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Coelho DRA, Renet C, López-Rodríguez S, Cassano P, Vieira WF. Transcranial photobiomodulation for neurodevelopmental disorders: a narrative review. Photochem Photobiol Sci 2024:10.1007/s43630-024-00613-7. [PMID: 39009808 DOI: 10.1007/s43630-024-00613-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 07/07/2024] [Indexed: 07/17/2024]
Abstract
BACKGROUND Neurodevelopmental disorders (NDDs) such as autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), and Down syndrome (DS) significantly impact social, communicative, and behavioral functioning. Transcranial photobiomodulation (t-PBM) with near-infrared light is a promising non-invasive neurostimulation technique for neuropsychiatric disorders, including NDDs. This narrative review aimed to examine the preclinical and clinical evidence of photobiomodulation (PBM) in treating NDDs. METHODS A comprehensive search across six databases was conducted, using a combination of MeSH terms and title/abstract keywords: "photobiomodulation", "PBM", "neurodevelopmental disorders", "NDD", and others. Studies applying PBM to diagnosed NDD cases or animal models replicating NDDs were included. Protocols, reviews, studies published in languages other than English, and studies not evaluating clinical or cognitive outcomes were excluded. RESULTS Nine studies were identified, including one preclinical and eight clinical studies (five on ASD, two on ADHD, and one on DS). The reviewed studies encompassed various t-PBM parameters (wavelengths: 635-905 nm) and targeted primarily frontal cortex areas. t-PBM showed efficacy in improving disruptive behavior, social communication, cognitive rigidity, sleep quality, and attention in ASD; in enhancing attention in ADHD; and in improving motor skills and verbal fluency in DS. Minimal adverse effects were reported. Proposed mechanisms involve enhanced mitochondrial function, modulated oxidative stress, and reduced neuroinflammation. CONCLUSIONS t-PBM emerges as a promising intervention for NDDs, with potential therapeutic effects across ASD, ADHD, and DS. These findings underscore the need for further research, including larger-scale, randomized sham-controlled clinical trials with comprehensive biomarker analyses, to optimize treatment parameters and understand the underlying mechanisms associated with the effects of t-PBM.
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Affiliation(s)
- David Richer Araujo Coelho
- Division of Neuropsychiatry and Neuromodulation, Massachusetts General Hospital, Boston, USA
- Department of Psychiatry, Harvard Medical School, Boston, USA
- Harvard T. H. Chan School of Public Health, Boston, USA
| | - Christian Renet
- Division of Neuropsychiatry and Neuromodulation, Massachusetts General Hospital, Boston, USA
- Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Sergi López-Rodríguez
- Division of Neuropsychiatry and Neuromodulation, Massachusetts General Hospital, Boston, USA
- Department of Psychiatry, Bellvitge University Hospital, Bellvitge Biomedical Research Institute, Carlos III Health Institute, Institute of Neurosciences, University of Barcelona, Barcelona, Spain
| | - Paolo Cassano
- Division of Neuropsychiatry and Neuromodulation, Massachusetts General Hospital, Boston, USA
- Department of Psychiatry, Harvard Medical School, Boston, USA
| | - Willians Fernando Vieira
- Division of Neuropsychiatry and Neuromodulation, Massachusetts General Hospital, Boston, USA.
- Department of Psychiatry, Harvard Medical School, Boston, USA.
- Department of Anatomy, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil.
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Arutiunian V, Arcara G, Buyanova I, Fedorov M, Davydova E, Pereverzeva D, Sorokin A, Tyushkevich S, Mamokhina U, Danilina K, Dragoy O. Abnormalities in both stimulus-induced and baseline MEG alpha oscillations in the auditory cortex of children with Autism Spectrum Disorder. Brain Struct Funct 2024; 229:1225-1242. [PMID: 38683212 DOI: 10.1007/s00429-024-02802-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 04/22/2024] [Indexed: 05/01/2024]
Abstract
The neurobiology of Autism Spectrum Disorder (ASD) is hypothetically related to the imbalance between neural excitation (E) and inhibition (I). Different studies have revealed that alpha-band (8-12 Hz) activity in magneto- and electroencephalography (MEG and EEG) may reflect E and I processes and, thus, can be of particular interest in ASD research. Previous findings indicated alterations in event-related and baseline alpha activity in different cortical systems in individuals with ASD, and these abnormalities were associated with core and co-occurring conditions of ASD. However, the knowledge on auditory alpha oscillations in this population is limited. This MEG study investigated stimulus-induced (Event-Related Desynchronization, ERD) and baseline alpha-band activity (both periodic and aperiodic) in the auditory cortex and also the relationships between these neural activities and behavioral measures of children with ASD. Ninety amplitude-modulated tones were presented to two groups of children: 20 children with ASD (5 girls, Mage = 10.03, SD = 1.7) and 20 typically developing controls (9 girls, Mage = 9.11, SD = 1.3). Children with ASD had a bilateral reduction of alpha-band ERD, reduced baseline aperiodic-adjusted alpha power, and flattened aperiodic exponent in comparison to TD children. Moreover, lower raw baseline alpha power and aperiodic offset in the language-dominant left auditory cortex were associated with better language skills of children with ASD measured in formal assessment. The findings highlighted the alterations of E / I balance metrics in response to basic auditory stimuli in children with ASD and also provided evidence for the contribution of low-level processing to language difficulties in ASD.
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Affiliation(s)
- Vardan Arutiunian
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, 1920 Terry Ave, Seattle, WA, 98101, United States of America.
| | | | - Irina Buyanova
- Center for Language and Brain, HSE University, Moscow, Russia
- University of Otago, Dunedin, New Zealand
| | - Makar Fedorov
- Center for Language and Brain, HSE University, Nizhny Novgorod, Russia
| | - Elizaveta Davydova
- Federal Resource Center for ASD, Moscow State University of Psychology and Education, Moscow, Russia
- Chair of Differential Psychology and Psychophysiology, Moscow State University of Psychology and Education, Moscow, Russia
| | - Darya Pereverzeva
- Federal Resource Center for ASD, Moscow State University of Psychology and Education, Moscow, Russia
| | - Alexander Sorokin
- Federal Resource Center for ASD, Moscow State University of Psychology and Education, Moscow, Russia
- Haskins Laboratories, New Haven, CT, United States of America
| | - Svetlana Tyushkevich
- Federal Resource Center for ASD, Moscow State University of Psychology and Education, Moscow, Russia
| | - Uliana Mamokhina
- Federal Resource Center for ASD, Moscow State University of Psychology and Education, Moscow, Russia
| | - Kamilla Danilina
- Federal Resource Center for ASD, Moscow State University of Psychology and Education, Moscow, Russia
- Scientific Research and Practical Center of Pediatric Psychoneurology, Moscow, Russia
| | - Olga Dragoy
- Center for Language and Brain, HSE University, Moscow, Russia
- Institute of Linguistics, Russian Academy of Sciences, Moscow, Russia
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Mahjoob M, Cardy R, Penner M, Anagnostou E, Andrade BF, Crosbie J, Kelley E, Ayub M, Ayub M, Brian J, Iaboni A, Schachar R, Georgiades S, Nicolson R, Jones J, Kushki A. Predictors of health-related quality of life for children with neurodevelopmental conditions. Sci Rep 2024; 14:6377. [PMID: 38493236 PMCID: PMC10944519 DOI: 10.1038/s41598-024-56821-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 03/11/2024] [Indexed: 03/18/2024] Open
Abstract
Neurodevelopmental conditions can be associated with decreased health-related quality of life; however, the predictors of these outcomes remain largely unknown. We characterized the predictors of health-related quality of life (HRQoL) in a sample of neurodiverse children and youth. We used a cross-sectional subsample from the Province of Ontario Neurodevelopmental Disorders Network (POND) consisting of those children and young people in the POND dataset with complete study data (total n = 615; 31% female; age: 11.28 years ± 2.84 years). Using a structural equation model, we investigated the effects of demographics (age, sex, socioeconomic status), core features (Social Communication Questionnaire, Toronto Obsessive Compulsive Scale, Strengths and Weaknesses of attention deficit/hyperactivity disorder (ADHD)-symptoms and Normal Behavior), co-occurring symptoms (Child Behaviour Checklist), and adaptive functioning (Adaptive Behaviour Assessment System) on HRQoL (KINDL). A total of 615 participants had complete data for this study (autism = 135, ADHD = 273, subthreshold ADHD = 7, obsessive-compulsive disorder (OCD) = 38, sub-threshold OCD = 1, neurotypical = 161). Of these participants, 190 (31%) identified as female, and 425 (69%) identified as male. The mean age was 11.28 years ± 2.84 years. Health-related quality of life was negatively associated with co-occurring symptoms (B = - 0.6, SE = 0.20, CI (- 0.95, - 0.19), p = 0.004)) and age (B = - 0.1, SE = 0.04, CI (- 0.19, - 0.01), p = 0.037). Fewer co-occurring symptoms were associated with higher socioeconomic status (B = - 0.5, SE = - 0.05, CI (- 0.58, - 0.37), p < 0.001). This study used a cross-sectional design. Given that one's experiences, needs, supports, and environment and thus HrQoL may change significantly over the lifespan and a longitudinal analysis of predictors is needed to capture these changes. Future studies with more diverse participant groups are needed. These results demonstrate the importance of behavioural and sociodemographic characteristics on health-related quality of life across neurodevelopmental conditions.
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Affiliation(s)
- Maryam Mahjoob
- Institute of Biomedical Engineering, University of Toronto, Toronto, Canada
| | - Robyn Cardy
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, 150 Kilgour Road, Toronto, ON, M4G 1R8, Canada
| | - Melanie Penner
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, 150 Kilgour Road, Toronto, ON, M4G 1R8, Canada
| | - Evdokia Anagnostou
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, 150 Kilgour Road, Toronto, ON, M4G 1R8, Canada
| | - Brendan F Andrade
- Department of Psychiatry, Margaret and Wallace McCain Centre for Child Youth and Family Mental Health, Centre for Addiction and Mental Health, University of Toronto, Toronto, Canada
| | - Jennifer Crosbie
- Department of Psychiatry, The Hospital for Sick Children (SickKids), Toronto, Canada
| | | | - Muhammad Ayub
- Department of Psychiatry, Queen's University, Kingston, Canada
| | - Muhammad Ayub
- Department of Psychology, Queen's University, Kingston, Canada
| | - Jessica Brian
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, 150 Kilgour Road, Toronto, ON, M4G 1R8, Canada
| | - Alana Iaboni
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, 150 Kilgour Road, Toronto, ON, M4G 1R8, Canada
| | - Russell Schachar
- Department of Psychiatry, The Hospital for Sick Children (SickKids), Toronto, Canada
| | - Stelios Georgiades
- Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | - Rob Nicolson
- Department of Psychiatry, Western University, London, Canada
| | - Jessica Jones
- Department of Psychiatry, Queen's University, Kingston, Canada
| | - Azadeh Kushki
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, 150 Kilgour Road, Toronto, ON, M4G 1R8, Canada.
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Nogay HS, Adeli H. Multiple Classification of Brain MRI Autism Spectrum Disorder by Age and Gender Using Deep Learning. J Med Syst 2024; 48:15. [PMID: 38252192 PMCID: PMC10803393 DOI: 10.1007/s10916-023-02032-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 12/31/2023] [Indexed: 01/23/2024]
Abstract
The fact that the rapid and definitive diagnosis of autism cannot be made today and that autism cannot be treated provides an impetus to look into novel technological solutions. To contribute to the resolution of this problem through multiple classifications by considering age and gender factors, in this study, two quadruple and one octal classifications were performed using a deep learning (DL) approach. Gender in one of the four classifications and age groups in the other were considered. In the octal classification, classes were created considering gender and age groups. In addition to the diagnosis of ASD (Autism Spectrum Disorders), another goal of this study is to find out the contribution of gender and age factors to the diagnosis of ASD by making multiple classifications based on age and gender for the first time. Brain structural MRI (sMRI) scans of participators with ASD and TD (Typical Development) were pre-processed in the system originally designed for this purpose. Using the Canny Edge Detection (CED) algorithm, the sMRI image data was cropped in the data pre-processing stage, and the data set was enlarged five times with the data augmentation (DA) techniques. The most optimal convolutional neural network (CNN) models were developed using the grid search optimization (GSO) algorism. The proposed DL prediction system was tested with the five-fold cross-validation technique. Three CNN models were designed to be used in the system. The first of these models is the quadruple classification model created by taking gender into account (model 1), the second is the quadruple classification model created by taking into account age (model 2), and the third is the eightfold classification model created by taking into account both gender and age (model 3). ). The accuracy rates obtained for all three designed models are 80.94, 85.42 and 67.94, respectively. These obtained accuracy rates were compared with pre-trained models by using the transfer learning approach. As a result, it was revealed that age and gender factors were effective in the diagnosis of ASD with the system developed for ASD multiple classifications, and higher accuracy rates were achieved compared to pre-trained models.
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Affiliation(s)
- Hidir Selcuk Nogay
- Electrical and Energy Department, Bursa Uludag University, Bursa, Turkey
| | - Hojjat Adeli
- Departments of Biomedical Informatics and Neuroscience, College of Medicine, The Ohio State University Neurology, 370 W. 9th Avenue, Columbus, OH, 43210, USA.
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Petti T, Gupta M, Fradkin Y, Gupta N. Management of sleep disorders in autism spectrum disorder with co-occurring attention-deficit hyperactivity disorder: update for clinicians. BJPsych Open 2023; 10:e11. [PMID: 38088185 PMCID: PMC10755553 DOI: 10.1192/bjo.2023.589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 08/24/2023] [Accepted: 09/01/2023] [Indexed: 12/31/2023] Open
Abstract
AIMS To update and examine available literature germane to the recognition, assessment and treatment of comorbid autism spectrum disorder (ASD), attention-deficit hyperactivity disorder (ADHD) and sleep disruption, with a predominant focus on children, adolescents and emerging adults. BACKGROUND Considerable overlaps exist among ASD, ADHD and sleep disruption. Literature and guidance for clinicians, administrators, policy makers and families have been limited, as such deliberations were rarely considered until 2013. METHOD This narrative review of the literature addressing sleep disruption issues among those with ASD, ADHD and comorbid ASD and ADHD involved searching multiple databases and use of reverse citations up to the end of September 2022. Emphasis is placed on secondary sources and relevant data for clinical practice. RESULTS Complex clinical presentations of ASD/ADHD/sleep disruption are frequently encountered in clinical practice. Prior to 2013, prevalence, clinical presentation, pathophysiology, prognosis, other sleep-related factors and interventions were determined separately for each disorder, often with overlapping objective and subjective methods employed in the process. High percentages of ADHD and ASD patients have both disorders and sleep disruption. Here, the extant literature is integrated to provide a multidimensional understanding of the relevant issues and insights, allowing enhanced awareness and better care of this complex clinical population. Database limitations are considered. CONCLUSIONS Assessment of ASD symptomatology in youth with ADHD, and the reverse, in cases with disrupted sleep is critical to address the special challenges for case formulation and treatment. Evidence-based approaches to treatment planning and multi-treatment modalities should consider combining psychosocial and biological interventions to address the complexities of each case.
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Affiliation(s)
- Theodore Petti
- Rutgers University-Robert Wood Johnson Medical School, Piscataway, New Jersey, USA
| | - Mayank Gupta
- Southwood Psychiatric Hospital, Pittsburgh, Pennsylvania, USA
| | - Yuli Fradkin
- Rutgers University-Robert Wood Johnson Medical School, Piscataway, New Jersey, USA
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Fan X, Kolodny T, Woodard KM, Tasevac A, Ganz WR, Rea HM, Kurtz-Nelson EC, Webb SJ, Murray SO. Rhythmic attentional sampling in autism. Autism Res 2023; 16:2090-2099. [PMID: 37676241 PMCID: PMC10840939 DOI: 10.1002/aur.3021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 08/16/2023] [Indexed: 09/08/2023]
Abstract
Individuals diagnosed with autism often display alterations in visual spatial attention toward visual stimuli, but the underlying cause of these differences remains unclear. Recent evidence has demonstrated that covert spatial attention, rather than remaining constant at a cued location, samples stimuli rhythmically at a frequency of 4-8 Hz (theta). Here we tested whether rhythmic sampling of attention is altered in autism. Participants were asked to monitor three locations to detect a brief target presented 300-1200 ms after a spatial cue. Visual attention was oriented to the cue and modified visual processing at the cued location, consistent with previous studies. We measured detection performance at different cue-target intervals when the target occurred at the cued location. Significant oscillations in detection performance were identified using both a traditional time-shuffled approach and a new autoregressive surrogate method developed by Brookshire in 2022. We found that attention enhances behavioral performance rhythmically at the same frequency in both autism and control group at the cued location. However, rhythmic temporal structure was not observed in a subgroup of autistic individuals with co-occurring attention-deficit/hyperactivity disorder (ADHD). Our results imply that intrinsic brain rhythms which organize neural activity into alternating attentional states is functional in autistic individuals, but may be altered in autistic participants who have a concurrent ADHD diagnosis.
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Affiliation(s)
- Xiaoxu Fan
- Department of Psychology, University of Washington, Seattle, Washington, USA
| | - Tamar Kolodny
- Department of Psychology, University of Washington, Seattle, Washington, USA
| | - Kristin M Woodard
- Department of Psychology, University of Washington, Seattle, Washington, USA
| | - Aydin Tasevac
- Department of Psychology, University of Washington, Seattle, Washington, USA
| | - Wesley R Ganz
- Department of Psychiatry and Behavioral Science, University of Washington, Seattle, Washington, USA
| | - Hannah M Rea
- Department of Psychiatry and Behavioral Science, University of Washington, Seattle, Washington, USA
| | | | - Sara Jane Webb
- Department of Psychiatry and Behavioral Science, University of Washington, Seattle, Washington, USA
| | - Scott O Murray
- Department of Psychology, University of Washington, Seattle, Washington, USA
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Arutiunian V, Arcara G, Buyanova I, Buivolova O, Davydova E, Pereverzeva D, Sorokin A, Tyushkevich S, Mamokhina U, Danilina K, Dragoy O. Event-Related Desynchronization of MEG Alpha-Band Oscillations during Simultaneous Presentation of Audio and Visual Stimuli in Children with Autism Spectrum Disorder. Brain Sci 2023; 13:1313. [PMID: 37759914 PMCID: PMC10526124 DOI: 10.3390/brainsci13091313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 09/07/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
Alpha-band (8-12 Hz) event-related desynchronization (ERD) or a decrease in alpha power in electro- and magnetoencephalography (EEG and MEG) reflects the involvement of a neural tissue in information processing. It is known that most children with autism spectrum disorder (ASD) have difficulties in information processing, and, thus, investigation of alpha oscillations is of particular interest in this population. Previous studies have demonstrated alterations in this neural activity in individuals with ASD; however, little is known about alpha ERD during simultaneous presentation of auditory and visual stimuli in children with and without ASD. As alpha oscillations are intimately related to attention, and attention deficit is one of the common co-occurring conditions of ASD, we predict that children with ASD can have altered alpha ERD in one of the sensory domains. In the present study, we used MEG to investigate alpha ERD in groups of 20 children with ASD and 20 age-matched typically developing controls. Simple amplitude-modulated tones were presented together with a fixation cross appearing on the screen. The results showed that children with ASD had a bilateral reduction in alpha-band ERD in the auditory but not visual cortex. Moreover, alterations in the auditory cortex were associated with a higher presence of autistic traits measured in behavioral assessment.
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Affiliation(s)
- Vardan Arutiunian
- Center for Child Health, Behavior and Development, Seattle Children’s Research Institute, 1920 Terry Ave., Seattle, WA 98101, USA
| | - Giorgio Arcara
- IRCCS San Camillo Hospital, 70 Via Alberoni, Lido, 30126 Venice, Italy;
| | - Irina Buyanova
- Center for Language and Brain, HSE University, 3 Krivokolenny Pereulok, 101000 Moscow, Russia; (I.B.); (O.B.); (O.D.)
| | - Olga Buivolova
- Center for Language and Brain, HSE University, 3 Krivokolenny Pereulok, 101000 Moscow, Russia; (I.B.); (O.B.); (O.D.)
| | - Elizaveta Davydova
- Federal Resource Center for ASD, Moscow State University of Psychology and Education, 19 Architectora Vlasova Str., 117335 Moscow, Russia; (E.D.); (D.P.); (A.S.); (S.T.); (U.M.); (K.D.)
- Chair of Differential Psychology and Psychophysiology, Moscow State University of Psychology and Education, 2A Shelepikhinaskaya Naberezhnaya, 123290 Moscow, Russia
| | - Darya Pereverzeva
- Federal Resource Center for ASD, Moscow State University of Psychology and Education, 19 Architectora Vlasova Str., 117335 Moscow, Russia; (E.D.); (D.P.); (A.S.); (S.T.); (U.M.); (K.D.)
| | - Alexander Sorokin
- Federal Resource Center for ASD, Moscow State University of Psychology and Education, 19 Architectora Vlasova Str., 117335 Moscow, Russia; (E.D.); (D.P.); (A.S.); (S.T.); (U.M.); (K.D.)
- Haskins Laboratories, 300 George St., New Haven, CT 06511, USA
| | - Svetlana Tyushkevich
- Federal Resource Center for ASD, Moscow State University of Psychology and Education, 19 Architectora Vlasova Str., 117335 Moscow, Russia; (E.D.); (D.P.); (A.S.); (S.T.); (U.M.); (K.D.)
| | - Uliana Mamokhina
- Federal Resource Center for ASD, Moscow State University of Psychology and Education, 19 Architectora Vlasova Str., 117335 Moscow, Russia; (E.D.); (D.P.); (A.S.); (S.T.); (U.M.); (K.D.)
| | - Kamilla Danilina
- Federal Resource Center for ASD, Moscow State University of Psychology and Education, 19 Architectora Vlasova Str., 117335 Moscow, Russia; (E.D.); (D.P.); (A.S.); (S.T.); (U.M.); (K.D.)
- Scientific Research and Practical Center of Pediatric Psychoneurology, 74 Michurinskiy Prospekt, 119602 Moscow, Russia
| | - Olga Dragoy
- Center for Language and Brain, HSE University, 3 Krivokolenny Pereulok, 101000 Moscow, Russia; (I.B.); (O.B.); (O.D.)
- Institute of Linguistics, Russian Academy of Sciences, 1/1 Bolshoy Kislovsky Ln, 125009 Moscow, Russia
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Qin T, Wang Z, Li X, Zhang S. Selective Attentional Networks Deficits in Parents of Children With Autism Spectrum Disorder: Evidence From Attention Network Test. Psychiatry Investig 2023; 20:721-729. [PMID: 37559453 PMCID: PMC10460981 DOI: 10.30773/pi.2022.0248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 12/21/2022] [Accepted: 05/21/2023] [Indexed: 08/11/2023] Open
Abstract
OBJECTIVE We primarily aimed to investigate the attention network function among parents of children with autism spectrum disorder (ASD) using the Attention Network Test (ANT). The secondary objective was to observe whether the three attention networks of all participants were related to each other. METHODS We included 28 parents of children with ASD and 28 well-matched parents of typically developing children. All participants underwent the neuropsychological assessment and ANT test. The three distinct attention networks, including alerting, orienting, and executive control, were also measured. RESULTS Compared with controls, parents of children with ASD showed less-efficient alerting and executive control network (all p<0.05), but not orienting network (p=0.74). No significant correlation was found between the alerting, orienting, and executive control network for either group. CONCLUSION Our findings showed that parents of children with ASD had deficits in alerting and executive control attention functions. The deficits are indications of a broad autism phenotype.
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Affiliation(s)
- Tian Qin
- School of Medical Imaging, Bengbu Medical College, Bengbu, China
- Anhui Key Laboratory of Computational Medicine and Intelligent Health, Bengbu Medical College, Bengbu, China
| | - Zihan Wang
- School of Medical Imaging, Bengbu Medical College, Bengbu, China
- Anhui Key Laboratory of Computational Medicine and Intelligent Health, Bengbu Medical College, Bengbu, China
| | - Xiaoming Li
- School of Medical Imaging, Bengbu Medical College, Bengbu, China
- Anhui Key Laboratory of Computational Medicine and Intelligent Health, Bengbu Medical College, Bengbu, China
| | - Shunhua Zhang
- School of Medical Imaging, Bengbu Medical College, Bengbu, China
- Anhui Key Laboratory of Computational Medicine and Intelligent Health, Bengbu Medical College, Bengbu, China
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Favole I, Davico C, Marcotulli D, Sodero R, Svevi B, Amianto F, Ricci FS, Arduino GM, Vitiello B. Sleep disturbances and emotional dysregulation in young children with autism spectrum, intellectual disability, or global developmental delay. Sleep Med 2023; 105:45-52. [PMID: 36963320 DOI: 10.1016/j.sleep.2023.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/25/2023] [Accepted: 02/28/2023] [Indexed: 03/26/2023]
Abstract
OBJECTIVE Sleep disturbance and emotional dysregulation (ED) are common and often functionally impairing in young children with neurodevelopmental disorders (NDD). This study investigated the relationship between sleep disturbance and ED in a sample of preschoolers with ASD, intellectual disability, or global developmental delay, and examined possible predictors of their persistence over time. METHODS All children under 6 years of age clinically referred between July 2018 and May 2022 to two neuropsychiatric specialized centers for NDD received a comprehensive diagnostic evaluation, including the Child Behavior Checklist 1.5-5 (CBCL), the Autism Diagnostic Observation Schedule-2 (ADOS-2), and standardized tests of cognitive and global development. Sleep disturbances were assessed with the CBCL-sleep score, and ED with the CBCL Attention, Aggression, and Anxious/Depressed scales (CBCL-AAA). A reassessment of sleep and ED was conducted after 6 months or longer, including the Child Sleep Habits Questionnaire (CSHQ). Multivariate analyses and mixed linear regression models were conducted. RESULTS A total of 136 children, 75.7% male, median age 38.27 months, IQR 15.39, 41.2% with global developmental disorder (GDD) or intellectual disability (ID) participated in the study. Of them, 64.7% were diagnosed with autism spectrum disorder (ASD) and 35.3% with other NDD (w/o ASD). Sleep disturbances (CBCL-Sleep) and ED (CBCL-AAA) were positively correlated (p < 0.001), after accounting for age, ID/GDD and autism symptom severity, in both the entire sample and separately in each diagnostic group (ASD and NDD w/o ASD). Seventy-five children (55%) were reassessed a mean 17.2 months afterwards. There was persistence of the positive correlation between sleep problems and ED (p < 0.001) in both the entire sample and each diagnostic group. The longitudinal mixed linear model showed that ED at follow-up was predicted by baseline sleep problems (p = 0.008), ED (p < 0.001), and ASD severity (p = 0.015). CONCLUSIONS Sleep disturbances are significantly associated with ED in young children with NDD, either with or without ASD, both cross-sectionally and prospectively over time. Sleep problems represent an important comorbidity and a potential treatment target for improving emotional stability in NDD.
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Affiliation(s)
- Irene Favole
- Section of Child and Adolescent Neuropsychiatry, Department of Public Health and Pediatric Sciences, University of Turin, 10126, Turin, Italy
| | - Chiara Davico
- Section of Child and Adolescent Neuropsychiatry, Department of Public Health and Pediatric Sciences, University of Turin, 10126, Turin, Italy
| | - Daniele Marcotulli
- Section of Child and Adolescent Neuropsychiatry, Department of Public Health and Pediatric Sciences, University of Turin, 10126, Turin, Italy.
| | - Roberta Sodero
- Section of Child and Adolescent Neuropsychiatry, Department of Public Health and Pediatric Sciences, University of Turin, 10126, Turin, Italy
| | - Barbara Svevi
- Section of Child and Adolescent Neuropsychiatry, Department of Public Health and Pediatric Sciences, University of Turin, 10126, Turin, Italy
| | - Federico Amianto
- Department of Neuroscience, University of Turin, 10100, Turin, Italy
| | - Federica S Ricci
- Section of Child and Adolescent Neuropsychiatry, Department of Public Health and Pediatric Sciences, University of Turin, 10126, Turin, Italy
| | - G Maurizio Arduino
- Autism Center, Developmental Psychology and Psychopathology, ASL CN1, Cuneo, Italy
| | - Benedetto Vitiello
- Section of Child and Adolescent Neuropsychiatry, Department of Public Health and Pediatric Sciences, University of Turin, 10126, Turin, Italy
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Nasiri E, Khalilzad M, Hakimzadeh Z, Isari A, Faryabi-Yousefabad S, Sadigh-Eteghad S, Naseri A. A comprehensive review of attention tests: can we assess what we exactly do not understand? THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2023. [DOI: 10.1186/s41983-023-00628-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
AbstractAttention, as it is now defined as a process matching data from the environment to the needs of the organism, is one of the main aspects of human cognitive processes. There are several aspects to attention including tonic alertness (a process of intrinsic arousal that varies by minutes to hours), phasic alertness (a process that causes a quick change in attention as a result of a brief stimulus), selective attention (a process differentiating multiple stimuli), and sustained attention (a process maintaining persistence of response and continuous effort over an extended period). Attention dysfunction is associated with multiple disorders; therefore, there has been much effort in assessing attention and its domains, resulting in a battery of tests evaluating one or several attentional domains; instances of which are the Stroop color-word test, Test of Everyday Attention, Wisconsin Card Sorting Test, and Cambridge Neuropsychological Test Automated Battery. These tests vary in terms of utilities, range of age, and domains. The role of attention in human life and the importance of assessing it merits an inclusive review of the efforts made to assess attention and the resulting tests; Here we highlight all the necessary data regarding neurophysiological tests which assess human attentive function and investigates the evolution of attention tests over time. Also, the ways of assessing the attention in untestable patients who have difficulty in reading or using a computer, along with the lack of ability to comprehend verbal instructions and executive tasks, are discussed. This review can be of help as a platform for designing new studies to researchers who are interested in working on attention and conditions causing deficits in this aspect of body function, by collecting and organizing information on its assessment.
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11
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Selcuk Nogay H, Adeli H. Diagnostic of autism spectrum disorder based on structural brain MRI images using, grid search optimization, and convolutional neural networks. Biomed Signal Process Control 2023. [DOI: 10.1016/j.bspc.2022.104234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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12
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Lin TL, Lu CC, Chen TW, Huang CW, Lu JJ, Lai WF, Wu TS, Lai CH, Lai HC, Chen YL. Amelioration of Maternal Immune Activation-Induced Autism Relevant Behaviors by Gut Commensal Parabacteroides goldsteinii. Int J Mol Sci 2022; 23:ijms232113070. [PMID: 36361859 PMCID: PMC9657948 DOI: 10.3390/ijms232113070] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/25/2022] [Accepted: 10/25/2022] [Indexed: 11/26/2022] Open
Abstract
Autism spectrum disorder (ASD) is characterized by cognitive inflexibility and social deficits. Probiotics have been demonstrated to play a promising role in managing the severity of ASD. However, there are no effective probiotics for clinical use. Identifying new probiotic strains for ameliorating ASD is therefore essential. Using the maternal immune activation (MIA)-based offspring ASD-like mouse model, a probiotic-based intervention strategy was examined in female mice. The gut commensal microbe Parabacteroides goldsteinii MTS01, which was previously demonstrated to exert multiple beneficial effects on chronic inflammation-related-diseases, was evaluated. Prenatal lipopolysaccharide (LPS) exposure induced leaky gut-related inflammatory phenotypes in the colon, increased LPS activity in sera, and induced autistic-like behaviors in offspring mice. By contrast, P. goldsteinii MTS01 treatment significantly reduced intestinal and systemic inflammation and ameliorated disease development. Transcriptomic analyses of MIA offspring indicated that in the intestine, P. goldsteinii MTS01 enhanced neuropeptide-related signaling and suppressed aberrant cell proliferation and inflammatory responses. In the hippocampus, P. goldsteinii MTS01 increased ribosomal/mitochondrial and antioxidant activities and decreased glutamate receptor signaling. Together, significant ameliorative effects of P. goldsteinii MTS01 on ASD relevant behaviors in MIA offspring were identified. Therefore, P. goldsteinii MTS01 could be developed as a next-generation probiotic for ameliorating ASD.
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Affiliation(s)
- Tzu-Lung Lin
- Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Microbiota Research Center and Emerging Viral Infections Research Center, Chang Gung University, Taoyuan 33302, Taiwan
| | - Cha-Chen Lu
- Microbiota Research Center and Emerging Viral Infections Research Center, Chang Gung University, Taoyuan 33302, Taiwan
- Department of Chest Medicine, Internal Medicine, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City 24205, Taiwan
- Department of Respiratory Therapy, Fu Jen Catholic University, New Taipei City 24205, Taiwan
| | - Ting-Wen Chen
- Institute of Bioinformatics and Systems Biology, National Yang Ming Chiao Tung University, Hsinchu 300, Taiwan
- Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu 300, Taiwan
- Center For Intelligent Drug Systems and Smart Bio-Devices (IDS2B), National Yang Ming Chiao Tung University, Hsinchu 300, Taiwan
| | - Chih-Wei Huang
- Institute of Bioinformatics and Systems Biology, National Yang Ming Chiao Tung University, Hsinchu 300, Taiwan
- Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu 300, Taiwan
| | - Jang-Jih Lu
- Department of Laboratory Medicine and Internal Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
| | - Wei-Fan Lai
- Department of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Ting-Shu Wu
- Department of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
| | - Chih-Ho Lai
- Department of Microbiology and Immunology, Graduate Institute of Biomedical Sciences, Chang Gung University, Taoyuan 33302, Taiwan
- Department of Pediatrics, Molecular Infectious Disease Research Center, Linkou Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
- Department of Microbiology, School of Medicine, China Medical University, Taichung 40402, Taiwan
- Department of Nursing, Asia University, Taichung 41354, Taiwan
| | - Hsin-Chih Lai
- Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Microbiota Research Center and Emerging Viral Infections Research Center, Chang Gung University, Taoyuan 33302, Taiwan
- Department of Laboratory Medicine and Internal Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
- Research Center for Chinese Herbal Medicine and Research Center for Food and Cosmetic Safety, College of Human Ecology, Chang Gung University of Science and Technology, Taoyuan 33303, Taiwan
- Medical Research Center, Xiamen Chang Gung Hospital, Xiamen 361028, China
- Correspondence: (H.-C.L.); (Y.-L.C.)
| | - Ya-Lei Chen
- Department of Biotechnology, National Kaohsiung Normal University, Kaohsiung 82446, Taiwan
- Correspondence: (H.-C.L.); (Y.-L.C.)
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13
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Attentional Engagement and Disengagement Differences for Circumscribed Interest Objects in Young Chinese Children with Autism. Brain Sci 2022; 12:brainsci12111461. [DOI: 10.3390/brainsci12111461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/16/2022] [Accepted: 10/25/2022] [Indexed: 11/16/2022] Open
Abstract
The current study aimed to investigate attentional processing differences for circumscribed interest (CI) and non-CI objects in young Chinese children with autism spectrum condition (ASC) and typically developing (TD) controls. In Experiment 1, a visual preference task explored attentional allocation to cartoon CI and non-CI materials between the two groups. We found that ASC children (n = 22, 4.95 ± 0.59 years) exhibited a preference for CI-related objects compared to non-CI objects, and this effect was absent in the TD children (n = 22, 5.14 ± 0.44 years). Experiment 2 utilized the traditional gap-overlap paradigm (GOP) to investigate attentional disengagement from CI or non-CI items in both groups (ASC: n = 20, 5.92 ± 1.13 years; TD: n = 25, 5.77 ± 0.77 years). There were no group or stimulus interactions in this study. Experiment 3 adopted a modified GOP (MGOP) to further explore disengagement in the two groups (ASC: n = 20, 5.54 ± 0.95 years; TD: n = 24, 5.75 ± 0.52 years), and the results suggested that exogenous disengagement performance was preserved in the ASC group, but the children with ASC exhibited increased endogenous attentional disengagement compared to TD peers. Moreover, endogenous disengagement was influenced further in the presence of CI-related objects in the ASC children. The current results have implications for understanding how the nature of engagement and disengagement processes can contribute to differences in the development of core cognitive skills in young children with ASC.
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Sakdalan J, Maxwell Y. The application of adapted dialectical behaviour therapy concepts and skills in the treatment of adults with autistic spectrum disorder who display challenging or offending behaviours. ADVANCES IN AUTISM 2022. [DOI: 10.1108/aia-01-2022-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Despite some advances in the assessment and treatment of autism spectrum disorder (ASD), there remains a paucity of intervention and research literature in treating adults with ASD. There is growing evidence supporting a relationship between the core features of ASD and emotion dysregulation. There is an overlap between ASD and borderline personality disorder (BPD) characteristics such as emotional dysregulation, sensory issues and social skills deficits. This paper aims to explore the applications of dialectical behaviour therapy (DBT) concepts and skills in treating ASD individuals who display challenging or offending behaviours. The similarities in characteristics between ASD and BPD and the core issue of emotion dysregulation hold promise in the utility of DBT with ASD.
Design/methodology/approach
This is a conceptual paper that includes a case vignette.
Findings
A DBT-informed treatment approach using the adaptations and reconceptualization, i.e. risky mind–wise mind outlined in this paper, can be considered promising in addressing issues for ASD individuals, particularly those with challenging and/or offending behaviours. DBT incorporates different elements of applied behaviour analysis, cognitive behavioural therapy, mindfulness skills, sensory-based treatments, psychosocial interventions and emotion regulation skills, which makes it a more cohesive and integrated approach to treatment. The authors assert that DBT can be considered a more integrated, strengths-based, habilitative and trauma-informed approach which can be promising in its application to address challenging behaviours or offending in ASD individuals.
Research limitations/implications
It is recommended that research be carried out to evaluate the effectiveness of adapted DBT programs in treating ASD individuals presenting with challenging and/or offending behaviours. Future research can focus on evaluating the effectiveness of the different DBT concepts and skills and the different DBT modules to determine which components of the program are particularly useful for this client group.
Practical implications
Treatment manuals have already been developed for clients with intellectual disability and developmental disabilities who exhibit challenging and/or offending behaviour; hence, it is recommended that modifications be made to make it more applicable and appropriate for ASD individuals. Modifications should address ASD-specific issues (e.g. black and white thinking, cognitive rigidity, sensory issues, impaired theory of mind, emotion dysregulation issues, social skills deficits and anxiety issues). The use of DBT has much wider implications regarding addressing comorbid mental health conditions and personality issues in this client group.
Originality/value
There are limited psychological interventions that prove to be useful for individuals with ASD with complex presentations and challenging or offending behaviours. This paper discusses the application of adapted DBT concepts and skills that appear to be promising in the treatment of this client group.
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Ip A, Poon BT, Hanley G, Guhn M, Oberlander TF. Developmental profiles of children at risk for autism spectrum disorder at school entry. Autism Res 2022; 15:1301-1310. [PMID: 35586913 PMCID: PMC9322442 DOI: 10.1002/aur.2742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 04/28/2022] [Indexed: 11/11/2022]
Abstract
Functional abilities in children with autism spectrum disorder (ASD) are highly heterogenous, and impairments can overlap with non-ASD neurodevelopmental disorders. We compared the profiles of children assessed for ASD with and without an ASD diagnosis using a retrospective cohort study of 101,739 children born in British Columbia (2000-2008). The children were grouped into the following five comparison groups: (1) ASD- (n = 1131), (2) ASD+ (n = 1583), (3) Ministry of Education designated ASD+ (n = 654), (4) special need other than ASD (n = 11,663), and (5) typically developing (n = 86,708). Five developmental domains were assessed using the Early Development Instrument. ANCOVA was used to control for covariates, Tukey's HSD test for multiple comparisons, and Cohen's d for effect size. The ASD- group had slightly higher scores than the ASD+ group with small to medium effect sizes in all domains (d = 0.20-0.48). The ASD- group had slightly higher scores than the Ministry of Education ASD+ group in only three domains with small effect sizes (d = 0.21-0.25). The ASD- group had lower scores in all domains compared to the typically developing group with large effect sizes in all domains (d = 1.12-1.77). The ASD- group received less education funding at school entry than both ASD+ groups. Overall, only small to medium differences in development were detected between the ASD- and ASD+ groups. While these children differ diagnostically, they share similar functional profiles and have substantially more difficulties than typically developing children. Therefore, differences in levels of support at school entry raise critical questions of equity. LAY SUMMARY: Comparison of children in British Columbia who have been referred for an autism assessment, with or without a diagnosis, shows similarities in their functional and developmental profiles in kindergarten. Furthermore, both groups of children have more difficulties than typically developing children. However, children who have been referred for assessment without an autism diagnosis receive less financial support at school entry, raising important questions on equity.
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Affiliation(s)
- Angie Ip
- Division of Developmental Pediatrics, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.,Sunny Hill Health Centre, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Brenda T Poon
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.,Human Early Learning Partnership, University of British Columbia, Vancouver, British Columbia, Canada
| | - Gillian Hanley
- Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada.,BC Children's Hospital Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Martin Guhn
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.,Human Early Learning Partnership, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tim F Oberlander
- Division of Developmental Pediatrics, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.,Sunny Hill Health Centre, BC Children's Hospital, Vancouver, British Columbia, Canada.,BC Children's Hospital Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
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16
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Petrolini V, Vicente A. The challenges raised by comorbidity in psychiatric research: The case of autism. PHILOSOPHICAL PSYCHOLOGY 2022. [DOI: 10.1080/09515089.2022.2052829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Valentina Petrolini
- Department of Linguistics and Basque Studies, Centro de Investigación Micaela Portilla, University of the Basque Country- UPV/EHU, Vitoria-Gasteiz, Spain
| | - Agustín Vicente
- Ikerbasque Foundation of Science/ Department of Linguistics and Basque Studies, Centro de Investigación Micaela Portilla, Ikerbasque Foundation of Science/University of the Basque Country - UPV/EHU, Vitoria-Gasteiz, Spain
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17
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Dupuis A, Mudiyanselage P, Burton CL, Arnold PD, Crosbie J, Schachar RJ. Hyperfocus or flow? Attentional strengths in autism spectrum disorder. Front Psychiatry 2022; 13:886692. [PMID: 36276327 PMCID: PMC9579965 DOI: 10.3389/fpsyt.2022.886692] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 08/30/2022] [Indexed: 12/03/2022] Open
Abstract
The comorbidity of autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) diagnoses is well established. An ASD diagnosis is associated with elevated ADHD traits and symptoms, as well as strengths in attention. In the ASD literature, attentional strengths have been described as maladaptive (e.g., hyperfocus), in contrast with positive portrayals in the typically developing population (e.g., flow). The objective of this study was to (1) compare profiles of attentional strengths and weaknesses in ASD and ADHD and (2) determine whether attentional strengths in ASD are associated with impairment, poorer cognitive flexibility, and perseveration/perfectionism. In a community sample of 5,744 children and youth, 131 children were reported as having a diagnosis of ASD (mean age 10.3 years) and 346 children were reported as having a diagnosis of ADHD (mean age 10.7 years). We used the Strengths and Weaknesses of Attention-Deficit/Hyperactivity-symptoms and Normal-behaviors (SWAN) rating scale to calculate attentional and hyperactive/impulse control strength and weakness counts and scores. The Autism-Spectrum Quotient Switching factor served as a measure of cognitive flexibility. Impairment was assessed with the Columbia Impairment Scale. We used the symmetry/ordering factor on the Toronto Obsessive-Compulsive Scale as a measure of perseveration/perfectionism. No differences were found between the ADHD and ASD groups in SWAN weakness scores, symptoms, or hyperactive/impulse control strengths; however, autistic children had higher rates of attentional strengths [odds ratio: 5.7, 95% CI (2.8, 11.6), p < 0.0001]. Post-hoc pairwise testing identified four attentional strengths with significantly higher rates in ASD than in ADHD. Attentional strength scores were not associated with impairment or poor cognitive flexibility, but predicted levels of perseveration/perfectionism. The effect of attentional strengths on impairment and cognitive flexibility did not differ between autistic and Control children, but the higher perseveration/perfectionism scores seen in ASD were not found in Control children. ASD is associated with a pattern of attentional strengths that is not found in ADHD Characterizing the full range of attentional abilities in autistic children may explain variability in outcomes such as quality-of-life indicators and identify protective factors, providing targets for strength-based behavioral interventions. The clinical and etiological implications of the subgroup of autistic children with attentional strengths require further investigation.
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Affiliation(s)
- Annie Dupuis
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Piyumi Mudiyanselage
- Neurosciences and Mental Health, Hospital for Sick Children, Toronto, ON, Canada
| | - Christie L Burton
- Neurosciences and Mental Health, Hospital for Sick Children, Toronto, ON, Canada
| | - Paul D Arnold
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,The Mathison Centre for Mental Health Research and Education, Calgary, AB, Canada.,Hotchkiss Brain Centre, University of Calgary, Calgary, AB, Canada
| | - Jennifer Crosbie
- Neurosciences and Mental Health, Hospital for Sick Children, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Russell J Schachar
- Neurosciences and Mental Health, Hospital for Sick Children, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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18
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Fantozzi P, Muratori P, Caponi MC, Levantini V, Nardoni C, Pfanner C, Ricci F, Sesso G, Tacchi A, Milone A, Masi G. Treatment with Methylphenidate Improves Affective but Not Cognitive Empathy in Youths with Attention-Deficit/Hyperactivity Disorder. CHILDREN-BASEL 2021; 8:children8070596. [PMID: 34356575 PMCID: PMC8307630 DOI: 10.3390/children8070596] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/07/2021] [Accepted: 07/13/2021] [Indexed: 12/30/2022]
Abstract
Background: Beside the core symptoms, patients with attention-deficit/hyperactivity disorder (ADHD) frequently show relevant difficulty in developing relationships with peers. Although ADHD symptoms may account for social impairment, deficits in cognitive and/or affective empathy have also been involved. Our aim was to investigate the effect of methylphenidate (MPH) treatment on affective and cognitive empathy. Methods: Sixty-one drug-naïve youths with ADHD (age range 6 to 17 years, mean 10.3 ± 2.8 years, 51 males) naturalistically treated with MPH monotherapy were followed up for 6 months for ADHD symptoms and empathy, measured with the Basic Empathy Scale. Results: After being treated with MPH, the patients showed a significant improvement in affective and cognitive empathy scores. Linear regression models showed that changes in inattention symptoms predicted changes in affective but not in cognitive empathy, while changes in the hyperactivity/impulsivity symptoms did not predict changes in affective or cognitive empathy. Conclusions: Our study provides a further contribution for a better understanding of the possible effects of the MPH on youth’s characteristics.
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Affiliation(s)
- Pamela Fantozzi
- IRCCS Stella Maris Foundation, Scientific Institute of Child Neurology and Psychiatry, Calambrone, 56128 Pisa, Italy; (P.M.); (M.C.C.); (V.L.); (C.N.); (C.P.); (F.R.); (G.S.); (A.T.); (A.M.); (G.M.)
- Correspondence: ; Tel.: +39-050-886293
| | - Pietro Muratori
- IRCCS Stella Maris Foundation, Scientific Institute of Child Neurology and Psychiatry, Calambrone, 56128 Pisa, Italy; (P.M.); (M.C.C.); (V.L.); (C.N.); (C.P.); (F.R.); (G.S.); (A.T.); (A.M.); (G.M.)
| | - Maria Celeste Caponi
- IRCCS Stella Maris Foundation, Scientific Institute of Child Neurology and Psychiatry, Calambrone, 56128 Pisa, Italy; (P.M.); (M.C.C.); (V.L.); (C.N.); (C.P.); (F.R.); (G.S.); (A.T.); (A.M.); (G.M.)
| | - Valentina Levantini
- IRCCS Stella Maris Foundation, Scientific Institute of Child Neurology and Psychiatry, Calambrone, 56128 Pisa, Italy; (P.M.); (M.C.C.); (V.L.); (C.N.); (C.P.); (F.R.); (G.S.); (A.T.); (A.M.); (G.M.)
| | - Cristina Nardoni
- IRCCS Stella Maris Foundation, Scientific Institute of Child Neurology and Psychiatry, Calambrone, 56128 Pisa, Italy; (P.M.); (M.C.C.); (V.L.); (C.N.); (C.P.); (F.R.); (G.S.); (A.T.); (A.M.); (G.M.)
| | - Chiara Pfanner
- IRCCS Stella Maris Foundation, Scientific Institute of Child Neurology and Psychiatry, Calambrone, 56128 Pisa, Italy; (P.M.); (M.C.C.); (V.L.); (C.N.); (C.P.); (F.R.); (G.S.); (A.T.); (A.M.); (G.M.)
| | - Federica Ricci
- IRCCS Stella Maris Foundation, Scientific Institute of Child Neurology and Psychiatry, Calambrone, 56128 Pisa, Italy; (P.M.); (M.C.C.); (V.L.); (C.N.); (C.P.); (F.R.); (G.S.); (A.T.); (A.M.); (G.M.)
| | - Gianluca Sesso
- IRCCS Stella Maris Foundation, Scientific Institute of Child Neurology and Psychiatry, Calambrone, 56128 Pisa, Italy; (P.M.); (M.C.C.); (V.L.); (C.N.); (C.P.); (F.R.); (G.S.); (A.T.); (A.M.); (G.M.)
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Annalisa Tacchi
- IRCCS Stella Maris Foundation, Scientific Institute of Child Neurology and Psychiatry, Calambrone, 56128 Pisa, Italy; (P.M.); (M.C.C.); (V.L.); (C.N.); (C.P.); (F.R.); (G.S.); (A.T.); (A.M.); (G.M.)
| | - Annarita Milone
- IRCCS Stella Maris Foundation, Scientific Institute of Child Neurology and Psychiatry, Calambrone, 56128 Pisa, Italy; (P.M.); (M.C.C.); (V.L.); (C.N.); (C.P.); (F.R.); (G.S.); (A.T.); (A.M.); (G.M.)
| | - Gabriele Masi
- IRCCS Stella Maris Foundation, Scientific Institute of Child Neurology and Psychiatry, Calambrone, 56128 Pisa, Italy; (P.M.); (M.C.C.); (V.L.); (C.N.); (C.P.); (F.R.); (G.S.); (A.T.); (A.M.); (G.M.)
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Heyman M, Ledoux Galligan M, Salinas GB, Baker E, Blacher J, Stavropoulos K. Differential diagnosis of autism spectrum disorder, intellectual disability and attention-deficit hyperactivity disorder (ADHD). ADVANCES IN AUTISM 2021. [DOI: 10.1108/aia-01-2021-0002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Professionals working with community populations are often presented with complicated cases where it is difficult to determine which diagnosis or diagnoses are appropriate. Differentiating among neurodevelopmental disorders such as autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder and intellectual disability can be a complex process, especially, as these disorders have some overlapping symptoms and often co-occur in young children. This series of case studies aims to present commonly overlapping symptoms in children who present to clinics with developmental concerns.
Design/methodology/approach
This paper presents three case studies that were completed at a free community ASD screening clinic in Southern California.
Findings
The case studies have common presenting behaviors and symptoms (e.g. social communication difficulties) that often co-occur across diagnoses; explanations for the final diagnoses are given in each case.
Research limitations/implications
Conclusions from these three cases cannot generalize to all children being seen in clinics for neurodevelopmental concerns.
Practical implications
This series of case studies highlights commonly overlapping symptoms in children who present for differential diagnosis with social and/or behavioral concerns. Implications for educational placement and intervention are discussed.
Social implications
These cases highlight the challenges involved in the differential and dual diagnostic process for young children with developmental concerns. Diagnostic considerations can affect later educational placement and opportunities for socialization.
Originality/value
This series of case studies provide practical information for clinicians about how to effectively differentiate between commonly occurring neurodevelopmental disorders, particularly given recent changes to the Diagnostic and Statistical Manual, 5th edition (DSM-5).
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20
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Nogay HS, Adeli H. Machine learning (ML) for the diagnosis of autism spectrum disorder (ASD) using brain imaging. Rev Neurosci 2020; 31:/j/revneuro.ahead-of-print/revneuro-2020-0043/revneuro-2020-0043.xml. [PMID: 32866134 DOI: 10.1515/revneuro-2020-0043] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 07/25/2020] [Indexed: 02/24/2024]
Abstract
Autism spectrum disorder (ASD) is a neurodevelopmental incurable disorder with a long diagnostic period encountered in the early years of life. If diagnosed early, the negative effects of this disease can be reduced by starting special education early. Machine learning (ML), an increasingly ubiquitous technology, can be applied for the early diagnosis of ASD. The aim of this study is to examine and provide a comprehensive state-of-the-art review of ML research for the diagnosis of ASD based on (a) structural magnetic resonance image (MRI), (b) functional MRI and (c) hybrid imaging techniques over the past decade. The accuracy of the studies with a large number of participants is in general lower than those with fewer participants leading to the conclusion that further large-scale studies are needed. An examination of the age of the participants shows that the accuracy of the automated diagnosis of ASD is higher at a younger age range. ML technology is expected to contribute significantly to the early and rapid diagnosis of ASD in the coming years and become available to clinicians in the near future. This review is aimed to facilitate that.
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Affiliation(s)
- Hidir Selcuk Nogay
- Department of Electrical and Energy, Kayseri University, Kayseri, Turkey
- The Ohio State University, Mathematical Bioscience Institute, Columbus, OH, USA
| | - Hojjat Adeli
- Departments of Biomedical Informatics and Neuroscience, The Ohio State University, Columbus, US
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21
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Methylphenidate in Autism Spectrum Disorder: A Long-Term Follow up Naturalistic Study. J Clin Med 2020; 9:jcm9082566. [PMID: 32784735 PMCID: PMC7463802 DOI: 10.3390/jcm9082566] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/25/2020] [Accepted: 08/04/2020] [Indexed: 11/18/2022] Open
Abstract
Autism spectrum disorder (ASD) often co-occurs with attention deficit/hyperactivity disorder (ADHD). Although methylphenidate (MPH) efficacy and safety are well-demonstrated for ADHD, evidences are scant in the context of ASD. This naturalistic study aimed to analyze long-term MPH efficacy and safety in 40 ADHD children and adolescents with comorbid ASD, comparing them with 40 ones affected by ADHD without ASD. Treatment lasted from 6 to 156 months (longer than 24 months in more than three quarters of patients). Efficacy and safety were measured by clinical global impression and children global assessment scales; influence of intellectual functioning was examined. Comparisons between groups were made by Wilcoxon or Friedmann tests; relationships between functioning scores and other characteristics were analyzed by ordinal logistic and linear regression. Results demonstrated that MPH in patients with ASD was associated with significative reduction of illness severity, clinical improvement and amelioration of global functioning, without significant differences with patients having ADHD without ASD. The trend of reduction of illness severity and increase of global functioning were favorably related with intellectual functioning. No serious adverse events were reported. The findings showed that long-term MPH was effective and well-tolerated in ADHD children and adolescents with comorbid high functioning ASD.
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Carta A, Fucà E, Guerrera S, Napoli E, Valeri G, Vicari S. Characterization of Clinical Manifestations in the Co-occurring Phenotype of Attention Deficit/Hyperactivity Disorder and Autism Spectrum Disorder. Front Psychol 2020; 11:861. [PMID: 32499739 PMCID: PMC7244252 DOI: 10.3389/fpsyg.2020.00861] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 04/07/2020] [Indexed: 12/27/2022] Open
Abstract
Comorbidity between attention deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) is a frequently reported condition. However, the clinical overlaps between the two disorders are not well characterized. The Child Behavior Checklist (CBCL) is a well-documented measure of emotional and behavioral problems in children and adolescents. The aim of the present study was to evaluate whether CBCL scales were able to detect psychopathological comorbidities as well as emotional and behavioral profiles across three groups of children with ASD, ADHD, and with the co-occurrence of both disorders. The results show that around 30% of participants with ASD exhibited internalizing problems, which was in line with previous findings. Co-occurrence condition showed a clinical intermediate phenotype: relative to ADHD and ASD, youths with co-occurrence of ADHD and ASD phenotype showed respectively lower (p < 0.000) and higher externalizing problems (p < 0.000). No differences emerged in internalizing problems (p > 0.05) across groups. CBCL is a useful measure to study the psychopathological conditions as well as emotional and behavioral profiles associated with ASD, ADHD, and the co-occurrence of ADHD and ASD. The identification of psychopathological and behavioral profiles associated with ASD and ADHD is crucial to perform specific and individualized treatments. Our preliminary findings suggested the existence of an intermediate and independent phenotype between ADHD and ASD that seems to be defined by the externalizing problems. Internalizing problems do not significantly differ between the combined phenotype and the two groups.
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Affiliation(s)
- Alessandra Carta
- Department of Neurosciences, Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.,Section of Child Neuropsychiatry, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Elisa Fucà
- Department of Neurosciences, Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Silvia Guerrera
- Department of Neurosciences, Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Eleonora Napoli
- Department of Neurosciences, Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Giovanni Valeri
- Department of Neurosciences, Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Stefano Vicari
- Department of Neurosciences, Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.,Department of Life Sciences and Public Health, Catholic University of the Sacred Heart, Rome, Italy
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23
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Hyperacusis in Children with Attention Deficit Hyperactivity Disorder: A Preliminary Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17093045. [PMID: 32349379 PMCID: PMC7246428 DOI: 10.3390/ijerph17093045] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 04/19/2020] [Accepted: 04/21/2020] [Indexed: 11/16/2022]
Abstract
The association between hyperacusis and developmental disorders such as autism spectrum disorders has been extensively reported in the literature; however, the specific prevalence of hyperacusis in attention deficit hyperactivity disorder (ADHD) has never been investigated. In this preliminary study, we evaluated the presence of hyperacusis in a small sample of children affected by ADHD compared to a control group of healthy children. Thirty normal hearing children with a diagnosis of ADHD and 30 children matched for sex and age were enrolled in the study. All children underwent audiological and multidisciplinary neuropsychiatric evaluation. Hearing was assessed using pure tone audiometry and immittance test; ADHD was diagnosed following the Diagnostic and Statistical Manual of Mental Disorder criteria. Hyperacusis was assessed through the administration of a questionnaire to parents and an interview with children. Hyperacusis was diagnosed in 11 children (36.7%) in the study group and in four children (13.3%) in the control group; this difference was statistically significant (p = 0.03). The preliminary results of this study suggest a higher presence of hyperacusis in children with attention deficit hyperactivity disorder compared to control children. More studies on larger samples are necessary to confirm these results.
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24
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Waddington H, McLay L, Woods L, Whitehouse AJO. Child and Family Characteristics Associated with Sleep Disturbance in Children with Autism Spectrum Disorder. J Autism Dev Disord 2020; 50:4121-4132. [DOI: 10.1007/s10803-020-04475-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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25
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Bakker-Huvenaars MJ, Greven CU, Herpers P, Wiegers E, Jansen A, van der Steen R, van Herwaarden AE, Baanders AN, Nijhof KS, Scheepers F, Rommelse N, Glennon JC, Buitelaar JK. Saliva oxytocin, cortisol, and testosterone levels in adolescent boys with autism spectrum disorder, oppositional defiant disorder/conduct disorder and typically developing individuals. Eur Neuropsychopharmacol 2020; 30:87-101. [PMID: 30201120 DOI: 10.1016/j.euroneuro.2018.07.097] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 06/19/2018] [Accepted: 07/08/2018] [Indexed: 11/29/2022]
Abstract
The aim of the current study was to compare levels of oxytocin, cortisol, and testosterone in adolescents with either autism spectrum disorder (ASD), or oppositional defiant disorder (ODD)/conduct disorder (CD), and in typically developing individuals (TDI), and relate hormone levels to severity and subtype of aggression and callous-unemotional (CU) traits. Saliva concentrations of oxytocin, cortisol, and testosterone were assessed in 114 male participants (N = 49 ASD, N = 37 ODD/CD, N = 28 TDI,) aged 12-19 years (M = 15.4 years, SD = 1.9). The ASD and the ODD/CD groups had significantly lower levels of oxytocin than the TDI group, and the ODD/CD group had significantly higher levels of testosterone than the ASD group. There were no group effects on cortisol levels. Group differences remained for oxytocin after correcting for the influence of CU traits, but were not significant after controlling for aggression. Results for testosterone became non-significant after correction for either CU traits or aggression. Across groups, higher levels of CU traits were related to higher levels of cortisol and testosterone, however, proactive and reactive aggression were unrelated to all three hormonal levels. The current findings show that, regardless of cognitive ability or comorbid disorders, the diagnostic groups (ASD, ODD/CD) differ from each other by their hormonal levels, with the ASD group characterized by relative low level of oxytocin, and the ODD/CD group by a relative low level of oxytocin and high level of testosterone. These group effects were partly driven by differences in CU traits between the groups.
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Affiliation(s)
- M J Bakker-Huvenaars
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Centre, Nijmegen, The Netherlands; Karakter Child and Adolescent Psychiatry University Centre Nijmegen, Nijmegen, The Netherlands
| | - C U Greven
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Centre, Nijmegen, The Netherlands; Karakter Child and Adolescent Psychiatry University Centre Nijmegen, Nijmegen, The Netherlands; King's College London, Medical Research Council Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, UK
| | - P Herpers
- Karakter Child and Adolescent Psychiatry University Centre Nijmegen, Nijmegen, The Netherlands
| | - E Wiegers
- Karakter Child and Adolescent Psychiatry University Centre Nijmegen, Nijmegen, The Netherlands
| | - A Jansen
- Karakter Child and Adolescent Psychiatry University Centre Nijmegen, Nijmegen, The Netherlands
| | - R van der Steen
- Department of Laboratory Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - A E van Herwaarden
- Department of Laboratory Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - A N Baanders
- Stichting Otto Gerhard Heldring, Zetten, The Netherlands
| | - K S Nijhof
- Pluryn, Hoenderloo, The Netherlands; Department of Developmental Psychopathology, Behavioral Science Institute, Radboud University Nijmegen, The Netherlands
| | - F Scheepers
- Brain Centre Rudolf Magnus, UMC Utrecht, Utrecht, The Netherlands
| | - N Rommelse
- Karakter Child and Adolescent Psychiatry University Centre Nijmegen, Nijmegen, The Netherlands; Department of Psychiatry, University Medical Centre Nijmegen, Nijmegen, The Netherlands
| | - J C Glennon
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - J K Buitelaar
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Centre, Nijmegen, The Netherlands; Karakter Child and Adolescent Psychiatry University Centre Nijmegen, Nijmegen, The Netherlands.
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26
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Schroder CM, Malow BA, Maras A, Melmed RD, Findling RL, Breddy J, Nir T, Shahmoon S, Zisapel N, Gringras P. Pediatric Prolonged-Release Melatonin for Sleep in Children with Autism Spectrum Disorder: Impact on Child Behavior and Caregiver's Quality of Life. J Autism Dev Disord 2019; 49:3218-3230. [PMID: 31079275 PMCID: PMC6647439 DOI: 10.1007/s10803-019-04046-5] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
A randomized, 13-weeks, placebo-controlled double-blind study in 125 subjects aged 2-17.5 years with Autism Spectrum Disorder or Smith-Magenis syndrome and insomnia demonstrated efficacy and safety of easily-swallowed prolonged-release melatonin mini-tablets (PedPRM; 2-5 mg) in improving sleep duration and onset. Treatment effects on child behavior and caregiver's quality of life were evaluated. PedPRM treatment resulted in significant improvement in externalizing but not internalizing behavior (Strengths and Difficulties questionnaire; SDQ) compared to placebo (p = 0.021) with clinically-relevant improvements in 53.7% of PedPRM-treated versus 27.6% of placebo-treated subjects (p = 0.008). Caregivers' quality of life also improved with PedPRM versus placebo (p = 0.010) and correlated with the change in total SDQ (p = 0.0005). PedPRM alleviates insomnia-related difficulties, particularly externalizing behavior in the children, subsequently improving caregivers' quality of life.
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Affiliation(s)
- Carmen M Schroder
- Department of Child and Adolescent Psychiatry & CIRCSom, Strasbourg University Hospital, Strasbourg, France.,CNRS UPR 3212, Institute of Cellular and Integrative Neurosciences, Strasbourg, France
| | - Beth A Malow
- Sleep Division, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Athanasios Maras
- Yulius Academy, Yulius Mental Health Organization, Dordrecht, Delft, The Netherlands
| | - Raun D Melmed
- Southwest Autism Research and Resource Center, Scottsdale, Phoenix, AZ, USA
| | - Robert L Findling
- Department of Psychiatry and Behavioral Sciences, Kennedy Krieger Institute/Johns Hopkins University, Baltimore, MD, USA
| | | | - Tali Nir
- Neurim Pharmaceuticals Ltd, Tel Aviv, Israel
| | | | | | - Paul Gringras
- Children's Sleep Medicine, Evelina London Children's Hospital, Guy's and St Thomas', London, UK
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27
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Mouti A, Dryer R, Kohn M. Differentiating Autism Spectrum Disorder From ADHD Using the Social Communication Questionnaire. J Atten Disord 2019; 23:828-837. [PMID: 29936891 DOI: 10.1177/1087054718781945] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This study examined the ability of the Social Communication Questionnaire (SCQ) to differentiate between autism spectrum disorder (ASD), ADHD, and typically developing (TD) children. METHOD Children ( Mage = 11.27 years, SDage = 3.28) identified with ASD Severity Levels "1" and/or "2" ( n = 28), ADHD ( n = 44), dual diagnoses of ADHD and ASD ( n = 29), and TD ( n = 61) were assessed using the SCQ. RESULTS The SCQ differentiated between ASD and non-ASD groups. Children with ASD had higher total and domain scores on the SCQ than ADHD and TD children. The optimal cutoff total score of 13 was identified for differentiating between ASD and ADHD groups (area under the curve [AUC] = .96). Twenty eight of the 39 items were identified as significant in differentiating between ASD and ADHD. CONCLUSION The SCQ continues to be a well-validated screening tool for ASD and is suitable for determining whether further ASD assessment is warranted in children with ADHD symptoms.
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Affiliation(s)
- Anissa Mouti
- 1 Charles Sturt University, Bathurst, New South Wales, Australia
| | - Rachel Dryer
- 2 Australian College of Applied Psychology, Sydney, New South Wales, Australia
| | - Michael Kohn
- 3 The Children's Hospital at Westmead, New South Wales, Australia
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28
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Urbano MR, Teal Raffaele C, Kreiser NL, Flaherty JM, Hartmann K. Clinical considerations for the inclusion of individuals with autism spectrum disorder in clinical trials. Prog Neuropsychopharmacol Biol Psychiatry 2019; 89:295-302. [PMID: 30290207 DOI: 10.1016/j.pnpbp.2018.09.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 09/21/2018] [Accepted: 09/30/2018] [Indexed: 10/28/2022]
Abstract
Diagnoses of autism spectrum disorder (ASD) have increased considerably over the past 20 years. Because of this rise and the inherent complexity of ASD, there is a need for an increased number of scientifically valid basic and clinical research studies addressing this disorder. This manuscript serves as an introduction to the clinical presentation of ASD as well as the unique challenges and modifications required to conduct clinical research with this population. This includes detailing the current diagnostic criteria, process of receiving an ASD diagnosis, information on assessment measures, and special considerations when developing research. It is the hope that this information will provide researchers interested in conducting clinical trials with those with ASD with baseline information and considerations when developing their research topics and methodology.
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Affiliation(s)
- Maria R Urbano
- Eastern Virginia Medical School, Psychiatry and Behavioral Sciences, 825 Fairfax Avenue, Suite 710, Norfolk, VA 23507-1912, United States.
| | - C Teal Raffaele
- Eastern Virginia Medical School, Psychiatry and Behavioral Sciences, 825 Fairfax Avenue, Suite 710, Norfolk, VA 23507-1912, United States
| | - Nicole L Kreiser
- Eastern Virginia Medical School, Psychiatry and Behavioral Sciences, 825 Fairfax Avenue, Suite 710, Norfolk, VA 23507-1912, United States
| | - Jennifer M Flaherty
- Eastern Virginia Medical School, Psychiatry and Behavioral Sciences, 825 Fairfax Avenue, Suite 710, Norfolk, VA 23507-1912, United States
| | - Kathrin Hartmann
- Eastern Virginia Medical School, Psychiatry and Behavioral Sciences, 825 Fairfax Avenue, Suite 710, Norfolk, VA 23507-1912, United States
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29
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Murphy D, Allely C. Autism spectrum disorders in high secure psychiatric care: a review of literature, future research and clinical directions. ADVANCES IN AUTISM 2019. [DOI: 10.1108/aia-10-2018-0044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper is to review available literature targeting the assessment and management of individuals with an autism spectrum disorder (ASD) admitted to high secure psychiatric care (HSPC). Key areas of examination include the prevalence of ASD in HSPC, how individuals with an ASD differ from other patient groups in clinical and cognitive characteristics, the views of staff regarding patients with an ASD, an exploration of the experiences and quality of life of patients with an ASD, as well as treatment and interventions.
Design/methodology/approach
A review of the published literature.
Findings
Although individuals with an ASD comprise a relatively small proportion of the total HSPC cohort, they appear to be over represented relative to the general population prevalence. Several research projects suggest that individuals with an ASD present with difficulties and needs different to other patient groups, as well as being viewed by staff as potentially vulnerable and requiring a different care approach. Individuals with an ASD report both positive and negative aspects to life in HSPC.
Practical implications
Suggestions are made with regard to how individuals with an ASD might be better managed in HSPC. Following the spirit of various pieces of government legislation such as the Autism Act (2009) and the Equalities Act (2010) the role of a specialist ASD HSPC service is proposed.
Originality/value
This paper provides a detailed review of the research to date exploring the assessment and management of individuals with an ASD detained in HSPC. It outlines key research findings, highlights limitations with it and provides a personal perspective on future research and clinical targets.
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30
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Licari MK, Finlay-Jones A, Reynolds JE, Alvares GA, Spittle AJ, Downs J, Whitehouse AJO, Leonard H, Evans KL, Varcin K. The Brain Basis of Comorbidity in Neurodevelopmental Disorders. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2019. [DOI: 10.1007/s40474-019-0156-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Clark B, Bélanger SA. ADHD in children and youth: Part 3-Assessment and treatment with comorbid ASD, ID, or prematurity. Paediatr Child Health 2019; 23:485-490. [PMID: 30681666 DOI: 10.1093/pch/pxy111] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Attention-deficit hyperactivity disorder (ADHD) is a chronic neurodevelopmental disorder. Three position statements have been developed by the Canadian Paediatric Society, following systematic literature reviews. Statement objectives are to: 1) Summarize the current clinical evidence regarding ADHD,2) Establish a standard for ADHD care, and3) Assist Canadian clinicians in making well-informed, evidence-based decisions to enhance care of children and youth with this condition. Specific topics reviewed in Part 3, which focuses on associated autism spectrum disorder, intellectual disability, and prematurity, include the challenges of diagnostic assessment, common presentations, the role of genetics, and treatment, including the benefits of physical activity. Recommendations are based on current guidelines, evidence from the literature, and expert consensus.
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Affiliation(s)
- Brenda Clark
- Canadian Paediatric Society, Mental Health and Developmental Disabilities Committee, Ottawa, Ontario
| | - Stacey A Bélanger
- Canadian Paediatric Society, Mental Health and Developmental Disabilities Committee, Ottawa, Ontario
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32
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Sakai K, Yamada K. Machine learning studies on major brain diseases: 5-year trends of 2014–2018. Jpn J Radiol 2018; 37:34-72. [DOI: 10.1007/s11604-018-0794-4] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Accepted: 11/14/2018] [Indexed: 12/17/2022]
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Clark B, Bélanger SA. Le TDAH chez les enfants et les adolescents, partie 3 : l’évaluation et le traitement en cas d’association au trouble du spectre de l’autisme, au handicap intellectuel ou à la prématurité. Paediatr Child Health 2018. [DOI: 10.1093/pch/pxy112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Brenda Clark
- Société canadienne de pédiatrie, comité de la santé mentale et des troubles du développement, Ottawa (Ontario)
| | - Stacey A Bélanger
- Société canadienne de pédiatrie, comité de la santé mentale et des troubles du développement, Ottawa (Ontario)
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34
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Gomez R, Stavropoulos V, Vance A. Psychometric Properties of the Autism Spectrum Quotient: Children’s Version (AQ-Child). J Autism Dev Disord 2018; 49:468-480. [DOI: 10.1007/s10803-018-3713-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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35
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Wong CT, Bestard-Lorigados I, Crawford DA. Autism-related behaviors in the cyclooxygenase-2-deficient mouse model. GENES BRAIN AND BEHAVIOR 2018; 18:e12506. [PMID: 30027581 DOI: 10.1111/gbb.12506] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 07/16/2018] [Accepted: 07/16/2018] [Indexed: 12/15/2022]
Abstract
Prostaglandin E2 (PGE2) is an endogenous lipid molecule involved in normal brain development. Cyclooxygenase-2 (COX2) is the main regulator of PGE2 synthesis. Emerging clinical and molecular research provides compelling evidence that abnormal COX2/PGE2 signaling is associated with autism spectrum disorder (ASD). We previously found that COX2 knockout mice had dysregulated expression of many ASD genes belonging to important biological pathways for neurodevelopment. The present study is the first to show the connection between irregular COX2/PGE2 signaling and autism-related behaviors in male and female COX2-deficient knockin, (COX)-2- , mice at young (4-6 weeks) or adult (8-11 weeks) ages. Autism-related behaviors were prominent in male (COX)-2- mice for most behavioral tests. In the open field test, (COX)-2- mice traveled more than controls and adult male (COX)-2- mice spent less time in the center indicating elevated hyperactive and anxiety-linked behaviors. (COX)-2- mice also buried more marbles, with males burying more than females, suggesting increased anxiety and repetitive behaviors. Young male (COX)-2- mice fell more frequently in the inverted screen test revealing motor deficits. The three-chamber sociability test found that adult female (COX)-2- mice spent less time in the novel mouse chamber indicative of social abnormalities. In addition, male (COX)-2- mice showed altered expression of several autism-linked genes: Wnt2, Glo1, Grm5 and Mmp9. Overall, our findings offer new insight into the involvement of disrupted COX2/PGE2 signaling in ASD pathology with age-related differences and greater impact on males. We propose that (COX)-2- mice might serve as a novel model system to study specific types of autism.
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Affiliation(s)
- Christine T Wong
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada.,Neuroscience Graduate Diploma Program, York University, Toronto, ON, Canada
| | - Isabel Bestard-Lorigados
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada.,Neuroscience Graduate Diploma Program, York University, Toronto, ON, Canada
| | - Dorota A Crawford
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada.,Neuroscience Graduate Diploma Program, York University, Toronto, ON, Canada.,Department of Biology, York University, Toronto, ON, Canada
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36
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Thomas S, Lycett K, Papadopoulos N, Sciberras E, Rinehart N. Exploring Behavioral Sleep Problems in Children With ADHD and Comorbid Autism Spectrum Disorder. J Atten Disord 2018; 22:947-958. [PMID: 26637841 DOI: 10.1177/1087054715613439] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE This study (a) compared behavioral sleep problems in children with comorbid ADHD and autism spectrum disorder (ASD) with those with ADHD and (b) examined child/family factors associated with sleep problems. METHOD Cross-sectional study comparison of 392 children with a confirmed ADHD diagnosis (ADHD+ASD, n=93, ADHD, n=299) recruited from 21 peadiatric practises in Victoria, Australia. Data were collected from parents. Key measures included the Child Sleep Habits Questionnaire (CSHQ). RESULTS Children with ADHD + ASD experienced similar levels and types of behavioral sleep problems compared with those with ADHD. In both groups, the presence of co-occurring internalizing and externalizing comorbidities was associated with sleep problems. Sleep problems were also associated with parent age in the ADHD + ASD group and poorer parent mental health in the ADHD group. CONCLUSION Findings suggest comorbid ASD is not associated with increased behavioral sleep problems in children with ADHD and that co-occurring internalizing and externalizing comorbidities may flag children in these groups with sleep problems.
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Affiliation(s)
- Simone Thomas
- 1 Deakin University, Burwood, Australia.,2 Murdoch Childrens Research Institute, Parkville, Australia
| | - Kate Lycett
- 2 Murdoch Childrens Research Institute, Parkville, Australia.,3 The University of Melbourne, Parkville, Australia.,4 The Royal Children's Hospital, Parkville, Australia
| | | | - Emma Sciberras
- 2 Murdoch Childrens Research Institute, Parkville, Australia.,3 The University of Melbourne, Parkville, Australia.,4 The Royal Children's Hospital, Parkville, Australia
| | - Nicole Rinehart
- 2 Murdoch Childrens Research Institute, Parkville, Australia
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37
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Cole EJ, Barraclough NE, Enticott PG. Investigating Mirror System (MS) Activity in Adults with ASD When Inferring Others' Intentions Using Both TMS and EEG. J Autism Dev Disord 2018; 48:2350-2367. [PMID: 29453710 PMCID: PMC5996018 DOI: 10.1007/s10803-018-3492-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
ASD is associated with mentalizing deficits that may correspond with atypical mirror system (MS) activation. We investigated MS activity in adults with and without ASD when inferring others' intentions using TMS-induced motor evoked potentials (MEPs) and mu suppression measured by EEG. Autistic traits were measured for all participants. Our EEG data show, high levels of autistic traits predicted reduced right mu (8-10 Hz) suppression when mentalizing. Higher left mu (8-10 Hz) suppression was associated with superior mentalizing performances. Eye-tracking and TMS data showed no differences associated with autistic traits. Our data suggest ASD is associated with reduced right MS activity when mentalizing, TMS-induced MEPs and mu suppression measure different aspects of MS functioning and the MS is directly involved in inferring intentions.
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Affiliation(s)
- Eleanor J Cole
- The Department of Psychology, The University of York, Heslington, York, North Yorkshire, YO10 5DD, UK.
| | - Nick E Barraclough
- The Department of Psychology, The University of York, Heslington, York, North Yorkshire, YO10 5DD, UK
| | - Peter G Enticott
- Cognitive Neuroscience Unit, Faculty of Health, Deakin University Burwood Campus, 221 Burwood Highway, Melbourne, VIC, 3125, Australia
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Sokolova E, Oerlemans AM, Rommelse NN, Groot P, Hartman CA, Glennon JC, Claassen T, Heskes T, Buitelaar JK. A Causal and Mediation Analysis of the Comorbidity Between Attention Deficit Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD). J Autism Dev Disord 2017; 47:1595-1604. [PMID: 28255761 PMCID: PMC5432632 DOI: 10.1007/s10803-017-3083-7] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Autism spectrum disorder (ASD) and Attention-deficit/hyperactivity disorder (ADHD) are often comorbid. The purpose of this study is to explore the relationships between ASD and ADHD symptoms by applying causal modeling. We used a large phenotypic data set of 417 children with ASD and/or ADHD, 562 affected and unaffected siblings, and 414 controls, to infer a structural equation model using a causal discovery algorithm. Three distinct pathways between ASD and ADHD were identified: (1) from impulsivity to difficulties with understanding social information, (2) from hyperactivity to stereotypic, repetitive behavior, (3) a pairwise pathway between inattention, difficulties with understanding social information, and verbal IQ. These findings may inform future studies on understanding the pathophysiological mechanisms behind the overlap between ASD and ADHD.
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Affiliation(s)
- Elena Sokolova
- Radboud University, Postbus 9010, 6500, Nijmegen, The Netherlands.
- Institute for Computing and Information Sciences, Radboud University, Nijmegen, The Netherlands.
| | - Anoek M Oerlemans
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nanda N Rommelse
- Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Perry Groot
- Institute for Computing and Information Sciences, Radboud University, Nijmegen, The Netherlands
| | - Catharina A Hartman
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jeffrey C Glennon
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tom Claassen
- Institute for Computing and Information Sciences, Radboud University, Nijmegen, The Netherlands
| | - Tom Heskes
- Institute for Computing and Information Sciences, Radboud University, Nijmegen, The Netherlands
| | - Jan K Buitelaar
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
- Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands
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McClain MB, Hasty Mills AM, Murphy LE. Inattention and hyperactivity/impulsivity among children with attention-deficit/hyperactivity-disorder, autism spectrum disorder, and intellectual disability. RESEARCH IN DEVELOPMENTAL DISABILITIES 2017; 70:175-184. [PMID: 28957735 DOI: 10.1016/j.ridd.2017.09.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Revised: 08/18/2017] [Accepted: 09/15/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Attention-Deficit/Hyperactivity Disorder (ADHD), Autism Spectrum Disorder (ASD), and Intellectual Disability (ID) are common co-occurring neurodevelopmental disorders; however, limited research exists regarding the presentation and severity of overlapping symptomology, particularly inattention and hyperactivity/impulsivity, when a child is diagnosed with one of more of these neurodevelopmental disorders. AIMS As difficulties with inattention and hyperactivity/impulsivity are symptoms frequently associated with these disorders, the current study aims to determine the differences in the severity of inattention and hyperactivity/impulsivity in children diagnosed with ADHD, ASD, ID, and co-occurring diagnosis of ADHD/ID, ASD/ADHD, and ASD/ID. METHODS AND PROCEDURES Participants in the current study included 113 children between the ages of 6 and 11 who were diagnosed with ADHD, ASD, ID, ADHD/ID, ASD/ADHD, or ASD/ID. Two MANOVA analyses were used to compare these groups witih respsect to symptom (i.e., inattention, hyperactivity/impulsivity) severity. OUTCOMES AND RESULTS Results indicated that the majority of diagnostic groups experienced elevated levels of both inattention and hyperactivity/impulsivity. However, results yielded differences in inattention and hyperactivity/impulsivity severity. In addition, differences in measure sensitivity across behavioral instruments was found. CONCLUSIONS AND IMPLICATIONS Children with neurodevelopmental disorders often exhibit inattention and hyperactivity/impulsivity, particularly those with ADHD, ASD, ASD/ADHD, and ADHD/ID; therefore, differential diagnosis may be complicated due to similarities in ADHD symptom severity. However, intellectual abilities may be an important consideration for practitioners in the differential diagnosis process as children with ID and ASD/ID exhibited significantly less inattention and hyperactive/impulsive behaviors. Additionally, the use of multiple behavior rating measures in conjunction with other assessment procedures may help practitioners determine the most appropriate diagnosis.
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Affiliation(s)
- Maryellen Brunson McClain
- Utah State University, Emma Eccles Jones College of Education and Human Services, Department of Psychology, 2800 Old Main Hill, Logan, UT 84322, USA.
| | - Amber M Hasty Mills
- Glenwood Autism and Behavioral Health Center, 150 Glenwood Lane, Birmingham, AL, 35242, USA.
| | - Laura E Murphy
- University of Tennessee Health Science Center (UTHSC), Boling Center for Developmental Disabilities (BCDD) and UTHSC Department of Psychiatry, 711 Jefferson Avenue, Memphis, TN 38105, USA.
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Reduced emotional empathy in adults with subclinical ADHD: evidence from the empathy and systemizing quotient. ACTA ACUST UNITED AC 2017; 10:141-150. [PMID: 28836147 PMCID: PMC5973978 DOI: 10.1007/s12402-017-0236-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Accepted: 08/07/2017] [Indexed: 11/24/2022]
Abstract
Studies in children with ADHD suggest impairments in social cognitive functions, whereas studies in adults with ADHD are scarce and inconclusive. The aim of this study was to investigate the relationship between ADHD traits and self-reported social cognitive style in a sample of adults from the general population. For this purpose, a community sample of 685 adults filled out online self-report questionnaires about ADHD symptoms (ADHD Rating Scale, ARS), social cognitive functioning and friendships. The Empathy Quotient (EQ) with the subscales Cognitive Empathy (CE), Emotional Empathy (EE) and Social Skills (SS), and the Systemizing Quotient (SQ) were included for measuring social cognitive style and the Friendship Questionnaire (FQ) for the quality of friendships. Participants who met the DSM-5 criteria on the ARS (‘subclinical ADHD’; n = 56) were compared regarding their social cognitive functioning scores with a control group (n = 56) that was matched for age, sex and student status. With small effect sizes, the subclinical ADHD group showed reduced EE scores on the EQ and a more male social cognitive profile. This result was not influenced by sex or ADHD subtype. This study points to a relationship between traits of ADHD and the emotional aspect of empathy, whereas more complex aspects of empathy were unrelated. These findings should be corroborated in clinical patients with ADHD, employing neuropsychological tests rather than self-report questionnaires.
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41
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Uddin LQ, Dajani DR, Voorhies W, Bednarz H, Kana RK. Progress and roadblocks in the search for brain-based biomarkers of autism and attention-deficit/hyperactivity disorder. Transl Psychiatry 2017; 7:e1218. [PMID: 28892073 PMCID: PMC5611731 DOI: 10.1038/tp.2017.164] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 06/07/2017] [Indexed: 11/22/2022] Open
Abstract
Children with neurodevelopmental disorders benefit most from early interventions and treatments. The development and validation of brain-based biomarkers to aid in objective diagnosis can facilitate this important clinical aim. The objective of this review is to provide an overview of current progress in the use of neuroimaging to identify brain-based biomarkers for autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD), two prevalent neurodevelopmental disorders. We summarize empirical work that has laid the foundation for using neuroimaging to objectively quantify brain structure and function in ways that are beginning to be used in biomarker development, noting limitations of the data currently available. The most successful machine learning methods that have been developed and applied to date are discussed. Overall, there is increasing evidence that specific features (for example, functional connectivity, gray matter volume) of brain regions comprising the salience and default mode networks can be used to discriminate ASD from typical development. Brain regions contributing to successful discrimination of ADHD from typical development appear to be more widespread, however there is initial evidence that features derived from frontal and cerebellar regions are most informative for classification. The identification of brain-based biomarkers for ASD and ADHD could potentially assist in objective diagnosis, monitoring of treatment response and prediction of outcomes for children with these neurodevelopmental disorders. At present, however, the field has yet to identify reliable and reproducible biomarkers for these disorders, and must address issues related to clinical heterogeneity, methodological standardization and cross-site validation before further progress can be achieved.
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Affiliation(s)
- L Q Uddin
- Department of Psychology, University of Miami, Coral Gables, FL, USA,Neuroscience Program, University of Miami Miller School of Medicine, Miami, FL, USA,Department of Psychology, University of Miami, P.O. Box 248185-0751, Coral Gables, FL 33124, USA. E-mail:
| | - D R Dajani
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - W Voorhies
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - H Bednarz
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - R K Kana
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
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Hsueh PT, Wang HH, Liu CL, Ni WF, Chen YL, Liu JK. Expression of cerebral serotonin related to anxiety-like behaviors in C57BL/6 offspring induced by repeated subcutaneous prenatal exposure to low-dose lipopolysaccharide. PLoS One 2017. [PMID: 28650979 PMCID: PMC5484498 DOI: 10.1371/journal.pone.0179970] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Prenatal exposure to lipopolysaccharide (LPS), which likely occurs due to infection or contact with environmental allergens during pregnancy, is a proposed risk factor that induces anxiety- and autism spectrum disorder-like behaviors in offspring. However, the molecular and behavioral changes in offspring after maternal immune activation have not been completely identified. We hypothesized that a subcutaneous injection of LPS in a pregnant mouse would induce changes in cerebral serotonin (5-HT) in parallel to the appearance of anxiety-like behaviors in the dam’s offspring. After LPS injections (total, 100 μg/Kg), the time spent in the central region during the open field test and the number of times that the mice moved between the light and dark boxes and between the open and closed arms on the elevated plus maze test revealed anxiety-like behaviors in offspring at 5, 6 and 9 weeks of age. The mRNA expression levels of tph2 (5-HT synthesizing enzyme) and slc6a4 (5-HT transporter) were down-regulated in both adolescent (5 weeks of age) and adult (8 weeks of age) brains. Immunohistochemistry revealed that the numbers and sizes of tph2-expressing cells were notably decreased in the raphe nuclei of the midbrain of adults. Moreover, compared with controls (phosphate-buffered saline-treated offspring), the cerebral 5-HT concentration at adolescence and adulthood in LPS-induced offspring was significantly decreased. We concluded that maternal immune activation induced by exposure to a low dose of LPS decreased cerebral 5-HT levels in parallel to the down-regulation of the tph2 and slc6a4 genes and in conjunction with anxiety-like behaviors in offspring.
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Affiliation(s)
- Pei-Tan Hsueh
- Department of Biological Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Hsuan-Han Wang
- Department of Biotechnology, National Kaohsiung Normal University, Kaohsiung, Taiwan
| | - Chiu-Lin Liu
- Department of Biotechnology, National Kaohsiung Normal University, Kaohsiung, Taiwan
| | - Wei-Fen Ni
- Department of Biotechnology, National Kaohsiung Normal University, Kaohsiung, Taiwan
| | - Ya-Lei Chen
- Department of Biotechnology, National Kaohsiung Normal University, Kaohsiung, Taiwan
- * E-mail: (LJK); (CYL)
| | - Jong-Kang Liu
- Department of Biological Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan
- * E-mail: (LJK); (CYL)
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Chee DY, Lee HC, Patomella AH, Falkmer T. Driving Behaviour Profile of Drivers with Autism Spectrum Disorder (ASD). J Autism Dev Disord 2017; 47:2658-2670. [DOI: 10.1007/s10803-017-3178-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Lyall K, Schweitzer JB, Schmidt RJ, Hertz-Picciotto I, Solomon M. Inattention and hyperactivity in association with autism spectrum disorders in the CHARGE study. RESEARCH IN AUTISM SPECTRUM DISORDERS 2017; 35:1-12. [PMID: 29276530 PMCID: PMC5738931 DOI: 10.1016/j.rasd.2016.11.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Attention deficits in young children with autism spectrum disorder (ASD) are not well understood. This study sought to determine: 1) the prevalence of ADHD symptoms in young children with ASD, typical development (TD), and developmental delay (DD) and 2) the association between ADHD symptoms and cognitive and behavioral functioning in children with ASD. METHOD ADHD symptoms, defined according to Aberrant Behavior Checklist (ABC) hyperactivity subscale scores, were compared across children aged 2-5 from a large case-control study with ASD (n=548), TD (n=423), and DD (n=180). Inattention and hyperactivity items within this subscale were also explored. Within the ASD group, linear and logistic regression were used to examine how ADHD symptoms were associated with cognition as assessed by the Mullen Scales of Early Learning and adaptive functioning as assessed by the Vineland Adaptive Behavior Scales. RESULTS Mean hyperactivity subscale scores were lowest in children with TD (mean=3.19), higher in children with DD (12.3), and highest in children with ASD (18.2; between-group p<0.001). Among children with ASD, significant associations were observed with higher ADHD symptoms and poorer adaptive and cognitive functioning (adjusted beta for hyperactivity score in association with: Vineland composite = -5.63, p=0.0005; Mullen visual reception scale = -2.94, p=0.02; for the highest vs. lowest quartile of hyperactivity score, odds of lowest quintile of these scores was approximately doubled). Exploratory analyses highlighted associations with inattention-related items specifically. CONCLUSION These results suggest ADHD symptoms may play a key role in the functioning of young children with ASD.
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Affiliation(s)
- Kristen Lyall
- Univeristy of California, Department of Public Health Sciences, Davis CA 95616
| | | | - Rebecca J. Schmidt
- Univeristy of California, Department of Public Health Sciences, Davis CA 95616
| | - Irva Hertz-Picciotto
- Univeristy of California, Department of Public Health Sciences, Davis CA 95616
- University of California, Davis, MIND Institute, Sacramento, CA 95817
| | - Marjorie Solomon
- University of California, Davis, MIND Institute, Sacramento, CA 95817
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Bijlenga D, Tjon-Ka-Jie JYM, Schuijers F, Kooij JJS. Atypical sensory profiles as core features of adult ADHD, irrespective of autistic symptoms. Eur Psychiatry 2017; 43:51-57. [PMID: 28371743 DOI: 10.1016/j.eurpsy.2017.02.481] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 02/06/2017] [Accepted: 02/06/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Abnormal sensory sensitivity is a feature of autism-spectrum disorder (ASD), but is also reported in attention-deficit/hyperactivity disorder (ADHD). In many cases, ADHD and ASD are comorbid. This study investigated the prevalence of sensory hyper- and hyposensitivity among adults with ADHD, controlling for autistic symptoms. METHOD One hundred and sixteen adults diagnosed with ADHD completed the Adolescent/Adult Sensory Profile-NL (AASP-NL) and the Autism-spectrum Quotient (AQ) questionnaires. Prevalences of hyper- and hyposensitivity and autism-spectrum symptoms were compared to norm values. Multivariate binary logistic regressions were used to determine the association of autistic symptoms, age, gender, ADHD subtype, self-reported severity of ADHD symptoms, comorbid disorders, and use of medication on the sensory hypo- and hypersensitivity in adults with ADHD. RESULTS Adults with ADHD had more autistic symptoms, and they had both more hyper- and hyposensitivity compared to norm groups. This was especially apparent in the Activity level and Auditory sensory modalities. Sensory hypo- and hypersensitivity were both related to an increased ADHD score, even showing a dose-response relationship, but not to any autistic symptom or comorbid disorder. As much as 43% of the females with ADHD reported sensory hypo- and/or hypersensitivity, compared to 22% of the men. CONCLUSIONS Sensory hypo- and hypersensitivity may be viewed as key features of adult ADHD, especially in females, regardless of any autistic symptoms. Future research should be directed at the implications of this sensory dysregulation for the understanding of the pathophysiology of (female) ADHD, and on the usefulness of assessment of atypical sensory profiles in the diagnostic procedure of ADHD in adults.
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Affiliation(s)
- D Bijlenga
- PsyQ Psycho-Medical Programs, Expertise Center Adult ADHD, Carel Reinierszkade 197, 2593 HR The Hague, The Netherlands.
| | - J Y M Tjon-Ka-Jie
- PsyQ Psycho-Medical Programs, Expertise Center Adult ADHD, Carel Reinierszkade 197, 2593 HR The Hague, The Netherlands
| | - F Schuijers
- PsyQ Psycho-Medical Programs, Expertise Center Adult ADHD, Carel Reinierszkade 197, 2593 HR The Hague, The Netherlands
| | - J J S Kooij
- PsyQ Psycho-Medical Programs, Expertise Center Adult ADHD, Carel Reinierszkade 197, 2593 HR The Hague, The Netherlands
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Kanai C, Hashimoto R, Itahashi T, Tani M, Yamada T, Ota H, Iwanami A, Kato N. Cognitive profiles of adults with high-functioning autism spectrum disorder and those with attention-deficit/hyperactivity disorder based on the WAIS-III. RESEARCH IN DEVELOPMENTAL DISABILITIES 2017; 61:108-115. [PMID: 28064024 DOI: 10.1016/j.ridd.2016.12.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 06/13/2016] [Accepted: 12/19/2016] [Indexed: 06/06/2023]
Abstract
The cognitive profile differences between adult patients with autism spectrum disorder (ASD) and those with attention-deficit/hyperactivity disorder (ADHD) are not well characterized. We examined the cognitive profiles of adults having either ASD (n=120) or ADHD (n=76) with no intellectual disabilities (IQ≥70) using the Wechsler Intelligence Scale III (WAIS-III). Verbal Intelligence (VIQ) - Performance Intelligence (PIQ) difference discrepancies were detected between the two groups. Information subtest scores of the Verbal Comprehension index and Arithmetic and Digit Span subtests of the Freedom from Distractibility index were significantly higher in ASD than in ADHD, while the Picture Completion subtest was significantly lower in ASD. To our knowledge, this is the first study to evaluate the difference in the cognitive profiles of adults with ASD and those with ADHD based on the WAIS III with a large number of participants.
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Affiliation(s)
- Chieko Kanai
- Medical Institute of Developmental Disabilities Research, Showa University, 6-11-11 Kitakarasuyama, Setagayaku, Tokyo 157-8577, Japan; Department of Psychiatry, Showa University Karasuyama Hospital, 6-11-11 Kitakarasuyama, Setagayaku, Tokyo 157-8577, Japan.
| | - Ryuichiro Hashimoto
- Medical Institute of Developmental Disabilities Research, Showa University, 6-11-11 Kitakarasuyama, Setagayaku, Tokyo 157-8577, Japan; Department of Language Sciences, Graduate School of Humanities, Tokyo Metropolitan University, 1-1 Minami-Osawa, Hachioji-shi, Tokyo, 192-0397, Japan
| | - Takashi Itahashi
- Medical Institute of Developmental Disabilities Research, Showa University, 6-11-11 Kitakarasuyama, Setagayaku, Tokyo 157-8577, Japan
| | - Masayuki Tani
- Department of Psychiatry, Showa University Karasuyama Hospital, 6-11-11 Kitakarasuyama, Setagayaku, Tokyo 157-8577, Japan
| | - Takashi Yamada
- Medical Institute of Developmental Disabilities Research, Showa University, 6-11-11 Kitakarasuyama, Setagayaku, Tokyo 157-8577, Japan; ATR Brain Information Communication Research Laboratory Group, 2-2-2 Hikaridai, sorakugun seika-cho, Kyoto, 619-0288, Japan
| | - Haruhisa Ota
- Medical Institute of Developmental Disabilities Research, Showa University, 6-11-11 Kitakarasuyama, Setagayaku, Tokyo 157-8577, Japan; Department of Psychiatry, Showa University Karasuyama Hospital, 6-11-11 Kitakarasuyama, Setagayaku, Tokyo 157-8577, Japan
| | - Akira Iwanami
- Department of Psychiatry, Showa University Karasuyama Hospital, 6-11-11 Kitakarasuyama, Setagayaku, Tokyo 157-8577, Japan
| | - Nobumasa Kato
- Medical Institute of Developmental Disabilities Research, Showa University, 6-11-11 Kitakarasuyama, Setagayaku, Tokyo 157-8577, Japan; Department of Psychiatry, Showa University Karasuyama Hospital, 6-11-11 Kitakarasuyama, Setagayaku, Tokyo 157-8577, Japan
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Abstract
STATEMENT OF PURPOSE Individuals with autism spectrum disorder (ASD) often demonstrate deficient attentional ability, but the specific nature of the deficit is unclear. The Attention Networks model provides a useful approach to deconstruct this attentional deficit into its component parts. METHOD Fifty-two neurotypical (NT) children and 14 children with ASD performed the child version of the Attention Network Test (ANT). The latter requires participants to indicate the direction of a centre target stimulus, which is presented above/below fixation and sometimes flanked by either congruent or incongruent distractor stimuli. RESULTS Relative to NT children, those with ASD were: (1) slower to react to spatially cued trials and (2) more error prone on executive (conflict) attention trials. CONCLUSIONS Young children with ASD have intact alerting attention, but less-efficient orienting and executive attention.
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Affiliation(s)
- Rachna Mutreja
- a Department of Human Development and Family Studies , College of Human Sciences, Texas Tech University , Lubbock , TX , USA and
| | - Curtis Craig
- b Department of Psychology , College of Arts and Sciences, Texas Tech University , Lubbock , TX , USA
| | - Michael W O'Boyle
- a Department of Human Development and Family Studies , College of Human Sciences, Texas Tech University , Lubbock , TX , USA and
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Hames EC, Rajmohan R, Fang D, Anderson R, Baker M, Richman DM, O'Boyle M. Attentional Networks in Adolescents with High-functioning Autism: An fMRI Investigation. Open Neuroimag J 2016; 10:102-110. [PMID: 27843514 PMCID: PMC5074002 DOI: 10.2174/1874440001610010102] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 07/27/2016] [Accepted: 08/23/2016] [Indexed: 01/31/2023] Open
Abstract
Background: Attentional deficits in Autism spectrum disorder (ASD) are often noted, but their specific nature remains unclear. Objective: The present study used the child Attentional Network Task (Child ANT) in combination with functional magnetic resonance imaging (fMRI) to determine if the consistently cited deficits of orienting attention are truly due to dysfunctions of orienting-based networks. We hypothesized that these observations are, in fact, a reflection of executive dysfunctions. As such, we expected that although ASD adolescents would perform worse on the orienting portion of the Child ANT, the strongest differences in activation between them and the neurotypical (NT) control group would be in areas classically associated with executive functioning (e.g., the frontal gyri and anterior cingulate cortex). Method: The brain activity of six high-functioning adolescents with ASD and six NT adolescents was recorded while these individuals performed the three subcomponents of the Child ANT. Results: ASDs were shown to be more accurate than NTs for the alerting, less accurate for the orienting, and similar in accuracy for the executive portions of the Child ANT. fMRI data showed increased bilateral frontal gyri recruitment, areas conventionally associated with executive control, during the orienting task for the ASD group. Conclusion: We submit that the increased activations represent neurocorrelates of signal fixation attributable to the subset of executive control responsible for sustained maintenance signals, not the main components of orienting. Therefore, excessive fixation in ASD adolescents is likely due to dysfunctions of executive control and not the orienting subcomponent of the attention network.
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Affiliation(s)
- Elizabeth C Hames
- Department of Electrical and Computer Engineering, Texas Tech University, Lubbock, TX 79409, USA
| | - Ravi Rajmohan
- Department of Pharmacology and Neuroscience, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - Dan Fang
- College of Human Sciences, Texas Tech University, Lubbock, TX 79409, USA
| | - Ronald Anderson
- Department of Electrical and Computer Engineering, Texas Tech University, Lubbock, TX 79409, USA
| | - Mary Baker
- Department of Electrical and Computer Engineering, Texas Tech University, Lubbock, TX 79409, USA
| | - David M Richman
- College of Education, Texas Tech University, Lubbock, TX 79409, USA
| | - Michael O'Boyle
- College of Human Sciences, Texas Tech University, Lubbock, TX 79409, USA
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Abstract
Abstract
ASD research is at an important crossroads. The ASD diagnosis is important for assigning a child to early behavioral intervention and explaining a child’s condition. But ASD research has not provided a diagnosis-specific medical treatment, or a consistent early predictor, or a unified life course. If the ASD diagnosis also lacks biological and construct validity, a shift away from studying ASD-defined samples would be warranted. Consequently, this paper reviews recent findings for the neurobiological validity of ASD, the construct validity of ASD diagnostic criteria, and the construct validity of ASD spectrum features. The findings reviewed indicate that the ASD diagnosis lacks biological and construct validity. The paper concludes with proposals for research going forward.
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Joelsson P, Chudal R, Gyllenberg D, Kesti AK, Hinkka-Yli-Salomäki S, Virtanen JP, Huttunen J, Ristkari T, Parkkola K, Gissler M, Sourander A. Demographic Characteristics and Psychiatric Comorbidity of Children and Adolescents Diagnosed with ADHD in Specialized Healthcare. Child Psychiatry Hum Dev 2016; 47:574-82. [PMID: 26399420 DOI: 10.1007/s10578-015-0591-6] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Recent studies have shown an increasing incidence of attention-deficit/hyperactivity disorder (ADHD) among children diagnosed in specialized services. This study aims to describe children with ADHD in Finnish specialized healthcare by reporting the demographic characteristics, time trends in diagnosis, psychiatric comorbidity, and the validity of register-based diagnoses. All the singletons born in Finland between 1991 and 2005 and diagnosed with ADHD by 2011 were identified and their psychiatric comorbidity data was obtained from the Finnish Hospital Discharge Register (FHDR). Parents of 69 patients were interviewed via telephone for a diagnostic validation. A total of 10,409 children were identified with ADHD, with a male: female ratio of 5.3:1 and a psychiatric comorbidity rate of 76.7 %. Of the validation sample 88 % met the diagnostic criteria of ADHD for DSM-IV. There is an increasing trend of ADHD diagnosis among both males and females. Psychiatric comorbidity is common and includes a wide range of disorders among children with ADHD. There was an increase of ADHD diagnoses especially among boys. More attention is needed to detect ADHD among girls in health services. Diagnoses in the FHDR show diagnostic validity and their sociodemographic patterns are in line with previous studies.
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Affiliation(s)
- Petteri Joelsson
- Department of Child Psychiatry, University of Turku, Lemminkäisenkatu 3/Teutori. 3rd Floor, 20014, Turku, Finland.
| | - Roshan Chudal
- Department of Child Psychiatry, University of Turku, Lemminkäisenkatu 3/Teutori. 3rd Floor, 20014, Turku, Finland
| | - David Gyllenberg
- Department of Child Psychiatry, University of Turku, Lemminkäisenkatu 3/Teutori. 3rd Floor, 20014, Turku, Finland.,Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Anna-Kaisa Kesti
- Department of Child Psychiatry, University of Turku, Lemminkäisenkatu 3/Teutori. 3rd Floor, 20014, Turku, Finland
| | - Susanna Hinkka-Yli-Salomäki
- Department of Child Psychiatry, University of Turku, Lemminkäisenkatu 3/Teutori. 3rd Floor, 20014, Turku, Finland
| | - Juha-Pekka Virtanen
- Department of Child Psychiatry, University of Turku, Lemminkäisenkatu 3/Teutori. 3rd Floor, 20014, Turku, Finland
| | - Jukka Huttunen
- Department of Child Psychiatry, University of Turku, Lemminkäisenkatu 3/Teutori. 3rd Floor, 20014, Turku, Finland
| | - Terja Ristkari
- Department of Child Psychiatry, University of Turku, Lemminkäisenkatu 3/Teutori. 3rd Floor, 20014, Turku, Finland
| | - Kai Parkkola
- Navy Command Finland, Turku, Finland.,School of Medicine, University of Tampere, Tampere, Finland
| | - Mika Gissler
- Department of Child Psychiatry, University of Turku, Lemminkäisenkatu 3/Teutori. 3rd Floor, 20014, Turku, Finland.,Nordic School of Public Health, Gothenburg, Sweden.,National Institute for Health and Welfare, Helsinki, Finland.,New York State Psychiatric Institute, New York, NY, USA
| | - Andre Sourander
- Department of Child Psychiatry, University of Turku, Lemminkäisenkatu 3/Teutori. 3rd Floor, 20014, Turku, Finland.,Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA.,Department of Child Psychiatry, Turku University Hospital, Turku, Finland
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