Does the severity of autism symptoms change over time? A review of the evidence, impacts, and gaps in current knowledge

Identifying Distinct Developmental Patterns of Brain Complexity in Autism: A Cross-Sectional Cohort Analysis Using the Autism Brain Imaging Data Exchange

AIM

Autistic traits exhibit neurodiversity with varying behaviors across developmental stages. Brain complexity theory, illustrating the dynamics of neural activity, may elucidate the evolution of autistic traits over time. Our study explored the patterns of brain complexity in autistic individuals from childhood to adulthood.

METHODS

We analyzed functional magnetic resonance imaging data from 1087 autistic participants and neurotypical controls aged 6 to 30 years within the ABIDE I (Autism Brain Imaging Data Exchange) data set. Sample entropy was calculated to measure brain complexity among 90 brain regions, utilizing an automated anatomical labeling template for voxel parcellation. Participants were grouped using sliding age windows with partial overlaps. We assessed the average brain complexity of the entire brain and brain regions for both groups across age categories. Cluster analysis was conducted using generalized association plots to identify brain regions with similar developmental complexity trajectories. Finally, the relationship between brain region complexity and autistic traits was examined.

RESULTS

Autistic individuals may tend toward higher whole-brain complexity during adolescence and lower complexity during childhood and adulthood, indicating possible distinct developmental trajectories. However, these results do not remain after Bonferroni correction. Two clusters of brain regions were identified, each with unique patterns of complexity changes over time. Correlations between brain region complexity, age, and autistic traits were also identified.

CONCLUSION

The study revealed brain complexity trajectories in autistic individuals, providing insight into the neurodiversity of autism and suggesting that age-related changes in brain complexity could be a potential neurodevelopmental marker for the dynamic nature of autism.

Face perception and social cognitive development in early autism: A prospective longitudinal study from 3 months to 7 years of age

Autism spectrum condition (ASC) is characterized by atypical attention to eyes and faces, but the onset and impact of these atypicalities remain unclear. This prospective longitudinal study examined face perception in infants who develop ASC (N = 22, female = 5, 100% White) compared with typically developing infants (N = 131, female = 65, 55.6% White), tracking social-cognitive and ASC development through age seven. Reduced interest in direct gaze and eyes during infancy correlated with atypical development of adaptive behavior at age four and theory of mind at age seven. Principal component analyses revealed less integrated processing of facial features and eye-gaze information in ASC infants, potentially impacting their childhood social functioning. These findings highlight the intertwined nature of social-cognitive development and ASC.

Secondary effects of dialectical behaviour therapy on social functioning, quality of life, and autism traits in autistic adults with suicidality

LAY ABSTRACT

Dialectical behaviour therapy is a comprehensive treatment that helps individuals improve distress tolerance, mindfulness, interpersonal effectiveness and emotion regulation. It is commonly used to assist those experiencing self-harm and suicidal thoughts or behaviours. Despite its broad application, our understanding of how dialectical behaviour therapy impacts autistic individuals with suicidal behaviour remains limited. This study compared dialectical behaviour therapy with treatment as usual in 123 autistic adults experiencing suicidal behaviours. Participants were recruited from six mental health centres, with 63 receiving dialectical behaviour therapy and 60 receiving treatment as usual. The study assessed outcomes such as social functioning, quality of life and specific autism traits over 12 months. Findings revealed that dialectical behaviour therapy led to significant improvements in social functioning and quality of life compared to treatment as usual, though there were no effects on autism traits. These improvements suggest that dialectical behaviour therapy holds promise as an effective treatment for autistic individuals grappling with suicidal behaviour. The findings strongly support the broader implementation of dialectical behaviour therapy in mental health centres, especially given the limited treatment options available for autistic individuals with suicidal tendencies.

"I Know it's Good to Do it": A Qualitative Study Exploring the Perspective of Autistic Men on Social Motivation

The social motivation hypothesis states that people with Autism Spectrum Condition (ASC) have a diminished social motivation, that is (1) less priority in attention for objects of social importance, (2) diminished social reward, and (3) less desire to maintain and strengthen relationships. Little is known about the perception of autistic people on their social motivation. This study used semi-structured interviews to explore how eleven autistic men perceived their social motivation, behaviour, and interactions. In the interpretative phenomenological analysis, five themes were identified: (1) social network, (2) importance of social contact, (3) challenges regarding social contact, (4) conditionality of social contact, and (5) the struggle between importance, challenges and conditionality of social contact. Social motivation appeared to be a dynamic concept that varied between individuals and contexts. Most participants struggled between valuing social contact as important and the challenges they faced on a social level over the different contexts in which they participated. Even though elements of the social motivation hypothesis were recognized, the main finding was that this struggle seemed to be the source of the diminished social motivation that was observed in some of these men. Although more research is needed, the findings of this study could imply that social motivation might not be as straightforward for autistic men as described in the social motivation hypothesis.

Longitudinal change in symptom severity in children with ASD: Results from the ELENA cohort

Autism spectrum disorder (ASD) is a lifelong neurodevelopmental condition and understanding the changes in autism symptoms over time is crucial for tailoring support and interventions. This study therefore aimed to investigate the changes in symptom severity in a large cohort of children with ASD over a three-year follow-up period and identify factors that influence these changes. The study included 575 children diagnosed with ASD, ranging in age from 2 to 12 years, who were assessed at baseline and again 3 years later using the Autism Diagnostic Observational Schedule-2 (ADOS-2). ASD severity changes were investigated using the ADOS calibrated severity score (CSS) scores for total, social affect (SA) and restricted and repetitive behaviors (RRB). Results highlight four distinct patterns: stable high, stable low, increased, and decreased severity. The ADOS CSS total score changed for half of the sample, reflecting an increase in ASD severity for 21.9% and a decrease for 29.1% of children. For the other half, the ADOS CSS score remained stable, either high (34.4%) or low (14.6%). While the majority of previous studies reported stability in ASD severity, our findings revealed significant variability with frequent improvements in SA symptoms whereas RRBs remained stable or worsened. Our findings also showed that an improvement in SA was associated with the youngest group and early diagnosis. However, no clinical or sociodemographic factors were linked to changes in RRB, emphasizing the necessity for RRB-specific therapies. The third six-year follow-up point of the ongoing ELENA cohort study will map the long-term trajectories of the severity of ASD symptoms and their potential risk factors.

Trajectories of adaptive functioning from early childhood to adolescence in autism: Identifying turning points and key correlates of chronogeneity

Background

Previous research has demonstrated heterogeneous adaptive outcomes across the autism spectrum; however, the current literature remains limited in elucidating turning points and associated factors for longitudinal variability (chronogeneity). To address these empirical gaps, we aimed to provide a finer-grained characterization of trajectories of adaptive functioning from early childhood to adolescence in autism.

Methods

Our sample (N = 406) was drawn from an inception cohort of children diagnosed Autistic at ages 2-5. Adaptive functioning was assessed with Vineland Adaptive Behavior Scales (VABS, 2nd Edition) across 6 visits from the time of diagnosis by age 18. Parallel-process latent growth curve modeling were used to estimate domain-level VABS trajectories, followed by latent class growth analysis to identify trajectory subgroups. Child characteristics at diagnosis, family demographics, and participation outcomes at adolescence were compared across subgroups.

Results

Piecewise latent growth models best described VABS trajectories with two turning points identified at around ages 5-6 and 9-10, respectively reflecting transitions into school age and early adolescence. We parsed four VABS trajectory subgroups that vary by level of functioning and change rate for certain domains and periods. Around 16% of the sample exhibited overall adequate functioning (standard score >85) with notable early growth and social adaptation during adolescence. About 21% showed low adaptive functioning (standard score ≤70), with decreasing slopes by age 6 followed by improvements in communication and daily-living skills by age 10. The other two subgroups (63% in total) were characterized by adaptive functioning between low and adequate levels, with relatively stable trajectories entering school age. These subgroups differed most in their cognitive ability at diagnosis, household income, and social participation in adolescence.

Conclusions

We identified key individual and family characteristics and time windows associated with distinct adaptive functioning trajectories, which have important implications for providing timely and tailored supports to Autistic people across developmental stages.

Autism Severity and its Relationship to Disability

Autism severity is currently defined and measured based exclusively on the severity levels of the two core symptom domains: social-communication and restricted or repetitive patterns of behaviors and interests. Autistic individuals, however, are often diagnosed with other medical, developmental, and psychological co-occurring conditions. These additional challenges such as intellectual disability, limited expressive and/or receptive language, and anxiety disorders, can have a tremendous impact on the day-to-day lives of autistic individuals, for both their adaptive functioning as well as their sense of wellbeing. Furthermore, the initial presentation of core symptoms and their likelihood of changing over time are influenced by the presence of such co-occurring conditions. In order to truly understand how a person's autism impacts their life, both core symptoms as well as other challenges should be considered. This approach was recently taken by The Lancet Commission on the future of care and clinical research in autism, which proposed the term "profound autism" for a subgroup of individuals presenting with high core symptom severity, co-occurring intellectual disability, and little or no language, who require extensive long-term care. Considering other individual factors such as daily living skills, specific support needs and environmental resources would also enhance the evaluation of disability in autistic individuals. As currently employed in the assessment of intellectual disability, a multidimensional approach to autism could provide a more comprehensive system for classification of impairment. At present, however, there is no formal way to designate the combined effect of these different aspects of autism on a person's life. A comprehensive outlook that acknowledges impairments, capabilities, co-occurring conditions, and environmental factors would be useful for identifying subgroups of individuals as well as for determining individual needs and strengths in clinical assessments. Lay Summary: The severity of a person's autism is currently defined based on the severity of their core autism symptoms: impaired social-communication and the presence of restricted or repetitive patterns of behaviors and interests. But autistic people often face additional challenges such as intellectual disability, epilepsy, and anxiety disorder, that considerably impact their everyday life, wellbeing, and the need for support. A more complete view of autism severity, one that includes core symptoms as well as additional challenges, could help identify meaningful sub-groups of autistic individuals and could be useful in clinical care. Appeared originally in Autism Res 2023; 16:685-696.

Affectivity, sexuality, and autism spectrum disorder: qualitative analysis of the experiences of autistic young adults and their families

BACKGROUND

Autistic people have communication, sensorial, and social difficulties, which on many occasions, make their adaptation on the sexual and affective levels difficult. For this reason, it is important to know the opinion of individuals with autism spectrum disorders (ASD) and their families, to offer this perspective to professionals to facilitate adapted health education programs in mental health units.

METHODS

This qualitative descriptive design presents the experiences of autistic individuals and their families in relation to the affective-sexual experiences from individual, family, and social perspectives. Two focus group sessions were held with eight family members and seven individual semi-structured interviews with autistic young adults. The transcripts were qualitatively analysed using content analysis.

RESULTS

Four themes (Family and social dynamic; Social behaviour of the autistic individual; Affective-sexual relationships; Addressing affective and sex education) and 13 related categories emerged from these results. Communication and social interaction problems act as barriers for young adults when developing affective-sexual relationships, leading to the emergence of negative feelings and experiences that reinforce avoidance behaviours, further intensifying their difficulties in interacting with others. Families, especially mothers, exhibit a poor perception of their ability to provide affective-sexual guidance, leading to anxiety and frustration. There are also reports of poor sex education and lack of support systems.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

The experiences of young people and their families are sometimes conflicting when it comes to affectivity and sexuality, but the parental role emerges as relevant in the sex education process. Families play a pivotal role in sex education, which is why professionals should provide them with support and information through health education programmes, foster empathetic communication and promote sexual and emotional development that is adapted to the characteristics and interests of autistic people.

Prototypical autism: New diagnostic criteria and asymmetrical bifurcation model

The current "autism spectrum" DSM 5 diagnostic criteria and autism standardized diagnostic instruments promote considerable heterogeneity or clinical indecision and may be detrimental to the advancement of fundamental research on autism mechanisms. To increase clinical specificity and reorient research towards core autistic presentations, we propose new diagnostic criteria for prototypical autism during the age of 2- to 5-years. We include autism within other non-dominant, familiarly aggregated phenomena sharing asymmetrical developmental bifurcations, such as twin pregnancy, left handedness, and breech presentation/delivery. Following this model, nature, trajectory, and positive/negative signs structure of autism would result from the polarized problem of whether or not language and information is processed in a socially biased manner. Prototypical autism would follow a canonical developmental trajectory by which a gradual decline in social bias in the processing of incoming information, overtly beginning at the end of the first year, bifurcates into a prototypical autistic presentation in the second half of the second year of life. This bifurcation event is followed by a plateau, in which these atypicalities show maximal stringency and distinctiveness, and then ultimately, in most cases, by partial normalization. During the plateau period, the orientation towards, and processing of, information is considerably modified, with an absence of bias for social information, contrasting with a high level of interest in complex, unbiased information, independently of its social or non-social nature. Integrating autism into asymmetrical developmental bifurcations would explain the absence of deleterious neurological and genetic markers and the presence of familial transmission in canonical autistic presentations.

Autism severity and its relationship to disability

Autism severity is currently defined and measured based exclusively on the severity levels of the two core symptom domains: social-communication and restricted or repetitive patterns of behaviors and interests. Autistic individuals, however, are often diagnosed with other medical, developmental, and psychological co-occurring conditions. These additional challenges such as intellectual disability, limited expressive and/or receptive language, and anxiety disorders, can have a tremendous impact on the day-to-day lives of autistic individuals, for both their adaptive functioning as well as their sense of wellbeing. Furthermore, the initial presentation of core symptoms and their likelihood of changing over time are influenced by the presence of such co-occurring conditions. In order to truly understand how a person's autism impacts their life, both core symptoms as well as other challenges should be considered. This approach was recently taken byThe Lancet Commission on the future of care and clinical research in autism, which proposed the term "profound autism" for a subgroup of individuals presenting with high core symptom severity, co-occurring intellectual disability, and little or no language, who require extensive long-term care. Considering other individual factors such as daily living skills, specific support needs and environmental resources would also enhance the evaluation of disability in autistic individuals. As currently employed in the assessment of intellectual disability, a multidimensional approach to autism could provide a more comprehensive system for classification of impairment. At present, however, there is no formal way to designate the combined effect of these different aspects of autism on a person's life. A comprehensive outlook that acknowledges impairments, capabilities, co-occurring conditions, and environmental factors would be useful for identifying subgroups of individuals as well as for determining individual needs and strengths in clinical assessments.