnose both the core disorders and their associated symptoms. We also provide proof of concept for the effectiveness of simple psychological interventions to treat obsessional symptoms, the potential to run treatment trials in prisons and training interventions.LimitationsOur findings only apply to clinical service settings.ConclusionsAs individuals ‘transition’ their contact with treatment and support services reduces significantly. Needs-led services are required, which can both identify individuals with the ‘core symptoms’ of ASD and ADHD and treat their residual symptoms and associated conditions.Future workTo test our new diagnostic measures and treatment approaches in larger controlled trials.Trial registrationCurrent Controlled Trials ISRCTN87114880.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.
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Affiliation(s)
- Declan Murphy
- Sackler Institute for Translational Neurodevelopment and Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, King’s College London, London, UK
| | - Karen Glaser
- Institute of Gerontology, King’s College London, London, UK
| | - Hannah Hayward
- Sackler Institute for Translational Neurodevelopment and Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, King’s College London, London, UK
| | - Hanna Eklund
- Sackler Institute for Translational Neurodevelopment and Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, King’s College London, London, UK
| | - Tim Cadman
- Sackler Institute for Translational Neurodevelopment and Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, King’s College London, London, UK
| | - James Findon
- Sackler Institute for Translational Neurodevelopment and Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, King’s College London, London, UK
| | - Emma Woodhouse
- Medical Research Council Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King’s College London, London, UK
| | - Karen Ashwood
- Medical Research Council Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King’s College London, London, UK
| | | | - Patrick Bolton
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, King’s College London, London, UK
| | - Fiona McEwen
- Medical Research Council Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King’s College London, London, UK
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, King’s College London, London, UK
| | - Ellie Wilson
- Sackler Institute for Translational Neurodevelopment and Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, King’s College London, London, UK
| | - Christine Ecker
- Sackler Institute for Translational Neurodevelopment and Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, King’s College London, London, UK
| | - Ian Wong
- Department of Pharmacology and Pharmacy, University of Hong Kong, PokFuLam, Hong Kong
| | - Emily Simonoff
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, King’s College London, London, UK
| | - Ailsa Russell
- Department of Psychology, University of Bath, Bath, UK
| | | | - Eddie Chaplin
- Sackler Institute for Translational Neurodevelopment and Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, King’s College London, London, UK
| | - Susan Young
- Sackler Institute for Translational Neurodevelopment and Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, King’s College London, London, UK
| | - Philip Asherson
- Medical Research Council Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King’s College London, London, UK
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Murphy CM, Christakou A, Giampietro V, Brammer M, Daly EM, Ecker C, Johnston P, Spain D, Robertson DM, Murphy DG, Rubia K. Abnormal functional activation and maturation of ventromedial prefrontal cortex and cerebellum during temporal discounting in autism spectrum disorder. Hum Brain Mapp 2017; 38:5343-5355. [PMID: 28744969 DOI: 10.1002/hbm.23718] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 06/06/2017] [Accepted: 06/22/2017] [Indexed: 11/10/2022] Open
Abstract
People with autism spectrum disorder (ASD) have poor decision-making and temporal foresight. This may adversely impact on their everyday life, mental health, and productivity. However, the neural substrates underlying poor choice behavior in people with ASD, or its' neurofunctional development from childhood to adulthood, are unknown. Despite evidence of atypical structural brain development in ASD, investigation of functional brain maturation in people with ASD is lacking. This cross-sectional developmental fMRI study investigated the neural substrates underlying performance on a temporal discounting (TD) task in 38 healthy (11-35 years old) male adolescents and adults with ASD and 40 age, sex, and IQ-matched typically developing healthy controls. Most importantly, we assessed group differences in the neurofunctional maturation of TD across childhood and adulthood. Males with ASD had significantly poorer task performance and significantly lower brain activation in typical regions that mediate TD for delayed choices, in predominantly right hemispheric regions of ventrolateral/dorsolateral prefrontal cortices, ventromedial prefrontal cortex, striatolimbic regions, and cerebellum. Importantly, differential activation in ventromedial frontal cortex and cerebellum was associated with abnormal functional brain maturation; controls, in contrast to people with ASD, showed progressively increasing activation with increasing age in these regions; which furthermore was associated with performance measures and clinical ASD measures (stereotyped/restricted interests). Findings provide first cross-sectional evidence that reduced activation of TD mediating brain regions in people with ASD during TD is associated with abnormal functional brain development in these regions between childhood and adulthood, and this is related to poor task performance and clinical measures of ASD. Hum Brain Mapp 38:5343-5355, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Clodagh M Murphy
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Sackler Institute for Translational Neurodevelopment, London, United Kingdom.,Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.,Behavioural Genetics Clinic, Adult Autism Service, Behavioural and Developmental Psychiatry Clinical Academic Group, South London and Maudsley Foundation NHS Trust, London, United Kingdom
| | - Anastasia Christakou
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.,School of Psychology & Clinical Language Sciences, University of Reading, Reading, United Kingdom
| | - Vincent Giampietro
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Michael Brammer
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Eileen M Daly
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Sackler Institute for Translational Neurodevelopment, London, United Kingdom
| | - Christine Ecker
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Sackler Institute for Translational Neurodevelopment, London, United Kingdom
| | - Patrick Johnston
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Sackler Institute for Translational Neurodevelopment, London, United Kingdom.,Behavioural Genetics Clinic, Adult Autism Service, Behavioural and Developmental Psychiatry Clinical Academic Group, South London and Maudsley Foundation NHS Trust, London, United Kingdom
| | - Debbie Spain
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Sackler Institute for Translational Neurodevelopment, London, United Kingdom.,Behavioural Genetics Clinic, Adult Autism Service, Behavioural and Developmental Psychiatry Clinical Academic Group, South London and Maudsley Foundation NHS Trust, London, United Kingdom
| | - Dene M Robertson
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Sackler Institute for Translational Neurodevelopment, London, United Kingdom.,Behavioural Genetics Clinic, Adult Autism Service, Behavioural and Developmental Psychiatry Clinical Academic Group, South London and Maudsley Foundation NHS Trust, London, United Kingdom
| | | | - Declan G Murphy
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Sackler Institute for Translational Neurodevelopment, London, United Kingdom.,Behavioural Genetics Clinic, Adult Autism Service, Behavioural and Developmental Psychiatry Clinical Academic Group, South London and Maudsley Foundation NHS Trust, London, United Kingdom.,National Institute for Health Research (NIHR) Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Katya Rubia
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.,National Institute for Health Research (NIHR) Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
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11
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Zeestraten EA, Gudbrandsen MC, Daly E, de Schotten MT, Catani M, Dell'Acqua F, Lai MC, Ruigrok ANV, Lombardo MV, Chakrabarti B, Baron-Cohen S, Ecker C, Murphy DGM, Craig MC. Sex differences in frontal lobe connectivity in adults with autism spectrum conditions. Transl Psychiatry 2017; 7:e1090. [PMID: 28398337 PMCID: PMC5416715 DOI: 10.1038/tp.2017.9] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 11/28/2016] [Accepted: 11/30/2016] [Indexed: 01/04/2023] Open
Abstract
Autism spectrum conditions (ASC) are more prevalent in males than females. The biological basis of this difference remains unclear. It has been postulated that one of the primary causes of ASC is a partial disconnection of the frontal lobe from higher-order association areas during development (that is, a frontal 'disconnection syndrome'). Therefore, in the current study we investigated whether frontal connectivity differs between males and females with ASC. We recruited 98 adults with a confirmed high-functioning ASC diagnosis (61 males: aged 18-41 years; 37 females: aged 18-37 years) and 115 neurotypical controls (61 males: aged 18-45 years; 54 females: aged 18-52 years). Current ASC symptoms were evaluated using the Autism Diagnostic Observation Schedule (ADOS). Diffusion tensor imaging was performed and fractional anisotropy (FA) maps were created. Mean FA values were determined for five frontal fiber bundles and two non-frontal fiber tracts. Between-group differences in mean tract FA, as well as sex-by-diagnosis interactions were assessed. Additional analyses including ADOS scores informed us on the influence of current ASC symptom severity on frontal connectivity. We found that males with ASC had higher scores of current symptom severity than females, and had significantly lower mean FA values for all but one tract compared to controls. No differences were found between females with or without ASC. Significant sex-by-diagnosis effects were limited to the frontal tracts. Taking current ASC symptom severity scores into account did not alter the findings, although the observed power for these analyses varied. We suggest these findings of frontal connectivity abnormalities in males with ASC, but not in females with ASC, have the potential to inform us on some of the sex differences reported in the behavioral phenotype of ASC.
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Affiliation(s)
- E A Zeestraten
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - M C Gudbrandsen
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - E Daly
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - M T de Schotten
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - M Catani
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - F Dell'Acqua
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - M-C Lai
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
- Child and Youth Mental Health Collaborative at the Centre for Addiction and Mental Health and The Hospital for Sick Children, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - A N V Ruigrok
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - M V Lombardo
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
- Department of Psychology and Center for Applied Neuroscience, University of Cyprus, Nicosia, Cyprus
| | - B Chakrabarti
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
- School of Psychology and Clinical Language Sciences, Centre for Integrative Neuroscience and Neurodynamics, University of Reading, Reading, UK
| | - S Baron-Cohen
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
- CLASS Clinic, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - C Ecker
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - D G M Murphy
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Sackler Institute for Translational Neurodevelopment, Institute of Psychiatry, King's College London, London, UK
| | - M C Craig
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- National Autism Unit, Bethlem Royal Hospital, SLAM NHS Foundation Trust, London, UK
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12
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Abstract
OBJECTIVE Harm avoidance (HA) and "not just right experience" (NJRE) have been proposed to be 2 core motivational processes underlying obsessive-compulsive disorder (OCD). The objective of this study was to explore whether NJRE demarcates a neurodevelopmental OCD subgroup distinct from HA related to autistic traits and/or to a broader phenotype of cognitive rigidity and sensory processing difficulties associated with an earlier age of OCD onset. METHODS A correlational design investigated whether NJRE and HA are distinct entities in OCD and explored their relationship to autism spectrum disorder (ASD) traits measured by the Autism Quotient (AQ), sensory processing, set-shifting, and age of OCD onset in an OCD sample (N=25). RESULTS NJRE was only moderately (r=.34) correlated to HA and not significant in this study. Consistent with predictions, NJRE was associated with sensory processing difficulties and an earlier age of OCD onset. No significant relationships were found between NJRE and ASD traits as measured by the AQ or set-shifting difficulties. CONCLUSIONS These preliminary findings suggest a lack of evidence demonstrating NJRE as a manifestation of core autistic traits as measured by the AQ. However, NJRE was associated with sensory abnormalities and an earlier age of OCD onset. The role of NJRE as a developmental, and possibly neurodevelopmental, risk factor for OCD possibly warrants further investigation.
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13
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Cross-Cultural Validity of the Social Communication Questionnaire for Adults with Intellectual Developmental Disorder. J Autism Dev Disord 2016; 47:393-404. [DOI: 10.1007/s10803-016-2967-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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14
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Ashwood KL, Gillan N, Horder J, Hayward H, Woodhouse E, McEwen FS, Findon J, Eklund H, Spain D, Wilson CE, Cadman T, Young S, Stoencheva V, Murphy CM, Robertson D, Charman T, Bolton P, Glaser K, Asherson P, Simonoff E, Murphy DG. Predicting the diagnosis of autism in adults using the Autism-Spectrum Quotient (AQ) questionnaire. Psychol Med 2016; 46:2595-2604. [PMID: 27353452 PMCID: PMC4988267 DOI: 10.1017/s0033291716001082] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 04/18/2016] [Accepted: 04/21/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND Many adults with autism spectrum disorder (ASD) remain undiagnosed. Specialist assessment clinics enable the detection of these cases, but such services are often overstretched. It has been proposed that unnecessary referrals to these services could be reduced by prioritizing individuals who score highly on the Autism-Spectrum Quotient (AQ), a self-report questionnaire measure of autistic traits. However, the ability of the AQ to predict who will go on to receive a diagnosis of ASD in adults is unclear. METHOD We studied 476 adults, seen consecutively at a national ASD diagnostic referral service for suspected ASD. We tested AQ scores as predictors of ASD diagnosis made by expert clinicians according to International Classification of Diseases (ICD)-10 criteria, informed by the Autism Diagnostic Observation Schedule-Generic (ADOS-G) and Autism Diagnostic Interview-Revised (ADI-R) assessments. RESULTS Of the participants, 73% received a clinical diagnosis of ASD. Self-report AQ scores did not significantly predict receipt of a diagnosis. While AQ scores provided high sensitivity of 0.77 [95% confidence interval (CI) 0.72-0.82] and positive predictive value of 0.76 (95% CI 0.70-0.80), the specificity of 0.29 (95% CI 0.20-0.38) and negative predictive value of 0.36 (95% CI 0.22-0.40) were low. Thus, 64% of those who scored below the AQ cut-off were 'false negatives' who did in fact have ASD. Co-morbidity data revealed that generalized anxiety disorder may 'mimic' ASD and inflate AQ scores, leading to false positives. CONCLUSIONS The AQ's utility for screening referrals was limited in this sample. Recommendations supporting the AQ's role in the assessment of adult ASD, e.g. UK NICE guidelines, may need to be reconsidered.
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Affiliation(s)
- K. L. Ashwood
- Department of Forensic and Neurodevelopmental
Sciences, Institute of Psychiatry, Psychology &
Neuroscience, King's College London, London,
UK
- South London and Maudsley National Health Service
Foundation Trust (SLAM), Maudsley Hospital,
London, UK
| | - N. Gillan
- Department of Forensic and Neurodevelopmental
Sciences, Institute of Psychiatry, Psychology &
Neuroscience, King's College London, London,
UK
| | - J. Horder
- Department of Forensic and Neurodevelopmental
Sciences, Institute of Psychiatry, Psychology &
Neuroscience, King's College London, London,
UK
| | - H. Hayward
- Department of Forensic and Neurodevelopmental
Sciences, Institute of Psychiatry, Psychology &
Neuroscience, King's College London, London,
UK
| | - E. Woodhouse
- Department of Forensic and Neurodevelopmental
Sciences, Institute of Psychiatry, Psychology &
Neuroscience, King's College London, London,
UK
| | - F. S. McEwen
- South London and Maudsley National Health Service
Foundation Trust (SLAM), Maudsley Hospital,
London, UK
- Child & Adolescent Psychiatry,
Institute of Psychiatry, Psychology & Neuroscience, King's College
London, London, UK
- Social, Genetic & Developmental Psychiatry
(SGDP) Centre, Institute of Psychiatry, Psychology &
Neuroscience, King's College London, London,
UK
- Biological and Experimental Psychology,
School of Biological and Chemical Sciences, Queen Mary
University of London, London, UK
| | - J. Findon
- Department of Forensic and Neurodevelopmental
Sciences, Institute of Psychiatry, Psychology &
Neuroscience, King's College London, London,
UK
| | - H. Eklund
- Department of Forensic and Neurodevelopmental
Sciences, Institute of Psychiatry, Psychology &
Neuroscience, King's College London, London,
UK
| | - D. Spain
- Department of Forensic and Neurodevelopmental
Sciences, Institute of Psychiatry, Psychology &
Neuroscience, King's College London, London,
UK
- South London and Maudsley National Health Service
Foundation Trust (SLAM), Maudsley Hospital,
London, UK
| | - C. E. Wilson
- Department of Forensic and Neurodevelopmental
Sciences, Institute of Psychiatry, Psychology &
Neuroscience, King's College London, London,
UK
- South London and Maudsley National Health Service
Foundation Trust (SLAM), Maudsley Hospital,
London, UK
- Individual Differences, Language and Cognition
Laboratory, Department of Developmental and Educational
Psychology, University of Seville,
Seville, Spain
| | - T. Cadman
- Department of Forensic and Neurodevelopmental
Sciences, Institute of Psychiatry, Psychology &
Neuroscience, King's College London, London,
UK
| | - S. Young
- Centre for Mental Health, Imperial College
London, London, UK
| | - V. Stoencheva
- Department of Forensic and Neurodevelopmental
Sciences, Institute of Psychiatry, Psychology &
Neuroscience, King's College London, London,
UK
- South London and Maudsley National Health Service
Foundation Trust (SLAM), Maudsley Hospital,
London, UK
| | - C. M. Murphy
- Department of Forensic and Neurodevelopmental
Sciences, Institute of Psychiatry, Psychology &
Neuroscience, King's College London, London,
UK
- South London and Maudsley National Health Service
Foundation Trust (SLAM), Maudsley Hospital,
London, UK
| | - D. Robertson
- South London and Maudsley National Health Service
Foundation Trust (SLAM), Maudsley Hospital,
London, UK
| | - T. Charman
- Department of Psychology,
Institute of Psychiatry, Psychology & Neuroscience, King's College
London, London, UK
| | - P. Bolton
- Social, Genetic & Developmental Psychiatry
(SGDP) Centre, Institute of Psychiatry, Psychology &
Neuroscience, King's College London, London,
UK
| | - K. Glaser
- Department of Social Science, Health &
Medicine, School of Social Science & Public
Policy, King's College London,
London, UK
| | - P. Asherson
- Social, Genetic & Developmental Psychiatry
(SGDP) Centre, Institute of Psychiatry, Psychology &
Neuroscience, King's College London, London,
UK
| | - E. Simonoff
- Child & Adolescent Psychiatry,
Institute of Psychiatry, Psychology & Neuroscience, King's College
London, London, UK
| | - D. G. Murphy
- Department of Forensic and Neurodevelopmental
Sciences, Institute of Psychiatry, Psychology &
Neuroscience, King's College London, London,
UK
- South London and Maudsley National Health Service
Foundation Trust (SLAM), Maudsley Hospital,
London, UK
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15
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Yang X, Si T, Gong Q, Qiu L, Jia Z, Zhou M, Zhao Y, Hu X, Wu M, Zhu H. Brain gray matter alterations and associated demographic profiles in adults with autism spectrum disorder: A meta-analysis of voxel-based morphometry studies. Aust N Z J Psychiatry 2016; 50:741-53. [PMID: 26769980 DOI: 10.1177/0004867415623858] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND There is increasing evidence that children with autism spectrum disorder are accompanied by specific anatomical alterations. However, the anatomical abnormalities in adults with autism spectrum disorder are poorly understood. This study was aimed to identify the neuroanatomical substrates underlying the pathophysiology of adults with autism spectrum disorder. We also investigated the relationship between neuroanatomical alterations and clinical and demographic characteristics. METHODS A total of 13 datasets were enrolled, of which 12 studies compared whole-brain differences of 382 adult patients with autism and 393 healthy control subjects. We conducted a meta-analysis to quantitatively estimate regional gray matter volume abnormalities in individuals with autism using the effect-size signed differential mapping. RESULTS The voxel-wise meta-analysis revealed that relative to controls, adults with autism spectrum disorder had significantly increased gray matter volume in the middle temporal gyrus, superior temporal gyrus, postcentral gyrus and parahippocampal gyrus, and reduced gray matter volume in the anterior cingulate cortex and cerebellum. Variations in gray matter volume were significantly associated with the mean age and mean total IQ score of the patients, as well as with the percentage of male patients with autism. CONCLUSION These findings confirmed that the neuroanatomical alterations in the fronto-temporal cortices, limbic system and cerebellum in adult individuals with autism were different from the children and young adolescent's autism. The effects of demographic characteristics on the brain morphological changes allow us to further clarify the neurobiological mechanisms and developmental trajectory in adult population with autism spectrum disorder.
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Affiliation(s)
- Xun Yang
- School of Sociality and Psychology, Southwest University for Nationalities, Chengdu, China Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Tianjing Si
- School of Sociality and Psychology, Southwest University for Nationalities, Chengdu, China
| | - Qiyong Gong
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China Department of Psychology, School of Public Administration, Sichuan University, Chengdu, China
| | - Lihua Qiu
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China Department of Radiology, The Second People's Hospital of Yibin, Yibin, China
| | - Zhiyun Jia
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Mi Zhou
- School of Sociality and Psychology, Southwest University for Nationalities, Chengdu, China
| | - Youjin Zhao
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Xinyu Hu
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Min Wu
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Hongyan Zhu
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China Laboratory of Stem Cell Biology, State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, China
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16
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Murphy CM, Wilson CE, Robertson DM, Ecker C, Daly EM, Hammond N, Galanopoulos A, Dud I, Murphy DG, McAlonan GM. Autism spectrum disorder in adults: diagnosis, management, and health services development. Neuropsychiatr Dis Treat 2016; 12:1669-86. [PMID: 27462160 PMCID: PMC4940003 DOI: 10.2147/ndt.s65455] [Citation(s) in RCA: 117] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Autism spectrum disorder (ASD) is a common neurodevelopmental disorder characterized by pervasive difficulties since early childhood across reciprocal social communication and restricted, repetitive interests and behaviors. Although early ASD research focused primarily on children, there is increasing recognition that ASD is a lifelong neurodevelopmental disorder. However, although health and education services for children with ASD are relatively well established, service provision for adults with ASD is in its infancy. There is a lack of health services research for adults with ASD, including identification of comorbid health difficulties, rigorous treatment trials (pharmacological and psychological), development of new pharmacotherapies, investigation of transition and aging across the lifespan, and consideration of sex differences and the views of people with ASD. This article reviews available evidence regarding the etiology, legislation, diagnosis, management, and service provision for adults with ASD and considers what is needed to support adults with ASD as they age. We conclude that health services research for adults with ASD is urgently warranted. In particular, research is required to better understand the needs of adults with ASD, including health, aging, service development, transition, treatment options across the lifespan, sex, and the views of people with ASD. Additionally, the outcomes of recent international legislative efforts to raise awareness of ASD and service provision for adults with ASD are to be determined. Future research is required to identify high-quality, evidence-based, and cost-effective models of care. Furthermore, future health services research is also required at the beginning and end of adulthood, including improved transition from youth to adult health care and increased understanding of aging and health in older adults with ASD.
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Affiliation(s)
- Clodagh M Murphy
- Sackler Institute for Translational Neurodevelopment, Department of Forensic and Neurodevelopmental Sciences, King’s College London, Institute of Psychiatry, Psychology & Neuroscience
- Behavioural and Developmental Psychiatry Clinical Academic Group, Behavioural Genetics Clinic, National Adult Autism Service, South London and Maudsley Foundation NHS Trust, London, UK
| | - C Ellie Wilson
- Sackler Institute for Translational Neurodevelopment, Department of Forensic and Neurodevelopmental Sciences, King’s College London, Institute of Psychiatry, Psychology & Neuroscience
- Behavioural and Developmental Psychiatry Clinical Academic Group, Behavioural Genetics Clinic, National Adult Autism Service, South London and Maudsley Foundation NHS Trust, London, UK
- Individual Differences, Language and Cognition Lab, Department of Developmental and Educational Psychology, University of Seville, Spain
| | - Dene M Robertson
- Sackler Institute for Translational Neurodevelopment, Department of Forensic and Neurodevelopmental Sciences, King’s College London, Institute of Psychiatry, Psychology & Neuroscience
- Behavioural and Developmental Psychiatry Clinical Academic Group, Behavioural Genetics Clinic, National Adult Autism Service, South London and Maudsley Foundation NHS Trust, London, UK
| | - Christine Ecker
- Sackler Institute for Translational Neurodevelopment, Department of Forensic and Neurodevelopmental Sciences, King’s College London, Institute of Psychiatry, Psychology & Neuroscience
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, Goethe-University, Frankfurt am Main, Germany
| | - Eileen M Daly
- Sackler Institute for Translational Neurodevelopment, Department of Forensic and Neurodevelopmental Sciences, King’s College London, Institute of Psychiatry, Psychology & Neuroscience
- Behavioural and Developmental Psychiatry Clinical Academic Group, Behavioural Genetics Clinic, National Adult Autism Service, South London and Maudsley Foundation NHS Trust, London, UK
| | - Neil Hammond
- Sackler Institute for Translational Neurodevelopment, Department of Forensic and Neurodevelopmental Sciences, King’s College London, Institute of Psychiatry, Psychology & Neuroscience
- Behavioural and Developmental Psychiatry Clinical Academic Group, Behavioural Genetics Clinic, National Adult Autism Service, South London and Maudsley Foundation NHS Trust, London, UK
| | - Anastasios Galanopoulos
- Sackler Institute for Translational Neurodevelopment, Department of Forensic and Neurodevelopmental Sciences, King’s College London, Institute of Psychiatry, Psychology & Neuroscience
- Behavioural and Developmental Psychiatry Clinical Academic Group, Behavioural Genetics Clinic, National Adult Autism Service, South London and Maudsley Foundation NHS Trust, London, UK
| | - Iulia Dud
- Sackler Institute for Translational Neurodevelopment, Department of Forensic and Neurodevelopmental Sciences, King’s College London, Institute of Psychiatry, Psychology & Neuroscience
- Behavioural and Developmental Psychiatry Clinical Academic Group, Behavioural Genetics Clinic, National Adult Autism Service, South London and Maudsley Foundation NHS Trust, London, UK
| | - Declan G Murphy
- Sackler Institute for Translational Neurodevelopment, Department of Forensic and Neurodevelopmental Sciences, King’s College London, Institute of Psychiatry, Psychology & Neuroscience
- Behavioural and Developmental Psychiatry Clinical Academic Group, Behavioural Genetics Clinic, National Adult Autism Service, South London and Maudsley Foundation NHS Trust, London, UK
| | - Grainne M McAlonan
- Sackler Institute for Translational Neurodevelopment, Department of Forensic and Neurodevelopmental Sciences, King’s College London, Institute of Psychiatry, Psychology & Neuroscience
- Behavioural and Developmental Psychiatry Clinical Academic Group, Behavioural Genetics Clinic, National Adult Autism Service, South London and Maudsley Foundation NHS Trust, London, UK
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17
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Wilson CE, Murphy CM, McAlonan G, Robertson DM, Spain D, Hayward H, Woodhouse E, Deeley PQ, Gillan N, Ohlsen JC, Zinkstok J, Stoencheva V, Faulkner J, Yildiran H, Bell V, Hammond N, Craig MC, Murphy DG. Does sex influence the diagnostic evaluation of autism spectrum disorder in adults? AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2016; 20:808-19. [PMID: 26802113 PMCID: PMC5363500 DOI: 10.1177/1362361315611381] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
It is unknown whether sex influences the diagnostic evaluation of autism spectrum disorder, or whether male and female adults within the spectrum have different symptom profiles. This study reports sex differences in clinical outcomes for 1244 adults (935 males and 309 females) referred for autism spectrum disorder assessment. Significantly, more males (72%) than females (66%) were diagnosed with an autism spectrum disorder of any subtype (x(2) = 4.09; p = 0.04). In high-functioning autism spectrum disorder adults (IQ > 70; N = 827), there were no significant sex differences in severity of socio-communicative domain symptoms. Males had significantly more repetitive behaviours/restricted interests than females (p = 0.001, d = 0.3). A multivariate analysis of variance indicated a significant interaction between autism spectrum disorder subtype (full-autism spectrum disorder/partial-autism spectrum disorder) and sex: in full-autism spectrum disorder, males had more severe socio-communicative symptoms than females; for partial-autism spectrum disorder, the reverse was true. There were no sex differences in prevalence of co-morbid psychopathologies. Sex influenced diagnostic evaluation in a clinical sample of adults with suspected autism spectrum disorder. The sexes may present with different manifestations of the autism spectrum disorder phenotype and differences vary by diagnostic subtype. Understanding and awareness of adult female repetitive behaviours/restricted interests warrant attention and sex-specific diagnostic assessment tools may need to be considered.
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Affiliation(s)
- C Ellie Wilson
- King's College London, UK South London and Maudsley NHS Foundation Trust, UK University of Seville, Spain
| | - Clodagh M Murphy
- King's College London, UK South London and Maudsley NHS Foundation Trust, UK
| | - Grainne McAlonan
- King's College London, UK South London and Maudsley NHS Foundation Trust, UK
| | - Dene M Robertson
- King's College London, UK South London and Maudsley NHS Foundation Trust, UK
| | - Debbie Spain
- King's College London, UK South London and Maudsley NHS Foundation Trust, UK
| | - Hannah Hayward
- King's College London, UK South London and Maudsley NHS Foundation Trust, UK
| | - Emma Woodhouse
- King's College London, UK South London and Maudsley NHS Foundation Trust, UK
| | - P Quinton Deeley
- King's College London, UK South London and Maudsley NHS Foundation Trust, UK Bethlem Royal Hospital, UK
| | - Nicola Gillan
- South London and Maudsley NHS Foundation Trust, UK Bristol Autism Spectrum Service, UK University of Bristol, UK
| | | | - Janneke Zinkstok
- King's College London, UK South London and Maudsley NHS Foundation Trust, UK
| | | | - Jessica Faulkner
- King's College London, UK South London and Maudsley NHS Foundation Trust, UK
| | | | - Vaughan Bell
- South London and Maudsley NHS Foundation Trust, UK University College London, UK
| | - Neil Hammond
- South London and Maudsley NHS Foundation Trust, UK
| | - Michael C Craig
- King's College London, UK South London and Maudsley NHS Foundation Trust, UK Bethlem Royal Hospital, UK
| | - Declan Gm Murphy
- King's College London, UK South London and Maudsley NHS Foundation Trust, UK
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18
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Gender Differences in Vocational Rehabilitation Service Predictors of Successful Competitive Employment for Transition-Aged Individuals with Autism. J Autism Dev Disord 2015; 45:3204-18. [DOI: 10.1007/s10803-015-2480-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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19
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Codagnone MG, Podestá MF, Uccelli NA, Reinés A. Differential Local Connectivity and Neuroinflammation Profiles in the Medial Prefrontal Cortex and Hippocampus in the Valproic Acid Rat Model of Autism. Dev Neurosci 2015; 37:215-31. [DOI: 10.1159/000375489] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 01/26/2015] [Indexed: 11/19/2022] Open
Abstract
Autism spectrum disorders (ASD) are a group of developmental disabilities characterized by impaired social interaction, communication deficit and repetitive and stereotyped behaviors. Neuroinflammation and synaptic alterations in several brain areas have been suggested to contribute to the physiopathology of ASD. Although the limbic system plays an important role in the functions found impaired in ASD, reports on these areas are scarce and results controversial. In the present study we searched in the medial prefrontal cortex (mPFC) and hippocampus of rats exposed to the valproic acid (VPA) model of ASD for early structural and molecular changes, coincident in time with the behavioral alterations. After confirming delayed growth and maturation in VPA rats, we were able to detect decreased exploratory activity and social interaction at an early time point (postnatal day 35). In mPFC, although typical cortical column organization was preserved in VPA animals, we found that interneuronal space was wider than in controls. Hippocampal CA3 (cornu ammonis 3) pyramidal layer and the granular layer of the dentate gyrus both showed a disorganized spatial arrangement in VPA animals. Neuronal alterations were accompanied with increased tomato lectin and glial fibrillary acidic protein (GFAP) immunostainings both in the mPFC and hippocampus. In the latter region, the increased GFAP immunoreactivity was CA3 specific. At the synaptic level, while mPFC from VPA animals showed increased synaptophysin (SYN) immunostaining, a SYN deficit was found in all hippocampal subfields. Additionally, both the mPFC and the hippocampus of VPA rats showed increased neuronal cell adhesion molecule (NCAM) immunostaining together with decreased levels of its polysialylated form (PSA-NCAM). Interestingly, these changes were more robust in the CA3 hippocampal subfield. Our results indicate that exploratory and social deficits correlate with region-dependent neuronal disorganization and reactive gliosis in the mPFC and hippocampus of VPA rats. While microgliosis is spread in these two limbic areas, astrogliosis, although extended in the mPFC, is circumscribed to the CA3 hippocampal subfield. Our work indicates that neuroinflammation and synaptic alterations do coexist in VPA rats, making this model suitable for studying novel aspects of neuron-glia interactions. Moreover, it suggests that the mPFC and hippocampus might behave differently in the context of the local hyperconnectivity and synaptic hypotheses of autism.
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20
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Osipowicz K, Bosenbark DD, Patrick KE. Cortical Changes Across the Autism Lifespan. Autism Res 2015; 8:379-85. [DOI: 10.1002/aur.1453] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Accepted: 11/25/2014] [Indexed: 11/09/2022]
Affiliation(s)
- Karol Osipowicz
- Department of Psychology, 3201 Chestnut Street; Drexel University; Philadelphia Pennsylvania 19104
| | - Danielle D. Bosenbark
- Department of Psychology, 3201 Chestnut Street; Drexel University; Philadelphia Pennsylvania 19104
| | - Kristina E. Patrick
- Department of Psychology, 3201 Chestnut Street; Drexel University; Philadelphia Pennsylvania 19104
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Wilson CE, Gillan N, Spain D, Robertson D, Roberts G, Murphy CM, Maltezos S, Zinkstok J, Johnston K, Dardani C, Ohlsen C, Deeley PQ, Craig M, Mendez MA, Happé F, Murphy DGM. Comparison of ICD-10R, DSM-IV-TR and DSM-5 in an adult autism spectrum disorder diagnostic clinic. J Autism Dev Disord 2014; 43:2515-25. [PMID: 23504376 DOI: 10.1007/s10803-013-1799-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
An Autism Spectrum Disorder (ASD) diagnosis is often used to access services. We investigated whether ASD diagnostic outcome varied when DSM-5 was used compared to ICD-10R and DSM-IV-TR in a clinical sample of 150 intellectually able adults. Of those diagnosed with an ASD using ICD-10R, 56 % met DSM-5 ASD criteria. A further 19 % met DSM-5 (draft) criteria for Social Communication Disorder. Of those diagnosed with Autistic Disorder/Asperger Syndrome on DSM-IV-TR, 78 % met DSM-5 ASD criteria. Sensitivity of DSM-5 was significantly increased by reducing the number of criteria required for a DSM-5 diagnosis, or by rating 'uncertain' criteria as 'present', without sacrificing specificity. Reduced rates of ASD diagnosis may mean some ASD individuals will be unable to access clinical services.
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Affiliation(s)
- C Ellie Wilson
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, King's College, London, SE5 8AF, UK,
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22
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Koelkebeck K, Riedel A, Ohrmann P, Biscaldi M, Tebartz van Elst L. [High-functioning autism spectrum disorders in adulthood]. DER NERVENARZT 2014; 85:891-902. [PMID: 24969950 DOI: 10.1007/s00115-014-4050-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The prevalence of autism spectrum disorders in the general population is approximately 1 %. Some individuals with high-functioning autism graduate from regular schools without autism having been diagnosed and problems only occur when the demands for social competence increase. Then patients often present with secondary psychiatric symptoms, such as depression, anxiety or interpersonal problems. At this time, typical autistic features, such as social interaction deficits, restricted interests and stereotypic behavior can be camouflaged by high compensatory skills, particularly in highly intelligent patients. Therefore, missed or wrong diagnoses are frequent. Interviews, questionnaires and neuropsychological tests might be used to support the diagnosis. In cases where there is evidence for a secondary cause of autistic symptoms, somatic disorders should be excluded. Pharmacological treatment should be symptom-oriented. Individualized psychotherapeutic approaches are becoming increasingly more available; however, pragmatic solutions often need to be deployed.
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Affiliation(s)
- K Koelkebeck
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude A9, 48149, Münster, Deutschland,
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23
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Lehnhardt FG, Gawronski A, Pfeiffer K, Kockler H, Schilbach L, Vogeley K. The investigation and differential diagnosis of Asperger syndrome in adults. DEUTSCHES ARZTEBLATT INTERNATIONAL 2014; 110:755-63. [PMID: 24290364 DOI: 10.3238/arztebl.2013.0755] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Revised: 06/25/2013] [Accepted: 06/25/2013] [Indexed: 12/14/2022]
Abstract
BACKGROUND As a result of the increased public interest in autism spectrum disorders (ASD), certain core manifestations of ASD--impaired social interaction and communication, bizarre interests--are now commonly recognized as being typical of autism, not only in children, but in adults as well. More often than before, general practitioners, neurologists, and psychiatrists find themselves being asked whether a patient is suffering from previously unrecognized Asperger syndrome (AS). The prevalence of ASD is estimated at 1%, and the ratio of diagnosed to undiagnosed cases at about 3:2. Little is known about the diagnostic evaluation of AS in adulthood. METHOD We selectively searched the Medline database for pertinent literature, paying special attention to diagnostic manuals and to the guideline of the United Kingdom's National Institute for Health and Care Excellence (NICE). RESULTS Centrally important aspects of the diagnosis of AS include an assessment of the patient's ability to assume the emotional perspectives of others, non-verbal modes of expression, repetitive behavior patterns, and childhood social behavioral history. The autism quotient (AQ) is now established as a simple but nonspecific screening test. Up to 70% of all affected adults have comorbid disturbances, most often depression and anxiety disorders. The differential diagnosis includes personality disorders, anxiety disorders, obsessive-compulsive disorder, and attention deficit-hyperactivity disorder. The diagnostic assessment should proceed in stepwise fashion, starting from simple screening in primary care and then moving on to evaluation of the suspected diagnosis by a mental health care specialist, followed by extensive further investigation in an outpatient clinic specifically devoted to patients with autism spectrum disorders. CONCLUSION The diagnostic assessment of autism in adults requires knowledge of the core and accompanying manifestations of autism and of their differential diagnoses. More research is needed for the development of further screening tests and the precise determination of diagnosis rates, differential diagnoses, nd comorbidities.
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Affiliation(s)
- Fritz-Georg Lehnhardt
- Department of Psychiatry and Psychotherapy, University of Cologne, Institute of Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Forschungszentrum Jülich
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Lai MC, Lombardo MV, Suckling J, Ruigrok ANV, Chakrabarti B, Ecker C, Deoni SCL, Craig MC, Murphy DGM, Bullmore ET, Baron-Cohen S. Biological sex affects the neurobiology of autism. Brain 2013; 136:2799-815. [PMID: 23935125 PMCID: PMC3754459 DOI: 10.1093/brain/awt216] [Citation(s) in RCA: 197] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
In autism, heterogeneity is the rule rather than the exception. One obvious source of heterogeneity is biological sex. Since autism was first recognized, males with autism have disproportionately skewed research. Females with autism have thus been relatively overlooked, and have generally been assumed to have the same underlying neurobiology as males with autism. Growing evidence, however, suggests that this is an oversimplification that risks obscuring the biological base of autism. This study seeks to answer two questions about how autism is modulated by biological sex at the level of the brain: (i) is the neuroanatomy of autism different in males and females? and (ii) does the neuroanatomy of autism fit predictions from the ‘extreme male brain’ theory of autism, in males and/or in females? Neuroanatomical features derived from voxel-based morphometry were compared in a sample of equal-sized high-functioning male and female adults with and without autism (n = 120, n = 30/group). The first question was investigated using a 2 × 2 factorial design, and by spatial overlap analyses of the neuroanatomy of autism in males and females. The second question was tested through spatial overlap analyses of specific patterns predicted by the extreme male brain theory. We found that the neuroanatomy of autism differed between adult males and females, evidenced by minimal spatial overlap (not different from that occurred under random condition) in both grey and white matter, and substantially large white matter regions showing significant sex × diagnosis interactions in the 2 × 2 factorial design. These suggest that autism manifests differently by biological sex. Furthermore, atypical brain areas in females with autism substantially and non-randomly (P < 0.001) overlapped with areas that were sexually dimorphic in neurotypical controls, in both grey and white matter, suggesting neural ‘masculinization’. This was not seen in males with autism. How differences in neuroanatomy relate to the similarities in cognition between males and females with autism remains to be understood. Future research should stratify by biological sex to reduce heterogeneity and to provide greater insight into the neurobiology of autism.
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Affiliation(s)
- Meng-Chuan Lai
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Douglas House, 18B, Trumpington Road, Cambridge CB2 8AH, UK.
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Chukoskie L, Townsend J, Westerfield M. Motor Skill in Autism Spectrum Disorders. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2013; 113:207-49. [DOI: 10.1016/b978-0-12-418700-9.00007-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
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Raznahan A, Lenroot R, Thurm A, Gozzi M, Hanley A, Spence SJ, Swedo SE, Giedd JN. Mapping cortical anatomy in preschool aged children with autism using surface-based morphometry. NEUROIMAGE-CLINICAL 2012; 2:111-9. [PMID: 24179764 PMCID: PMC3777762 DOI: 10.1016/j.nicl.2012.10.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Revised: 10/10/2012] [Accepted: 10/18/2012] [Indexed: 12/30/2022]
Abstract
The challenges of gathering in-vivo measures of brain anatomy from young children have limited the number of independent studies examining neuroanatomical differences between children with autism and typically developing controls (TDCs) during early life, and almost all studies in this critical developmental window focus on global or lobar measures of brain volume. Using a novel cohort of young males with Autistic Disorder and TDCs aged 2 to 5 years, we (i) tested for group differences in traditional measures of global anatomy (total brain, total white, total gray and total cortical volume), and (ii) employed surface-based methods for cortical morphometry to directly measure the two biologically distinct sub-components of cortical volume (CV) at high spatial resolution—cortical thickness (CT) and surface area (SA). While measures of global brain anatomy did not show statistically significant group differences, children with autism showed focal, and CT-specific anatomical disruptions compared to TDCs, consisting of relative cortical thickening in regions with central roles in behavioral regulation, and the processing of language, biological movement and social information. Our findings demonstrate the focal nature of brain involvement in early autism, and provide more spatially and morphometrically specific anatomical phenotypes for subsequent translational study.
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Ipser JC, Syal S, Bentley J, Adnams CM, Steyn B, Stein DJ. 1H-MRS in autism spectrum disorders: a systematic meta-analysis. Metab Brain Dis 2012; 27:275-87. [PMID: 22426803 DOI: 10.1007/s11011-012-9293-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Accepted: 02/24/2012] [Indexed: 10/28/2022]
Abstract
We conducted a systematic review and meta-analysis of proton magnetic resonance spectroscopy (1H-MRS) studies comparing autism spectrum disorder (ASD) patients with healthy controls, with the aim of profiling ASD-associated changes in the metabolites N-acetyl-aspartate (NAA) and Creatine (Cr). Meta-regression models of NAA and Cr levels were employed, using data from 20 eligible studies (N = 852), to investigate age-dependent differences in both global brain and region-specific metabolite levels, while controlling for measurement method (Cr-ratio versus absolute concentrations). Decreased NAA concentrations that were specific to children were found for whole-brain grey and white matter. In addition, a significant decrease in NAA was evident across age categories in the parietal cortex, the cerebellum, and the anterior cingulate cortex. Higher levels of Cr were observed for ASD adults than children in global grey matter, with specific increases for adults in the temporal lobe and decreased Cr in the occipital lobe in children. No differences were found for either NAA or Cr in the frontal lobes. These data provide some evidence that ASD is characterized by age-dependent fluctuations in metabolite levels across the whole brain and at the level of specific regions thought to underlie ASD-associated behavioural and affective deficits. Differences in Cr as a function of age and brain region suggests caution in the interpretation of Cr-based ratio measures of metabolites. Despite efforts to control for sources of heterogeneity, considerable variability in metabolite levels was observed in frontal and temporal regions, warranting further investigation.
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Affiliation(s)
- Jonathan C Ipser
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
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29
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May GABA transaminase inhibitors improve stereotyped behaviors in Rett syndrome? Amino Acids 2012; 42:2037-8. [DOI: 10.1007/s00726-011-0845-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Accepted: 02/04/2011] [Indexed: 10/18/2022]
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30
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In search of biomarkers for autism: scientific, social and ethical challenges. Nat Rev Neurosci 2011; 12:603-12. [DOI: 10.1038/nrn3113] [Citation(s) in RCA: 173] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Happé F, Charlton RA. Aging in autism spectrum disorders: a mini-review. Gerontology 2011; 58:70-8. [PMID: 21865667 DOI: 10.1159/000329720] [Citation(s) in RCA: 115] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2010] [Accepted: 05/25/2011] [Indexed: 11/19/2022] Open
Abstract
This article addresses an important and barely researched topic: what happens to children with autism spectrum disorders when they grow old. We review the small published literature on aging in autism. We then consider the relevance of research on 'neurotypical' aging in core domains of autistic impairment: social cognition, executive function, cognitive style and memory. Research themes from the study of normal aging, including cognitive reserve, compensation, quality of life, loneliness and physical health are of relevance for future research on autism. Studies of aging in autism will be important not only to plan appropriate services, but also to shed light on the full developmental trajectory of this neurodevelopmental condition, and perhaps provide clues to neuropathology and etiology.
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Affiliation(s)
- Francesca Happé
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, London, UK.
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33
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Lai MC, Lombardo MV, Pasco G, Ruigrok ANV, Wheelwright SJ, Sadek SA, Chakrabarti B, Baron-Cohen S. A behavioral comparison of male and female adults with high functioning autism spectrum conditions. PLoS One 2011; 6:e20835. [PMID: 21695147 PMCID: PMC3113855 DOI: 10.1371/journal.pone.0020835] [Citation(s) in RCA: 349] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Accepted: 05/10/2011] [Indexed: 12/04/2022] Open
Abstract
Autism spectrum conditions (ASC) affect more males than females in the general population. However, within ASC it is unclear if there are phenotypic sex differences. Testing for similarities and differences between the sexes is important not only for clinical assessment but also has implications for theories of typical sex differences and of autism. Using cognitive and behavioral measures, we investigated similarities and differences between the sexes in age- and IQ-matched adults with ASC (high-functioning autism or Asperger syndrome). Of the 83 (45 males and 38 females) participants, 62 (33 males and 29 females) met Autism Diagnostic Interview-Revised (ADI-R) cut-off criteria for autism in childhood and were included in all subsequent analyses. The severity of childhood core autism symptoms did not differ between the sexes. Males and females also did not differ in self-reported empathy, systemizing, anxiety, depression, and obsessive-compulsive traits/symptoms or mentalizing performance. However, adult females with ASC showed more lifetime sensory symptoms (p = 0.036), fewer current socio-communication difficulties (p = 0.001), and more self-reported autistic traits (p = 0.012) than males. In addition, females with ASC who also had developmental language delay had lower current performance IQ than those without developmental language delay (p<0.001), a pattern not seen in males. The absence of typical sex differences in empathizing-systemizing profiles within the autism spectrum confirms a prediction from the extreme male brain theory. Behavioral sex differences within ASC may also reflect different developmental mechanisms between males and females with ASC. We discuss the importance of the superficially better socio-communication ability in adult females with ASC in terms of why females with ASC may more often go under-recognized, and receive their diagnosis later, than males.
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Affiliation(s)
- Meng-Chuan Lai
- Department of Psychiatry, Autism Research Centre, University of Cambridge, Cambridge, United Kingdom.
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Rommelse NN, Geurts HM, Franke B, Buitelaar JK, Hartman CA. A review on cognitive and brain endophenotypes that may be common in autism spectrum disorder and attention-deficit/hyperactivity disorder and facilitate the search for pleiotropic genes. Neurosci Biobehav Rev 2011; 35:1363-96. [DOI: 10.1016/j.neubiorev.2011.02.015] [Citation(s) in RCA: 249] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2010] [Revised: 02/25/2011] [Accepted: 02/27/2011] [Indexed: 02/01/2023]
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