Autism spectrum disorders in the DSM-V: better or worse than the DSM-IV?

Mechanistic perspective on the actions of vitamin a in autism spectrum disorder etiology

Vitamin A (VA) has many functions in the body, some of which are key for the development and functioning of the nervous system, while some others might indirectly influence neural function. Both hypovitaminosis and hypervitaminosis A can lead to clinical manifestations of concern for individuals and for general global health. Scientific evidence on the link between VA and autism spectrum disorder (ASD) is growing, with some clinical studies and accumulating results obtained from basic research using cellular and animal models. Remarkably, it has been shown that VA deficiency can exacerbate autistic symptomatology. In turn, VA supplementation has been shown to be able to improve autistic symptomatology in selected groups of individuals with ASD. However, it is important to recognize that ASD is a highly heterogeneous condition. Therefore, it is important to clarify how and when VA supplementation can be of benefit for affected individuals. Here we delve into the relationship between VA and ASD, discussing clinical observations and mechanistic insights obtained from research on selected autistic syndromes and laboratory models to advance in defining how the VA signaling pathway can be exploited for treatment of ASD.

Autism spectrum disorder diagnosis based on deep unrolling-based spatial constraint representation

Accurate diagnosis of autism spectrum disorder (ASD) is crucial for effective treatment and prognosis. Functional brain networks (FBNs) constructed from functional magnetic resonance imaging (fMRI) have become a popular tool for ASD diagnosis. However, existing model-driven approaches used to construct FBNs lack the ability to capture potential non-linear relationships between data and labels. Moreover, most existing studies treat the FBNs construction and disease classification as separate steps, leading to large inter-subject variability in the estimated FBNs and reducing the statistical power of subsequent group comparison. To address these limitations, we propose a new approach to FBNs construction called the deep unrolling-based spatial constraint representation (DUSCR) model and integrate it with a convolutional classifier to create an end-to-end framework for ASD recognition. Specifically, the model spatial constraint representation (SCR) is solved using a proximal gradient descent algorithm, and we unroll it into deep networks using the deep unrolling algorithm. Classification is then performed using a convolutional prototype learning model. We evaluated the effectiveness of the proposed method on the ABIDE I dataset and observed a significant improvement in model performance and classification accuracy. The resting state fMRI images are preprocessed into time series data and 3D coordinates of each region of interest. The data are fed into the DUSCR model, a model for building functional brain networks using deep learning instead of traditional models, that we propose, and then the outputs are fed into the convolutional classifier with prototype learning to determine whether the patient has ASD disease.

The Relationship between Retained Primitive Reflexes and Hemispheric Connectivity in Autism Spectrum Disorders

BACKGROUND

Autism Spectrum Disorder (ASD) can be identified by a general tendency toward a reduction in the expression of low-band, widely dispersed integrative activities, which is made up for by an increase in localized, high-frequency, regionally dispersed activity. The study assessed ASD children and adults all possessing retained primitive reflexes (RPRs) compared with a control group that did not attempt to reduce or remove those RPRs and then examined the effects on qEEG and brain network connectivity.

METHODS

Analysis of qEEG spectral and functional connectivity was performed, to identify associations with the presence or absence of retained primitive reflexes (RPRs), before and after an intervention based on TENS unilateral stimulation.

RESULTS

The results point to abnormal lateralization in ASD, including long-range underconnectivity, a greater left-over-right qEEG functional connectivity ratio, and short-range overconnectivity in ASD.

CONCLUSIONS

Clinical improvement and the absence of RPRs may be linked to variations in qEEG frequency bands and more optimized brain networks, resulting in more developmentally appropriate long-range connectivity links, primarily in the right hemisphere.

Maternal Folate Status and the Relation between Gestational Arsenic Exposure and Child Health Outcomes

Gestational arsenic exposure adversely impacts child health. Folate-mediated 1-carbon metabolism facilitates urinary excretion of arsenic and may prevent arsenic-related adverse health outcomes. We investigated the potential for maternal folate status to modify associations between gestational arsenic exposure and child health. We used data from 364 mother-child pairs in the MIREC study, a prospective pan-Canadian cohort. During pregnancy, we measured first trimester urinary arsenic concentrations, plasma folate biomarkers, and folic acid supplementation intake. At age 3 years, we evaluated twelve neurodevelopmental and anthropometric features. Using latent profile analysis and multinomial regression, we developed phenotypic profiles of child health, estimated covariate-adjusted associations between arsenic and these phenotypic profiles, and evaluated whether folate status modified these associations. We identified three phenotypic profiles of neurodevelopment and three of anthropometry, ranging from less to more optimal child health. Gestational arsenic was associated with decreased odds of optimal neurodevelopment. Maternal folate status did not modify associations of arsenic with neurodevelopmental phenotypic profiles, but gestational arsenic was associated with increased odds of excess adiposity among those who exceed recommendations for folic acid (>1000 μg/day). However, arsenic exposure was low and folate status was high. Gestational arsenic exposure may adversely impact child neurodevelopment and anthropometry, and maternal folate status may not modify these associations; however, future work should examine these associations in more arsenic-exposed or lower folate-status populations.

Use of routine health records to study mental health care of Brazilian children

ABSTRACT Objective To investigate the clinical epidemiological characteristics of a large data set of visits to outpatient children mental health services in Brazil, as well as to identify relevant relationships between age, sex and three common mental disorders in childhood: pervasive developmental disorders, ADHD, and mild depressive disorders. Methods We extracted data from the Ambulatorial Information System (SIA) part of a public repository, Datasus, regarding child outpatient mental health services in Brazil, from 2008 to 2012. We performed an analysis of the number of visits per one hundred thousand inhabitants and further analyses with logistic regressions for ADHD (F90.0), Pervasive Developmental Disorders (F84.0-F84.9), and Mild Depressive Episode (F32.0) as outcomes, controlling for age, year of the visit, number of new CAPSI stratified by region. Results Attention-deficit hyperactivity disorder (ADHD) was the most common condition identified across the country. The analyses by region showed a high number of visits due to mental retardation in the Northeast and depressive episodes in the South. Regressions showed that older children are less likely to visit outpatient services with a diagnosis of ADHD (F90.0). Conclusions Our analysis shows the conditions which cause the most burden to the child psychiatry outpatient centers in Brazil and relevant differences between regions. This information has immediate use for the training of staff and allocation of resources in each region.

Exploratory Study of Parenting Differences for Autism Spectrum Disorder and Attachment Disorder

The current study explored similarities and differences in parenting stress (PSI) and behaviours in parent reports of autism spectrum disorder (ASD) and attachment disorder (AD). 155 parents whose children had developmental delays and disorders completed the social communication questionnaire, Randolph attachment questionnaire, strengths and difficulties questionnaire, PSI, and parent-child relationship inventory. Parents of children with AD reported greater levels of PSI than parents of children with ASD. Parents of children reaching criteria for both disorders reported the greatest levels of PSI. Limit setting was poorest in parents of children with both classifications, followed by parents of children with AD, and then ASD. Limit setting mediated the relationship between PSI and child behaviour problems for parents of children with ASD < but not for parents of children with AD. These findings suggest different areas of difficulty for parents of children with these conditions, which may be of help in designing interventions.

Autistic Personality Traits and Treatment Outcome for Alcohol Use Disorders

ABSTRACT

The importance of personality traits for the outcome of psychiatric treatment, including treatment for alcohol use disorder (AUD), has been widely acknowledged. Also, research on autism spectrum disorders has evolved in recent years, emphasizing that the behavioral traits within these neuropsychiatric disorders exist on a dimension both within and outside the boundaries of psychopathology. In the present study, the relationship between personality traits associated with autistic functioning and level of alcohol use among patients before and after concluded AUD treatment was investigated. The participants (n = 165, diagnosed with AUD) were part of a longitudinal project on AUD treatment. Data from personality questionnaires (Structured Clinical Interview of Personality Disorders II and Temperament and Character Inventory) were used to assess autistic personality traits (APTs) based on behavior within Wing's triad, which were related to background and treatment outcome. The chosen APT items illustrated a personality functioning with an emphasis on social interaction and rigidity. Only certain included questions were indicative of still having a problematic drinking pattern 2.5 years after treatment entry, which adhered to phobic, obsessive-compulsive, and schizoid personality traits, as well as rigidity/stubbornness. Albeit with modest influence, the degree of APTs was associated with heavier drinking at treatment entry, and symptoms relating to social interaction and rigidity were associated with still having a problematic drinking pattern 2.5 years after treatment entry. A higher degree of such traits may result in having problems taking advice from others and establishing treatment alliance, important parts of treatment efficacy, making assessment of such traits relevant to clinicians.

Joint attention and intelligence in children with autism spectrum disorder without severe intellectual disability

In children with autism spectrum disorder (ASD), joint attention is regarded as a predictor of language function, social skills, communication, adaptive function, and intelligence. However, existing information about the association between joint attention and intelligence is limited. Most such studies have examined children with low intelligence. For this study, we investigated whether joint attention is related to intelligence in young children with autism spectrum disorder (ASD) without severe intellectual disability. We analyzed 113 children with ASD aged 40–98 months. Their Kaufman Assessment Battery (K‐ABC) Mental Processing Index (MPI) scores are 60 and more (mean 93.4). We evaluated their intelligence using K‐ABC and evaluated their joint attention using ADOS‐2. After we performed simple regression analyses using K‐ABC MPI and its nine subscales as dependent variables, using joint attention as the independent variable, we identified joint attention as a positive predictor of the MPI and its two subscales. From this result, we conclude that joint attention is related to intelligence in young children with ASD without severe intellectual disability. This result suggests a beneficial effect of early intervention targeting joint attention for children with ASD.

Attention deficit hyperactivity disorder (ADHD) symptoms, comorbid psychopathology, behaviour problems and gastrointestinal symptoms in children and adolescents with autism spectrum disorder

OBJECTIVES

The study aims to investigate attention deficit hyperactivity disorder (ADHD) symptoms, gastrointestinal (GI) symptoms, comorbid psychopathology and behaviour problems in children and adolescents with autism spectrum disorder (ASD).

METHODS

Parents of 147 children and adolescents with ASD aged 6-18 years completed the Conners 3 Parent-Short Form, Gastrointestinal Symptom Inventory, Behavior Problems Inventory-Short Form and Autism Spectrum Disorder-Comorbid for Children.

RESULTS

Fifty-six per cent of children and adolescents had a comorbid diagnosis of ADHD, yet over 70% presented with clinically significant ADHD symptoms. Forty per cent of participants received a diagnosis of ADHD before ASD and 25.6% received a diagnosis of ASD first. Relationships were found between ADHD symptoms and comorbid psychopathology, GI symptoms, and behaviour problems.

CONCLUSIONS

The outcomes suggest that ADHD is being underestimated as a comorbid disorder of ASD. This may have implications on treatment and interventions for children and adolescents who have a diagnosis of both ASD and ADHD.

Diagnosis of Autism Spectrum Disorder Across the Lifespan

Although autism spectrum disorder (ASD) is one of the most common neurodevelopmental disorders it is also one of the most heterogeneous conditions, making identification and diagnosis complex. The importance of a stable and consistent diagnosis cannot be overstated. An accurate diagnosis is the basis for understanding the individual and establishing an individualized treatment plan. We present those elements that should be included in any assessment for ASD and describe the ways in which ASD typically manifests itself at various developmental stages. The implications and challenges for assessment at different ages and levels of functioning are discussed.

Comparing Rates of Diagnosis Using DSM-IV-TR Versus DSM-5 Criteria for Autism Spectrum Disorder

With the publication of DSM-5, many changes were introduced regarding how Autism Spectrum Disorder (ASD) would be diagnosed. Changes from DSM-IV-TR were controversial, with many arguing that individuals would lose their diagnosis with the new criteria. The purpose of this study was to examine differences in the application of diagnostic criteria across both recent versions in a sample of infants and toddlers. Fewer individuals met criteria according to DSM-5; however, a larger proportion of individuals met criteria for both. Additionally, individuals with higher levels of symptoms were more likely to meet criteria for both versions as compared to either alone. Overall, results suggest that there are meaningful differences in how DSM criteria may apply to individuals with an ASD.

Psychiatric comorbidities in Asperger syndrome are related with polygenic overlap and differ from other Autism subtypes

There is great phenotypic heterogeneity within autism spectrum disorders (ASD), which has led to question their classification into a single diagnostic category. The study of the common genetic variation in ASD has suggested a greater contribution of other psychiatric conditions in Asperger syndrome (AS) than in the rest of the DSM-IV ASD subtypes (Non_AS). Here, using available genetic data from previously performed genome-wide association studies (GWAS), we aimed to study the genetic overlap between five of the most related disorders (schizophrenia (SCZ), major depression disorder (MDD), attention deficit hyperactivity disorder (ADHD), obsessive-compulsive disorders (OCD) and anxiety (ANX)), and AS, comparing it with the overlap in Non_AS subtypes. A Spanish cohort of autism trios (N = 371) was exome sequenced as part of the Autism Sequencing Consortium (ASC) and 241 trios were extensively characterized to be diagnosed with AS following DSM-IV and Gillberg's criteria (N = 39) or not (N = 202). Following exome imputation, polygenic risk scores (PRS) were calculated for ASD, SCZ, ADHD, MDD, ANX, and OCD (from available summary data from Psychiatric Genomic Consortium (PGC) repository) in the Spanish trios' cohort. By using polygenic transmission disequilibrium test (pTDT), we reported that risk for SCZ (P_scz= 0.008, corrected-P_SCZ = 0.0409), ADHD (P_ADHD = 0.021, corrected-P_ADHD = 0.0301), and MDD (P_MDD = 0.039, corrected-P_MDD = 0.0501) is over-transmitted to children with AS but not to Non_AS. Indeed, agnostic clustering procedure with deviation values from pTDT tests suggested two differentiated clusters of subjects, one of which is significantly enriched in AS (P = 0.025). Subsequent analysis with S-Predixcan, a recently developed software to predict gene expression from genotype data, revealed a clear pattern of correlation between cortical gene expression in ADHD and AS (P < 0.001) and a similar strong correlation pattern between MDD and AS, but also extendable to another non-brain tissue such as lung (P < 0.001). Altogether, these results support the idea of AS being qualitatively distinct from Non_AS autism and consistently evidence the genetic overlap between AS and ADHD, MDD, or SCZ.

Application of Supervised Machine Learning for Behavioral Biomarkers of Autism Spectrum Disorder Based on Electrodermal Activity and Virtual Reality

OBJECTIVE

Sensory processing is the ability to capture, elaborate, and integrate information through the five senses and is impaired in over 90% of children with autism spectrum disorder (ASD). The ASD population shows hyper-hypo sensitiveness to sensory stimuli that can generate alteration in information processing, affecting cognitive and social responses to daily life situations. Structured and semi-structured interviews are generally used for ASD assessment, and the evaluation relies on the examiner's subjectivity and expertise, which can lead to misleading outcomes. Recently, there has been a growing need for more objective, reliable, and valid diagnostic measures, such as biomarkers, to distinguish typical from atypical functioning and to reliably track the progression of the illness, helping to diagnose ASD. Implicit measures and ecological valid settings have been showing high accuracy on predicting outcomes and correctly classifying populations in categories.

METHODS

Two experiments investigated whether sensory processing can discriminate between ASD and typical development (TD) populations using electrodermal activity (EDA) in two multimodal virtual environments (VE): forest VE and city VE. In the first experiment, 24 children with ASD diagnosis and 30 TDs participated in both virtual experiences, and changes in EDA have been recorded before and during the presentation of visual, auditive, and olfactive stimuli. In the second experiment, 40 children have been added to test the model of experiment 1.

RESULTS

The first exploratory results on EDA comparison models showed that the integration of visual, auditive, and olfactive stimuli in the forest environment provided higher accuracy (90.3%) on sensory dysfunction discrimination than specific stimuli. In the second experiment, 92 subjects experienced the forest VE, and results on 72 subjects showed that stimuli integration achieved an accuracy of 83.33%. The final confirmatory test set (n = 20) achieved 85% accuracy, simulating a real application of the models. Further relevant result concerns the visual stimuli condition in the first experiment, which achieved 84.6% of accuracy in recognizing ASD sensory dysfunction.

CONCLUSION

According to our studies' results, implicit measures, such as EDA, and ecological valid settings can represent valid quantitative methods, along with traditional assessment measures, to classify ASD population, enhancing knowledge on the development of relevant specific treatments.

Diagnosis of Autism Spectrum Disorder Across the Lifespan

Although autism spectrum disorder (ASD) is one of the most common neurodevelopmental disorders it is also one of the most heterogeneous conditions, making identification and diagnosis complex. The importance of a stable and consistent diagnosis cannot be overstated. An accurate diagnosis is the basis for understanding the individual and establishing an individualized treatment plan. We present those elements that should be included in any assessment for ASD and describe the ways in which ASD typically manifests itself at various developmental stages. The implications and challenges for assessment at different ages and levels of functioning are discussed.

Non-complicit: Revisiting Hans Asperger's Career in Nazi-era Vienna

Recent allegations that pediatrician Hans Asperger legitimized Nazi policies, including forced sterilization and child euthanasia, are refuted with newly translated and chronologically-ordered information that takes into account Hitler's deceptive 'halt' to the T4 euthanasia program in 1941. It is highly unlikely that Asperger was aware of the T4 program when he referred Herta Schreiber to Am Spiegelgrund or when he mentioned that institution 4 months later on the medical chart of another (unrelated) girl, Elisabeth Schreiber. Asperger campaigned vigorously from 1938 to 1943 to have his specialization, Curative Education, take priority in the diagnosis and treatment of disabled children over other fields that promoted Nazi racial hygiene policies. He neither disparaged his patients nor was he sexist. By 1938, he had identified the essentials of Asperger syndrome and described an unnamed boy whom he later profiled (as Ernst K.) in 1944. Rather than doing 'thin' research, Asperger made discoveries that were prescient, and some of his activities conformed to definitions of "individual resistance."

Subtyping the Autism Spectrum Disorder: Comparison of Children with High Functioning Autism and Asperger Syndrome

Since Hans Asperger's first description (Arch Psych Nervenkrankh 117:76-136, 1944), through Lorna Wing's translation and definition (Psychol Med 11:115-129, 1981), to its introduction in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM, 1994), Asperger Syndrome has always aroused huge interest and debate, until vanishing in the DSM fifth edition (2013). The debate regarded its diagnostic validity and its differentiation from high functioning autism (HFA). The present study aimed to examine whether AS differed from HFA in clinical profiles and to analyze the impact of DSM-5's innovation. Differences in cognitive, language, school functioning and comorbidities, were revealed when 80 AS and 70 HFA patients (3-18 years) were compared. Results suggested that an AS empirical distinction within autism spectrum disorder should be clinically useful.

The Contribution of Inflammation to Autism Spectrum Disorders: Recent Clinical Evidence

Autism comprises a complex and heterogeneous spectrum of neurodevelopmental disorders, usually termed autism spectrum disorders (ASD). It is more prevalent in males than females, and genetic and environmental factors are believed to account in similar percentages to the development of ASD. In recent years, the contribution of inflammation and inflammatory mediators to disease aetiology and perpetuation has been the object of intense research. In this chapter, inflammatory aspects that contribute to ASD are discussed, including abnormal microglia activation and polarization phenotypes, increased systemic levels of pro-inflammatory mediators, and altered patterns of immune cell response to activation stimuli. Also, inflammation in the context of gut microbiome and the impact of inflammation on gender prevalence of ASD are considered. Finally, treatment impact on inflammatory parameters and the potential for use of anti-inflammatory drugs, alone or in combination with antipsychotics, to manage ASD are examined.

Assessing subtypes of restricted and repetitive behaviour using the Adult Repetitive Behaviour Questionnaire-2 in autistic adults

Background

The majority of previous research into restricted and repetitive behaviours (RRBs) has focussed on children, partly due to a lack of suitable measures for RRBs in adults. This study aimed to explore the psychometric properties of the Adult Repetitive Behaviour Questionnaire-2 (RBQ-2A) in a large sample of autistic adults using a self-report questionnaire method.

Methods

The RBQ-2A and Autism-Spectrum Quotient (AQ) were administered online. Data from 275 autistic adults aged 18-66 (M = 36.56, SD = 12.24; 100 men and 171 women) were analysed using polychoric principal components analysis (PCA). Reliability and validity were assessed using Cronbach's alpha and correlation analyses.

Results

PCA resulted in two components of the RBQ-2A, interpretable as repetitive sensory and motor behaviours (RSMB) and insistence on sameness (IS). Both components showed acceptable internal consistency (α = .70 and .81 respectively) and were significantly moderately correlated with scores on the AQ (r _s  = .25 and .42). Participants' scores on IS were higher than their scores on RSMB. RSMB, but not IS, was negatively associated with age, particularly in older adults (≥ 50 years). There were no gender differences.

Conclusions

The RBQ-2A is a reliable and valid self-report measure of RRBs in the present sample of autistic adults. As one of the few measures of RRBs aimed at adults, it is suitable for adults with the ability to read and complete a self-report questionnaire. Results build on previous work with children using the Repetitive Behaviour Questionnaire-2 (RBQ-2).

Examining the Association Between Autistic Traits and Atypical Sensory Reactivity: A Twin Study

OBJECTIVE

Atypical responses to sensory stimuli are common features of autism spectrum disorders (ASD). Consequently, atypical sensory reactivity (SR) is now a diagnostic feature of ASD. Quantitative genetic research on ASD has overlooked these symptoms, however. We therefore investigated the association between autistic traits and SR using twin methods.

METHOD

Autistic traits and SR were assessed by 2 separate scales in 12,419 Swedish twin pairs (n = 3,586 monozygotic [MZ], n = 8,833 dizygotic [DZ]) when the twins were 9 or 12 years of age. The classic twin design estimated the degree to which etiological factors associated with autistic traits were also associated with SR, and the degree to which such shared factors explained the covariance between these phenotypes. DeFries-Fulker analysis estimated the genetic correlation between screening diagnoses of ASD, defined broadly and strictly, and SR.

RESULTS

Autistic traits and SR were both highly heritable (62%-75% and 66%-71%, respectively). There was a moderate phenotypic correlation between autistic traits and SR (r = 0.47). Genetic influences on these phenotypes correlated moderately (genetic correlation = 0.60). These overlapping genetic factors explained most of the correlation between autistic traits and SR. Genetic correlations with SR increased for broad ASD (genetic correlation = 0.72) and strict ASD (genetic correlation = 0.80).

CONCLUSION

The genetic overlap observed between autistic traits and SR lends quantitative genetic support to the notion that ASD and SR are strongly linked. Such symptoms may thus comprise part of the ASD genotype, as well as phenotype. Associations persisted across all definitions of ASD, indicating a genetic link between the broader ASD phenotype and SR.

A psycho-legal perspective on sexual offending in individuals with autism Spectrum disorder

It is important to consider whether there are innate vulnerabilities that increase the risk of an individual with an autistic spectrum disorder (ASD), predominantly those defendants with a diagnosis of Asperger's Syndrome, being charged and convicted of a sexual offence. The significance of such can be readily seen in recent English case law, with judgments on appeal finding convictions unsafe where there have been a number of failings in the Judge's summing up. In this article, we will consider the gravity of Judges omitting to highlight a defendant's diagnosis of autism spectrum disorder and the necessity of detailed explanations to jury members regarding the condition and its effect upon thoughts and behaviour. Consideration will be specifically given to the necessity to prove sexual motivation in such offences and the judicial direction required in relation to whether the appellant's actions had been sexually motivated. Recognition of the social impairments inherent in ASDs are vital to this work and we shall consider whether the difficulty with the capacity to develop appropriate, consenting sexual relationships as a result of impaired social cognition may be one of the factors which increases the risk of sexual offending in individuals with ASD (Higgs & Carter, 2015).

Sociopsychological and physiological effects of a robot-assisted therapy for children with autism

This article reports our findings from a robot-assisted therapeutic study conducted over 49 days to investigate the sociopsychological and physiological effects in children with autism spectrum disorder using a parrot-inspired robot, KiliRo, that we developed to help in therapeutic settings. We investigated the frequency of participants’ interactions among each other and assessed any changes in interaction using social network analysis. Interactions were assessed through manual observation before and after exposure to the robot. Urinary and salivary tests were performed to obtain protein and α-amylase levels, respectively, to report the physiological changes in participating children with autism spectrum disorder before and after interacting with the robot. This is a pioneering human–robot interaction study to investigate changes in stress levels using salivary samples. Systolic and diastolic blood pressure, heart rate, and arterial oxygen saturation level in blood were also monitored to investigate the physiological changes in participating children before, during, and after interacting with our parrot-inspired robot, KiliRo. The results show that the robot can help increase social interaction among children with autism spectrum disorder and assist in learning tasks. Furthermore, the clinical biochemistry test report using urinary and salivary samples indicates that the stress levels of children with autism reduced notably after interacting with the robot. Nevertheless, blood pressure, heart rate, and oxygen levels in blood did not show positive change in all participants.

Profile of two hundred children with Autism Spectrum Disorder from a tertiary child and adolescent psychiatry centre

BACKGROUND

There is a recent trend of increase in diagnosis of Autism Spectrum Disorder in India. Till date, there are few retrospective and prospective Indian studies with limited sample sizes ranging from 16 to 94 children. With this background, we planned a retrospective chart review of all new cases of Autism Spectrum Disorder for a period of 1 year in our tertiary care child psychiatry centre.

METHODOLOGY

Objectives of this study were to compare the sociodemographic and clinical profile of children below and above 3 years of age and between those who were self-referred versus those referred by professionals.

RESULTS

Out of a total of 1957 case records, 201 children (10.3%) were diagnosed with Autism Spectrum Disorder. Male to female ratio was 4:1.2. Mean age of consultation was significantly higher in males. Seventy six percent had a comorbid disorder with Intellectual disability, Attention Deficit Hyperactivity Disorder and Epilepsy being the most common comorbidities. Most caregivers (92.5%) recognized symptoms by 3 years of age. Presenting complaint of poor social response was more prevalent in children <3 years and co-morbidities in children above 3 years. Presenting complaint of speech delay was more common in children who were referred by professionals when compared with those who were self-referred.

DISCUSSION

There is a need to sensitize parents and professionals for early intervention and to standardize protocols for assessment and intervention.

Color Vision Losses in Autism Spectrum Disorders

Autism spectrum disorders (ASDs) are neurodevelopmental conditions characterized by impairments in social/communication abilities and restricted behaviors. The present study aims to examine color vision discrimination in ASD children and adolescents without intellectual disability. The participants were also subdivided in order to compare color vision thresholds of autistic participants and those who achieved diagnostic criteria for Asperger Syndrome (AS). Nine subjects with autism, 11 participants with AS and 36 typically developing children and adolescents participated in the study. Color vision was assessed by the Cambridge Color Test (CCT). The Trivector protocol was administered to determine color discrimination thresholds along the protan, deutan, and tritan color confusion lines. Data from ASD participants were compared to tolerance limits for 90% of the population with 90% probability obtained from controls thresholds. Of the 20 ASD individuals examined, 6 (30%) showed color vision losses. Elevated color discrimination thresholds were found in 3/9 participants with autism and in 3/11 AS participants. Diffuse and tritan deficits were found. Mechanisms for chromatic losses may be either at the retinal level and/or reflect reduced cortical integration.

Stochastic Signatures of Involuntary Head Micro-movements Can Be Used to Classify Females of ABIDE into Different Subtypes of Neurodevelopmental Disorders

Background: The approximate 5:1 male to female ratio in clinical detection of Autism Spectrum Disorder (ASD) prevents research from characterizing the female phenotype. Current open access repositories [such as those in the Autism Brain Imaging Data Exchange (ABIDE I-II)] contain large numbers of females to help begin providing a new characterization of females on the autistic spectrum. Here we introduce new methods to integrate data in a scale-free manner from continuous biophysical rhythms of the nervous systems and discrete (ordinal) observational scores.

Methods: New data-types derived from image-based involuntary head motions and personalized statistical platform were combined with a data-driven approach to unveil sub-groups within the female cohort. Further, to help refine the clinical DSM-based ASD vs. Asperger's Syndrome (AS) criteria, distributional analyses of ordinal score data from Autism Diagnostic Observation Schedule (ADOS)-based criteria were used on both the female and male phenotypes.

Results: Separate clusters were automatically uncovered in the female cohort corresponding to differential levels of severity. Specifically, the AS-subgroup emerged as the most severely affected with an excess level of noise and randomness in the involuntary head micro-movements. Extending the methods to characterize males of ABIDE revealed ASD-males to be more affected than AS-males. A thorough study of ADOS-2 and ADOS-G scores provided confounding results regarding the ASD vs. AS male comparison, whereby the ADOS-2 rendered the AS-phenotype worse off than the ASD-phenotype, while ADOS-G flipped the results. Females with AS scored higher on severity than ASD-females in all ADOS test versions and their scores provided evidence for significantly higher severity than males. However, the statistical landscapes underlying female and male scores appeared disparate. As such, further interpretation of the ADOS data seems problematic, rather suggesting the critical need to develop an entirely new metric to measure social behavior in females.

Conclusions: According to the outcome of objective, data-driven analyses and subjective clinical observation, these results support the proposition that the female phenotype is different. Consequently the “social behavioral male ruler” will continue to mask the female autistic phenotype. It is our proposition that new observational behavioral tests ought to contain normative scales, be statistically sound and combined with objective data-driven approaches to better characterize the females across the human lifespan.

On the nature of the speech perception deficits in children with autism spectrum disorders

Previous studies have claimed to show deficits in the perception of speech sounds in autism spectrum disorders (ASD). The aim of the current study was to clarify the nature of such deficits. Children with ASD might only exhibit a lesser amount of precision in the perception of phoneme categories (CPR deficit). However, these children might further present an allophonic mode of speech perception, similar to the one evidenced in dyslexia, characterised by enhanced discrimination of acoustic differences within phoneme categories. Allophonic perception usually gives rise to a categorical perception (CP) deficit, characterised by a weaker coherence between discrimination and identification of speech sounds. The perceptual performance of ASD children was compared to that of control children of the same chronological age. Identification and discrimination data were collected for continua of natural vowels, synthetic vowels, and synthetic consonants. Results confirmed that children with ASD exhibit a CPR deficit for the three stimulus continua. These children further exhibited a trend toward allophonic perception that was, however, not accompanied by the usual CP deficit. These findings confirm that the commonly found CPR deficit is also present in ASD. Whether children with ASD also present allophonic perception requires further investigations.

Perinatal issues for women with high functioning autism spectrum disorder

PROBLEM

Autistic Spectrum Disorder (ASD) is an increasingly commonly diagnosed disability. People with ASD commonly report challenges in social interaction and a heightened sensory perception. These challenges may be particularly difficult for women during pregnancy, birthing and beyond.

BACKGROUND

Very little is known about the experiences and needs of birthing women who have ASD. There is a large body of literature about women who have autistic children, but almost nothing about women who may have this disability themselves. Internet blogs provide some insights and suggest that birthing women with ASD may have particular challenges related to communication, decision making and sensory overload.

QUESTION

This study explores the particular issues and experiences of birthing women who have ASD, through pregnancy, birth and early mothering.

METHOD

This qualitative research used a case study approach, with in-depth interviewing and email exchange providing the data for the study. This data was verified, transcribed and analysed thematically.

FINDINGS

The findings of this case study identified three key issues: communication and service difficulties; sensory stress and parenting challenges.

DISCUSSION AND CONCLUSION

Findings suggest that women with ASD may face particular challenges during pregnancy, birthing and early mothering. These challenges evolve from perceptions of the woman about her midwives and other caregivers. If a woman perceives that her midwife is judgemental about her, then she may withdraw from the care and support she and her baby need.

[The Revision and 5th Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5): Consequences for the Diagnostic Work with Children and Adolescents]

The Revision and 5th Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5): Consequences for the Diagnostic Work with Children and Adolescents.The present paper describes and discusses the major revisions in DSM-5 for children and adolescents. A major modification is that the separate chapter for disorders first diagnosed in childhood and adolescence was abandoned in favour of the integration of these clinical pictures into the relevant disorder-specific chapters. Several new diagnoses and diagnostic groups were introduced: "Disruptive mood regulation disorder" is a new diagnosis; the different diagnoses for autism were brought together into one, and a new diagnostic group for obsessive-compulsive disorders has been established. The developmental approach of DSM-5 and the integration of dimensional assessment tools are to be welcomed. Practice will show if the critiques afraid of possible increases in prevalences or those who approve the changes will end up being right.

Can you see it too? Observed and self-rated participation in mainstream schools in students with and without autism spectrum disorders

OBJECTIVES

To examine the degree to which observations can capture perception of participation, observed and self-rated levels of interactions for students with and without autism spectrum disorders (ASD) were explored.

METHODS

Frequencies and levels of involvement in interactions with classmates were observed and compared in 22 students with ASD and 84 of their classmates in mainstream schools, using a standardized protocol. Self-reported participation measurements regarding interactions with classmates and teachers from five questionnaire items were correlated with the observations. In total, 51,516 data points were coded and entered into the analyses, and correlated with 530 questionnaire ratings.

RESULTS

Only one weak correlation was found in each group. Compared with classmates, students with ASD participated less frequently, but were not less involved when they actually did.

CONCLUSIONS

Observations alone do not capture the individuals' perception of participation and are not sufficient if the subjective aspect of participation is to be measured.

[Clinical Implications of Changes in Child Psychiatry in the DSM-5. Strengths and Weaknesses of the Changes]

The Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Statistical Classification of Diseases and related health problems (ICD) integrate the diagnostic criteria commonly used in psychiatric practice, but the DSM-IV-TR was insufficient for current clinical work. The DSM-5 was first made public in May at the Congress of the American Psychiatric Association, and it includes changes to some aspects of Child Psychiatry, as many of the conditions that were at the beginning in chapter of infancy, childhood and adolescence disorders have been transferred to other chapters and there are new diagnostic criteria or new terms are added. It is therefore important to provide it to Psychiatrists who attend children in order to assess the changes they will be facing in the nomenclature and classification in pursuit of a better classification of the childhood psychopathology.

Psychiatric comorbidities in autism spectrum disorder: A comparative study between DSM-IV-TR and DSM-5 diagnosis

Background/Objective: The heterogeneous clinical presentations of individuals with Autism Spectrum Disorders (ASD) pose a significant challenge for sample characterization. Therefore the main goal of DSM-5 must be to identify subgroups of ASD, including comorbidity disorders and severity. The main goal of this study is to explore the psychiatric comorbidities and the severity of symptoms that could be relevant for the phenotype characterization in ASD and also to compare these results according to the different classification criteria between the DSM-IV-TR and the DSM-5. Method: A comparative study of severity and psychiatric comorbidities was carried out between a sample of participants that only met criteria for Pervasive Developmental Disorder (PDD) according to the DSM-IV-TR and a sample of participants that also met ASD criteria according to DSM-5 classification. The recruitment of children was via educational (N = 123). The psychiatric symptoms, comorbid disorders and severity of symptoms were assessed through The Nisonger Child Behavior Rating Form, clinical interview and The Inventory of Autism Spectrum Disorder, respectively. The psychiatric comorbidities considered were: anxiety, eating behavioural problems, self-aggressiveness, hetero–aggressiveness, self-harm, obsessive compulsive disorder and attention deficit and hyperactivity disorder. Results: Statistically significant differences between both groups were found regarding obsessive compulsive disorder, eating behavioural problems and severity. Conclusions: The results support the hypothesis that patients who meet the DSM-5 criteria have more severe symptoms, not only regarding the core autistic symptoms but also in relation with psychiatric comorbidities.

Comorbid psychopathology rates in children diagnosed with autism spectrum disorders according to the DSM-IV-TR and the proposed DSM-5

OBJECTIVE

To investigate differences in comorbid psychopathology rates between individuals who meet criteria of Autism Spectrum Disorders (ASDs) according to DSM-5 or the DSM-IV-TR.

METHODS

Comorbid psychopathology was measured using the Autism Spectrum Disorders- Comorbid for Children. 424 individuals between the ages of 2 and 18 years of age; including children who met criteria for an ASD according to the DSM-5, the DSM-IV-TR only, and a control group that did not meet either set of criteria.

RESULTS

Of the ASD participants, 36% would no longer meet criteria according to proposed DSM-5. Comorbidity rates for the ASD groups were significantly different from the control group; however, ASD groups were not significantly different in terms of total comorbid psychopathology.

CONCLUSION

The results elucidate the need for further research regarding services and treatments for those individuals that will no longer meet criteria for an ASD but still have significant rates of comorbid psychopathology.

Factor structure of the Childhood Autism Rating Scale as per DSM-5

BACKGROUND

The DSM-5 recently proposed new diagnostic criteria for autism spectrum disorder (ASD). Although many new or updated tools have been developed since the DSM-IV was published in 1994, the Childhood Autism Rating Scale (CARS) has been used consistently in ASD diagnosis and research due to its technical adequacy, cost-effectiveness, and practicality. Additionally, items in the CARS did not alter following the release of the revised DSM-IV because the CARS factor structure was found to be consistent with the revised criteria after factor analysis. For that reason, in this study confirmatory factor analysis was used to identify the factor structure of the CARS.

METHOD

Participants (n = 150) consisted of children with an ASD diagnosis or who met the criteria for broader autism or emotional/behavior disorder with comorbid disorders such as attention-deficit hyperactivity disorder, bipolar disorder, intellectual or developmental disabilities. Previous studies used one-, two-, and four-factor models, all of which we examined to confirm the best-fit model on confirmatory factor analysis.

RESULTS

Appropriate comparative fit indices and root mean square errors were obtained for all four models. The two-factor model, based on DSM-5 criteria, was the most valid and reliable. The inter-item consistency of the CARS was 0.926 and demonstrated adequate reliability, thereby supporting the validity and reliability of the two-factor model of CARS.

CONCLUSIONS

Although CARS was developed prior to the introduction of DSM-5, its psychometric properties, conceptual relevance, and flexible administration procedures support its continued role as a screening device in the diagnostic decision-making process.

A Concise History of Asperger Syndrome: The Short Reign of a Troublesome Diagnosis

First described in 1944 by Hans Asperger (1944), it was not before 1994 that Asperger Syndrome (AS) was included in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, only to disappear in the Manual's fifth edition in 2013. During its brief existence as a diagnostic entity, AS aroused immense interest and controversy. Similar to patients with autism, AS patients show deficits in social interaction, inappropriate communication skills, and interest restriction, but also display a rich variety of subtle clinical characteristics that for many distinguish AS from autism. However, difficulties operationalising diagnostic criteria and differentiating AS from autism ultimately led to its merging into the unifying category of Autistic Spectrum Disorders. Here we briefly review the short history of this fascinating condition.

The effect of gender on the neuroanatomy of children with autism spectrum disorders: a support vector machine case-control study

Background

Genetic, hormonal, and environmental factors contribute since infancy to sexual dimorphism in regional brain structures of subjects with typical development. However, the neuroanatomical differences between male and female children with autism spectrum disorders (ASD) are an intriguing and still poorly investigated issue. This study aims to evaluate whether the brain of young children with ASD exhibits sex-related structural differences and if a correlation exists between clinical ASD features and neuroanatomical underpinnings.

Methods

A total of 152 structural MRI scans were analysed. Specifically, 76 young children with ASD (38 males and 38 females; 2–7 years of age; mean = 53 months, standard deviation = 17 months) were evaluated employing a support vector machine (SVM)-based analysis of the grey matter (GM). Group comparisons consisted of 76 age-, gender- and non-verbal-intelligence quotient-matched children with typical development or idiopathic developmental delay without autism.

Results

For both genders combined, SVM showed a significantly increased GM volume in young children with ASD with respect to control subjects, predominantly in the bilateral superior frontal gyrus (Brodmann area –BA– 10), bilateral precuneus (BA 31), bilateral superior temporal gyrus (BA 20/22), whereas less GM in patients with ASD was found in right inferior temporal gyrus (BA 37). For the within gender comparisons (i.e., females with ASD vs. controls and males with ASD vs. controls), two overlapping regions in bilateral precuneus (BA 31) and left superior frontal gyrus (BA 9/10) were detected. Sex-by-group analyses revealed in males with ASD compared to matched controls two male-specific regions of increased GM volume (left middle occipital gyrus—BA 19—and right superior temporal gyrus—BA 22). Comparisons in females with and without ASD demonstrated increased GM volumes predominantly in the bilateral frontal regions. Additional regions of significantly increased GM volume in the right anterior cingulate cortex (BA 32) and right cerebellum were typical only of females with ASD.

Conclusions

Despite the specific behavioural correlates of sex-dimorphism in ASD, brain morphology as yet remains unclear and requires future dedicated investigations. This study provides evidence of structural brain gender differences in young children with ASD that possibly contribute to the different phenotypic disease manifestations in males and females.

Electronic supplementary material

The online version of this article (doi:10.1186/s13229-015-0067-3) contains supplementary material, which is available to authorized users.

Factors influencing waiting times for diagnosis of Autism Spectrum Disorder in children and adults

AIMS

To identify the main factors predicting delays in diagnosis for Autism Spectrum Disorder (ASD) at three stages in the diagnostic process: wait for first appointment; assessment duration, and total wait for diagnosis.

METHOD

Data were gathered from 150 case notes (80 child and 70 adult cases) from 16 diagnosing services across Scotland.

RESULTS

Having more information pre-assessment was associated with a reduced duration of the diagnostic process for children. This relationship was partially mediated by a reduction in the number of contacts required for diagnosis. In adults, having more factors associated with ASD (increased risk) reduced the wait time from referral to first appointment, but increased the overall duration of the diagnostic process. The latter relationship was partially mediated by an increase in the number of contacts required for diagnosis.

CONCLUSION

Within children's services, increasing the amount of relevant information available pre-assessment is likely to reduce total duration of the assessment process by reducing number of contacts required. Having a high risk of ASD as an adult appears to result in being seen more quickly following referral, but also to increase the number of contacts needed and assessment duration. As a result, it increases and total duration overall.

Removal of Asperger's syndrome from the DSM V: community response to uncertainty

The May 2013 release of the new version of the Diagnostic and Statistical Manual of Mental Disorders (DSM V) subsumed Asperger's syndrome under the wider diagnostic label of autism spectrum disorder (ASD). The revision has created much uncertainty in the community affected by this condition. This study uses problematic integration theory and thematic analysis to investigate how participants in Wrong Planet, a large online community associated with autism and Asperger's syndrome, have constructed these uncertainties. The analysis illuminates uncertainties concerning both the likelihood of diagnosis and value of diagnosis, and it details specific issues within these two general areas of uncertainty. The article concludes with both conceptual and practical implications.

QEEG spectral and coherence assessment of autistic children in three different experimental conditions

We studied autistics by quantitative EEG spectral and coherence analysis during three experimental conditions: basal, watching a cartoon with audio (V–A), and with muted audio band (VwA). Significant reductions were found for the absolute power spectral density (PSD) in the central region for delta and theta, and in the posterior region for sigma and beta bands, lateralized to the right hemisphere. When comparing VwA versus the V–A in the midline regions, we found significant decrements of absolute PSD for delta, theta and alpha, and increments for the beta and gamma bands. In autistics, VwA versus V–A tended to show lower coherence values in the right hemisphere. An impairment of visual and auditory sensory integration in autistics might explain our results.