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Corbett BA, Muscatello RA, McGonigle T, Vandekar S, Burroughs C, Sparks S. Trajectory of depressive symptoms over adolescence in autistic and neurotypical youth. Mol Autism 2024; 15:18. [PMID: 38698474 PMCID: PMC11064411 DOI: 10.1186/s13229-024-00600-w] [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: 11/29/2023] [Accepted: 04/25/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Adolescence coincides with a dramatic rise in the onset of psychiatric conditions including depression. Depression symptoms may be particularly prevalent and impairing for youth with autism spectrum disorder (ASD). While prior research suggests adolescence is associated with worsening depression symptoms for typically developing (TD) and autistic youth, it is unclear if they follow a similar course. METHOD The study examined the trajectory of depressive symptoms in autistic and neurotypical youth over a 4-year longitudinal study using linear and logistic mixed effects models. In youth with clinically relevant depressive scores (t-score > 65), moderating factors (i.e., diagnosis, age, puberty, sex) were explored. During Year 1, the sample included 244 youth 10-to-13 years: 140 in the ASD group (36 females) and 104 in the TD group (46 females). RESULTS Autistic youth had elevated depression scores compared to TD peers (p < 0.001) and females were higher than males in both groups (p = 0.001). There was significant diagnosis by age (p < 0.001) and diagnosis by pubertal stage (p < 0.05) interactions. In the ASD group, elevated depressive scores presented in early adolescence and decreased during middle adolescence and puberty, whereas the TD group showed the opposite trend with an increase in depression symptoms with advancing development. LIMITATIONS Limitations include an unequal sex distribution (fewer females), non-representative autistic sample (e.g., cognition and race/ethnicity), and potential confound of the COVID-19 pandemic. CONCLUSIONS Autistic youth present with higher rates of depressive symptoms early in development; yet, approaching middle adolescence and puberty, the symptom trajectory in the autistic youth declines coinciding with an increase in the TD youth. While group trajectories are divergent, they lead to similar levels of depression in late adolescence with higher symptoms in females. Findings suggest a period of quiescence in depressive symptomology influenced by biopsychosocial factors impacting affective profiles.
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Affiliation(s)
- Blythe A Corbett
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, 1500 21st Avenue South, Nashville, TN, 37212, USA.
- Vanderbilt Kennedy Center, Vanderbilt University Medical Center, Nashville, TN, USA.
- Department of Psychology, Vanderbilt University, Nashville, TN, USA.
| | - Rachael A Muscatello
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, 1500 21st Avenue South, Nashville, TN, 37212, USA
- Vanderbilt Kennedy Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Trey McGonigle
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Simon Vandekar
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Christina Burroughs
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, 1500 21st Avenue South, Nashville, TN, 37212, USA
| | - Sloane Sparks
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, 1500 21st Avenue South, Nashville, TN, 37212, USA
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All K, Chawarska K, Macari SL. Early executive functioning predicts externalizing problems in neurodiverse preschoolers. Autism Res 2024; 17:1053-1065. [PMID: 38476104 DOI: 10.1002/aur.3109] [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: 07/05/2023] [Accepted: 01/31/2024] [Indexed: 03/14/2024]
Abstract
Children with autism spectrum disorder (ASD) often exhibit externalizing problems, which have been linked with increased anxiety and depression, peer rejection, and parental stress. Identification of early predictors of externalizing behaviors in autism will facilitate identification of vulnerable children and implementation of early preventative interventions. There is ample evidence that executive functioning, social functioning, and temperament are predictive of later externalizing problems in general populations, but less is known about these relations in ASD and other neurodiverse populations, particularly in the early preschool years. To address this gap, we assessed the relations between executive functioning, social functioning, and temperament at age 3 and externalizing problems at age 5 in a sample of neurodiverse children with ASD and other neurodevelopmental disorders and delays. Analyses revealed that severity of early executive functioning impairment predicted increased externalizing problems. Severity of social autism symptoms moderated this relationship such that the effect of executive functioning on externalizing problems decreased as autism symptoms increased. These findings suggest that executive functioning is an important target for identifying and developing interventions for vulnerable children and underscore the necessity of considering severity of autism symptoms when researching the development of externalizing problems in children with neurodevelopmental disorders.
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Affiliation(s)
- Katherine All
- Child Study Center, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Katarzyna Chawarska
- Child Study Center, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Suzanne L Macari
- Child Study Center, Yale University School of Medicine, New Haven, Connecticut, USA
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3
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Wong CM, Aljunied M, Chan DKL, Cheong JMY, Chew B, Chin CH, Choo SHT, Chua AHL, Foo MTS, Goh TJ, Khader M, Khoo SKM, Koh HC, Lian WB, Lim HH, Poon KKL, Sim ZL, Sung M, Tan PC, Yong S, Zhang G, Aishworiya R. 2023 clinical practice guidelines on autism spectrum disorder in children and adolescents in Singapore. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2024; 53:541-552. [PMID: 38920181 DOI: 10.47102/annals-acadmedsg.2023307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
Introduction Autism is a neurodevelopmental condition that is increasing in prevalence worldwide. There has been an exponential increase in autism-related research since 2010, when the first Singapore Clinical Practice Guidelines (CPG) on autism was published. Understanding of autism has since evolved to adopt a lifespan approach beyond that of a childhood condition. The aim of this CPG was to provide an updated set of recommendations for children and adolescents to aid clinical practice for professionals. Method A multidisciplinary workgroup that comprised representatives from various sectors worked on this CPG. Clinical questions were organised into 10 different sections, each with its own subgroup of members. Seventeen existing international guidelines were evaluated using the Appraisal of Guidelines for REsearch & Evaluation II (AGREE-II) framework, of which 4 met criteria to act as references. Literature review across multiple databases was conducted between January 2011 to 2023; Grading of Recommendations, Assessment, Development and Evaluation (GRADE-like) methodology was used to synthesise evidence. Recommendation statements were derived, following Delphi-style consensus surveys among the workgroup. The draft guidelines underwent external review and public consultation before being formalised. Results Recommendation and good practice statements pertaining to care of children and adolescents on the autism spectrum across 10 different sections were developed. Evidence matrices complement these recommendations and detail relevant evidence behind each recommendation statement. Conclusion It is intended for these guidelines to promote effective management and healthcare services for children and adolescents on the autism spectrum, by reinforcing good and evidence-based clinical practice within our national context.
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Affiliation(s)
- Chui Mae Wong
- Department of Child Development, KK Women's and Children's Hospital, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Duke-NUS Medical School, Singapore
- Lee Kong Chian School of Medicine, Singapore
| | - Mariam Aljunied
- Special Educational Needs Division, Ministry of Education, Singapore
| | - Daisy Kwai Lin Chan
- Department of Child Development, KK Women's and Children's Hospital, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Duke-NUS Medical School, Singapore
- Lee Kong Chian School of Medicine, Singapore
- Department of Neonatal and Developmental Medicine, Singapore General Hospital
| | - Janice Mun Yi Cheong
- Department of Psychological Medicine, KK Women's and Children's Hospital, Singapore
| | | | - Chee Hon Chin
- Department of Developmental Psychiatry, Institute of Mental Health, Singapore
| | - Sylvia Henn Tean Choo
- Department of Child Development, KK Women's and Children's Hospital, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Duke-NUS Medical School, Singapore
- Lee Kong Chian School of Medicine, Singapore
| | | | | | - Tze Jui Goh
- Department of Developmental Psychiatry, Institute of Mental Health, Singapore
| | | | | | - Hwan Cui Koh
- Department of Child Development, KK Women's and Children's Hospital, Singapore
| | - Wee Bin Lian
- SpecialKids Child Health & Development Clinic, Singapore
| | | | | | | | - Min Sung
- Department of Developmental Psychiatry, Institute of Mental Health, Singapore
| | - Peng Chian Tan
- National Institute of Education, Nanyang Technological University, Singapore
| | - Sarah Yong
- Specialised Assistive Technology Centre, SPD, Singapore
| | - Guiyue Zhang
- Child Development Unit, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, Singapore
| | - Ramkumar Aishworiya
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Child Development Unit, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, Singapore
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4
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Marshall C, Hoshi R, Gregory J. Parental Expressed Emotion and Behavioural Outcomes in Autistic Children and Adolescents: A Systematic Review. Child Psychiatry Hum Dev 2024:10.1007/s10578-023-01660-4. [PMID: 38319471 DOI: 10.1007/s10578-023-01660-4] [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] [Accepted: 12/16/2023] [Indexed: 02/07/2024]
Abstract
Growing interest in the links between parent-child relationships and child behavioural presentations in families of autistic children has led to an increased use of the Five Minute Speech Sample (FMSS) measure of parental expressed emotion (EE) in autism research. This review focuses on studies exploring the relationships between parental EE and behavioural outcomes in autistic children. Electronic searches of six databases and grey literature wielded eight studies that met eligibility criteria. Study designs were a mixture of cross-sectional and longitudinal and quality of studies was variable. Parental criticism was largely positively related to, and showed some predictive value for, child behaviour problems. Warmth was mostly negatively related to, and showed some predictive value for, child behaviour problems. Preliminary evidence from one study showed paternal warmth to be significantly related to child behaviours, whilst child behaviours were also significantly related to paternal warmth, suggesting a bidirectional relationship. Analysis of additional EE components produced variable results, however parental stress and depressive symptoms were consistently related to child behaviour, and preliminary evidence suggests a possible role of maternal education level and family cohesion. Outcomes were variable across FMSS coding systems and greater consistency in their application is needed in future research. The current findings suggest that parental EE has an important relationship with child behaviour and future intervention efforts may benefit from aiming to reduced EE in order to improve child outcomes.
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Affiliation(s)
- Corinne Marshall
- South Wales Doctoral Programme in Clinical Psychology, Cardiff University, Cardiff, UK.
- Cardiff University, 70 Park Place, Tower Building, 11th Floor, Cardiff, CF10 3AT, UK.
| | - Rosa Hoshi
- South Wales Doctoral Programme in Clinical Psychology, Cardiff University, Cardiff, UK
| | - James Gregory
- South Wales Doctoral Programme in Clinical Psychology, Cardiff University, Cardiff, UK
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5
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Reis SL, Monteiro P. From synaptic dysfunction to atypical emotional processing in autism. FEBS Lett 2024; 598:269-282. [PMID: 38233224 DOI: 10.1002/1873-3468.14801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 12/21/2023] [Accepted: 12/27/2023] [Indexed: 01/19/2024]
Abstract
Autism spectrum disorder (ASD) is a complex neurodevelopmental condition mainly characterized by social impairments and repetitive behaviors. Among these core symptoms, a notable aspect of ASD is the presence of emotional complexities, including high rates of anxiety disorders. The inherent heterogeneity of ASD poses a unique challenge in understanding its etiological origins, yet the utilization of diverse animal models replicating ASD traits has enabled researchers to dissect the intricate relationship between autism and atypical emotional processing. In this review, we delve into the general findings about the neural circuits underpinning one of the most extensively researched and evolutionarily conserved emotional states: fear and anxiety. Additionally, we explore how distinct ASD animal models exhibit various anxiety phenotypes, making them a crucial tool for dissecting ASD's multifaceted nature. Overall, to a proper display of fear response, it is crucial to properly process and integrate sensorial and visceral cues to the fear-induced stimuli. ASD individuals exhibit altered sensory processing, possibly contributing to the emergence of atypical phobias, a prevailing anxiety disorder manifested in this population. Moreover, these individuals display distinctive alterations in a pivotal fear and anxiety processing hub, the amygdala. By examining the neurobiological mechanisms underlying fear and anxiety regulation, we can gain insights into the factors contributing to the distinctive emotional profile observed in individuals with ASD. Such insights hold the potential to pave the way for more targeted interventions and therapies that address the emotional challenges faced by individuals within the autism spectrum.
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Affiliation(s)
- Sara L Reis
- Department of Biomedicine - Experimental Biology Unit, Faculty of Medicine of the University of Porto, Portugal
| | - Patricia Monteiro
- Department of Biomedicine - Experimental Biology Unit, Faculty of Medicine of the University of Porto, Portugal
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6
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Raihan MMH, Chowdhury N, Chowdhury MZI, Turin TC. Involuntary delayed retirement and mental health of older adults. Aging Ment Health 2024; 28:169-177. [PMID: 37403767 DOI: 10.1080/13607863.2023.2230927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 06/14/2023] [Indexed: 07/06/2023]
Abstract
OBJECTIVE This study examined the association of multiple mental health measures with involuntary delayed retirement (IDR) in working older adults (≥ 65 years) in the USA. METHODS Data were derived from the Health and Retirement Study, focusing on two combined waves of working older adults in 2010 and 2012. IDR was measured as the desire to stop working but the inability to do so due to financial constraints. In addition, mental health outcomes included depression, anxiety, anger-in, and anger-out. Using Stata 16.0, primary analyses were conducted for descriptive statistics and multivariable logistic regression. The odds ratios were reported with 95% confidence intervals (CIs). RESULTS Older adults who reported IDR were more likely to have depression (OR = 3.20, CI = 1.03-9.88), anxiety (OR = 2.12, CI = 1.00-5.18), and anger-in (OR = 1.71, CI = 1.12-2.60) compared to those who did not report IDR. However, IDR was not significantly associated with anger-out in older adults who worked past the traditional retirement age. CONCLUSION The findings suggest that IDR is likely to act as a stressor and affects the mental health of older adults aged 65 and more. Policymakers should pay more attention to helping older adults maintain positive mental health even if they are required to work past retirement age.
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Affiliation(s)
- Mohammad M H Raihan
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Sociology, University of Calgary, Calgary, Canada
- The O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Nashit Chowdhury
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
- The O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Mohammad Z I Chowdhury
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
- The O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Tanvir C Turin
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
- The O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Canada
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7
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Lai MC. Mental health challenges faced by autistic people. Nat Hum Behav 2023; 7:1620-1637. [PMID: 37864080 DOI: 10.1038/s41562-023-01718-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 09/07/2023] [Indexed: 10/22/2023]
Abstract
Mental health challenges impede the well-being of autistic people. This Review outlines contributing neurodevelopmental and physical health conditions, rates and developmental trajectories of mental health challenges experienced by autistic people, as well as unique clinical presentations. A framework is proposed to consider four contributing themes to aid personalized formulation: social-contextual determinants, adverse life experiences, autistic cognitive features, and shared genetic and early environmental predispositions. Current evidence-based and clinical-knowledge-informed intervention guidance and ongoing development of support are highlighted for specific mental health areas. Tailored mental health support for autistic people should be neurodivergence-informed, which is fundamentally humanistic and compatible with the prevailing bio-psycho-social frameworks. The personalized formulation should be holistic, considering physical health and transdiagnostic neurodevelopmental factors, intellectual and communication abilities, and contextual-experiential determinants and their interplay with autistic cognition and biology, alongside resilience. Supporting family well-being is integral. Mutual empathic understanding is fundamental to creating societies in which people across neurotypes are all empowered to thrive.
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Affiliation(s)
- Meng-Chuan Lai
- Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health and Azrieli Adult Neurodevelopmental Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
- Department of Psychology, Faculty of Arts and Science, University of Toronto, Toronto, Ontario, Canada.
- Department of Psychiatry, Hospital for Sick Children, Toronto, Ontario, Canada.
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK.
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.
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8
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Horwitz E, Vos M, De Bildt A, Greaves-Lord K, Rommelse N, Schoevers R, Hartman C. Sex differences in the course of autistic and co-occurring psychopathological symptoms in adolescents with and without autism spectrum disorder. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023:13623613221146477. [PMID: 36680498 PMCID: PMC10375001 DOI: 10.1177/13623613221146477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
LAY ABSTRACT There is an ongoing debate as to whether autism spectrum disorder (ASD) is expressed differently in women than men. Studies on sex differences in autistic symptoms and symptoms of other psychiatric problems present in individuals with autism generally do not include a general population comparison group, making it unclear whether differences are specific to autism or merely reflecting development in the general population. In this study, we compared sex differences in the course of autistic and at the same time present symptoms of other psychiatric problems in adolescents with milder forms of ASD to those in a group of the general population with an equal intelligence quotient (IQ) and socioeconomic status. Data of five assessment moments from ages 11 to 22 years were analyzed using a statistic procedure that allowed us to determine which factors affect the course of symptoms over time. We found that in adolescence, sex differences in the course of psychopathological symptoms specific for autism are confined to the repetitive stereotyped domains. Males had higher scores on the sensory/stereotypic and resistance to change domains, the latter difference disappeared during the course of adolescence due to an increase of these problems in autistic females. Other sex differences, among which an increase over time in mood and anxiety problems in females was the most outstanding, were also observed in females without autism. These sex-specific differences have relevance in the clinical care of autistic men and women, although they are subtle compared to differences between individuals with and without autism.
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Affiliation(s)
| | - Melissa Vos
- University Medical Center Groningen, The Netherlands
| | | | - Kirstin Greaves-Lord
- Erasmus Medical Center Rotterdam, The Netherlands.,Sophia Children's Hospital, The Netherlands
| | - Nanda Rommelse
- Karakter Child and Adolescent Psychiatry University Centre, The Netherlands
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9
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Heitzer AM, Longoria J, Porter JS, MacArthur E, Potter B, Ding J, Gossett J, Kang G, Hankins JS. Internalizing Symptoms in Adolescents With Sickle Cell Disease. J Pediatr Psychol 2023; 48:91-103. [PMID: 35980301 PMCID: PMC10120839 DOI: 10.1093/jpepsy/jsac068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 07/26/2022] [Accepted: 08/01/2022] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE Sickle cell disease (SCD) is a genetic blood disorder that may affect patients' mood and behavior. However, measuring the prevalence of internalizing symptoms (anxiety and depression) in patients with SCD has been elusive. We assessed internalizing symptoms in adolescents with SCD to evaluate prevalence and to test whether neurocognitive performance and frequency of pain-related episodes were associated with internalizing concerns. METHODS One hundred eighty-five patients (57% HbSS/HbSß0-thalassemia, 43% HbSC/HbSß+-thalassemia), ages 12-18 years, received a neuropsychological evaluation as a part of a larger cohort study. Internalizing symptoms were measured using the Behavior Assessment System for Children, Second or Third Edition. Scores on the depression and anxiety scales were compared to normative values using Wilcoxon signed rank test. Spearman correlations examined associations between neurocognitive performances and internalizing symptoms. Robust multivariable regression models measured associations between internalizing symptoms and age, sex, sickle genotype, total hemoglobin, fetal hemoglobin, socioeconomic status, and frequency of pain episodes. RESULTS Parent- and self-reported ratings of internalizing symptoms were not elevated compared to normative expectations. Overall, 1.8% and 6.3% of the sample displayed clinically elevated symptoms of anxiety and depression based on self-report, respectively. There were no associations between internalizing symptoms and neurocognitive performance (all p > .05). In multivariable analyses, the frequency of pain episodes was positively associated with self-reported anxiety (p = .006) and parent-reported depressive symptoms (p = .017). CONCLUSIONS Adolescents with SCD do not report elevated internalizing symptoms compared to normative expectations. Further research is needed to examine the trajectory of internalizing symptoms and the bidirectional relationship between pain and psychosocial functioning in SCD.
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Affiliation(s)
- Andrew M Heitzer
- Department of Psychology, St. Jude Children's Research Hospital, USA
| | - Jennifer Longoria
- Department of Psychology, St. Jude Children's Research Hospital, USA
| | - Jerlym S Porter
- Department of Psychology, St. Jude Children's Research Hospital, USA
| | - Erin MacArthur
- Department of Psychology, St. Jude Children's Research Hospital, USA
| | - Brian Potter
- Department of Psychology, St. Jude Children's Research Hospital, USA
| | - Juan Ding
- Department of Biostatistics, St. Jude Children's Research Hospital, USA
| | - Jeffrey Gossett
- Department of Biostatistics, St. Jude Children's Research Hospital, USA
| | - Guolian Kang
- Department of Biostatistics, St. Jude Children's Research Hospital, USA
| | - Jane S Hankins
- Department of Hematology, St. Jude Children's Research Hospital, USA
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Charalampopoulou M, Choi EJ, Korczak DJ, Cost KT, Crosbie J, Birken CS, Charach A, Monga S, Kelley E, Nicolson R, Georgiades S, Ayub M, Schachar RJ, Iaboni A, Anagnostou E. Les profils de santé mentale des enfants et adolescents autistes pendant la pandémie de COVID-19. Paediatr Child Health 2022; 27:S143-S150. [PMID: 36092298 PMCID: PMC9455656 DOI: 10.1093/pch/pxac016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 01/24/2022] [Indexed: 11/13/2022] Open
Abstract
Objectifs Les confinements dans les provinces canadiennes ont malmené la santé mentale des enfants pendant la pandémie de COVID-19, et les enfants autistes y ont été particulièrement vulnérables. La présente étude visait à recenser les sous-groupes d’enfants autistes ayant des profils distincts de modification à leur santé mentale, afin de comprendre les facteurs propres aux enfants, aux parents et au système qui y sont associés et d’éclairer de futures interventions. Méthodologie Les chercheurs ont extrait les données d’une vaste cohorte ontarienne (n=1 570), dont faisaient partie 265 enfants autistes (âge moyen=10,9 ans, 76 % de sexe masculin). Ils ont utilisé l’analyse des nuées dynamiques pour répartir les profils de santé mentale distincts en six mesures (humeur, anxiété, symptômes de trouble obsessionnel-compulsif, irritabilité, inattention, hyperactivité) et ont examiné les différences entre les groupes. Ils ont également étudié les caractéristiques des enfants qui ont accédé à des services aigus en santé mentale. Résultats Le nombre optimal de grappes était fixé à deux. La première incluait ceux qui avaient éprouvé une détérioration de leur santé mentale dans les six mesures (61,3 %, intervalle de confiance à 95 %=54,9 à 67,4) et la seconde, les jeunes dont la santé mentale n’avait pas changé (38,7 %, intervalle de confiance à 95 %=32,6 à 45,1). Des facteurs étaient associés à la détérioration de la santé mentale des enfants : plus de symptômes internalisés préexistants et de forts taux de stress liés à la COVID-19. Les problèmes de santé mentale des parents et les facteurs propres aux systèmes, tels que la perte de soutien à l’apprentissage, l’accès aux médecins et les difficultés matérielles, étaient aussi liés à cette détérioration. L’accès à des services aigus en santé mentale découlait d’abord de l’insécurité financière et de la perte de services. Conclusions Plus de la moitié des enfants autistes ont éprouvé une détérioration de leur santé mentale, et les caractéristiques individuelles (troubles de santé mentale préexistants, stress lié à la COVID-19), parentales (santé mentale des parents) et systémiques (perte de services et difficultés matérielles) y étaient reliées, ce qui ouvrait la voie à des interventions cliniques et politiques multiniveaux.
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Affiliation(s)
| | - Eun Jung Choi
- Holland Bloorview Research Institute, Toronto (Ontario)Canada
| | - Daphne J Korczak
- Département de psychiatrie, The Hospital for Sick Children, Toronto (Ontario)Canada
- Département de psychiatrie, faculté de médecine Temerty, Universitéde Toronto, Toronto (Ontario)Canada
| | - Katherine T Cost
- Département de psychiatrie, The Hospital for Sick Children, Toronto (Ontario)Canada
| | - Jennifer Crosbie
- Département de psychiatrie, The Hospital for Sick Children, Toronto (Ontario)Canada
- Département de psychiatrie, faculté de médecine Temerty, Universitéde Toronto, Toronto (Ontario)Canada
| | - Catherine S Birken
- Département de pédiatrie, faculté de médecine, Université de Toronto, Toronto (Ontario)Canada
- Sciences évaluatives de la santé des enfants, The Hospital for Sick Children Research Institute, Toronto (Ontario)Canada
| | - Alice Charach
- Département de psychiatrie, The Hospital for Sick Children, Toronto (Ontario)Canada
- Département de psychiatrie, faculté de médecine Temerty, Universitéde Toronto, Toronto (Ontario)Canada
- Sciences évaluatives de la santé des enfants, The Hospital for Sick Children Research Institute, Toronto (Ontario)Canada
- Institut des politiques, de la gestion et de l’évaluation de la santé, faculté de médecine Temerty, Université de Toronto, Toronto (Ontario)Canada
| | - Suneeta Monga
- Département de psychiatrie, The Hospital for Sick Children, Toronto (Ontario)Canada
- Département de psychiatrie, faculté de médecine Temerty, Universitéde Toronto, Toronto (Ontario)Canada
| | - Elizabeth Kelley
- Département de psychologie, Université Queen’s, Kingston (Ontario)Canada
- Département de psychiatrie, Université Queen’s, Kingston (Ontario)Canada
| | - Rob Nicolson
- Département de psychiatrie, Université Western, London (Ontario)Canada
| | - Stelios Georgiades
- Département de psychiatrie et de neurosciences comportementales, Université McMaster, Hamilton (Ontario)Canada
| | - Muhammad Ayub
- Département de psychiatrie, Université Queen’s, Kingston (Ontario)Canada
| | - Russell J Schachar
- Département de psychiatrie, The Hospital for Sick Children, Toronto (Ontario)Canada
- Département de psychiatrie, faculté de médecine Temerty, Universitéde Toronto, Toronto (Ontario)Canada
| | - Alana Iaboni
- Holland Bloorview Research Institute, Toronto (Ontario)Canada
| | - Evdokia Anagnostou
- Holland Bloorview Research Institute, Toronto (Ontario)Canada
- Département de pédiatrie, faculté de médecine, Université de Toronto, Toronto (Ontario)Canada
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11
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Charalampopoulou M, Choi EJ, Korczak DJ, Cost KT, Crosbie J, Birken CS, Charach A, Monga S, Kelley E, Nicolson R, Georgiades S, Ayub M, Schachar RJ, Iaboni A, Anagnostou E. Mental health profiles of autistic children and youth during the COVID-19 pandemic. Paediatr Child Health 2022; 27:S59-S65. [PMID: 35615409 PMCID: PMC9126276 DOI: 10.1093/pch/pxab111] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 01/24/2022] [Indexed: 12/18/2022] Open
Abstract
Objectives Canadian province-wide lockdowns have challenged children's mental health (MH) during the COVID-19 pandemic, with autistic children being at particular risk. The purpose of our study was to identify sub-groups of autistic children with distinct mental health change profiles, to understand the child-, parent-, and system-specific factors associated with such profiles in order to ultimately inform future interventions. Methods Data were drawn from a large Canadian cohort (N=1,570) across Ontario, resulting in 265 autistic children (mean age=10.9 years, 76% male). K-means clustering analyses were employed to partition distinct MH profiles in six MH measures (mood, anxiety, OCD symptoms, irritability, inattention, hyperactivity) and group differences were examined with reference to the above factors. Additionally, we investigated the characteristics of children who accessed acute MH services. Results The optimal number of clusters was two; one included those experiencing MH deterioration across all six MH measures (61.3%, 95% confidence interval [CI]=54.9 to 67.4), and a second included youth that did not experience MH changes (38.7%, 95%CI=32.6 to 45.1). Child-specific factors associated with MH deterioration included higher pre-existing internalizing symptoms, high levels of COVID stress. Parental MH challenges and system-specific factors, such as the loss of learning supports, access to physicians and material deprivation, were also associated with MH deterioration. Access to acute MH services were primarily associated with financial insecurity and loss of services. Conclusions More than half of autistic children experienced MH deterioration, and person-specific (pre-existing MH, COVID related stress), parent-specific (Parent MH) and system-level (loss of services and material deprivation) characteristics were associated with such decline, providing clinical and policy opportunities for intervention at multiple levels.
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Affiliation(s)
| | - Eun Jung Choi
- Holland Bloorview Research Institute, Toronto, Ontario, Canada
| | - Daphne J Korczak
- Department of Psychiatry, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Katherine T Cost
- Department of Psychiatry, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jennifer Crosbie
- Department of Psychiatry, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Catherine S Birken
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Child Health Evaluative Sciences, Research Institute Hospital for Sick Children, Canada
| | - Alice Charach
- Department of Psychiatry, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Child Health Evaluative Sciences, Research Institute Hospital for Sick Children, Canada.,Institute for Health Policy, Management and Evaluation, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Suneeta Monga
- Department of Psychiatry, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth Kelley
- Department of Psychology, Queen's University, Kingston, Ontario, Canada.,Department of Psychiatry, Queen's University, Kingston, Ontario, Canada
| | - Rob Nicolson
- Department of Psychiatry, Western University, London, Ontario, Canada
| | - Stelios Georgiades
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Muhammad Ayub
- Department of Psychiatry, Queen's University, Kingston, Ontario, Canada
| | - Russell J Schachar
- Department of Psychiatry, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Alana Iaboni
- Holland Bloorview Research Institute, Toronto, Ontario, Canada
| | - Evdokia Anagnostou
- Holland Bloorview Research Institute, Toronto, Ontario, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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12
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Hollocks MJ, Charman T, Baird G, Lord C, Pickles A, Simonoff E. Exploring the impact of adolescent cognitive inflexibility on emotional and behavioural problems experienced by autistic adults. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 26:1229-1241. [PMID: 34579554 PMCID: PMC9340135 DOI: 10.1177/13623613211046160] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
LAY ABSTRACT Autistic people experience high levels of co-occurring mental health difficulties. To develop more effective treatments, a greater understanding of the thinking processes that may lead to these difficulties is needed. Cognitive inflexibility, defined as a rigid pattern of thoughts and subsequently behaviours, is one possible thinking trait which has previously been associated with both co-occurring mental health difficulties but also other features of autism such as restricted and repetitive behaviours. Restricted and repetitive behaviours include repetitive movements, ritualistic behaviours, and/or highly focused interests. This study investigates the relationship between, cognitive inflexibility, measured using neuropsychological tasks, and emotional and behavioural problems across adolescence and early adulthood. Eighty-one autistic people who were recruited to be representative of the wider autism population were assessed at 16 and 23 years on measures of emotional and behavioural problems, with cognitive inflexibility, restricted and repetitive behaviours and verbal intelligence measured at 16 years. We used statistical modelling to investigate the relationship between cognitive inflexibility and emotional and behavioural symptoms at both timepoints while accounting for the possible relationship with restricted and repetitive behaviours and verbal intelligence quotient. Our results suggest that cognitive inflexibility may be an important factor associated with emotional difficulties across adolescence and early adulthood. This suggests that developing intervention approaches targeting cognitive inflexibility may be an important step in improving the mental health of those with autism.
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Affiliation(s)
- Matthew J Hollocks
- King's College London, UK.,South London and Maudsley NHS Foundation Trust, UK
| | - Tony Charman
- King's College London, UK.,South London and Maudsley NHS Foundation Trust, UK
| | - Gillian Baird
- Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, UK
| | - Catherine Lord
- UCLA Semel Institute for Neuroscience and Human Behavior, USA
| | - Andrew Pickles
- King's College London and Biomedical Research Centre for Mental Health, UK
| | - Emily Simonoff
- King's College London, UK.,South London and Maudsley NHS Foundation Trust, UK
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13
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Hollocks MJ, Meiser-Stedman R, Kent R, Lukito S, Briskman J, Stringer D, Lord C, Pickles A, Baird G, Charman T, Simonoff E. The association of adverse life events and parental mental health with emotional and behavioral outcomes in young adults with autism spectrum disorder. Autism Res 2021; 14:1724-1735. [PMID: 34076371 DOI: 10.1002/aur.2548] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 04/09/2021] [Accepted: 05/03/2021] [Indexed: 11/06/2022]
Abstract
People with autism spectrum disorder (ASD) are at increased risk of developing co-occurring mental health difficulties across the lifespan. Exposure to adverse life events and parental mental health difficulties are known risk factors for developing a range of mental health difficulties. This study investigates the association of adverse life events, parental stress and mental health with emotional and behavioral problems in young adults with ASD. One hundred and fifteen young adults with ASD derived from a population-based longitudinal study were assessed at three time-points (12-, 16-, and 23-year) on questionnaire measures of emotional and behavioral problems. Parent-reported exposure to adverse life events and parental stress/mental health were measured at age 23. We used structural equation modeling to investigate the stability of emotional and behavioral problems over time, and the association between adverse life events and parental stress and mental health and emotional and behavioral outcomes at 23-year. Our results indicate that exposure to adverse life events was significantly associated with increased emotional and behavioral problems in young adults with ASD, while controlling for symptoms in childhood and adolescence. Higher reported parental stress and mental health difficulties were associated with a higher frequency of behavioral, but not emotional problems, and did not mediate the impact of adverse life events. These results suggest that child and adolescent emotional and behavioral problems, exposure to life events and parent stress and mental health are independently associated, to differing degrees, with emotional or behavioral outcomes in early adulthood. LAY SUMMARY: People with autism experience high rates of mental health difficulties throughout childhood and into adult life. Adverse life events and parental stress and mental health may contribute to poor mental health in adulthood. We used data at three time points (12-, 16-, and 23-year) to understand how these factors relate to symptoms at 23-year. We found that emotional and behavioral problems in childhood, adverse life events and parent mental health were all associated with increased emotional and behavioral problems in adulthood.
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Affiliation(s)
- Matthew J Hollocks
- Department of Child and Adolescent Psychiatry, King's College London, Institute of Psychiatry, Psychology & Neuroscience, and South London and Maudsley Foundation Trust, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Rachel Kent
- Department of Child and Adolescent Psychiatry, King's College London, Institute of Psychiatry, Psychology & Neuroscience, and South London and Maudsley Foundation Trust, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Steve Lukito
- Department of Child and Adolescent Psychiatry, King's College London, Institute of Psychiatry, Psychology & Neuroscience, and South London and Maudsley Foundation Trust, London, UK
| | | | - Dominic Stringer
- Department of Biostatistics and Health Informatics, King's College London, Institute of Psychiatry, Psychology & Neuroscience and Biomedical Research Centre for Mental Health, London, UK
| | - Catherine Lord
- UCLA Semel Institute of Neuroscience and Human Behavior, Los Angeles, California, USA
| | - Andrew Pickles
- Department of Biostatistics and Health Informatics, King's College London, Institute of Psychiatry, Psychology & Neuroscience and Biomedical Research Centre for Mental Health, London, UK
| | - Gillian Baird
- Newcomen Centre, Evelina Children's Hospital, Guys & St Thomas NHS Foundation Trust, London, UK
| | - Tony Charman
- Department of Psychology, King's College London, Institute of Psychiatry Psychology & Neuroscience, London, UK
| | - Emily Simonoff
- Department of Child and Adolescent Psychiatry, King's College London, Institute of Psychiatry, Psychology & Neuroscience, and South London and Maudsley Foundation Trust, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
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14
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Clarke EB, McCauley JB, Lord C. Post-High School Daily Living Skills in Autism Spectrum Disorder. J Am Acad Child Adolesc Psychiatry 2021; 60:978-985. [PMID: 33220430 PMCID: PMC8128936 DOI: 10.1016/j.jaac.2020.11.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 10/15/2020] [Accepted: 11/12/2020] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Daily living skills (DLS) are a predictor of positive outcomes in youths with autism spectrum disorder (ASD), yet little is known about trajectories of DLS in adults with ASD. This study investigated the impact of high school exit on participants' trajectories of daily living skills age equivalent (DLS-AE) scores from ages 2 to 26 and the relationship between DLS-AE trajectories and employment and education outcomes. METHOD Participants were 98 adults with ASD drawn from an ongoing longitudinal study. The Vineland Adaptive Behavior Scales were administered 8 times from ages 2 to 26. Employment and education data were compiled from parent report demographic forms. RESULTS DLS-AE trajectories modestly increased with age before exiting school, at which point DLS-AE trajectories plateaued, then declined. A significant (p < .01) decrease occurred in the slope of DLS-AE trajectories following school exit. High DLS-AE scores predicted participation in postsecondary education (χ25 [n = 73] = 27.83, p < .001). Autism symptom severity predicted participation in employment (χ25 [n = 58] = 27.54, p < .001). CONCLUSION These findings provide evidence that DLS decline in adults with ASD, specifically after school exit, and highlight the importance of DLS in normative adult outcomes. Future work should examine the trajectories of DLS in middle and later adulthood and consider intervention targets for bolstering DLS following school exit.
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15
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Andersen AJ, Mary-Krause M, Bustamante JJH, Héron M, El Aarbaoui T, Melchior M. Symptoms of anxiety/depression during the COVID-19 pandemic and associated lockdown in the community: longitudinal data from the TEMPO cohort in France. BMC Psychiatry 2021; 21:381. [PMID: 34320943 PMCID: PMC8316881 DOI: 10.1186/s12888-021-03383-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 07/08/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND To cope with the COVID-19 pandemic, social distancing restrictions where implemented in France, which could have led to social isolation. This is expected to have affected the mental health situation, including increasing risk of symptoms of anxiety and depression in the general population. Persons with prior mental health difficulties could be an especially vulnerable group, however, few studies have tested this empirically considering preexisting mental health difficulties. We examine the association between preexisting symptoms of anxiety/depression and anxiety/depression during lockdown due to the COVID-19 pandemic in a longitudinal community sample. METHODS A longitudinal follow-up during lockdown (data collection March-June 2020) was implemented among participants of the TEMPO cohort. Prior knowledge of anxiety/depression was included from prior waves of data collection. Generalized estimation equations models were used to estimate the association between preexisting symptoms of anxiety/depression and symptoms of anxiety/depression during lockdown among 662 mid-aged individuals. RESULTS Individuals with symptoms of anxiety/depression measured prior to lockdown had 6.73 higher odds [95% CI = 4.45-10.17] of symptoms of anxiety/depression during lockdown. Additionally, the likelihood of symptoms of anxiety/depression during lockdown was elevated among women (OR = 2.07 [95% CI = 1.32-3.25]), subjects with low household income (OR = 2.28 [1.29-4.01]) and persons who reported being lonely (OR = 3.94 [95% CI = 2.47-6.28]). CONCLUSIONS Our study underlines the role of preexisting symptoms of anxiety/depression as a vulnerability factor of anxiety/depression during lockdown. Interventions focusing on individuals with mental health difficulties as well as people feeling lonely should be considered, to reduce the psychological impact of the COVID-19 pandemic.
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Affiliation(s)
- Astrid Juhl Andersen
- grid.7429.80000000121866389Sorbonne Université, INSERM, Institut Pierre Louis d’Épidémiologie et de Santé Publique (IPLESP), Equipe de Recherche en Epidémiologie Sociale (ERES), F75012 Paris, France
| | - Murielle Mary-Krause
- grid.7429.80000000121866389Sorbonne Université, INSERM, Institut Pierre Louis d’Épidémiologie et de Santé Publique (IPLESP), Equipe de Recherche en Epidémiologie Sociale (ERES), F75012 Paris, France
| | - Joel José Herranz Bustamante
- grid.7429.80000000121866389Sorbonne Université, INSERM, Institut Pierre Louis d’Épidémiologie et de Santé Publique (IPLESP), Equipe de Recherche en Epidémiologie Sociale (ERES), F75012 Paris, France
| | - Mégane Héron
- grid.7429.80000000121866389Sorbonne Université, INSERM, Institut Pierre Louis d’Épidémiologie et de Santé Publique (IPLESP), Equipe de Recherche en Epidémiologie Sociale (ERES), F75012 Paris, France
| | | | - Maria Melchior
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), Equipe de Recherche en Epidémiologie Sociale (ERES), F75012, Paris, France.
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16
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McCauley JB, Elias R, Lord C. Trajectories of co-occurring psychopathology symptoms in autism from late childhood to adulthood. Dev Psychopathol 2020; 32:1287-1302. [PMID: 32677592 PMCID: PMC7655668 DOI: 10.1017/s0954579420000826] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Given high rates of co-occurring conditions in youth and adults with autism spectrum disorder (ASD), it is critical to examine the developmental trajectories of these symptoms of psychopathology. Using data from a cohort of participants (n = 194), most of whom were first assessed for ASD in very early childhood, we investigated the trajectories of co-occurring depressive, anxiety, and attention-deficit hyperactivity disorder (ADHD) symptoms from late childhood to adulthood. Additionally, childhood predictors and adult outcomes associated with these symptom trajectories were examined. Using group-based trajectory modeling, we found two distinct classes of individuals exhibiting each of these co-occurring symptom patterns: one class exhibited fairly low symptoms across time, and one class with elevated symptoms with varied fluctuation across time (ADHD symptoms starting high but decreasing, anxiety symptoms high and stable, and depressive symptoms fluctuating but peaking at clinically significant levels in young adulthood). All high trajectory classes were associated with age 9 adaptive skills; verbal IQ predicted higher anxiety and depressive symptom classes. After accounting for verbal IQ, all high symptom trajectory classes were negative predictors of objective adult outcomes. These findings call for wide-ranging considerations of the needs of individuals across ability levels, autism symptoms, and behavioral and emotional challenges.
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Affiliation(s)
- James B McCauley
- Department of Psychiatry, University of California, Los Angeles, CA, USA
| | - Rebecca Elias
- Department of Psychiatry, University of California, Los Angeles, CA, USA
| | - Catherine Lord
- Department of Psychiatry, University of California, Los Angeles, CA, USA
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17
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Tovo-Rodrigues L, Carpena MX, Martins-Silva T, Santos IS, Anselmi L, Barros AJD, Barros FC, Bertoldi AD, Matijasevich A. Low neurodevelopmental performance and behavioural/emotional problems at 24 and 48 months in Brazilian children exposed to acetaminophen during foetal development. Paediatr Perinat Epidemiol 2020; 34:278-286. [PMID: 32196712 DOI: 10.1111/ppe.12649] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 11/26/2019] [Accepted: 12/22/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Several studies have reported that there is an association between developmental and emotional/behavioural problems in children exposed to acetaminophen during foetal development. However, few studies have focused on development and behavioural outcomes in early life. OBJECTIVES To test the association between prenatal exposure to acetaminophen and low neurodevelopmental performance at 24 months and behavioural/emotional problems at 48 months of life. METHODS We used data from the 2004 Pelotas Birth Cohort, a population-based longitudinal prospective study. Neurodevelopment was evaluated at 24 months using Battelle's Developmental Inventory (BDI) (n = 3737). We assessed global function as well as each domain (personal-social, adaptative, motor, cognitive, and communication). Behavioural/emotional problems were assessed at 48 months using the Child Behaviour Checklist (CBCL) (n = 3624). We used the CBCL total, externalising, and internalising symptomatology and individual subscales (withdrawn, somatic complaints, anxious/depressed, social problems, cognitive problems, attention problems, aggressive behaviour, and rule-breaking behaviour). Acetaminophen use during pregnancy was retrospectively assessed at the perinatal follow-up. Poisson regression and multiple linear regression analyses were used to test the association, adjusting for several family and maternal sociodemographic and health factors, medication use during pregnancy, and the sex of the child. RESULTS Acetaminophen exposure during prenatal development was not associated with low neurodevelopmental performance at 24 months assessed using the BDI or to emotional and behavioural problems assessed at 48 months using the CBCL in the adjusted models. CONCLUSIONS We cannot confirm the existence of an association between acetaminophen used during pregnancy and low neurodevelopmental performance at 24 months and emotional/behavioural problems at 48 months of life based on the present results.
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Affiliation(s)
| | - Marina Xavier Carpena
- Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Thais Martins-Silva
- Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Iná S Santos
- Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil.,Postgraduate Program Pediatrics Child Health, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Luciana Anselmi
- Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Aluísio J D Barros
- Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Fernando C Barros
- Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Andréa D Bertoldi
- Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Alicia Matijasevich
- Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de São Paulo, SP, Brazil
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18
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Baker JK, Fenning RM, Erath SA, Baucom BR, Messinger DS, Moffitt J, Kaeppler A, Bailey A. Respiratory sinus arrhythmia, parenting, and externalizing behavior in children with autism spectrum disorder. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2020; 24:109-120. [PMID: 31122030 PMCID: PMC7155915 DOI: 10.1177/1362361319848525] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Children with autism spectrum disorder exhibit significant difficulties with emotion regulation. Respiratory sinus arrhythmia is a biomarker for processes related to emotion regulation, with higher baseline rates linked to beneficial outcomes. Although reduction in respiratory sinus arrhythmia in response to challenge can index adaptive processes in community samples, excessive withdrawal may suggest loss of regulatory control among children with clinical concerns. Psychophysiological risk for problems may be protected against or exacerbated by parenting environments more or less supportive of the development of children's regulatory competence. Respiratory sinus arrhythmia was examined in 61 children with autism spectrum disorder ages 6-10 years in relation to externalizing behavior, and parenting was considered as a moderator. Respiratory sinus arrhythmia was obtained during laboratory tasks, and positive parenting, negative parenting, and children's externalizing behaviors were each indexed through multiple methods. Respiratory sinus arrhythmia reactivity interacted with negative, but not positive parenting. Higher respiratory sinus arrhythmia reactivity was associated with more externalizing behavior under conditions of higher negative parenting, but with lower externalizing behavior at lower levels of negative parenting. Similarly, negative parenting was only associated with externalizing behaviors in the context of high child respiratory sinus arrhythmia reactivity. Implications for our understanding of emotion regulation in children with autism spectrum disorder, and for related interventions, are discussed.
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19
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Syu YC, Huang PC, Wang TY, Chang YC, Lin LY. Relationship Among Sensory Over-Responsivity, Problem Behaviors, and Anxiety in Emerging Adults with Autism Spectrum Disorder. Neuropsychiatr Dis Treat 2020; 16:2181-2190. [PMID: 33061389 PMCID: PMC7522413 DOI: 10.2147/ndt.s270308] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 08/17/2020] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Despite the highly prevailing rate of sensory over-responsivity, problem behaviors, and anxiety among emerging adults with autism spectrum disorder (ASD), little is known about the nature of their experiences. While previous studies have indicated potential relationships among these conditions, their connections still need to be clarified. This study aimed to examine the relationships between sensory over-responsivity, problem behaviors, and anxiety. METHODS Fifty-seven emerging adults with ASD (Mage = 21.4, SD = 2.5; males = 80.7%) were recruited. The Adult Sensory Profile - Chinese version, Problem Behavior Scale of Scales of Independent Behavior - Revised, and Generalized Anxiety Disorder-7 - Chinese version (GAD-7) were used. RESULTS The percentage of emerging adults with ASD who scored more than most people in the two quadrants were sensation sensitivity = 33.3% and sensation avoiding = 26.3%. Approximately 66.7%, 27.5%, and 50.9% of participants had internalizing behaviors, externalizing behaviors, and asocial behaviors, respectively. Approximately, 64.9% of the participants scored on or above the cut-off score of 6 on the GAD-7. Sensation sensitivity and sensation avoiding were significantly correlated to problem behaviors; and anxiety was a mediating variable that accounts for the relationships between sensory over-responsivity and problem behaviors. CONCLUSION These results indicated that emerging adults with ASD showing problem behaviors might also report more exaggerated responses toward sensory inputs and experience more anxiety symptoms. The results indicate that sensory over-responsivity, problem behaviors, and anxiety may have common underlying mechanisms. Findings can be useful to understand the impacts of such difficulties for emerging adults with ASD.
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Affiliation(s)
- Ya-Cing Syu
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Pai-Chuan Huang
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Tsui-Ying Wang
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yen-Ching Chang
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ling-Yi Lin
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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20
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Ozdenizci O, Cumpanasoiu C, Mazefsky C, Siegel M, Erdoggmus D, Ioannidis S, Goodwin MS. Time-Series Prediction of Proximal Aggression Onset in Minimally-Verbal Youth with Autism Spectrum Disorder Using Physiological Biosignals. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2019; 2018:5745-5748. [PMID: 30441641 DOI: 10.1109/embc.2018.8513524] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
It has been suggested that changes in physiological arousal precede potentially dangerous aggressive behavior in youth with autism spectrum disorder (ASD) who are minimally verbal (MV-ASD). The current work tests this hypothesis through time-series analyses on biosignals acquired prior to proximal aggression onset. We implement ridge-regularized logistic regression models on physiological biosensor data wirelessly recorded from 15 MV-ASD youth over 64 independent naturalistic observations in a hospital inpatient unit. Our results demonstrate proof-of-concept, feasibility, and incipient validity predicting aggression onset 1 minute before it occurs using global, person-dependent, and hybrid classifier models.
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21
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Baker JK, Fenning RM, Howland MA, Huynh D. Parental criticism and behavior problems in children with autism spectrum disorder. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2019; 23:1249-1261. [PMID: 30394790 PMCID: PMC6499715 DOI: 10.1177/1362361318804190] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Associations between parent critical attitudes (a component of the Expressed Emotion construct) and behavior problems have been relatively well established in adolescents and young adults with autism spectrum disorder, but use of systems adapted for children with autism spectrum disorder and additional investigations with younger samples are needed. This study examined parental criticism, derived from a population-specific coding system, as related to behavior problems in children with autism spectrum disorder between the ages of 4 and 11 years, and considered parental warmth and children's psychophysiological reactivity as statistical moderators of these associations. In all, 40 children with autism spectrum disorder and their primary caregivers attended a visit involving collection of child electrodermal activity, parent-child interaction, a parent interview from which critical attitudes and warmth were coded, and parent report of child behavior problems. Criticism was directly related to higher child externalizing but not internalizing problems. Parental criticism interacted with warmth in the prediction of internalizing problems such that criticism was only associated with more problems in the context of moderate but not high warmth. Criticism was positively associated with externalizing problems under conditions of moderate and high, but not low, child electrodermal activity reactivity. Implications for conceptualizations of parental criticism in autism spectrum disorder, for understanding comorbid behavior problems in this population, and for intervention are discussed.
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Affiliation(s)
| | | | | | - David Huynh
- 1 California State University, Fullerton, USA
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Goodwin MS, Mazefsky CA, Ioannidis S, Erdogmus D, Siegel M. Predicting aggression to others in youth with autism using a wearable biosensor. Autism Res 2019; 12:1286-1296. [PMID: 31225952 DOI: 10.1002/aur.2151] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 05/03/2019] [Accepted: 05/14/2019] [Indexed: 12/28/2022]
Abstract
Unpredictable and potentially dangerous aggressive behavior by youth with Autism Spectrum Disorder (ASD) can isolate them from foundational educational, social, and familial activities, thereby markedly exacerbating morbidity and costs associated with ASD. This study investigates whether preceding physiological and motion data measured by a wrist-worn biosensor can predict aggression to others by youth with ASD. We recorded peripheral physiological (cardiovascular and electrodermal activity) and motion (accelerometry) signals from a biosensor worn by 20 youth with ASD (ages 6-17 years, 75% male, 85% minimally verbal) during 69 independent naturalistic observation sessions with concurrent behavioral coding in a specialized inpatient psychiatry unit. We developed prediction models based on ridge-regularized logistic regression. Our results suggest that aggression to others can be predicted 1 min before it occurs using 3 min of prior biosensor data with an average area under the curve of 0.71 for a global model and 0.84 for person-dependent models. The biosensor was well tolerated, we obtained useable data in all cases, and no users withdrew from the study. Relatively high predictive accuracy was achieved using antecedent physiological and motion data. Larger trials are needed to further establish an ideal ratio of measurement density to predictive accuracy and reliability. These findings lay the groundwork for the future development of precursor behavior analysis and just-in-time adaptive intervention systems to prevent or mitigate the emergence, occurrence, and impact of aggression in ASD. Autism Res 2019, 12: 1286-1296. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Unpredictable aggression can create a barrier to accessing community, therapeutic, medical, and educational services. The present study evaluated whether data from a wearable biosensor can be used to predict aggression to others by youth with autism spectrum disorder (ASD). Results demonstrate that aggression to others can be predicted 1 min before it occurs with high accuracy, laying the groundwork for the future development of preemptive behavioral interventions and just-in-time adaptive intervention systems to prevent or mitigate the emergence, occurrence, and impact of aggression to others in ASD.
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Affiliation(s)
- Matthew S Goodwin
- Department of Health Sciences, Northeastern University, Boston, Massachusetts
| | - Carla A Mazefsky
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Stratis Ioannidis
- Department of Electrical and Computer Engineering, Northeastern University, Boston, Massachusetts
| | - Deniz Erdogmus
- Department of Electrical and Computer Engineering, Northeastern University, Boston, Massachusetts
| | - Matthew Siegel
- Maine Medical Center Research Institute, Portland, Maine
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Goodwin MS, Özdenizci O, Cumpanasoiu C, Tian P, Guo Y, Stedman A, Peura C, Mazefsky C, Siegel M, Erdoğmuş D, Ioannidis S. Predicting Imminent Aggression Onset in Minimally-Verbal Youth with Autism Spectrum Disorder Using Preceding Physiological Signals. INTERNATIONAL CONFERENCE ON PERVASIVE COMPUTING TECHNOLOGIES FOR HEALTHCARE : [PROCEEDINGS]. INTERNATIONAL CONFERENCE ON PERVASIVE COMPUTING TECHNOLOGIES FOR HEALTHCARE 2018; 2018:201-207. [PMID: 30420938 DOI: 10.1145/3240925.3240980] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
We test the hypothesis that changes in preceding physiological arousal can be used to predict imminent aggression proximally before it occurs in youth with autism spectrum disorder (ASD) who are minimally verbal (MV-ASD). We evaluate this hypothesis through statistical analyses performed on physiological biosensor data wirelessly recorded from 20 MV-ASD youth over 69 independent naturalistic observations in a hospital inpatient unit. Using ridge-regularized logistic regression, results demonstrate that, on average, our models are able to predict the onset of aggression 1 minute before it occurs using 3 minutes of prior data with a 0.71 AUC for global, and a 0.84 AUC for person-dependent models.
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Affiliation(s)
| | | | | | - Peng Tian
- Northeastern University, Boston, MA, USA,
| | - Yuan Guo
- Northeastern University, Boston, MA, USA,
| | - Amy Stedman
- Maine Medical Center Research Institute, Portland, ME, USA,
| | | | | | - Matthew Siegel
- Maine Medical Center Research Institute, Portland, ME, USA,
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Tint A, Hamdani Y, Sawyer A, Desarkar P, Ameis SH, Bardikoff N, Lai MC. Wellness Efforts for Autistic Women. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2018. [DOI: 10.1007/s40474-018-0148-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Rai D, Heuvelman H, Dalman C, Culpin I, Lundberg M, Carpenter P, Magnusson C. Association Between Autism Spectrum Disorders With or Without Intellectual Disability and Depression in Young Adulthood. JAMA Netw Open 2018; 1:e181465. [PMID: 30646131 PMCID: PMC6324523 DOI: 10.1001/jamanetworkopen.2018.1465] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
IMPORTANCE Depression is a frequently occurring mental disorder and may be common in adults with autism spectrum disorders (ASD), but there is a lack of longitudinal population-based studies examining this association. Whether any increased risk of depression in ASD has a shared familial basis and whether it differs by co-occurring intellectual disability is not well known. OBJECTIVES To examine whether individuals with ASD are more likely to be diagnosed as having depression in adulthood than the general population and their nonautistic siblings and to investigate whether these risks differ by the presence or absence of intellectual disability. DESIGN, SETTING, AND PARTICIPANTS Population-based cohort study with a nested sibling comparison. The Stockholm Youth Cohort is a total population record linkage study that includes all children and young people (age range, 0-17 years) who were ever resident in Stockholm County, Sweden, between January 2001 and December 2011 (n = 735 096). Data analysis was conducted between January 5 and November 30, 2017, in Stockholm County, Sweden. MAIN OUTCOMES AND MEASURES Clinical diagnosis of depressive disorders was identified using the Stockholm County Adult Psychiatric Outpatient Register and the Swedish National Patient Register. RESULTS Participants were 223 842 individuals followed up to age 27 years by 2011, of whom 4073 had diagnosed ASD (mean [SD] age, 21.5 [2.7] years; 65.9% male; 2927 without intellectual disability and 1146 with intellectual disability) and 219 769 had no ASD (mean [SD] age, 22.1 [2.8] years; 50.9% male). By age 27 years, 19.8% (n = 808) of individuals diagnosed having ASD had a diagnosis of depression compared with 6.0% (n = 13 114) of the general population (adjusted relative risk [RR], 3.64; 95% CI, 3.41-3.88). The risk of a depression diagnosis was higher in ASD without intellectual disability (adjusted RR, 4.28; 95% CI, 4.00-4.58) than in ASD with intellectual disability (adjusted RR, 1.81; 95% CI, 1.51-2.17). Nonautistic full-siblings (adjusted RR, 1.37; 95% CI, 1.23-1.53) and half-siblings (adjusted RR, 1.42; 95% CI, 1.23-1.64) of individuals with ASD also had a higher risk of depression than the general population. Compared with their nonautistic full-siblings, individuals with ASD had more than a 2-fold risk of a depression diagnosis (adjusted odds ratio, 2.50; 95% CI, 1.91-3.27) in young adulthood. CONCLUSIONS AND RELEVANCE According to this study's results, ASD, particularly ASD without intellectual disability, is associated with depression by young adulthood compared with the general population. It appears that this association is unlikely to be explained by shared familial liability. Future research to identify modifiable pathways between ASD and depression may assist in the development of preventive interventions.
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Affiliation(s)
- Dheeraj Rai
- National Institute for Health Research Biomedical Research Centre, University of Bristol, Bristol, United Kingdom
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- Avon and Wiltshire Partnership National Health Service Mental Health Trust, Bristol, United Kingdom
| | - Hein Heuvelman
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Christina Dalman
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Centre for Epidemiology and Community Medicine, Stockholm Health Care Services, Stockholm, Sweden
| | - Iryna Culpin
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Michael Lundberg
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Centre for Epidemiology and Community Medicine, Stockholm Health Care Services, Stockholm, Sweden
| | - Peter Carpenter
- Avon and Wiltshire Partnership National Health Service Mental Health Trust, Bristol, United Kingdom
| | - Cecilia Magnusson
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Centre for Epidemiology and Community Medicine, Stockholm Health Care Services, Stockholm, Sweden
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Rai D, Culpin I, Heuvelman H, Magnusson CMK, Carpenter P, Jones HJ, Emond AM, Zammit S, Golding J, Pearson RM. Association of Autistic Traits With Depression From Childhood to Age 18 Years. JAMA Psychiatry 2018; 75:835-843. [PMID: 29898212 PMCID: PMC6143081 DOI: 10.1001/jamapsychiatry.2018.1323] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 04/12/2018] [Indexed: 12/13/2022]
Abstract
Importance Population-based studies following trajectories of depression in autism spectrum disorders (ASD) from childhood into early adulthood are rare. The role of genetic confounding and of potential environmental intermediaries, such as bullying, in any associations is unclear. Objectives To compare trajectories of depressive symptoms from ages 10 to 18 years for children with or without ASD and autistic traits, to assess associations between ASD and autistic traits and an International Statistical Classification of Diseases, 10th Revision (ICD-10) depression diagnosis at age 18 years, and to explore the importance of genetic confounding and bullying. Design, Setting, and Participants Longitudinal study of participants in the Avon Longitudinal Study of Parents and Children birth cohort in Bristol, United Kingdom, followed up through age 18 years. Data analysis was conducted from January to November 2017. Main Outcomes and Measures Depressive symptoms were assessed using the Short Mood and Feelings Questionnaire (SMFQ) at 6 time points between ages 10 and 18 years. An ICD-10 depression diagnosis at age 18 years was established using the Clinical Interview Schedule-Revised. Exposures were ASD diagnosis and 4 dichotomized autistic traits (social communication, coherence, repetitive behavior, and sociability). An autism polygenic risk score was derived using the Psychiatric Genomics Consortium autism discovery genome-wide association study summary data. Bullying was assessed at ages 8, 10, and 13 years. Results The maximum sample with complete data was 6091 for the trajectory analysis (48.8% male) and 3168 for analysis of depression diagnosis at age 18 years (44.4% male). Children with ASD and autistic traits had higher average SMFQ depressive symptom scores than the general population at age 10 years (eg, for social communication 5.55 [95% CI, 5.16-5.95] vs 3.73 [95% CI, 3.61-3.85], for ASD 7.31 [95% CI, 6.22-8.40] vs 3.94 [95% CI, 3.83-4.05], remaining elevated in an upward trajectory until age 18 years (eg, for social communication 7.65 [95% CI, 6.92-8.37] vs 6.50 [95% CI, 6.29-6.71], for ASD 7.66 [95% CI, 5.96-9.35] vs 6.62 [95% CI, 6.43-6.81]). Social communication impairments were associated with depression at age 18 years (adjusted relative risk, 1.68; 95% CI, 1.05-2.70), and bullying explained a substantial proportion of this risk. There was no evidence of confounding by the autism polygenic risk score. Analysis in larger samples using multiple imputation led to similar but more precise results. Conclusions and Relevance Children with ASD and ASD traits have higher depressive symptom scores than the general population by age 10 years, which persist to age 18 years, particularly in the context of bullying. Social communication impairments are an important autistic trait in relation to depression. Bullying, as an environmental intermediary, could be a target for interventions.
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Affiliation(s)
- Dheeraj Rai
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- BASS Autism Services for Adults, Avon and Wiltshire Mental Health Partnership National Health Service (NHS) Trust, Bristol, United Kingdom
- National Institute for Health Research (NIHR) Biomedical Research Centre, University of Bristol, Bristol, United Kingdom
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Iryna Culpin
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Hein Heuvelman
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Cecilia M. K. Magnusson
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Centre for Epidemiology and Community Medicine, Stockholm Health Care Services, Stockholm, Sweden
| | - Peter Carpenter
- BASS Autism Services for Adults, Avon and Wiltshire Mental Health Partnership National Health Service (NHS) Trust, Bristol, United Kingdom
| | - Hannah J. Jones
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- National Institute for Health Research (NIHR) Biomedical Research Centre, University of Bristol, Bristol, United Kingdom
- Medical Research Council (MRC) Integrative Epidemiology Unit, University of Bristol, United Kingdom
| | - Alan M. Emond
- Centre for Child and Adolescent Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Stanley Zammit
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- National Institute for Health Research (NIHR) Biomedical Research Centre, University of Bristol, Bristol, United Kingdom
- Medical Research Council (MRC) Centre for Neuropsychiatric Genetics and Genomics, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, United Kingdom
| | - Jean Golding
- Centre for Child and Adolescent Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Rebecca M. Pearson
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- National Institute for Health Research (NIHR) Biomedical Research Centre, University of Bristol, Bristol, United Kingdom
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The Gap Between Adaptive Behavior and Intelligence in Autism Persists into Young Adulthood and is Linked to Psychiatric Co-morbidities. J Autism Dev Disord 2018; 47:3007-3017. [PMID: 28710532 DOI: 10.1007/s10803-017-3213-2] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
For individuals with autism spectrum disorder (ASD), long-term outcomes have been troubling, and intact IQ has not been shown to be protective. Nevertheless, relatively little research into adaptive functioning among adults with ASD has been completed to date. Therefore, both adaptive functioning and comorbid psychopathology were assessed among 52 adults with ASD without intellectual disability (ID). Adaptive functioning was found to substantially lag behind IQ, and socialization was a particular weakness. Comorbid psychopathology was significantly correlated with the size of IQ-adaptive functioning discrepancy. These findings emphasize key intervention targets of both adaptive skill and psychopathology for transition-age youth and young adults with ASD, as well as the need for ongoing monitoring of anxiety and depression symptoms during this developmental window.
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28
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Woodman AC, Smith LE, Greenberg JS, Mailick MR. Change in autism symptoms and maladaptive behaviors in adolescence and adulthood: the role of positive family processes. J Autism Dev Disord 2015; 45:111-26. [PMID: 25070471 PMCID: PMC4289113 DOI: 10.1007/s10803-014-2199-2] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Little is known about outcomes for individuals with autism spectrum disorders (ASD) into adulthood. Several characteristics of individuals with ASD predict long-term outcomes, and the family environment may also play a role. The present study uses a prospective, longitudinal design to describe and predict trajectories of autism symptoms and maladaptive behaviors over 8.5 years in a large, community-based sample of adolescents and adults with ASD. Overall, autism symptoms and maladaptive behaviors were observed to improve over the study period. Above and beyond the adult's gender, age, and level of intellectual disability, greater improvements were associated with higher levels of maternal praise (based on maternal speech samples) and higher quality mother-child relationships. Implications for future research and intervention are discussed.
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Affiliation(s)
- Ashley C Woodman
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Avenue, Madison, WI, 53705, USA,
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